eHEALTH Magazine - May 2013 by eHealth Magazine - Elets Technomedia Pvt Ltd

asiaâ&#x20AC;&#x2122;s first monthly magazine on The Enterprise of Healthcare

eHealth Magazine

volume 8 / issue 05 / may 2013 / ` 75 / US $10 / ISSN 0973-8959

T C Benjamin

Additional Chief Secretary, Public Health Department, Govt of Maharashtra

Pradipta Kumar Mohapatra IAS, Principal Secretary, Department of Health and Family Welfare, Government of Odisha

AK Mahapatra Director-AIIMs, Bhubaneswar

Patient Monitoring System First Aid Box For Hopitals

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volume

issue

contents

ISSN 0973-8959

cover story PMS: A Complete Patient Care

tech trend Health Insurance Claims: New Era of Management

Dr Mukesh Batra, Founder and Chairman, Dr Batra’s Positive Health Clinic Pvt Ltd

Pehel Birthing a New Hope

India’s First Public Health University in Odisha

expert speak Saving Life Is a Passion Dr Ganesh Kumar Mani

policy

power hosipital Striving for Something Better

Dr Jyoti Vajpayee, Global Technical Advisor, Population Services International (PSI)

Pradipta Kumar Mohapatra, IAS, Principal Secretary, Department of Health and Family Welfare, Government of Odisha

speacial feature Cath Lab Listens to Your Heart

T C Benjamin Additional Chief Secretary, Public Health Department, Government of Maharashtra

‘Odisha Should Focus on Affordable Optimal Healthcare Services’

Dr Ashok Kumar Mahapatra, Director, All India Institute of Medical Science (AIIMS)-Bhubaneswar

42 28

16 42 4

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asia’s first monthly magazine on The Enterprise of Healthcare volume

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May 2013

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta group editor: Anoop Verma

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editorial

Today’s Healthcare is More Happening! Recently the news about sanctioning `22,507 crore National Urban Health Mission (NUHM) from the Union Cabinet has received much appreciation from the healthcare fraternity. As the focus is on addressing healthcare challenges in towns and cities, it is reported that the mission will be implemented in 779 cities and towns with more than 50, 000 population and cover over 7.75 crore people. Under the scheme, Government proposes to set up one Urban Primary Health Centre for every 50,000-60,000 population, one Urban Community Health Centre for five to six urban Public Healthcare Centers in big cities, an Auxiliary Nursing Midwives (ANM) for 10,000 population and an Accredited Social Health Activist (ASHA) (community link worker) for 200 to 500 households. The interventions under this sub-mission will result in reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), universal access to reproductive healthcare and convergence of all health related interventions. The Government of India has launched Special Immunisation Weeks to vaccinate every eligible child of India. Four weeks, with one week each in the months of April, June, July and August will be used to hold special immunisation sessions in high-risk areas across the country. For this, the year 2012-13 was declared as “Year of Intensification of Routine Immunisation.” Intensification efforts saw the expansion of Pentavalent vaccine to six more states in India after successful introduction in Tamil Nadu and Kerala. To keep up the pace of development, we thus have taken views of T C Benjamin, Additional Chief Secretary, Public Health Department, Govt of Maharashtra in the May issue of eHEALTH. The interview is a good reference to know all the healthcare initiatives running in the state. In addition, this issue has interview of A K Mahapatra, Director-AIIMs, Bhuvneshwar. Also we have covered the first Public Health University that was recently launched in Odisha. Pradipta Kumar Mohapatra, IAS, Principal Secretary, Department of Health and Family Welfare, Government of Odisha has spoken about the objective behind the initiative and its future plans. The eHEALTH May issue has interviews of several infamous cardiolologists who have shared their insight on the advancements happened in Indian Cardiology sector. The story on Health Insurance Claims Management is a fresh thought; it has too included updates that have happened in utilising IT in different claim management services. Hope this issue too will be useful for you, happy reading!

Dr. Ravi Gupta ravi.gupta@elets.in

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cover story

PMS: A Complete

Patient Care Patient Monitoring System (PMS) offers faster and easier access of patient information in a comprehensive way. Over the years, the usage of the system has increased manifold with increasing cases of emergency care and beyond. A report! By Sharmila Das, ENN

atient monitoring system is the term for all the various devices that are used to supervise patients. One category of such devices alerts the medical staff if the patient gets into a critical state. Example of one such device is a heart monitor. The need for patient monitoring is apparent in situations where the patient is: in unstable physiological regulatory systems, for

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example in the case of a drug overdose or anesthesia. Patient monitoring is not a new concept in healthcare. The first primitive patient monitoring started with the work done by Santorio in 1625 that was measuring of body temperature and blood pressure. The development of new technology after World War II and up to today has developed a vast amount of different types of monitoring that can be done.

Dr Vikram Khatri, Consultant, Intensive Care Unit, Moolchand Medcity, New Delhi says, â&#x20AC;&#x153;Patient monitoring is the primary thing which allows clinician to detect abnormal physiology, which changes rapidly to changing situation of patientâ&#x20AC;&#x2122;s physiological condition. Change in physiology and objective measurement of it such as a low or high BP, oxygen saturation or heart rate combined with patient history and physical ex-

amination helps the doctors make diagnoses. Technology helps in objectively quantifying the derangement of body function in the human body. Continuous monitoring if these and other parameters help the clinicians reduce the lag time in identifying a changing state of patient and acting appropriately. That may include escalation or de-escalation of therapy”.

Where to fit? It is almost imperative for operating rooms, emergency rooms, intensive care units and critical care units to have patient monitoring equipment. Its applications span across various specialties including respiratory care, recovery rooms, out-patient care, patient transport, radiology, cathe-terisation labs, and gastroenterology departments, among others. Products in the Indian market range from single- parameter instruments to specialised multi-parameter instruments. Dr Rajat Agarwal, Consultant, Critical Care medicine, Fortis Escorts Heart Institute says, “Care of patients in critical areas is not possible without monitoring systems. They help us to make day to day patient management decisions faster and easier, this has made evident difference in patient care outcomes”. A patient monitor may not only alert caregivers to potentially lifethreatening events; many provide physiologic input data used to control directly connected life-support devices. Repeated or continuous observations or measurements of the patient, his or her physiological function, and the function of life support equipment, for the purpose of guid-

ing management decisions, including when to make therapeutic interventions, and assessment of those interventions. There are at least four categories of patients who need to be treated in a monitoring system: Physiologic monitoring: Patients with unstable physiologic regulatory systems; for example, a patient whose respiratory system is suppressed by a drug overdose or anesthesia. Patients with a suspected lifethreatening condition: For example, a patient who has findings indicating an acute myocardial infarction (heart attack). Patients at high risk of developing a life-threatening condition: For example, patients immediately post open-heart surgery, or a premature infant whose heart and lungs are not fully developed. Patients in a critical physiological state: For example, patients with multiple trauma or septic shock.

“Care of patients in critical areas is not possible without monitoring systems. They help us to make day to day patient management decisions faster and easier, this has made evident difference in patient care outcomes”. Rajat Agarwal, Consultant, Critical Care Medicine, Fortis Escorts Heart Institute

Patient monitoring today The experts say to a large extent computer based monitoring and intensive care unit systems have become cheap enough to be deployed on a large scale in many intensive care units around the world. The bedside has become an important point of displaying data. Bedside monitors have capabilities of intelligent monitoring, intelligent alarming, plug and play modules, TCP/ IP and Ethernet networking and many other features provide easy, integrated monitoring in any facility. The systems often provide database and analysis functions that previously only was available on

large systems. Most bedside monitors sold today can incorporate data from clinical laboratories, bedside laboratories devices. The drawbacks of these features are that they usually have proprietary communications protocols and data acquisition schemes. Dr Khatri says, “The patient monitoring equipment industry

A patient monitor may not only alert caregivers to potentially life-threatening events; many provide physiologic input data used to control directly connected life-support devices. may / 2013 ehealth.eletsonline.com

cover story

“Technology helps in objectively quantifying the derangement of body function in the human body. Continuous monitoring of these and other parameters help the clinicians reduce the lag time in identifying a changing state of patient and acting appropriately. That may include escalation or de-escalation of therapy”. Dr Vikram Khatri

has evolved over the years, owing to deeper penetration of technologies which have enhanced the development of best-in-class products. Patient monitoring, one of the biggest pieces of the medical technology pie, has been continuously infused with new technologies ever since it was developed. Novel technologies in patient monitoring are emerging to meet the increasing demands of an ageing population, and placing an emphasis on reducing hospital stays. Nearly all focus on some form of ambulatory monitoring, using wired or wireless technologies. Patient monitoring equipment is readily integrating information management, and clinical decision support systems. Networking solutions also play an essential role in centralising information, and therefore are critical for information management”. The patient monitoring data only make up for 13 percent of the total information used by doctors in the treatment of the patient. Other information sources that has to be taken into account is laboratory results, observa-

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Newer developments Dr Vikram Khatri, Consultant, Intensive Care Unit, Moolchand Medcity, New Delhi

Minimally invasive methods of monitoring include efforts in the field of Cardiac output measurement with advent and constant refinement of technologies like Lidco, Flowtrac and PiCCO, which allow to get some assessment of cardiac output from arterial lines than placing a Pulmonary artery catheter. These technologies also help in deciding fluid therapy in patients. Endotracheal tube mounted impedance technology is also coming to fore which also enables to get idea of cardiac state in intubated patients. Efforts are on to define the use of contrast-enhanced ultrasonography, a technique developed by cardiologists and nephrologists, to measure organspecific blood flow in organs accessible to ultrasound waves. Venous Oximetry has found a place in sepsis resuscitation and a host of devices have been promoted in the market, which measure it continuously via fibreoptic technology. World of Neuro-anesthesia and Critical care has seen advent of consciousness monitors which work by surface pads and a algorithmic compression/analysis plus numbering of

EEG waves, which allow monitoring of brain activity. “Intelligent” Closed-Loop Insulin Administration Algorithm with Glucommander® (Glytec Systems, Greenville, SC), is an “intelligent” computerised algorithm that directs the administration of intravenous insulin by taking into account both current glucose levels as well as an estimate of the patient’s insulin sensitivity. This can be revolutionary in hospitalised patient reducing workload and increasing patient comfort. Good glucose control has been shown to reduce mortality. Non-invasive Hemoglobin (Masimo, Irving, CA) has been developed. It is a completely non-invasive realtime hemoglobin monitor (Rainbow SET pulse oximeter). This has promise in country like India where blood test can be expensive or simply unavailable with high burden of anemia. End-tidal and transcutaneous Co2 monitoring (Sentec AG (Therwil, Switzerland) is gaining popularity as it allows for rapid diagnosis of inefficient or insufficient respiration. This allows for the clinician to prevent hypoxic events and deaths due to sedation and depressed consciousness level. Finally great strides have been taken in the world of distance monitoring where integrated systems like eICU and Pisces systems have allowed real-time audiovisual and monitor outputs to be displayed to a physician in distance without lag and with high fidelity allowing them to engage and direct treatment from a central location. The hidden benefit is providing back up coverage for a large number of patients. This would help in reducing physician workload and bring change in workforce management.

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cover story

nology doing the monitoring do not fail. In a wireless setting the system must be designed in such a way that it can deal with less reliability. For example if health workers were to be alerted from a monitoring device through wireless it could be possible that the person was out of reach from the wireless network. This may not be a problem as long as it is not a critical emergency. If it is something that has to be dealt with within the day it can be sufficient to try to resend the message or resend it to somebody else that can deal with it. When it comes to how it actually is going to be used, it is likely to see two cases; real-time alerting which is the primary use of patient monitoring systems, and second use

Novel technologies in patient monitoring are emerging to meet the increasing demands of an ageing population, and placing an emphasis on reducing hospital stays tion, drugs used, blood samples etc. These other systems used to document medication (Medication Administration Record) and Intensive Care Unit flow sheets applications have little support for interchanging information between them, and the health workers often have to chart the same information in multiple systems.

Future of patient monitoring systems A lot of the patients monitoring systems are based on stationary systems. The most foresighted example is where the book describes an example where a doctor receives an alert for a urine condition on one of his patients on his mobile. This could be a taste for what possibilities there are for patient monitoring in the future. How the systems of tomorrow will look like will of course be just speculation. It is likely that the doctors and nurses would want to be mobile. When they visit a patient they could have a tablet

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PC with all the current charts and data for that particular patient ready. The architecture for supporting this could be designed in different ways. It could also be realised in such way that the monitoring device stores all the data and applications needing data connected directly to the monitoring device. If this becomes the reality it raises a big question for how the data security must be. Any data associated with a patient is confidential, and must be treated with the highest importance. The standards for wireless networking used today may not be as secure as needed. Some of the things that have been raised at the standards today are that they offer very little support for frequent updating of the encryption keys. Medical applications offering various alerting and monitoring facilities is very crucial they have a high availability and run stable. When a person’s life depends on it there must be high guarantees that the tech-

of the data for diagnostic of patients. The real time alerting must be dealt with in a critical way, and wireless for these types of applications is probably not wise. The use of patient monitoring data in consultation is probably likely that can be done wireless. It is not that critical, in the case where wireless network connection fails the doctor can probably go somewhere to get better wireless connection, or transfer the data through other means. The interchange and integration of information should be better. The need for this has already been established today. It is required to must enter data in multiple systems and use many different systems to get a “total picture”. It would be useful to have patient monitoring data integrated in patient journal systems. And have patient journal data available in the patient monitoring charting applications. Dr Khatri informs, “The patient monitoring market is witnessing substantial growth, due to an ageing popu-

cover story

Patient Care Is Easier With PMS Nikil Rao, General Manager, Draeger Medical India Pvt Ltd How has the patient monitoring system evolved over the years?

tors as it serves as base for clinical information system

In the past few years, we were keenly looking at growth in upper, mid and premium segments as this is the area suitable to our operations, and we are glad to see good shift in terms of customers demanding more of IT integration, process support and modern simplified data access solutions

What are the patient monitoring products/equipments you provide to hospitals?

“Major issue is that a patient monitor is looked as a commodity but the growing need of healthcare IT and data management will surely increase the awareness on quality of patient monitors as it serves as base for clinical information system”

Draeger Medical has over 120 years of experience in medical technology. We are focused on acute point of care business and accordingly we expanded our offering range by including patient monitoring recently Draeger Medical helps hospital and clinicians in n Innovative patient care technologies n Integrated care technologies and clinical information systems n Information management We offer unique process benefits to our customers in shape of concepts such as Pick and Go (so that a single type of monitor can be used in various departments with its modularity and scalability facility. It reduces time during transport to 1/4th the current time required without losing any information or compromising with parameters monitored at bed side)

multiple benefits they offer in terms of allowing a healthcare professional to monitor patients from anywhere, and the increased productivity and costefficiency of these systems. The market for self-monitoring activities may also expand, as chronic care patients (especially persons with diabetes and heart disorders) are encouraged by medical groups to focus greater attention on preventive care”. Nikil Rao, General Manager, Draeger Medical India Pvt Ltd says “Earlier in hospitals, factors driving the patient monitoring equipment

was limited to parameters and features like display size and number of channels but now customer has widen their vision by thinking of total solution. Nowadays we see clear drivers as demand for point of care IT, flexible network solutions (wired, wireless), process support for patient transport, standardisation of devices across entire hospitals. This is a key factor driving upwards value growth. The growth in volumes is driven by all other common factors responsible for across industry growth in healthcare industry”.

How has patient monitoring system influenced the patient care? Patient monitors help to bring patient care and patient information system closer and increases care efficiency and productivity of hospitals

What are the four major information management issues in patient monitoring system? Major issue is that a patient monitor is looked as a commodity but the growing need of healthcare IT and data management will surely increase the awareness on quality of patient moni-

lation, rises in healthcare expenditure, and initiatives taken by Government to improve healthcare delivery. Raised standard of living and improved incomes are the main drivers of the patient monitoring market. The turnover of patients from critical care to subacute areas continues to boost the demand for patient monitoring devices in cardiac step-down units, and other sub-acute care areas. Wireless and ambulatory monitoring systems appear to be the key segment driving further growth in patient monitoring equipment. The reasons, being, the

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tech trend

Health Insurance Claims: New Era

of Management

Healthcare industry in India is going through a massive changeover. Consciousness towards healthcare and increase in the income among all the classes, liberal pricing and most importantly the introduction of private sector finance has introduced a new dimension to it By Kartik Sharma, ENN

ealth insurance, which traditionally has remained a less important sector, is now coming up as a major instrument to manage financial requirements of people to look for health services. In 1991, the new economic policy of liberalisation, privatisation and globalisation followed

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by the Government of India paved the way for privatisation of insurance sector in the country. The Insurance Regulatory and Development Authority (IRDA) bill, passed in Indian parliament, is the vital commencement of changes having major implications for the health sector. Yogesh Lohiya, MD & CEO, Iffco Tokio Genreral Insurance

says, â&#x20AC;&#x153;In a country like India, where the customers are price sensitive, Health Insurance Claims Management (HICM) plays a very vital role. Many have not opted for health insurance coverage as they feel the outgo is substantial and hence in case HICM contributes to reduction of premium, there exists a definite possibility of

increasing the number of persons taking insurance.” Equally challenging is the process of health insurance claims management. Today, more and more people are inclining towards health insurance. At the same time, due to lifestyle related health issues, the health insurance claims are increasing tremendously. Every healthcare organisation today is challenged to process high volumes of claims quickly and accurately. However, hospitals, healthcare insurance companies and Third Party Administrators (TPA) are determined to accept this challenge.

How it happens The hospitals check the insurance status of the patient on the onset of his/ her treatment after that the hospital informs the concerned insurance company. The patient is first seen in the OPD then the treatment process begins. Dr RV Karanjekar, CEO & Group Director, Global Hospitals says, “Generally it takes from three to four hours to a whole day at times to an insurance company to check and investigate the genuineness of the insurance claim, how much the claim is, and how much money can be approved. In the meantime the doctors would have seen the patient so the treatment line and cost could have been shared with the insurance company. This process is done in almost 5 to 6 hours in a standard hospital. The report by the hospital gives a fairly good idea about the cost and timeline of the treatment to the insurance companies hence it gives the approval. However, if there is a gap between the claim amount and the cost, then either the patient pays the remaining amount or he asks his insurance company to consider a higher budget. A hospital generally doesn’t interfere in this event.” Insurance package: Easy to claim Generally the offerings by insurance

companies are of two kinds – one is the insurance at the individual rate and the other one is the insurance package. According to the industry experts, there are around 75 different kinds of predetermined insurance packages in market. This system of package insurance makes the process of claims easier and quicker. Hospitals need not to charge anything extra to the patients with the package because the package covers almost all the aspects. Tewari at Rockland Hospital opines that in these cases, it takes lesser time to the hospitals to prepare the time line and the cost of the treatment, whereas insurance companies generally take no time to approve the insurance claim. Today, in almost 80 percent of the insured treatment cases are under package insurance and that makes the health insurance claims management faster.

Medical tourism Medical tourism is different from the conventional model of international medical travel where patients normally travel from less developed countries to developed countries for medical treatment. Medical treatment in India is advantageous because it consists of reduced costs with the availability of latest medical technologies, and international quality standards. It is a growing sector in India. According to a survey, India’s medical tourism sector is expected to experience an annual growth rate of 30 percent, making it a USD2 billion industry by 2015. Approximately 150,000 of these people travel to India for healthcare procedures. So, it is not by accident that medical tourism is briskly growing in India and the insurance companies are welcoming it. Tewari explains, “Western world sees a huge opportunity in India. It is mainly because of the big cost deferential. If the ensured person comes from a western developed

Dr RV Karanjekar, CEO & Group Director, Global Hospitals

Today no hospital can work without tying up with insurance companies. It is the major part of the healthcare business. Normally we receive insurance patients through Third Party Administrators (TPA). We carry out provisional diagnosis and find out what treatment is required then send notice to the concerned insurance company. Once we get the authorisation we go ahead with the surgery. Then we prepare the discharge summary and pass it to the TPA who further passes it to the general insurance companies. After the process, the payment is done in a particular time. may / 2013 ehealth.eletsonline.com

tech trend

country his cost of treatment along with staying in a five star hotel and flight tickets is extremely lesser than the total expenditure in his own country. This benefits the patient as well as the insurance companies as now they have less amount of claim to pay. Indian hospitals are getting a huge amount of business through medical tourism. This new system also gives a huge business to aviation industry. So, if we combine the aviation, hospitals and the insurance companies the nomenclature changes from medical tourism to medical travel”. He adds further by saying, “The growth of medical travel in India is exemplified by the growing business of the hospitals in Delhi/NCR region where every hospital is reporting a 100 percent growth. Earlier when medical travel used to be four to five percent now it is about 25 percent of a hospital’s business. Future prospects Currently, the insurance companies

are facing a huge challenge of losing money, and this is a global phenomena. The number of people getting insured is increasing. Generally in the hospital where the billing for insured people supposed to be around four to five percent has now increased to more than 20 percent and it is continuously increasing. This phenomenon is more in urban scenario for time being, but the private sector is also tracking rural market gradually. With lifestyle diseases on the rise and treatment getting expensive, the cost of health insurance is prone to go up. The only way to control this is to prevent the lifestyle disease in the first place. With almost all the healthcare systems catering to curative treatment, focus has to shift to preventive healthcare and management, says Lohiya at IFFCO Tokio General Insurance Company. Government is also a trending sector in health insurance. Government departments will get all its employees

insured. Tewari says, “Today, there are so many limitations in the Central Government Health Insurance Scheme (CGHIS), Universal Health Insurance Scheme (UHIS). Taking Government employees in the periphery of private insurance will give them more options to get admitted in the hospital of his own choice, and the insurance claim process will also be cut short due to less formalities. This will also allow Government to cut short the expenditure over its employees. Because of the large number of people working in Government sector, it has bulk customers. Private insurance companies and hospitals will tie up with Government in lower premiums and fees respectively. And the assured payment is one major reason for private players to tie up with Government”. Challenges: Use of ICT False claims: False claims by the hospitals and patients are one of the major challenges for insurance companies. According to the industry ex-

Time for Cashless Claims D D Dass, CAO, Focus Health Services (TPA) Pvt Ltd

After the emergence of private partaking, the insurance industry has seen dramatic changes. In which, health insurance is a method to finance the healthcare requirements. The health insurance industry has

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gained new dimension of better quality of deliver with Third Party Administrators (TPA). TPA ensures better services to all the health insurance policy holders. TPA is an intermediately between insured and insurance company. TPA companies are like the BPO of the general insurance companies and they take the responsibility of all the aspects of the health insurance claims. TPA’s work starts once a policy gets issued. Once a policy is issued, the general insurance company provides all the records of the ensured to the TPA and they remain under the care of the TPA itself.

Cashless claim: An important function of TPA companies

Insurance companies and TPAs give ID cards to all their policyholders in order to authenticate their identity at the time of admittance. In case of claim, policyholder will have to inform TPA. After informing TPA, the policyholder will be directed to a hospital, which is tied up with the company. TPA issues authorisation letter to the hospital for admittance of policyholder. At the time of discharge the discharge summary is sent to TPA then the TPA makes the payment to hospital. TPA further sends all the required claim documents to the general insurance company. This is followed by reimbursement by the general insurance company to TPA.

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tech trend

Automated Claims Management Decreases Cost Yogesh Lohiya, MD & CEO, Iffco Tokio, General Insurance Company Ltd attains even greater relevance and importance.

How crucial the role of Information technology is in health insurance claims management?

What is the importance of Health Insurance Claims Management (HICM) in the healthcare and insurance industry? Managing claims involves not only claims processing but goes on to cover the entire gamut of claims management â&#x20AC;&#x201C; strategic role, cost monitoring role, service aspect as well as the role of people handling the claim. Promptness, fairness, correctness and transparency in claims settlement are the keys to customer satisfaction. This is not only a business responsibility but also a responsibility towards masses/society. Suitable claims management leads to a possibility of maintaining better ratios of claims resulting in better pricing of premium. Furthermore, from the perspective of the insurance industry, HICM is very important to build a sustainable portfolio. In the absence of any regulation or regulator in our country to control the healthcare providers, coupled with no standardisation of protocols and tariffs nor categorisation and certification of healthcare providers, the area of HICM

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Claims handling is an important activity due to increasing expectations on the part of consumers and compliance with Government regulations. Efficient claims management is vital to the success and sustenance of the portfolio. Major components of the claims handling process include developing strategies to cut costs and reduce fraud while keeping customers satisfied. Companies can benefit from claims management tools and technology. Earlier to the year 2000, the process of claims management only involved reimbursement claims and it used to be slow and fully paper/document based, with no role for IT. With the advent of cashless hospitalisation, the entire claim process changed. New processes, such as prior authorisation became vital. Time, which was not a crucial element in processing reimbursement claims earlier, all of a sudden became a vital parameter. The use of claims management system software that speeds the process and minimises costs offered a practical solution. Simplifying the claims process through automation helps reduce expenses. Automation of the claims management process helps decrease a companyâ&#x20AC;&#x2122;s operating costs. One example is the increased cost of investigating a claim manually. Information technology systems improve efficiency by decreasing the number of claim errors, detecting fraud early and reducing the time it takes to process and settle a claim -- all

factors that cut costs and increase profitability. Also, paying fraudulent claims costs insurance companies money -- a cost it passes on to its customers. Consequently, underwriting guidelines become tougher and the insurance premiums that the consumers pay increase. Software tools designed to examine payment history and evaluate trends in claim payments can help insurance companies detect fraud. Information Technology is one of the best enablers for data storage, data mining and the very important area of data analytics. With the increasing numbers, it is expensive and cumbersome to keep all information in paper form. Furthermore to retrieve the huge voluminous data and analyse it is a near impossible task. It is here that IT comes in as a valuable aide. Last, but not the least, an effective IT based claims management system can provide excellent insight to management.

Where do you see the future of health insurance and claims management? Health insurance is growing at a fast pace. In 2012-13 health insurance contributed 22 percent to the total general insurance premium and grew at 17 percent. This is due to many contributors such as a growing population, poor state owned health services and due to overdependence on private service providers â&#x20AC;&#x201C; exorbitant medical costs coupled with no medical insurance coverage for the majority. Over and above this, increasing shift of people from rural active lifestyle to urban sedentary lifestyle, poor dietary choices and stress has led to a spurt of lifestyle diseases in India.

tech trend

Paying Claims Quickly with

Least Denials

to bank customers through better engagement and communications. It will ensure a wider reach and help a long way in increasing awareness rapidly.

How important is it to tie up with hospitals and healthcare companies and how Apollo Munich is doing that?

Antony Jacob, CEO, Apollo Munich Health Insurance

What is the state of health insurance business from the Apollo Munich perspective? Over the last decade and a half, India is on a fast-track to get integrated with the rest of the world through economic and cultural inclusion. Technological advancements in communications have led to never-ending work-days. People are always connected to their offices, even on their breaks. This continuous pace of life has led to increased instances of lifestyle related ailments such as higher blood pressure levels, sugar levels, obesity, cardiac concerns, etc. And medical technological advancements have resulted in an ever increasing healthcare cost, making healthcare unaffordable for many. Health insurance is the best possible solution to combat the effect of this double whammy. Bancassurance will prove to be a very effective channel for health insurance distribution as it allows insurance companies to tie up with banks across locations to sell their products

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With our parentage that includes Apollo Hospitals, a leading healthcare provider in the country, we believe it is indispensable for a health insurer to have tie ups with hospitals. Positive and long term partnerships with healthcare providers help to ensure that customers receive the best care when and wherever it is required. Today, we have tie-ups with over 4,000 hospitals and other healthcare providers. We have a team of doctors on our staff who works very closely with the medical community to ensure that the right services are rendered to our customers, at the right price. Our customers benefit as they can avail the best treatment at best facilities on cashless basis, while paying an affordable premium rate.

What are the challenges in health insurance claims management, and how do you overcome them? We have a robust claims process management system in place that takes care of the entire claims procedure, from the time a claim is sent in to us to verification and disbursal. From e-cards to ensuring approval for cashless treatment within 65 minutes to the fastest claims payment time among stand-alone health insurers, we go to great lengths to ensure

customer satisfaction in this important area. 98 percent of the claims are paid by 15 days. The largest challenge we face in our claims management process is ensuring that we pay claims to our customers quickly and with the least amount of denials. Due to several reasons such as hiding facts, illegible writing on proposal forms, exclusion of certain procedures, claims are often delayed or denied. We ensure that each of our customers has a thorough understanding of the inclusions, exclusions, waiting periods and procedures at the time of signing on with us to ensure that no hiccups occur during claims.

How do you perceive the importance of ICT in the health insurance claims management? ICT perhaps plays the most critical role in automating the fulfilment processes in customer facing businesses such as insurance. However, the pace of ICT utilisation has been slow when it comes to the claims processes. This may be due to the fact that the processes related to claims require integration of multiple stakeholders including healthcare providers. We believe ICT should play a significant role in enabling real time data sharing requirements between the claims facilitators and providers. This may be possible by creating a data highway where each customer, provider and claims facilitator can work in tandem for faster decision making through real time sharing of information. We have recently transformed its core IT infrastructure and this has led to increased operational efficiencies as well as business up-time.

covertrend tech story

We Empower

Insurance Companies Arindam Mukherjee, Manager, Regional Sales, BFSI, Cisco India & SAARC talks to Kartik Sharma, ENN about Cisco’s offerings for health insurance sector How does Cisco see the significance of Information technology in health insurance sector, and what is Cisco’s strategy in future? The health insurance industry has evolved over the years as consumers have become more educated and savvy about their insurance choices. Insurance companies are addressing the need for greater customer centricity holistically by investing in tools for better insight, optimised processes, and enhanced customer reach by direct/indirect channels. To survive and grow in the market, insurance carriers need greater agility. They can achieve this by unifying data, applications, and human expertise to efficiently deliver personalised service at the right time, to the right customer, across sales, underwriting, and claims. At the same time, to remain competitive, it’s imperative for today’s insurer to not only attract and retain talented next generation employees to drive future innovation and growth, but to also enable a more flexible agent network. Insurance firms increasingly face the dilemma of giving employees more freedom to work the way they want— while at the same time reducing IT

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Cisco’s strategy has been focused on developing a portfolio of solutions that empowers insurance companies as well as their agent/broker networks to engage with customers in the way the customers choose. complexity. For example, brokers and their agents increasingly are bringing personally owned consumer devices like smartphones and tablets into the office and out in the field, which is proving to be a cost effective and attractive way to keep them engaged and productive while serving customers. However, many insurers struggle with securely placing these personal devices on the network. Ultimately, whether in the field, the contact center, regional office, or carrier headquarters, workers re-

quire their workspace to move with them. Whether enabling work to be done on a “bring your own device” (BYOD), enabling the sharing of workstations in the office, or empowering subject matter experts to service insurance customers wherever they may be physically located, employees want this kind of flexibility. Cisco’s strategy has been focused on developing a portfolio of solutions that empowers insurance companies as well as their agent/broker networks to engage with customers in the way the customers choose, by using customer knowledge to delivery personalised service, simplify operations and support, and safeguard privacy and security.

Tell us about Cisco’s offerings for health insurance industry. Cisco offers the following solutions that are specifically tailored to meet the needs of the insurance industry: • The Cisco Unified Workspace offers an integrated and strategic approach to the enterprise workspace that is designed to help insurance industry employees access all of the people and resources they need to do their jobs effectively from wherever they are, on whatever device they

choose, and with an enhanced quality of experience. With all three Cisco Smart Solutions (BYOD, VXI, and Remote Expert), insurance organisations can make employees more agile, efficient and productive. • The Cisco BYOD for Insurance Smart Solution simplifies insurer operations with end-to-end and network lifecycle management, delivers an uncompromising work-your-way user experience, and enables organizations to secure devices with unified policy and essential controls necessary to support beyond the traditional office environment. With this solution, insurance organizations can have a uniified policy for devices to securely access their data; applications, and systems across the entire insurance network and ensure an uncompromised experience for employees and agents with leading collaboration tools and mission-critical wireless reliability. It also considerably simplifies operations for IT so they can focus on innovation, instead of intervention. • Cisco Remote Expert Smart Solution lets consumers locate and connect with financial experts anywhere in the insurance firm, over whichever channel the customer prefers. It allows insurers to create a virtual pool of experts and specialists, whether co-located in specific call centers or dispersed throughout the enterprise. And, it integrates with the firm’s customer information systems, providing the subject matter experts with a complete view of the customer relationship and activity. • Cisco Assurance Management Solution (AMS) can deliver service providers and large enterprises near realtime centralised monitoring and root cause analysis. Cisco AMS provides the key building blocks for flexible deployment of end-to-end assurance management for complex multivendor networks. It extends the existing Cisco Info Center solution to provide network fault monitoring, trouble isolation, and real-time service-level management.

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Expert speak

Rising up The Ladder

Association of Biotechnology Led eneterprise (ABLE) was formed in April 2003 to accelerate the pace of growth of the biotechnology industry in India, interfacing between the industry, Government, academic and research institutes and domestic and international investors

By Dr PM Murali, President, ABLE India

Dr P M Murali

iotechnology remains a great hope for the country with its potential to impact health, food and energy security and effect environmental remediation. Despite the challenges in the last three years with the global financial crises, the Indian biotech industry grew steadily at close to 20 per cent per annum in revenues. The next three years should be even more exciting. With the new leadership team

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at ABLE achieving tangible advocacy impact we will see the industry charting a strong course ahead. ABLE’s ten successful years in India has been a great journey to boost the biotech sector in the country which has grown many fold over the years and the domestic industry is now recognised globally in terms of its talent and research prowess. We are very happy to announce awards for outstanding contribution to the Indian biotech sector which will encourage all stakeholders to enable the industry to grow exponentially. According to the statement issued by the ABLE, few of key roadblocks that the industry is currently facing are the fuzzy regulatory environment that is delaying the developments in the area. Healthcare sector is the most regulated in the world and delaying development further would hamper the progress of bringing out vital healthcare products. Also, the Government should come up with an affordable health policy that clearly states how Intellectual Property (IP) rights of innovative companies are protected. This will cast away the doubts that foreign companies have in setting research and development facilities in India. Although opportunities are available, connection and communication is required for bridging the gap. Today the market size is USD five billion and expected to go over 80 billion by 2025 with a current growth rate of 18-21 percent.

ABLE has played an essential role in assisting the Government to develop a road map for the next decade in association with the Department of Biotechnology (DBT), Government of India. This lays the foundation for the industry to grow to a USD 100 billion industry. Additionally, ABLE has also helped to devise the roadmap for biosimilars, which was done in association with Department of Pharmaceuticals (DoP), outlining the new bio-economy. The key highlights where ABLE has played a role in assisting the Government include – • Development of a road map for the next decade done in association with the Department of Biotechnology, Government of India • Road map for Biosimilars done in association with Department of Pharmaceutical, Government of India • Biosimilars guidelines successfully launched by the Government last year to guide the growth of this industry ABLE provides roadmap for the biotech Industry, building the Biotechnology Entrepreneurship Students team (BEST) and North East Life Science Entrepreneurship (NEST) programs, the BioInvest Program and the International promotion of Brand India through organising the India Pavilion in various BIO Shows for encouraging students. The biotechnology companies need a balance between investment and regulation.

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ICT in Blood Banking Sector

IT will play a big role in development of blood banks and blood storage units g

By Dr Harish Jachak, Manager Presales and Marketing, Birlamedisoft Pvt Ltd

e know that healthcare industry in India is highly unregulated. But this may not come true in case of blood banks. They, on the other hand, are under regulation. Also, nowadays opening a blood bank has become very difficult. If you ask me about growth of blood banks, I would say, the growth is slow. On top of that blood banking facilities are limited to major cities only. We need more storage units in small towns. These regulations and statutory

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requirements make the role of ICT in blood bank very important. Blood bank employees need to maintain at least 10 to 15 different types of registers and records for reporting purpose. Since there are many regulators and each has different formats for their records, this process of record keeping is very time consuming and cumbersome.

Challenges for blood bank Some major challenges for blood banks, I would summarise as follows:

• Safer blood supply and storage comes at higher costs. • Growing number of infections that transmit through blood. • Customer expectations of quality and safety. • Strict regulations. • Motivating people to donate blood. In other words maintaining continuous supply. • Blood transport and storage facilities. • Increasing longevity of blood and blood components.

• Wastage of blood and blood components. • Appealing doctors to prescribe components and encouraging blood banks to prepare blood components. This should optimally utilise the scarce whole blood.

How ICT could help Proper implementation of ICT can change for good how blood banks function. • Bar coding and scanning technology can reduce reporting errors. • Timely reminders of expiring bags, with identification of bags can make staff to distribute older bags first (FIFO model). This will not only reduce cost of storage but also save money lost with discarded bags. • Real time status of available stock in storage centres and/or blood bank will help in maintaining optimal level of usable bags. • Online data of donors would be helpful in identifying habitual donors, maintaining contact list in case of emergency, etc. • Forecasting of blood demand or possible stock-outs in near future will help blood banks to plan and replenish stock well in advance by arranging blood donation camps. • Interfacing with machines can be done so there remains no need of manual entry of test results. Bar code and stickers printing further reduces any chances of human error. • Web based blood banks information management systems will allow the users to enter the data of donors and bags at the point of collection. Otherwise staffs have to enter data once they come to centre form any camp. This results in duplication of efforts. • Well formatted reports can suffice requirement of any regulating agency. No need of repeating the entries in each report. • Full array of MIS reports for admin-

istrators of blood bank facilities. • Customer support features like SMS, online booking of blood for planned surgeries, etc. will definitely lead to customer satisfaction.

What we do? We are developers of IT solutions for healthcare industry, providing services to small to large hospitals, diagnostics centres, blood banks, imaging centres, pharmacy shops and healthcare operations of big industrial plants.

of bags gives zero chances to miss-reporting or wrong supply of blood.

What’s in future? I see great scope of business expansion in blood transfusion related business, since most of the blood banks are running without any automation or something just for billing purpose. Blood bank, collection centres and storage units will talk to each other and will maintain continuous availability of life saving fluid. Hospitals would be able to check status of avail-

Role of Government and regulators such as National AIDS Control Organisaion and State AIDS Control Societies is very critical. Government should certainly look into matters of data banking, security of data and standardisation of records We have Information Management System for blood banks, both online and offline, catering to some of the leading blood banks in their respective areas. By making process of registration, blood collection, testing and cross matching, storage of blood bags according to expiry date, blood groups, components, donor and blood bag database, monitored distribution of blood bags and reporting of adverse reactions automated we are making life easy for our clients. As I said earlier reporting is very critical part of blood bank management, our online and offline blood baning management software gives more than 40 different types of reports and records. This allows managers to monitor all functions of blood bank. Donor tracking has been made so easy that blood bank can have large database of emergency donors handy. Also their health profile is maintained to avoid infected blood entry into system at first check point. Identification and tracking system

ability of blood of desired group or the components online and how long will it take to reach them. Confidentiality of donor/receiver data would be of utmost importance and efforts would be placed to protect them. In future I would like to see minimal wastage of precious blood. This could be achieved by timely utilisation of near expiry stock, increased usage of components and keeping the supply (donors) within timely reach whenever there is demand. Role of Government and regulators such as NACO and State AIDS Control Societies is very critical. Government should certainly look into matters of data banking, security of data, standardisation of records, sample and blood bags tracking etc. as a policy matter. With advancement of newer technology in collection, separation of components and storage of blood, ICT had already entered blood banks. Need of the hour is a system for managing the information.

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zoom inspeak expert

Technology Comes Handy in Managing Blood Banks Karthik Tirupathi, CEO, Napier Healthcare Solutions feels collaboration and interoperability are key considerations for safe and efficient management of blood banking To start with, could you give a brief overview of the current status of the blood bank sector in India in terms of its market share and its overall progress? As per Central Drugs Standard Control Organisation there were a total of 2,535 licensed blood banks in India as on 31st March 2012. In 2011, the total blood banking and blood products market in India was estimated at USD 36 million. Fuelled by a greater awareness and acceptance of blood transfusion as a safe option, increasing efforts to make quality blood available, stringent regulatory and healthcare policies adopted across the world, the global market for blood banking and blood products is expected to touch USD 36 billion by the year 2015 and USD 43 billion by 2018.

In what ways can the adoption of ICT help address improving the supply chain management of blood banks, management of donors and blood bags database? ICT can be used to provide predictable outcomes and such outcomes can be monitored efficiently to further improve the processes. A virtuous closed loop is the key in the blood management process. Blood bank solutions offered by EHR vendors exponentially increase the efficiency to help identify and manage all the blood components from the donor to recipient or disposal, thereby realising the dream of closed loop blood component management. The ecosystem of the blood chain stakeholders consists of different players operating in silos. Consequently, collaboration and interoperability are key considerations for safe and efficient management of the environment. The process of updating statuses of blood units can be easily automated. This helps to reduce the burden on the service provider in the blood banks. The real time updates accentuate the service ability, safety of blood supply, and helps in optimising the usage and avoiding waste.

Please give us details about the technology solutions that your company is offering to the blood bank industry?

Karthik Tirupathi

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Napier’s EHR solution creates seamless process between all stakeholders, their roles and requirements in play-

ing their part for delivering safe and timely blood/ blood components to the patient in need. The blood bank module in Napier’s EHR has a functionally rich suite of products that have been successfully deployed and in some hospitals for over 16 years. Donor Registry: Providing a user friendly and efficient interface for easy registration of volunteers / donors. Donor Clinic Management: Efficiently administering permanent and mobile donor clinics and donation camps. Quarantine Management: A robust module that supports the storing of collected blood or component units while their test results are pending. Stock and Storage Management systemm, Supply chain management, Order Management, Disposal Management, Rare Blood & Priority Management, Quality Management, Blood Bank Collaboration, Blood Bank Portal, Interactive Communication System are some other blood banking solution from us. Napier’s Blood Bank Solution has ready interfaces for leading manufacturers of centrifuges and irradiators. Automated interfaces record test results directly and eliminate errors arising due to manual intervention. Napier’s Blood Bank solution also supports multiple mobile devices as many of the activities involve recording data either at point of sourcing, point of store or point of care.

ICT Is Useful in Blood Banks Dr Gautam Wankhede, Director-Medical Affairs, Alliance Transfusion Pvt Ltd shares his insight on the upcoming trend of blood banking sector To start with, could you give a brief overview of the current status of the blood bank industry in India? In terms of revenue, a study in 2009 had put the value of the Indian blood transfusion services at about `617 Crore. The industry has the potential to be a much bigger one revenue-wise. However, blood banking is perhaps the only branch of medicine which is very closely regulated and controlled by Government policies. This also includes ceiling on prices that blood banks can charge for blood and other services, thus restricting the overall revenue share of this sector when compared to other medical industry sectors. However, with many blood banks getting greater flexibility in pricing and offering tests and services at par with the best in the world, the blood banking industry should now be much bigger than the figure quoted above.

What are some of the major challenges that the blood bank industry is currently facing in India? India has a deficit of blood supply in the range of 20 percent to 40 percent. In most districts, blood banks often do not have enough stocks to meet the demands. Another challenge is the lack of a centralised system that coordinates or monitors the services provided by various blood banking units in the country. For example, in the UK, there are hundreds of blood collection and donor recruitment centres, but the testing/processing is restricted to just a handful of centres spread across the country. This ensures that the testing/ processing is standardised and automated. The lack of standardisation in

India means that the level of services can vary substantially. The strict control maintained by the Government over pricing of blood and related services is another major challenge. For example, in India, a cardiologist or an oncologist can bring in the latest and most advanced therapy/diagnostic test and charge the patient for the new treatment option, which as a rule will be more expensive. However, the blood banking industry finds it difficult to implement any new state of the art tests/ services because the ceiling leaves them with very little money for investment in new technologies or research.

In what ways can the adoption of ICT help address improving the supply chain management of blood banks, management of donors and blood bags database? The blood banking sector in India has only recently accepted the use of ICT. A software based Blood Bank Management System (BBMS) can help the blood transfusion in many ways: â&#x20AC;˘ Enables fast, easy and effective communication with donors (for appointments, conveying camp details and donor reports) and blood donation camp organisers. This will result in increasing voluntary repeat blood donations rates â&#x20AC;˘ Real time status of stocks, alerts about near expiry/expired stocks, quarantine management, inventory being sent to satellite centres/ storage centres will help in better and effective stock utilisation and supply chain management â&#x20AC;˘ With all records available for audit and analysis, better planning

Dr Gautam Wankhede

and resource allocation/utilisation can be done.

Please tell us about the technology solutions that your company is offering to the blood bank industry? Alliance Transfusion has a strong commercial understanding of the market and also is backed by specialised clinical knowledge of the field. We have launched blood bank Management and Surveillance System; AT Strides. This has been successfully installed in more than 25 blood banks across India. The biggest advantage of this system is the surveillance capabilities during storage and transport of blood. Alliance Transfusion has also recently introduced TimeStrip Time and Temperature monitoring devices to be used on blood bags.

May / 2013 ehealth.eletsonline.com

power hospital

Striving for

Something Better

Dr Mukesh Batra, Founder and Chairman, Dr Batraâ&#x20AC;&#x2122;s Positive Health Clinic Pvt Ltd proudly mentions, â&#x20AC;&#x153;We strive to be the leader in our field. We work on our own benchmarks by regularly upgrading our quality baselines.â&#x20AC;? In conversation with Shally Makin, ENN How do you think the upcoming technologies can help in providing healthcare to all? What are the latest medical equipments procured by your hospital and has raised standards? Technology is more than a tool. When used optimally and efficiently, it provides desired outcomes with minimum cost, as also applicability in delivery system and extensive shelf-life. It also helps to optimise results, even with limited resources. Taking this into contemplation, we have endeavoured to achieve the following in our organisation â&#x20AC;&#x201D; â&#x20AC;˘Use of latest diagnostic tools in consonance with the major diseases we treat in our organisation â&#x20AC;&#x201D; for example, video microscopy (folliscope) for trichology, advance skin analyser for dermatology, and spirometry for respiratory diseases â&#x20AC;˘For accessibility of patients to reach our doctors, we launched our cyberclinic a decade ago for treating the maximum number of patients in a year. We also launched mhealth, where patients can send us queries with minimum effort through mobile phone â&#x20AC;˘To improve accessibility of doctors within the organisation and for patients to take second opinion, we started telemedicine services â&#x20AC;&#x201D; where patients can be seen by our â&#x20AC;&#x2DC;medical

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Centralised Management System (CMS) helps us to improve accessibility and uniformity in our servicesâ&#x20AC;?

Challenges and Solutions How to help and retain the customer/patient by giving them the â&#x20AC;&#x2DC;Wow!â&#x20AC;&#x2122; experience What steps need to be taken to achieve and sustain the experience How can we ensure that a customer/patient is takes care of in the best manner possible when they enter the clinic? Time management â&#x20AC;&#x201D; to optimise the patient experience Sustain the quality of treatment â&#x20AC;&#x201D; through SOPs How to maintain leadership status in the industry, and set new benchmarks

expert teamâ&#x20AC;&#x2122; sitting afar from the clinics, where the patient has enrolled for treatment. This has augmented our services and made us expand our reach efficiently â&#x20AC;˘The use of a centralised â&#x20AC;&#x2DC;Clinic Management Systemâ&#x20AC;&#x2122; has worked well for us â&#x20AC;&#x201D; this helps us to maintain clinical records of our patients. The current trend of â&#x20AC;&#x2DC;floatingâ&#x20AC;&#x2122; population is also no problem, because all records are available at our clinics, across the country, at the click of the mouse

About the Hospital Founded in 1982 by Dr Mukesh Batra, Dr Batraâ&#x20AC;&#x2122;s Positive Health Clinic has come a long way today with 105 clinics spread across 46 cities in India, Dubai and UK. It provides state-of-the-art services to more than half a million people from all over the world, with the numbers growing steadily. Transparency in business and abiding by their fundamental principles has brought Dr Batraâ&#x20AC;&#x2122;s a long way in developing and maintaining excellent relations with customers. The commitment and dedication in providing customers with the best service helped Dr Batraâ&#x20AC;&#x2122;s to become the worldâ&#x20AC;&#x2122;s largest homeopathic corporate.

What are the IT investments your hospital has made over the years? Total IT solution for patient care, right from registration, follow-up and continual cycle of treatment is undertaken. Total online real system, accessible from all locations by staff at all levels â&#x20AC;&#x201D; doctors, management, PROs etc. has been introduced along with total online MIS, which provides the latest status to all concerned â&#x20AC;&#x201D; to manage the business. A range of totally automated e-mail/ SMS systems for patients â&#x20AC;&#x201D; for reminders and follow-ups and comprehensive system to monitor patient experience and satisfaction has been achieved by the hospital. We have invested in both software and hardware. We have online ERP and specialised software for HR, including attendance, leave, rota duties and payroll management and performance appraisals. We firmly believe that ICT

is a game changer for our operations, because it not only helps us to cut down errors to the â&#x20AC;&#x2DC;barestâ&#x20AC;&#x2122; minimum, but also enhances the quality of our operations and services for our patients.

What are your views on the regulatory issues of healthcare? Regulation in healthcare should be made with the intent of minimising errors and enhancing maximum safety juxtaposed by optimum efforts, while taking into account the local conditions. Plagiarising regulations from other state authoritiesâ&#x20AC;&#x2122; increases cost

We sail through challenges, thanks to Patient flow management â&#x20AC;&#x201D; which helps improves communication with the patient Getting and retaining competency by constant training, competent compensation and conducting continuing medical education (CME) Standardisation of systems and processes through compliance to SOPs Expansion plans â&#x20AC;&#x201D; with uniformity in services across the clinics and constant monitoring through MIS

of healthcare delivery; it also does not significantly add to the quality of medical care. Regulatory issues in healthcare for alternative systems of medicine are not well-defined yet â&#x20AC;&#x201D; especially in case of OPD clinic set up. It is difficult to find a benchmark. It appears to be more self-regulatory â&#x20AC;&#x201D; this has prompted us to incorporate all possible standards practiced in top-class conventional clinics into our chain of clinics. Since we also dispense medicines within our premises, we provide medicines procured from a homoeopathic pharma company, which follows GMP and all national and international guidelines and protocols. Medicines are provided to the patients in â&#x20AC;&#x2DC;blister-packing.â&#x20AC;&#x2122; This is done with no human hand â&#x20AC;&#x2DC;touchingâ&#x20AC;&#x2122; the medicines, while packing and with minimum paperwork. True to our mission, it has been our policyto provide prompt and effective healthcare systems and homeopathic treatment services,which meet the needs of patients, through competent staff and excellent infrastructure.

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Women Health Matters A Lot For Our Nation By Himanshu Bhatt, Director, KS Biomed Healthcare Pvt Ltd-Ahmedabad (Gujarat)

henever we think about women health in India, first question comes to my mind is, “Are we really committed to women health in India?” On paper, loads and loads of “Tests and schemes announced by Government” but how much Indian women are really utilising these schemes for really needed tests is a serious issue to address. We at K S Biomed Services are committed to spread awareness of women health in India and this started four years back with our direct focus on two modalities which directly involves women health. 1. Mammography 2. Bone Densitometry(DEXA_BMD) Let me elaborate both one by one.

Mammography Test Breast cancer is the most excruciating challenge in urban India (as well as in rural India also up to some extent). It is evident from the various statistics available that breast cancer amounts at a very high percentage among all cancers in women. Risk of breast cancer is among one in 30 women in urban India and one on 65 in rural India. 70 percent of the breast cancer can be treated with very positive results if it’s detected at early stage. Mammography is the modality which is used worldwide to detect breast cancer. Due to very high cost of equipment it was not a preferred investment by diagnostic centers in India. K S Biomed Services started offering high-tech refurbished mam-

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Himanshu Bhatt mography equipment four years back sensing the “real need of it” in urban and rural India. The result is outstanding and today we feel proud that thousand of women in India are benefited by this most economical solution offered by us with more than 95 installations all over India by us. Saying this I feel responsible for presenting following details to Indian women for another serious “Silent Killer” disease affecting their health: Osteoporosis.

Bone Densitometry (dexabmd) test: Your bones continue to change with

your age. They may get weaker, putting you at higher risk for a fracture. Also many Cancer, Asthma treatments or steroid induced medication puts women bone health at a very high risk. Bones may also get weaker postmenopausal phase. How can you know if your bones are improving? One way is to have routine bone density tests. You can know the health of your bone by getting bone density checked at regular interval of at least once a year after age of 40. Although there are many types of bone density tests available, the most authentic and preferred test is “Dexa Scan. In this test your T-score and Z-score are measured for diagnosis of your bone health. As said earlier for Mammography units, these equipments for BMD tests are very costly and list preferred due to viability issues by Diagnostic set ups in India for many years till now. As an ongoing commitment towards women health in India by us we have introduced the concept of refurbished BMD units last year and once again we are proud that many needy women are diagnosed and being treated now in India due to so many units we have installed in urban as well as rural areas in India. Women are integral part of man’s existence and Indian society. Women health is ‘Our Future”. Please protect yourself from “silent killers” like breast cancer and Osteoporosis. Consult your radiologist now.

cover story expert speak

Saving Life

Is a Passion A pioneer in bypass surgery, Dr Ganesh Kumar Mani has the distinction of 18,000 cardio surgeries to his credit. Besides recognitions and awards, including the Padma Shree, he has served relentlessly to save lives. A surgeon par excellence, he shares his thoughts with Shahid Akhter, ENN Do you agree with Indiaâ&#x20AC;&#x2122;s heart burden pegged at 32 million? Reasons behind this frightening figure? Studies reveal that Indians are four times more prone to coronary artery diseases than their Western counterparts. Besides genetic predisposition and climatic conditions, faulty lifestyle (improper food habits, lack of physical activity, high level of stress, increase in smoking, enhanced alcohol consumption, etc) are some of the probable factors contributing to steep rise in coronary heart disease. In India sweets are de rigueur; no occasion or festival or celebration passes

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by without the avalanche of sweets. Equally harsh is our association with spices and salt. Studies reveal that early diagnosis can prevent many of the long-term effects and can save the person from all invasive and noninvasive procedures.

People prefer angioplasties (2.5 lakhs) as compared to cardiac surgeries (1.5 lakhs). Why the surge in angioplasty ? Coronary-artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are the two alternative options for revascularization in patients with coronary artery disease. The choice of angioplasty or bypass surgery is based on patient – physician interaction and understanding of the scenario. A lot of things need to be taken into consideration before deciding the ideal approach. For instance, the severity of the coronary artery damage, symptoms, overall health of the heart ( heart valves) and co-existing medical condition, diabetes, kidney status and so on…. At times a patient’s thinking is to be blamed. He finds it easy to accept angioplasty, not realizing the future implications and the road ahead. The easy route and the lure of stents and its marketing are some of the factors in favour of angioplasty. It is all about understanding the road map. In the US, 80,000 more surgeries were conducted in 2012 when compared to 2011 figures. People need to be thoroughly educated before they can take a decision.

What recent advancements have surfaced in cardiac surgery ? Minimally invasive procedures and cosmetic surgeries are two thresholds where a lot of things are happening. In fact, it has changed the way people used to think about surgery.

A lot of innovations are marked here but again caution needs to be exercised to ensure that surgery serves it purpose. Advancements are simply unending. Today we may be talking about robotic surgery, tomorrow, something more promising may pave the technological path. Given the expenses, robotic surgery is not the solution for us today. It is exclusively for the ultra rich. May be, when things are cheaper or designed indigenously or possibly with Indo China collaboration, prices may come down and robotic surgery may gain wider acceptance.

Dr Mani is one of the first surgeons who pioneered ‘beating heart bypass surgery’ and has introduced various new techniques to practice and teach What technological advancements have been introduced at Pushpanjali hospital in cardiothorasic surgery ? The Cardiology team at Pushpanjali Crosslay Hospital accords utmost importance to proper diagnosis, which helps decide the most appropriate line of treatment. The interventional cardiology department has FD-20 Philips Cath Lab capable of performing coronary as well as peripheral interventions and is supported by excellent diagnostic services like elctrocardiography, computerized Tread mill test, Colour Doppler Echocardiography System and Computerized Holter Monitoring Units etc, for proper planning and execution of treatment.

The department also offers individually tailored strategies for healthy living with regular cardiac checkups for different age groups to keep your heart fit for years to come. Add to this our fleet of Cardiac Ambulances that are well equipped with latest mobile ventilator, defibrillator, ECG machines and monitors to provide accurate information while the specially trained doctors and paramedics on board deal with all kinds of cardiac situations.

With 18,000 cardiac surgeries, zero mortality and a Padma Shree award (besides several other honours), would you like to share your most memorable moment ? Saving the life of my friend Dr. E Sreedharan. He had developed multiple blockages and was unconscious at the air port. I was confused about my strategy to save him. Finally, I prepared for his arrival at Apollo Hospital, temporary pace makers were in place and he was operated upon the next day. I feel happy and proud when my memory takes me back to that eventful life saving day.

What are your future plans ? In days to come, possibly stem cells will be a vital issue in resolving healthcare crisis. In coronary matters too, stem cells can be harvested and ease the heart. Stem cells are under research and they seem to show some promising results. Given the improvement in life expectancy, heart problems will be on the increase and stems cells may be the lead player in days to come.

What are the heart health rules that you personally live by? I believe in the 7s strategy – less or moderate salt, sweet, smoke, sedentary lifestyle, spices, spirit and stress.

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expert speak

Healthcare is Affordable and Accessible State of the art technology need not make healthcare prohibitive. There are strategies that can ensure that healthcare is affordable and accessible. Suresh Soni, Co-Founder, Chairman and CEO of Nova Medical Centers shares his vision with Shahid Akhter, ENN To begin with, please share your inspiration behind Nova Medical Centers.

Suresh Soni

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In Oct 2009, Kaya Skin Clinic, based out of Mumbai was raising capital and reached out to GTI, where I was the Managing Partner. During the discussion on Kaya in GTI, I wondered why a company would be engaged in just undertaking cosmetic dermatology procedures, when real estate in India was so expensive. That was when I thought of ‘Short-stay Surgery’ as a potential business. Although I did not have a background in healthcare, I thought that “Short-stay Surgery” would inherently make surgery more affordable and efficient as it could lead to optimal use of the Operation Theaters. I immediately reached out to an anesthetist friend and spent 2 days with him to understand the surgical centers in the USA. That was the first time I saw a surgery center. Inspired by the concept, I returned to Bangalore to under-

stand the Indian Healthcare scenario and then worked on conceptualizing the idea along with Dr Mahesh Reddy to found Nova Medical Centers

How many hospitals are there in the Nova Group and the services that you offer? Nova Specialty Surgery and Nova IVI Fertility (in collaboration with IVI in Spain) are the two verticals of Nova Medical Centers. Currently we have twelve specialty surgery centers and six in-vitro fertilization (IVF) clinics. Nova Specialty Surgery centers perform over 800 types of surgical procedures across multiple specialties, like Orthopaedics, Spine, General Surgery, Bariatric Surgery, Urology, ENT, Ophthalmology, Surgical Oncology amongst others. The Nova Orthopaedic Hospital in Delhi is dedicated to Orthopaedic and Spine specialties and offers the full range of surgeries including joint replacements, Spinal surgery, Arthroplasty, rheumatology and sports injuries. Nova IVI Fertility (NIF) centers offer the full range of assisted reproductive services.

What are the technological advancements your hospitals have introduced lately in different verticals? At Nova, the focus is on advance technology & experienced doctors. To achieve our mission of delivering the best patient experience and medical outcomes, We have invested in the latest and most advanced spine medical equipment including robots with advanced navigation systems. There are only around 26 installations of such equipment in the world and we are proud to be the first in India. These equipment’s’ help increase precision, accuracy and safety. Nova’s doctors and facilities also adopt the latest techniques and advances in minimally invasive surgery. We have obtained India’s first • BrainLab & DePuy’s navigation

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machine, used for knee and hip surgeries resulting in perfect and precise alignment In-house Jackson spinal surgery positioning, which facilitates a 360 degree view of the spine. Mazor Robotics’ Renaissance, a specially designed surgical guidance system that ensures greater accuracy in spinal surgeries. We use the advanced 3 D planning software to create a surgical blueprint that is ideal for each patient’s procedure. India’s first 4 Embryoscope’s Every Nova facility has the most

many renowned surgeons from multiple specialties to focus on patient care. Fixed Package Prices , at 20-25 % less than comparable Corporate hospitals • The Most experienced doctors • The best available technology • The focus of the Nova Specialty Surgery rebranding has been to communicate the uniqueness of this care model, best exemplified in the proverb “life is not merely to be alive, but to be well”.

Who is your target group and how affordable is Nova ? Absolutely Affordable to the masses..

Nova Orthopaedic & Spine Hospital is a world class facility covering the entire gamut of orthopaedics - from surgery to rehabilitation. We combine wisdom and formidable experience with advanced technology and evidence driven therapies to deliver the highest level of patient care and satisfaction. advanced Minimally invasive equipment for Arthroscopy & Laparoscopy • Nova has ten 120 Watt Lasers for Urology (Prostate and Kidney Stones)

What is the USP of Nova ? At Nova our vision is to provide world class surgical care that is affordable and accessible to everyone. Short stay surgery at Nova reduces unnecessary hospitalization and also hospital induced infections. All this leads to highest level of customer (patient) satisfaction. Another module unique to Nova is the concept of ‘doctor-owned and doctor managed’ centers. This enables the doctors to have a sense of ownership and a long term association with the company. This has attracted a good

lower middle class to the rich Despite having high end equipment and the best of doctors, we are 15 to 25 % lower than corporate hospitals. Add to this that there are no hidden costs. At the very outset we hand over a precise estimate. Further, we do our best to ensure that no patient is disappointed and our doctors personally ensure that the outcome is a happy patient.

What are your future plans ? We currently have 18 centers (surgical and IVF) and shall expand to 25 centers in this financial year.By 2017 we expect to expand to 25 Surgery Centers and 25 IVF Centres. Nova shall be one of the largest healthcare providers in Asia Pacific performing in excess of 100,000 surgeries per annum and 25,000 IVF Cycles

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CEO column

“Within Every 2-3 Years Modernisation Is Required” “Patients don’t realise what technology can do in their case and they behave reluctantly to pay little high for good technology” mentions Dr Shekhar Agarwal, Chief Surgeon, Delhi Institute of Trauma & Orthopedic, Executive Director, Sant Parmanand Hospital. What is your take on the Indian healthcare sector? What is your take on the term affordable healthcare? We are not lagging in usage of technology but yes it may not be prevalent in every area across the country. Centers in far flung areas do not have the same level of technology. Starting from operating tables that are motor driven to robot operated machine operating arms, there are various top class facilities that only metros have and not available to common man from smaller towns. We are lagging in terms of usage of technology in every sphere of country. Having said that, latest technology today is available in the country immediately it’s launched in overseas. This is the reason that India has become a medical tourism hub as we can provide treatment at western standard and charge very little as our salary scale, infrastructure cost is very low in comparison to west. Most of these technologies are coming from foreign country as there is not much research going in our country for making indigenous products matching the standard of west. Therefore every time there is a cost of importing, cost of duty and cost of maintenance so all these things automatically become very expensive for common man here. The government

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needs to encourage research & development here so that we have in-house facilities and the manufacturing needs to be started within the country.

How do you think the upcoming technologies can help in providing healthcare to all? Technology is the main factor for increasing survivorship of so many patients. Earlier after infection survival rate was somewhere around 40 percent but now that has moved to 69 percent for women and 65 percent for men. The mortality rate has decreased. Things like cardiac surgery and joint replacement surgery requires latest technology to give good result which will automatically turn into high price. If government encourages more R&D in India all these

of a patient after a surgery or in between a surgery is possible only with the help of present monitoring technology. Now you can see and record real time blood pressure on monitors along with the alarms. This is simple example how technology has brought change in medical field. Same way operating on television, I can see where my screws are going where my plate is going in large screen now. Similar with the provision of ultra sound where you can pick birth defects, long before the child is born, which helps you know the route cause.

How do you ensure quality and patient safety for a superspecialty hospital? The only risk in joint replacement is of infections and there is very low rate

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The Government’s budget on health in one percent of GDP and average man spends at least four percent of his income on health. So the rest is all paid by patients”

getting escalated because so and so part is upgraded. We have now a technology where we have patient specific instrumentation. It’s like tailor made fitting for the knee. So for that we have to give all the specifications to the manufacturer which actually escalates the cost. Contrary to this if we manufacture it here the cost will be a little fraction of the earlier one.

What are your views on the regulatory issues of healthcare? The Government’s budget on health in one percent of GDP and average man spends at least four percent of his income on health. So the rest is all paid by patients. There is more scope, as health of the nation will be better by health of individual. I think more efforts need to be put in research and development. Public and private partnership should be encouraged. There is too much of red-tapesim, manipulations that we have to remove. We tired types to shape the public-private partnership that could not work.

What is the USP of your hospital? technologies that are imported can be made indigenously which will bring down the cost a lot more.

What are the IT investments your hospital has made over the years? How do you think ICT is a game changer in the overall hospital operation? Within every two to three years modernization is required. That’s a constant process you don’t do it on specific periods. Annual spent is about Rs 3-4 crores or closer to it. Technology has brought in big change in health sector like in other sectors. Computers and microchips have done real wonders. Things that we would have imagined in terms of diagnosis and treatment is now a reality because of technology. Just a simple thing like measuring blood pressure

of infection if proper maintenance is kept. We ensure quality and cleanliness standards matching top class hospitals in foreign countries. This is a big factor which helps to ensure good quality and proper safety in super specialty hospital.

What are the top five challenges you face in the hospital operation and execution and how do you sail through the challenges? Patients don’t realise what technology can do in their case and they behave reluctantly to pay little high for good technology. Patenting of anything take a lot of time here but otherwise importing is not a big issue now. I really don’t feel anything challenging in implementing technology except bringing awareness to people that cost is

We have operation theatre with laminal floor with pepa fliter ,zero bacteria, pressure dose and we maintain strict A-Septic discipline like top international centers where joint replacement is done like Meo Clinical USA, super specialty health centers in other western countries. We have our own MRI’s CT scanners, our own laboratory to do test within fraction of second. We do laparoscopic surgery and minimal invasive surgery. We specialise in gender specific implant as 80 percent of knee replacement surgery is done for women. This knee will fit to specific size and bone structure for Indian women. Other latest technologies we use are ceramic implants for young patients, metal on plastic implants for older patient. In term of success for last to 20-25 years we are known for our joint replacements in north India.

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Special Feature Cath Lab

Cath Lab

Listens to Your Heart From single â&#x20AC;&#x201C;plane to digital flat panel labs, catheterisation laboratory (cath lab) has gone a long way in serving Indian healthcare better g

By Sharmila Das, ENN

ising incidence of cardiac diseases is driving the cath lab market in India. The Indian market for cath lab is growing steadily as a result of advancements in technology and the resultant increase in demand from hospitals, nursing homes, and other medical centers. There are two types of cath labs available in the market; fixed cath labs and mobile cath labs. Fixed cath labs are installed in a specific area in a medical center and mobile cath labs can be moved from one place to another. Due to the growing healthcare centers, the cath lab mar-

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ket has huge potential for growth and players can benefit tremendously.

Advancements that has happened Today, cath labs provide high resolution, low radiation, and multiple-view systems with facilities for rapid imaging from 6 to 40 frames per second. Cath labs are being used for both diagnostic and therapeutic practices. The arena of cath labs has also broadened with interventional cardiologists and interventional radiologists sharing the same space. And with the volume of minimally invasive procedures expand-

ing, the use of hybrid cath labs/operating room (OR) has picked up, and thus, even cardiac surgeons, electrophysiologists, vascular surgeons, and neuro surgeons are using them. Dr Balbir Singh, MBBS, MD, DM (Cardiology), Chairman - Division of Electrophysiology, Medanta Heart Institute says, â&#x20AC;&#x153;Because of big size population. the occurrence of heart diseases is increasing. Second point is that the average life- span has increased, people are living longer. Third is westernisation of the society. We are tending more towards smoking; we are eating more junks and exercising lessâ&#x20AC;?.

Ashok Kumar, President, Cardiology Society of India shares, “There are lots of factors fueling the need of cath labs like lack of physical activity, diabetes, hypertension etc”. Dr Sanjay Mehrotra, Senior Consultant Cardiologist, Narayana Hrudayalaya Hospital says, “There is need of more patients with heart disease who require treatment and investigations where cath/ angiography are required and therefore there is more cath labs required”. Dr SK Gupta, Senior ConsultantCardiology, Indraprastha Apollo Hospitals says, “The cath lab is an examination room with diagnostic imaging equipment use to support the catheterisation procedure. It offers complete cardiac diagnostic services with critical cardiac intervention when needed”.

Market dynamics With sales of 135 units, the market for cath labs is estimated at `240 crore in 2010. The premium segment which is fixed cath labs continued to dominate the market in 2010, with sales contribution of `191.4 crore and unit-wise sales of 87 numbers. The market for value segment (mobile and fixed) cath labs, with an average selling price at `1 crore remained almost stagnant at 48 units. Philips and Siemens continued to dominate the cath labs market with a combined market share of 74 percent.

The market for interventional cardiology products in India is growing in line with a dramatic rise in cardiovascular disease among increasingly affluent and urbanised Indians with a resulting surge in demand for high quality cardiac care. Established interventional cardiology procedures - diagnostic angiography, PTCA, and coronary stenting - are performed widely in India, across medium-sized and larger hospitals equipped with catheterisation laboratories. More advanced procedures and devices are concentrated at large corporate and private hospitals in key metropolitan cities. Innovative products such as drug-eluting coronary stents, rapid exchange balloon catheters, and novel vascular closure devices are providing new market opportunities. The market is growing with the proliferation of cath labs and physicians using interventional cardiology products. New drug eluting stent designs are expected to assist physicians in treating vulnerable plaque, thus accelerating market acceptance of the products. Key demand drivers include a surge in disease incidence due to affluence and lifestyle changes, resulting increase in demand for diagnosis and treatment, and infrastructure expansion driven partly by a fast-growing cluster of corporate hospitals, among other factors. However, the main constraints to growth re-

main high device and procedure costs, uneven infrastructure and skill levels across hospitals, and a persistent tendency to re-use disposable devices. Advancements in medical technology accompanied by improved patient outcomes have led to an increase in the number of catheter-based therapies performed by clinicians, a trend that is expected to continue with the discovery of novel techniques and superior medical technology. As science continues to guide medical advancement, the design and functionality of the cath lab and interventional vascular suite will likely continue to evolve. However, the potential patient population for coronary stenting has historically been under-penetrated due to the high cost of the devices. Despite a rising incidence of coronary artery disease in the country and lowering prices of the interventional devices, many patients choose to forego a coronary intervention due to a lack of insurance coverage and an inability to privately finance these procedures.

Mobile versus fixed cath lab Most catheterisation laboratories are “single plane” facilities, those that have a single X-ray generator source and an image intensifier. Older cath labs used cine film to record the information obtained, but since 2000, most new facilities are digital. The latest

“After the discovery of flat panel cath lab where the resolution has improved drastically, there are other improvement in combining various features like inclusion of hybrid systems, intravascular ultrasound, CT angiography and more recently combined cath lab and CT machines” Dr Sanjay Mehrotra, Senior Consultant Cardiologist, Narayana Hrudayalaya Hospital

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Special Feature Cath Lab

digital cath labs are biplane (have two X-ray sources) and digital, flat panel labs. Biplane laboratories achieve two separate planes of view with the same injection and thus save time and limit contrast dye, limiting kidney damage in susceptible patients. Dr Gupta says, “About 70 to 90 per cent of labs in India are fixed labs and the rest are mobile. Contribution in terms of quality of fixed cath labs in the total markets is much larger as compared to that of mobile cath labs. Mobile cath labs can easily be wheeled into the sterile environment of the operation theatre that enables the cardiologist to carry procedures peacefully. The biggest advantage of the mobile cath labs is that it avoids the inconvenience of patients travelling to big cities to avail the facilities. That said, fixed cath labs are the preferred choice of bigger hospitals with heavy load of cardiac-related procedure, whereas mobile cath labs need a rest after attending a patient and therefore cannot be used continuously”. Dr Amar Singhal, HOD, Interventional Cardiology, Sri Balaji Action Medical Institute says, “Benefit of fixed

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cath lab is better for bigger hospital because they can take excess load of diagnosing and treating patients while a mobile cath lab has limited usage which can be more beneficial to smaller cities and town” Dr Singh says, “The mobile cath labs have their own advantages and disadvantages. Advantages are that they are cheaper and they require less peripheral like generator to run them. Mobile cath lab doesn’t mean that you can take them from one state to another state. They have to be stationed somewhere to get the maximum benefits. But the picture quality is not good in mobile cath lab. People who use mobile cath lab should understand these boundaries cannot be crossed using mobile cath. We use mobile cath labs in small centers of outside Delhi”. Dr Mehrotra says, “Mobile cath lab may be of use but have not taken up in our country in a big way but there is need of more cath lab systems. Mobile cath labs can be helpful for travel minimisation but they do not provide proper pictures. There is also lack of back-up facility in mobile cath labs. Fixed cath

labs on the other hand are equipped with better equipments and services. It is easier for the doctor and the team to operate at the hospital where the cath lab is situated”.

Technology advancement in the space With coming of newer devices/technology the market for cath lab is set for a giant leap. Dr Singh says, “Everyday we see something new is coming up. Quality of images we use in cath labs got improved. Now there is use of intravascular ultrasound, we can see the heart through ultrasound and then there is optical tomography, which is again another lift. With this you can go into the artery or perform CT scan of the arteries and see what is happening inside and how the development of cholesterol has happened etc. In the field of electrophysiology, there have been a lot of achievements. For example, we could see into arterial fibrillation through doing Dyna CT Scan in the cath lab. So you could do the scan of the heart in the cath lab itself to look

“Mobile cath labs can easily be wheeled into the sterile environment of the operation theatre that enables the cardiologist to carry procedures peacefully. Mobile cath avoids the inconvenience of patients travelling to big cities to avail the facilities” Dr SK Gupta, Senior Consultant- Cardiology, Indraprastha Apollo Hospitals where the impulses originating, how to carried it etc. Then new technology also has come in the pacemaker, defibrillator and device that save human life. So there has been huge development in each area then we have stem cells transplant in the cath lab too”. Dr Gupta says, “This technology has graduated from high resolution to multiple-view rapid-imaging systems. The effect of radiation is much lesser

for both the patient as well as the operator. Today, cath labs are more sophisticated, flat panel and digital”. Dr Mehrotra says, “Over a period of time, resolution of pictures used at the cath labs have improved. The advancement of digitisation has helped in the improvement. Another upgradation is in terms of the compactness of the labs. After the discovery of flat panel cath lab where the

resolution has improved drastically there are other improvement in combining various features like inclusion of hybrid systems, intravascular ultrasound, CT angiography and more recently combined cath lab and CT machines”. Looking at the demand side, it is imperative to conclude that that in the years to come majority of Indian hospitals will think of having cath labs in their infrastructure.

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Special Feature cath lab

Counting

Every Beat Measures Dr Balbir Singh, MBBS, MD, DM (Cardiology), Chairman-Division of Electrophysiology, Medanta Heart Institute speaks about the technology development that has happened in the cardiology segment of Indian healthcare. In conversation with Sharmila Das, ENN

From how long you have been associated with Medanta? I have been associated with Mednata right from the launch of the first cath lab in December 2009. We started the cath lab here on 16th December and I did the first case.

What are the changes you have noticed during this period and what are the developments or new technologies have come in this space?

Dr Balbir Singh

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Every day we see something new is coming up. Image quality has improved a lot in cath lab. Now there is use of intravascular ultrasound, we can see the heart through ultrasound and then there is optical tomography, which is again another lift. With this you can go into the artery or perform

CT scan of the arteries and see what is happening inside and how the development of cholesterol has happened etc. In the field of electrophysiology, there have been a lot of achievements. For example, we could see arterial fibrillation through doing Dyna CT Scan in the cath lab. You could scan heart in the cath lab itself to look where the impulses originating, how to carried it etc. Then new technology also has come in the pacemaker, defibrillator and device that save human life. So there has been huge development in each area then we have stem cell transplant in the cath lab too.

Over the years do you think there is an increasing trend of keeping cath lab in every hospital? The number of cath lab is too few if you compare it with Indian population. You will realise that the number of CT scan and MRI centre is much more than cath labs. In cath lab, doctors do the procedure while CT scan and MRIs are done by technicians and the doctor interprets it. In cath lab the procedure requires skilled doctors and there is not enough trained operators in India at the moment. However, for cath lab the scope is very high and there has been immense growth happened in last five years. I donâ&#x20AC;&#x2122;t think anybody in the world can believe that so many cath labs have come up in India during these years. The number is going to multiply in the years to come. So there is a huge scope, because every human being may have a heart problem and for that we will need a cath lab.

What are the factors responsible for the increasing trend of heart diseases? Because of big size population the occurrence of heart diseases is increasing. Second point is that the average

â&#x20AC;&#x153;

The smaller hospitals that have not invested into cath lab yet is because they have not been able to get the right person. If a small hospital has good facilities and it can offer you ICU or CCU they will definitely have a live cath lab life- span has increased, people are living longer. Third is westernisation of the society. We are tending more towards smoking; we are eating more junks and exercising less.

Do you think mobile cath lab is more beneficial? The mobile cath labs have their own advantages and disadvantages. Advantages are like they are cheaper and they require less peripheral like generator to run them. Mobile cath lab doesnâ&#x20AC;&#x2122;t mean that you can take them from one state to another state. They have to be stationed somewhere to get the maximum benefits. The image quality of mobile cath lab is not good. People using mobile cath lab should understand boundaries and the complicated issues can be referred outside. We use mobile cath labs in small centers of outside Delhi.

Do you think the super specialty hospitals require cath labs more than the single specialty hospital? Why? The smaller hospital which has not invested into cath lab is because they have not been able to get the right person. If a small hospital has good facilities and it can offer you ICU or CCU they will definitely have a live cath lab.

Tell us about the latest equipment you are using in your cath lab? Are all of these imported? Yes all are imported and there is no Indian company manufacturing the

cath lab equipments. The hospital would need to invest `2-3 crore for such products and in India there are three major companies supplying cath lab equipments like Siemens, GE Healthcare and Philips. Certainly the cost will be much less if India and China starts manufacturing cath lab devices.

Tell us about the latest devices you have deployed in your cath lab? Tell us about ILR and the advantages it offers. How costeffective it is? The ILR is implanted on the chest under the skin to monitor heart beat of the patient. We have another device called CareLink. CareLink is an Internet-based system to help physicians and patients better manage chronic cardiovascular disease treated by implantable device therapy, such as pacemakers and implantable cardioverter-defibrillators (ICDs). The service provides an efficient, safe and convenient way for specialty physicians to remotely monitor the condition of their patients. ELR patch is a web based technology we use in our cath lab and it is an endless heart beat recorder. Without any cut it can be pasted on the chest. Patient can take bath without removing it. If the patient gets some symptom then they can press a button on it and his ECG will be recorded and transmitted to the doctor with whom he is linked through the Internet. So doctors can see what actually happens on the website.

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Special Feature Cath Lab

Pediatric Cardiology

Goes Sea Change Dr Shreesha Maiya, Consultant, Pediatric Cardiology, Narayana Hrudayalaya Multispecialty Hospital, Bangalore speaks to Sharmila Das, ENN about the intricacy of handling pediatric cardiology How do you find the role of Pediatric Cardiology in delivering improved patient care? Congenital heart defects are seen in 8 to 10 children out of 1000 live-born children. Most importantly almost all of them can be treated if diagnosed early and majority of them would have a normal life in future. Hence it is important to diagnose children early and refer them to a centre where interventions can be offered when necessary.

What are the changes you have noticed in this domain over the years? Over the last 10-15 years, pediatric cardiology has taken a big leap in India. This is mainly due to the affordability and various schemes organised by the Government and charitable trusts. Hence there has been a major shift towards early referral from the pediatricians, understanding that these children have excellent prognosis. Technology has also advanced over the years .Children who earlier needed open heart surgeries can get interventions with key-hole surgeries that significantly reduces hospital stay. Fetal echocardiography has also made huge impact in the early diagnosis of children. Fetal cardiology has improved scope of early diagnosis and referral and considerably added to better survival.

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Dr Shreesha Maiya

Do you think these changes will improve the healthcare scenario in general and pediatric cardiology in particular? Diagnosis and treatment is the key. With improved education and understanding both in medical fraternity and public, we could change pediatric cardiology scenario in India. Most important factor had always been patient affordability. There are Government schemes in few states like Karnataka, Andhra Pradesh etc which has made significant impact. If this could be extended to other states, then we will see huge reduction in morbidity and mortality rates.

In dealing with high volume of infant mortality rate, do you think improved Pediatric Cardiology can contribute to improve the situation a bit? The causes for infant mortality rate due to congenital heart diseases contribute to a small percentage. But, improvements in pediatric cardiology care definitely lessen the burden of infant mortality. It will also contribute towards reducing the co-morbidity like multiple hospitalisations for pneumonia in patient with congenital heart diseases.

What are the new equipments/ technologies Narayana Hrudalaya has introduced lately in Pediatric Cardiology? On the diagnosis aspect, advances in fetal echocardiography, 3D echocardiography, MRI and high resolution CT have provided tremendous insight into the nature of congenital heart problems. Interventional cardiology with devices and stents has reduced the need for open heart surgeries in many children. State-of-the-art machinery in anesthesia, improved by-pass technologies and use of trans-esophageal echocardiography has reduced the risks of surgeries and interventional procedures and has improved overall patient care. Advent of minimally invasive surgeries has also

“

On the diagnosis aspect, advances in fetal echocardiography, 3D echocardiography, MRI and high resolution CT have provided

tremendous insight

reduced the duration of hospital stay and has improved cosmetic outcome. Newer medications and equipment like ECMO leads to better care in Intensive care units. All of these collectively have made huge impact in reducing morbidity and mortality rates associated with cardiac interventions.

What are the top five challenges of a pediatric cardiologist? How do you deal with them? Early diagnosis: Early diagnosis is the key; educating medical fraternity regarding congenital heart diseases will lead to early referral and appropriate management Delivering good quality affordable care: This is achieved by team work and multi-displinary approach with appropriate use of technologies Patient education and supporting families with congenital heart diseases: Creating empathy with patient /parents and educating them about the nature of problems and interventions should be a collective effort. Keeping up with new advancements and technologies so that the patient would benefit from state-ofthe-art treatment. Reaching out to public and creating awareness regarding congenital heart disease is an ongoing challenge. Appropriate referral systems need to be strengthened so that patient does not get lost in the transit and follow up care.

Narayana Hrudayalaya – Achievements The Bangalore cardiac unit of Narayana Hrudayalaya is one of the world’s largest pediatric heart hospitals. It is the brainchild of the renowned cardiac surgeon, Dr Devi Shetty. Narayana Hrudayalaya also receives patients from outside India. Narayana Hrudayalaya was started in the year 2000 by Dr Devi Shetty under the aegis of the Asian Heart Foundation (AHF). The flagship hospitals of the group are located in the cities of Bengaluru and Kolkata. They are both multi-specialty hospitals which cater to a wide variety of illnesses and diseases. Narayana Hrudayalaya has innovated with the concept of health city which means ‘Onepoint for all Healthcare needs. Narayana Hrudayalaya Health City, Bengaluru, is a conglomeration of hospitals in one campus. Apart from cardiology, the hospital also offers treatments in the area of Neurosurgery, Pediatrics, Neurology, Gastroenterology, General Surgery, Dental, Nephrology, Urology, Transplants, Nuclear Medicine, Medical Imaging and Radiology. It also houses a Blood bank and Laboratory. With the help of ISRO, Narayana Hrudayalaya has pioneered some of the aspects of Telemedicine. Narayana Hrudayalaya Group is one of India’s leading and fastest growing multi-specialty chains in India. With total bed strength of 5,700 beds, it is spread across 13 Indian cities. The Flagship Hospital at NH Health City, Bangalore has India’s largest Bone Marrow Transplant Unit and Dialysis with tertiary care expertise in Liver, Kidney and Heart transplants.

May / 2013 ehealth.eletsonline.com

expert speak

Pediatrics and IT

By Dr Alok Bhatia, Director & Business Head- Northern Region, NationWide Primary Healthcare Services Pvt Ltd

doption of health information technology (HIT) has been advocated by one and all as a major approach to improve patient safety through reduction and prevention of medical errors. Adoption of HIT tools such as Electronic Health Records (EHRs), Computerised Provider Order Entry (CPOE), and Clinical Decision Support (CDS) is increasing, and although current implementation of all these HIT tools is not yet widespread among Indian healthcare providers, although most tertiary care hospitals that provide care for children and infants use some form of an electronic information system to manage personal health information and other data that affect childrenâ&#x20AC;&#x2122;s health. Children and infants have vulnerabilities and needs that are distinct from adults with regard to the management of their clinical care and its associated information. The extended normal ranges of body weights, sizes, and physiologic responses require modifications of clinical, technical, and information workflows to provide pediatric-specific care that is safe. A systematic evidence base for design and implementation of effective HIT that improves care quality and safety is needed but lacking,and recent observations and experience indicate that changes (such as the adoption of information technology) can introduce new and unanticipated errors. The major technical barrier to adoption of pediatric HIT tools is a lack

May / 2013 ehealth.eletsonline.com

of pediatric-specific information technology standards. Among these needs for standards are pediatric data that are machine-readable, terminologies and dictionaries that fully describe pediatric clinical entities (such as pediatric drug-dose data), and electronic standards (Health Level 7 Child Health Functional Profile is currently in development in the US) that adequately describe pediatric clinical events.

Inpatient patient transitions & out patient departments During an inpatient stay, patients

undergo numerous care transitions, including admission (from emergency departments, transport services, and physician offices), discharge (to home or other facilities), and/or transfer to different locations within the institution for tests (imaging), procedures (surgery), and special levels of care (postanesthesia recovery care). The most common transition is the transfer of care responsibilities (handovers, handoffs, or sign-outs). Physicians, nurses, consultants, and ancillary staff members transfer responsibilities in parallel (physician to

physician, nurse to nurse, etc) and, in most cases, asynchronously according to shift and call schedules. It is commonly seen and felt that in almost all the above mentioned situations the IT & its usefulness is beyond doubt changed the inpatient care statistics. Another important milestone achieved has been the availability of these applications on the hand held devices & smart phones and in future will revolutionise the way we look at treating our children both in the hospital as well as in our out patient department.

Electronic Medical Record (EMR) EMRs are a central structure for patient-specific data documentation. Their multiple roles include facilitating communication among providers, standardising medico-legal documentation of care, historical record archiving and retrieval, and coordination of care. They can facilitate centralised clinical communication and documentation among hospitalists, primary care providers in medical homes, consultants, and emergency care providers. They form the basis for medication reconciliation and may support personal health records to inform and empower patients and families about their care. Important technical functions of EMRs include interoperability of data elements, connectivity to other electronic records, and information assurance (according to established standards). Essential in their implementation is effective user training to prevent misuse that may lead to errors. They have a significant contribution in the primary healthcare and family medicine where they form the main stay of medical records. Technical standards and certification criteria for inpatient systems are still in development. The Indian Academy of Paediatrics (IAP), the statutory body at par with AAP, is also equally focused on developing its own

Pediatric-Specific Features Pediatric functions in an EMR have been articulated in an AAP policy statement and include: • Immunisation management (recording data, linking to immunisation systems, decision support); • Growth tracking (graphing and percentile calculation); • Medication dosing (dosing by weight, dose-range checking, safe and convenient dose rounding, age-based decision support, dosing for the school day); • Patient identification (prenatal identifiers, newborn identifiers, name changes, ambiguous gender); • Norms for pediatric data (numeric; nonnumeric; complex normative, such as blood pressures; gestational age); and • Privacy (adolescent, foster/custodial care, consent by proxy, adoption, guardianship, emergency treatment). guidelines and algorithms for Indian subcontinent. Introduction of HIT may significantly improve clinical performance, reduce costs, and reduce workloads; however, every HIT-system implementation will invariably introduce new and sometimes unforeseen errors and challenges.

“The major technical barrier to adoption of pediatric HIT tools is a lack of pediatricspecific information technology standards”

Teaching & training Several modules have made it both easy as well as interesting to impart training and teaching to both undergraduate as well as postgraduate students. Simulation tools have been developed to orient students with uniformity. In situations where training was indeed difficult like the Paediatrics Advanced Life Support (PALS) & Neonatal Advanced Life Support (NALS) courses have seen more and more enthusiasm from the attendees. Availability of articles, journals and e-scripts has only made learning easy and effective. In conclusion, IT is there to stay in our lives.

May / 2013 ehealth.eletsonline.com May / 2013 ehealth.eletsonline.com

expert speak

Retinoblastoma ‑ They Live and See

By Dr Santosh G Honavar - Director – Medical Services, Centre for Sight

etinoblastoma is the most common eye cancer in children. Its incidence is 1 in about 10,000 live births. Over 1500 children develop retinoblastoma in India every year, contributing to a third of the global incidence. When retinoblastoma is managed at primary or secondary levels of eye care without adherence to protocols, the death rate is 30-40 percent. In India, over 60 percent of children undergo treatment at primary or secondary levels. Diagnosis of retinoblastoma is straight-forward and is based on a good clinical examination. Ultrasound B-scan, CT scan and MRI are performed in appropriate cases. Wide-field digital fundus imaging and image analysis immensely helps objectively monitor the regression of the tumor over time. Just about two decades ago, the standard management of retinoblastoma was eye removal or radiotherapy. The current treatment strategy, even for advanced retinoblastoma, is chemoreduction, which is like going back in time – chemoreduction helps shrink the size of the tumor to the maximum possible extent before treating the remaining portion with focal and eye conserving treatment measures such as laser thermotherapy. With this strategy, there is over 95 percent survival, 90 percent eye salvage and 85 percent vision salvage. We have adapted a protocol based on high-dose chemotherapy in combination with periocular chemotherapy for advanced retinoblastoma. This

May / 2013 ehealth.eletsonline.com

“When detected early, complete cure is possible with appropriate treatment. Public awareness campaigns will hopefully help in early diagnosis” multidisciplinary approach results in eye salvage in about 90 percent of patients with an excellent potential for residual vision. Advanced orbital tumors that had a mortality of over 70 percent can now be cured in a majority of patients with the current protocol combining chemoreduction with surgery and radiotherapy.

Superselective chemotherapy where the drug is injected selectively into the blood vessel that supplies the eye, thus achieving maximum drug concentration where it is needed, is rapidly catching up. Nanoparticle drug delivery, local drug delivery into the eye, and gene therapy are on the horizon. Nanoparticle carboplatin drug delivery bypasses the blood circulation and enters the eye directly thus eliminating systemic side effects of chemotherapy. The select centres in India such as the National Retinoblastoma Foundation at the Centre for Sight, Hyderabad has all the facilities at par with the most advanced centres in the rest of the World, and can treat retinoblastoma at less than 5 percent of what it costs in the West, with comparable, if not better outcome. Retinoblastoma gets the attention that it deserves at the National Retinoblastoma Foundation with a dedicated team comprising of a paediatric oncologist, ophthalmic oncopathologist, expert chemotherapy nurse, 24/7 counsellor, and an ocularist for customised prosthesis. Facilities include day care child-friendly chemotherapy facility, plaque brachytherapy, large spot indirect ophthalmoscope delivered transpupillary thermotherapy, sophisticated cryosurgery suite etc. Our time-tested protocols with over 95 percent life salvage, 90 percent eye salvage and 85percent vision salvage and low morbidity in advanced retinoblastoma will be personalised to individual child.

RNI NO. - UPENG/2008/25234

UP/GBD - 71/2012-2014

RNI NO. - UPENG/2008/25234

UP/GBD - 71/2012-2014

Knowledge Exchange Omar Abdullah

Knowledge Exchange

Hon’ble Chief Minister Jammu & Kashmir

Omar Abdullah Hon’ble Chief Minister Jammu & Kashmir

hOsT ParTner

gOvernmenT ParTners

Jammu and Kashmir e-Governance Agency

Organisers

Special focus

Calculating RoI on IT Projects-An Inescapable Reality This article addresses challenges related to IT adoption and provides certain guidelines and analytic framework for carrying out an accurate appraisal of IT investments with relevant examples to make the decision making process simple for Chief Information Officers (CIOs) g By Sanjeev Sood, NABH Empaneled Assessor, Certified Healthcare Quality Management & IT Consultant, Hospital & Health Systems Administrator

ne of the reasons that ICT have not deeply permeated into healthcare is that these are capital intensive and their successful outcome may be difficult to ascertain. Certain organisations who are less IT savvy and are laggards in technology adoption, view IT as a cost overhead rather than as an enabler and differentiator that can transform their operations and overall productivity.

Challenges in technology appraisal and adoption In most situations, financial barriers exceed other challenges like interoperability and lack of qualified staff for IT adoption. Further, the questions of scope, application, integration and timing complicate the decision. In view of the above challenges, any proposal by CIOs on IT projects, such as implementation of EMRs or PACS or transition to digitisation, is met with certain skepticism and a barrage of questions by CFOs and management that needs cost justification, critical valuations, return on investment, discounted cash flows, internal

May / 2013 ehealth.eletsonline.com

Sanjeev Sood

rate of interest and pay-back period etc. Given the complexity of the problem and lack of comprehensive data involved in estimation of IT value, decisions on IT investments are often made on anecdote, inference and opinion at best and hope at worse, putting the poor CIOs on defensive. The economic appraisal of such projects needs systemic analytic approach applying knowledge spanning disciplines of project management, cost accounting and finance, which the CIOs are not so well equipped with. Thus, calculating RoI for CIOs may be an inescapable reality which they have to face in this era of fiscal accountability, though it need not become their Achilles’ heel and dampen their zeal for adoption of IT solutions. Here’s some help for them.

Using the simple paradigm Calculation of RoI of IT Projects should begin with the realisation of the following realitiesIT projects have long gestation period and payback should be looked at only after 3 to 5 years. Most IT applications and solutions yield several intangible benefits such as, improving healthcare quality, efficiency and accessibility, and are difficult to assign any monetary value. Certain benefits of IT adoption such as coordinated and efficient care, extend and span beyond the organisational units due to integrated delivery systems ( Enthoven and Tollen 2005) For example, use of data analytics may provide treatment breakthroughs in cancer by offering personalized medicine –the benefits may extend far beyond the immediate financial gains by the organization. Having understood these realities, a simple question to ask is, does the investment in IT increase, have no effect, or decrease costs to the organization? Table 1 presents a simple paradigm from which decisions can be made. The matrix comprise of 9 cells of cost/ impact combination.

Economic appraisal techniques Cost-benefit analysis - This technique is used to evaluate, systematically, multiple objectives and actions that are not mutually exclusive and is applied, when all aspects of cost and benefit of the selected technology can be assigned a monetary value. The outcome of this analysis is presented in rupee terms that enable decision makers to decide in favor of alternative that has the lowest cost and highest benefit. Today, the IT architects such as cloud computing, virtualiza-

titative and qualitative aspects of healthcare, like measuring the quality of life extended by using tools like QALYs e.g., the extended year spent in leading a healthy life rather than suffering in a hospital .

Steps in economic analysis The key to use any of above economic evaluation technique involves series of 11 stepsDefine problem and identify the objectives, identify alternatives, develop an analytic framework for cost/ benefits, analyse costs, analyse ben-

“Any proposal by CIOs on IT projects is met with certain skepticism and a barrage of questions by CFOs that needs cost justification, critical valuations, return on investment, discounted cash flows, internal rate of interest and pay-back period etc.” tion, mobile technologies and SOA do exactly that, giving maximum value for money. Cost-effectiveness – This technique is used to evaluate multiple ways (usually mutually exclusive alternatives) of reaching a single objective e.g., to buy HMIS off the shelf or develop and customise one’s own .For many health IT applications, it may not be feasible to measure the benefits or outcome in financial terms e.g., loss of life or limb cannot be precisely assessed. Similarly, the benefits of the shortened ALOS may not be possible to assess considering more number of patients that will be treated on the same number of hospital beds in view of the existing shortage of beds in India. In this case, one might estimate the cost associated with extending life for additional year or cost of hospitalisation per day .The decision makers may adopt the technology with lowest cost per life year saved or hospital day reduced of treatment. Cost-utility analysis- Measures interventions effect on both the quan-

efits, differentiate perspective of analysis, perform discounting, deal with uncertainties, ethical issues, discuss results and re-evaluate decisions.

Summing up From the above discussion, it is amply clear that accurate technology appraisal and its value realisation is a complex, data intensive and challenging process that demands diverse skills and time by the CIO. But when armed with above knowledge and the given analytic framework, the CIO is better equipped to put up a strong business case and convincing argument for IT investments .And if supported by a mature and visionary leadership, he can have a smooth sailing in achieving an IT empowered organisation as a benefit, and also empowered patients as a bonus! The author, Gp Capt (Dr) Sanjeev Sood is a Hospital Administrator and NABH empanelled Assessor serving in Chandigarh. He is an accomplished writer and speaker on healthcare matters. Email : doc_ssood@yahoo.com

May / 2013 ehealth.eletsonline.com

Zoom In

We Believe in Public Private Partnership with People By K N Bhagat, Managing Trustee, OTTET

he Government cannot by itself provide all the conveniences without the cooperation of people. While individual effort is crucial, another golden triangle of cooperation and convergence of efforts of industries, Government and R&D institutions with the involvement of its people really forms the countryâ&#x20AC;&#x2122;s development. OTTET Telemedicine Network with the support of Government of Odisha has successfully been implementing telemedicine project

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throughout the state to bridge the gap of demand-supply mismatch, doctorwise, facility-wise in order to give access to healthcare at the doorsteps to the population living in far flung areas of 51000 villages of Odisha. Based on the Public Private Partnership (PPP) model, first of kind in country, in such dimension, with Government of Odisha, at no cost to Government., Doctors, Hospitals and Nursing Homes, OTTET rolled out such a platform in technical collaboration with School of Telemedicine & Biomedical Informatics (The National Resource Center), SGPGI, Lucknow, i.e through involvement of Government partners from design, planning, architecture of network and service model throughout implementation process with strict monitoring guidelines and exploring potential of employment generation among unemployed rural youth, school dropouts, women segment of the society, which is otherwise a model of PPP + P, i.e. Public Private Partnership with its People. This Network is designed to function in a synergistic manner so that it is going to bring all holistic results. Here IT is used as a great enabler, a tool for creation of better information system. As IT itself is not a solution, this also creates a huge employment opportunity for a technology driven quality healthcare services. It has also the potential for creating a mass of semi-skilled, productive; IT based health workers from among unskilled young unproductive

population reducing the burden of the society through providing healthcare services through creating a mix of those with IT skills and those with public health informatics skills who act as ancillary unit of the OTTET Telemedicine Network. When the IT initiatives are working in isolation, OTTET Telemedicine Network not only bridges the gap of demand-supply mismatch doctor-wise and facility-wise but also through deployment of biomedical devices in OPD and IPD, creating PHR for the patients with continued ownership of data for access of public, to their own health information and medical records, while preserving confidentiality of data by adopting all possible security measures. This innovative programme has certain clear messages to convey which can be summed up as: 1. Globalisation of Medicare. 2. De-commercialisation of Medicare. 3. Humanisation of Medical aid. 4. Spiritualisation of Medical Profession. Telemedicine is the only branch of medicine where you can Love All and Serve All, because hospitals cannot serve without physical contact and the only branch of medicine which can serve All - rural, urban, semi-urban, outreach, where ever is through TELEMEDICINE. Much has been done and much is on to be done. OTTET continues its march on!.

Fresh Venture

Every Penny Counts Ravitej Yadalam, Founder, Pennyful.in identifies the demand supply gap in Indian healthcare and thought of coming up with a business model where every penny matters. He shares his roadmap with Sharmila Das.

such a NHO/IHO charge upto `3000 for an annual membership, however our membership is absolutely free, with better tie-ups. It benefits every single party involved in the transaction

Ravitej Yadalam

How does it work?

Was there any demand supply gap that inspired you to think of Medicash? If yes, what was that? Healthcare costs are rising considerably, given the majority of the healthcare is managed by the private sector in India. There are huge costs associated with setting up a healthcare institution in India, especially state of the art facilities; this directly results in the costs of healthcare going up. While the costs are rising, the other major gap in India is the method of financing the healthcare costs. Out of pocket expense is the single largest form of financing (Over 70 percent currently). Health insurance is around five percent and the remaining is state and central Government related financing. Therefore an institution like Medicash can go some way in reducing the burden on the customer, for absolutely no charge, free of costs.

May / 2013 ehealth.eletsonline.com

Medicash allows you to save on your healthcare expenses by either obtaining a cashback on all your healthcare expenditure with our partners or receiving an upfront discount at their facilities. The model differs based on the merchant. The profile of the merchant will clearly state if the nature of the rebate is a cashback or an upfront discount.

â&#x20AC;&#x153;

We also focus on those healthcare treatments/services that are not covered by insurance for instance, cosmetic surgery, dermatology related treatments, laser correction of vision, etc. How do you think Medicash is different from other eCommerce health ventures? Other online ventures usually connect a patient with a hospital or doctor and take a marketing fee which they keep to themselves entirely. Our competitors

Who is your target group? Any customer looking for healthcare services in India, with a focus on those paying out of pocket. In addition to that we also focus on those healthcare treatments/services that are not covered by insurance for instance, cosmetic surgery, dermatology related treatments, laser correction of vision, infertility treatments, dental, diagnostics (both pathology and imaging), pharmacy, spaâ&#x20AC;&#x2122;s etc.

What is the revenue model of Medicash? We market our partnersâ&#x20AC;&#x2122; products and services in exchange for a marketing fee when we refer our members to them. We then share this fee with our member in the form of a cashback rebate. Our members may also get an upfront discount. Membership is 100 percent free.

cover story POLICY

From Primary to

Tertiary Healthcare T C Benjamin, Additional Chief Secretary, Public Health Department, Government of Maharashtra, provides an overview of the IT initiatives that have been undertaken by his department. He also talks about providing better tertiary healthcare to all. In conversation with Nikita Apraj, ENN Today ICT has become an inseparable part of healthcare. What are the ways by which Public Health Department can be benefitted from the usage of latest ICT solutions? Public Health Department is one of the largest departments in the state as far as number of staff is concerned. We have more than 65,000 employees at various levels dealing with delivery of health services across the state. We have three levels of service delivery. At the primary level, we have SubCentres and Primary Health Centres. At the secondary level, we have Rural Hospitals, Sub-district Hospitals, Women Hospitals and District Hospitals. At the tertiary level, we have Super Speciality Hospitals. Since we have a large number of employees, we have adopted e-Governance for effective functioning. We use software for monitoring the posting and transfers of medical staff. Postings and transfers are difficult to track unless we have a system in which we can capture data on real-time basis. We have developed an online system for requesting transfers and paperwork is totally avoided as far as submission of requests for transfers are concerned. Likewise, information regarding avail-

may / 2013 ehealth.eletsonline.com

ability of doctors across all healthcare institutions is readily available online and it is updated every quarter. Other information like availability of staff, Accredited Social Health Activists (ASHAs), medicines and details regarding construction related activities of health institutions being undertaken by the department are also available online. Recently, the department has introduced online software that assists the doctors to evaluate physically challenged persons at the District Hospitals and thereby avoids any human error in the process. The software certifies the extent of disability and issues online certificate or rejection note as appropriate.

What kind of e-Governance initiatives have been undertaken under National Rural Health Mission (NRHM) in Maharashtra? NRHM was launched in 2005 in Maharashtra. The mainstay of the mission is to protect and track health of the mother and the child from conception to the time when child is around five years old. Various milestones are associated with pre-natal and post-natal period and various inputs are required during this period for effective track-

ing. Around 22 lakh deliveries happen in Maharashtra every year. To track this we use Mother and Child Tracking system (MCTS). Through MCTS, our Auxiliary Nurse & Midwives (ANMs) register the pregnant women on MCTS card, which gets computerised on MCTS portal. The unique number on MCTS card becomes the identification number of each pregnant woman for further tracking. We also have created an application for around 59000 ASHAs. ASHA members are not our employees; they are village level activists who are given incentives for various activities such as ANC checks, facilitating deliveries, immunisation and family welfare services. An online ASHA application has been developed for tracking the personal information, training, performance and payment details of all ASHAs in the state. Saving the girl child is one of our most important concerns. The (PreConception and Pre-Natal Diagnostic Techniques (PCPNDT) Act bans pre-natal sex determination. With the use of an online application and associated analytical reports, we are able to monitor the performance of the Ultrasonography Centres and can also record the purpose of sonography tests. We have the data of all the

sonography centres across the state registered with us. Any pregnant lady coming at the centre is required to fill the ‘F’ form. The purpose of performing a sonography test is declared in the ‘F’ form which is now filled online. At present, we have 6041 sonography centres registered in the software and so far 10, 45,675 ‘F’ forms have been filled online.

“We have 6041 sonography centres registered in the online application and so far 1045675 ‘F’ forms have been filled online”

What are the major challenges that the health department faces in its endeavour to reach out to the citizens? Infant Mortality Rate (IMR) for Maharashtra is 25 per 1000, whereas it is 35-40 per 1000 in tribal areas. Similar is the situation for Maternal Mortality. Major challenges before the department are lack of specialised staff and providing service to remote areas, which are not accessible especially in tribal and hill areas. People in these areas rely on local people for treatment. Primary healthcare centres are available in these areas but there is a lack of specialist such as Gynaecologists, Paediatrics, and Anaesthetics. Patients in remote areas need to be transferred to the nearest district hospital and super speciality hospitals in case they need secondary and tertiary care. This delay in providing timely care may cause deaths. Lack of specialists and accessibility to healthcare remain the main challenges in providing better healthcare to all.

What initiatives has the Public Health Department taken to improve its presence in tertiary healthcare? Over the years, the department has been dealing primarily with communicable disease like Dengue, Flu and Cholera to name a few. While we are equipped and adept in managing them, we are not geared up to the desired level to provide tertiary level treatment, especially non-communicable diseases. Today, non-communicable

T C Benjamin

may / 2013 ehealth.eletsonline.com

cover story POLICY

diseases such as cancer, diabetes, etc. are claiming much more lives than communicable diseases. Our involvement in this segment is very minimal. For cancer treatment, we have only Tata Memorial Hospital that provides comprehensive treatment. We hardly have any such facility in Vidarbha, Marathwada or other parts of Maharashtra. That is the reason that we plan to set-up establishments treating non-communicable lifestyle diseases in these regions. There are no facilities to deal with geriatrics problems i.e. problems related to old people. Palliative care means taking care of an old person who may be ill and dying at hospital or at their home. Looking after this population becomes a major concern for the public healthcare system. World Health Organisation too has recognised this as one of the prime

objectives of healthcare delivery system. We have done very little in this area. There are few initiatives started in palliative care in Vidarbha area. We have trained nurses and doctors for handling and dealing with old patients not only through the required medication but also the desired counselling. We are very keen on helping these patients to reduce their suffering while they approach death. I would like to set-up the institute of Palliative care where nurses and doctors can be trained. The need is to sensitize them about this issue. This institution would be set up in Mumbai, most probably at Tata Memorial Hospital. Maharashtra was the first state to roll out Jeevandayee Yojana for BPL patients which was later adopted by the central government. Tell us about it. If a poor person needs tertiary healthcare for ailments related to heart

“We want to set-up establishments treating non-communicable lifestyle diseases”

surgery or a brain surgery, s/he cannot afford it. To support such needy patients, the Government of Maharashtra started Jeevandayee Yojana in 1997 which used to provide `25,000 for surgeries. Now we have successfully implemented Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) in eight districts of the state to improve access of Below Poverty Line citizens to quality medical care for identified specialty services requiring hospitalisation for surgeries and therapies or consultations through an identified network of healthcare providers. The RGJAY provides each beneficiary a cover of `1,50,000 through

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insurance. The scheme provides reimbursement through insurance for 972 surgeries/therapies/procedures along with121 follow-up packages across 30 identified specialised. We pay to the insurance company a premium of `333 per annum per beneficiary family. Through this scheme, we have been able to undertake 47000 surgeries. The scheme has become extremely popular among the beneficiaries and we are planning to roll out the RGJAY in the entire state.

The private hospitals have mushroomed all over the country. What is your view of the contribution that is being made by private hospitals in Maharashtra? In Mumbai there are about 53 private charitable hospitals. On inspecting all of these hospitals we found that many hospitals were not complying with the rule of reserving 20 percent of their beds for the poor patients. Hospitals are also supposed to keep aside two percent of their income in the form of an ‘ Integrated Patients Fund’ which many of them were not adhering to. Few hospitals do not pass on the concessions in fees offered by surgeons to the poor patients. Besides, as per the ‘Charitable Act’ items such as food, bed charges, linen, OPD charges amongst others are not to be billed to the poor patients. However, some hospitals are found to be charging poor patients for these items. On the other hand, we have given hospitals many concessions in the form of land, extra FSI, exemptions in customs duty and income tax. We have offered concessions to the hospitals because they are expected to provide certain free services to the poor people. We appeal the private charitable hospitals to be socially responsible. Another possible recourse is to withdraw some of their concessions, though we have not done it so far.

zoom in

Philips Allura Clarity Cardiovascular Cath Labs Industry-leading image quality at a fraction of the dose

n the dynamic field of minimally invasive therapy, exceptional drive and dedication is required to perform an increasing number of complex procedures. Accurate visualisations and real-time navigation are crucial, whether delicately maneuvering through tortuous vasculature or racing to remove a blood clot. During interventions you can’t afford to make a trade-off between image quality and X-ray dose. But what if you could reduce X-ray dose by 73 percent for neuro-radiology interventions without affecting image quality and your way of working? Now you can with Philips revolutionary new generation of interventional X-ray systems: the Allura Clarity family. Philips’ unique ClarityIQ technology makes this quantum leap in X-ray dose reduction possible. It dra-

With AlluraClarity, the initial clinical trials have shown an average reduction of 50 percent radiation dose without sacrificing image quality in coronary angiography. Studies in other types of applications, such as DSA angiography, have shown even further dose reduction of up to 83 percent

may / 2013 ehealth.eletsonline.com

“We were willing to accept that the image quality would decrease because we thought 73 percent X-ray dose reduction was so significant. But it turned out that image quality actually improved” Dr M Söderman, Stockholm, Sweden (interventional Neuroradiology) matically reduces X-ray dose by 73 percent while delivering equivalent image quality. ClarityIQ technology pushes the boundaries of the As Low as Reasonably Achievable (ALARA) principle to improve interventional medicine. Patient and staff risks from exposure to radiation are radically reduced. Longer and more complex procedures can now be performed more safely. Reduced X-ray dose leads to fewer patient complications from radiation exposure. Decreased scatter radiation reduces long-term health risks for staff. Lower X-ray dose enables longer procedures to treat obese and high-risk patients.

Key advantages • Improves patient safety – dramatically reduces X-ray dose for fewer complications from radiation exposure. • Improves physician and staff safety – decreases scatter radiation, thereby reducing long-term health risks. • Expands treatment options – enables longer procedures to treat obese and high-risk patients more safely. The advancements in technology will not only significantly help improve diagnostic effectiveness, but will also ensure that patients and hospital staff will experience fewer complications from radiation exposure.

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POLICY

Pehel

Birthing a New Hope Dr Jyoti Vajpayee, Global Technical Advisor, Population Services International (PSI) speaks about the significant programmes that they have taken up in reducing maternal mortality rate in the country in collaboration with the Government of India. In conversation with Sharmila Das, ENN

Dr Jyoti Vajpayee

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Starting the journey in the year 2008 in India, what are the milestones you have achieved serving Indian healthcare? Given the high unmet need for family planning (20.5 percent) and maternal mortality (212 per 1,00,000 live births), PSI/India began the project Pehel in mid 2008 with the goal of improving the health status and quality of life of poor and vulnerable women by reducing maternal mortality and morbidity in the states of UP, Rajasthan and Delhi. Pehel aims to build a sustained enabling environment through advocacy, private sector partnerships and social marketing to increase the use of Intrauterine Devices (IUDs) and improve access to safe Medication Abortion (MA) among married women in the reproductive age group of 15-49 years, living in urban and peri-urban areas, belonging to middle to lower income categories and non-users of modern Family Planning (FP) methods. An IUD provides the advantage of an effective, convenient and affordable method with minimal side-effects and is an ideal long term contraceptive choice for women who wish to limit or space childbirths. Despite these advantages, it continues to have low acceptability and remains an unpopular method among women who intend to use long acting contraceptives This is chiefly attributable to lack of access to quality IUD services and accurate information, myths and misconceptions prevalent in the community, and provider bias against their use. The current IUD use according to NFHS-3 is 1.8 percent and has remained low for over a decade.

How Pehel was born? Do you have any form of collaboration with Government of India? India has a fertility rate of 2.6 (2008, down from 3.0 in 2003) and less than half (48.5 percent) of currently married women use any modern form of contraception. Data from NFHS-3 further shows that 21 percent of all preg-

nancies (about 5.6 million) in India were unintended, with some variations across the project sites (Uttar Pradesh 35 percent, Rajasthan 18 percent and Delhi 12 percent). The contraceptive prevalence rate (CPR) for modern methods among all women of reproductive age (WRA) in urban areas of WHP project is 34 percent in UP, 59.1 percent in Rajasthan and 54.2 percent in Delhi, respectively. Additionally, the project areas have very high Maternal Mortality Ratio (MMR) of 345 in UP , 337 in Rajasthan and 127 in Delhi . Repeated unwanted pregnancies, which are often poorly spaced are known to be, associated with high maternal mortality and morbidity. Estimates show that 6.7 million induced abortions take place annually in India and about half of these (around 3.5 million) are unsafe – performed in unhygienic conditions by untrained providers . Complications from unsafe abortion are one of the leading causes of maternal death in India. As part of the response to maternal health challenges, the PSI India started a Women’s Health Project (WHP) called as “Pehel” meaning initiative, with the goal to reduce unintended pregnancies and maternal mortality among low income women of reproductive age. The programme was started in 2008 to build a sustained enabling environment through

With its channelised efforts, PSI/India has successfully increased 1) Use of IUDs from 3.2 percent to 5.7 percent in the project districts 2) Awareness of IUD among Women of Reproductive Age (WRA), from 67 percent to 94.5 percent 3) Proportion of women who have correct knowledge about freedom5- IUD has increased from 33.9 percent to 65.1 percent

advocacy efforts, harnessing the power of private sector and using social marketing to increase the use of long acting contraceptive IUDs. PSI/India support the Government of India’s efforts to reduce MMR and increase CPR. In phase three, PSI/ India will expand the programme intervention sites from 20 to 30 districts and will contribute to increasing CPR in the 30 project districts to 59.6 percent and increasing the percentage of WRA using intrauterine devices (IUDs) to 6.9 percent by 2015. PSI/ India will also support the Ministry of Health and Family Welfare (MOHFW) and the private sector to increase access to safe abortion services through medication abortion (MA) kits.

What are the initiatives taken by Pehel to reduce the Maternal Mortality Rate (MMR)? Preventing unintended pregnancies and unsafe abortions can significantly contribute to decrease in MMR. The goal of the Women’s Health Project (WHP) or Pehel is to reduce unintended pregnancies, maternal mortality and morbidity among low income women of reproductive age. Project components: To create an enabling environment for increasing access to Intrauterine Devices (IUDs) and safe abortions through Medical Abortion (MA) in the private sector by creating a network of private providers. To improve the quality of care for IUD and MA services provided in the private sector network by constant supervision and monitoring through medical services and training team. Facilitating site registration of private clinics for providing safe abortion services as per the MTP act. To address providers’ biases and motivate them to recommend IUD through various advocacy efforts and Behavior Change Communication activities.

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POLICY

Pehel aims to generate demand among women of reproductive age for long-acting contraceptive methods through mass media, mid-media and Inter Personal Communicator (IPC) activities. We also strive to undertake strategic research studies that help in improving the quality and efficiency of the programme intervention.

What are the healthcare services you have initiated through Pehel and in which states the services are available? “Pehel” programme is currently running in three states of India.Uttar Pradesh- Agra, Kanpur, Lucknow, Varanasi, Bareilly, Gorakhpur, Barabanki, Mirzapur, Firozabad, Ghaziabad, Aligarh, Mathura, Allahabad, Bulandshahar, Saharanpur. Rajasthan- Sriganganagar, Jaipur, Alwar, Jodhpur, Ajmer, Pali, Kota, Tonk, Bharatpur, Bhilwara, Hanumangarh, Bikaner, Sawai Madhopur, Udaipur, Delhi Healthcare services under Pehel programme are: Increase the use of long acting contraceptive IUD and ensuring quality of service delivery through private network providers, increasing access to safe abortion services through Medical Abortion.

Is there any difference of percentage of MMR in rural India in comparison to Indian cities? If so why and how you are facing the issue? MMR measures number of women aged 15-49 years dying due to maternal causes per 1, 00,000 live births. Current MMR of India is 212 per 100,000 childbirth (SRS). The risk of maternal deaths is not uniformly spread across the country. Despite a declining MMR, huge disparities persist between different states, and between districts in the same state, rural or urban areas. The most common causes of maternal mortality are Haemorrhage, Eclampsia, Sepsis, Unsafe abortions etc. Three delays- delay in decision making, delay

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Rugged terrain, unpaved roads, lack of transport at the critical hour, poor communications, and poor health infrastructure are also some of the key barriers between pregnant women in remote villages in India and good quality healthcare in transport and delay in getting treatment at facility level are the reasons attributed to this. This disparity is due to differential levels of socioeconomic development. The glaring differences are reflected in access to skilled birth attendance, emergency obstetric care, and overall status of women, marked by levels of various factors such as female literacy, maternal health, and anaemia. The knowledge barrier among community is not the only concern. Rugged terrain, unpaved roads, lack of transport at the critical hour, poor communications, and poor health infrastructure are also some of the key barriers between pregnant women in remote villages in India and good quality healthcare. While conducting verbal autopsies of maternal deaths, the most common problem is lack of awareness of danger signs among rural families and lack of vehicles to take them to the health centres in time.

NRHM, the key steps being taken by the Government of India to reduce MMR & IMR in the country are: Promotion of institutional deliveries through JananiSurakshaYojana (JSY) offers cash incentives to health workers and families to encourage poor, pregnant women to have institutional deliveries. Capacity building of healthcare providers in basic and comprehensive obstetric care, Integrated Management of Neo-natal and Childhood Illness (IMINCI) and NavjaatShishuSurakshtaKaryakaram (NSSK) etc. Operationalisation of subcenters, Primary Health Centers, Community Health Centers and District Hospitals for providing 24x7 basic and comprehensive obstetric care and child care services. Strengthening of facility based newborn care by setting up Newborn Care Corners (NBCC) in all health facilities where deliveries take place to provide essential newborn care at birth; and Special New Born Care Units (SNCUs) at District Hospitals and New Born Stabilisation Units (NBSUs) at First Referral Units for the care of sick newborn. Name Based web enabled tracking of pregnant women and children has been introduced to ensure antenatal, intra-natal and postnatal care to pregnant women and care to newborns, infants and children etc. All these are good interventions but without monitoring, supervision, and strict quality control, there will be little effect on the country’s MMR and infant mortality ratio. This is how Government is taking up the issue. Further under PSI’s programme “Pehel” program mentioned above is offering services in three states (selected districts) with private sector providers.

How are we facing the issue?

What are the future healthcare projects you are planning to launch?

At the policy level, maternal and child survival are the top two priorities of the Federal Government’s National Rural Health Mission (NRHM), launched with much fanfare in 2005. Under the

PSI has a network of qualified private providers mostly gynecologists and there is a strong opportunity of integrating the other public health problem projects eg. Cervical Cancer.

event report

Enabling Healthcare

Entrepreneurship, February 15th, 2013

ith the objective of providing gamut of incubation help, the Enabling Healthcare Entrepreneurship conference was organised by TiE Delhi-NCR at Indian Habitat Centre, New Delhi on February 15th, 2013. The event has witnessed the launch of HealthStart Pvt Ltd, an angel organisation focusing to help high potential healthcare and wellness start-ups seeking seed stage investments to make their vision a reality. HealthStart promises to enable successful healthcare entrepreneurship in the country. HealthStart promoters are distinguished names from the world of healthcare, various industries, entrepreneurs and senior executives, venture capital and private equity with proven track record and other relevant fields. Pradeep K Jaisingh, Founding Chairman-HealthStart, Vivek Jetley, Raj Airey, Anil P Gupta, Suhail Chander are the Founding Partners of HealthStart in India. The conference saw eminent speakers from the healthcare industry with names like Ajay Kumar Vij: Co-Founder & CEO, Asian Health Care Fund, ex-CEO Dabur Pharma, Sunil Baijal, MD, Futures First, Sameer Maheshwari : Founder HealthKartIndia’s Premier e-Healthcare store and many more. The seminar was able to evoke thoughts on Healthcare Entrepreneurship - Opportunities & Challenges in India Healthcare Sys-

tem, Encouraging Frugal Innovation & Entrepreneurship: Finding the Jugaad for the India Healthcare system. The event has also showcased successful healthcare business models. Pradeep K Jaisingh, Founding Chairman, HealthStart stated “Within a span of last few years the healthcare sector in India has undergone a paradigm shift and has become highly visible in the last few years. India’s economic growth and rapid urbanisation is bringing with it an expected health transition in terms of shifting demographics, increasing ability to afford quality healthcare and demand for quality healthcare services with easy access. At the same time India has the most inequitable healthcare scenario where good quality affordable medical

treatment is not available to most of its population. This in turn provides incomparable opportunity to make a direct positive impact on people’s lives and also simultaneously presents an incredibly attractive business opportunity to people with ideas and a vision”. “We believe that although there are a lot of entrepreneurs who are interested in the segment and want to start a company, but there is not sufficient support structure to enable and turn their business into a successful business” This he explained was the idea behind HealthStart. Its objective is to help build an eco-system that can enable strong entrepreneurial system in healthcare and make a direct positive impact on people’s lives in India”

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policy

India’s First Public Health University in Odisha Pradipta Kumar Mohapatra, IAS, Principal Secretary, Department of Health and Family Welfare, Government of Odisha speaks to Kartik Sharma, ENN about the first Public Health University in Odisha ward poor people like tribal,scheduled caste and other backward classes live. This makes it very important for us to come up with a university dedicated to public health.

What will be the target area of this university?

Government has planned to establish India’s first public health university in Odisha. What will be the significance of this university? We are going to establish the first public health university of India. This project will be implemented in collaboration with Prof Pinaki Panigrahi of AIPH. He works with the University of Nebraska Medical Center. The state Government has allotted 50 acres of land for the proposed university at Gramdiha. The initiative will definitely help us in working with the public health issues. Health is the most important area of concern for us in the state. Although we are taking many steps in public health through medical colleges but that does not suffice. This university is very important because in Odisha we have 16 high focused districts where poor and back-

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We have just signed the MoU for this university, which is also the first in Odisha to be established through the direct support of a foreign university – University of Nebraska Medical Centre, College of Public Health, USA. The MoU was signed between me and Prof Pinaki Panigrahi of AIPH. Now they will be submitting a University bill, which our State Government will try to get passed in the state assembly. We are targeting to get the university bill passed in the monsoon session of the state assembly.

How will this university help in curbing public health issues? It will be of tremendous help to the public. Today, we have a lot of public health issues spread across Odisha. Diarrhea, malaria and dengue are some of the bigger public health issues in Odisha. Once this University comes up, we will also be going to have a public health cadre. Right now everybody is on the clinical side. We need to have the specialist doctors in the public health area. We need to train the doctors who have their inclination towards public health. Soon we will have a cadre of health person-

nel and the university will give us the research inputs, we will also produce public health personnel by training the doctors and other related people in the university. In this way the public health issues will be tackled very effectively and that is our objective. From the onset of this university the big focus will be on preparing public health specialist doctors.

What are the benefits that the University will offer to the common people of Odisha? There will be a lot of benefits to the people. The entire university will be setup by the doctors from the US, which will ensure the quality of services at the global level. However right now we can’t predict much about the impacts of the university. We have initiated from our side by giving them the land, now its upto them to execute the process successfully.

By when the university will be completely functional? Our aim is to start the university by 2016. Everything has happened in last four five months only. We are looking forward with a positive outlook. Public Health University has nothing to do with Medical Council of India (MCI) and the related agencies. It is not a medical college or related institute. There will be courses and classes on public health and related issues. Mainly it will focus on training our public personnel.

POLICY

‘Odisha Should Focus

on Affordable Optimal Healthcare Services’

Dr Ashok Kumar Mahapatra is Director of newly established All India Institute of Medical Science (AIIMS), Bhubaneswar. In an interview with Mohd Ujaley he says that an affordable healthcare service is the need of the day for Odisha

When you were appointed as the Director of AIIMS, you said that your aim was to make AIIMS, Bhubaneswar a world class institution and take it to the level of AIIMS, Delhi. How successful have you been so far? I spent 37 years in AIIMS, Delhi and also served as a director of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. The aim of coming from Delhi to Bhubaneswar is to create a center of excellence, a small nucleus in Odisha which is practically one of the middle order states in India; it is neither in the lowest strata nor in the highest strata like Gujarat, Kerala, Maharashtra, etc. Here, the people are simple, per capita income is low so affordable optimal healthcare services is highly required. And as you know that many States in India, including Odisha have not created any Government medical colleges in the last 50 years. I joined my MBBS in 1970 in Berhampur Medical College that is the last medical college Government of India created in 1962. I think, health has not prioritised as it should have been.Health being state subject, state Government is equally responsible as the federal Government for this apathy.

According to UNICEF, 40 percent of all the children under three years old are underweight

productive adults then you have to look after them since the pediatric age. If a child is malnourished, he cannot be educated well because his performance will be bad. So you are absolutely right, this is a big challenge for the healthcare people and the administrator to see that our children are fed very well with balanced diet.

and 61 percent of adolescent girls are anemic. Don’t you think these are bigger challenges related to nutrition, medical care and education in Odisha? You are absolutely right, India has about 400 million children and amongst the children, probably 50 percent of malnourished children of the world will be in India.It’s not that children are malnourished only in Odisha, your figure might be absolutely right, but even in Gujarat which is an affluent state faces same problem. When the same question was asked to Chief Minister, he said people are dieting. We cannot cover up our crime by giving answers like that. We have to really know the reason why the children are malnourished. It’s an international concern, because if we want to have intellectual, highly educated and highly

Government at the center and state, both are running various welfare schemes to eradicate poverty but they seem to have little or no impact on the life of people at grass root level, why it is so? All over India, the public distribution system (PDS) has nearly not worked out. It’s not necessary that rice sold in Rupee One or two will benefit the public unless it reaches the intended beneficiaries. Many of the Central Government and State Government policies all over India do not work out because the policies are made only in the parliament and the assemblies across the country, when it comes to grassroots level people don’t get the benefit as in some cases they don’t incorporate adequately the regional aspiration or diversity. For example, in 1952, we started our Family Planning Programme, we are the first country in the world to have family planning programme but that was not given the

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POLICY

adequate dividend, We also had malaria control programme, tuberculosis control prpgramme, about 12 million people suffer from tuberculosis in India every year and half a million die. There is nothing wrong in planning, we are absolutely a master planner, we plan very well and spend money but when at the ground level somewhere down the line the people who are involved with implementation, they default. So if you give one rupee rice or even distribute it for free, it may not reach the people. The sad story is that in our country about 20-30 percent food grains are eaten up by the rats or get rotten in the godown, yet it’s ironical

areas. What is the best way of overcoming this challenge? I think it is a real challenge all over India. To take the doctors to the village is not only difficult, it’s totally impossible. With the materialistic life we lead during the MBBS course and when you have to give up this life to go to a village where there is no electricity, no water, and there is no proper road, you will think that you are going from some heaven to hell. It is not only true for the Government doctors alone; same applies to the engineers, lecturers and IAS officers. When you see a doctor who completes his MBBS at the age of 23-24 he is at par with engineer, IAS officer and a lecturer. They

“We have to know the reason why the children are malnourished. If a child is malnourished, he cannot be educated well because his performance will be bad” that people don’t get food. So it is something, where our policy makers, administrators and parliamentarian need to think. As you know Food Safety Bill has not yet been passed by the Parliament. Even if it is passed by the Parliament, what is the guarantee that the poorest of poor in the small tribal areas will get the food? So there is lot more to think and do and I, as a human being, get demoralised, when I see people are dying of malnutrition, children are malnourished, especially because I look after the pediatric age group in Neurosurgery. I sometimes operate upon a two kilograms child and face the challenge of saving a small baby of two kilograms with brain tumour. So for me, a healthy baby is always a welcome step for the country.

You have come from Delhi to Bhubaneswar to serve in tier-II city but young doctors are reluctant to serve in rural

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all get promotion in their career but an MBBS doctor will join as an MBBS and retire as an MBBS. He will not get any promotion over the 30 years time. At times, public may blame doctors for various shortcomings but they do not understand in the circumstance our doctors serve. You cannot have a bank or ATM at a place where there is no electricity but you do have a Primary Health Care (PHC), that’s why across the country about 30 percent of the doctor posts in PHCs are vacant. Our ambitious plan such as National Rural Health Mission (NRHM) will have lots of doctors in village but they have not created any infrastructure where the doctor can stay or their children can get education. Suppose, I am a doctor and posted at a PHC for the next 10 years, where do my children go for studies? So posting is a bigger issue. If you have a teacher who is underpaid, a policeman who is underpaid, a doctor who is underpaid, an under-

paid person will always be craving for more money to meet his daily needs. So he cannot deliver the goals in a depressed and agonistic state of mind. There are more needs and no money. If you are giving a doctor Rs. 12,000 rupees in NRHM, you have done the greatest injustice to humanity rather than to the doctor, because no doctor will work in such circumstances. So the best way forward are to create conducive environment and at least put in place minimum infrastructure.

Odisha has the second largest population of tribal in India; they are the one who is least served. How we can reach them with better healthcare services? May be half of Odisha’s population is tribal, but we have got 8 or 10 states in India with tribal population. The tribal population across India has the lowest occupational status and also less education and high infant mortality rate. So it is a challenge not only in Odisha but all over India. And I am sure the doctors who are educated in city will never go to the tribal areas to see their shortcomings. So it is a challenge socially, financially and from healthcare point of view. But if you have to really take the medicine to the grassroots level where the doctors are not willing to go, then we have to manage the healthcare services by paramedical people like pharmacists, technicians and nurses, because their ambition and a doctor’s ambition is totally different. In such a scenario, ehealth or telemedicine has good role to play. We can have a programme like tribal telemedicine, where we can trainsome people in telemedicine and post them in tribal areas with the video conferencing system. The patient comes to him, he interacts with the patient and communicates with us and accordingly deal with patient.A good telemedicine strategy through consultation can serve the community exponentially.

news

EU Introduces a Black symbol to Identify Medicines Undergoing Additional Monitoring An inverted triangle will shortly appear on the inside leaflet of certain medicinal products on the EU market, following a legal act adopted by the European Commission.

The symbol will allow patients and health care professionals to easily identify medicinal products that are undergoing additional monitoring, and its accompanying text will encourage them to report unex-

pected adverse reactions through national reporting systems. From September 2013, the symbol will be used to identify these pharmaceutical products that are subject to additional monitoring.

Cipla Launches ETACEPT for Rheumatic Mumbai’s Jaslok Disorders Hospital opts for one of India’s leading generic pharmaceutical comNapier EHR Solution Cipla, panies announces the launch of the first biosimilar of Jaslok Hospital has selected the Napier HER management suite of products for its end-toend hospital management needs. The fully mobile-enabled solution is Napier’s next-generation platform that helps deliver the vision of a Digital Hospital. The Napier EHR is an open-source based platform; when fully deployed in the course of the next few months, it will be used by over 1,100 users from the hospital.

Finally, a Way to Measure pain

Pain can be objectively measured in patients for the first time ever by examining scans of their brains, according to scientists at the University of Colorado Boulder. Researchers say the findings could lead to the development of reliable methods to measure pain, allowing doctors to objectively understand the amount of pain a patient is suffering instead of relying solely on their description. The study, which was published in the New England Journal of Medicine, could also lead to new clues about how the brain generates different types of pain, as well help generate methods to objectively measure anxiety, depression, anger and other emotional stress.

Etanercept in India; under the brand name ‘ETACEPT’ for the treatment of rheumatic disorders. Formed through a partnership alliance, ETACEPT is manufactured by a China-based company Shanghai CP Guojian Pharmaceutical Co. Ltd., which will be marketed by Cipla in India.

Online Mapping System Helps Fight Malaria The first online mapping tool to track insecticide resistance in mosquitoes that cause malaria was launched today. The interactive website, called IR Mapper.com, identifies locations in more than 50 malaria-endemic countries where mosquitoes have developed resistance to the insecticides used in bed nets and indoor residual sprays. IR Mapper incorporates the just-released World Health Organisation (WHO) revised criteria for reporting insecticide resistance which is designed to detect it earlier. With the most comprehensive and up-to-date information, the IR Mapper helps direct which vector control tools should be deployed in areas of high resistance.

Robot Therapy to Reduce Pain and Anxiety Pet therapy can help patients cope with the pain, stress, and emotional effects of a serious illness, but access to a companion animal is not always possible. Robotic animals may offer the same benefits, as explored in a fascinating study presented in Cyberpsychology, Behavior, and Social Networking, a peerreviewed journal from Mary Ann Liebert, Inc., publishers. Sandra Okita, PhD, Columbia University (New York, NY) evaluated the effectiveness of robotic companions to reduce feelings of pain and emotional anxiety among pediatric patients and their parents.

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news

Schiller India Launches MAGLIFE Serenity Schiller India, a leading Swiss Joint Venture Company in the field of Medical Diagnostics, has launched anew MRI compatible monitor called MAGLIFE Serenity.The MAGLIFE Serenity guarantees highest ECG quality during magnetic resonance imaging (MRI) scanning – even under strongest gradient influence. It monitors all vital parameters during anesthesia in an MRI environment and is specifically designed for adults, children and neonates. According to Hormazd Cooper, Vice President, Sales, “Schiller’s MAGLIFE Serenity has already clocked up major sales in Europe with its capability of being used with MRI scanners upto 3.0 Tesla.”-

Tool created to Help Kidney Patients Decide on Transplant

Johns Hopkins scientists have created a free, Web-based tool to help patients decide whether it’s best to accept an immediately available, but less-than-ideal deceased donor kidney for transplant, or wait for a healthier one in the future. Historically, the researchers say, it has been difficult, if not impossible, to accurately quantify the risk of accepting a deceased-donor kidney that may have been infected by hepatitis C, as compared to waiting what could be months or years for a better organ. There is a 5 to 15 percent chance of dying every year on the waiting list. Often, organs that may have been at risk of infection are thrown away and never transplanted.

First H7N9 Avian Influenza Vaccine Developed Scientists at vaccine manufacturer Greffex say they have created the first comprehensive vaccine for H7N9 avian influenza, one month after the virus was characterised. H7N9 avian influenza has infected 126 people in China and killed 24 over the past month. The virus is transmitted by birds and can spread quickly as infected birds show no symptoms. Keiji Fukuda Assistant Director-General for health security at the WHO characterized H7N9 as an “unusually dangerous virus for humans.” Greffex Chief Scientific Officer, Dr Uwe Staerz said, “Speed, as well as flexibility, is needed for vaccine design to combat emerged infectious threats.”

A new Sub Type of Bowel Cancer Found A new sub-type of bowel cancer has been discovered that is resistant to some targeted treatment and that is believed to have a worse outcome than other types of colon cancer, say scientists. This latest research was published in Nature Medicine jour-

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nal and is the work of scientists from the Cancer Research UK Cambridge Institute and the Netherlands. Scientists say more research is needed into this new harder-to-treat bowel cancer sub-type, as well as the development of new specific treatments to target it.

Algorithms Find Genetic Cancer Networks

Researchers at Washington University in St., Louis, using powerful algorithms developed by computer scientists at Brown University, have assembled the most complete genetic profile yet of acute myeloid leukemia, an aggressive form of blood cancer. Findings are reported in the New England Journal of Medicine. Researchers from Washington University in St. Louis used two algorithms developed at Brown to assemble the most complete genetic profile yet of acute myeloid leukemia.

Risk Posed by Lung Nodules Identified by New Software A multidisciplinary team of researchers at Mayo Clinic has developed a new software tool to noninvasively characterize pulmonary adenocarcinoma, a common type of cancerous nodule in the lungs. Results from a pilot study of the computer-aided nodule assessment and risk yield (CANARY) are published in the Journal of Thoracic Oncology.

Cadila Pharma to Build Plant at Astrakhan

Eyeing a presence in the lucrative and growing Russian market, Ahmedabadbased Cadila Pharmaceuticals is looking at investing up to $150 million to build a pharmaceutical manufacturing plant in the Astrakhan Region. Cadila Managing Director Rajiv Modi visited the Russian region and signed a protocol with Astrakhan representative Konstantin Markelov. Modi was part of a delegation from the Indian state of Gujarat, which has a cooperation agreement with Astrakhan.

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