India’s Tryst to Fill Gaps of Skilled Medical Professionals- eHealth Magazine September 2019 Issue

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SEPTEMBER 2019 | VOLUME 14 | ISSUE 08

COVER STORY

INDIA’S TRYST TO FILL GAPS OF SKILLED MEDICAL PROFESSIONALS POLICYMAKERS PERSPECTIVE

Dr Vinod K Paul

Member NITI Aayog, Government of India

EXPERT’S OPINION

Dr KM Cherian Chairman & CEO, Frontier Lifeline Hospital

TECHNOLOGY PERSPECTIVE 18 Sterrad Sterility Guide: 5 Reasons Medical

Centre Should Use Sterrad for Sterilisation 20 EMR - Implementation and Adoption Barriers

INDUSTRY PERSPECTIVE

Sameer Mehta

Vice Chairman Mehta’s Multispeciality Hospital

Raj Shekher Janapareddy Director, Bloom Hospitals

CONFERENCE REPORT

Editorial Skilled Workforce — The Bedrock of Robust Healthcare Today the Indian healthcare industry is on the cusp of transformation with modern-day digital technology, latest innovative practices and mobile applications are ruling the roost. These tools are proving to be instrumental in providing enriched healthcare experience to people at large in every nook and corner of the country. Despite immense importance of above mentioned determinants in delivery of healthcare services, one can easily gauge the role of skilled medical professionals to orchestrate the end result in terms of clinical excellence. They are effectively at top of the pyramid of the healthcare delivery mechanism, responsible for accessible and affordable medical care synchronising all these aspects together. But depressing part of the story--India is at the crossroad and grappling with the workforce challenge. Our cover story ‘India’s Tryst to Fill Gaps of Skilled Medical Professionals’ is highlighting various contour of the issue. India has skewed ratio of medical professionals and lacks on both, number and skill. The story encapsulates existing situation of the country in terms of shortage of doctors, nurses, technicians and other professionals who play a vital role in patient care delivery in urban as well as rural areas. A series of steps undertaken by the Government to improve the situation including opening of new medical colleges to train more number of professionals, strategy to provide training to mid-level practitioners, overhauling medical education, speak volume about its intent to ramp up the number of skilled professionals. The Magazine also carries an article of Dr Vinod K Paul, Member, NITI Aayog, Government of India who sheds light on various steps undertaken by the Centre to refine delivery of care system. We also have expert’s opinion by Dr KM Cherian, Chairman & CEO, Frontier Lifeline Hospital, who talks about heart issues and simple remedies. The latest issue also carries insightful interviews of Sameer Mehta, Vice Chairman, Dr Mehta’s Multispeciality Hospital and Raj Shekher Janapareddy, Director, Bloom Hospitals, who talk at length about their contributions to bolster patient care. The magazine also carries a conference report on the Healthcare Summit Jharkhand, comprising outcomes in terms of expert’s inputs to tackle the existing challenges of India’s healthcare delivery mechanism. With such a bouquet of special features, articles, and interviews, I hope the latest issue of the magazine will evoke an invaluable feedback of our esteemed readers.

Dr Ravi Gupta Editor-in-Chief eHEALTH Magazine and Founder Publisher & CEO Elets Technomedia Pvt. Ltd. ravi.gupta@elets.in

COVER STORY

India’s Tryst to Fill Gaps of Skilled Medical Professionals There is a shortage of approximately over six lakh doctors and two million nurses in India. This brings to the fore the glaring fact that Indian healthcare system is facing big challenge on front of skilled medical professionals who play a vital role in enabling masses to avail accessible and affordable medical facilities to their doorsteps. Mukul Kumar Mishra of Elets News Network (ENN) explores various facets of the health workforce and steps undertaken by the Government to bridge the skewed ratio in the distribution of doctors, nurses and technicians working in the urban and rural areas.

ndian healthcare is evolving in unprecedented rate with digital technology, modern-day applications and innovative practices are driving delivery of healthcare services as never before. Though the technology as an enabler have proven its worth, it alone can’t execute things as skilled medical professionals are the one who leverage the modern-day tools to bridge the multifarious gaps pertaining to patient care. On the scale of importance, skilled workforce is being placed at top of the pyramid of healthcare delivery system. But sad part is India doesn’t have enough expert doctors, nurses and technicians to sustain the dream to create an accessible, affordable and quality healthcare model to enable every strata of society to avail better medical care in India. ‘India has a little over one million modern medicine doctors to treat its 1.3 billion people. As per the data from National health profile 2017 we have

SEPTEMBER 2019

one government allopathic doctor for every 10,189 people, one govt hospital bed for every 2,046 people and one State hospital for every 90,343 people. In these kinds of situation one can easily predict the collapse of the healthcare system when patients are sharing beds and doctors are over worked,” believes Praveshh Gaur, Founder and Director, Srauta Wellness. Meena Ganesh, Co-Founder, MD & CEO, Portea Medical says, “The Indian healthcare sector is facing crisis of qualified healthcare professionals, and the situation is worse in the rural areas. Although recent statistics indicate that there is an improvement in the doctor-to-patient ratio or the skilled-healthcare-workers ratio to population, there is still lack of access to timely healthcare. This is one of the major factors hampering the critical goal of providing universal healthcare to everyone irrespective of where they are.” Taking cognisance of the glaring

issue engulfing the Indian healthcare sector, the government is toying with all possible options to improve the skewed ratio of human resources including doctor patient ratio. Dr Vinod K Paul, Member, NITI Aayog, Government of India has reiterated the importance of human resources adding that India lacks on experts in primary to tertiary care. “The most difficult journey that we face today is about having the right mix, the right numbers, right quality, right skills and the right distribution of human resources in the healthcare sector,” Paul said recently delivering speech at Ficci Heal 2019. GAPS BETWEEN URBAN AND RURAL CARE As urban people have become more health conscious nowadays, they want best quality care from private healthcare providers in order to experience enhanced personalised care. A section of people in metro cities can afford

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quality care from top private hospitals which make them available immediate medical help for their patients suffering with deadly non-communicable diseases including heart issues, cancer, and stoke. This becomes possible as doctors and nurses are easily available

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in urban areas and people can afford costly facilities. Unfortunately, this is not the case in tier three and four cities, and in rural areas which are grappling with shortage of health workforce. Primary health centres are devoid of doctors

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COVER STORY

CHWS ARE PROVIDING HEALTHCARE SERVICES IN ETHIOPIA, RWANDA, BANGLADESH, AND THAILAND. THEY ARE CALLED “HEALTH EXTENSION WORKERS” IN ETHIOPIA AND SWASTHYA SEBIKAS & SWASTHYA KORMIS IN BANGLADESH. NURSE PRACTITIONERS ARE A WELL-DEFINED CATEGORY IN THE US, NEW ZEALAND AND AUSTRALIA.

and other required medical staff. “India has a world class private hospitals infrastructure but that only caters the one third of the total population. A report released by KPMG and the Organisation of Pharmaceutical Producers of India in 2016 stated that 75% of dispensaries, 60% of the hospitals and 80% of the doctors are located in the urban area and serving only 28% of the total population. On a comparison rural areas have only 39.8 physician per 100,000 people where as Urban area has around 55 physicians for the same number of residents,” Gaur said. Satish Kannan, Co-Founder & CEO, DocsApp believes, “With more than 70% of the population living in rural areas and a low level of health facilities, mortality rates are high due to diseases. Health care for the rural population is expensive, often unregulated and variable in quality. Besides being unreliable for the illiterate, it is also unaffordable for low-income rural patients,” says

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SEPTEMBER 2019

COVER STORY Satish Kannan, Co-Founder & CEO, DocsApp. “Retention of doctors in rural India is the biggest challenge. Due to lack of proper infrastructure & amenities, doctors prefer settling in urban cities. Remote areas barely get timely help unless they visit a nearby city which is equally difficult for Individuals in rural areas,” Kannan further said. At a time when India is facing triple burden of diseases including lifestyle diseases, maternal & child health and infectious diseases, and the emerging infections like Nipah, trained workforce including doctors, nurses and technicians are needed to provide accessible and affordable care to masses. Situation is same in case of government hospitals, which are facing human resources crunch. Issues like overworked doctors, and unavailability of beds, technicians and nurses explains the story of India’s public healthcare sector. UPGRADING DISTRICT HOSPITALS INTO MEDICAL COLLEGES The Government is working on every

SEPTEMBER 2019

front to increase number of skilled professionals in healthcare. It aims to reach one doctor for 1,000 people by 2024. As part of the Centre-sponsored programme Human Resources for Health and Medical Education, the Government has decided to convert district hospitals into medical colleges in phased-manner. In the first phase, the Centre had given approval to convert 58 district hospitals into medical colleges while in the second phase, 24 hospitals were selected. Of the 58 medical colleges approved under the first phase of the scheme, 39 have already started functioning. In order to boost availability of human resource for the health sector, the government gave nod to setting up of 75 government medical colleges, to be attached with existing district or referral hospitals, by 2021-22. The establishment of these medical colleges will add at least 15,700 MBBS seats in the country. These medical colleges will be set up in under-served areas having no such

institutes and attached with district hospitals having at least 200 beds. The exercise is aimed to increase the availability of qualified health professionals, improve tertiary care in government sector, utilise existing infrastructure of district hospitals and promote affordable medical education in the country. NMC BILL TO REFORM MEDICAL EDUCATION Medical education is the bedrock on which the needs of ‘human resources for health’, one of the major building blocks of any health system, are met. Today’s health professionals are required to have knowledge, skills, and professionalism to provide safe, effective, efficient, timely, and affordable care to people. With this objective, the Government came up with National Medical Commission Bill. Its objective is to create a transparent, accessible and affordable medical education system leading to better healthcare outcomes. Through the bill the Centre will ensure transparency, accountability and

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PRIVATE AND PUBLIC SECTOR NEED TO WORK IN SYNC TO MEET THE GAP Partnership between public and private sector is needed to meet the gap in the human resources. The Government has now allowed a consortium of private players to set up a medical college, unlike in the past when a medical college had to be established by a single entity. It also made a strong appeal from the private sector to contribute more to medical education and also to have more DNB (Diplomate of National Board) Seats. TRAINED MID-LEVEL PROVIDERS TO BOLSTER PRIMARY CARE Clause 32 in NMC bill is one among many issues in NMC Bill on which the Government is facing stiff protest from a section of medical fraternity. As per the provision, mid-level providers would be trained to practice medicine in order to bolster primary care. In a FAQ document on NMC Bill

2019 available on PIB website, the government justifies its decision. “The ambitious Ayushman Bharat initiative announced by GoI in this year’s Budget Speech needs 1,50,000 mid-level providers within the next 3-5 years to provide comprehensive primary and preventive care. It will take 7-8 years to ramp up the supply of doctors, therefore, in the interim we have no option but to rely upon a cadre of specially trained mid-level providers who can lead the Health and Wellness Centres,” document states. Refuting all misconceptions on the clause, Paul said: “It is proven facts across the globe that mid level providers augment doctor led team to boost care delivery system. In several European countries, mid level providers are a norm. We will be providing extra trainings to mid level providers thereby equipped them to provide first line of treatment for diabetes and other diseases.” Chhattisgarh and Assam experimented with community health workers in past, but couldn’t implement the idea in fullfledged manner. GLOBAL EXAMPLE WHERE CHPS PLAYING PIVOTAL ROLE

India’s struggle on Human Resource • As per Indian Journal of Public Health 2017 data, in India on an average, a government doctor attends to 11,082 people • A total of 10,22,859 allopathic doctors are registered with MCI • There is a shortage of over 600,000 doctors in the country and two million nurses • Currently urban to rural doctor density ratio is 3.8:1. • There is one nurse per 483 patient in India • 57.3% of personnel currently practising allopathic medicine do not have a medical qualification • 65 per cent of health expenditure is outof-pocket, and such expenditures push some 57 million people into poverty each year • Primary health centres across the country are in want of at least 3,000 doctors with 1,974 such centres operating without a single doctor • In community health centres, there is a shortfall of close to 5,000 surgeons • If India has to achieve 1:1,000 ratio, it will need 2.07 million more doctors by 2030

COVER STORY

quality in the governance of medical education in the country. With two dozen of new government medical colleges, the academic year 2019-20 saw the biggest addition of medical seats in government colleges in a single year.

There are many countries--developing and developed which have deployed Community Health Workers under different names but with the same intent — providing basic health services at primary level. CHWs are providing healthcare services in Ethiopia, Rwanda, Bangladesh, and Thailand. They are called “health extension workers” in Ethiopia and Swasthya Sebikas & Swasthya Kormis in Bangladesh. Nurse practitioners are a welldefined category in the US, New

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COVER STORY Zealand and Australia. Apart from shortages of doctors in some regions, the rising costs of healthcare also catalysed the emergence of mid-level healthcare providers. IDEA OF CHP AS MID LEVEL PROVIDERS GETTING STIFF OPPOSITION A section of medical fraternity is vehemently opposing the Bill, stating that it will encourage quacks to prescribe allopathic medicine. They have least idea who these ‘community health providers’ will be and how they would be trained by the Government. “The government’s plan to provide training to community health workers to augment the primary care system in the country is a good decision policywise. It will help ensure delivery of basic healthcare to people residing in rural and far-flung areas. At the same time, it is the execution and the quality of training imparted that is going to be extremely crucial. They must be trained well in primary healthcare and sanitized on operating only in a supporting role and not acting as

SEPTEMBER 2019

IN ORDER TO BOOST AVAILABILITY OF HUMAN RESOURCE FOR THE HEALTH SECTOR, THE GOVERNMENT GAVE NOD TO SETTING UP OF 75 GOVERNMENT MEDICAL COLLEGES, TO BE ATTACHED WITH EXISTING DISTRICT OR REFERRAL HOSPITALS, BY 2021-22. THE ESTABLISHMENT OF THESE MEDICAL COLLEGES WILL ADD AT LEAST 15,700 MBBS SEATS IN THE COUNTRY.

qualified doctors,” Kannan believes. Experts who are opposing the move believe the Bill doesn’t clearly define “mid-level practitioner” and “limited license”. It seems that the Bill seeks to conflate all types of practitioners and allow all to prescrible modern medicine, something that was previously only allowed to those who had done an MBBS. Another concern this raises is on how these practitioners will be regulated as no clear solution has been offered so far. It is proven fact that whenever some new initiative is undertaken by the Government, it bounds to face criticism from many quarters. Nonetheless, criticism encourages people at the helm to further finetune the step so that masses could be benefitted to the maximum. Though the latest policy is little vague on many points, the Government’s intension is crystal clear that to improve skewed ratio of doctors, nurses, technicians, so that people at large could be catered with accessible and affordable medical facilities in every nook and corner of the country.

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POLICYMAKER’S PERSPECTIVE

Mid Level Providers to be Trained to Augment Primary Care: Dr Vinod K Paul National Medical Bill will reform medical education. There is misconception about mid level providers among a section of medical fraternity that it will encourage quacks, but I assure everyone that it won’t do so, said Dr Vinod K Paul, Member, NITI Aayog, Government of India while delivering speech at Healthcare Summit Jharkhand held in Ranchi. level providers are a norm. We don’t have such mechanism in place because our rule doesn’t allow so. We are not creating barefoot doctors. We are not certifying quacks. We will be providing extra trainings to mid level providers thereby equipped them to provide first line of treatment for diabetes and other diseases. It is needed to fill human resource gap in the wake of shortage of doctors across country.

Dr Vinod K Paul Member, NITI Aayog, Government of India

e further said there is no bridge course for Ayush in the Bill. “Mid level providers by definition is above the nurses and below the doctors and specialists. ANM and nurses would get extra trainings. We will be empowering those who are above nurses,” Paul said. ‘MID LEVEL PROVIDERS AUGMENT DOCTOR LED TEAM’ It is proven facts across globe that mid level providers augment doctor led team to boost care delivery system. In several European countries, mid

SEPTEMBER 2019

‘JHARKHAND WITNESSING PROGRESS IN HEALTHCARE’ Though Jharkhand is a new State, it has lots of potential. The State is making big strides in the leadership of Chief Minister Raghubar Das. We are also trying to contribute to the Jharkhand’s healthcare delivery bandwagon, which is evolving in unprecedented manner. One of the biggest healthcare protection schemes Ayushman Bharat was launched from this State last year. Jharkhand has witnessed tremendous progress on this front, leveraging the scheme to create affordable model of healthcare. We are working to further accelerate the programme and trying to resolve issues like harmonisation of packages and its rates. Our objective is to reach last-mile through the programme.

Jharkhand along with Andhra Pradesh and Haryana witnessed incremental progress on different healthcare indicators in Niti Aayog’s health index. It proves that one can accomplish things with grit and determination. ‘RESOURCE SHOULD BE OPTIMALLY USED’ We need to ensure that available resource should be optimally used to improve deliverables in healthcare. I agree that more money is needed to resuscitate healthcare sector. Healthcare sector should get eight percent allocation of total GDP in every State, as per our national health policy. There should be 2.5 percent GDP allocation on health. But the Centre is responsible for only one third of the total 2.5 percent. States should contribute to rest of the two third portions. We should aim to reach this target by 2025 and for that States need to increase budget by eight percent. ‘MORE HEALTH FOR MONEY IS EQUALLY IMPORTANT’ It means that we should ensure that available resources should be used in prudent manner. Our government gives us the opportunity to translate

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CHALLENGES OF HEALTHCARE SECTOR Human resource is a major challenge in healthcare. Infrastructure like bed ratio is another constrain. One bed is available per 3,000 people in our country. It should be improved to 1 per 1,000. As per National Health policy there should be two bed per 2,000 people. We together need to deliberate on how to improve healthcare infrastructure both in public and private sector in the State. Private investment is needed in both secondary and tertiary care if we want to improve our record on infrastructure front. Ayushman Bharat has emphasized on one India and one model of healthcare including public and private–primary, secondary and tertiary care. Pro people approach drives both public and private sector. Jharkhand needs support of private

sector to boost healthcare delivery mechanism. ‘SINGLE WINDOW OPPORTUNITY IS NEEDED TO GIVE CLEARANCE’ Investors want no hassle on front of clearance and if they find lesser number of windows in other States then they opt for that. Healthcare is important sector as it opens avenue of jobs, increases survival of our children, and serves country in creating a healthy society. One bed paves path for four jobs. PRIMARY CARE Primary care is another important area which needs to be focussed upon. It is primarily the responsibility of a State. Human resource is available in primary care, based on nurses. We have announced that all sub centres would be developed as wellness centres. Nurses would get bit more extra trainings. Mid level providers are part of the team who contribute to bolster primary care. Sub centres are not deficient of HR. Primary care

WE WILL BE PROVIDING EXTRA TRAININGS TO MID LEVEL PROVIDERS THEREBY EQUIPPED THEM TO PROVIDE FIRST LINE OF TREATMENT FOR DIABETES AND OTHER DISEASES. IT IS NEEDED TO FILL HUMAN RESOURCE GAP IN THE WAKE OF SHORTAGE OF DOCTORS ACROSS COUNTRY.

POLICYMAKER’S PERSPECTIVE

resources into achievements. Jharkhand has outperformed in terms of resources as well.

should be unleashed. Primary care doesn’t put extra load on exchequer and considered cheap comparatively. We already have nurses, technology, and plenty supply of medicines. We need to ponder on ‘plan of action’ to accelerate primary care. TELEHEALTH Being cost effective, telehealth has huge scope today. Jharkhand can study Andhra model for the same. If the State Government feels that satellite communication could be helpful apart from broadband services, we can work on it through ISRO. POSHAN ABHIYAN Poshan Abhiyan is equally important which aims to end malnutrition, stunted growth, and anemia. The State should also prioritise this. Asha workers should spread awareness on how to feed small children.

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EXPERT’S OPINION

‘Healthy lifestyle, Regular Exercise Panacea for Healthy Heart’ Unhealthy lifestyle, stress, and no exercises are among the factors responsible for unprecedented increse in heart diseases. The Frontier Lifeline Hospital is catering such patients with all advanced facilities in cardiac care including transplants and stem cell therapy, and valve surgery, says Dr KM Cherian, Chairman & CEO, Frontier Lifeline Hospital, in conversation with Mukul Kumar Mishra of Elets News Network

Frontier Lifeline Hospital is one of the best cardiac care hospitals in Chennai having 3 Cs- Compassion, Commitment, and Clinical Excellence as guiding principles. Tell us about its mission and vision. Whatever the treatment is available in cardiac care for neonates, children, and adults, they are all available in our hospital. Valve surgery, bypass surgery, transplants, stem cell therapy are some of the treatment modalities available in our hospital. Stem cell therapy is not available in this country for cardiac condition. We have no license to produce cardiac stem cell what we call cardiomyocytes in any institution including AIIMS. We have the largest Good Manufacturing Practice (GMP) available in the country. We are the largest number of stem cell, and clinical experience hospital in Asia. A total of 127 patients have been treated not only from India but other countries as well. The youngest patient who got stem cell therapy was two-years old.

Explain in simple terms ‘Minimally Invasive CABG’ and ‘valve repair/replacement’.

SEPTEMBER 2019

How technology plays a pivotal role in this area? Today Coronary Artery Bypass Grafting (CABG) can be done by Minimal Invasive Procedures such as mini CAB, MICAS, and ROBOTIC. Even valve replacement can be done by that through the chest without opening the sternum, the middle bone of the body.

Some people misinterpret cardiac arrest as heart attack. Please explain the difference between the two. Cardiac arrest means stoppage of heart. It doesn’t beat and can’t perform the normal function. Heart in relaxed phase is called diastole while in contract stage it is known systole. In these two stages cardiac arrest can occur. Heart could contract and stops like a cricket ball or balloon filed with water. In heart attack, blood supply to heart machinery gets blocked. It’s because of angina that is chest pain. 70 percent of heart attacks can be treated. Immediate treatment is to dissolve the clot which has blocked the artery. This can be done as first aid by just giving an antiplatelet to patients. The cheapest antiplatelet is a tablet of

Dr KM Cherian Chairman & CEO, Frontier Lifeline Hospital

aspirin. Such patients are given clot lytic agent in hospital. In this process, clot is lysed through injection.

What can be done to provide immediate aid in such an emergency situation? If someone in your family or a friend suddenly gets a heart attack, you can dissolve an aspirin in a glass of water and give it to him. But the patient must be taken to the hospital immediately. Heart suddenly stops functioning during the cardiac arrest. The immediate remedy is Cardiopulmonary Resuscitation

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(CPR). It can be done by compressing the lower part of the sternal bone with both hands for minimum 30-40 times. Patient can be given mouth to mouth respiration minimum 10 times/minute. Meanwhile somebody should contact ambulance service for immediate help.

Youngsters are falling victim of heart attack and cardiac arrest today. How due to see the role of risk factors like stress, food habits, and sedentary lifestyle? If youngsters are falling victims for heart attack, usually it is hereditary. If your father had heart attack in past, your chance of getting the attack is 60 percent. Similarly if your mother had attack, you are again vulnerable. If both mother and father had heart attacks, there is 80 percent chance that you will face the problem. Obesity, too much intake of salt, no exercise, and smoking are some of the causes. Exercise is must to keep stress at the bay. It is advisable to people especially in fourties to do regular exercise and maintain healthy habits so that they don’t get inflicted with the fatal disease.

India is home to 40% of the world’s 2.6 crore patients with heart failure, yet there is poor awareness about the condition and its

treatment. What is your viewpoint? Preventive education to children is must. It should be taught in schools. They must be involved in sports activities daily for at least half an hour. One should keep in mind that sport exercises are equally important like tuition classes. Without physical activities tuition will not help body. It might not help even the brain. Students should be given time for meditation and relaxation to ease out peer pressure and other sort of built up tension. Role of family holds huge importance here to encourage kids for physical activities. Both, exercise for body and brain are important. In addition, good healthy habits, healthy food and self discipline are equally important.

What are your suggestions to improve things on front of cardiac care? India should work on basic research to build solid organs like liver, kidney, heart, and lungs. The country needs to focus on research to grow these vital organs. Countries across the globe are doing exemplary work in medical research. There is no encouragement for the basic research in our country. The Department of Biotechnology doesn’t work on this front. India should invest heavily on research work, that’s utmost important.

TECHNOLOGY PERSPECTIVE

Sterrad Sterility Guide: 5 Reasons Medical Centre Should Use Sterrad for Sterilisation

nfection control and preventing cross-contamination are critical in medical facilities everywhere. Bacteria and viruses can thrive in a medical setting unless your team is vigilant in pursuing proper sterilisation techniques. Ensuring that your medical instruments are contaminant-free is one of the most important things your practice can do in order to provide the best possible patient outcomes and experiences. One of the most effective choices is the STERRAD line of surgical sterilisers.

There are many historical disinfection and sterilisation methods that help ensure you are effectively purging your surgical instruments and equipment of all microbes: steam under pressure, liquid chemicals, hydrogen peroxide, dry heat, gas plasma, and ethylene oxide gas are just a few options. Each sterilisation method has its pros and cons, and the broad range of options means that some healthcare centers may use varying methods for different instruments and material.

5 REASONS TO USE STERRAD FOR STERILIZATION A STERRAD machine uses lowtemperature gas plasma, combined with hydrogen peroxide vapor, to fully sterilise most medical equipment. Some of its most positive attributes include:

1. RAPID TURNAROUND TIME With a STERRAD machine, the sterilisation process typically takes around 75 minutes, and some STERRAD models even work within a 45-minute time frame or shorter. This helps you guarantee that your surgical team is ready to go for its next procedure within an hour. 2. COST-EFFECTIVENESS Not only is the STERRAD system itself surprisingly affordable, but the lack of plumbing, monitoring, and ventilation support expenses also is a cost-saver for your practice. Because of the gentleness of the advanced sterilisation process, your surgical instruments will last longer, needing to be repaired and replaced much less often than if you were using other sterilisation methods. 3. NO DAMAGE TO INSTRUMENTS Studies have shown that hydrogen-

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peroxide based, low-temperature sterilisation does less damage to medical instruments than traditional autoclaves. This means youâ&#x20AC;&#x2122;ll have longer surgical instrument life and lower costs for instrument repairs over the useful life of your equipment. 4. STRONG MANUFACTURER SUPPORT AND EDUCATION STERRAD machines and consumables are manufactured by Advanced Sterilisation Products (ASP), a division of Ethicon (a Johnson & Johnson company). Advanced Sterilisation Products have a wide range of support and educational options including the ASP University. The ASP University provides many courses and training overviews and it even has online continuing education courses. The STERRAD system comes with industry-leading support from Advanced Sterilisation Products to ensure that the equipment is used correctly and to the full benefit of your surgical team. In fact, the STERRAD Sterility Guide is considered groundbreaking within the industry. The guide is available online and is updated in real time, so you can always find the latest information on instrument validation and system compatibility. In addition, youâ&#x20AC;&#x2122;ll find that the STERRAD line is designed with simplicity and ease-of-use in mind; this thoughtful design can tremendously limit the potential for human error. Many systems operate

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hydrogen peroxide.

STERRAD CONSUMABLES Advanced Sterilisation Products manufactures all the necessary consumable products to effectively use your sterilisation system. STERRAD sterilant cassettes are necessary to operate the STERRAD NX, STERRAD 100NX, STERRAD 100S sterilizers. STERRAD sterilant cassettes use low-temperature hydrogen peroxide gas plasma for terminal sterilisation of medical devices. STERRAD sterilant cassettes come in a convenient pre-loaded cassette that delivers a predefined quantity of hydrogen peroxide per cycle to achieve sterilisation both conveniently and effectively. Each cassette is a closed system, sealed for the operator’s safety, and has a chemical indicator on the packaging in order to detect any leakage of sterilant during transportation. STERRAD chemical indicator strips and STERRAD chemical indicator tape are sterilisation indicator strips and tape that have a color indicator that changes from red to yellow to show exposure to hydrogen peroxide. Advanced Sterilisation Products also produces the Tyvek product line of sterilisation rolls and sterilisation pouches. Tyvek sterilisation pouches and sterilisation roll come with the built-in convenience of having a STERRAD chemical indicator to show medical instruments were exposed to

5. VERSATILE RANGE OF STERRAD STERILISERS STERRAD does not take a onesize-fits-all approach to sterilisation. Instead, their STERRAD sterilisers are a diverse product line to ensures that your practice and surgical team can choose the optimal system that best meets the needs of the practice and its patients. Some of the newest models even minimise workflow interruptions before they occur through built-in quality assurance features that can help encourage and guarantee industry compliance. For example, the STERRAD 100S system can improve load tolerance and provide faster sterilisation in diffusionrestricted areas. It can also retrofit the original STERRAD 100 for faster cycles. The STERRAD 100NX is considered the most advanced sterilisation technology. It includes features such as network connectivity for remote monitoring, touch-screen displays, a hydrogen peroxide monitor and more. The STERRAD NX is a compact version that can be used virtually anywhere in a healthcare setting. Its two-tiered chamber and two cycle options can be cart-mounted and easily transferred wherever sterilisation is needed. The STERRAD NX with ALLClear is the compact STERRAD NX sterilizer with ASP’s new ALLClear technology.

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TECHNOLOGY PERSPECTIVE

with the simple push of one button.

THE STERRAD 100NX ALLCLEAR IS CONSIDERED THE MOST ADVANCED STERILISATION TECHNOLOGY. IT INCLUDES FEATURES SUCH AS NETWORK CONNECTIVITY FOR REMOTE MONITORING, TOUCHSCREEN DISPLAYS, A HYDROGEN PEROXIDE MONITOR AND MORE.

The STERRAD 100NX with ALLClear is STERRAD 100NX sterilizer with ASP’s new ALLClear technology. STERRAD sterilisers with ALLClear Technology feature new technology based on field research and process improvements. ALLClear Technology is designed to reduce workflow interruptions and improve compliance. ALLClear Technology is upgradeable as new innovations are released and ALLClear has networking capability with multiple instrument tracking systems and hospital servers. STERRAD SYSTEMS WITH ALLCLEAR TECHNOLOGY HAVE THE FOLLOWING FEATURES: • Fast, accurate detection and correction of load and system issues, which may otherwise cause cycle interruptions. • Automatic precycle system diagnostics and load conditioning in five minutes or less* (*Timing is based on typical loads. ALLClear Technology can be disabled.). • ALLClear Technology is designed to optimise package and instrument conditions for sterilisation.

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SEPTEMBER 2019

TECHNOLOGY PERSPECTIVE

EMR - Implementation and Adoption Barriers

he Government officials are mandated to ensure that every healthcare institution should have Electronic Medical Record (EMR) systems in place. Despite many benefits of the modern-day tool, many clinical users & healthcare providers are apprehensive to implement EMR. Whilst EMRs possess many useful features to help streamline the healthcare processes, some people find the entire system overly complex and feel that they could take smashing care of patients even without it. But when it is implemented properly, EMR serves as a stonking tool to preserve critical clinical information and increase workflow efficiency, TAT,

SEPTEMBER 2019

continuous improvement of patient & provider experiences. Having said this, there are a few issues that you need to overcome if you want to get the full benefits of EMR. 1. IN-CORRECT GOALS IMPLEMENTATION PERSPECTIVE: What do you want to achieve out of your EMR implementation? Have you set realistic goals and expectations? Is the goal to justÂ digitiseÂ your paper records or is it to improve patient care while bringing in 20-25% increase in revenue? Only when you have a clearly defined and understood set of goals and expectations, then you

will be able to evaluate the success or failure of EMR implementation. The goals provide you the criteria to evaluate the implementation and define a plan to overcome any deficit during the EMR implementation. Taking everything into account, the product owner should perform a detail due diligence whether the healthcare provider (Hospital) is ready or not for the EMR deployment and adoption.

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PRODUCT PERSPECTIVE: Most EMR deployment fail due to product design and its capabilities. Therefore, it is very essential for the organisation to choose the right product which could have been designed and developed to enabling the following capabilities: ✓ Sub second response (faster than paper) ✓ Ease of use (zero typing to perform the clinical documentation) ✓ Required zero training to the end users ✓ Gadgets independent ✓ More of open source tool usage

technological advancements. Incorrect technology, which is non-scalable, non-responsive, does not work as fast as people are used to, or which cannot capture multiple data points, can soon be discarded by the users. Maximum failure comes in the way if the product has got the performance, navigation, nonstandard controls usage & mobile gadget dependency across the EMR application.

2. INADEQUATE INFRASTRUCTURE: Lack of concrete IT infrastructure is one of the most common causes of failure in EMR implementation. Most of the healthcare organisations lack the technical skills and infrastructure to support EMR safety and fail to take care of aspects such as networking over good bandwidth, good wireless coverage, regular data backups, patient data security, interpretability or scalable data centers. All such issues can severely reduce the productivity of clinicians and hamper the patient care. Without having the state-of-the-art infrastructure in place, the availability of patient longitudinal records at point of care would always be questioned to enable quality of care within the individual reach.

4. NO STAKEHOLDER BUY-IN Although, EMR implementation involves a lot of technology activity, it certainly cannot be only an IT decision. There are multiple stakeholders who are involved in the use of EMR and the buy-in from all the users is essential. Successful EMR implementation requires physician champions who are early adopters and can help in getting various stakeholders on the same page, respond to queries in a timely manner, and help clinicians in reaching a common consent. It is important to note that the EMR implementation involves multiple factors such as leadership, change management, training, and technology; therefore, it must support both technical and personnel-related components. The complete solution stack of EMR involves only 30% of technology and 70% is catered by people & process. Ideally it should be people and process driven instead of technology driven.

3. LIMITATION OF TECHNOLOGY USAGE In today’s world with the rapid increase in the number of mobile devices, everybody is used to work in a certain way – mobile-based devices have become the natural way of working, touch has replaced type in most of the mobile devices, compatibility across devices has been taken for granted, computers are supposed to work really fast. The EMR systems need to adapt themselves to such changing

5. NON-AVAILABILITY OF INTERDEPARTMENTAL PROCESSES TO IMPLEMENT CHANGES The objective of the EMR deployment is 100% adoption from day one onward and it is mostly people and process driven. Therefore the entire organisation must emphasise to execute the workflows in line with process which could be supporting to get the expected outcome from EMR at PoC. In certain cases, there could be a fundamental change in the way departments work, and in such cases,

TECHNOLOGY PERSPECTIVE

hospitals need to spend time in designing and implementing processes pre and post deployment of EMR. Adhering to processes should be mandated by the management to the HODs and user level for better adoption to get the utmost use of the clinical outcome to the HCPs toward enabling the quality care, patient safety and patient experiences. 6. BUDGET CONSTRAINT There is no denial that the cost of EMR & its deployment is huge. This involves infrastructure, software, implementation assistance, training, support, and ongoing subscription & support fees of the application. In fact, the cost of EMR is the number one reason why most of healthcare institutions have not yet made the switch from paper to paperless & digitised. But the benefits of EMR are innumerable, and more significant than the cost of implementation. If you find EMR costs to be out of your budget, you should make a thorough assessment of your needs, and consult with vendors to develop economical EMR solutions. However, the recent trend from the vendor to provide the quote & bid based on op-ex model which helps to make it more costeffective and affordable. 7. CLINICAL TEMPLATE DESIGNING LIMITATION Some hospitals may find that even after careful planning and implementation, EMR just doesn’t provide the functionality they need. The clinical templating/ designing is one of the major features of the EMR for clinical documentation for clinical users which decide the success and failure of the EMR implementation programme and the project. As the usage of EMR increases, a scenario comes to the fore where the user is not able to enhance the template designed by adding few more components on their own as it might

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Overcoming barriers / Issues in implementing EMR • Continuous customer buy-in • Clear mandate in line with EMR deployment goals – organisation level • Mobility based EMR • Must be a clinically driven – Project management and escalation • Don’t reinvent the wheel • Minimum incentive programme • Strong clinical documentation tool with zero technical dependency • Clinical information interoperability • Continuous clinical content improvement, training and change management • Slicing the redundant data capturing • Providing clinical predictive analytics – organisation level • Adopting newer technology time to time • Strategies, people, process, and technology methodology be that new clinical guidelines could have published to treat a certain disease and disease type. As a result, the clinical user becomes hesitant to use it as they will not be getting related clinical reports for further study and analysis. Therefore, the application should be capable enough to change the clinical content based on the user needs as and when it is required, instead of making the users dependent on the product owner to make L1, L2 level of changes in the existing content. 8. CLINICAL USERS RESIST USING EMR Clinicians refuse to accept new system either because they do not believe in its capabilities - they are very much convinced that their way of doing things can produce better results, or perhaps because they are intimidated by it. Once again, you need to identify a

super-user who can encourage others to adopt EMR and feel more comfortable about it. A peer-to-peer approach will work best in this situation. On the other hand, the hospitals should come-up with basic minimum reward in the form of incentives which has proved to be beneficial in the past. 9. MISSING MANAGEMENT MANDATE This is one of the major missing elements. The organisation does not appraise the high-level goals and deliverables with the HODs before bringing this change. Every organisation should perform internal change management before implementing the EMR whereby the management should pass the message as to why this initiative has been taken with all the goals and deliverables. To get 100% success, the process would be put in place which will be adhered by each stakeholder right from the departmental HODs to the end users from day one when EMR goes live. 10. CONTINUOUS CHANGE MANAGEMENT & TRAINING Post EMR implementation, change management and training should be a continuous activity at the organisation level else the adoption rate will fall drastically and bringing it back on track will become a nightmare. Therefore, the concept of trainthe-trainer would be more effective to mitigate this issue, better it could have been suggested to align this training for all the new hirees during their orientation programme right after on boarding of new hirees. This training would be more on the value added outcome by comparing before and after the EMR deployment which can be co-related with RoI, efficiency, TAT, control on possible clinical errors and patient, provider experiences. (Writer is Abdullah Saleem, Group CIO, OMNI Hospitals. Views expressed are a personal opinion.)

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Organiser

Host Partner

Supporting Partner

Government of Jharkhand

CONFERENCE REPORT 24

Knowledge Partner

CONFERENCE REPORT

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CONFERENCE REPORT

Dr Vinod K Paul (2nd from right), Member, NITI Aayog, Government of India, inaugurating the Healthcare Summit Jharkhand in presence of Raghubar Das (extreme right), Chief Minister of Jharkhand, Ramchandra Chandravanshi(3rd from right), Minister of Health, Medical Education & Family Welfare, Government of Jharkhand, and Dr Nitin Madan Kulkarni(extreme left), Secretary, Department of Health, Medical Education & Family Welfare, Government of Jharkhand

WHEN EXPERTS PONDERED SMART DELIVERY OF HEALTHCARE SERVICES

n a bid to highlight various existing healthcare practices being followed upon in the State of Jharkhand and deliberate upon how to further evolve the care delivery model in terms of accessibility and cost-efficiency, the Healthcare Summit Jharkhand held in Ranchi recently. Organised by the Department of Health, Medical Education & Family Welfare, Government of Jharkhand along with Elets Technomedia, the healthcare summit witnessed confluence of key policymakers, international experts and industry leaders. The healthcare stalwarts shed light on innovative practices, conducive policies and ways to reach out to people living on the last-mile, their vision for it and the huddles in that roadmap. Inaugurated by Raghubar Das, Chief Minister of Jharkhand, in the presence of Ramchandra Chandravanshi, Minister of Health, Medical Education & Family Welfare, Government of Jharkhand; Dr Nitin Madan Kulkarni, Secretary, Department of Health, Medical Education & Family Welfare, Government of Jharkhand, and Dr Vinod K Paul, Member, NITI Aayog, Government of India, the conference witnessed one of the finest congregations of top luminaries of the healthcare world. The conclave also witnessed presence of Mission Directors of National Health Mission (NHM) across

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country and representatives from world renowned organisations including United Nations Development Programme (UNDP) and Ernst & Young. The healthcare experts highlighted global trends and innovative practices across the States and how that can be leveraged to improve healthcare delivery system in Jharkhand. They also brainstormed about existing issues of the Indian healthcare system and ways to do away the same with PPP playing a pivotal role on this front. Various enlightening discussion sessions touched upon issues such as: ‘Jharkhand--Gearing Up For Better Healthcare – Taking Healthcare Delivery to the Last Mile’, ‘Role of PPP in running Health Institutions and Developing Sustainable Healthcare Infrastructure’, ‘Best & Next Practices in States for Effective Public Healthcare Delivery’, and ‘Role of IT For Providing Effective Healthcare Services’ were also organised, with stalwarts shedding light on contours of quality, accessibility, and affordability which are determining factors of any healthcare delivery system, influencing patient care and safety. Eminent dignitaries, on this occasion, unveiled a special issue of eHEALTH Magazine, which has been promoting innovations in healthcare ecosystem for over a decade. A glimpse of the conclave:

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Inaugural Session Jharkhand - Gearing Up For Better Healthcare â&#x20AC;&#x201C; Taking Healthcare Delivery to the Last Mile

RAGHUBAR DAS

Chief Minister of Jharkhand

"Healthy mind lives in a healthy body. There has been an increase in the number of patients in recent years and main cause is swelling population across the country. This is a major challenge which needs to be controlled. We have improved on all parameters of healthcare delivery. Our Maternal Mortality Rate (MMR) was 400 per lakh population in 2000 which has decreased to 165 today. Our Neonatal Mortality Rate (NMR) was 72 per thousand in 2000 which has come down to 29. Niti Aayog's health index report proves that Jharkhand is striving to improve healthcare delivery to the last mile. Jharkhand's 108 Ambulance has been one of the most successful initiatives which facilitates care within 20 minutes."

RAMCHANDRA CHANDRAVANSHI Minister of Health, Medical Education & Family Welfare, Government of Jharkhand

"The State government is leaving no stone unturned to improve records on front of maternal and child care. In last 10 months, a total of 2 crore 19 lakh patients have availed various medical facilities under the scheme at empanelled public and private hospitals. The Government is also planning to establish wellness centres in remote areas. In addition, bike ambulance, telemedicine projects are being worked upon to boost healthcare delivery in remote areas."

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DR NITIN MADAN KULKARNI

DR VINOD K PAUL

"Indian healthcare is at transition phase today. Non-communicable diseases are cropping up in unprecedented manner affecting people at large. In this light, we need to chalk out ways to deal with new kind of diseases and other prevailing challenges of healthcare sector. Latest technology including artificial intelligence and innovative ideas must be leveraged to enable masses to avail quality healthcare services to their doorsteps. We need to replicate best practices undertaken by different States to improve healthcare infrastructure."

"One of the biggest healthcare protection schemes Ayushman Bharat was launched from this State last year. Jharkhand has witnessed tremendous progress on this front, leveraging the scheme to create affordable model of healthcare. Jharkhand along with Andhra Pradesh and Haryana witnessed incremental progress on different healthcare indicators in Niti Aayog’s health index. We need to ensure that available resource should be optimally used to improve deliverables in healthcare. Human resource is a major challenge in healthcare sector. Infrastructure like bed ratio is another constrain."

Secretary Department of Health, Medical Education & Family Welfare, Government of Jharkhand

Member, NITI Aayog Government of India

Significant Growth in Diagnostic Market in India

VISHWANATH H N Senior Vice President Medall Healthcare Pvt Ltd

"Increasing population, incidence of lifestyle diseases, and rising affordability, are key drivers of diagnostic market in India. India’s lower healthcare spends as compared to global average and lack of adequate infrastructure demonstrates enormous scope of growth in healthcare sector. We spend only 4 percent of GDP on healthcare while the US spends 17 percent. In this light, there is a huge market opportunity in diagnostic segment."

‘Digital Dispensary (Telemedicine Services)

ANURAG VOHRA

Chief Technology Officer Apollo Tele Health Services "There is an asymmetry in availability of doctors across country. Though we have enough doctors in urban areas, we lack the same in remote rural areas. Digital Dispensary holds importance in the wake of the fact that people in rural areas have to travel faraway places just to get primary care which can be made available right there. With support from the Jharkhand Government, we have set up 100 digital dispensaries in rural areas. Since February this year, we have conducted 98,000 patients’ visit, and 95,000 video consults."

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CONFERENCE REPORT 28

Panel Discussion Role of PPP in Running Health Institutions and Developing Sustainable Healthcare Infrastructure

RAMANAN S V

MANISH SACHETI

"Challenges are plenty in PPP models. Its success depends upon will and vision of the government which wants to execute the way it was visualised. PPP is proving to be a game-changer today. The speed, infrastructure, internet connectivity, power supplies, and lack of skilled manpower are some of the challenges in implementing PPP projects in the heartland. The government has been very supportive. Once the government becomes payer and private party providers, then stakeholder management also has a role."

"We started journey 13 years back as a private player from Maharashtra and Kerala. Initially we used to charge patients for ambulance services. We scaled up from a fleet of 10-20 to 50-60 ambulances. At that time there was no centralised call centre which could facilitate ambulance service. One had to make enquiry into separate hospitals to check availability of ambulance. In 2008, Government leveraged PPP models to establish network of ambulance and today we have 108 services available almost in every State."

ANURAG VOHRA

NEERAJ ARORA

Executive Vice President Medall Healthcare Pvt Ltd

Chief Financial Officer Ziqitza Health Care Limited

Chief Technology Officer Apollo Tele Health Services

Chief Executive Officer HealthMaP Diagnostics Private Limited

"Apollo has state specific approach of PPP model as every state has its own set of requirements. Accelerating primary healthcare is need of the hour. We have operationalised more than 500 centres in last two and half years. The Government should come into defining the scope really well with proper homework that really makes a difference in implementing PPP projects. At the same time, it should also do quality monitoring. We have lot of quality inbuilt systems."

"PPP was not an organised model till seven-eight years back when Government stepped in to improve things on this front. From last few years, neatly and rightly crafted documents are being prepared to maintain transparency at every level. More corporates are joining the bandwagon. In Haryana we have 12 locations in radiology while in Jharkhand we have 20-22 locations. There is no set formula of success. PPP projects benefit patients in terms of quality and affordable care."

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Panel Discussion Best & Next Practices in States for Effective Public Healthcare Delivery

D S RAMESH

Mission Director National Health Mission, Department of Health & Family Welfare Services, Government of Karnataka "Comprehensive primary healthcare includes community health, communicable and non communicable diseases, ENT, ophthalmology, and mental health. Considering mental healthcare an important aspect, the Karnataka Government collaborated with National Institute of Mental Health (NIMH) in 2017 to address the challenge. We have taken up a pilot project in one of the districts. As per a survey, around 14 percent people suffer from mental health issue which needs to be tackled at primary level."

SANJAYA KUMAR SINGH

KESHVENDRA KUMAR

Mission Director, National Health Mission, Department of Health & Family Welfare, Government of Kerala "People are health conscious in Kerala. They have health seeking behaviour. Kerala has lowest maternal mortality rate across country. The Government has state specific target on front of Sustainable Development Goal. We aim for MMR of 30 by 2030 and 20 by 2030. We conduct strategy meet on every single death and plan on how to prevent it with concerted efforts in this direction. Confidential death audit is also being practised to improve records further."

DR ASHOK KUMAR

Managing Director, Bihar Medical Services and Infrastructure Corporation Limited, Government of Bihar

Director General, Directorate General of Health Services (DGHS), Government of NCT of Delhi

"Bihar has 38 districts and 534 blocks. Providing healthcare and diagnostic facilities to every single citizen is big challenge in the State, which has highest population density in the country. We are assisting State Health Department in bolstering healthcare delivery services to masses. Our responsibilities include procurement of drugs & equipments, and building infrastructure right from primary health centres to tertiary medical colleges and hospitals."

"With the motive to provide quality healthcare to last mile, the Delhi government has adopted four-tier model. We have 60 dispensaries which have been converted into polyclinics. In addition, the Delhi Government has successful model of Mohalla clinic which is based on the concept of curative followed by preventive care. Community participation is prerequisite for success of primary care. We have a total of 202 Mohalla clinics in national capital and targets for 1,000."

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Panel Discussion Role of IT for Providing Effective Healthcare Services

PREM KAMAL

ANKUR KATHURIA

State Head A I & Senior Project Officer, United Nations Development Programme (UNDP), Jharkhand

Vice President Government & Transaction Advisory Services, EYLLP

"Routine immunisation is the largest programme in the country by the UNDP which has been working in various areas of development. We started immunisation programme in 2014 with phase-zero districts including Rajasthan and Uttar Pradesh. We incorporated a system where IT could make a big difference. We designed eVINÂ (electronic vaccine intelligence network) which gives real time information of vaccine logistics, and temperature of cold chain management."

"Traditionally we have done brick and mortar services in healthcare when it comes to developing superspeciality hospitals, and medical colleges. Today technology has evolved with IT playing a pivotal role. We have just not embraced the technology but racing ahead with it. We have recently concluded ambulance tender in UP. The State government is expanding ambulance services from 1,400 to 2,200 ensuring 15 minute response time. These ambulances are equipped with GPS tracking system and fleet management system. We are also working on teleconsultation with the UP Government."

SUMIT BASU

Senior Vice President Ziqitza Health Care Ltd "Information Technology is a great enabler. It helps to optimise resources. It improves the accessibility of services, and helps to ensure that services can be rendered in the fastest, safest and optimum manner. We run the emergency medical services in Jharkhand since past two years. We run 350 ambulances in the State. We started with private business and graduated into PPP models. Ziqitza was the first organisation which identified the need for cross subsidiary model."

Experts during photo-ops with Dr Ravi Gupta (third from left), Editor-in-Chief, eHealth Magazine and Founder Publisher & CEO, Elets Technomedia at the Conclave

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A Glimpse of Inaugural Session

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CONFERENCE REPORT 32

Eminent Dignitaries Visiting Innovation Gallery

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Thank You for Making Healthcare Summit a Grand Success!

We would like to take this opportunity to thank the Department of Health, Medical Education & Family Welfare, Government of Jharkhand, and everyone else who supported our conference. We appreciate the time, efforts, and skill of the participants.

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INDUSTRY PERSPECTIVE 34

‘Ensuring Sustainable Quality Healthcare to Masses’ As a leading healthcare provider Dr Mehta’s Hospitals has carved a niche through it sole vision and mission to cater patient with best facilities in cost-efficient manner. With a legacy of tens of millions consumers, one million plus successful deliveries, and top one percent benchmarked clinical outcomes, the hospital has envious track record, says Sameer Mehta, Vice Chairman, Dr Mehta’s Multispeciality Hospital, in conversation with Mukul Kumar Mishra of Elets News Network(ENN).

With over eight-decades of experience in healthcare, Dr Mehta’s Multispecialty Hospital has come a long way since its inception in 1933. Give us an overview of the journey. Dr Mehta’s Hospitals, the pioneer in quality healthcare and healthcare transformation in India is widely recognised as a leading healthcare provider in India. With over 85 years of expertise and experience, we have helped heal consumers across generations and is the oldest and most experienced private hospital in India. With a legacy of tens of millions consumers, one million plus successful deliveries, top one percent benchmarked clinical outcomes and over 250 thousand complex surgeries, Dr Mehta’s Hospitals is committed to live up to the expectations of families by providing world-class care closer to home. We are probably the only hospital in India with two families with four generations born at Mehta’s, 300 families with three generations born at Mehta’s and over 20,000 families with two generations born at Dr Mehta’s (that we know of).

SEPTEMBER 2019

Tell us some distinct facts about facilities and services you offer to patients. Delivering very strong ethical, effective, stringent infection control has helped Dr Mehta’s to deliver top clinical outcomes consistently and has helped heal over millions of our consumers across all age groups. Dr Mehta’s Hospitals is widely respected as among the safest and healthiest birthing locations in India having helped deliver over one million successful births. Our pediatric speciality units, emergency services, neonatal, pediatric intensive care and orthopaedics have been recognised by clinicians and consumers as leaders and Center of Excellence across India.

Affordability and costefficiency are major issues of the Indian healthcare sector. How do you analyse the statement in context of your hospital? The cost of healthcare today is being influenced greatly by the payer and the policymakers, making it a complex challenge to deliver quality healthcare at low cost. We at Dr Mehta’s strongly believe

Sameer Mehta Vice Chairman Dr Mehta’s Multispeciality Hospital

that leveraging technology and optimising the value of the critical resources like the doctors and nurses will help deliver sustainable quality healthcare at low cost.

How do you analyse the Indian healthcare system in terms of leveraging technology and innovations to improve patient care? Indian healthcare is evolving with unprecedented rate like never before. The sector is experimenting with

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technology available for resource optimisation, cost reduction, improved quality and clinical outcome. The industry is much more open and receptive today to looking at technology and consortiums like Consortium of Accredited Healthcare Organisations(CAHO), Association of Healthcare Providers (AHP) have started creating a platform for healthcare and technology to come and resolve the problems together, which was not possible a few years ago. Today in our hospital the doctor spends less than two minutes for the entire documentation from assessment to prescription allowing more time for better communication with patients. This was possible because of the EMR which we have designed and adapted.

India faces huge challenge of skilled workforce in terms of doctors, nurses and technicians which affects delivery of services in rural areasâ&#x20AC;Ś.What is your viewpoint? Itâ&#x20AC;&#x2122;s not just in rural areas, even in urban settings sourcing, training

and retaining are big challenge. The critical gaps in access, quality, patient safety and customer experience can be bridged greatly by low cost technology like telehealth. Monitoring health remotely like Health Sensei could help solve issue pertaining to health workforce.

Unveil you plan of expansion or collaboration with any Government for any specific project. Dr Mehtaâ&#x20AC;&#x2122;s has just launched new 250-bed multispeciality hospital in Chennai and is looking forward to provide a high quality, fully digital and integrated medical experience to our customers. Soon, we will be expanding it to a 1,200 bed facility in order to provide a variety of options in various types of medicine systems including alternative medical therapies.

GLIMPSES OF THIT 2019

9th International Conference on Transforming Healthcare with IT Heartfelt Thanks to all delegates, speakers and sponsors for being with us at the 9th International Conference on Transforming Healthcare with IT, HICC Novotel, Hyderabad, on September 12, 13, and 14, 2019.

GLIMPSES OF THE CONFERENCE

The conference days of 13-14, September saw 49 speakers from 12 countries and 780 delegates. We had exhibitors from 47 Health IT solution providers. It was heartening to see participation from NitiAayog, Union Ministry for Human Resources Development, Union and State ministries of Health and Family Welfare in addition to trade delegations from UK, Holland, Mongolia, South Korea, and several African nations. It is indeed heartening to see that the conﬂuence of technology and patient safety resulted in a genuine and action-oriented “International Health Dialogue”.

SEPTEMBER 2019

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9th Interna*onal Conference on Transforming Healthcare with IT Some interesting highlights were Microsoft announced the National Preview of the Cardiac Risk Score, Zebra Med announced Thanksto the ML algorithm for brainspeakers bleeds, CHiME Hear%elt all delegates, and sponsors for being with us at the 9th Interna:onal unveiled the plans for the innovation collaboration in IT, India, Conference on Transforming Healthcare with HICC Novotel, Hyderabad, on September 12, 13, and 14, and Apollo Remote Healthcare in collaboration with Zipline 2019. and Government of Telangana announced the launch of pilot Glimpses of theDelivering conference: program “Drones Medicine”.

GLIMPSES OF THIT 2019

The CHiME Masterclass on Leadership and Digital Transforma:on saw close to 84 delegates with CIOs from 35 hospitals and health systems in India. The presence of the leadership team from CHiME( College of Health Informa:on management execu:ves) was truly inspira:onal and mo:va:ng. The depth of the knowledge shared in the masterclass was deeply per:nent to the audience. Beyond all of this, we deﬁnitely had a very enlightening session from you that truly made the conference and its content stand out. We are deeply thankful that you could take time from your busy schedule and share your insights with all of us. We look forward to your continued friendship and collaboration... SEE YOU IN 2020 www.transformhealth-it.org

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The conference days of 13-14, September saw 49 speakers from 12 countries and 780 delegates. We had exhibitors from 47 Health IT solu:on providers. It was heartening to see par:cipa:on from Ni:Aayog , Union Ministry for Human resources development , Union and State ministries of Health and Family welfare in addi:on to trade delega:ons from UK , Holland , Mongolia , South Korea, and several African na:ons. It is indeed heartening to see that the conﬂuence of technology and pa:ent safety resulted in a genuine and ac:on-oriented “Interna:onal Health Dialogue”.

A pre conference CHiME Masterclass on Leadership and Digital Transformation was held on 12th September 2019 and saw close to 84 delegates with CIOs from 35 hospitals and health systems in India.

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INDUSTRY PERSPECTIVE 38

SafePoint India Applauds Bihar Govt for Adoption of ‘AD Syringes for Patient Safety’

r (Col) HS Ratti, Public Health expert, epidemiologist and project advisor to SafePoint India has applauded the Bihar Government for adopting auto-disable syringes in all medical colleges & PSEs across districts of Bihar. The move holds importance in order to contribute towards promotion of safe injection practices across country. The Governments of Punjab and Andhra Pradesh have already adopted this as a State policy. Bihar now joins the league and takes the lead to encourage use of Auto-Disable Syringes in Bihar. Dr HS Ratti, said “I congratulate Bihar Govt. for implementing this important initiative and we are hopeful that Bihar Govt will soon switch to auto disable syringes in all private sectors as well. If need be, as a value addition, SafePoint India is ready to help Govt. of Bihar by offering to conduct training programmes for all the healthcare workers of Bihar on correct and best injection practices to avoid hospital borne infections.” SafePoint India urges, Sanjay Kumar, Principal Secretary Healthcare; Dr NK Gupta, Bihar State Blood, Safety Nodal Officer; and Sanjay Singh, Managing Director, BMSICL to kindly review and implement 100% usage of AD syringes in private sector as a State Govt. policy. INCLEN study estimated that India consumes over four billion syringes per year of which nearly 60% are found to be unsafe and 1/3 being reused. Addressing the unsafe injection practices is an important public health

SEPTEMBER 2019

agenda, especially in low and middle income countries. WHO has made it one of the main goals of its Patient Safety Programme. With advancement in medical technology the patient safety profile have also changed. While modern technology brings advanced safety, it also brings new complexity. Govt. of Bihar endeavours to find technological solution to progressively and positively impact the safety of patients and care providers. “We urge the Central government and other progressive States who are still contemplating on the adoption of AD syringes to follow the lead taken by Bihar, AP & Punjab in Healthcare System Strengthening and lowering burden of infections by breaking the cycle of cross infection – let there be no more Unnao, no more Modasa type tragedies in India. We urge West Bengal & Odisha Govt. who have partially adopted the use of AutoDisable Syringes to adopt 100% use of AD syringes ”, added Dr Ratti “We are hopeful that Govt of Bihar launching ‘AD Syringes for Patient Safety’ is a commitment towards elimination of HIV and Hepatitis Epidemic.” added Dr. Ratti Global Campaign for use of Safe Injection Practice came early in 2015 when WHO Director General Margaret Chen flagged off the largest Global initiative since Polio Eradication and Hand Wash Campaign called “Global Health Initiative on Injection Safety” and chose India, Egypt and Uganda as the focus countries to spearhead the campaign. WHO had stated that for every

dollar invested in Injections Safety, the RoI (Returns on Investment) was 14 dollars. WHO issued advisory to all Member States and Institutions to go for mandatory use of SMART AutoDisable Safety Engineered Syringes in healthcare system by 2020 and urged all Donor Institutions to supply only AD / RUP / SIP Syringes henceforth in their campaigns depending upon local manufacturing capacity and availability and affordability. Many countries including USA, EU, Canada and Japan have already adopted Safety Engineered Syringes (SES) said Dr HS Ratti, an Army trained Public Health expert epidemiologist and advisor to SafePoint India.. “The poor hygiene in hospitals acts as amplifier for disease as patient gets admitted for a specific treatment but ends up getting treated for a hospital acquired infection. The reuse of medical syringes continues to be a matter of serious concern as it poses grave health risks both to the patient as well as to medical professionals in light of growing AMR (Anti Microbial Resistance) and also acts as a barrier to the Government’s resolve of eliminating these diseases by 2030,” said Dr HS Ratti.

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any people may have experienced searing pain in their back. Numerous creams and treatments proclaim about a total cure and relief from it, but very few actually have a beneficial effect. Even if it happens, that too is temporary. Even nontraditional and nonmedicinal methods have proved to be rather futile on this matter. Chronic back ache can cause a lot of discomfort and can lead to other health problems as well. Early detection and cure goes a long way in not only providing relief but also in leading a hassle free and normal life. Now a total solution of back problems is available in the form of “Back and Neck Clinic”. Situated at the Vihaa Multi speciality hospital near Roundtana in Anna Nagar, Tamil Nadu, the Back and Neck Clinic has a unique treatment called ‘Better Back Solution’, which guarantees the highest quality chiropractic care. Leveraging modern

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technologies, it helps patients to reduce or eliminate back pain forever. The back and neck clinic is a unique multi-disciplinary place for the non surgical treatment of severe back and neck pain. Here, the most advanced techniques are available, which are put to use to increase the patient’s physical capacity and to help them return to their daily activities, work and sports. With the help of unique equipment, “DRX9000”, the clinic provides cure to its patients. The equipment proves its worth in terms of reducing back pain in almost 86% of the patients who have undergone this treatment. The trained personnel at the clinic includes Orthopaedicians, Physiotherapists, Patient Counsellors who specialise in neuromuscular, musculoskeletal heath and the full spectrum of comprehensive injury treatment and rehabilitation using non-invasive method of therapy, that is, without surgery. There are abundant reasons for chronic back pain which include hectic lifestyle, active participation in sports, occupational or automobile accidents, bending, lifting, spraining etc. and also due to incorrect back posture, sitting habits, frequent and routine travelling on bumpy roads. These cause

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‘Offering Best Remedy for Backache’ M herniated discs, bulging discs, which puts a halt in one’s daily activities and disturbs the routine. A complete solution for these problems has been found through DRX9000, which is the only FDA Approved Spinal Decompression Machine. Here at Back and Neck Clinic, a new and better option for lower back pain treatment called Discogenic pain treatment is available. It is a combination of non-surgical spinal decompression followed by muscle stabilisation and strengthening. A study published in the American Journal of pain management states that decompression method done with the use of DRX9000 provides excellent relief in 86% of patients with ruptured intervertebral disease and 75% of patients with facet arthosis. Every patient completing the spinal decompression therapy experienced improvement, ranging from being completely pain-free to experiencing a substantial relief from pain, numbness or tinging. With the available facilities and treatment at the Vihaa hospital, there is no need to silently bear back ache any more. Now those suffering from constant back and neck pain can say goodbye to the throbbing pain and welcome a painless and trouble free routine.

(Writer is Dr. J. Hariharan M.S. Ortho, Vihaa Multi Speciality Hospital.)

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SEPTEMBER 2019

INDUSTRY PERSPECTIVE

‘Healthcare Industry Undergoing Paradigm Shift’ The experience industry runs on a different philosophy and the key driving factors are empathy, compassion, ethics, expertise and experience. Bloom Hospital is making a giant leap to serve patients by adapting to the new norms of the Experience Industry by shifting from Patient Satisfaction to Patient Experience. With the X & Y Gen the interface and interaction models are changing, Leveraging ICT and digital platform has become essential, says Raj Shekher Janapareddy, Director, Bloom Hospitals in conversation with Mukul Kumar Mishra of Elets News Network (ENN).

Bloom Hospital has created a niche for itself, serving patient with an international standard healthcare services. Tell us about its mission and vision. We believe in providing quality healthcare services enriched by ethics and expertise. Our mission is to bring back ethics into quality medical care delivery system by embracing best practices enabled by modern technology. Bloom hospital practices preventive over curative healthcare and ensures holistic health to people at large, leveraging ICT and digital platforms. With the changing world order, we may have to do version 2.0 with our vision too. Vision can no more be static.. it has to be dynamic and adaptive to changing needs.

Give us a gist about your offerings & services and tell something distinct about the same which makes you frontrunner in any particular segment. Our key specialties include Pediatrics, Gynecology & Obstetrics. We cater to the patients’ end-to-end needs in these specialties. The one thing that’s distinct about us is our attitude and approach to serve people with

SEPTEMBER 2019

hospital encourages normal delivery and dissuades couples to opt for C-section surgery. We have long term programmes to support couples with pre & post natal classes, yoga, physio, and nutrition. The best part is we make the couples participate in these programs together – our team put great efforts to make childbirth a memorable experience. We have painless, epidural, entonox assisted deliveries to it painless. Raj Shekher Janapareddy Director, Bloom Hospitals

holistic health. We not just listen and address to the chief complaint and the symptoms but try to get to the root causes (why, what, when, how) of the issue and address it. Many of our patients come to us after visiting multiple hospitals and clinics – saying they have recurrent episodes of illness and their relief is temporary. To name a few: in pediatrics our focus is on the holistic growth & development, wellness. We believe in early detection & prevention, and minimal use of antibiotics, etc. In gynecology & obstetrics, we focus on normal deliveries. The

Maternal and child care are considered an important part of healthcare delivery system. What kind of facilities does the hospital provide to patients? We have out-patient, speciality clinics, minor & day care surgeries, Neonatal Intensive Care Unit (NICU), pediatric intensive care unit (PICU), and intensive care unit (ICU). In addition, the hospital has other facilities including LDR birthing suites and modern operation theaters.

Affordable care is talk of the town and in the wake of costly equipment and other associated expenditure it becomes tough to achieve it practically. How you

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them with the help of best practices & technology Automation & Digitization.

Q maintain a balance between quality and affordability in fertility segment? Affordable is an oxymoron term. It is not clear - affordable for whom? which segment? and the scope? I firmly believe the attitude and approach should change - one should look at TCoT -Total Cost of Treatment – not piece meal. Today there isn’t a way to know the TCoT for the patients or the healthcare providers. They can only provide the individual costs of Consulting / Surgery but not the total. However at our hospital we look at affordability differently - the levers that drive the cost, include: • AoR: Admit only if required – based on the protocols • Where to admit: Normal room / Ward / ICU? Based on NEWS, UK. • Diagnostics: protocol based orders - specific test what is required. Plus, before giving orders for the test, one has to justify why it is ordered, and what actions will be taken on positive or negative results. • Medication: The hospital suggests only mandatory & essential medication. • LoS - length of stay of patient is determined based on the protocols. We have been able to achieve the some of the best results, which speak volume about our credibility in this domain. These include least LoS ~ 3 days; Medication ~ 1.2k/ day; Disgnostics ~ 1 k / day, and Readmissions : < 0.2%. We have been able to achieve this because of our change in philosophy and more importantly implementing

A section of patients today prefer minimally invasive surgery for any serious ailment as the process is less painful and provide quick recovery. Shed some light on the whole procedure. The technological developments in the field of minimally invasive surgery have opened up new horizons which have given the surgeons the options to achieve a greater degree of precision, accuracy, reduction in time for surgery, reduction in anesthesia time, and reduction in recovery time etc. But it should be used where it is needed – backed with rational medical reasoning. There should not be any perception that such surgeries are meant for business class not for economy class. One should understand that minimally invasive surgery may not be always expensive, at times it could be cost-efficient. In the case of ENT tonsilitis, adenoids the cobulation procedure could be a bit expensive but the length of stay reduces to 50 percent. One has to look into the total cost of treatment and not just only the surgery cost. When all factors are taken into account, at times patient finds minimally invasive surgery cheaper than the traditional procedure of surgery. The new technologies and innovations initially are expensive, but the costs drastically come down depending on the adoption and critical volumes.

Do you have any collaboration with the State Governments for any specific projects or any expansion plan in the near future? Yes, we do work with the State Government along with our partners Healpha, MGHN-UK in the areas of child health, mass gathering, and NCDs.

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