Taking Control-Medical Devices Industry to get a Regulatory Authority: March 2008 Issue

v o l u m e 3 | issue 3 | M ARCH 2008

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

Cover Story: Taking Control Medical Devices Industry to get a Regulatory Authority

Page 8

In Conversation: One Stop Shop George Paul, Executive Vice President (Mktg.)

HCL Infosystems

Page 18

Company Profile: Dr. Lal Path Labs Page 36

Exclusive Interview: O. P. Manchanda CEO, Dr. Lal Path Labs Page 38

Expert Corner: Implementing EMR Are Indian hospitals ready?

Anurag Dubey, Industry Analyst, Frost & Sullivan Page 46

www. e h e a l t h o n l i n e . o r g

ISSN 0973-8959

Rs. 75

w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 3 | March 2008

CONTENTS Cover story

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Taking Control

Medical Devices Industry to get a Regulatory Authority

eHEALTH Team

spotlight

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Preparing for the Healthcare boom

Sarita Falcao, Research Associate, eHEALTH

in conversation

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One Stop Shop

George Paul

Executive Vice President (Marketing), HCL Infosystems

EVENT REPORT

on 28Conference Medical Value Travel

eHEALTH Team

March 2008

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w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 3 | March 2008

COMPANY PROFILE

36

Dr. Lal Path Labs

eHEALTH Team

38 Exclusive Interview: O. P. Manchanda CEO, Dr. Lal Path Labs

EXPERT CORNER

46

Implementing EMR: Are Indian Hospitals ready?

Anurag Dubey Industry Analyst, Healthcare Practice, Frost & Sullivan

perspective

54

Virtual consultation a click away

eHEALTH Team

REG ULAR SE C TIO NS pRODUCT prOFILE

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india news

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BUSINESS NEWS

32

wORLD NEWS 40 NUMBERS events diary

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Editorial Guidelines eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. - an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and well-researched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and inter-national case studies, research outcomes, policy developments, industry trends, expert interviews, news, views and market intelligence on all aspects of IT applications in the healthcare sector.

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Volume 3 | Issue 3 | March 2008

president

EDITORIAL

Dr. M P Narayanan editor-in-chief

A hospital a town, keeps away the frown!

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eHealth G-4 Sector 39, NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org printed by

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The Union Budget 2008 is out and a silent celebration is on in almost every board room... (and drawing rooms too!)

Without a doubt, it’s a budget that will better everyone else’s budget. Be it a corporate giant, a small or medium business, a service holder or a pensioner.. there are reasons for everybody to smile. (I can see those glittering teeth!)

Healthcare in particular, finally got its booster budget. With a five year tax holiday granted for new hospitals in tier II and III cities, private players might now find it feasible to go beyond metros. Amidst the shower of appreciation bestowed on the government for this ‘path-breaking’ step to take quality healthcare beyond high-flying cities, there remains a simple question.

Exactly what took them so long (sixty years to be precise) to think of this simple thing?

Or is it that they have almost made it a practice to learn simple solutions to complex problems only the hard way! Wonder if one can find a simple answer to this simple question. Is it that the Goverment thought people in tier II and III cities could not have afforded private healthcare till now? Is it that they thought people in those cities should have a reasonable excuse to visit metros? Or is it that they finally gave up, and just gave in? I leave it to all of you to ponder on it and let us know.

Following closely at the heels of our hitherto sloppy healthcare system is another burning issue that we have fought for long - the unregulated medical devices market in India. However, finally there seems to be some ray of hope at the end of the tunnel...

The Government is contemplating to set up a Medical Devices Regulatory Authority of India or MDRA in short. The draft Medical Device Regulation Bill 2006, drawn up by the Department of Science and Technology, Government of India, is currently in circulation and it forms the basis for the proposed MDRA, expected to be established by December 31, 2009. There are mixed reactions from different corners of the industry, and for sure, the post-regulation era will have varying effects on different market players. Whatever it is, the end-objective needs to be met - ‘interest of patients should be safeguarded and maximum benefit should accrue ‘only’ to them.’ (Apologies for heartburn, if any!)

Get a low down on this and know what’s on the anvil in the cover story of this issue.

Let us know how much you enjoyed (or hated) this issue.

is published by Centre for Science, Development and Media Studies (CSDMS) is published & marketed in collaboration with Elets Technomedia Pvt. Ltd. (www.elets.in) © Centre for Science, Development and Media Studies www.csdms.in

March 2008

Ravi Gupta Ravi.Gupta@ehealthonline.org

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COVER STORY

Taking Control

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Medical Devices Industry to get a Regulatory Authority

The medical equipment market in India is growing at an annual rate of 15% and is expected to touch US$ 4.98 billion by 2012. With a highly unregulated environment in terms of quality, reliability, pricing and control, uncertainty rules the roost. Often, it’s a confusing maze for care providers and medical professionals, and the brunt of all this has to be borne solely by those at the end of the chain - ‘the patients’ !

There is a dire need for a legal framework and a regulatory agency to look after the industry. How far have we reached? Is the Government taking the right steps? eHEALTH takes stock of the matter.

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Background It is a widely known fact that the majority of all medical devices and equipments used in India are imported from abroad.

With high duties and custom fees, most of such devices would cost substantially higher (often exceeding 100% of the original price). Hence, the cost of diagnosis and treatments involving such sophisticated equipments remains prohibitive, and hence, well beyond the reach of common people.

However, there is a way around! Thanks to the longstanding government apathy and lack of proper regulations and legal obligations, there is a rampant market for old and refurbished medical devices that come quite cheap. Very often, outdated and even banned equipment from the Western world would land up in India and other unregulated markets at a fraction of the cost of the original one.

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Although no concrete data is available as to what extent accordance with the provisions of this Act.’ such devices have caused loss of life till now and/or hampered medical diagnosis and treatments, one can well underThe draft MDR Bill 2006 takes into account the lack of a proper legal framework for regulating the medical device stand how fatal things can be. market in India and also attempts to define the term ‘medical devices’ in accordance to international practice. The Chapter What’s Ahead: I,AB(6) of the Bill states that - ‘having regard to the proposal If things go as planned (don’t be surprised, miracles do for ensuring the safety of the public in the use of medical dehappen), you might just be saved from being subjected to one vices, and the fact that the content and scope of the present such ‘refurbished’ machine, the next time you go for machine laws of the country including the regulations and administrabased treatment/diagnosis at your neighbourhood clinic or tive provisions in force do not extend to and cover adequately medical center. the safety, health protection and performance characteristics of medical devices; and that in the amendments to the The Government of India is proposing to set-up a ‘Medical Drugs and Cosmetics Act, 1940, the scope of the definition Devices Regulatory Authority of India’ (MDRA) to regulate of the expression ‘drugs’ has been extended to cover ‘devicusage, manufacturing and marketing of medical devices in es’; whereas this definition does not adequately cover all the the country. The Department of Science and Technology has products which are covered by the current internationally acdrafted the ‘Medical Devices Regulation Bill, 2006’ which is cepted definition of ‘medical devices.’ currently being circulated for comments. The Bill seeks to set up the regulatory authority for ‘establishing and maintain- Definition of ‘Medical Devices’: ing a national system of controls relating to quality, safety, efficacy and availability of medical devices that are used in The MDR Bill 2006 defines medical devices as (Chapter I, India, whether produced in India or elsewhere and exported AD,12-O) ‘any instrument, apparatus, implement, machine, from India.’ appliance, implant, in vitro reagent or calibrator, software, material or other similar or related article: Overview of MDR Bill 2006 & MDRA: i) intended by the manufacturer to be used, alone or in comThe MDR Bill 2006 is proposed to be enforced as an Act bination, for human beings for one or more of the specific Parliament, the provisions of which are expected to come purpose(s) of: into force by 31 December, 2009. Thereafter, ‘the design, • diagnosis, prevention, monitoring, treatment or alleviamanufacture, packaging, labeling, import, sale, usage and tion of disease, disposal of medical devices in India, shall be in • diagnosis, monitoring, treatment, alleviation of or March 2008

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INDUSTRY SPEAK In the wake of formation of the proposed ‘Medical Devices Regulatory Authority’ (MDRA) under Government of India, how do you foresee the growth of market opportunities, reliability and brand value of medical devices industry of India?

This is a welcome initiative by the Government, which is in the interest of the entire industry, including the consumers. With the Indian healthcare sector moving at such a fast pace and getting more technology and capital intensive, there is no doubt that this regulatory framework is progressive and will only work for the general improvement in quality of healthcare in the country. India is probably one of the very few countries in the world where the medical devices industry does not have a regulatory process and mechanism in place. The MDRA will create a win-win situation for all stake-holders in the industry... consumers will obviously be saved from unscrupulous trade practices and risks of inferior equipment. Also, reputed manufactures will now be able to compete on level playing fields without any threat from rampant proliferation of low-cost and sub-standard manufacturers/importers - Praveen C. Rajgopal, General Manager - Marketing (India Cluster), Carestream Health India Pvt. Ltd. There will be no increase in the growth of the device market due to regulation of quality. There are willing consumers for high and low quality medical products in India. Until we see what standards are finally laid down for reliability testing, its not clear if the MDRA will improve their reliability.

The MDRA is a nascent brand... Indian hospitals tend to favour foreign standards over Indian standards e.g. CE/FDA over ISI even though most users have only a passing acquaintance of what the FDA or CE certifications mean for medical devices, or their implications for reliability. MDRA will have to be up to the challenge of displacing these huge brands (FDA/CE) that are today being accepted without scrutiny by most users. The government has a role in giving the MDRA a central role. It is imperative for the Indian market that MDRA be given preference over all other regulatory certifications like FDA/CE etc.

- K Y Ashok Murthy, Managing Partner, Erkadi Systems What are your personal expectations and wish-list from MDRA? ‘Simplicity’ and ‘Speed’ will be the key factors that will make this process work efficiently and be appreciated by the industry. The processes framed should be flexible and less bureaucratic such that the timeliness of technology is not lost. Procedural delays can often lead to missing out on potential market opportunities given the fast technological obsolescence in the field of medical devices - Praveen C. Rajgopal, General Manager - Marketing (India Cluster), Carestream Health India Pvt. Ltd.

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The MDRA should be autonomous, well managed and be able to subject all equipment being imported into or made in India. It is only in this way that it can become a truly India-specific standards organisation. Its relevance should be highlighted to users. Today, many foreign companies are able to get away with marketing their products as FDA approved, but when it comes to responsibilities like implementing recalls they have either not done so at all, or, done it at a leisurely pace. Hopefully, the MDRA will address this huge loophole.

- K Y Ashok Murthy, Managing Partner, Erkadi Systems Existing (unregulated) pricing system of medical devices has always been the single largest concern for care providers and patients. What can be the possible business implications on the industry in a price regulation era, post MDRA? The focus in a post MDRA era is more on quality healthcare and not so much on the pricing system. But a natural outcome of this process will be that healthcare providers will be able to ensure reliable quality in their patient-care, and for patients this would essentially mean more value for money in terms of assured levels of diagnosis and treatment. India will no longer be the dumping yard for obsolete and sub-standard devices from developed countries that have either been discarded or not allowed to market in their own countries. The business implication of such a system can only be positive for everybody involved in the value chain - Praveen C. Rajgopal, General Manager - Marketing (India Cluster), Carestream Health India Pvt. Ltd. MDRA’s real role should be to protect patients from being put on devices that are not up to the prescribed standards. It should also keep a check on healthcare providers from going in for sub-standard or refurbished products. There is a certain congruence of objectives of NABH and the MDRA, and I would encourage them to work in tandem e.g. in relation to proper maintainence of devices. Regulations will in fact, increase prices, but it is necessary to address safety and reliability issues. Of course, healthcare institutions will be affected. However, once regulation starts eroding their arbitrage advantages, it would appear that using indigenous products of acceptable MDRA standards is a better way for long-term, sustainable competitiveness. Therefore, in their own interest, Indian healthcare providers should support the MDRA over FDA/CE. Price regulation should be applied first at the front end, (i.e. on hospitals) and then worked backwards to the medical device manufacturers and pharmaceuticals, ensuring priorities are identified and addressed. When rising cost cannot be passed on, efficiencies brought about by scale and innovation will become the only way to survive and grow. The model of telecom sector where a regulatory body fixes prices for services, rather than handsets, is something that may work well even in healthcare.

- K Y Ashok Murthy, Managing Partner, Erkadi Systems

compensation for an injury, • providing information for medical or diagnostic purposes investigation, replacement, modification, or support by means of in vitro examination of specimens derived of the anatomy or of a physiological process, from the human body; supporting or sustaining life, control of conception, ii) which does not achieve its primary intended action in or disinfection of medical devices, on the human body by pharmacological, immunological or www.ehealthonline.org

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metabolic means, but which may be assisted in its intended to ensure the highest standards of competence and the broad function by such means.’ range of relevant expertise; regards being had also to the aspect of geographic representation from within the country.

Corporate Status & Composition of MDRA: (Chapter II, AF-17,18,19) The MDRA shall be a body corporate, having perpetual suc- Technical Panels of MDRA: cession and a common seal with power to acquire, hold and dispose of property, both movable and immovable, and to The MDRA will be consisted of three ‘Technical Panels’ of contract and shall, by the said name, sue or be sued. (Chapter relevant segments of the industry. These panels will take care II, AE,14) of specific issues such as a) Classification of medical devices and disputes regarding The MDRA shall consist of the following nine members to the same b) Conformity assessment and technical standards be appointed by the Central Government, namely  Two Members, to be nominated by the central govern- c) Medical devices testing and evaluation ment, not below the rank of Additional Secretary to the Government of India or equivalent rank to represent the The MDRA may also establish as many technical panels as it Ministries or Departments of the Central Government considers necessary on matters such as: a) Good manufacturing practices and quality systems dealing with (1) Science & Technology (ex-officio); (2) Health (ex-of- b) Medical devices packaging and sterilization c) Medical instrumentation and radiation safety, and also ficio)  One eminent jurist, to be nominated by the Central Gov- d) Sector wise such as - i) Anesthesiology and Respiratory ernment in the manner prescribed by the rules Therapy Devices; ii) Cardiovascular devices; iii) Den Two eminent medical practitioners, to be nominated by tal products; iv) ENT devices; v) Gastroenterology and the Central Government in the manner prescribed by the Urology devices; vi) Plastic surgery devices; vii) Obstetrules rics and Gynecology devices; viii)Ophthalmic devices;  Two eminent medical device technologists or scientists, to ix) Orthopaedic and Rehabilitation devices; x) Hospital be nominated by the Central Government in the manner disposables; xi) Neurological devices; xii) Radiological prescribed by the rules devices; xiii)Biological devices; xiv) and combinational  Secretary General of Quality Council of India (ex-officio) products.  Chief Executive Officer (CEO) of MDRA, (ex-officio) Conclusion There shall be a Chairperson of the MDRA who shall be With hopes flying high, finally, the medical and healthcare nominated by the Central Government from among the mem- industry in India might soon have their sigh of relief. With an bers other than the CEO. The Chairperson shall exercise such array of standardisation and control mechanisms coming in powers and discharge such functions as are laid down in this place, the thick, old ‘haze’ might just give way to ‘clean’, clear Act or as may be prescribed by rules or regulations. The CEO days, where quality is assured, performance is guaranteed, of the MDRA shall be appointed by the Central Government price is fair and most importantly.. class is among the best. on the recommendations of a selection committee to be constituted by it. The selection shall be made in such a manner as Keep your fingers crossed !

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SPOTLIGHT

Preparing for the

HEAL HCARE BOOM 9 million jobs are expected to be created in the health care industry by 2012. Find out where, why and who stand to gain the most.

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ooking to the rapidly increasing demand of specialists in Hospital and Health Management, the Institute of Health Management Research (IHMR), Bangalore, is preparing professionals to take up middle and senior level managerial positions in corporate hospitals like Fortis, Max, Apollo, Escorts and Wockhardt; International health care organizations like UNICEF, UNFPA, UNDP, Care, Futures Group, Population Services International; IT companies like TCS and Covansys that work on health care solutions and health insurance companies or TPAs like Bajaj Allianz, Raksha, Tata AIG and other health based organizations.

Their Post Graduate Professional Program in Hospital Management (PGPHM), scheduled to begin in February, is an 11 month full time course. The Institute will conduct two programs this year and students will have the option of specialising in: a) Hospital Operations Management b) Marketing Management c) Finance & Accounts d) Strategy Management March 2008

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Though the course is open to students from all streams of medicine, preference is given to graduates of MBBS, Dental Surgery, Physiotherapy, Occupational Therapy, BAMS (Ayurvedic), Yoga & Naturopathy and Homeopathy.

As part of the training, students work with hospitals and health care organizations in the country or abroad for a period of four weeks to understand the structure of the organisations, their activities and workflow. Proof of the popularity and necessity of such a course is borne out by the 100 percent placement rate of past batches.

The IHMR branch in Jaipur, Rajasthan offers a two-year post graduate program in Hospital and Health Management.

It recently began offering a specialisation in IT in health c are, along with other options of Health, Hospital and Pharmaceutical Management. The programme’s highly selective admission process ensures representation of diverse educational and work backgrounds.

The course, which is also open to graduates from any stream (subject to a management aptitude test), is aimed at developing trained professional managers with requisite skills in planning and operating management techniques; diagnosing and solving management problems; and acquiring consultancy skills. This is with a view to prepare them to manage hospitals and pharmaceutical and health care institutions in developing countries both in the public and the private sectors, to meet the rising demand for quality care.

Currently there are 837 medical, dental, nursing and pharmacology colleges with an annual intake capacity of less than 40,000 annually. Medical education infrastructure in India has grown rapidly over the past 15 years. However, some states like Jharkhand, Madhya Pradesh and Tamil Nadu still

have a high doctor to population ratio of over 1:20,000. This reflects not just the lack of manpower, but also the uneven and highly skewed distribution of medical personnel in favour of economically developed and urban areas.

In the medium to long term, this translates into a range of auxiliary industries and in turn, millions of new job opportunities. Educational institutions are fast realising the need to cater to these sectoral needs – both numerical and qualitative. Apart from doctors and nurses, paramedical staff, entrepreneurs, health insurance employees, hospital managers, business managers and other such non-clinical personnel are required.

The health care informatics sector alone employs over 8000 professionals. Application maintenance, system integration,

BIOINFORMATICS

Cheminformatics

Major institutes/universities in India, offering a specialised course are:

The combination of chemical synthesis, biological screening and data-mining approaches used to guide drug discovery and development, will be the most sought after science in coming future. The integration of cheminformatics with related disciplines such as genomics, proteomics and the application of these sciences are the most sought-after careers worldwide.

 Institute of Bioinformatics and Applied Biotechnology (IBAB), Bangalore  Indian Institute of Technology Delhi (Biochemical Engineering and Biotechnology), and IIT Kharagpur. You need to qualify IIT-JEE Entrance exam for admission into IITs  Jawaharlal Nehru University (Advanced Graduate Diploma in Bioinformatics)  Madurai Kamaraj University, Madurai  The University of Pune, Maharashtra (Advanced Diploma in Bioinformatics)  Bioinformatics Institute of India, Sector 62 Noida ( U.P ). Correspondence course on one year Industry Program in Bioinformatics, Biomedical Informatics, Clinical Trial and Clinical Research, Pharma Regulatory Affairs, Biotechnology. Institute is also offering various online Program through www. biionline.org

Institute of Cheminformatics Studies offers a one year Post Graduate Diploma course in Cheminformatics.

C-56A/28, Sector - 62Noida - 201301, UP(INDIA), Tel : 0120 - 4320801/02 Mob: 09312355740 E-mail: reply@cheminformaticscentre.org

 Mar Athanasios College for Advanced Studies (MACFAST), Thiruvalla, Kerala

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Mobile: 09312355740 Website: www.cheminformaticscentre.org

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CLINICAL RESEARCH The clinical research industry continues to expand, creating new and lucrative vistas of employment. The average nominal annual salary growth across all the positions is 4% as against less than 1% for other segments. India’s pharmaceutical market, the second largest in Asia, is growing by over 9% per annum. Mc Kinsey estimates that the outsourced pharmaceutical clinical trial industry will touch INR 5,000 by 2010, requiring 50,000 professionals. As the amount of clinical research expands, a large number of researchers, trainers and business development managers will be required. Industry analysts expect total clinical research spending in India to increase by more than 30% annually through 2010. Over 250,000 positions remain vacant worldwide and salaries start at Rs. 2.4 lacs p.a. and go to over Rs. 15 lacs p.a. for professional with less than 5 years experience.

In 2007, the Indian Clinical Research Institute (ICRI) started an M.Sc. in clinical research in collaboration with Cranfield University, UK, at Delhi, Mumbai, Ahmedabad and Bangalore. It covers general pharmacology, clinical data management, business management, health economics, marketing and industry training. The course is designed to provide strong functional skills and the ability to integrate and apply them in different management settings. This is in addition to the Post Graduate Diploma in Advanced Clinical Research which it already offers.

application development, product reengineering/maintenance and Health Insurance Portability and Accountability Act (HIPAA) consulting are the main services outsourced. In 2007 India produced the most number of 120 HL7 (Health Level 7) certified professionals worldwide. HL7 is the main standard for data exchange in the health provider market. Ehealth is a fast emerging field which is shaping medical informatics, public health and business. It refers to health services and information delivered or enhanced through the Internet and related technologies.

However, India is yet to establish that it has a critical mass of specialist health care professionals to become a major hub of outsourced health medical service.

programmes. I also hope the government provides a policy framework to facilitate consolidation.” The government also needs to budget for medical insurance premiums to help those who can’t afford quality medical care.

Several major international health care companies are setting up shop in the country and government and private industry reports indicate that the pharmaceutical sector is growing at over 7% annually. The cardiovascular (15%) and anti-diabetic (10-12%) industries show an even higher growth rate. As a result, numerous large Indian companies have entered health care delivery. Max India, Ranbaxy, Escorts, Wockhardt and Birla are some of the big players who have entered the arena of speciality hospitals. SRL-Ranbaxy, Nicholas Piramal and Dr. Lal’s have expanded their laboratory services significantly in recent years.

With its large pool of technical talent and fast paced infrastructure development, India stands to gain tremendously from this labour-intensive industry.

This year, payer spending is estimated to increase to US$ 7.5 billion and provider spending is likely to touch US$ 26.7 billion. Approximately 60% of international health care organisations outsource more than half their IT operations.

Projects worth billions of dollars are also in the pipeline. Accenture, EDS, CGEY, FCG, Keane and IBM are some of the biggest players in this market.

The Indian health care industry is undergoing rapid expansion, driven by a host of factors and stimulants. Consistently high GDP growth rates are reflected in the growing demand for a variety of high-quality health services. The Indian Clinical Research Association (ICRA) estimates the current industry potential to be INR 1,408 billion (US$ 30 billion). This includes retail pharmaceutical, health care services, medical and diagnostic equipment and supplies. Private players are providing over 80% of services and this figure is expected to further increase in the near future. This segment includes private practitioners, for-profit hospitals/nursing homes and charitable hospitals. Says Shivinder Mohan Singh, CEO & MD, Fortis Healthcare, “I am looking forward to the governA gradually aging population has its specific demands. Carment granting “Infrastructure Status” to the healthcare sec- diac, diabetes and central nervous system – related specialties tor. I expect the government to support robust public health are urgently required to serve relevant population segments.

March 2008

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Institutes offering Hospital Administration* to medical students 

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Administrative Staff College of India, Bella Vista, Khairatabad, Raj Bhavan Road, Hyderabad-500 082. (In association with the Hinduja Foundation) All India Institute of Local Self Government, Sthanikraj Bhavan, CD Barfiwala Marg, Andheri West, Mumbai-58 All India Institute of Medical Sciences (AIIMS) Ansari Nagar, New Delhi-110 029 Apollo Institute of Hospital Administration, Apollo Hospital Campus, Jubilee Hills, Hyderabad-500 033 Armed Forces Medical College, Sholapur Road, Pune ASCI-Hinduja Institute of Healthcare Management, ASCI College Park, Banjara Hills, Road #3, Hyderabad-500 034 Birla Institute of Science and Technology, Pilani-333 031, Rajasthan Birla Institute of Technology, Mestra, Ranchi-835 125, Bihar Christian Medical College, Vellore-632 002, TN Department of Management Studies, Madurai Kamaraj University, Palkalai Nagar, Madurai-625 021 Faculty of Management Studies, University of Delhi, Delhi-110 007 Indian Institute of Health Management Research (IHMR), Opp. Sanganer Airport, Jaipur-302 011 IHMR, Bangalore Institute of Management Studies, Devi Ahalya Viswa vidyalaya, Indore-452 001, Madhya Pradesh Manipal Academy of Higher Education, University Building, Madhav Nagar, Manipal-576 119, Karnataka National Institute of Health and Family Welfare, New Mehrauli Road, Munirka, New Delhi-110 067 School of Medical Education, Gandhi Nagar, Kottayam-686 008, Kerala Tata Institute of Social Sciences, Deonar, Mumbai-88.

non-medical students 

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Tata Institute of Social Science, SionTrombay Road, Deonar, Mumbai400088 Apollo Institute of Hospital Administration, Apollo Hospital Campus, Jubilee Hills, Hyderabad-500033 Indian Institute of Health Management Research (IIHMR), 1, Prabhu Dayal Marg, Sanganer Airport, Jaipur-302011 Sri Ramachandra Medical College & Research Institute (Deemed University), Porur, Chennai-600116. Admission is usually on the basis of a competitive entrance examination.

Indian Institute of Social Welfare and Business Management Management House, College Square West, Kolkata-700 073 Phone :+91-33-22413648 /3756 /5792 /8694, Fax : +91-33-2241 3975 Symbiosis Centre of Health Care Senapati Bapat Road Pune - 411004

* (Indicative)

significant possibilities for advances in telemedicine, e-health and low-cost infrastructure.

Professionals in the health care industry today, need to also tap the possibilities offered by advancements in ICT to ensure that their skills have the maximum reach. The extreme shortage of specialists can be mitigated to some extent through ‘virtual’ consultation and online sharing of patient information.

The Indian job market requires professionals with a blend of technological, medical and managerial skills in order to keep pace with the major advances in data communication systems and networks.

The first initiative in this field was taken by the National Informatics Centre (NIC). The NIC state centres use teleconsultation on a regular basis to upgrade the knowledge of medical professionals in the North East, Uttrakhand, Lakshadweep, Maharashtra, Jammu and Kashmir and Orissa.

Ehealth Care Foundation’s (eHCF) School of Medical Informatics has a long-distance certificate course in Medical Informatics aimed at improving the ICT knowledge of general practitioners, surgeons and paramedics. Now with its fourth batch, the course contents include case studies on deployment of Windows Vista in Hospitals, exposure

High-stress levels are putting pressure Another factor which needs to be to Hospital Management Software and on existing facilities which are facing taken into account is the polarisation electronic health recording. a serious shortage of manpower and of currently available services. Rural InApollo Telemedicine Networking grossly inadequate infrastructure. dia remains under served, throwing up Foundation (ATNF) has developed the 16

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Ms Vijayanti Khare gives us an insight into healthcare management programs offered by Symbiosis Institute of Health Sciences.

What kind of educational background do students opting for the post graduate diploma in Hospital and Health Care Management come from?

The PGD program is mainly a distance learning program and the backgrounds range from practicing doctors, nurses, hospital front office workers, administrators, pharmacists and science graduates.

We now provide an MBA in Hospital & Healthcare Management, and the students range from microbiologists, biotechies, pharma, all streams of doctors, physiotherapists, nurses, BTechies, and even the humanities & commerce graduates. One wonders if, in fact, the MBA program is poised to be an alternative to an MD/MS? What is the average starting salary (INR per annum) one could expect after specialising in such a course?

The PGD program is a good upgradation, so it could change one’s package by a couple of thousands, but the MBA program is lucrative enough to fetch a range of INR 6-10 (lakhs p.a.) depending upon the graduation background and work experience. One must realize that this market is still in its infancy.

Does Symbiosis Institute of Health Sciences (SIHS) have a placement program for its students?

All programs have a placement assistance, but it is important to note that it is the credibility of the academic inputs and not the job agency aspect of the Institution.

Does SIHS plan to offer any similar courses in the future? If yes, what kind and why?

The programs in healthcare are in response to the trends, demands and changing scenarios in the management of healthcare itself. For a Business school like ours, the opportunity to educate, train and empower ‘health managers’ is immense and expanding. It is obvious that such programs have migrated from the traditional medical schools to B-schools!

Programs like, a graduate program in Medical Technology with 5 specializations (Imaging sciences, Cardiac care, Respiratory care, Dialysis care, Clinical care), a graduate program in Radiotherapy and an Executive MBA in Healthcare Management are on the anvil. Semester programs in super specialized Healthcare Management on the lines of HBS or Wharton are a part of the plans too.

Vaijayanti Khare Head - Corporate Relations Symbiosis Institute of Health Sciences, Pune

treat one in thousand population by 2012 (as against 600,000 in 2005). Exim Bank estimates that revenue generation from health care tourism in 2006 was over US$ 600 million.

The concept of ‘health cities’ has already caught on. Moreover, India is a young country with about a fifth of the population under 24 years of age. Policy makers have an important role to play and face major challenges to ensure an appropriate supply and distribution of trained health workers and to manage their performance in delivery of services.

first formal short course in Asia on Telehealth Technology. It is designed ‘to anticipate the demand for people with skills to deliver and manage new health care delivery systems’.

According to estimates, health and wellness is a INR 40,000 crore category, growing at nearly 15% annually. While analysts put the current countrywide demand - supply gap for doctors between 200,000 and 300,000, Ernst & Young estimates that the country will need at least 1.2 million doctors to March 2008

Human resources are the crucial core of a health system, but they have been a neglected component of health-system development. The demands on health systems have escalated in low income countries, in the form of the Millennium Development Goals and new targets for more access to HIV/AIDS treatment. Apart from the short supply of human resources to cater to our growing health care needs, there is a parallel need to maintain a high quality of education and education systems and the productivity of the health workforce. Expansion of continuing medical education (CME) facilities is also urgently required.

Sarita Falcao, Research Associate sarita@ehealthonline.org 17

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in conversation

One

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top hop

“HCL foresees itself as the IT partner of hospitals so that they can focus on their core activity of efficient patient care.”

George Paul Executive VP – Marketing HCL Infosystems What is the range and diversity of IT services/solutions that HCL Infosystems is offering for healthcare institutions? How are these services/solutions aligned for catering to varying needs for different players in the healthcare industry?

The future belongs to ‘convergence’. The last decade witnessed emergence of technologies that converge voice, video and data. Many of the applications that use such technologies have revolutionised the way we do business at present. In the next decade, we are expecting to see such applications and technologies getting into healthcare services, and bringing 18

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“With the entry of corporate hospitals and insurance companies, the way of healthcare delivery is changing and IT adoption is on the rise.”

real benefits in care delivery to patients. HCL with its specialty in multi-technology areas like - communication, imaging, storage, computing, printing etc. is using this know-how to deliver high performance solutions for the industry.

healthcare institutions. We have our core expertise in Hardware, Networking, Internet connectivity etc. Apart from these core areas, we have tied up with best-of-breed healthcare solutions in the market, and can offer hospitals complete integrated solutions and consultancy services. We have a good pool of in-house resources for this, and in future we plan to expand our resource base for this vertical. HCL Infosystems Ltd. is an ISO 9000 organisation and we practice best of internationally acclaimed standards in each of our business verticals.

Healthcare industry had been a rather ‘slow-taker’ of technology. What do you think are the primary reasons behind this trend?

I feel that this is primarily due to the traditional way our healthcare system has been working over the years. But with the entry of corporate hospitals and insurance companies, the way of healthcare delivery is changing and IT adoption is on the rise. We feel that the healthcare sector is poised to adopt IT in a big manner in future.

HCL Infosystems Ltd. is one of the largest ‘System Integrators’ in the country. We have been working in the healthcare sector for a long time… and in order to consolidate our exHow do you foresee the growth of healthcare IT market pertise in this industry, last year, we created a separate vertical in both short and long term? called the ‘SI Healthcare’ to address the ICT needs of hospitals and other healthcare players in the country.

The healthcare IT market is already happening in the short term and is poised for a giant leap in the long term. The The solutions which HCL can offer would include - Hos- healthcare industry now realises that IT is an enabler for them pital Information Systems, PACS, Telemedicine, Consultancy to provide good patient care at affordable rates. for Business Process Improvement, Datacenter creation and maintenance, Facilities Management, RFID based solution There is a huge shortage of beds in the country to meet the for patient and equipment tracking, Energy Audit and con- healthcare needs of the current population. As both governsultancy for efficient use of power in the hospitals, Building ment and private sector are jointly working towards creating Management Solutions, Information Display Solutions, Tele- the infrastructure to meet the growing healthcare needs, we com Solutions, Network Creation, Maintenance & Monitor- see that there is a big market for healthcare IT in the near and ing etc. long term future. Latest research estimates Indian healthcare IT market to reach nearly US$ 3 billion by 2010, growing at HCL foresees itself as the IT partner of hospitals so that they a CAGR of 22%. can focus on their core activity of efficient patient care. We would be also focusing on consultancy services for hospitals Currently, what is the annual revenue earning of HCL to help them identify right medical equipment and devices. Infosystems from the healthcare business vertical? What In addition, we can also help them with supply and mainte- market share do you expect to capture in next 3-5 years? nance of equipment using our capabilities and reach across the country.

I will not be able to comment on the revenues specifically from healthcare business vertical. As per the company policy, What are the core areas of expertise for HCL Infosys- segment wise revenue figures are not available in public dotems in system integration (SI) services? What technol- main. ogy standards and certifications do you adhere to in providing these services?

Presently, who are your major clients from the healthcare industry in India?

Our core areas of SI services are as mentioned previously.

We can meet all possible ICT requirements for hospitals and We have government organisations as our clients.

March 2008

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PRODUCT PROFILE

HEALTH BABY Leadtek has designed a complete home health care product in its new portable electrocardiogram – ‘Health Baby’, which can be used anywhere, anytime, in all kinds of environment – be it home, work, while travelling or sporting.

Built around Texas Instrument’s MSP430FG439 micro controller unit (MCU), it can be easily operated by simply placing thumbs on the two side wings of the portable device; or place the device on the chest, or on the forearms, or even under the armpit. Data collected through this device can be transmitted through a notebook, PDA or a smart phone and uploaded via Internet. One can also combine it with their supervisory control apparatus such as a videophone & carephone to connect with the hospital or healthcare group when in need of professional advice. Else, it can also record data with the help of a software directly on the Leadtek’s self-care site. An HRV Analysis also allows to get the report.

Features

How it really works:

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An electrocardiogram (ECG), also called an EKG, is a graphic tracing of the voltage generated by the cardiac or heart muscle during a heartbeat. It provides very accurate evaluation of the performance of the heart.

• • • • • • •

Small & accurate 3 electrodes (thumb, chest and forearm) for ECG detection Colour OLED display (128X64 pixels) Quick-start buttons and Easy-accessed rotational Low battery alarm Record for up to 6 users account and 120 records Integrate distance medical care system HRV analysis (with PC and Internet) Abnormality and finish warning sound

Specifications • • • • • • • • • •

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Dimensions: 43*36*15 (mm) Weight: 18g Heart rate measurement range: 30-120 beats/min Normal heart rate: 60-100 beats/min Temperature measurement range: 32.0*C-41.9*C Normal heart rate: 60-100 beats/min Temperature measurement range: 34.7*C-37.1*C Sampling rate: 256Hz Battery: Li-ion Battery (100 mA) ECG lead: 5 mins/lead I

The heart generates an electrochemical impulse that spreads out in the heart in such a fashion as to cause the cells to contract and relax in a timely order and, thus, give the heart a pumping characteristic. This sequence is initiated by a group of nerve cells called the sinoatrial (SA) node, resulting in a polarization and depolarization of the cells of the heart. Because this action is electrical in nature and the body is conductive with its fluid content, this electrochemical action can be measured at the surface of the body.

An actual voltage potential of approximately 1 mV develops between various body points. This can be measured by placing electrode contacts on the body. The four extremities and the chest wall have become standard sites for applying the electrodes. Standardizing electrocardiograms makes it possible to compare them as taken from person to person and from time to time from the same person. The normal electrocardiogram shows typical upward and downward deflections that reflect the alternate contraction of the atria (the two upper chambers) and of the ventricles (the two lower chambers) of the heart. www.ehealthonline.org

Monalisa Patient Monitor Key Features: • 8.4” Color TFT display with 4 wave forms • Suitable for adult, pediatric and neonatal patient care • Basic parameters (ECG, RSEP, TEMP, Spo , NIBP) in a durable case for bedside monitoring and transport • Audible and visual alarms with adjustable alarm ranges • SpO2 pulse-tone modulation (Pitch Tone) • Networkable with central monitoring system • Powerful data management and storage capacity • (72 - hour graphic and tabular trends for all parameters, 400 NIBP measurments, 60 alarm events 60 arthythmia events with waveforms, etc.)

Monet Patient Monitor Key Features • • • • • • • •

10.4” colour TFT display, with maximum 4 waveforms Parameters including ECG/RESP, SpO , NIBP, TEMP and Pulse Rate 2 Maximum 72-hour graphic and tabular trends of all parameters SpO pulse-tone modulation(Pitch Tone) 2 Adjustable 10-level alarm sound Optional recorder and removable battery Suitable for adult, paediatric and neonatal patient Networking capacity

Cellenium 2700

The Cellenium 2700 from Trivitron Diagnostics is an advanced, high-performance hematology analyzer providing accurate and precise CBC results and fully automated WBC 5-part differential.

Cellenium 2700 provides 27 parameters including 5 Part differentials, Research parameters ATY#, ATY%, LIC#, LIC% plus two scatter plots and two histograms.

Use of the latest technologies including flow Cytometry, laser scatter and chemical dye method bring about flawless separation between pathological and normal blood samples, and give the physicians a clear-cut picture of the patients’ hematological status.

Some of the salient features of this advanced system are: • Excellent separation of normal & abnormal cell populations, with use of flow Cytometry, laser scatter and chemical dye method.

• Separate channels for WBC LMNE and BASO analysis.

• Reliable, economical semiconductor laser as light source for flow Cytometry.

• Optional Autoloader, cost-effective discrete testing modes & real-time random access testing significantly improve Turn Around Time (TAT).

• Network capability allows for easy integration with computer network.

March 2008

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Large touch screen display with Graphical User Interface (GUI) ensures standard easy operation.

With optional Autoloader the system can run at 80 samples per hour. With the Walk-away capabilities, Cellenium 2700 is an ideal analyzer to meet the requirements of a large as well as medium size hospital or laboratory.

Use of long life, self lubricating shear valve and maintenance free fixed volume pumps in Cellenium 2700 ensures high precision and lower maintenance. Cellenium 2700 can reduce recurring cost, thereby making blood analysis affordable to the masses.

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NEWS REVIEW

INDIA

Centre to regulate private, public clinics

Budget Booster for Healthcare Industry

As the kidney racket throws light on illegal clinics running across the country, the Centre issued a statement saying it would soon bring in a law to regulate both private and public clinics.

“The Clinical Establishment Act is before a standing committee of Parliament and would be soon introduced,” Union Health and Family Welfare Minister Anbumani Ramadoss said.

Under the act, all public and private clinics across the country will have to register themselves.

“All the clinics across the country should improve the quality and standard of the services,” Ramadoss said while inaugurating a Diagnostic Centre set up as a public private partnership venture between Hindustan Latex, a mini ratna enterprise under the Ministry of Health and Central Government Health Scheme (CGHS).

Ramadoss said his ministry wanted to provide quality care and health related services to the beneficiaries of CHGS. HINDLABS is equipped with the most modern lab facility and will deliver reliable, accurate and quality diagnostic services to CGHS beneficiaries at CHGS rates. The same services will also be provided to patients outside the CGHS at affordable rates.

CGHS is one of the primary health care delivery networks of the Ministry of Health and Family welfare, which delivers economical and quality medical care facilities to Central government employees across the country.

The project, if successful, will be scaled up in the coming six months period in the national capital.

The recently announced Union Budget 2008 must have been music to the ears of healthcare service providers in the country. Taking cognizance of the tremendous potential of this rapidly growing sector and its impact on the society at large, Finance Minister, P Chidambaram doled out a five-year tax holiday for hospitals in tier II & III cities. Such a move is expected to trigger a surge of new healthcare facilities in non-metro cities/towns, which are currently in dire need of quality healthcare.

With a five year long tax-vacation, it might be an economical proposition for private players to spread beyond metro cities, and still remain profitable. At the same time, this will give a financial bandwidth for existing providers to revamp services and modernise their facilities.

Ripple effects of the Budget announcement was quite evident at the stock market, with healthcare majors gaining a handsome rise in stock prices over the day. While Fortis Healthcare seem to have gained the most with a stock appreciation of 7.4%, Wockhardt and Apollo also made their mark with an increase of 1.3% and 1.2% respectively.

Some of the other highlights for healthcare sector in the recent budget includes - INR 16,000 crore allocation for public health, 15% hike in outlay for NRHM, INR 30,000 insurance cover for BPL workers and INR 1,000 crore allocation for polio eradication in Bihar.

QCI-Max Seminar on Process Management & Globalisation for Indian Healthcare Industry Quality Council of India (QCI) in association with Max Super Speciality Hospital, Saket, New Delhi recently organised a half-day seminar on Process Management and Globalisation of healthcare industry in India. Conducted by Shashi Madhok, VP - Quality, Robert Wood Jhonson, University Hospital, Hamilton, USA, this two-part presentation focused on important aspects of process management for healthcare outcome indicators and globalisation of healthcare with high standards of patient care.

With a marked eloquence and a lucid presentation style Ms Madhok brought to light some of the crucial aspects of process management in the first part of her talk, with special emphasis on issues such as key performance indicators, quality control

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measures, service enhancement, process standardisation and the like. The second session specifically discussed global market opportunities for the domestic industry and the need for adapting international best practices and standardisation of care delivery. Keeping the audience involved throughout her presentation, Ms Madhok brilliantly responded to questions from the floor, infusing fresh perspectives to conventional wisdom and industry knowledge. Most appreciable aspect of the seminar was perhaps the seamless contextualisation of a rich professional experience in the western world with situations at the domestic healthcare industry. A true learning experience!

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Hinduja’s eye plan of medicity in Kolkata The Hinduja group has evinced interest to set up a state-of-the-art medicity near Kolkata. The proposed medicity will house a medical college, a dental college, a nurses’ training college and a super-speciality hospital. This was announced

by West Bengal’s commerce & industries minister Nirupam Sen. Talking to newsmen Mr Sen said: “We met Hinduja group supremo Ashok P Hinduja at Mumbai, urging him to invest in West Bengal. Mr Hinduja expressed his interest to make a foray into the state’s health sector. He is keen to set up a medicity or a multi-speciality hospital in West Bengal. If we can provide 50 acres, then he is willing to set up a medicity. For a multi-speciality hospital, the land requirement will be much less.” The minister has already informed the state health department about the Hinduja group’s proposal.

In fact, the Hinduja group at the recently held World Economic Forum in Davos had indicated that it has firmed up plans to invest US$ 1 billion in India’s commercial healthcare industry by setting up specialty hospitals in several cities. The Hindujas are already present

in the health care sector in India.

They have set up P D Hinduja National Hospital & Medical Research Centre in Mumbai.

The state government has also urged the Hinduja group to make some investments in the proposed PCPIR at Haldia and adjoining areas (including Nayachara island). “Hindujas have already decided to set up a refinery somewhere in western India.

We have urged them to set up a cracker unit at PCPIR.” said Sabyasachi Sen, the commerce and industries secretary, who was also present at the press conference.

Better healthcare key to good economic growth for India

Clearer pharma policy soon: Union Minister of Chem & Fertilisers

India must improve its health care system to realise its economic potential and the country is well positioned to tackle challenges in the sector, says a report.

Furthermore, public-private collaboration is required for better insurance coverage.

Widespread health education and better disease prevention could improve the health care system.

“The problems facing the system are large but not intractable, if business, government and civil society work together to solve them.“, said the report published by McKinsey Quarterly.

The report, titled “A Healthier Future for India”, pointed out that subsidising health care and insurance for the country’s poor people would be necessary to improve the system.

India is expected to become the most populous country by 2035 while it already has the youngest people - 20 per cent of the world’s people under 24 years of age.

According to the report, India has the privilege of learning from and avoiding, the costly errors of the advanced economies apart from having the opportunity to create new models for health care.

Moreover, increased availability of quality care, access to affordable health care services and awareness of the benefits of preventive measures are expected to help better the system.

The report also pointed out that lack of qualified medical personnel is a serious problem.

Union Minister of Chemical and Fertilisers, Ram Vilas Paswan, recently said that the much-awaited pharma policy would be cleared by the Group of Ministers in its next meeting.

“I am sure that GoM would clear the pharma policy in its next meeting, the date for which is not yet decided but it will be held soon.” Paswan told reporters.

The GoM, headed by Agriculture Minister Sharad Pawar has held three meetings so far, but has not been able to come up with an amicable solution.

However, the minister didn’t give any further information about the changes and the amendment needed to the draft policy to overcome the differences. “It is up to the GoM to decide what changes they want to bring in the draft policy.” he said.

The Union Cabinet in January 2007 referred the draft pharma policy to the GoM after differences arose between the chemicals ministry and pharmaceutical industry over certain provisions, including price control.

The draft policy, prepared by the Chemicals Ministry, has sought to expand the ambit of National List of Essential Medicines (NLEM) from 74 to 354 by bringing more drugs under price control.

The proposal had evoked a sharp reaction from the industry which argues that the move would adversely affect research and development activities in India.

The National Pharmaceuticals Pricing Authority (NPPA), the watchdog of drug prices, had also earlier made a presentation to the GoM on the status of the pharma industry, price of drugs and the need for price control.

March 2008

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Mobile telemedicine service soon in Andhra Pradesh Andhra Pradesh (India) Chief Minister Y.S. Rajasekhara Reddy has announced that mobile clinics will tour villages and telemedicine would be introduced through the ‘104 service’ being implemented in the state via the public-private partnership mode.

Addressing a meeting of the AP branch of the Indian Medical Association, he urged the medical fraternity to join hands with the Government in its endeavour to provide improved medicare to the poor.

Dr. Reddy said the mobile clinics would daily visit two villages situated 3.5 km away from the primary health centre to check blood pressure, diabetes and other health parameters of people.

The Chief Minister announced that a bill to replace the recently promulgated ordinance providing protection to government and private doctors would be introduced in the ensuing budget session of the Assembly. On the plea to include common diseases under the Rajiv Aarogyasri scheme, he said it was a totally different scheme meant to benefit low income groups by covering 210 specific diseases. He promised to provide land to IMA for constructing buildings in Hyderabad, Vijayawada and Visakhapatnam.

Private institutions were involved since the Government hospitals were not in a position to conduct so many surgeries. S.N. Mishra, allIndia IMA general secretary, and E. Ravinder Reddy, State IMA president, hailed the Government for promulgating the ordinance. Sangeeta Reddy, Executive Director of Apollo Hospitals, was among those who spoke.

Reliance Wellness eyes INR 6000 cr revenue in 3 yrs Reliance Retail’s tenth retail format, Reliance Wellness, a chain of beauty and wellness products, is looking at INR 6,000 crore revenues from its operations in the next three years. The company will have 1,200 stores by then.

The company has six wellness stores, including the 3,500 sq ft store it opened in Chembur, Mumbai, on Thursday and plans to open 150 stores by the end of 2008-09. For a 3,500 sq ft store, it employs 16 people and invests INR 80 lakh.

They intend to hire 19,000 people and invest INR 900 crore in the wellness business.

The wellness stores have four broad categories such as health foods, personal care products, healthcare products and pharma products and sell nearly 8,000 items.

According to estimates, health and wellness is a INR 40,000 crore category and growing at nearly 15 per cent every year. Health and wellness products have a margin of 15 per cent to 30 per cent and sourcing them directly from manufacturers would increase the gross margins of the retailers, the sources said.

Symposium on “Emerging Therapies in Heart Failure” Organized by Escorts Heart Institute and Research Centre Escorts Heart Institute and Research Centre Limited (EHIRCL) organized a symposium on ‘Emerging Therapies in Heart Failure’ on February 24, 2008 in New Delhi. Concerned over the rising cases of Heart Failure and lack of awareness about the factors leading to heart failure, doctors from across Delhi & NCR came together to discuss the latest technology available for its treatment. Eminent cardiac specialists from EHIRCL like Dr. T. S. Kler, Dr. V. K. Chopra, Dr. Peeyush Jain, Dr. Suman Bhandari, Dr. Aparna Jaswal, Dr. Nishith Chandra addressed the sessions of the symposium with case studies.

Dr. Roberto Ferrari, Director of the Centre of Cardiovascular Research, Gussago, Brescia and Dr. Inder S. Anand, Director, Heart Failure Programme. VA Hospital, Minneapolis and Secretary, World Heart Failure Society also addressed the sessions and discussed global trends in the field of Heart Failure.

Dr. T. S. Kler, Executive Director, Escorts Heart Institute and Research Centre, said, “The rising number of heart failures can be treated if the symptoms are detected in patients at an early stage. Although there are medicines and devices available to help patients survive longer; patients should try to help themselves by making lifestyle changes such as stopping smoking and eating a healthy diet containing fruit, vegetables and fibre.”

Talking about the growing application of modern technology in treatment of Heart Failure, Dr. V. K. Chopra, Senior Consultant, Department of Cardiology, EHIRCL said, “Several heart assisting devices like pacemakers, ICDs etc have significantly helped heart failure patients live a longer and healthy life. We hope that researches and studies will make these devices accessible to a large number of people very soon.”

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Global Healthcare Transformation Congress 7th & 8th April 2008 I Kuala Lumpur, Malaysia Global Healthcare Transformation Congress brings you the best in professional development offerings, opportunities to network with and learn from peers in the field, and the latest healthcare information to enhance your career and your organization.

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CRITICAL REASONS WHY YOU SHOULD ATTEND

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Gaps in rural healthcare facilities Despite being one of the most developed states in the country, 93 per cent of hospital beds in Maharashtra are in urban areas, claimed an advocacy group which released a survey on health inequities recently.

The study, based on secondary data analysis done by Support for Advocacy and Training to Health Initiatives (SATHI) has found the rural population, women and persons from the backward class population do not have the same access to healthcare as others.

“The rural population, poorer sections, women, Scheduled Castes, Scheduled Tribes and Muslims bear a heavier burden of deprivation resulting in bad health. In addition, they have much worse access to health care,” said Magsasay award winning journalist P. Sainath , who released the report.

Other findings of the report, which is based on primary data obtained from reports which government bodies have come out with are - 32.6 per cent women have low body mass index compared to 24.9 per cent in men.

The report claimed that 54 per cent of the SC/ST population in rural areas live below the poverty line. It claimed that many people have stopped using the health care system due to “privatisation”.

“Two hundred million people have stopped seeking medical attention as they cannot afford it. Sadly, we are emulating the US model of private health care rather than that of other successful public health systems world over,” said Sainath.

LIC’s Health Plus insurance policy under IRDA lens Life Insurance Corporation of India (LIC) has launched its first long-term unit-linked health insurance policy called Health Plus, which will provide health cover for an entire family.

The plan will have 3 components - hospital cash, major surgical benefits along with a ULIP component to meet domiciliary treatmentrelated expenses for insured members.

Hospital cash benefit is a daily benefit payable in case of hospitalisation and the maximum account can be between INR 250 and INR 2,500 for the principal insured. The maximum account for spouse/child is INR 1,500.

In case of hospitalisation in an ICU, the amount payable is double the eligible daily cash benefit. If the insured undergoes any major operation as mentioned in the policy, a lump-sum benefit, regardless of the actual costs incurred, will be payable.

But Health Plus has now run into trouble with insurance regulator IRDA. LIC officials had told reporters that the premiums paid under the scheme will be eligible for tax benefits under section 80D. After reports of the launch of the LIC product and the tax benefit, IRDA wrote to LIC seeking clarification on the issue.

The portion of premium that belongs to the base health cover will be eligible for tax benefits under section 80D. The balance of the premium that goes towards the wealth earning or unit linked plan comes under section 80C. According to LIC, however, the product was approved by the regulator as a health insurance product and therefore should be eligible for the same benefits.

Chandigarh launches telemedicine project The Chandigarh Administration has launched a telemedicine project to provide critical healthcare advice and right treatment, thereby eliminating unnecessary travelling of patients for high quality medical services.

The project would enhance communication between Government Medical College and Hospital (GMCH) and Post Graduate Institute of Medical Education and Research (PGIMER) of Chandigarh for better patient management and health services.

Under the project, a state-of-art telemedicine facility will be available at GMCH. Realising the shortage of specialists in the Health Department not only in Chandigarh, but also all over the country, the GMCH would start providing the best care to the patients in this region through telemedicine. The Chandigarh Administration will expand this network and interconnect all medical facilities under it for seamless flow of patient related information for better implementation of national and local healthcare projects.

It would also result in faster dissemination of knowledge from centres of excellence to lesser hospitals, which would ultimately result in overall improvement in healthcare delivery.

This project will be a stepping stone which in future would lead to a more comprehensive all inclusive network for providing excellent healthcare to people of the region.

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16-18 April 2008 Luxexpo, Luxembourg

THE INTERNATIONAL EDUCATIONAL AND NETWORKING FORUM FOR eHEALTH, TELEMEDICINE AND HEALTH ICT Med-e-Tel offers opportunities to meet and network with qualified buyers, specialists, users, healthcare providers, industry representatives, researchers, and policy makers from 50 countries around the world.

The event provides hands-on experience and an opportunity to discover and evaluate new products, systems and technologies and to hear about the latest ehealth/telemedicine news and trends.

Med-e-Tel features an extensive educational and conference program with more than 150 presentations and workshops on a wide variety of telemedicine and ehealth topics.

Med-e-Tel 2007 was accredited by the European Accreditation Council for Continuing Medical Education to provide 18 CME credits for medical professionals. Accreditation for the 2008 event is also underway.

Topics will include a.o.: - personal monitoring systems - use of ICTs in independent living for the ageing and disabled - chronic disease management - mobile ehealth solutions - telemedicine for diabetes care - telecardiology - telepaediatrics and child health experiences - telenursing

- telepsychiatry and mental health - interoperability and standardization - maximizing the potential of ehealth in low resource settings - early warning for infectious diseases - satellite communication - elearning - and more

Additional events being planned in conjunction with Med-e-Tel 2008, include meetings and workshops by some of the following organizations: - International Society for Telemedicine & eHealth - International Association of Homes and Services for the Ageing / Center for Aging Services Technologies - European Commission & European eHealth Projects - World Health Organization - European Telecommunications Standards Institute - World Academy of Biomedical Technologies - United Nations Office for Outer Space Affairs - Centre de Recherche Public – SantÊ For registration, exhibition and sponsorship applications, conference program, hotel and travel information, newsletter subscription and more, go to: www.medetel.lu

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in conversation

Conference on

Medical Value Tourism 7 – 8 February 2008, CII Northern Region Headquarters, Chandigarh

(left to right) S. M. Singh, CEO & MD, Fortis Healthcare; Dr. Manjit Singh Bains, Director, Health Services, Chandigarh Administration; Dr. Rana Mehta, Principal Consultant, Technopak Advisors; Pratap K Aggrawal, Chairman, CII Chandigarh Council & Managing Director, IDS Infotech Ltd.

CII Northern Region Headquarters recently organised a one and half day conference on medical value tourism, between 7-8 February 2008 at the impressive office premises of its headquarters in Chandigarh.

The august gathering, comprising eminent healthcare professionals from leading medical institutions and corporate houses across the country, engaged in serious deliberation to take stock of emerging market opportunities, level of preparedness among service providers, best practices, benchmarks and most importantly, the challenges in terms of existing public infrastructure and government policies.

Pratap K Aggrawal, Chairman, CII Chandigarh Council & Managing Director, IDS Infotech Ltd. delivered the opening remarks of the event, emphasizing the US$ 2 billion medical tourism market projected for India, by the year 2012.

Powered with an impressive presentation Dr. Rana Mehta, VP-Healthcare Practise, Technopak Advisors, gave a vivid insight into the present and future landscape of medical tour28

ism in India. “3-4 million people came to Asia in 2007 for medical care, and most of them were from US, UK, Middle East and Africa”, said Dr. Mehta. Highlighting the estimated 30% compounded annual growth rate (CAGR) for medical tourists visiting India, Dr. Mehta said, “nearly 1 million foreign patients are expected to visit India in 2012, considerably higher than 0.175 million who visited the country in 2005”.

In order to facilitate medical value travel, development of proper public infrastructure and sound civic amenities are definite pre-requisites. With the existing ground conditions, both healthcare providers and medical travel facilitators are feeling the pinch. Patients from western countries often find Indian public facilities inconvenient – primarily due to poor maintenance of airports, roads and transport facilities. Commenting on this topic, and reassuring the audience about ongoing efforts of Chandigarh Administration to facilitate medical tourism in the UT, Dr. Manjit Singh Bains, Director, Health Services, Chandigarh Administration, laid out an overview plan of the proposed Chandigarh Medicity. Scheduled to get operational in next 2 years, the Chandigarh Medicity is www.ehealthonline.org

set to provide modern facilities and advanced infrastructural support to become an ideal destination for foreign patients.

Enumerating on this, Dr. Singh said “The Chandigarh medicity will be a self-sufficient facility.. having medical, a dental and nursing colleges, a college for alternative medicine, a centre for advanced R&D, along with recuperation and rehabilitation centres, and full service hotel facilities”.

Availability of skilled professionals and proper expertise are of paramount importance for attracting medical tourists. The session titled ‘Indian Expertise on Medical Procedures’ witnessed some of the best known medical practitioners from select specialities talk about the available talent pool in the industry and also forecast the need in coming years. Speakers of this session included – Dr S P S Grewal, CEO, Grewal Eye Institute; Dr Pradeep Chowbey, Chairman, Minimal AcPrivate providers have indeed revolutionised healthcare cess & Bariatric & Surgery Centre, Sir Ganga Ram Hospital, service standards in India. Giving a fillip to the hitherto fled- New Delhi; Dr. Ajay Kashyap, Fortis Healthcare & Dr. S P geling healthcare scenario in the country, and going beyond Kaushik, Senior Consultant, Silver Oaks Hospital. the ordinary to bring international best practices and qualWhile medical value travel promises to be ‘the next big ity excellence, corporate service providers are redefining the rules of the game. Reflecting on this, Mr. Shivinder Mohan thing’, there are a number of crucial factors pertaining to leSingh, CEO & Managing Director, Fortis Health Care & Es- gal, commercial and cultural issues that demand proper uncorts Heart Institute & Research Centre, delivered a scintil- derstanding and attention from service providers, medical lating speech laced with his signature flamboyance. Referring professionals and health travel facilitators. The session titled to the CII-McKinsey report, Mr. Singh underlined the fact ‘Understanding the Protocols for Medical Value Travel’ delved that 80% of healthcare delivery in India currently happens into some of these critical aspects of the industry. While through private sector. The Human Development Index of Sumedha Sen (Director – Sales & International Business, Forthe country is depressingly low and is primarily attributed tis Healthcare) talked about activity flow between arrival to to poor public health conditions. Lack of access, even for departure of foreign patients, Dr. Ashok Chordiya (Medical primary and preventive healthcare, is increasingly burdening Director, Fortis Hospital, Mohali) presented on post-op resecondary and often, tertiary care facilities. Commenting on hab and follow-up care’. Commenting on future facilities for ground realities that continues to exist, Mr. Singh said, “All medical value travel, Dr. Vikram Chhatwal (CEO, Reliance hopes for healthcare in India is as good, as it is bad. Still it Healthcare) delivered an overview of his strategic approach is better to say the glass is half-full, rather than half-empty”. and understanding of healthcare delivery per-se, in the conHowever, opportunities continue to exist in the face of ad- text of medical tourism. IT based systems and processes are versity. Commenting on the situation in US he said, “No sig- increasingly getting prominence in healthcare, more so, web nificant innovation is happening in US health industry and centric solutions are being aggressively adopted for both clinihospitals are closing down by passing each day”. On a lighter cal and business functions. Web marketing tools can prove to note, he added, “With 38% doctors of Indian origin, the US be highly effective channels of communication between prohealth system will virtually come to a halt, if Indian doctors viders, payers and patients. Some of these possibilities were call a strike”. Referring to examples of service best practices, demonstrated by Dr. Benosh Haris, COO, e-Medsol. he highlighted the case of Bumrungrad International, Bangkok, while emphasising that hospitality need to come handIn the final session, an eminent panel comprising of Dr. in-hand with healthcare in order to make medical tourism a Azizullah Amir, Managing Director, Afghan Hospital, Kabul; Dr. K M Kapoor, Sr. Consultant-Plastic & Cosmetic Surgery, success.

Fortis Hospital; Dr. R Kumar, Consultant, Medical Value Development of an ideal medical tourism destina- Tourism and Garry Miller, Director, UK Operations, SAHARA tion is dependent on a number of factors, involving both Medical Worldwide, along with Cheryl Isherwood - a patient private and public sector. The issue was discussed in length from UK, discussed the expectations for referral companies in the session titled – ‘The Making of a Medical Tourism and patients opting for overseas medical care. The event conDestination’, with an impressive line up of speakers from cluded on a high note with inspiring words from the confertop-of-line service providers and travel facilitators, including ence Chairman - S M Singh, along with Dr. Rana Mehta, and - Escorts Heart Institute & Research Centre, Apollo Hospi- with a common conviction to make India the preffered meditals, Wockhardt Hospitals, Sahara Medical Worldwide and cal tourism destination of the world. others.

March 2008

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Opportunities for Digital India healthcare industry in India is growing at a phenomenol pace - so are the standards

INDIA

2008 29-31 July, 2008 Pragati Maidan, New Delhi

of service delivery. technology is redefining ways of care management, clinical processes and business pathways. be it providers, payers or patients ..everybody can be a winner when technology lends its magic wand and transforms the way we do healthcare.

Join us to find it all for yourself !

High powered sessions and panel discussions would focus on • IT Innovations in Healthcare Delivery • EMR Best Practices & Standardisation • Network Infrastructure for Connected Healthcare • TeleHealth Applications and Service Delivery • Medical Imaging & Diagnostic Technologies

...the definitive event on

healthcare ICTs, technologies and applications

• Information Sharing & Regulation for Insurance Sector • Investment Landscape in Healthcare & Medical Technology Industry • Medical Tourism - Opportunities for Healthcare Industry

...BE A PART OF IT

For Programme Enquiries Dipanjan Banerjee (dipanjan@ehealthonline.org; Mob: +91-9968251626)

For Sponsorship and Exhibition Enquiries Arpan Dasgupta (arpan@ehealthonline.org; Mob: +91-9911960753) Amitabh Mukherjee (amitabh@ehealthonline.org; Mob: +91-9871686548)

Presenting Publication

Supporting Partner

www.eINDIA.net.in/2008/ehealth/

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NEWS REVIEW

BUSINESS

Cerner moves into Ireland Cerner, a leading international supplier of healthcare information technology (HIT) solutions, recently announced the opening of a new office in Dublin as it continues to expand its healthcare IT presence in Ireland.

After serving the Republic of Ireland via its London operations for the past three years, this new office serves to strengthen Cerner’s relationships with key clients and enhance its software offerings for the European market by having translation and localization services in Ireland, which is being touted to be a rapidly growing market for advanced healthcare technology, with an increasing focus on improving healthcare at the primary level.

With operations in 18 countries, Cerner has provided healthcare solutions to clients in the United Kingdom for more than 20 years.

The company’s entry into the Irish market came in June 2004, when St. James’s Hospital, the Republic of Ireland’s largest teaching hospital, chose Cerner as their healthcare IT partner to implement an integrated RIS/PACS and Order Communications solution as the first stage of their hospital-wide, patient centric, clinical information solution.

Cerner Ireland Ltd. is located at Newenham House in the Northern Cross Business Park, Dublin.

iSOFT in agreement with ML Park (Russia) iSOFT Deutschland, part of the IBA Health Group - the world’s fourth largest healthcare IT provider will focus on providing modern laboratory software solutions in Russia and has strengthened its position in Russia’s healthcare market after a partnership agreement with ML Park of Moscow to distribute and support iSOFT’s laboratory information systems (LIS).

The market in Russia offers huge potential and is set to grow at unprecedented rates. The Russian market for medical technology is worth US$2 billion a year and is growing by about 15 % per annum. The ‘National Health Programme’, which continues until 2010, provides US$1.7 billion to build 15 specialised health centres. iSOFT has already installed its LabCentre laboratory system at KDL Test, a private laboratory chain with laboratories in Moscow, Omsk, Perm and Krasnodar. ML Park and KDL Test are sister companies and both are subsidiaries of ML Group.

Core elements of the agreement are the distribution, implementation and support of the iSOFT laboratory solution, LabCentre. LabCentre is a full-graphic integrated system, covering clinical laboratory, blood donation and microbiology.

Wockhardt Hospitals to invest INR 569 cr in growth Wockhardt Hospitals, associate of Harvard Medical International (HMI) a self supporting not-for-profit subsidiary of Harvard Medical School has chalked out a growth strategy with an investment of INR 5.69 billion in expanding, developing and constructing both greenfield and brownfield expansion plans.

The company plans to leverage growth model with flexible expansion plans. Since 2000, it has grown from three hospitals, with 139 beds, to a network of 10 super-specialty hospitals and five regional speciality ICU hospitals, with a total of 1,374 in-patient beds.

Besides establishing additional healthcare facilities, the company plans to strengthen its presence in cities, such as Bangalore, Mumbai, Kolkata, Hyderabad and Delhi, by expanding the current operations through new greenfield and brownfield projects, as well as increasing

beds at existing hospitals.

It is currently expanding bed capacity at Wockhardt Hospital, Mulund (Mumbai) and it intends to add 270 beds in total. The Mulund facility is super-specialty hospital which is one of the first hospitals in South Asia that received international accreditation from Joint Commission International (JCI), the largest accreditor of healthcare organizations in the United States.

The company is pursuing brownfield projects in selected tier II cities, such as Madgaon (Goa), Bhopal, Nashik, Bhavnagar, Ludhiana, Jabalpur, Bhuj, Patna, Hubli and Varanasi.

In most of these cities, it expects to be among the first major private healthcare services providers to commence focused tertiary care operations, which it believes will help it attract patients, recruit better medical personnel and establish benchmarks for care and sustainable operations.

ITC Welcom hotels eye medical tourism ITC-Welcom Group Hotel, Palaces and Resorts is testing waters for the medical tourism needs of India. Through its subsidiary, Fortune Park Hotels Ltd, the group expects to come up with its first property for the specialised tourism in Thane, near Mumbai.

With the property, the group looks at tapping business potential emerging from the requirement for safe and growing accommodation of patients coming to the 32

country for treatment of various ailments and surgeries.

The hotel is under management-contract and is modeled to suit the growing demand for medical tourism in the country. The 55-60 rooms property is adjacent to a 200-beds Jupiter hospital, located on the Thane highway. The hotel would be internally accessible from the hospital and would also provide wheel-in facility for the patients.

It would also address the accommodation needs of patients as well as their visiting relatives.

According to healthcare industry estimates, the country’s medical tourism opportunity is projected at US$2 billion by 2012.

www.ehealthonline.org

INDIA

2008

Opportunities for Digital India

29-31 July, 2008 Pragati Maidan, New Delhi

Hospital

CIOCONCLAVE healthcare is finally getting the better share of IT! a high growth rate of the industry, coupled with heightened focus on quality and efficiency of service delivery is fueling heavy IT investments from hospitals and care providers. no wonder why India is fast emerging as the leading Asian country in terms of growth in healthcare IT market. however, still, IT practices in this industry is neither standardised nor wellunderstood ..and to a large extent 'undermined'. there is a need for appropriate capacity building and unadulterated knowledge-sharing among solution providers, practitioners and end users. get all of these and much more when some of the finest IT brains of the industry get together this summer at the 'Hospital CIO Conclave' of eHEALTH India 2008.

To participate as a panelist Dipanjan (dipanjan@ehealthonline.org, +91-9968251626) For Sponsorship Opportunites Arpan (arpan@ehealthonline.org, +91-9911960753) Presenting Publication

Supporting Partner

>

System C Healthcare acquires Care Records System C Healthcare, the provider of specialist IT products and services to the healthcare sector, recently announced the acquisition of clinical systems developer Care Records Limited from Huntleigh Healthcare Ltd, one of the UK’s largest medical equipment manufacturers.

Care Records is a developer of leading-edge technology for the design and development of clinical IT systems. It has used this core technology to produce the Eclipse maternity system and a diabetes management system, both extensively installed in UK hospitals.

During 2007, Care Records has sold successfully implemented its products at five hospitals: Bradford Teaching Hospitals Foundation Trust; Surrey and Sussex Healthcare NHS Trusts; Royal Shrewsbury Hospitals Foundation Trust; the Nobles Hospital on the Isle of Man and at the University Hospitals of Leicester NHS Trust.

System C will maintain and extend Care Records’ relationship with Huntleigh Healthcare, and is setting up joint distribution and collaboration agreements with Huntleigh for both the UK and overseas markets. The consideration for the acquisition is £0.85m in cash on completion, with up to a further £2.6m payable in cash over the next 3 financial years dependent on the achievement of demanding performance targets. The consideration is to be funded from System C’s existing resources.

Mayar to open 14 Medispa, invest INR 400 cr in 3 yrs Diversified business conglomerate Mayar Group intends to set up a chain of medical spa centres in the country with an investment of INR 400 crore in the next three years and is also looking to have an inorganic growth in West Europe through acquisitions.

The company is planning to open 14 such centres through its wholly-owned subsidiary Maya Health Resorts Limited (MHRL) and has opened its first such centre in the national capital with an investment of around INR 30 crore.

The medical spa centre, Medispa, will have ayurvedic massage therapy, aesthetic medical skin care and other holistic beauty treatments to provide a complete health care solution to the customers, the company said.

MHRL is also going to open the first Spa training and awareness academy in the country to provide training in the segment, and is also looking for acquisitions in the Far East Asia and in the West Europe for its global expansions.

Mayar Group is an INR 3,000 crore business house with interests in publications, forests, agriculture products and hospitality. The company would arrange funds for the expansions through debt and by equity partnership.

Apollo, Tenet Health enter pact Healthcare group Apollo Hospitals has signed a Memorandum of Understanding with US giant Tenet Health. The pact seeks to be an unique exchange programme between the two healthcare majors to learn and share best healthcare practices.

Under the pact, both organisations have agreed to share their best

practices in creating and maintaining healthcare delivery systems, through exchange programmes.

The senior management staff will be imparted training and exposed to the quality delivery standards prevailing in the respective entities, said the Apollo Hospitals Group chairman, Prathap C Reddy.

GE acquires Image Diagnost International

Accentia Technologies eyes eight healthcare BPO firms

GE Healthcare has acquired German based Image Diagnost International, a provider of IT systems used in the diagnosis of breast cancer. Image Diagnost’s software offering will expand its capabilities in breast cancer detection, offering clinicians and national screening services one of the most comprehensive ranges of systems available.

Image Diagnost develops integrated software solutions for mammography workflow and image processing, used in over 150 locations across Germany. The company has recently filed for US FDA approval for its Mammo Workstation system.

GE Healthcare believe that as the institutions using their digital mammography increase, customers will use Image Diagnost’s software solutions to facilitate reporting, storage, sharing and transmission of data. Image Diagnost’s head office in Munich, Germany, will now become a GE Healthcare centre of excellence in breast cancer detection software.

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Accentia Technologies, a healthcare receivables cycle management (HRCM) player, has firmed up measures to buy out as many as eight companies this year. The targeted companies, all players in the healthcare BPO segment, include three foreign (one each in Canada, the US and London) and five Indian firms.

Accentia will also take into its fold the three healthcare firms by March 31 this year. The company would opt for an all-cash deal to complete the acquisitions, having set aside US$ 11 million for three acquisitions.

Accentia, a Bombay Stock Exchange - listed company with headquarters at Thiruvananthapuram, has also kicked-off its GDR on the Singapore bourse. The company employs as many as 2,140 professionals in its offices in Thiruvananthapuram, Bangalore, Mumbai, the US and the UAE.And expects to push up the number to 15,000 by 2011. The company, which has seen its turnover touch INR 130 crore this year, is aiming to touch the INR 250 crore mark over the next nine months.

www.ehealthonline.org

Siemens plans acquisition of CAS innovations Siemens Healthcare unveiled plans to strengthen its position in the field of computer-assisted surgery with the acquisition of German operating room system developers, CAS innovations. A deal for an undisclosed fee has been agreed between the two companies, pending approval from antitrust authorities.

CAS innovations manufactures surgical navigation systems which improve planning for operations, while at the same time making them faster and safer. Its primary focus is on systems for trauma surgery and orthopedics, as well as on interventional radiology. With headquarters based in Erlangen, Germany, the company has 27 employees.

Siemens says the deal will help progress work into developing minimally invasive interventions in the operating theatre, allowing to improve the quality of medical care while simultaneously reducing the costs.

CAS systems will provide the doctor with accurate insight into the patient’s anatomy, and using surgical navigation systems, the surgeon can additionally work out on the computer the approximate path that needs to be taken before the operation. During the intervention the system shows the surgeon the position of the operating instruments directly on-screen as well as possible deviations from the previously defined route in the body.

Clinical Research to become INR 10,000 Cr industry by 2010 Clinical Research in India is expected to grow to a INR 10,000 crore industry by 2010 spelling an opportunity of 50,000 jobs within India.

According to the Clinical Research Institute of India, the pharmaceutical industry in India was growing at the rate of 11 per cent and clinical research industry was growing at the rate of 84 per cent. It is also said that the investments by global drug companies in India, have crossed INR 500 crore in 2005-06.

India has emerged as one of the most important hubs in south East Asia for clinical research due to its huge population base, high prevalence of disease, large pool of talent and cost advantage as compared to competitors.

The regulatory norms here having become more favaourable and with India having caught up with international standards in terms of facilities well trained investigators and abundance of medical professionals, well versed in English language as well as superior communication and IT network, nearly 50 percent of drug development process is being outsourced to India by giant multinationals.

World over the Clinical Research industry has been growing at unprecedent rate while the clinical trial market worldwide is worth over US$ 52 billion.

Around INR 70,000 crore is spent globally every year on clinical trials. Globally there are more than 250,000 vacant positions in this industry.

Satyam, Mohawk collaborate for health informatics Satyam Computer Services Ltd, a leading business and information technology services provider, will donate more than US$1 million in cash and in-kind services to establish SATYAM Interoperable Electronic Health Records (iEHR) CENTRE at the Mohawk Applied Research Centre for Health Informatics (MARC HI) at Mohawk College in Hamilton.

The centre will help Canada establish universal connectivity and interoperability of electronic health records, bolstered by a robust and advanced patient information exchange standards.

Benefits include reduced waiting periods for medical attention, a decrease in adverse reactions to medication and the ability for healthcare providers to concentrate on patients’ health rather than focusing on extensive paperwork and operational issues.

MARC HI is the world’s first initiative to develop working versions of the new HL7v3 healthcare messaging standards, which are recognized as the industry-leading solution for achieving “semantic interoperability,” the ability of interoperable healthcare systems to fully “understand” a clinical diagnosis or medical order.

March 2008

The iEHR centre will leverage Satyam’s global presence to be knowledgeable of the recent developments and trends in the healthcare industry across countries, such as the United Kingdom (U.K.). The U.K., one of the earliest adopters of healthcare industry standards to achieve healthcare interoperability, has been working on their system for several years. These programs have had some success, but early attempts have not exploited recent technology advancements, such as service-oriented architecture.

Previous attempts in Canada to achieve interoperability led to the creation of the Canada Health Infoway EHRS Blueprint.

Mohawk is taking the blueprint and improving upon it to create a working prototype. Parts of the program are already proving to be successful. In other areas, issues have arisen.

Mohawk is applying the lessons from both successful and unsuccessful projects to pilot the new healthcare messaging system, which, once perfected, can be developed commercially by the university’s partners, including Satyam.

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COMPANY PROFILE

Dr. Lal Path Labs AT A GLANCE  8,000 clients served daily  1650 different tests and panels  27 laboratories and 450 collection centres in more than 250 cities  Home collection and delivery  Laboratories accredited by the College of American Pathologists (CAP), Clinical Laboratory Improvement Amendments (CLIA), ISO 9001:2000 and the National Accreditation Board for Testing and Calibration Laboratories (NABL)

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Dr. Lal Path Labs was established in 1949 by Major S.K. Lal. One of India’s largest medical diagnostics company, it is primarily Delhi-based, though it has a pan-India presence. The total employee strength stands at 900. The technical core works hand-in-hand with the commercial wing in an ongoing attempt to scale-up operations.

The Growth Story The company expanded rapidly to other parts of north India and across the country, such as Kolkata, Bombay and Bangalore. Starting with about 10 labs in 2005, today that number stands at 27 and plans are afoot to take this number to 50 www.ehealthonline.org

LPL’s Labs & Collection Centres all over INDIA

labs in 1999, making them the pioneers of LIS in India. Each instrument is bi-directionally interfaced with Ultra. The instrument speaks to the application and vice versa. This helps in monitoring quality in each of the labs. A process of validation is followed, where the values of various parameters are shaped to ensure that they are meeting the company’s SOP’s on quality.

There are two levels of quality control. The first is within the lab itself where the chief of a lab checks the reports. The other is that on a real time basis, the data also gets transmitted to the main lab in Delhi. The report sitting in Delhi is also monitored.

Collection Centers Labs Main Labs

by March 2009. Delhi itself presently has 7 satellite labs.

The second area where IT is used is between centres. The sample from the local lab might get split into two. Some tests will be done locally and others at the centre. The container has a bar code which the computer or other such instrument will recognise. The instrument speaks through the LIS and picks up the details of the tests to be conducted on that sample. Through this technology, it is also possible for the report to be delivered at a third location.

The organisation has a pyramid structure with a central lab at Delhi, also called the reference lab. It does about 1650 tests, Speed is very important, along with accuracy of the report. the widest menu by any lab in the country. In June 2007, Dr The moment a sample is collected, the registration time and Lal Path Labs opened two high hi-tech laboratories in Kol- collection time is noted. Thereafter, every step is tracked until kata. They have hi-tech laboratories in Mumbai, Ghaziabad, the report is finally uploaded onto the system. Patients can Faridabad, Bangalore, Jaipur, Chandigarh, Bhopal, Nagpur, Pune and Guwahati also.

Lower on the structure are the satellite labs. These perform 300-500 routine tests. Each satellite lab is flanked by sample collection centres. Presently there are 600 collection centres which is expected to touch 1000 by 2009-2010. Collection centres are franchisees though laboratories are owned by the company. A state-of-the art 4,000 sq ft facility was recently set up at its Gurgaon headquarters, exclusively for clinical trial operations.

This ensures that quality is maintained. Dr. Lal’s now operates what are called Patient Service Centres (PSC). These fall between a collection centre and a satellite lab. The difference between a lab and a PSC is that a patient will get all the services of a lab, except the testing. The experience is the same as would be when you walk into a lab. You can give the blood sample, you can have any query answered and collect your report.

Use Of IT Quality is non-negotiable in this industry and Dr. Lal Path Labs ensure that all their labs are interconnected and the test reports are validated by a central pool of pathologists at the centre, before being delivered to the patient.

Each instrument is interfaced with a Unix-based Lab Information System - LIS. This LIS, called Ultra, is from Triple G (now with GE). Triple G is used by at least 100 top-notch labs in the world for LIS. Dr. Lal’s bought Triple G for 8 of their March 2008

Located at Hanuman Road, Connaught Place, it is the first lab established by LPL in 1949. Equipped with highly sophisticated and state of the art instruments for testing in the field of Biochemistry & Immunoassays, High Performance Liquid Chromatography, Electrophoresis, Coagulation, Tandem Mass Spectrometry, Hematology, Histopathology, Cytopathology, Serology, Microbiology, Clinical Pathology and Immunology. It is open 24 X 7, enabling the company to service the market at any time.

The laboratory acts as a central testing hub for Satellite labs, Pick-up points and Collection centres all over India.

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“Our priority is ERP” What is the level and nature of IT applications in your overall delivery process?

How is it adding value to your business efficiency?

LPL was the first Indian company to make extensive use of IT. Our entire lab operation is IT driven. We are currently using Centercity ULTRA, a software solution from GE Health Care, as laboratory information system (LIS) which is the industry standard. We have deployed ULTRA for the entire lab operations, as all the labs are connected with the central location through leased lines. They are also connected online with the same application.

Most of the sophisticated analysers we use are also interfaced (Bi/Uni-directionally) with the centrally deployed LIS system. The ULTRA application is deployed right from the patient registration up to the final output in terms of delivery of reports.

Since all the analyzers are interfaced, it reduces specimen processing and report delivery time up to a great extent. This is one of the most important factor of healthcare industry. With the help of IT we have achieved a lot of automation inside the lab, which ensures quality and error free lab operation. All these IT systems help LPL to handle huge specimen load in an organised manner.

Which are your major vendors in terms of clinical software, ERP, networking solutions and telecom/V-Sat? We have always believed in strong relationships with industry leaders such as, GE Health Care, who provides us goods and services on the lab operations side. Wipro is our partner in ERP (MS Axapta) implementation. MTNL and Tulip IT are the major service providers for WAN connectivity, companies like IBM and Dell provide IT infrastructure and related services.

What is the average IT spend in your company and which areas would you prioritise for future technology investments?

Our average annual IT spending is approximately INR 2.5 - 3 crores. As of now, our top priority is ERP implementation, which is already on. Immediately after ERP we will go for the newer version of Centercity ULTRA and associated software solutions.

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O. P. Manchanda Chief Executive Officer Dr. Lal Path Labs www.ehealthonline.org

then download it from anywhere. This report is a valid document – just like downloading an account statement from the net. Even so, a hard copy of the report is made available. This ensures that immediate action is taken on the treatment. There are times when the doctor is also provided access and he can see the report on the website. At Dr. Lal Path Labs, you can also receive a collation of earlier reports in a tabular form.

Tele-registration services are available in the Delhi branches and is being well received. This way patients can register the previous evening, which helps ease the rush and saves time for both the patient and lab employees.

Their website too was recently re-launched and is now more user-friendly, knowledge-based and more interactive. Plans are afoot to find innovative ways of engaging and educating the patient during his/her waiting time. A screen relaying information is one such example.

Accreditations and In-House R&D In 2002, Dr. Lal’s Path Labs was the first in India to be accredited by the College of American Pathologists, the highest accreditation in the world. It is also accredited by Clinical Laboratory Improvement Amendments (CLIA) and ISO 9001:2000. Another distinction it has under its belt is that it owns 7 out of 100 National Accreditation Board for Testing and Calibration Laboratories (NABL)-accredited labs in India.

The company has the most advanced neonatal screening tests for screening newborn babies for genetic disorders called Inborn Errors of Metabolism (IEM), where a single blood spot taken from the heel puncture of a newborn detects 30 such IEMs. In the Pipeline Patient ID system. Each patient will be given a unique number. They already have a mechanism to keep track of patients’ data through date of birth as well as name of the person, keeping an EMR of the persons who have had their tests done at Dr. Lal Path Labs, for the last 8-9 years.

The clinical trial business is expected to grow rapidly in the coming years and about 30% of that will be relevant for lab business. Dr. Lal Path Labs’ Gurgaon facility is fully dedicated for clinical trials. Trials are conducted for domestic pharma companies and the lab’s capabilities are being increased so that it can cater to MNC’s as well.

An 82,000 sq. ft laboratory at Rohini, North Delhi, is expected to be in place this year. LPL has one of the oldest and most structured lab network in the industry.

More services to the patient. One of these is home collection of samples. Patients will be able to place the order on the net through the customer service. An appointment is fixed, and the sample picked up – anytime and from anywhere. The report can be downloaded from the net. Payment too can be made online.

Their main testing lab at Okhla, Delhi, is the sole provider of several high-end oncology tests using RoHS - BCR technology. It has developed an HIV test which is not offered by any other lab in the country. Moreover, this is at INR 2400 - almost half the price of those currently available in the market.

ERP and Customer Relationship Management (CRM). Innovative marketing campaigns that will allow flexible interfacing with hospital information systems (HIS). They are also looking at getting hospitals to outsource their testing. Reports will be accessible on HIS. The high speed part will be taken care of by technology-enabled innovations in terms of registration, downloading of reports, or quick validation.

Market expansion. LPL is focusing on geographical expansion within India and increasing its market share in strongholds like Delhi. They plan to have 50 labs, 50 PSCs and A bar code - based Radio Frequency Identification (RFID) about 1000 collection centres all interconnected on real-time is already used to track samples and they are looking at ways basis. to use the technology to further speed up the process and Clinical trials. Outsourcing presents significant opportuniregister the samples in-transit, especially those collected from ties from the US and the Western world. An operating model the patient’s residence. has already been established and tested wherein samples from the US can be tested here, maintaining the highest standards.

Tie-ups with US companies are in the offing.

Services offered exclusively by Dr. Lal Path Labs

March 2008

39

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NEWS REVIEW

WORLD

Camera pills detect disease A scanning fibre endoscope can be fitted into a casing usually used for covering medicines, and is small enough to be swallowed. This device records 15 colour images per second with a resolution of more than 500 lines per inch.

Developed by a team at the University of Washington, it has been designed to take high-quality pictures in confined spaces. Such a device may help detect warning signs of oesophageal cancer, and that too, at a cheaper cost.

The oesophagus is the section of the digestive tract that moves food from the throat down to the stomach. Oesophageal cancer often follows a condition called Barrett’s oesophagus, a noticeable change in the oesophageal lining, which is treatable.

However, due to huge costs, people get dissuaded to go for internal scanning, and they often end up developing oesophageal cancer.

Unlike traditional approaches, the new endoscope has been designed in such a way that it would not require sedating patients during the scan. It consists of just a single optical fibre for illumination and six fibres for collecting light, all encased in a pill.

Cisco’s ‘HealthPresence Pod’ pilot tested in Scottish hospital A new invention, known as ‘HealthPresence Pod’, developed by the leading American technology company Cisco, is being assessed in a series of world-first patient trials at Aberdeen Royal Infirmary in partnership with the Scottish Centre for Telehealth and NHS Scotland.

Using the ‘Pod’, doctors will be able to examine and diagnose the conditions of patients living hundreds of miles away - monitoring a patient’s heartbeat, their temperature, blood pressure, and carrying out a number of detailed medical examinations without having to leave their clinics.

Eventually it is hoped that the virtual-reality surgeries could be housed in dedicated booths available for use by the public in community hospitals, community centres, and even supermarkets - improving the triage assessments currently being made by the out-of-hours NHS 24 service.

Currently the system is being tested in a small room within the accident and emergency centre at the Royal Infirmary with the “virtualreality” doctor in a separate room only a few yards away.

The first fully fitted booth is expected to go on trial at a more remote location later this year - probably within a dedicated medical facility in Aberdeen - but eventually it is hoped that hundreds of virtual-reality GP surgery pods could be used to cover the country.

New medical imager detects ultra small breast tumors A new medical imager with the potential to spot ultra small breast tumors has been developed by the research teams of the West Virginia University School of Medicine and the Maryland School of Medicine. The imager is adept at not only detecting tumors but also in guiding the biopsy of suspiciouslooking breast cancer lesions.

This medical imager provides image resolution below two millimetres while in a regular PET, the image resolution is over five millimetres. Also, the initial tests showed that the PEM/PET system could complete an image and biopsy in about the same amount of time as a traditional biopsy.

The ability of the device to do a biopsy is probably one of its most unique characteristics. The PEM/PET system has components designed for imaging the unique contours of the breast. Known as positron emission mammography (PEM), this imaging capability enables users to attain high-resolution, threedimensional PET images of the breast.

If a suspected lesion is discovered, the biopsy is performed with a personcontrolled robot arm. The system is especially useful in imaging tumours in women who have indeterminate mammograms because of dense or fibroglandular breasts.

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INDIA

2008 Opportunities for Digital India

29-31 July, 2008 Pragati Maidan, New Delhi

MEDICAL

TECHNOLOGY FORUM

the midas touch of technology has redefined medicare over the years! starting with the invention of 'stethoscope' till the modern day 'nuclear medicine' technology continues to revolutionise medical practise ..all of these, to create a healthier world. at the present day, 'India' is a synonym to 'Innovation' ..and a promising global hub of medical technology and manufacturing. with a booming healthcare sector, the market potential is enormous. there is a dire need to get over regulatory hurdles, create enabling environment for market access and encourage standardisation. get the leaders of this industry 'unplugged' at ‘Medical Technology Forum’ of eHEALTH India 2008

To participate as a panelist Dipanjan (dipanjan@ehealthonline.org, +91-9968251626) For Sponsorship Opportunites Amitabh (amitabh@ehealthonline.org. +91-9871686548)

Presenting Publication

Supporting Partner

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NHS urged to partner pharma industry New guidelines issued by the Department of Health, call for more partnerships between the NHS and drug companies, stressing they should be “of mutual benefit with the principal beneficiary being the patient.”

In response to which, a spokesperson for the British Medical Association said that, “If there are clear, transparent guidelines so that the clinical freedom of doctors is not compromised, the BMA does not see why there cannot be closer cooperation between the NHS and the pharma industry. However, we would need to see the full details of individual planned projects before commenting fully.”

The department of health cited examples of successful joint working, including East Lincolnshire primary care trust’s partnership with three drug companies to identify sufferers of chronic obstructive pulmonary disease, train clinicians and establish clinics, which helped cut admissions by nearly a quarter.

Portable, inexpensive ‘lab-on-a-chip’ a hit It’s common knowledge that to carry out genetic tests, one would need expensive, state-of-the-art laboratory. But that might soon change thanks to a group of Canadian scientists who’ve developed a “lab-on-a-chip” device to conduct these tests. What is interesting about the device is that it’s supposed to be portable, inexpensive and efficient.

A team from the University of Alberta, have developed a US$ 1,000 device the size of a shoebox that can conduct genetic tests and deliver results in less than half an hour. Elaborating on the innovation, the researchers said that miniaturization is the key factor that has drastically brought down the cost of this gadget.

Life science technologies they said, do exist, but aren’t being utilized optimally because they’re very expensive. Hence, the key to this mini-laboratory was to integrate, shrink and automate. The ability of the device to implement a very wide range of tests on a standard platform quickly and inexpensively would make it indispensable for the future.

The research team believes that their miniature lab-on-a-chip will provide cancer patients with quick genetic tests, in turn speeding up treatment processes and that the device may be useful in finding genetic signatures for particular viruses or bacteria or for testing the quality of water and so on.

UAE to adopt WHO disease alert system The World Health Organisation (WHO) has finalised and deployed a regional disease alert system that will soon be adopted by the UAE. A spokesperson for WHO (Eastern Mediterranean Region) said the system has been tested and implemented 90 per cent in Tunisia as a pilot country.

The system has been presented to the AGCC Executive Board of Health Ministers’ Council for approval but the system is expected to be in place in all GCC countries before the end of this year. Under the system, the UAE will report disease outbreaks to WHO, which will have access to all the data and will use the appropriate information to display on its website.

WHO has opened strategic health operations centres in the GCC region for reporting of avian influenza where notifications can be received round the clock. The countries have also developed national plans to combat diseases.

WHO is also monitoring trends such as lifestyle diseases in the UAE, where there is a noticeable shift from communicable diseases such as malaria, polio and tuberculosis, to lifestyle diseases such as obesity, diabetes and hypertension causing deaths.

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£33m aid to boost telemedicine throughout Wales The Assembly government of Wales has ear-marked £33m to be spent on new machines and communications technology that allow healthcare professionals to link-up better. The new technology will mean patients’ test results can be looked at by doctors at other hospitals and practices via so-called telemedicine.

The Health Minister Edwina Hart said: “The allocation of this £33m will help the NHS deliver better services for patients, including access to diagnostic tests, such as scans... Our aim is to provide as many services as close to the patient as possible...

The increasing use of telemedicine will reduce the need for patients to travel.”

But Liberal Democrat health spokeswoman Jenny Randerson said: “I will be asking the minister detailed questions about the bidding process because of the stark contrast between the more than £18m for mid and West Wales compared with less than £5m to south-east Wales. “I will want to be reassured that the money has been distributed on the basis of clear clinical need rather than on a first come, first served basis.”

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>

BMJ, Cerner collaborate to provide better information to doctors

BMJ Group has entered into an agreement with Cerner Corporation to integrate its evidence-based medical information with a range of solutions offered by Cerner in the UK and internationally.

The first outcome of this collaboration will be the introduction of Order Entry sets for the hospital sector which brings together BMJ Group’s evidence-based research database, BMJ Clinical Evidence, with Cerner Millennium(r) software.

BMJ Clinical Evidence is a compendium of the latest research evidence. It sums up what’s known - and not known - about more than 200 medical conditions and more than 2,000 treatments and is an invaluable tool for any health professional wanting to base their clinical decisions on the best available evidence. It is widely used by healthcare professionals as a trusted evidence-based resource.

While the Cerner Millennium is a healthcare information technology computing platform that helps health professionals connect to the centralised Cerner Millennium electronic patient record to access vital information for effective decision-making. Combining technology with knowledge, Cerner Millennium empowers health professionals to order tests and track results, make diagnoses, prescribe, dispense and document care using a single information system.

This combination automates and unifies patient information and clinical content, improving the quality of patient care by giving hospital staff access to the latest clinical evidence, empirical data and best practice.

XTend Medical launches diabetic telehealth program

XTend Medical Corporation has begun a remote diabetic monitoring program with a target of 500 patients to be part of the initial program.

The program, facilitated through local physicians in Southern California, will remotely monitor diabetic patients through the XTend Medical Disease Management Program. The patients will be able to take their glucose readings and transmit the results to the participating physicians via the Eocene transmitter.

Once the glucose meter is cradled to Eocene unit, the plugin system utilizes a standard phone line to send the encrypted patient data to a central server for review by the physician. Once the data is reviewed by the physician, then any adjustments in medication, compliance with testing, and/or any necessary followup visits can be relayed immediately to the patient.

The system is designed for physicians to be able to closely monitor diabetic patients from their office while the patients maintain their regular daily lives in their own homes.

XTend Medical is now poised to implement this system nationwide to any healthcare company looking to remotely monitor their diabetic patients.

Surgical Robot Improves Hip Surgery Success Rates UK scientists have developed a surgical robot that makes hip operations extremely simple. Generally, surgeries that involve using chrome alloy to resurface the ball of the hip joint are extremely difficult and need years of experience to perfect.

However, using the new technology for ‘virtual’ operations, even untrained students were able to achieve high levels of accuracy.

Researchers said that inexperienced surgeons often face a steep learning curve to gain the experience necessary to carry out hip resurfacing operations. Until now, this has only been gained through repeatedly performing the operations.

This can cause problems because if hipbones are repaired incorrectly wear and tear occurs, requiring patients to undergo further painful and expensive corrective operations.

Developed by PhD students at Imperial College London, the Wayfinder is similar to GPS navigation systems; it senses the movement of the surgical tools and compares it to detailed images of the bones. It therefore enables surgeons to see a ‘real-time’ virtual model of the progress of the operation. The robot then plots where surgical incisions should be made and calculates the correct angles for inserting chrome alloy parts needed to repair the hipbone.

In a study, it was found that students were able to carry out the procedure three times more accurately compared to when they used traditional methods to manually navigate the joint.

Clinical trials of the device are presently being carried out at Warwick Hospital, Bath Hospital, Truro Hospital and the London Clinic.

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Philips led HeartCycle project to help heart patients

Google, Cleveland Clinic team up on medical data

Royal Philips Electronics will lead a new European Union (EU) funded research project aimed at improving care of heart patients through the development of innovative telemonitoring solutions. The ‘HeartCycle’ project will be one of the largest biomedical and healthcare research projects within the EU. The HeartCycle consortium aims to improve the quality of care for coronary heart disease and heart failure patients by developing systems for monitoring their condition at home and involving them in the daily management of their disease. These systems will comprise unobtrusive sensors built into the patient’s clothing or bed sheets and home appliances such as weight scales and blood pressure monitors.

Dedicated software will analyze the acquired data, that can be programmed to provide feedback on the patient’s health status, plus his or her adherence to prescribed therapies and progress towards achieving health status milestones. It will also report relevant data back to clinicians automatically so that they can prescribe personalized therapies and lifestyle recommendations.

Public and private partners from 18 research, academic, industrial and medical organizations from nine different European countries and China will team up in the project. HeartCycle will run for four years and has a budget of approximately 21m, of which approximately 14m will be funded by the European Union as part of the EU 7th Framework Program.

Cardiovascular disease kills around 1.9 million people every year in the EU, with the associated annual health costs estimated at 105bn.

Around half of these deaths occur in people who have previously had a heart attack, most of whom will develop heart failure before they die.

Web search company Google Inc is collaborating with Cleveland Clinic (US) to pilot an exchange of data that puts patients in charge of their own medical records.

The health care industry has been trying to usher in a paperless era for more than a decade, holding out the promise that electronic medical records would bring significant cost savings. However, only a tiny minority of hospitals and primary care physicians use electronic medical records even today.

Google says it chose the Cleveland Clinic because it is one of the relatively few health institutions with an electronic system already in place. Its eCleveland Clinic MyChart stores medical records of 100,000 patients.

The Cleveland Clinic now plans to enroll 1,500 to 10,000 patients in a test of the secure exchange of medical data, including prescriptions, conditions and allergies, between its systems and a secure Google profile in a live clinical delivery setting.

The goal of the model was to allow patients to interact with multiple physicians, health care service providers and pharmacies. The pilot will eventually extend Cleveland Clinic’s online patient services to a broader audience and allow patients to take their medical data with them wherever they go.

This collaboration will help Google test features and services that will ultimately allow all Americans to direct the exchange of their medical information between their various providers without compromising their privacy.

t+ provides LifeScan patients remote access to data

Telemedicine specialist t+ Medical has partnered with LifeScan to take data from blood glucose meters and wirelessly transmit the information to a central database.

Using intelligent algorithms, information from LifeScan’s One Touch Ultra system will be analysed and translated for patients into simple graphs, which can be viewed on their mobile phone or a personal computer.

Though both companies are based in the US, the partnership will also apply in Europe where t+ Medical works with a number of PCTs. The purpose of the partnership is to provide patients with a method of tracking their condition, giving them greater insight into their disease.

This agreement brings together two highly complementary technologies and offers improved clinical outcomes and services to patients while creating the opportunities for substantial savings for healthcare providers.

LifeScan will co-ordinate information with healthcare professionals, responsible for the care of the patients who are placed on the system, to include them in the support network.

March 2008

Large US medical insurers to cover online doctor visits Aetna Inc. and Cigna Corp., two of the largest insurers in the US have agreed to reimburse doctors for online visits. Other large insurers are expected to follow, say experts.

These new online services, which typically cost the same as a regular office visit, are aimed primarily at those who already have a doctor. The virtual visits are considered best for follow-up consultations and treatment for minor ailments such as colds and sore throats.

Although visits to the doctor’s office certainly won’t disappear, the recent moves are evidence that long-delayed efforts to bring American medicine into the digital age may be gaining momentum.

The new online consultations are far more structured than a simple e-mail. If insurance companies are expected to pay the bill, physicians need documentation of the event, including diagnosis and time spent. As a result, service companies have emerged to help doctors handle this. They typically arrange the online visits, maintain records and handle insurance reimbursements, patient co-payments and other payments. Doctors are encouraged to respond to patients within a day; they receive an e-mail reminder if they haven’t, with a phone call on the second day. Prices vary from US$ 25 to US$ 125, which patients pay with a credit card at the end of the session.

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expert corner

Implementing EMR:

are Indian

Hospitals When introducing EMR to the hospital environment, it is critical to establish a Hospital Information System (HIS), prepare and involve various stakeholders (internal and external) and define a clear implementation path for EMR. All components of EMR must be compliant to integrate with other existing information systems in the hospital.

ready?

T

he increasing demand for quality care with rising competition has made hospitals maximize utilization of technology in driving processes and streamlining operations. Not only corporate, but also stand-alone small and mid-size hospitals have woken up to the adoption of Hospital Information Systems (HIS) making it an integral part of hospital management. Similarly, EMRs (Electronic Medical Records) are making their way into the hospitals but at a slow pace. Only large corporate hospitals are implementing EMR applications today, whereas most of the other hospitals still maintain the old format of paper based records.

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Anurag Dubey, Industry Analyst, Healthcare Practice, Frost & Sullivan

EMR is an evolving technology that is being adopted by Definition Electronic Medical Records (EMR) or simply ‘medical re- healthcare facilities as part of an ongoing trend to maximize cords in an electronic format’ is a complex system consisting efficiency and streamline functioning. of critical clinical information. EMR systems have the followPre-requisites ing key features: When introducing EMR to the hospital environment, it is  Patient’s Clinical information: medical history, prescrip- critical to establish a Hospital Information System (HIS), pretions, allergies, diagnosis, reports, etc. pare and involve various stakeholders (internal and external)  Clinical decision support databases: databases which help and define a clear implementation path for EMR. All comin making decisions during prescription writing, drug-to- ponents of EMR must be compliant to integrate with other allergy database, etc. existing information systems in the hospital. The other major  Orders Management: order entry, retrieval, result review- factors to consider include: ing, etc.  Work flow management: managing processes like ap-  Ease of use: most critical, as EMR will be used mostly by pointment viewing, check-in patients, review, etc. clinicians, who are rather reluctant in adopting technology  Security features: for maintaining security and confidentito be used in parallel along with their care services ality of critical information.  System Interoperability: capable enough to interface and  Electronic Prescription tool: for writing and managing interact with other information systems prescriptions  Standardization: standard compliance to avoid data loss/  Patient’s financial records: service bills, receipts etc. inconsistency when interacting with other systems March 2008

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 Work flow capacities: ideally only full solution systems should be adopted  The sales team of the chosen vendor: a good fit is crucial for success since these are frequently long term relationships  Vendor Services: good vendor after sales and maintenance support services are crucial Trends In India, the number of patients-to-hospital bed ratio is high, that is, there are far more patients compared to the number of hospital beds available. Hence process efficiency, i.e., quality care services in less delivery time are necessary. In this scenario, EMR benefits a hospital as it provides:    

Faster accessibility to records Less storage space Security of information Any time, anywhere accessibility (e.g., remote access from hand-held devices)  Easy to manage as compared to paper based records

and time to maintain and retrieve records. Paper-based records are still the most used form of medical record keeping.

Though corporate hospitals are the front-runners in adoption of electronic medical records, research shows that only 15-25 percent of paper work is reduced after implementing EMR in an Indian hospital.

Major Players Some of the major EMR providers in India include:  GE Healthcare  IBA Health  VEPRO  Siemens  Karishma Software  Sobha Renaissance IT Pvt. Ltd.  21st Century Healthcare solutions  Softlink International  Prognosys  Srishti Software  CDAC  Televital

The slow adoption rate of EMR is the main factor for the slow growth in the market along with the attitude towards its adoption. The necessity for implementing basic information systems in hospitals has been felt, resulting in more hospitals adopting them. But again, the reluctance from the key users Today, EMR is being largely used in big hospital set-ups to of these systems still remains a big challenge for the hospitals, specially the clinicians. Low IT investment is the other key share information within hospital(s). This eases the burden of a physical record file and helps patients share their medical factor affecting the adoption. records easily with other clinicians. But it is still not easy to The big question remains: are Indian hospitals ready to go share EMR with other healthcare service providers due to lack of standardization and integration capabilities amongst two totally paperless?

Paper-based medical record maintenance in itself, is a huge different EMR applications at hospitals. Format of one EMR task because of the space, manpower and time required for may not be readily acceptable by the other hospital’s EMR maintaining (that is, creating, filing, retrieving, etc.) these re- application. cords. This requires special space and manpower in a hospiDespite these challenges, various corporate / large hospitals tal, dedicated for record keeping. are still making stand-alone efforts to implement and use their On the other hand, EMR helps in saving this cost of space own EMR applications. Technologies like hand-held devices, wireless connectivity are being widely used across hospitals.

The management of these hospitals is all geared up to make best use of the technologies available in order to improve quality and efficiency and thus are allocating separate IT budgets.

All these technological investments may not show direct cost savings or return on investments in monetary terms but they do add up to many indirect cost savings, which reflect in streamlined and efficient processes.

Drivers, Restraints and Challenges Market Drivers For the Indian EMR market the key market drivers are:  Cost Saving. Benefits in terms of cost savings result from space, manpower and time required to maintain paperbased records  Process efficiency. Reduced time; as in waiting time, reporting time, administrative functions, etc. make processes 48

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the key decision makers while adopting EMR .  Transferring paper based information into electronic (EMR) format: the transition of paper-based records into electronic format is a manual and tedious process as it takes a lot of time converting each record, keeping in mind the high-level of accuracy and authenticity required.  Long implementation time: the implementation of EMR takes a lot of time as the system is based on the key information flowing across the hospital system and involves various levels of users.  Employing the right team: EMR implementation usually takes a very long time so it’s important to have the right team of people with the right skills required to implement the system. This is to avoid any delays in implementation, which may be caused due to lack of commitment, communication issues, infrastructure issues, time management issues, etc. more efficient  Better work flow through accessibility and availability.

The records are available anywhere, any time through the use of hand-held devices, wireless technologies and are accessible remotely  Increase in Medical tourism. Efficient and quality processes of a hospital encourage more foreign patients to access these healthcare facilities at low costs thus promoting medical tourism  Increasing competition amongst hospitals. With the increasing number of state-of-art healthcare facilities coming up, the competition is increasingly motivating hospitals to provide better quality to stay in business  Increasing awareness and demand for quality healthcare.

With increased healthcare awareness and changing lifestyles, a demand for quality services is compelling hospitals to provide better facilities and services Market Restraints

The Work done so far Some of the hospitals in India using EMR are:  Amrita Institute of Medical Sciences, Coimbatore  Apollo Hospital, Chennai  Artemis Healthsciences, Gurgaon  Christian Medical College, Vellore  Fortis Hospital, Mohali and Delhi  Manipal Hospital, Bangalore  Max Devki Devi Hospital, Delhi  P D Hinduja Hospital, Mumbai  Ruby Hall Clinic, Pune  Sahyadari Hospital, Pune  Sri Sathya Institute Of Higher Medical Sciences, Puttaparthi  Sri Sathya Institute Of Higher Medical Sciences, Bangalore  PGIMER, Chandigarh

 High application cost: high cost of implementing EMR is affecting hospitals’ move due to budget restraints.  Work flow Interruption: the transition to EMR systems is slow and requires a lot of dedication from all the stakeholders involved - from management (key decision makers) to end users (clinicians, nurses etc.), which could ul- Benefits of EMR timately affect the normal work flow drastically.  Easy accessibility and availability of patient information: Challenges any time, anywhere.

The slow growth/adoption of the EMR market is attributed  Improved clinical decision making thus improving quality to: of care.  Reduced costs: from core administrative and clinical op Attitude towards IT adoption: there are often some people erations. in any given hospital, who show reluctance in adoption of  Provides research and decision support. new technologies and are against system changes.  Increased hospital process efficiency.  Security and privacy issues: the patient information flowing across the system is not controlled centrally and many Anurag Dubey system users have access to it, which makes it critical to Industry Analyst, Healthcare Practice address issues of privacy, confidentiality and misuse or Frost & Sullivan mishandling. These issues are challenging and critical for 50

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PERSPECTIVES

Virtual Consultation

@ click away!

[

E-mail has transformed general communication worldwide, revolutionising banking and retail. A successful trial of e-mail communication between a surgeon and patients in Sydney, Australia highlights its potential to improve the doctor-patient relationship as a result of better communication.

]

L

eigh Delbridge, M.D., of the University of Sydney and Royal North Shore Hospital recently conducted a small trial of the use of e-mail as a means of communication with patients awaiting elective thyroid or parathyroid surgery. In the study, 50 patients were randomly assigned to receive an information sheet including the surgeon’s e-mail address and a statement informing them that e-mail was the surgeon’s preferred method of communication. The study, though done on a small group, brought out definite advantages of e-mail communication over conventional face-to-face or telephonic communication and consultancy.

Delbridge found the approach convenient and time-saving.

Patients too expressed their appreciation for the system.

As demonstrated in the trial, doctors can answer a variety of general questions of several patients simultaneously. The doctors’ office routine is not disrupted by telephone calls throughout the day, thus improving efficiency. An e-mail is also more accurate and comprehensive, since greater thought has been put into it. From a legal viewpoint, electronic mail can be filed and provides clear evidence, should any litigation ensue.

The trial, which did not reveal any detectable downside, shows that patients are likely to be more responsive and open

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In the controlled randomized study of 100 patients having thyroid or parathyroid surgery by the same surgeon, altogether, 22 e-mailed their surgeon requesting general information, recovery information, or reassurance

when communicating via e-mail and often ask questions or raise personal issues that they may have felt inhibited about in a face-to-face consultation. There were no differences in any outcome measures in relation to patient satisfaction with communication.

Implementation While urgent communication must not be made through this means, e-mail poses an extremely convenient and effi-

cient way for doctors and patients to communicate. In a country like India, its application on a wide scale is still impractical due to high illiteracy rates and the restricted access of the general public to Internet facilities. There remains a large percentage of the population, including elderly individuals and those of lower socioeconomic status, who neither possess a computer nor have experience of using email.

Another constraint would come in case the doctor has to

The Doctor 24X7 is an online portal for homeopaths aspiring to extend their practice worldwide. Its features include: •

•

The e-mailing service takes care of day to day general mailing like informing patients emails/ communications how to submit the case record or acknowledging patients etc. Easy mainte- • nance of follow ups.

•

100% confidentiality. No one can view your patient details or cases. Your consultation fees are • also confidential between doctor and patient.

•

All data is backed up on high speed web and database servers so there is no worry about loss of data or information.

•

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54

Multilingual Case Recording (MCR) in international languages. The data can be recorded in multiple languages and will also be automatically translated into English. The case record • can also be viewed in a language other than the one it was submitted in.

A patient can directly upload the previous or

recent investigation reports and photographs of affected skin lesions or of alopecia etc.

On receiving the case history, the system automatically classifies it from 29 repertories saving up to 80% of the time and energy usually spent on case taking and hunting for rubrics in the repertories. Only a physician has access to this utility.

Instructions on more than 600 clinical conditions, to educate the patient about the disease, the care and precautions to be taken and the do’s and don’ts.

Takes care of financial transactions from any part of the world and the payment gateway gives you the payment in your local currency through your bank.

Multiple patients from various locations can access your online patient management utility simultaneously.

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communicate bad or important news, which is best done verbally or in person. This means of communication is also not feasible if a physical examination is mandatory.

During the trial in Sydney, one issue that came to the fore was the potential threat to patient privacy due to e-mail communication. Emails from patients should be accessible only to those directly involved in patient care or in the running of the service.

In the UK, NHS Direct has an email service that responds to queries about specific health conditions, treatments and NHS services. Some health care settings are using email as a device to remind patients of appointments, or as a method of reinforcing health promotion advice. Email gives patients a permanent record and may reduce repeat queries from those who have forgotten or been skeptical about previous advice March 2008

or information.

A major concern in doctor-patient e-mailing is that there are few guidelines in relation to the ethical and legal issues.

The experience so far indicates that the problem lies not with e-mail communication per se, but with with the extent to which it can be applied. Virtual consultation offers exibility to people who find it difficult to visit the doctor during office hours.

In order for this innovative IT solution to be put to widespread use, among other things, clear government guidelines will have to be laid down and strictly enforced, which prevent the overwhelming of providers with e-mails, protect patient privacy and address other ethical issues on this front.

There are also the issues of choosing appropriate software, training of medical personnel and ensuring high-quality infrastructure. Nevertheless, e-mail is set to become an important part of any future electronic medical record.

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>>

NUMBERS

By 2015, US will spend of GDP on healthcare.

20% Currently, there are only

9

JCI accreditated hospitals in

Rural India has

India.

0.2

hospital beds for every 100 people.

A 100 bed hospital will typically require a minimum terabytes PACS server

1.5

7

US gets an average of US$

billion insurance claims each year.

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EVENTS DIARY

25 - 27 March, 2008 IV International Conference “Teleme-dicine- Experience Prospects”

12 - 13 April, 2008 Unite For Sight 5th Annual International Health Conference

Donetsk, Ukraine http://www.telemed.org.ua/Seminar/ eng/2008e/index_e.html

Connecticut United States of America http://uniteforsight.org/conference/2008/registration.php

25 - 28 March, 2008 Medical Tourism Asia 2008

16 - 18 April, 2008 Med-e-Tel

Singapore http://www.medicaltourism-asia.com/ ibcsg/medicaltourismasia/index.jsp

Luxembourg, Germany http://www.medetel.lu/index.php

7 - 9 March, 2008 52nd National Conference of Indian Public Health Association

26 - 29 March, 2008

New Delhi, India http://www.iphaconference.mamc. ac.in

Perth, Western Australia, Australia http://www.worldhealthcongress.org/

EVE SANTE 2008 Gurgaon (NCR Delhi) India http://www.evesante.com

1 - 3 March, 2008 Meditec Clinika 08 Chennai, India www.meditec-clinika.com

10 - 12 March, 2008 Dubai International Pharmaceuticals & Technologies Conference & Exhibition Dubai http://www.duphat.ae/

12 - 14 March, 2008 SE Asian Healthcare Show 2008 Kualalumpur, Malaysia

http://www.abcex.com/ 12 - 14 March, 2008 SALMED 2008 Poznan, Poland http://www.salmed.pl/

13 - 15 March, 2008 Georgian International Healthcare Exhibition (GIHE) Tbilisi, Georgia http://www.healthcare-events.com/ gihe/

14 - 16 March, 2008 HOSPIMedica INDIA 2008

World Congress of Health Professions

27 - 30 March, 2008 MedicExpo Helliniko, Greece http://www.medicexpo.com/

2 - 4 April, 2008 1st India Health Conclave Mumbai, India http://indiahealthsummit.com/

4 - 6 April, 2008 IDEM 2008 Singapore http://www.idem-singapore.com/

7 - 8 April, 2008 Global Healthcare Transformation Congress Singapore www.availcorp.com/english/events_ list.php?eventsid=130&backurl=upco mingevents_list.php

9 - 11 April, 2008 RFID World Asia 2008

8 - 20 April, 2008

16 - 19 April, 2008 Health Care Dental Damascus, Syria http://www.arabiangroup.com/healthcare/n_homepage.htm

10 - 11 May, 2008 1st International Online Medical Conference (IOMC 2008) Online, India http://ala.ir/iomc2008

13 – 15 May, 2008 HOSPIMedica Australia 2008 Sydney, Australia http://www.hospimedica-australia.com

14 - 17 May, 2008 Kazakhstan International Healthcare Exhibition (KIHE) Almaty, Kazakhstan http://www.healthcare-events.com/ kihe/

18 - 20 May, 2008 Symposium on Health Informatics and Bioinformatics, HIBIT ‘08

Mumbai, India http://www.hospimedica-india.com/

Singapore, Singapore http://www.terrapinn.com/2008/rfid/ index.stm

21 - 23 March, 2008 MEDEXPO East Africa 07

11 - 13 April, 2008 Pharma Future Expo ‘08

25 - 28 May, 2008 Geneva Health Forum

Nairobi, Kenya http://www.growexhibitions.com/kenya/medexpo/

Singapore, Singapore http://www.pharmafutureexpo.com/

Geneva, Switzerland http://www.genevahealthforum.org

58

Ýstanbul, Turkey http://fens.sabanciuniv.edu/hibit08/

www.ehealthonline.org