Telehealth in developing nations: March 2009 Issue

vo l u m e 4 | i s s u e 2 | FEBR UARY 2009

iSoft launches ‘Lorenzo’ in Asia

ISSN 0973-8959

Microsoft and HIMSS launch ‘Health Users Group’ in APAC

A Monthly Magazine on Healthcare ICTs, Technologies & Applications www.ehealthonline.org | vo l u m e 4 | is s u e 3 | M A R C H 2 0 0 9 | I N R 7 5 / U S D 1 0

Doctor @ your finger tips >>> 15. Insight into telemedicine instruments >>> 18. EHR vs EMR - What’s the difference? >>> 28. Seamless integration for quality care >>> 31. IT solution for Cath Labs >>> 32. HIMSS AsiaPac 09 event report >>> 36. Molecular Diagnostics: point-of-care infectious disease test >>> 41.

CONTENTS w w w . e h e a l t h o n l i n e . o r g | volume 4 | issue 3 | March 2009

32 8

COVER STORY

Role of telehealth in developing nations Rajendra P Gupta, President & Director, Disease Management Association of India (DMAI)

15

CASE STUDY

IT solution for Cath Labs

With inputs from Healthcare Sector, Imaging & IT Divisions, Siemens, AG, Germany

36

EVENT REPORT

Innovation Unplugged HIMSS AsiaPac 2009, 24-27 February KLCC, Kuala Lumpur, Malaysia

DEVELOPMENT DIMENSION

Doctor@your Fingertips Nilakshi Barooah

18

TELEMEDICINE

Insight into telemedicine instruments Lieutenant Colonel Salil Garg Cardiologist, Command Hospital, Pune Squadron Leader Mudit Mathur DD Space Ops, DSCC, Bhopal

26

41

SPOTLIGHT

Awards for Exemplary Implementation of e-Governance Initiatives (2008-09)

EXPERT CORNER

Molecular Diagnostics Poing-of-care (POC) Infectious Disease Test Market Insight Healthcare Practice, Frost & Sullivan

eHEALTH

28

PERSPECTIVE

EHR vs EMR What’s the Difference?

Houston Neal Director, Business Development Software Advice

31

APPLICATIONS

Seamless integration for quality care Rakesh Budhe Asst. General Manager (Sales & Marketing) Softlink International

March 2009

www.ehealthonline.org

REGULAR SECTIONS India News 12 Business News 22 World News 34 Numbers 44 Events Diary 46

Post Jobs Online for FREE @

www.ehealthonline.org Now a CAREER section specifically for professionals in eHealth, Health IT, Bio-medical Engineering, Medical Technologies, Medical Electronics, Telemedicine, Tele-health, Healthcare Operations and Administration.

Employers can now give specific details for the positions available & Job Seekers too can finally get a clearer picture of what jobs are on offer for them.

Get a clutter-free picture of the healthcare job market!!!

Get clicking on www.ehealthonline.org/careers to get started.

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 wellresearched 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 international 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.

Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to e-Health projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians.

We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: Articles/ case studies should not exceed 2500 words. For book reviews and event reports, the word limit is 800.

An abstract of the article/case study not exceeding 200 words should be submitted along with the article/case study.

All articles/ case studies should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.

Book reviews should include details of the book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi). Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable. In the case of website, provide the URL. The manuscripts should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post.

Relevant figures of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format.

A brief bio-data and passport size photograph(s) of the author(s) must be enclosed.

All contributions are subject to approval by the publisher.

Please send in your papers/articles/comments to: The Editor, eHealth, G-4, Sector 39, NOIDA (UP) 201 301, India. tel: +91 120 2502180-85, fax: +91 120 2500060, email: info@ehealthonline.org, www.ehealthonline.org

March 2009

www.ehealthonline.org

EDITORIAL Volume 4 | Issue 3 | March 2009

president

Dr. M P Narayanan editor-in-chief

Ravi Gupta group directors

Maneesh Prasad Sanjay Kumar Sr. manager - PRODUCT DEV EL OPMENT

Dipanjan Banerjee mobile: +91-9968251626 email: dipanjan@ehealthonline.org research A ssociates

Susan Thomas Sales & MARK ETING

Arpan Dasgupta mobile: +91-9911960753 email: arpan@ehealthonline.org Bharat Kumar Jaiswal mobile: +91-9971047550 email: bharat@ehealthonline.org Sr Graphic Designer

Back to the future..

While medical sciences have extensively enlarged its knowledge pool over the last few decades, healthcare delivery continued to become ever more complex, costlier and in some cases, even cumbersome.

Most experts predict that IT and automation technologies are what will drive the much required transformation in healthcare and untangle it from intertwined cobwebs of myriad clinical procedures, ever widening treatment options, often unpredictable health outcomes and increasing pressure on human, financial and material resources required for care delivery.

Arguably, the need also lies in making IT solutions more contextual for healthcare. While some of the functional areas are alike any other industry, clinical context of healthcare is what makes it somewhat typical, requiring specialised approach in designing solutions.

Health IT providers across the globe are increasingly focusing on this aspect of their development effort and progressively investing in this direction. Moving ahead from traditional solutions for hospital management and patient monitoring, the focus is shifting more towards ‘interoperable solutions’, ‘patient-centric integrated EMRs‘, ‘clinical decision support systems’ and ‘business intelligence’ for healthcare. In near future, each of these will emerge as essential elements of overall IT framework of healthcare enterprises and spearhead the ‘archetypal’ transformation.

Bishwajeet Kumar Singh Graphic D esigners

Ajay Negi Chandrakesh Bihari Lal Om Prakash Thakur web

Zia Salahuddin subscriptions & circul ation

Manoj Kumar (+91-9971404484) manoj@ehealthonline.org editorial correspondence

eHEALTH G-4 Sector 39, NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org is published in technical collaboration with Centre for Science, Development and Media Studies.

In a landmark development of collaborative work between IBM, Google and Continua Health Alliance, a new open standards-based software will soon be made available for facilitating remote personal health monitoring via online patient health records platforms, such as, Google health. This is certainly a step forward to make the concept of universal health records a reality. The new software promises to have the ability to connect with majority of such devices and upload patient data directly into any online PHR platform.

The biggest advantage of this probably lies within its potential to make routine patient monitoring possible outside hospital setting, and in the process, freeing up hospital resources for serving patients with more critical conditions.

Turning the focus from futuristic to basic and delving into technology-aided remote healthcare for rural areas, the phrase ‘healthcare transformation’ attains a different dimension. Under this context, it is all about bringing primary medicare to those who doesn’t have one. The need is more towards being able to provide ‘access’ to a doctor, rather than records. Interestingly enough, latest research indicates that healthcare condition of communities is directly proportional to the penetration of tele-connectivity channels (such as fixed telephone, mobile and Internet) available to those communities.

Catch up with more insight into this topic in the cover story of this edition.

Hope you like the issue.

does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided.

Owner, Publisher, Printer - Ravi Gupta.

Printed at Print Explorer 553, Udyog Vihar, Phase-V, Gurgaon, Haryana, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP Editor: Ravi Gupta

Ravi Gupta Ravi.Gupta@ehealthonline.org March 2009

COVER STORY

Role of telehealth in developing nations Economy and healthcare are two major thrust areas in every part of the world. If a country has a healthy population, it has a productive workforce that leads to a vibrant economy. Today, in a constantly changing multi-polar world, nations with younger population like China and India are driving the world markets with a high growth rate. As the economies grow, so do the healthcare concerns.

O

Rajendra P Gupta President & Director, Disease Management Association of India (DMAI)

The only way to address the current healthcare needs is to fuse basic healthcare with basic technology.

March 2009

ut of the 195 countries according to the World Bank, 152 are developing countries.

Ironically, developing countries have 84% of the world’s population, 93% of the burden of diseases and 11% of the global healthcare spending and it cannot get worse. If we see the geographical spread more than two billion people live in just South Africa and South East Asia. These are the countries with low income, high population growth, and low standard of living with no significant industrialisation. It is important to note that 80% of all deaths happening due to chronic diseases happen in developing countries. These countries have issues with regards to environmental sanitation, safe drinking water, undernourishment, and limited access to preventive and curative care. Approximately 80 % of the DALY’s (disability adjusted life years) are lost due to chronic diseases before the age of 60. Illness, ignorance, and poverty are a three-headed monster. Adding to the already over-burdened, underfunded healthcare system is the rate at which these countries are growing old. These countries will become old before they become rich. It is estimated that by 2030, elderly population will grow to 22% of the population. There will be more people above the age of 60 than the children below 15 years.

www.ehealthonline.org

Developing countries have a poor doctor-patient ratio. For some countries in Africa, there is one doctor for every 50,000 people.

South Africa has 1.3% of the health professionals but 25% of the global burden of diseases. No doubt that people in these countries spend a greater portion of their income on healthcare. Developing countries can be rightly classified as HPSA – Health Professional Shortage Areas.

Shift from diseases

infectious

to

chronic

Over the last three decades there has been a shift from infectious diseases to chronic diseases. What is alarming is that countries like India are fast growing infamous by becoming the ‘Diabetic capital’and ‘CVD capital.’ Whereas, 60 % of all deaths in these countries are happening due to chronic diseases. It is estimated that there are already one billion people who are overweight and this number is likely to cross 1.5 billion by 2015. The number of older people will grow from 249 million to 690 million from 2000-2030.

According to World Bank it is estimated that total deaths due to chronic diseases worldwide are 58 million. In 1990, the communicable diseases accounted for 49% of the illnesses and by 2020 non-communicable diseases will

COVER STORY

Graph 1. Mobile telephone subscribers per 100 inhabitants, 1997-2007

Graph 2. Internet users per 100 inhabitants, 1997-2007

Graph 3. Fixed telephone lines per 100 inhabitants, 1997-2007

Graph 4. World Internet users by world regions

account for 43% of the illnesses. Chronic diseases are now occurring at a much younger age than it was 20 years ago. World Bank estimates that approximately 60 million lives can be saved in low and middle-income countries if we are able to reduce deaths due to chronic diseases. In 2005, the chronic diseases accounted for 75% of all the deaths in low and middle-income countries.

The developing countries face the challenge of ageing population, shifts from infectious to chronic diseases and social changes, limited resources, lack of administrative capacity, high cost of reaching people and expensive delivery of care, huge population and geographical barriers, and limitations of the government in enhancing the GDP spend on healthcare.

The only way to address the current healthcare needs is to fuse basic healthcare with basic technology. Interestingly, cellphone usage is growing and Asia and Africa account for more than 42% of the worldwide Internet users.

Eighty per cent of the world population lives within cellular network range. If we see the growth of cellphones, 68% of the world’s new subscriptions in 2006 were in developing countries. Since the population of these countries is relatively younger, the adoption rates for the new technology is high.

Cellphone usage in Africa itself is growing at 65%.

In all the current limitations of limited healthcare professionals, huge geographical barriers, rising healthcare costs, increasing burden of chronic diseases, and the availability of the modern technology presents a unique opportunity.

Technology is getting cheaper day by day. With organisations like Indian Space Research Organisation (ISRO) proving VSAT connectivity to almost all parts of the developing world on a very low set up cost, it is now possible to roll out not just primary care in remote places but also the advanced medical care in the remotest regions of the world. While it might not be possible to set up a full-fledged healthcare facility everywhere as the cost is not just high, but maintenance is difficult.

However, setting up the telemedicine network is possible with minimal infrastructure. The best part of telemedicine is that we do not always require trained doctors at the point of care.

The remote monitoring can be done via a trained technician who would be literate. There are ‘Fool proof’ and ‘Idiot proof’ medical devices available that do not require much handling expertise. The results can be transmitted to a doctor at the center, and the investigation, diagnosis, and treatment can follow.

It is proven in different studies that if people don’t have a telephone access, 11% of the time people don’t go anywhere.

Telehealth can be via different mediums i.e. web-based or VSAT-based, Telephone/IVR-based, self-monitoring, and live consult. Today, telehealth includes eReminder, ePrescription, eConsultation, and eCounselling.

Telehealth is established in all branches of medicine i.e. telemonitoring, telediagnostic, telecardiology, telepathology, teleradiology, teleneurology, telereferral, teleonchology, telesurgery, teleopthalmology, teleprenatal screening, teledermatalogy, etc.

March 2009

COVER STORY

Graph 5. TelaDoc 2007 Customer Survery Data

Benefits of Telehealth •

• • •

• • •

•

• • • • •

•

• •

10

•

Outpatient visits are about seven times more expensive than electronic consultation Rural population doesn’t need to travel to difficult terrains Telemonitoring can avoid white coat hypertension CVD is the cause of death for 65 % of diabetic patients. If telehealth is introduced the death rate can reduce to 58.5%. With telehealth 10% of the pre-diabetic patients will not develop diabetes.

Telemonitoring can reduce emergency room visits Telemonitoring can get timely interventions thus saving lives Telehealth can deliver direct to patient service – educational, preventive, and administrative Telehealth has been known for fewer human interventions, thus reducing the chances of human errors Fewer missed appointments Increased compliance and adherence to treatments Improved coordination Universal access to EMR and specialist advice Telehealth empowers the chronic patients for self & managed care.

Allows home-based health Telephone/eConsult lasts approximately 10 minutes compared to 3-6 minutes for consultation with a doctor Privacy is protected Patient-centric care March 2009

Equivalent outcomes at lower costs.

Different controlled studies have shown that telehealth in chronic patients leads to 40% reduction in emergency room visits, 63% reduction in re-hospitalisations, 22% reductions in total bed days, and cost of care is 27% less in telemonitoring groups.

It is stated in a few reports that disease management saves USD 4.8 for every dollar spent and telehealth saves USD 5.6 for every dollar spent.

Help to the medical fraternity It is a fact that for each patient that exists in the developing world, there are nine who are still undiagnosed.

Telemonitoring can bring such patients to the doctor for treatment.

Further, many a time due to frivolous problems patients rush to the doctor and end up wasting their time and money. This can be judiciously used if a pre-screening could be done using telemedicine.

A lot of old doctors especially female doctors with children prefer to continue practising from home or at their convenience. Telehealth is one option that lets them practice at their convenience.

Telemonitoring can do a 12 lead ECG, ultrasound- X-ray, sugar check, cholesterol check, blood pressure, lung function test- Spirometry, Pulse oxymetry, etc.

Indian healthcare - need gap India has a healthcare system where

www.ehealthonline.org

the number of doctors are 0.60 per 1000 population, beds at 0.70 per 1000 population, nurses 0.80 per 1000 population, dentist 0.06 per 1000 population, and pharmacist at 0.56 per 1000 population. If we check on some of the specialities like psychiatry and take the rural and urban divide into account, doctor to population ratio is 1:1 million. We have just about 7,00,000 doctors and we churn out about 22,000 doctors per year. Current healthcare system is accessible to just 30-35 % of the population.

There was a shortage of 4,833 Primary healthcare centers (PHCs) across India and over 800 rural hospitals were functioning without a single doctor. “A total of 807 PHCs are working without a single doctor,” said Health Minister Anbumani Ramadoss in a written reply to the Lok Sabha.

“There are a total of 22,370 primary health centres functioning across the country, and the shortfall is of 4,833 PHCs. And, there are only 15,546 female health assistants against a requirement of 22,370,” he said.

PHCs function as the first contact point between villagers and medical officers. They render curative, preventive, promotive, and family welfare services to rural Indians.

Giving details about the status of community health centres, the minister said there was a shortage of 2,525 CHCs across the country and of the total 4045 CHCs 26 were running in rented buildings, 306 in panchayat buildings.

He said 449 buildings were under construction and 199 buildings needed to be constructed, and there were only 5,117 specialised doctors working in these CHCs but the requirement was of 16,180. Against a demand for 4,045 radiographers only 1,740 were working in such centres.

COVER STORY

document said that India was short of six lac doctors, 10 lac nurses and two lac dental surgeons.

Major private groups are shying away from foraying into healthcare in a big way due to high real estate costs, lack of trained manpower and high gestation periods. A few years ago two of the biggest business houses announced investments into healthcare aiming to capture 20% of the healthcare, but gave up quickly seeing the cash burnout without quick financial returns. Most of the privately run healthcare entities are run for charity.

Adding to the woes is low penetration of health insurance that is 1.08% of the total population .

Knowing well that currently two thirds of the Indian population is under 35 years of age, India will become older before it becomes rich. The healthcare issue is like a ticking time bomb.

The way forward for Telehealth

Graph 6. Patient Barriers to Physician Care

Graph 7. Teledermatology in Port St. Jons In both PHCs and CHCs there is a requirement of 50,685 nurses and midwives but only 29,776 are in position.

CHCs are established and maintained by the state governments. A CHC has at least 30 indoor beds and provides facilities for emergency obstraetrics care and specialist consultations.

Adding to this deficiency, absenteeism in PHC is around 40%. There is an average of one urban primary health facility for about 150000 urban population with only 2-4 health workers.

India according to WHO is short by 2.4 million physicians, nurses, and mid wives. A recent planning commission

Despite countries like the US that spend over USD 7000 per capita the healthcare issues remain unaddressed.

So there is a lesson to be learnt that just spending more on healthcare does not solve the problem. We don’t need just healthcare delivery, but pro-activeness and innovation in healthcare delivery to address the issue. We will have to reduce healthcare cost, avoid chronic disease burden and increase positive outcomes.

Telehealth should be used as the de facto POC (point of care) tool for preventive care and follow up care in chronic disease management.

The channels of delivery must not just be confined to doctors and hospitals but must also reach pharmacies and other channels nearer to the POC. Seeing the situation in developing countries telehealth is the only economically viable way to address the elderly population, rural areas, preventive care, chronic diseases, and increasing healthcare costs within current limitations.

(The writer is on the board of several companies across retail, hospital chains, disease management , pharma R&D, diagnostics, biotechnology, genomics amongst others.)

March 2009

11

NEWS REVIEW >> INDIA

Apollo’s white hope The healthcare group Apollo Hospitals have set up a new hospital Apollo Speciality Cancer Hospital (ASCH) in Chennai.

The hospital introduces the cyberknife robotic radio surgery system which is designed to treat tumours anywhere in the body.

Cyberknife treatment will cost patients double the amount they would spend otherwise, but the treatment claims to minimise or eliminate the complications associated with other conventional cancer therapies. The treatment takes a week’s time whereas the other procedures usually take about seven weeks.

Other features of the treatment is that it can be used to treat tumors previously considered inoperable. It is also possible to treat multiple tumours at different locations in the body during a single treatment session.

The advanced technology behind CyberKnifeÂŽ uses real-time image guidance technology and computer-controlled robotics to deliver an extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue and adjusting for patient and tumour movement during treatment. It is developed by Dr John R Adler MD, professor of neurosurgery and radiation oncology at Stanford University Medical Centre.

Apollo plans to expand this treatment option in other cities such as Hyderabad and Delhi.

12

51,000 Telemedicine centres for Orissa

Rural posting for medicos

The Orissa Trust of Technical Education and Training (OTTET) has announced plans to roll out 51000 telemedicine centres in villages across the state of Orissa in the next three years.

The project aims to take modern healthcare delivery to the doorsteps of the rural population and generate employment for educated youth in the state.

From 2009 medical graduates have to undergo a compulsory rural posting. The decision has been recently announced by the Union Health Minister Anbumani Ramadoss. According to the health minister the proposal has been taken in an effort to augment health facilities in rural areas.

The proposal has been cleared by all the states and would be

The project will be executed through a public-private partnership involving the Orissa state government and Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGI), Lucknow.

The project aims to impart training and skills in IT-based health delivery. Orissa hopes the facilities will generate jobs for 100,000 health workers, and the same model could later be expanded to urban areas where there is high unemployment.

Telemedicine activities first began in Orissa in 2001, and this marks the latest stage in their roll out.

implemented from next year. The provision entails a mandatory rural posting of doctors who have completed their MBBS and want to pursue post-graduate studies in medicine.

Earlier the proposal had kicked up a row with medical students protesting over the lengthening of the course.

March 2009

www.ehealthonline.org

INTEGRATED EMR Helps you eliminate paper charts Faster document processing Easy storage and retrieval of data Instant access to patient records Support for Charts and Schematics

EASY TO USE User friendly interface Simple mouse-click access Quick learning curve

CUSTOMIZABLE Designed for individual requirements Integration with existing applications Workflow based technology Selective modules

SECURE Access control passwords Encrypted data for confidentiality HIPAA compliant Audit on all transactions HL7 transactions

ADVANCED FEATURES Publish Charts/EMR Follow-ups Referral Management Voice Recognition Workflow Management Correspondence Manager SMS and Email Alerts Centralized/Distributed Implementation

NEWS REVIEW >> INDIA

24x7 Jan Aushadi shops To make drugs affordable to the poor sections of the society the central government has come up with an unique idea of setting-up 40 outlets of a medicine store chain Jan Aushadhi all over the country.

Jan Aushadi will sell high quality unbranded generic medicines at much cheaper rates than branded medicines available in the market.

A few Jan Aushadhi outlets have already started functioning. The first such store was opened in Amritsar last year. Delhi got its Jan Aushadhi store in the first week of Feb. It is opened in Shastri Bhavan and will be run by Kendriya Bhandar. The shop will remain open round the clock.

Opening generic drug stores was decided at a meeting of the Pharma Advisory Forum chaired by Chemicals, Fertilisers and Steel minister Ram Vilas Paswan last year. Primarily, five PSUs - IDPL, HAL, BPCL, KAPL and RDPL - will supply medicines but several private sector drug manufacture rs too had promised to help in the mission.

In fact the department of pharmaceuticals (DoP) has received 76 applications from domestic drug makers who are interested in supplying generic medicines at a lower price to the Jan Aushadhi Stores.

ESIC to set up medical colleges

Clinical Trials of AIDS vaccine

The Employees State Insurance Corporation (ESIC) plans to set up 11 medical colleges and 13 postgraduate medical institutions to provide better health care and superspeciality treatment to the insured.

The Indian Council of Medical Research (ICMR) will start phase I clinical trials to test a combination of two AIDS vaccine candidates.

The trials will be conducted at the National AIDS Research Institute (NARI) in Pune and the Tuberculosis Research Centre (TRC) in Chennai.

The combination drug will combine two AIDS vaccines ADVAX and TBC-M4 in a prime-boost regimen, which essentially means the two vaccine candidates will get better response from the body’s immune system than giving either vaccine candidate alone. The trials will be conducted under the aegis of a memorandum of understanding between ICMR and the National AIDS Control Organization (NACO) and the not-forprofit International AIDS Vaccine Initiative (IAVI).

There are about 50 lakh identified HIV patients in India, of which about 30 lakh are on treatment.

The first such college is scheduled to open in 2010-11. Minister of State for Labour and Employment Oscar Fernandes announced that forty per cent of the seats in each of these colleges will be allotted on an all-India basis and to the respective State governments. And, out of the remaining 20 per cent, 10 per cent will go to children of the insured employees, and five per cent each to children of the employers and the wards of ESIC staff.

At present, there are 144 hospitals, 42 annexes and 1,427 dispensaries under the scheme covering 3.30 crore beneficiaries.

14

March 2009

www.ehealthonline.org

DEVELOPMENT DIMENSION

Doctor@your

Fingertips I

magine you are in the midst of a heart attack… and require immediate medical attention to survive! Your chances of survival will be far greater if you happen to be in Kozhikode, Kerala, thanks to Dr. SMS for its prompt service available at your fingertips. Dr. SMS is not a doctor emerging out of your mobile phone, but an SMS service which will help you reach the nearest hospital in town. Dr. SMS is an innovative way of providing healthcare information through an SMS. This service was launched early in 2008 in Kozhikode city of the South Indian state of Kerala. An excellent example of Government to Citizen services in the health sphere, the magic number -9446460600- provides information on the availability of hospitals, medical centres, facilities, and doctors in the designated area that the sender wants to know.

Speaking to eGov Dr. Ajay Kumar, Secretary, Information Technology, Government of Kerala said, “This information-based service helps people contact the hospital concerned through their mobile phone as soon as an emergency arises.” All you need to do is to text the pin code of the locality about which you need the information and you will receive the information promptly via an SMS. Bridging the digital divide has been the prime moto of all Information and Communication Technology (ICT) initiatives and projects. With India adding millions of mobile subscriptions every month and heading towards meeting the 500 million mark by 2010, mobile device is all set to become the all-in-one gadget. Right from paying electricity bills to booking bus and railway tickets, mobile phones hold the ability for further value additions as and when required. Today, it is not rare to see a rickshaw puller or a daily wager to carry a mobile handset. Tapping such wide popularity of the mobile device, the Dr. SMS project is definitely a great move towards providing value-added services on a mobile phone. It also marks an innovative shift towards m-Governance.

Target Audience: Tourists, Migrants and Resident population Pilot Project: Kozhikode Services Available: Information on the availability of hospitals, medical centres, facilities and doctors Other cities in the pipeline: Kannur, Kasargode and Thrissur

Cost structure of Dr. SMS project Monthly rent for the SMS SIM: INR 225/month + service tax.

Free outgoing SMS provided/month 2000 numbers.

Additional SMS charge 5 paise/SMS irrespective of any service providers within LSA and 40 paise/SMS outside LSA.

March 2009

15

DEVELOPMENT DIMENSION

Dr. SMS @ Kozhikode Currently, Dr. SMS service is available in Kozhikode (formerly known as Calicut), which is the third largest city in Kerala with a population of approximately 20 lac. Kozhikode is the ‘chosen one’ for this project because it has the highest rate of mobile penetration in the state. The city has a huge migrant population and also attracts a large number of tourists every year. Dr. Kumar said, “Mobile phone is more affordable to people compared to the Internet facility – this fact again ensures the reach and success of a project like Dr SMS among the public, be it tourists, migrant population or the resident population.” The service acts like a first aid kit for any health emergency for the large number of tourists who are on the move in the town and are not aware of the whereabouts of the place. In the event of an emergency, people can contact the hospital concerned through their mobile phone.

This helps the hospital authorities prepare the emergency room as per the requirements as well as to mobilise the resources like specialist doctors and specialised equipment to take care of the emergency. Moreover, the database created for Dr. SMS can also be used for micro-level planning for ensuring an equitable geographic distribution of facilities. Given its novelty, the project has managed to get an average of approximately 200 transactions on a day-to-day basis.

Role of Kerala Government The Government of Kerala has taken a laudable step in creating this value added service for its people. Speaking about the initiative, Dr. Kumar stated, “Presently, the cost of the SMS sent to the user is being borne by the Government.” Even though there is no tie up with any of the hospitals for this project, the project claims a credible and a sound database on hospitals and emergency health services, which was based on a large data from the Health Infrastructure Survey conducted by the National Commission on Macro economics and Health (NCMH), Ministry of Health and Family Welfare, Government of

16

March 2009

Dr. SMS at affordable and cost effective rates has indeed made the services popular among the masses.

At present, the customer who uses the service is charged an amount of 40 paise per SMS. The Government of Kerala has taken the onus of taking care of the cost of the return-SMS delivered to the users.

In the Pipeline

The Government of Kerala has taken a laudable step in creating this value added service for its people. Speaking about the initiative, Dr. Ajay Kumar , Secretary - IT, Govt. of Kerala stated, “Presently, the cost of the SMS sent to the user is being borne by the Government”.

India. This survey extensively uses data on all medical facilities across all the districts of the state. Dr. Kumar added, “The validity of the data was ensured during the preparation of the database.”

Partnering with BSNL Dr. SMS is a success story in Kerala and Bharat Sanchar Nigam Limited (BSNL) has played a significant role in it. The services provided for

www.ehealthonline.org

With the success of the Dr. SMS project in Kozhikode, there are plans for replicating the model in all other cities of the state. Speaking about such plans, Dr. Kumar further reiterated that, “The pilot project was implemented in Kozhikode and is easily accessible to more than 20 lac people residing in the district. The services of Dr SMS will be available to the residents of Kannur, Kasargode and Thrissur within a few months.”

Expanding the scope of the project there are also plans for making it an umbrella service through various media of information distribution delivery outlets such as portals and the integrating of spatial data and GIS apart from the existing SMS service. There are also plans for making provisions to receive the details of the medical services on email or through an SMS. Talking further about the future plans of making the model sustainable, Dr. Kumar added that, “We are also in the process of identifying a SMS aggregator which would help us provide this service on a sustainable basis to subscribers of any mobile service provider’s network.” It is hoped that once the project is rolled out across the state, it will benefit the 3 crore population of Kerala. The state promises the best delivery of such digital technology given its high rate of mobile penetration, which is even higher than that of the national average of India. With such high levels of commitment towards addressing the digital divide, Kerala is not only a front-runner in the e-Governance map of India but also embarking on a path of m-Governance.

Nilakshi Barooah, Sr. Sub Editor, CSDMS

TELEMEDICINE

Insight into telemedicine instruments This is the second in a series of three articles on Telemedicine contributed by the authors.

T

elemedicine has the potential to significantly change the delivery of healthcare. Today doctor-todoctor or doctor-to-patient interaction through mobile telephony is routine, and with the advent of 3G networking even transmission of heavy images to handheld devices are possible.

However, the most accurate diagnosis and carefully planned treatment may fail, if there is a breakdown in the interpersonal skills necessary for communication. Therefore, patient satisfaction constitutes a crucial aspect of quality care. If clinicians are not comfortable with the technology or find that technology decreases their control over patient care, they may avoid using it, thereby precluding other benefits of telehealth. Clinical acceptance of a telehealth application may depend on the degree of confidence the clinician has in his or her clinical findings as well as the clinician’s satisfaction with the encounter in the absence of proximate, tactile interaction with the patient. Most doctors are most comfortable dealing with patients upfront. This maybe a habit of training and it is expected that younger doctors are more comfortable than their peers when dealing with faceless patients.

Telemedicine Instruments From a rudimentary beginning with telegraphic or telephonic consultations to more advanced information and communication technologies (ICT) tools of today, telemedicine has been trying to keep pace with technology, which has consistently been outpacing its usage. By the time a technology can be adopted, it gets outdated.

Telemedicine and health information networks allow healthcare provid-

18

March 2009

ers, payers, employers, pharmacies, laboratories, and other organisations to share patient data, financial data, and clinical data. Real time interactive audio and video connections may be essential in some situations, whereas telephonic consultations may prove satisfactory for others.

In most cases, the needs, options and cost of the service provided play a major role in deciding the technology to be adopted. Two different sites of an organisation may need two different technologies. For example, a consulting radiologist or dermatologist may need a very sophisticated and expensive display unit that is capable of showing fine high-resolution images, but for an attending physician lower resolution may be sufficient to support discussions of an image with a consultant or with a patient. A central consulting site will need significant radiographic storage capacity while the remote site may need very little. Hence, different telemedicine applications may involve quite different combination of technological configurations according to the organisational objectives in terms of equipment use and space requirement. Since the technology changes at a rapid pace, these complex issues of advanced technology usage make formidable demands on selecting the proper hardware and software options. The need to develop a variety of communication links with other organisations differs in the capacities and configurations of their systems.

A classical telemedicine clinical consultation would have the following four components: • Initial history taking - accomplished through an interactive

www.ehealthonline.org

Lieutenant Colonel Salil Garg Cardiologist, Command Hospital, Pune

Squadron Leader Mudit Mathur DD Space Ops, DSCC, Bhopal

audio video consultation and data exchange.

• Physical examination - done directly with or without consulting over the media using audio capability and followed by additional data transfer related to the exam.

Different medical peripherals may be used to acquire signals from auscultations. These are transferred in waveforms or as stills.

• Investigations - radiological and pathological examinations done and images transferred - evaluation of the acquired data images is carried out.

• Analysis and management depending on the analysis of the data, a diagnosis is reached and a treatment plan devised and followed.

The core equipment traditionally needed for a telemedicine services are:

TELEMEDICINE

• •

•

•

•

•

• •

Integrating Platform - a powerful computer CODEC - a technology that is required for transmission of video images. A CODEC compresses and decompresses the images transmitted.

MUX - a multiplexor to combine the communication lines to get the higher bandwidth.

Net Terminator - a device required at the point of termination of the ISDN lines.

Higher bandwidth providing lines are preferred, as the files of enriched medium that need to be transmitted is very large e.g. ISDN. INPUT devices are such as camera, scanners, and other medical peripherals that enable the system to capture information during the clinical encounter.

An application software to integrate the data from the different sources Robust operating system.

HARDWARE Devices are required which can capture and manipulate data so that it can be transmitted over the communication channel. These devices differ according to the necessities of the examination, and the consultant site but may not be absolutely sacrosanct as enumerated in the tables.

Specialised medical equipment for telemedicine application Bandwidth Demands: Both audio and video transmissions require high bandwidth usages, which are as under.

Audio Signals: Voice - normal 64kb/s (16-32kb/s), Hi - fi - 1.4Mb/s (192kb/s) Thus voice and low-resolution images need lower bandwidth from 10 KBPS to 100 KBPS, whereas high definition images, audio-video conferencing and VCD, SVCD, DVD quality video require higher bandwidth between 100 KBPS to 10 MBPS. Multimedia file transfer, broadcast video HDTV and visualisation requirements may go up to even 1 GBPS. One of the suggested methods is restructuring or manipulating information before it is sent on transmission media. Compressing data by ‘loss less’

compression technology increase communication capacity and reduce bandwidth.

Digital data packet switching technologies can also be used for fast transfer of large data. Integrated Service Digital Network (ISDN) protocol can be used for standardised high-speed digital transmission of integrated audio, video, and data Equipment needed for an Examination Site:

Equipment needed for a Consultant Workstation:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

1.

Directional Microphone Videoscopes Electronic Stethoscope Video Source switch box Audio Mixer Wireless receiver base Audio Codec Multiplexor Telecom link Routers Color printers

PC with either UNIX workstation or NT workstation A Video Console color monitor.

2. Camcorder 3. Directional Microphone 4. Audio Mixer 5. Telecom link 6. Multiplexor 7. Stethoscope Hearing Pieces 8. Mono Equalizer 9. Scanner 10. Image Input Devices 11. Audio Input Device

Table2

Table1

signals. The major benefit of ISDN is that it brings high bandwidth into homes and offices without the high expense of rewiring them to connect with the rest of the telephone system that is mostly digital. It has been amply proved that by appropriate installation, it is possible to improve interaction and provide quality healthcare.

The entire scenario is about to undergo a big change. There could be wireless microwave technologies such as wireless local loop, communications satellite systems,

Images: Video images bandwidth demands on transmission rate: Image type

Unit Size

Exam

Black & White

307 Kbytes/frame 640 * 480 @ 8 Bits

30 frames / sec8.8 Mbytes/sec

Color Partial Bandwidth Psuedo 614 Kbytes/frame640 * 480 @ 16 Bits 30 frames / sec17.6 Color Mbytes/sec Color Full BandwidthTrue Color 921 Kbytes/frame640 * 480 @ 24 Bits 30 frames/sec26.3

Mbytes/sec

Still images rate of transmission: Image type

Unit Size

Exam

Chest X-Ray Digitized

4 bytes/film 2k*2k @ 8 Bits

4-10 films/study 16-40 Mbytes

Magnetic Resonance 64 Kbytes/frame 256*256 @ 8 Bits

40 frames / study 2.5 Mbytes/ Study

Computed Tomography 256 Kbytes /frame 512*512 @ 8 Bits

40 frames /study 10 Mbytes / study

Pathology Slide

4-6 slides /study 72 Mbytes

12 Mbytes / film 2k * 2k @ 24 Bits

Radiographic image data sizes: Study Radiograph

Pixel size 2048 x 2048 with 12 bits precision

No. Of images/Study 4

File size 32 MB

Mammography

4096 x 5120 With 12- bit Precision

4

160 MB

CT

512 x 512 With 12 bit Precision

50

6.3 MB

MRI

256 x 256 With 12 bits Precision

50

6.3 MB

Ultrasound

256 x 256

1.5 MB

March 2009

19

TELEMEDICINE

Bandwidth requirement for clinical equipment: Pulse Oximeter Electrocardiogram Blood Pressure Monitor Electronic Stethoscope Spirometer Glucometer

9.6 KBPS 57.6 KBPS 57.6 KBPS 57.6 KBPS 14.4 KBPS 1.2 KBPS

stratospheric floating communications platforms, fiber-optic cables, cable modems, coaxial cables, or digital subscriber lines, smart antenna technology and software-programmable radio technology. All of these may substantially improve system performance.

Broadband communications and open source Nowadays most of the emergency equipment has started incorporating broadband communications. There is now greater emphasis on implementing operating systems in all types of devices, from portable monitors to complex, life critical equipment. However, as far as more complex or critical equipment is concerned, the use of commercial off-the-shelf (COTS) components, including software components such as operating systems is less well defined than in the military or aerospace industries. Proprietary operating systems are still widely used in high end or patient critical equipment, presenting barriers to future improvements in cost, time to market, functionality and interoperability.

A set of operating systems based on the UNIX framework and enabling easy migration and design reuse by conforming to the POSIX API standards provides a scalable platform for developers. In addition to saving time in software development, application reuse also eases certification. The POSIX standards define an open operating interface that promotes code portability between systems. Only systems that are POSIX Conformant – thereby meeting all of the profiles can guarantee code portability without modification. LynuxWorks’ LynxOS families of operating systems are POSIX Conformant and feature a native POSIX API, enabling portability of open standard Linux applications across all systems. This also gives

20

March 2009

engineering teams the flexibility to develop applications on a low cost Linux system, then migrate the application to the optimum OS for the end product.

Ultimately, the target may be a hard real time system, such as LynxOS, or a security partitioned system such as LynxOS-SE that allows multiple real time applications to run concurrently.

While taking advantage of established Windows and Linux media capabilities to stream video across a network connection, other systems running in separate partitions will manage secure access to patient records or patient critical aspects such as control of surgical instruments. A separation kernel, such as the LynxSecure hypervisor, achieves this by allowing virtualisation of several guest systems to operate in separate partitions. Multiple dissimilar systems, including BlueCat Linux systems or ordinary desktop systems such as Windows XP, can operate alongside more robust systems such as LynxOS or LynxOS-SE. As the medical community adopts reference standards from the aerospace and military sectors to promote the use of COTS components, including software, certified operating systems that also support open standards will

allow developers to deliver increasingly robust and feature rich products to market quickly and cost effectively

Software A recent editorial in the BMJ discussed the future of free medical software. It gave the staggering statistic that the government in the United Kingdom spent £7.1bn on information systems in 1998-9, of which £1bn was in healthcare.

It concluded that ‘free software concepts make particular sense in medicine: ... medical knowledge is becoming more open, not less, and the idea of locking it up in proprietary systems is untenable.’

This article generated a large number of responses and much debate.

The common software that is used today for telemedicine application is the Picture Archiving and Communication System (PACS). In some places the software is purpose built and designed by the service providers. Some COTS software packages are also available and are designed specifically for telemedicine application. This kind of software is basically used in applications such as teleradiology, teledermatology, telepathology and monitoring of vital signs.

Our current method of producing medical software requires revolutionary

Benefits Fewer bugs. Open-source software tends to be more reliable. Just as medical discoveries prove their value through peer review, open source software is validated by thorough inspection by programmers outside the medical software’s development team.

Reduced overall cost. The overall cost tends to be lower because development is distributed among many users.

Improved evaluation. Measurements of quality applied to proprietary software are not exact because evaluators do not have access to the source code. With open-source software, outside reviewers can determine not only whether a particular piece of software works, but also the difficulty of the problem it attempts to solve.

Infinitely supportable/customisable. When the source code is available, the problem of ‘vendor lock’ disappears. As long as programmers can be hired, the software can be customised and supported.

Despite the many advantages of the open source development model, there are challenges to overcome. First, there are few medical open source projects that are beyond the prototype stage. This lack of large scale, open source medical implementation introduces doubt as to open source’s feasibility in the medical arena. Another problem with open source projects is that implementation often requires a great deal of technical expertise.

www.ehealthonline.org

TELEMEDICINE

change in order to meet the needs of today’s patients, providers, and healthcare administrators. The open source software development model has the potential to deliver inexpensive software of higher quality than can be provided by proprietary vendors. There are several ways in which the open source software development model addresses the needs of the medical community most adequately.

Medical Linux operating system designed exclusively for medical networked applications There is now growing awareness that taking this technology into the healthcare environment can contribute to disease prevention and speedier diagnosis, while improving patient comfort and convenience. Improvements in software design are central to delivery of these advances. Developers need more flexible and robust platforms on which to build sophisticated features, such as graphical user interfaces to promote ease of use.

Scalability is also growing in importance as vendors seek to extend their product ranges, leveraging existing applications, and core competencies. Increased use of networking technologies to access patient records is also focusing developers’ attention on data security capabilities, as well as greater reliability and robustness to deliver devices that can simultaneously perform patient critical functions such as monitoring vital signs or supporting res-

piration. There is also a growing awareness of the benefits of ‘plug and play’ interoperability between instruments, as user communities seek to create systems based on standards to improve patient care and boost efficiency.

Telemedicine pre-purchase evaluation While purchasing equipment/software/ telecom services, a thorough assessment of the following is desired: • Does it meet all current and emerging standards for interoperability/data exchange?

• Does the design optimise the available telecommunications infrastructure?

• System appropriateness - Have all technological options been considered?

• Does the system allow for upgrades and can it communicate with other networks? (Stay away from proprietary hardware and software, use “open systems”) • Can it be operated and maintained with available resources? (In house versus outside technical support) • Can it be easily used by clinicians and patients?

• Can it generate sufficient revenue or achieve sufficient cost savings to cover telecommunications charges, equipment depreciation, maintenance and other system-related costs?

• Is it proven to work in the project setting? (i.e., space, lighting, acoustics, ease of use)

Ensuring easier health claims Milliman recently launched ‘ClaimsRef’, which provides a set of rules and criteria to assist a Third Party Administrator (TPA) or an insurance company at the time of authorisation and claims adjudication by providing a basis for the consistent and uniform handling of claims. This claims processing reference tool has been developed especially for the Indian health insurance industry. The guidelines present criteria for frequently occurring interventions / conditions, which commonly show variance in costs and utilisation. Such guidelines help TPA’s / Insurers to process prior authorisations and claims efficiently, in a standardised manner and by leveraging clinical logic.

•

Vendor and telecommunications service contracts, extended warranties, where appropriate. What is the maximum “down-time” when a system malfunctions?

Measure of physician satisfaction with telemedicine technology is important and one needs to answer questions such as the following: • How would this situation have been handled without telemedicine?

• How was the patient’s care affected by this encounter?

• What is the next step for the patient in terms of future care for this problem (e.g., continue with current care, referral, and admission)?

• Did current experience make it more or less likely that you would use telemedicine in the future?

CONCLUSION All in all the application and success of telemedicine broadly depends on end users - the patients and physicians.

There is a strong need for educating and familiarising physicians with the new medium, since it is up to them to see that the patients are made comfortable in such an environment. The technical team who maintain the systems and application software too must be dedicated towards keeping everything in order.

Acknowledgements and References will be available on www.ehealthonline.org

PRESS REALESE The use of guidelines will enhance productivity and optimise cost savings by improving efficiency, uniformity and accuracy in claims processing; promoting standard practices across different TPA sites and personnel; ensuring early identification of ‘incomplete claims’ and ‘inaccurate charges’; supporting information based negotiation with providers.

Richard Kipp, Managing Director of Milliman in India, explains that ”Our efforts in this direction started more than 2 years ago with discussions about treatment protocols with insurers, Insurance Regulatory Development Authority, Ministry of Health, Health

insurance companies and health care providers. It was very clear that standardization based on Indian evidence and practices is required in India. We have presented the product at various industry forums and have received repeated feedback that these products are very suitable and that they fulfill a significant need”.

Milliman officially launched the product at an event last month in Mumbai. At this event Milliman also demonstrated the work that has been done to date by its team of clinicians developing content for hospital order sets and treatment protocols for Indian Healthcare providers.

March 2009

21

NEWS REVIEW >> BUSINESS

Microsoft and HIMSS launch Health Users Group in APAC Microsoft Corp and Healthcare Information and Management Systems Society (HIMSS) have announced the launch of the Microsoft Health Users Group (MS-HUG) in Asia-Pacific.

MS-HUG forum is for influencers and developers of healthcare technology solutions to collaborate and contribute to aspects of solutions built on Microsoft software platforms. It allows the healthcare technology community to discover new uses for existing technology, provide development support, network with peers, and to discuss needs and desires arising from the current use of healthcare IT. It is currently accessible to healthcare organisations and technology partners in North America, Europe, Middle-East and Africa (EMEA).

The forum is designed to allow technology partners to gain insight into healthcare specific requirements, improve their ability to target technology innovation, help health organisations improve service delivery, and achieve a stronger return on technology investments. After several successful years of collaboration, MS-HUG’s diverse membership has grown to include more than 5,000 members and 31 corporate supporters across North America, Europe, Middle-East and Africa (EMEA). This community is united by a shared interest in implementing vendor- and user-developed software based on Microsoft technology to improve healthcare quality and efficiency, while reducing complexity and cost.

GTI plans to invest INR 250 cr in healthcare New York-based private equity (PE) firm GTI Group is setting up a wholly-owned subsidiary, India Management Company, to invest INR 250 crore into Indian healthcare sector. GTI will pick equity stakes of up to 10% in healthcare service firms in the country.

GTI will route the investment in India through its Mauritius arm GTI Mediventures. It will acquire shares in Indian companies in lieu of providing technical know-how to healthcare and medical services firms. India Management Company will also charge a license fee of 2% on the gross revenue of its partner companies.

The company has got the nod from the Foreign Investment Promotion Board (FIPB), the nodal body to clear foreign investment into India.

The firm provides equity capital for early stage venture, growth equity and middle market buyout opportunities in media, telecom, aviation, IT and software and industrial technologies sectors. Typically it invests in the range of USD 5-100 million in each of its target companies.

Trivitron JV Chennai facility commences production Aloka Trivitron Medical Technologies, a medical equipment manufacturing joint venture of Aloka, Japan and Trivitron healthcare recently commenced production of Aloka SSD 500, a portable black and white ultrasound scanner from its facility at Poonamallee in Chennai. It aims to roll out world-class medical equipment at most effective costs to national and international customers.

Trivitron MD, Dr G.S.K. Velu said the JV’s aim is to offer products of high quality suited to the needs of developing countries on a most cost effective basis. Apart from tapping the domestic market, the products will be exported to developing/developed countries across the world.

The core vision of Trivitron healthcare is to bring world-class medical technology within the reach of medical professionals all over the world. It also aims to set up advanced facilities for the manufacture of laboratory reagents for routine and special diagnostics testing in JV with Bio-systems, Spain and operation theatre Lights in tie up with Brandon Medical, U.K. He said Chennai facility will adhere to international standards such as ISO 9000-2001, ISO 13485 for medical product manufacturing and will also be compliant with requirements for CE, US FDA and Japan MITI certifications. An array of indigenous products from electronic equipment to consumables will be introduced under Pride series.

22

March 2009

www.ehealthonline.org

NEWS REVIEW >> BUSINESS

iSOFT launches ‘Lorenzo’ in Asia

BI key to improving NHS management

IT health provider iSOFT launched its next generation healthcare solution to the Asian market during the Healthcare Information and Management Systems Society (HIMMS) AsiaPac09 conference, held 24-27 February, Kuala Lumpur. iSoft Asia president and chief executive officer, Dr Wim Botermans, says, “LORENZO was developed as a unique innovation that will transform the way healthcare is delivered to the patient, boosting services by enhancing the quality of documentation and improving response times.”

According to Dr Botermans, the LORENZO platform, developed using a service-orientated architecture, delivers the flexibility necessary to connect people and processes throughout the healthcare supply chain. iSOFT, an IBA Health Group company, is one of the largest specialist health information technology providers in the world. iSOFT designs, develops and delivers healthcare IT platforms and applications that address the administrative, clinical and connectivity requirements of healthcare organisations around the world, optimising patient and financial outcomes.

LORENZO was a key solution for the UK’s USD 30 billion National Programme for IT (NPfIT)—the world’s biggest civilian IT project. The NPfIT is transforming the UK’s National Health Service by connecting the records of its 50 million patients. Following several years of development and testing at early adopter sites in the England, the Netherlands, Germany and Australia, LORENZO has now been launched in the Asian healthcare industry.

Business intelligence tools will play a central role in improving NHS management and meeting the goals of the Darzi report, according to Ardentia. Responding to the House of Commons healthcare committee’s comments on the quality of local NHS management, the healthcare intelligence specialist advises that having the right business intelligence tools will help to meet the aims set out by the report.

Lord Darzi’s year-long review of the NHS resulted in a blueprint that has the potential to radically transform healthcare delivery over the next decade. This blueprint paves the way for a more person-centred NHS, empowering patients with greater choice, better information and more control over services they receive.

One Trust which has the right tools in place to support management processes is Southampton University Hospital Trust, which has deployed Ardentia’s patient-level information and costing system, to deliver sound and controlled financial management and consequently to make the best use of healthcare resources.

The solution enables finance staff to work with more accurate costings based on actual interactions and events related to individual patients. It supports more accurate, tighter financial management and by ensuring that financial managers are working with information about individual patients, it provides a tool for engaging clinicians more directly in management decisions.

Moving towards a much more clinician-led approach to healthcare is a central concern of the Darzi review, and Patient Level Information and Costing Systems are central in supporting this initiative.

Star Health bullish on retail segment, to foray overseas Star Health and Allied Insurance, a standalone health insurance firm, is banking on retail spend on insurance to drive up its premium income, at a time when companies are trimming health insurance covers to cut costs.

The two-year-old company has collected premium of INR 487 crore so far and is targeting a premium income of INR 520 crore by the end of the current financial year. Star Health on Sunday launched a health magazine, to educate its customers about various illnesses and preventive measures for the same.

Star Health, which is implementing a medical insurance scheme for people below poverty line in Andhra Pradesh with the support of State Government said it recently reached an agreement with Haryana Government to provide the cover in five districts.

The company has also signed an agreement with Lakshmi Vilas Bank (LVB), through which the bank’s existing deposit holders would get a personal accident insurance cover free if their deposits are in the range of INR 1-2 lac. The company expects to earn INR 40 lac of premium income through the LVB tie up.

The company is also planning overseas branches in a few months in locations such as Muscat and Maldives.

24

March 2009

www.ehealthonline.org

NEWS REVIEW >> BUSINESS

Germany invests EUR 125m in ambient care The German national ministry of research will be investing EUR 125 million on ambient assisted living (AAL) projects over the next year.

The goal is to develop IT-solutions that help elderly and chronically ill people to stay in their own flat or house as long as possible. It is estimated that there are some 16 million people in Germany now who are older than 65, and this figure will touch 23 million in the year 2050.

The first 17 projects that are being funded have been announced. The projects involve companies from the IT industry as well as social service providers, home care providers, public and private house builders, health insurance companies and care insurance companies.

Barco sells advanced visualisation to Toshiba Belgian medical imaging specialist Barco has announced the closing of the divestment operation of its Advanced Visualisation (AVIS) activities to Toshiba Medical Systems Corporation, Tokyo, Japan.Based in Edinburgh, Scotland, the AVIS group specialises in 3D clinical software, marketed worldwide under the product names ‘Voxar 3D’ and ‘Voxar 3D Enterprise’. Toshiba now owns all AVIS assets, including its full product portfolio. Barco says it has sold its AVIS activities to concentrate all resources on the development and marketing of medical display systems for

Altogether, the 17 projects will receive EUR 45m, out of the total amount of EUR 125m, of state funding. The rest will be spent in other areas, such as basic technological research and on improving the social care infrastructure. It is hoped that the project partners will also engage financially, so that in the end there will be more than EUR 200m available.

The biggest project to be funded is SmartSenior, led by Deutsche Telekom and Charité University Hospital Berlin, who are developing an automatic emergency wristband that is equipped with GPS positioning. It was pointed out that if AAL helps 10% of the elderly people with dementia to stay at home for one year longer than they would have stayed at home without AAL, this alone will mean cost savings for the social security system of EUR 3 billion per year.

diagnostic, surgical and clinical imaging. The price of the deal was not disclosed.

Barco is active in more than 90 countries with about 3,600 employees worldwide. Barco posted sales of EUR 747 million in 2007.

Toshiba Medical Systems Corporation, a subsidiary of Toshiba Corporation, is a leading global provider of diagnostic imaging systems and comprehensive medical solutions. Toshiba is the market leader in diagnostic imaging systems in Japan and operates in over 120 countries around the world.

SPOTLIGHT

Awards for Exemplary Implementation of e-Governance Initiatives (2008-09)

T

he Department of Administrative Reforms and Public Grievances presents National Awards for e-Governance every year, to recognise and promote excellence in implementation of e-governance initiatives.

The purpose of this award is to, recognise achievements in the area of e-Governance; disseminate knowledge on effective methods of designing and implementing sustainable e-Governance initiatives; encourage horizontal transfer of successful e-Governance solutions; promote and exchange experiences in solving problems, mitigating risks, resolving issues and planning for success. Nominations for these awards were invited from Central Ministries/Departments, States/UTs, Districts, Local Bodies, PSUs, Civil Society Organisations and the Industry.

Special Sectoral Award - Focus Sector: Health Gold Award

The criteria for selection of Awards, included that all nominated projects should have been operational for a period of not less than one year (excluding the pilot period).

Specific criteria for the Sectoral Award, which had healthcare as the focus sector for the year 2007-08 included (i) Outreach (ii) Number of Services (iii) Enhancement of efficiency (iv) Ease of transaction

Tele-opthalmology Project-Vision Centre, Dept. of Health, Agartala, Govt. of Tripura This project aims at providing quality eye care services to rural patients in the State of Tripura in an all integrated manner, whereby every case is accounted for, classified and closed with a solution. People with poor eye sight in remote villages of Tripura used to have to travel to capital the city of Agartala due to inadequate medical facilities and limited eye care specialists in rural and inaccessibel areas.

The project provides comprehensive eye care by utilising the advances in medical sciences, bio-medical engineering and its convergence with information and communication technology effectively through a Vision Centre that facilitates providing of quality care at the doorstep of the rural population. It is a comprehensive model for providing primary and preventive eye care in a decentralised manner. All patients visiting the Centre for the first

26

March 2009

www.ehealthonline.org

time undergo a thorough examination by the Ophthalmologic Assistant (OA) with doctor’s consultation and the medical data is recorded electronically using a database management system.

During subsequent visits, the trained OAs provide the required eye care services, after which the patient is put on live consultation via the network with the base hospital doctor who interacts with the patient over a video-conferencing system. On an average 7 - 8 patients visit a Vision Centre in a day. The project serves a rural population size of around 26,48,074 people in remote areas across 38 blocks of 4 districts in the State of Tripura.

Silver Award Drug Logistics Information and Management System (DLIMS) Central Medical Stores Organisation,

SPOTLIGHT

Screenshot of www.cityhealthline.org drug logistics and warehousing process by automated online indenting, monitoring of requirements versus availability of stock, generating payment orders, automatic intimation of orders to suppliers, automatic updation of stock on receipt of delivery, automatic generation of late supply notices, etc.

Bronze Award Hospital Management Information System Health & Family Welfare Dept., Gandhinagar Govt. of Gujarat

(v) Appropriateness of context and degree of localisation (vi) Accessibility and User Convenience (vii) Scalability and (viii) Sustainability.

Specific criteria for awarding the Best Government Website award included (i) Information Availability (ii) Service delivery (iii) Public access (iv) Design & Visual appeal and (v) Frequency of Updation.

Health & Family Welfare Dept., Gandhinagar Govt. of Gujarat The DLIMS handles procurement, storage and distribution of medicines, drugs, injectibles, surgical goods and medical equipment and distributes them to medical colleges, district and taluka hospitals, community health centres and municipal corporation (435 Direct Demanding Offices). The system receives indents online from the 430 direct demanding offices spread over the State.

All activities of indenting, procurement, receipt dispatch, billing etc. are integrated in a single database, which helps maintain accuracy and integrity of data throughout the process. The supplier data is also stored to enhance transparency of the system.

The system improves efficiency and effectiveness of the

The HMIS is an integrated information system which facilitates efficiency of government managed hospitals and quality health services by providing a holistic view of the functioning of all district level hospitals at the state head quarter level. Earlier the hospital statistics were sent by individual hospitals at the end of the month and consolidated later, so the hospital performance figures during the month were not available. Also the hospital administrators were not able to get information about each department, resource scheduling, patients’ clinical data and demographic details online. Now they get it through HMIS easily. The system has dramatically improved efficiency in terms of saving time, prompt response, updated patient records, workflow assisted efficiency in service delivery, online disease surveillance and flexibility of operations to state administrators and Medical Superintendents, Doctors and other healthcare staff, and citizens.

Best Government Website Bronze Award www.cityhealthline.org Nagpur Municipal Corporation, Maharashtra This is a comprehensive and interactive health information and service delivery website. The website provides effective dissemination of Medical and Health related information to the citizens of Nagpur. The user interface has been kept functional and uncomplicated, with text materials designed for easy reading. A dedicated team is responsible for revising the contents on a regular basis and upkeep of the web servers and databases.

It provides for online registration and counselling. It helps to improve disease surveillance and control through active involvement of all pathology labs and hospitals. The website covers blood donation, eye donation, clinic registration and hospital registration and provides 30 services. It serves up to 5 million users in adjacent districts. It is complemented by a call centre and an SMS based server.

Additionally, it provides a Student Health Card System for online monitoring, a blood donor debit card and a online Drug Management and Information System.

March 2009

27

PERSPECTIVE

EHR vs EMR

What’s the Difference?

A website dedicated to helping decision-makers in healthcare organisations understand particulars of Health IT products and make an informed choice, helps you understand the difference between the seemingly similar sounding software.

S

hould you implement an EMR or an EHR? Do you know the difference? Is there a difference?

These are only a few, but very important questions that IT implementers at a healthcare organisation face while deciding which software to select from all the variety offered in the market.

Houston Neal Director, Business Development Software Advice

An EMR is the record of a single diagnosis or treatment maintained in silos, most likely used by a specialist

28

March 2009

In theory, and by definition, there is a difference and it should play into any provider’s clinical software selection. At the same time, marketing messages and technical terminology have clouded healthcare providers’ understanding of the two software definitions.

Recently, the National Alliance for Health Information Technology (NAHIT), established definitions for electronic medical records (EMR), electronic health records (EHR), and personal health records (PHR). NAHIT is a senior leadership organisation dedicated to leveraging the power of health IT to improve the US healthcare system.

EMR and EHR as NAHIT defines it The NAHIT has produced the following definitions for EMR and EHR: EMR: The electronic record of healthrelated information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organisation who are involved in the individual’s health and care.

www.ehealthonline.org

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organisation and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.

By these definitions, an EHR is an EMR with interoperability (i.e. integration to other providers’ systems).

Who needs which?

Marc Anderson, CEO of the AC Group, says it comes down to the words ‘medical’ and ‘health.’ An EHR will provide a more comprehensive view into a patient’s health and history by pulling information from other systems, providing clinical decision support and alerting providers to health maintenance requirements.

It will help providers report and measure quality indicators for payfor-performance incentives.

Meanwhile, an EMR is the record of a single diagnosis or treatment maintained in silos, most likely used by a specialist. If your responsibility is to take care of one unique problem - such as an orthopedist setting a bone - then a stand-alone EMR may well be sufficient. Certain specialists may not need information about patient history as much as they need speciality-specific workflows and templates.

PERSPECTIVE

Google search frequency index by healthcare IT keyword phrase.

amongst vendors? First, it simply takes time and effort to change over marketing terms.

Moreover, from a very practical standpoint, many vendors will want to continue to use the EMR label while it is the most commonly used - and ‘Googled’ - term for clinical records systems.

Marketing aside…

Regardless of who is using which terms, the key decision process for selecting an EMR/EHR is to map out your organisation’s requirements and methodically assess systems against those criteria.

In a review of 300 clinical records systems, 207 vendors market their software as an EMR, while 59 use the term EHR.

The market is still figuring it out Despite the NAHIT definitions, we think the market is still figuring out which definitions to adopt. An analysis of Google Trends data shows that roughly four times more searches are performed for ‘electronic medical record’ than for ‘electronic health record.’ At the same time, ‘electronic health record’ seems to be gaining in search frequency.

One interesting exception to the data was that the searches originating in Washington, D.C. are split evenly between ‘electronic medical record’ and ‘electronic health record!’

Software vendor marketing migrates slowly The same is true when we look at the usage of terminology by software vendors.

Why such limited adoption of EHR

30

March 2009

Justin Barnes, Chairman of the HIMSS Electronic Health Record Association and VP of Marketing and Government Affairs at Greenway Medical Technologies, believes ‘the future of healthcare IT is interoperability.’

And while Barnes is an advocate of the EHR terminology, he distills the following three criteria for selecting a medical records system: • Current-year interoperability certification standards (CCHIT, HL7); A unique workflow that matches your practice and speciality.

• Excellent usability at the point of care.

If you purchase an EMR or EHR with these three requirements, you should receive a significant ROI on your investment, and position yourself to receive incentives from payers.

Well what’s a PHR? NAHIT has provided the following definition of a PHR: ePHR: An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created, gathered, and managed

www.ehealthonline.org

A PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more by the individual. The integrity of the data in the ePHR and control of access to that data is the responsibility of the individual.

To be most effective, a PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more. Given the nature of the PHR, it’s the individual’s responsibility to decide what information is stored, and who has access to it.

Microsoft’s HealthVault and Google Health are two prominent examples of PHRs. Whether these systems are widely adopted and properly updated by patients is yet to be seen.

Even with complete definitions in place, it can be difficult to evaluate EMRs/EHRs and determine which system to buy.

At the same time, most providers will make their decisions based on their IT budget and their career stage. A young physician will almost certainly want to lay the IT foundation for participating in the future vision for healthcare interoperability. They will likely be supported in this effort by their health system.

Meanwhile, a more mature physician that wants to ‘go paperless,’ but is not an aggressive adopter of IT may well opt for a stand-alone EMR system and forgo the costs and challenges of integration.

In the end, these individual decisions underlie what is a deliberate, but very slow adoption of healthcare technologies.

(Medical Software Advice is a free website designed to help healthcare providers find the right software for their organisation.)

APPLICATIONS

Seamless integration for

quality care

Healthcare delivery has evolved dramatically in the last decade or so, but the same cannot be said about Healthcare IT (HIT).

T

here used to be a time when for speciality surgical procedures and treatments Indians would travel overseas, this trend was later followed by people travelling to metros for similar treatments. Now tier-2 and 3 cities are gaining ground and super-speciality hospitals are coming up across the country and major healthcare providers have big plans to set up hospitals in various corners of India. Healthcare delivery has evolved dramatically in the last decade or so, but the same cannot be said about Healthcare IT (HIT).

Major Original Equipment Manufacturers (OEMs) are now shipping equipment that are compliant to standards such as DICOM and HL7, as well as sharing information with the industry but hospitals need to deploy IT solutions that make this information and images portable across various stakeholders within and outside the hospitals such as doctors, administrators, paramedics, insurance provides etc.

for patient and exam information from the RIS to flow to the modality with the help of DICOM modality work list. With DICOM protocols the patient images generated on the medical equipment are transferred to PACS. These patient images in PACS has seamless integration with clinical information systems and/or Hospital Information System.

Inspite of having standards and communication protocol, fully integrated HIS/RIS/PACS from different vendors is an expensive process in terms of time, of implementation and interfacing fees charged by multiple vendors. System integration is significantly hampered, not by technological limitations, but by business and political issues.

Even though there is a lot of progress on the HIT front, one will still find major hospitals across india have “islands” of information that can not be interconnected resulting in manual transportation of data diluting efficacy of automation. In the last 2-3 years hospitals have started understanding the importance of HIT and started giving due importance to HIT that it deserves.

The technology for acquiring, storing, retrieving, displaying, and distributing medical images and patient information has changed dramatically in the last few years. The new buzzword is ‘enterprise solution’ in medical image and information management solutions, wherein, digital images from radiology, cardiology, and many other imaging modalities are seamlessly linked with information from clinical information systems and other databases, and they are accessed seamlessly from a single point.

One of the issues that plagued the progress of hospital information system / radiology information systems / picture archiving and communication systems (HIS/CIS/PACS) integration was a matter of language between Health Level-7 (HL7) and DICOM. The broker solved this barrier - a software and hardware device that accepts HL7 messages from the HIS and RIS then translates the data to produce DICOM messages for transmission to the PACS. The broker provides support

In response to these challenges, few companies like SoftLink have begun to offer ‘seamlessly integrated’ commonly termed ‘Broker Less’ RIS/PACS solutions and/or HIS/RIS/PACS solutions. These significantly improved solutions, achieve better ‘workflow automation’ as all the products that are required to create the solution are offered by a single vendor. Apart from backend integration, these solution also allows front-end integration and thus provides ‘single log in’ into HIS/RIS/ PACS solution, making information and images accessible to healthcare providers.

Rakesh Budhe Asst. General Manager, (Sales & Marketing) Softlink International

March 2009

31

CASE STUDY

IT solution for

Cath Labs A hospital in Peine interfaces cardiac cath lab with image archiving and reporting system for the first time with help from Siemens.

T

he Peine Clinic in Lower Saxony is the first hospital in Germany to interface its angiography systems with an image management and reporting system. All data generated prior to, or during an intervention in the cardiac cath lab is now automatically transferred to the new IT system.

One key advantage is that while the examination is still in progress, operating personnel can use important examination data to prepare a report for wards or referring physicians in just a matter of minutes. Previously, this took several hours, because the data was transferred from forms to the reporting system manually and the images were also stored manually.

For this innovative IT solution in the catheter laboratory in Peine, Siemens interfaced its dynamic image archiving system syngo Dynamics with the angiographic system Axiom Artis FC and the hemodynamic measuring station Axiom Sensis XP. In 2003, the Peine hospital passed to the ownership of the Klinikum Peine gGmbH. The AKH Celle and the Peine Clinic have 1,045 beds in total. The Peine Center has eight specialist departments under physician management, two in-patient wards and cares for approximately 14,000 in-patients annually.

An interface to the clinic’s ultrasound systems will be added in the future. Axiom Sensis XP, a state-of-the art recording procedure for interventional cardiology and electrophysiology, even transmits measurement data automatically to syngo Dynamics via real-time data transfer.

The reporting physicians are now provided with all data required to prepare the necessary reports as soon as catheter-

32

March 2009

www.ehealthonline.org

ization is completed directly at their syngo Dynamics workstations. This considerably accelerates the workflow in the cardiology department and allows for more precise reporting than in conventional catheter labs.

“While selecting a suitable provider, we were looking for integrated as well as cost-effective solutions for angiography systems and IT. The Siemens spectrum fully met these requirements with the real-time data exchange of Axiom Sensis XP and syngo Dynamics,” explains Arturo Junge, director of administration at the hospital.

The chief physician of Medical Clinic I (Cardiology & Pneumology), Dr. Petra Wacker, also appreciates the advantages of having this reporting system for diagnostic image viewing and dynamic image processing at a single workstation. According to Dr. Wacker, evidence-based reporting also supports both the efficiency and effectiveness of clinical procedures. “We benefit especially from the fact that reports are generated almost automatically, a fact which greatly reduces the risks incurred through user errors. This allows us to ensure highquality patient care,” says Dr. Wacker.

“With this scalable solution, we are best equipped to face the technical challenges of the future. Networking will make the data exchange even faster and offer further advantages, for example in long-term archiving. This will certainly expand the existing cooperation of our hospitals,” said Wilfried Schröter, Head of Medical Systems of the Peine Clinic.

With inputs from Healthcare Sector, Imaging & IT Division, Siemens, AG, Germany

NEWS REVIEW >> WORLD

New platform for connecting PHR

Queensland trials telehealth project

IBM has announced a collaboration with Google and Continua Health Alliance on new software to enable data to be easily moved from remote personal monitoring devices into Google Health personal health records (PHRs).

The new IBM software provides a platform for connecting personal health devices - increasingly expected to be mobile, wireless and interoperable - to personal health records.

The platform has been developed using open standards and is compliant with Continua Health guidelines. It will enable personal medical monitoring, screening and monitoring

The Australian state of Queensland has launched a telehealth project in the local government district of Ipswich to improve the efficiency of treatment for patients with chronic disease.

The Telehealth Lifestyle Coordination (TLC) project will monitor and manage chronic disease sufferers without the need for patients to leave their homes. If successful, the system could be rolled out nationwide.

devices to automatically stream data results into a patient’s Google Health Account or other PHR. Once stored in a PHR, the data can also be shared with physicians and other members of the extended care network. Automatically streaming patient monitoring and vital signs data should help add to the value of PHRs for citizens, by avoiding the need for manual data entry and ensuring PHRs are current and accurate.

The development should help health professionals provide more timely feedback to patients on their conditions, suggest treatments, and help improve overall quality of life.

Google Health allows users to store, manage, and share their medical records and personal health information securely online. Google Health was officially launched last May, is free to users and available online at www.google.com/health.

IBM developed the software based on guidelines from Continua Health Alliance, a globally recognised organisation dedicated to enabling interoperable personal healthcare products and solutions.

Chinese to have better medical facilities China’s State Council passed a long awaited medical reform plan which promised to spend 850 billion yuan (USD 123 billion) by 2011 to provide universal medical service to the country’s 1.3 billion population.

The plan was studied and passed at a meeting of the State Council chaired by Premier Wen Jiabao. The government has been deliberating medical reform since 2006.

According to reform plans, authorities would take measures within three years to provide basic medical security to all Chinese in urban and rural areas, improve the quality of medical services, and make medical services more accessible and affordable for ordinary people.

34

March 2009

www.ehealthonline.org

The pilot project aims to show that telehealth is a viable alternative - or supplement to - hospital care.

Telehealth enables patients who don’t need constant supervision to lead as normal a life as possible, while managing their illness.

A small HomeMed unit is installed in a patient’s home. The unit instructs the patient to take vital sign readings and ask tailored questions. The vital sign reading is then transmitted over telephone lines to a website where it is checked against pre-set parameters. If any readings exceed pre-set parameters, the data is red-flagged and a healthcare provider alerted.

NEWS REVIEW >> WORLD

Handy ECGs for cardiac patients

New-age patient ID cards

A new low-cost and portable tele-electro cardiogram (ECG) system has been developed by the scientists of the Bhabha Atomic Research Centre (BARC).

Humana, one of America’s largest health-benefits companies, has promised to adopt machine-readable patient ID cards and, in the process, won the acclaim of the Medical Group Management Association, which estimates that the cards could save physician offices and hospitals as much as USD 1 billion a year.

Less than three weeks ago, MGMA launched ProjectSwipeIT, an industry-wide effort calling on health insurers, vendors and healthcare providers to initiate processes to support standardised cards by January 1, 2010. Louisville, Kentucky-based Humana is the first insurer to publicly pledge its support.

MGMA estimates that machine-readable patient ID cards could save physician offices and hospitals money by reducing unnecessary administrative efforts and many denied claims.

Machine-readable cards like Humana’s could be linked to providers’ computer systems via a card reader allowing for the automatic population of patient information correctly and costeffectively with a simple swipe.

The system can be controlled by mobile phone with the help of a Bluetooth connection.

The device will be helpful for cardiac patients residing in rural or remote areas as patients need not go to hospitals for routine checkup.

This new machine reduces the load on the resources of hospitals. The system can be connected to a laptop or personal computer.

IT to fight infections

Telehealth services in Bangladesh

South Carolina’s 65 acute care hospitals are coming together to prevent healthcare-acquired infections across the state. The effort is expected to save hundreds of lives and as much AS USD 40 million a year.

Key to the effort is the use of an automated infectionmonitoring tool developed by the Premier healthcare alliance.

Premier will also develop an information-sharing portal to support the initiative.

Health Sciences South Carolina, the South Carolina Hospital Association and the Premier healthcare alliance announced the formation of the South Carolina Healthcare Quality Trust (SC HQT).

The trust includes the state’s largest research universities which will work with Health Sciences South Carolina to adopt existing evidence-based best practices, as well as research and develop new methods, to eliminate preventable infections.

The Premier portal will play a key role making it possible for all South Carolina hospitals to research the causes of healthcareacquired infections, or HAIs, and to identify and promote existing and new processes for prevention.

The Bangladesh government has planned to introduce “Telehealth Care Services” at every public hospital in the country. The aim of this project is to make healthcare available to everyone in the country. All public hospitals in the country’s 481 sub-districts will be

provided with logistics including mobile phones for establishing a telehealth care centre.

Doctors will be on duty in each unit of telehealth centres to receive phone calls from patients and administer treatment. This service is expected to benefit more than half of Bangladesh’s 144 million citizens who do not have access to healthcare facilities due to poverty. This service will be provided free-of-charge and the telehealth centres will be open for 24 hours.

These telehealth centres will also be used to spread awareness on non-communicable diseases.

March 2009

35

EVENT REPORT

Innovation HIMSS AsiaPac 09, 24-27 February

The annual conference and exhibition of the Healthcare Information and Management Systems Society’s AsiaPacific chapter (HIMSS Asiapac ’09) was recently held from 24-27 February, 2009 at the magnificent Kuala Lumpur Convention Centre in the heart of the beautiful city of Kuala Lumpur in Malaysia.

HIMSS Asiapac ‘09 witnessed participation of nearly 1800 delegates gathering from 26 countries from Asiapacific and beyond. A vibrant exhibition that ran along with three days of the conference had 62 exhibitors showcasing latest technologies and solutions in the domain of healthcare and medical IT. eHEALTH magazine is proud to be a ‘Media Partner’ of the event and takes great pleasure in bringing you this post event review.

36

March 2009

www.ehealthonline.org

O

ver the past few decades, healthcare and medical industry across the world had undergone significant transformation through adoption and uptake of IT. However, until even a few years ago, the majority of such success stories were found only among developed economies of the West – primarily in the USA and parts of Europe. Interestingly enough, over the last decade, an appreciable number of Asian healthcare organisations started looking into IT as a potential enabler for achieving global standards in care delivery and a tool to significantly improve overall organisational performance.

HIMSS Asiapac ’09 held recently in the city of Kuala Lumpur, Malaysia was a novel meeting ground of a large number of experts from around the world who are relentlessly com-

EVENT REPORT

Unplugged

KLCC, Kuala Lumpur, Malaysia mitted to forward the cause of IT in healthcare. Spanning over three and a half days, the event brought together senior professionals and executives from healthcare service providers, technology vendors, academic/research institutions and government.

Held under the endorsement of Ministry of Health, Malaysia, HIMSS Asiapac ‘09 was officiated by the Minister of Health Malaysia, Dato’ Liow Tiong Lai over an evening ceremony on February 24 at the Kuala Lumpur Convention Centre. Speaking on this occasion, Minister Dato’ Tiong Lai emphasised the need for adopting ICT best practices in healthcare and the boundless opportunity offered by advanced technologies (such as telemedicine and telehealth) to extend healthcare services and benefits to people spread far and wide across geographies.

Highlighting the effort of the Malaysian

government in this direction, Minister Dato’ Tiong Lai made special mention of some of the early initiatives of the country in bringing effective policy interventions, research support and fast track technology adoption in public healthcare system. Expressing his gratitude for organisations like HIMSS, he wished the conference a grand success and promised continued support for all such future initiatives.

The main conference opened on the morning of February 25th with a welcome keynote address by the Director-General of Ministry of Health Malaysia, Tan Sri Dato’ Seri Dr Mohd Ismail bin Merican, followed by the opening keynote address by Professor William Edward Hammond, Chairman, Health Level Seven Inc. Delivering his speech on the topic of global EHR best practices, Prof. Hammond said, “health IT is not just about using computers in

healthcare, it is about solving healthcare problems through computers”.

Further, commenting on the general misconception about EHR, Prof. Hammond added, “more data does not necessary mean more information.

Hence, EHR by itself cannot be a solution for all clinical problems. Rather, it is a mean to do so, only when used under a proper analytical framework.”

In this regard, he also underlined the need for adopting uniform global standards in technology, clinical practice and policy; and creating opportunities for collaborative knowledge sharing towards achievement of global EHR. The next two and half days was dotted with a plethora of technical sessions and paper presentations across topics covering – ‘eHealth Best Practices’; ‘EHR/EMR/EPR/PHR’; ‘IT Strategy & Innovation; ‘Business Models for Sustainable IT’; ‘Communication Networks and Connectivity March 2009

37

EVENT REPORT

showcased, ranging from hospital automation, ERP systems, network and mobility solutions, hand-held devices, point-of-care solutions, telemedicine and telehealth systems, public health and geospatial applications among others. Some of the well known vendors who participated in the exhibition included – InterSystems, iSoft, GE, Microsoft, Oracle, SAP, Agfa, Carestream, Eclipsys, Epic Systems, Clinical Solutions, Hospira, ProfDoc, Orion Health, Medical-Objects, Cisco, Extreme Networks, Aruba Networks, Trapeze Networks, ESRI, Motion Computing, Zynx Health among others. In addition, the exhibition also showcased initiatives of Ministry of Health Malaysia (highlight-

driven approaches, IT-based integration and expansion of care delivery, and overall implementation strategies for electronic systems in streamlining clinical processes and workflow)

System, Singapore), Dr. John Wocher (Kamenda Medical Center, Japan), Hyeoun-Ae Park (College of Nursing, Seoul National University, Republic of Korea), Victor J Strecher (University of Micigan Schools of Public Health and Medicine, USA), Deborah Chin (Standards New Zealand, New Zealand), Azrin Mohd Zubir (Meridian Project Management Sdn. Bhd., Malaysia), R Basil (Manipal Health Systems, India) and Winai Sawasdivorn (Thai National Health Security Office, Thailand).

ing their landmark eHealth initiative through the indigenously developed Tele Primary Care solution) and that of the Malaysian Multimedia Development Corporation (highlighting the MSC Malaysia Telehealth program).

built mini-theatres in the exhibition hall, product tutorials were designed to provide opportunities for exhibiting companies to present real life case studies of their product/solution through short presentations. A total of 11 presentations were scheduled over the conference days, with contribution from 9 vendors, namely – Microsoft, InterSystems, Philips, SAP, MedicalObjects, Capsule Technologies, Zynx Health, Advantech and Diversinet)

Besides having an active conferencing, HIMSS Asiapac ‘09, also provided an excellent opportunity for technology vendors and solution providers to showcase some of the latest innovations happening in health IT. As many as 62 exhibitors participated in this three day exhibition, which brought together both global and local vendors to share a common platform and leverage opportunities of business networking, knowledge sharing and development of new partnerships. A broad range of technologies and applications were

‘Developing Countries Workshop’ (held as a pre-conference session at the main venue, this full-day intensive workshop was created specifically for providers, leaders and government officials from emerging nations to discuss issues on primary healthcare, capacity building, human resource development, education and training)

Solutions’; ‘Clinical Leadership & Governance’ and ‘Health IT Standards’.

Capturing the mindshare of some global eHealth experts, a three day parallel track (‘Thought Leader Session’) featured as many as eight prominent healthcare experts speaking on wide ranging topics ranging from – ‘patientcentric and integrated EMRs’; ‘semantic interoperability in healthcare technologies’; ‘online PHR and personal health management’; ‘policy interventions for interoperability challenges’ and ‘best practices in hospital automation’, among others. Speakers in these sessions included – Benjamin ONG (National University Health

38

March 2009

HIMSS Apac ’09 also hosted a number of value-added side events in form of mini-seminars, symposiums, workshops, tutorials and study tours organised around the main show. Some of these are as follows –

‘Physicians’ & IT Leadership Symposium’ (held at Hospital Serdang in the outskirts of Kuala Lumpur city, the symposium focused on solution-

www.ehealthonline.org

‘Nursing Informatics Symposium’ (held at the Prince Court Medical Centre in Kuala Lumpur, this symposium provided opportunity for nurses, clinicians and managers to discuss key issues on how to effectively integrate IT tools to improve processes and workflow at the point of care and approaches for enhancing patient care and quality outcomes) ‘Product Tutorials’ (held in custom-

‘Interoperability Showcase’ (held in a special designated lounge in the exhibition area, the interop showcase highlighted ‘Integrating the Healthcare Enterprise’ (IHE) framework developed for creating a common framework for seamless flow of vital health information among multiple applications, systems and care settings, across different healthcare institutions. The showcase was sponsored by GE Healthcare and supported by MSC Malaysia, and drew contributions from implementers such as – 1001 Technologies, HeiTech, Kompakar, Initiate, Oracle,

EVENT REPORT

Pi and Speedminer). ‘InterSystems Breakfast Seminar’ (held as a special morning session on second day of the conference, this special seminar organised by InterSystems had Dr. Karanvir Singh, Consultant Surgeon & In-Charge of HIS Implementation in Ganga Ram Hospital, New Delhi to share his experience in implementing an advanced HIS in a complex hospital environment and how it has transformed organisational systems and the overall process of healthcare delivery).

GE Healthcare’s Product Launch & Partnership Announcement:

‘Cerner’s Study Tour to Prince Court Medical Centre’ (this special study tour conducted by Cerner was organised with the purpose of providing an

GE Healthcare (a leading global provider of healthcare products and IT solutions) unveiled a suite of webbased imaging solution – ‘Centricity PACS-IW’ and a web-based diagnostic viewer with workflow integration and streaming technology – ‘Centricity PACS Web Diagnostic’ (WebDX) targeted for healthcare markets in Asia. While the former will offer imaging portability with powerful clinical tools for hospitals and outpatient imaging centers, the later will enable richer collabora-

opportunity for participants to get a first-hand experience of a truly futuristic and completely paperless hospital environment at the prestigious Prince Court Medical Centre in the heart of Kuala Lumpur. The tour primarily highlighted the medical centre’s vision and experience in the process of becoming a leader of healthcare in Asia and how it is using some of the most advanced automated clinical systems for efficient care management and patient experience).

tion between radiologists, referring physicians and specialists. In addition, GE Healthcare also announced their newly structured partnership with HCL by integrating them with business and technology services of GE Healthcare’s portfolio of healthcare IT software. The partnership will enable current and future customers to utilise HCL for all aspects of their healthcare IT lifecycle across planning, deployment, customization, and ongoing maintenance.

The event was also marked by a couple of landmark product releases by some of the leading HIT vendors, along with launch of new alliances and collaborative initiatives.

Launch of Alliance for Clinical Excellence (ACE):

‘Lorenzo’ Soft Launch: iSoft (an IBA Health group company and one of the global leaders in healthcare IT solutions) launched their ‘Lorenzo’ solution for Asian market. This new solution aimed for complex healthcare enterprise environment promises to revolutionise care delivery through su-

40

perior process automation and worldclass clinical decision support system.

March 2009

Setting the tone for a collaborative effort towards advancement of IT in global healthcare industry, several organisations involved in the health IT domain announced the launch of a international initiative – the ‘Alliance for Clinical Excellence’ (ACE). ACE seeks to address the fundamental and growing need for change in the way healthcare industry evaluates the deployment of IT systems and aims to bring effectiveness, safety and innovation in the

www.ehealthonline.org

industry through value-added partnerships and research. ACE participants committed to the initiative at launch time are - Hong Kong Hospital Authority, Hong Kong Society of Medical Informatics, iSoft, MOH Holdings Pte. Ltd, National University of Singapore School of Computing, Oracle, Orion Health and CHIK Services-Australia.

Launch of Health User’s Group (HUG) in Apac by Microsoft & HIMSS: Microsoft Corporation and HIMSS jointly announced the launch of the Microsoft Health Users Group (MS-HUG) for Asia-Pacific region. This will provide healthcare organisations and technology partners in this region with access to an

online forum to facilitate the development of healthcare solutions. This forum will act as a venue for influencers and developers of healthcare technology solutions to collaborate and contribute to aspects of solutions built on Microsoft software platforms. It allows the healthcare technology community to discover new uses for existing technology, provide development support, network with peers, and to discuss needs and desires arising from the current use of healthcare IT. Until recently, it was accessible only to healthcare organisations and technology partners in North America, Europe, Middle-East and Africa.

With an array of weeklong activities, HIMSS Asiapac ’09 was a truly enriching experience to witness the latest advancements and developments in health IT. With more than 1800 delegates from 26 countries of Asia and beyond, it provided a perfect platform for quality business networking and knowledge sharing in a truly international setting.

EXPERT CORNER

Molecular Diagnostics Point-of-Care (POC) Infectious Disease Test At present, polymerase chain reaction (PCR) testing predominates; however, alternative technologies aimed at reducing genome complexity without PCR are anticipated to gain momentum in the coming years.

Market Insight Healthcare Practice, Frost & Sullivan

T

he In Vitro Diagnostics (IVD) industry is one of the most lucrative segments in the global healthcare industry, driven by factors such as increasing prevalence of several chronic and infectious diseases, emerging technologies, and increasing patient awareness. The IVD market is particularly characterised by the emergence of various novel technologies with molecular diagnostics and point-of-care (POC) tests expected to play a very important role in driving the future growth of the industry.

Currently, the consumer self-testing market is by far the largest segment of the POC diagnostics market, and mainly comprises blood glucose testing and pregnancy testing.

Fuelled by an ageing population and obesity, the number of people with diabetes is rising worldwide and it is now the fourth leading cause of death in most developed countries.

Beyond blood glucose monitoring Frost and Sullivan believes the fastest growing segments in the POC testing market are infectious disease and cardiac testing, especially the need for coagulation treatment and

monitoring owing to the increased number of tests available and greater demand for such tests.

The infectious disease testing market is primarily being driven by the increasing incidence of certain diseases, including viral hepatitis, respiratory syncytial virus (RSV), influenza, tuberculosis, HIV and other STDs, as well as the rapid rise in hospital-acquired infections (HAIs).

cases pure clinical diagnosis has been reported to be lower than 50% accurate.

Using POC tests in hospital settings have shown to bring more benefits than tests like PCR, especially in the diagnosis of a common cold or influenza.

To run a PCR test would take about five hours, meaning that patients suffering from influenza are not treated straight

The POC infectious disease market in Europe was worth USD 40.0 million in 2008 but is expected to grow at 4.9% CAGR, hitting USD 56.1 million by 2015.

Recent discoveries and innovations in the realm of molecular diagnostics hold the exciting promise of revolutionising the healthcare area. In particular, the evolution of POC testing expects to have a significant impact on patient care management. Additionally, public awareness initiatives and governmental campaigns across Europe are facilitating the uptake of new technologies and highlighting the value of POC molecular diagnostic for the improvement of medical care reducing the overall healthcare cost.

Many argue the accuracy and quality of the POC tests in relation to laboratory molecular tests. However, in most March 2009

41

EXEPRT CORNER

away, thus increasing the chances of infection and spread. If the physician is uncertain about the diagnosis, he or she may run numerous tests that can be expensive. Frost and Sullivan believes much more support should be given to physicians and nurses, with training programmes set in place to change the mindset of the healthcare management. In 2008, Group A streptococcus A accounted for 40.9% of the revenues generated by the POC infectious disease market followed by C-restrictive proteins (CRP) 29.8%.

CRP analysis has grown to be a useful test for supporting the diagnosis of infections and has proven to be a valuable tool in differential diagnosis, for example, distinguishing between bacterial and viral infections.

Source: Frost & Sullivan Chart 1. Contribution of Different Segments towards the Infectious Disease Market (Europe), 2008

“As part of patient care, physicians within the Scandinavian countries have started to use the CRP and Strep A POC tests to distinguish between common cold and influenza patients.

If the levels of CRP are high, that is the cause of bacterial infection, therefore introducing the need for strep A tests.

Strep A Test Strip detects the presence of Strep A antigen in throat swab specimens providing results within five minutes and a sensitivity of 97 per cent compared to culture” noted a spokesperson of POC tests, Germany.

The high prevalence of asymptomatic Chlamydia and gonorrhoea infections is one of the greatest obstacles to STD control. A widely available diagnosis test which allows prompt and effective treatment of asymptomatic patients could reduce the prevalence of these infections, preventing complications and reducing the transmission of HIV infection. Frost and Sullivan believes that when calculating the number of patients brought to treatment, rapid tests have a distinct advantage. In most healthcare settings, some patients do not return for the results of laboratory tests. The advantage of POC tests is that they can enable treatment to be given on the spot rather than hoping that the patient will return for treatment.

However, there still are concerns over the sensitivity and specificity of POC tests for detecting HIV or STDs since

42

March 2009

they are asymptomatic and therefore cannot be confirmed immediately. There are discussions over running PCR screens under such cases. In addition, despite technological advances enabling the continued development of POC tests, the use of POC tests presents many challenges for the sexual health services. It questions existing approaches to service delivery – for example, finger-stick testing for HIV raises questions about conventional counselling before and after testing. These challenges seem daunting. However, Frost and Sullivan believes that it should not come in the way of maximising the use of POCT where appropriate.

www.ehealthonline.org

Novel platform technologies and key advances in genomics are rapidly driving the development of molecular diagnostics. In the coming years, molecular diagnostics will continue to be of critical importance to public health worldwide. It will facilitate the detection and characterisation of disease, as well as monitoring of the drug response and will assist in the identification of genetic modifiers and disease susceptibility. A wide range of molecular based tests is available to assess DNA variation and changes in gene expression. However, there are major hurdles to overcome before the implementation of these tests in clinical laboratories, such as which test to employ, the choice of technology and equipment and issues such as cost-effectiveness, accuracy, reproducibility, personal training, reimbursement by third-party players and intellectual property. At present, polymerase chain reaction (PCR) testing predominates; however, alternative technologies aimed at reducing genome complexity without PCR are anticipated to gain momentum in the coming years.

Furthermore, development of integrated chip devices (‘lab-on-a-chip’) should allow POCT and facilitate genetic readouts from single cells and molecules.

Together with proteomic-based testing, these advances will improve molecular diagnostic testing and will present additional challenges for implementing such testing in healthcare settings.

NUMBERS

Globally, there are only 3.96 hospital beds for every 1000 people.

There will be an estimated shortfall of

0.5 million doctors in India by the year 2012.

The Indian health system is ranked 118 among 191 WHO member countries on overall health performance.

Healthcare sector in India is expected to receive investment of around USD

5 billion by 2011.

Average health insurance claims per year in the US is nearly USD 44

March 2009

www.ehealthonline.org

7 billion.

Read, Update and Stay Ahead...



Subscription Order Card Duration (Year)

1

2

3

Issues

Subscription USD

Newsstand Price INR

Subscription Price INR

Savings

12 24 36

100 150 250

900 1800 2700

900 1500 2000

-Rs. 300 Rs. 700

*Please make cheque/dd in favour of Elets Technomedia Pvt. Ltd., payable at New Delhi

Three easy ways to subscribe: Web Fax Post

: : :

Log on to http://www.ehealthonline.org/publication.asp and submit the subscription form online.

Complete the information on the card and fax it to +91-120-2500060 Mail the form along with the cheque to : eHealth magazine Elets Technomedia Pvt. Ltd. G-4 Sector-39, Noida 201 301, U.P. India Tel +91-120-250 2180 to 85 Fax +91-120-2500060 e-mail : manoj@elets.in, Web : www.ehealthonline.org

I/We would like to subscribe to monthly eHealth

magazine!

Please fill this form in Capital Letters First Name..................................................................................... Last Name......................................................................................................

Designation/Profession . ................................................................ Organisation .................................................................................................

Mailing address ....................................................................................................................................................................................................

City .............................................................................................. Postal code . ..................................................................................................

State . ........................................................................................... Country . .......................................................................................................

Telephone...................................................................................... Fax ................................................................................................................

Email ............................................................................................ Website . .......................................................................................................

I/We would like to subscribe for

1

2

3

Years

I am enclosing a cheque/DD No. ................................................ Drawn on ..................................................................................... (Specify Bank) Dated ............................................................................................................... in favour of Elets Technomedia Pvt. Ltd., payable at New Delhi.

For Rs./USD ................................................................................................................................................................................................... only Subscription Terms & Conditions: Payments for mailed subscriptions are only accepted via cheque or demand draft • Cash payments may be made in person • Please add Rs. 50 for outstation cheque • Allow four weeks for processing of your subscription • International subscription is inclusive of postal charges.

www.ehealthonline.org

EVENTS DIARY 6 - 10 March 2009 European Congress of Radiology 2009

1 - 3 May 2009 Medical Technology India 2009

Vienna, Austria

New Delhi India

http://www.myesr.org/cms/website.php

http://www.medicaltechnologyexpo.com/site/in-

28 - 30 June 2009 Healthcare Travel Exhibition & Congress Singapore, Singapore http://healthcaretravel-singapore.com/

dex.html

27 - 29 March 2009 Medical Fair India New Delhi, India http://www.mdna.com/shows/medfairindia.html

1 - 3 April 2009 Med-e-tel 2009 Luxembourg, Luxembourg http://www.medetel.lu/index.php

7 - 10 April 2009 PACS Admin Seminar Cairo, Egypt http://www.ictfh.com/

18 - 19 April 2009 India Medica 2009 Mumbai, India www.ibcinfo.com

6 – 8 May 2009 Medifest South Africa Cape Town South Africa

25-27 August 2009 eHEALTH India 2009 Hyderabad India http://www.eIndia.net.in/ehealth

http://www.vantagemedifest.com/medifest_southafrica/index.html

16 - 19 June 2009 CommunicAsia 2009 Singapore, Singapore

31 July - 02 August 2009 Medicall 2009 Chennai India http://www.medicall.in

http://www.communicasia.com/main.htm

16 - 19 June 2009 Enterprise IT 2009 Singapore Singapore http://www.goto-enterpriseit.com/main.htm

11 – 13 December 2009 Medifest ‘09 New Delhi http://www.vantagemedifest.com/medifest_india/ index.html

5th

India's Largest ICT Event

INDIA

2009 25-27 August 2009 HICC, Hyderabad, India

...the definitive event on healthcare ICTs, technologies and applications Focus Areas

Hospital Automation & Management Systems, Clinical Information Systems, HMIS & ERP, EMR & Medical Informatics, EMR & Medical Informatics, Medical Imaging, RIS & PACS, Communication & Network Solutions, Tele-medicine & Tele-health Target Audience

Hospital Directors/CEOs, CIOs/CTOs/GMs/VPs of IT and Systems, Medical Directors & Administrators, Central & State Health Officials, Technology Vendors & Solution Providers

be a part of it... www.eindia.net.in/2009/ehealth/

For Participation Opportunities: Arpan Dasgupta, m:+91 9911960753, e: arpan@ehealthonline.org Bharat Kumar Jaiswal, m: +91 9971047550, e: bharat@ehealthonline.org