'Heart’ of Technology Cardiovascular Diagnosis & Therapy : March 2010 Issue

30,000 beds in Narayana Hrudalaya hospital in 5 years

Clinigene deploys SAS clinical solution

The Monthly Magazine on Healthcare ICTs, Medical Technologies & Applications Vo l u m e 5 | I s s ue 3 | MARCH 2010 | I NR 75 / USD 10 | ISSN 0973-8959

“IT is the only facilitator for health services in the government sector” Dr. R C Patnaik Chief Medical Officer Municipal Corporation of Delhi PAGE 8

Capturing the Beat Milind Shah Managing Director India Medtronic Pvt Ltd. PAGE 16

External Cardiac Defibrillators Vijay Simha COO & VP BPL Health Management Solutions Group PAGE 22

Health - Just a click away Divya Chawla Principal Correspondent eHEALTH PAGE 28

‘Heart’ of Technology Car di o vasc ular D iagnosis & Therapy

“Today, corporate hospitals also recognise the utility of research” Prof. (Dr.) Upendra Kaul Executive Director Department of Cardiology & Dean - Dept. of Academics & Research Fortis Escorts Heart Institute & Research Centre, New Delhi PAGE 34

w w w .e h e a lt h o n l i n e . o r g

40 Edition

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CONTENTS w w w . e h e a l t h o n l i n e . o r g | volume 5 | Issue 3 | March 2010

8 | IN FOCUS

ISSN 0973-8959

34 | SPOTLIGHT

“IT is the only facilitator for health services in the government sector”

“Today, corporate hospitals also recognise the utility of research”

Dr. R.C Patnaik, Chief Medical Officer-Municipal Corporation of Delhi

Prof. Dr. Upendra Kaul, Executive Director Department of Cardiology & Dean-Department of Academics & Research Fortis Escorts Heart Institute & Research Centre, New Delhi

12 | COVER STORY Capturing the beat- Cardiovascular Diagnosis & Therapy

38 | EVENT REPORT Healthymagination summit 2010

Divya Chawla, Principal Correspondent-eHEALTH

ZOOM IN

22 | EXPERT CORNER External cardiac defibrillators

39 | Business intelligent open standards for telemedicine

Vijay Simha, COO & VP-BPL Health Management Solutions Group

43 | NEWS REVIEW 28 | TECH TRENDS Health just a click away

Divya Chawla, Principal Correspondent-eHEALTH

50 | EVENTS DIARY

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March 2010

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EDITORIAL GUIDELINES eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. - an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and well-researched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and 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.

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CORRIGENDUM: Februay 2010 issue of eHealth mistakenly carried the name of Gaurav Mundra, Director & COO, Truworth, as the author of the story titled - ‘Technology Enabled Proactive Healthcare’ (pg. 20 ), instead of, Rajeish Moondra, CEO, Truworth. The error is deeply regretted.

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EDITORIAL Volume 5 | Issue 3 | March 2010

40 Issues Young!

With the successful completion of 40th issue, eHEALTH magazine has reached one more milestone in its journey of propagating knowledge in the domain of healthcare IT and medical technologies.

Since inception in November ‘06 and till date, we have relentlessly tried to provide the latest and most relevant information on all aspects of healthcare technologies to our readers spanning across doctors, clinicians, hospital managers, healthcare administrators, technologists, policy makers and various other stakeholders in healthcare fraternity.

It is needless to say, that knowledge that stagnates gets limited in scope and serves little purpose. Hence, it is imperative that there are additions in form of newer inventions. The existing knowledge should be capable of assimilating changes with time to progress. Healthcare is one such field that needs constant expansion in its knowledge base to assert its suitability with the changing situations - afterall it is the question of human survival. As always, we promise to remain steadfast, through all our future editions, on our commitment to take forward the use and adoption of technology in healthcare.

The cover story of this issue (‘Capturing the Beat’, pg. 12) is focusing on devices and techniques for treating cardiovascular diseases and conditions. It is important to note that there are two segments of such devices - cardiac rhythm management (CRM) devices and cardiovascular monitoring and diagnostic devices. The issue has tried to address the radical changes of medical device industry that is playing a crucial role in transforming healthcare delivery system. With more and more innovations coming our way, technologies that would have existed in fiction have become a reality and we wish goodluck to all the players; both small and large in this domain.

Internet has been adopted as the latest tool in enhancing healthcare delivery and reach to the masses. Health information is now available at the mere click of a button. There are hundreds of healthcare providers and health portals that are offering services to people. The number of internet users is increasing by leaps and bounds. The success of this measure will mark a marvellous achievement in the history of healthcare delivery in India, vis-a-vis across the world. Catch up with this emerging trend in our special story - ‘Health-just a click away’, pg. 28.

A classic example of government’s growing efforts in using IT for public health transformation is that of Municipal Corporation of Delhi’s initiative in connecting its hospitals through a common IT network. A rapid integration of is taking place in these hospitals in form of online registration of births and deaths (under the scheme OLIR), maintaining electronic records, computerisation of hospital information system (HIS) and installation of dedicated LAN. There is an urgent need of replicating the example of MCD in government hospitals across India as IT is the only facilitator that can bring about a total reformation in health services. Know more about this project in an exclusive interview with Dr R C Patnaik, Chief Medical Officer, MCD, pg. 8.

Happy Reading!

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org President: Dr. M P Narayanan | Editor-in-Chief: Dr. Ravi Gupta Product Manager: Dipanjan Banerjee (Mobile: +91-9968251626) Email: dipanjan@elets.in Editorial Team: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Shipra Sharma, Divya Chawla, Sheena Joseph, Yukti Pahwa, Sangita Ghosh De, Subir Dey, Dinoj Kumar Upadhyay, Pratap Vikram Singh, Gayatri Maheshwary, Saba Firdaus Sales & Marketing Team: Arpan Dasgupta (Mobile: +91-9818644022), Bharat Kumar Jaiswal (+91-9971047550), Debabrata Ray, Anaam Sharma, Fahimul Haque, Ankur Agarwal, Priya Saxena, Vishal Kumar, Gaurav (sales@elets.in) Subscription & Circulation: Lipika Dutta (Mobile: +91-9871481708, subscription@elets.in), Manoj Kumar, Gunjan Singh Graphic Design Team: Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore Web Development Team: Zia Salahuddin, Amit Pal, Sandhya Giri, Anil Kumar IT Team: Mukesh Sharma, Devendra Singh | Events: Vicky Kalra Editorial Correspondence: eHEALTH, G-4 Sector 39, NOIDA 201301, India, tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.

Themagazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at R P Printers, G-68, Sector-6, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta

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“IT is the only facilitator for health services in the government sector” The health department is a constituent unit of Municipal Corporation of Delhi (MCD), providing holistic healthcare facilities to the population residing in the geographical territory under MCD. In the recent past, the department has undergone large-scale IT implementation for enhancing the delivery of healthcare services. Two of the IT projects of MCD have received national awards and one project has been appreciated by the UNICEF. Dr. R C Patnaik, CMO (HI), Municipal Corporation of Delhi, who heads the Health Informatics Department, has played a pioneering role in IT application in the Health Department. e-HEALTH traces the recent initiatives of the health department under MCD through deployment of IT.

Please tell us about MCD’s initiatives towards health sector reforms and improvement of existing healthcare facilities.

Dr. R C Patnaik Chief Medical Officer Municipal Corporation of Delhi

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MCD is responsible for providing civic services to almost 98 percent of the population of Delhi covering around 97 percent of the geographic area of Delhi. One of components of the civic services provided by MCD is comprehensive healthcare comprising of preventive, curative, promotive, and rehabilitative components. In addition to this, the health department under MCD, also focuses on medical education, training and research.

Almost 30 percent of Delhi’s population depends on the curative health services provided by MCD. However, in addition, MCD

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organizes an entire spectrum of public health services for Delhi. To provide qualitative healthcare the department has been divided into two wings— the public health wing and and the hospital administration wing. The health department of MCD realized the importance of information technology in improving operational efficiency and started its efforts to computerise all activities of healthcare delivery systems covering both public health as well as hospital administration, which encompasses medical care, mother and child welfare, TB control programme, school health services, disease surveillance, registration of births and deaths, and the like.

The department has tried to improve operational efficiency of

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the constituent units. To start with, a complete solution for registration of births and deaths was developed along with renewal of health trade license incorporated with other municipal services. Computerisation of MCD hospitals and hospital information system (HIS) has been taken up separately.

The health department under MCD is doing a large-scale IT implementation for modernising its hospitals. What is the scope and size of this initiative?

Over the years, the health trends have undergone a transformation with increase in patients’ expectations.

However, budgetary constraints, manpower shortage and frequent changes in political and legislative policies impede the health services offered by us. The number and socio-economic status of patients availing healthcare facilities in MCD institutions can not be compared with private sector institutions.

Also the work load on medical and paramedical staff is increasing constantly, thereby affecting the quality.

To overcome this, MCD decided to implement IT application reforms in a substantial way. MCD realised that IT is the only facilitator and a lot of issues can be resolved through IT implementation. There is no R&D in MCD, but MCD has created some new concepts during IT implementation, which have been appreciated at the national level.

In 2003, MCD kicked off its first project, for registration of births and deaths. The volume of registration was so high that the number of people engaged were not able to handle the work. Nearly 50 percent of the posts are still lying vacant. The citizens were dissatisfied because of a delayed response and difficulties in issuing certificates since all the work was being managed manually. But all these problems were resolved with the deployment of IT in hospitals. A centralised registration system was introduced and nearly 400 hospitals under the MCD area were linked with each other. A scheme called OLIR was

introduced for online registration of births and deaths. All linked hospitals were provided with user ids and passwords through which births and deaths could be registered online by the hospital. Apart from this, MCD opened registration centres in various cremation grounds and setup IT workstations in 12 zones under 12 registrars. These centres were equipped with desktops, broadband services, which aided in data entry for domestic events. Through this process, MCD was able to cut down on the time required for registration issuing of birth and death certificates.

Moreover, facility for submitting online application through payment gateways was introduced. MCD is the first agency in India to introduce such systems and this project was well appreciated and awarded for outstanding performance by the RGI in 2004.

The second major project is the HIS project. In a major move aimed to revolutionise the delivery of medical care, MCD initiated computerisation of six major hospitals . An agreement was signed with Wipro HealthCare IT Limited on 14th October 2004 to computerise the six hospitals in a phased manner. There were 33 modules in the package. Of the six hospitals, Swami Dayanand Hospital (230 bed general hospital) was selected as pilot for customization and implementation of software and HIS was commissioned in October 2005.

MCD decided to begin a pilot project in one of the hospitals and replicated the same in others.

In addition to the installation of LAN and procurement of servers and other hardware, civil and electrical work was done separately. New concepts such as patient registration scheme were implemented in which patients coming to hospitals were being registered for lifetime and were given a laminated card with a unique UHID. With this system in place it is easy to store all information of the patients on record and easy to retrieve on

demands of the patients. The major benefits achieved were standardisation and patient satisfaction.

Subsequently, electronic patient folder (EPF) module was implemented where all the records of the patients of all six hospitals were uploaded to a central server in a batch processing. This allows the physicians of any hospital to access patient records when patients are being referred to any of these hospitals.

This project was awarded in the e-India conference held at Hyderabad in August 2009.

Our third project was LIBRE (Linking Births Records & Immunisation Records). This was aimed at reducing the duplicities in data entry or data utilisation. This project focussed on generating an immunisation card on the basis of the data collected in birth record of a child where most of the fields of these two records are identical. This project also received funds and appreciation from the UNICEF. This has been implemented in 32 maternity homes.

Besides training in IT application, MCD also focused on digitisation of records. This has been effectively implemented in maintaining birth and death records.

Please provide an overview of the projects that are currently in the pipeline.

The main projects, which are currently in the pipeline and will be implemented shortly include the Mother and Child Welfare Information System (MCWIS), TBTRAM (TB patient tracing and monitoring system), which will integrate DOTS management system, integrated dots management system (IDMS), School Health Card and Disease surveillance system.

The MCWIS has been hosted and staff are doing the UAT. In this, all major activities undertaken like ANC, PNC, family planning and well baby clinics, etc., will be streamlined through IT application. MCD will be linking ANC registration to birth registration in order to track

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abortions undertaken to find out female foeticides. NRHM reporting system is a module in this project which will help ANMs to devote more time for clinical work rather than compiling reports manually. There is a plan to go live, with this project from the 1st of April 2010.

The next project in the pipeline is the IDMS project. On the basis of the experience gained from the inventory management module of HIS, the project has been out-lined. MCD is catering to four different systems under medicine including Allopathy, Unani, Ayurved and Homoeopathy.

The project will provide web-based solution to mange and monitor all processes of procurement and distribution of medicines, reagents, surgical items, etc. The modules will be ordering (EOQ), ABC/VED analysis, monitoring the expiry dates, maintaining the suppliers profile, etc. This will help the administrators to make effective utilization of the allocated budget.

Another system on which MCD is working right now, but still hasn’t designed is the TB tracking system.

This system will be able to track defaulters, who are under DOTS therapy but do not return to take subsequent doses after getting the symptomatic relief leading to MDR. Considering the constant increase in the number of TB patients, and lack of manpower, the defaulters can only be tracked with the help of IT application. MCD is also planning to do a project for school health. There are 1800 schools under control of MCD and nearly 9 lakh children are studying in these schools. There is a separate wing in health department called School Health Services, which organises curative and preventive healthcare for school children. In order to implement qualitative care, MCD has planned to utilise IT for a solution. The due diligence for the application has been completed.

MCD will focus on introducing a health card for individual students and follow this as long as they are enrolled in MCD schools. Having a project on registration of birth and

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immunisation, MCD in all likelihood can come up with a database of birth, immunisation and health of school children.

For public health, MCD wants to do a project on disease surveillance. As per the DMC act, there are 9 notifiable diseases like tuberculosis, cholera, measles, polio, meningitis, plague and dangerous disease like AIDS and dengue which are a perpetual threat to Delhi. To keep a track of these diseases, IT implementation is essential at a macro level. Under the disease surveillance system, the hospital where a patient is being diagnosed in any of these diseases may communicate to the Zonal Public Health Administrator (DHO), who can organise preventive/remedial measures in the locality to cut down on the spread of these diseases in the community, thereby reducing the chances of epidemic. Currently, there are separate programmes running such as malaria control programme and cholera control programme. So the aim is to club all these programmes together under the disease surveillance project.

What is the estimated investment for all these projects?

The health department is a part of the MCD and the investments are made

by MCD. Only for the HIS project, health department spent an amount of Rs. 174 lakh for procuring and customising the product. In addition, separate investments were made for procurement of hardware, LAN and for maintenance and manpower.

Registration of births and deaths was developed as a part of MCD project and part of LIBRE was funded by the UNICEF. However, IT department is in the process of developing other projects, so the accurate estimate of investment cannot be provided as of now.

What is your view regarding the support of technology partners and solution vendors for various projects?

Wipro is our IT partner in the HIS project. The birth and death

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registration project was done in collaboration with ECIL, who did a CSB project for the entire MCD. Now MCD has selected Tech Mahindra for the e-governance project. Tech Mahindra will develop IT applications for all departments and will integrate all these applications. MCD has proposed this e-governance initiative to harness the power of ICT platform for its vision as “a socially committed, technology driven, professionally managed and forward looking organisation�.

What are your measures to quantify the benefits?

There are significant and observed benefits in the areas where IT applications have already been deployed.

Through IT implementation, we are able to manage the shortage of manpower, subsequently balancing it with the increasing number of patients. Most of the processes have been managed efficiently where the citizens are being benefited.

IT also has helped in making different reports like statistical reports and MIS reports which are beneficial for the health administrators. The most important factor is that all the projects are being sustained and credit goes to the entire staff that uses these.

Overall, IT implementation in health sector under control of government will bring about a total reform in organizing health facilities and services, which benefit the citizens as well as administrators.

The projected benefits are to provide single window services to citizens on any time, anywhere basis (through the internet), increase the efficiency and productivity of health units, enhance monitoring and transparency, develop a single and integrated view of health information system across all units and provide timely and reliable management information relating to health administration for effective decision making.

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CAPTURING THE BEAT Cardiovascular Diagnosis & Therapy With global projected sales worth USD 86.4 billion in 2010, the cardiovascular devices market is one of the most significant segments in the medical technology domain.

Divya Chawla, eHEALTH, attempts to provide an overview of the cardiovascular device industry by estimating the overall market size, reviewing the major market segments, identifying key industry players, evaluating key products and examining new challenges and opportunities.

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ore than 80 million people worldwide have some form of cardiovascular diseases, as estimated by the American Heart Association. Cardiovascular illnesses, in fact, is one of the leading causes of mortality worldwide, as irrespective of the type of cardiovascular illness most people eventually die of cardiac arrest. Globally, a growing ageing population and increased attention on prevention and diagnosis of cardiovascular diseases have enhanced the focus on cardiovascular devices. In America alone, by 2030, almost 20 percent of the population will constitute of people above 65 years of age. Further opportunities in cardiovascular devices will emerge as a result of emergence of sophisticated, yet user-friendly equipment at affordable rates.

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@ 40 Market Statistics Cardiovascular devices represents a growing market within the medical technology and equipment segment because of continual increase in the number if people suffering from cardiovascular diseases and conditions. In addition, leading vendors worldwide are focussing more on research and development activities in this domain leading to development of exciting technologically advanced devices and techniques for treatment

will witness sales of cardiovascular devices to be valued at a phenomenal USD 97.3 billion. Cardiac rhythm management and cardiovascular monitoring and diagnostic devices represent high growth opportunities for the overall cardiovascular devices market. The treatment and diagnosis of cardiovascular diseases have and will provide the requisite impetus for undisputed growth of the overall cardiovascular devices segment. The projected sales of cardiovascular diagnostic devices in 2010 and

of cardiovascular diseases and conditions. This will not only guarantee strong revenue growth for the vendors developing these technologies, but also provide enhanced value to the patients as well as the cardiologists.

As per reports, the overall sales in the global market for cardiovascular devices in 2008 amounted to USD 76.7 billion, while the projected sales for 2010 is an estimated USD 86.4 billion. At a compound annual growth rate of 2.8 percent, year 2015

Global Presence of Established and Emerging Industry Players

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2015 are USD 14.1 billion and USD 16 billion, respectively with an estimated CAGR of 2.6 percent.

The major factors driving growth in this market include expansion of indications appropriate for use of cardiovascular devices, development of newer technologies that allow patients to be treated earlier in the disease process, and lack of equally effective other treatment modes.

Key Market Segments Broadly, cardiovascular devices may be segmented into cardiac rhythm management (CRM) devices and cardiovascular monitoring and diagnostic devices in addition to others.

Cardiac rhythm management (CRM) devices segment comprises of treatment devices for cardiovascular diseases. These include single or dual chamber pacemakers, single or dual chamber implantable cardioverter defibrillators (ICDs), defibrillators and the leads used in cardiovascular pacing and ICD. Almost a decade ago, CRM devices faced several

quality concerns, however, the life-saving benefits of CRM devices and development of high quality, feature-packed devices have helped the market regain a positive growth pattern.

The cardiovascular monitoring and diagnostic devices segment

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Milind Shah Managing Director India Medtronic Pvt Ltd.

The medical device industry is witnessing radical changes and is playing a crucial role in transforming the healthcare delivery system, providing new solutions that will challenge the existing paradigms.

Demand in times to come will be driven by devices/technologies that offer higher value in terms of better clinical outcomes, improved quality of life, reduced mortality in critical conditions, ease-ofuse for the clinicians, reduced hospitalization and affordability as equated to the life span of an individual.

The focus is increasingly on value of medical technology that is a combination of clinical based outcomes with more contemporary measures of economic efficiency and quality of life. With higher value, the overall cost of treating the disease comes down due to lower hospital stay, faster back to full productivity etc.

The pace of medical innovation is accelerating and technologies that were considered to be part of fiction till recently are already reality today. The next decade and beyond will bring rapid changes in this space. Minimally invasive therapies designed to help patients heal faster, while at the same time they streamline surgical procedures and reduce hospitalization

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expenses, medical devices which collect patient information, transmit them to doctors miles away and make necessary adjustments in the settings for better control of condition; implantable devices combined with drug therapies that target chronic conditions at their point of origination and miniaturization across many kinds of device technologies to provide advanced therapies are all on the horizon.

At Medtronic, these innovations and many more sit on the brink of not just discovery, but reality. The fact that 2/3rd of our revenue comes from products introduced in last 2 years shows the pace of innovation and commitment towards innovation at Medtronic. Medtronic since its inception has been challenging itself and has been at the forefront of innovation in medical devices across the globe thereby setting newer and higher benchmarks for the industry to follow. Keeping up with the newer emerging needs, some of our path breaking innovations at Medtronic in cardiac space have been MRI compatible pacemaker for arrhythmia patients, devices for Minimally Invasive Cardiac Surgery for CABG, mechanical defibrillators, to name a few.

Implantable Cardioverter Defibrillators Implantable Cardioverter Defibrillators (ICDs) have been developed and are in use for over 10 years now in India. Batteries used in implantable cardiac pacemakers and defibrillators present unique challenges to the developers and manufacturers in terms of high levels of durability safety and reliability.

It is important that the batteries must have longevity (long life) to avoid frequent replacements, repeat procedure & increased costs.

Advantages of having the highest quality of batteries in these implantable devices include reduced device replacement complications for patients, decreased costs of replacement, improved cost-

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effectiveness, and favourable cost per day comparisons as compared to other therapies.

Medtronic is the only company that manufactures its own batteries for the pacemakers and has been constantly working towards improving on this technology and currently remains a leader in battery technology used in implantable devices. The advantage of in-house battery technology development on the one hand provides the technical and clinical benefits as mentioned above while on the other also enables us to address the aesthetic aspects and requirements of the implant by keeping the size and thickness of the devices very compact while constantly improving on the longevity.

Importantly, we are able to make better estimates and projections of the device longevities as proven by many studies.

• Latest products launched MRI compatible pacemaker Patient care and treatment has reached new dimensions and Medtronic is a company that believes in developing pioneering technologies. For instance - The Enrhythm MRI compatible pacemaker has changed the lives of a large number of patients who need to undergo an MRI scan for diagnosing other ailments. MRI was contraindicated for pacemaker patients until now i.e. patients need to get the pacemakers explanted for getting the MRI done which is a major procedure as it means that besides the pacemeaker, even the leads that are implanted in the heart of patient need to be removed.

• Pacemakers are most often implanted in people whose heart rate is so slow that they are in danger of losing consciousness.

As a result, millions of patients have implanted pacemakers, and the numbers of new implants have averaged about 225,000 per year over a recent 5-year period (as per US Statistics). In India an average of 20,000 patients get pacemaker implants every

year and will now have the option of getting an MRI SAFE PACEMAKER. Medtronic’s latest V3D range of devices has proprietary features: Shock Reduction • Disease Management • Therapy Efficacy • Remote Patient Care • Medtronic’s Vision 3D • portfolio allows physicians to specify the unique feature options needed to meet their patients’ individual needs.

These products continue Medtronic’s legacy of leadership in the industry by delivering products based on customer feedback and mounting clinical evidence, including: MVP®, or Managed Ventricular • Pacing OptiVol® Fluid Status • Monitoring Conexus® Wireless Telemetry • ATP During Charging™ •

comprises of the traditional ECG monitors, ECG stress testing systems, Holter monitoring systems and event monitoring systems.

New advancements in this segment are mostly geared towards digital innovations that provide connectivity to PCs and electronic records, bringing some high-tech features into various practice settings. An exciting development is the integration of a wireless option in these devices that enhances their use and productivity.

External Defibrillators As performing manual chest compressions is both difficult and physically demanding, one of the emerging technologies is mechanical compression devices. At Medtronic, the largest medical device company in the world, we offer Mechanical Chest Compression Device “LUCAS™ which is an easyto-use and lightweight device that provides quality chest compressions according to the European Resuscitation Council and American Heart Association Guidelines for CPR (cardiopulmonary resuscitation).

It assists rescuers in facilitating the delivery of vital oxygen to the brain and priming the heart for a defibrillation shock in cardiac arrest situations. LUCAS is simple to use, applied within seconds and feasible for use on most cardiac arrest patients. LUCAS is used by firefighters and paramedics on the scene of a cardiac arrest and used by clinical personnel in the

Apart from these the other major segments in the cardiovascular market space include cardiovascular prosthetic devices, cardiovascular surgery, electrophysiology, interventional cardiology and peripheral vascular devices.

Established and Emerging Players Cardiovascular devices in India is a dynamic segment with several small and large players who make significant investments and rely on profits generated in, as well as outside India. While some players purely operate in India, there are others who have a global presence with sales, marketing, research and development and/or manufacturing affiliates around the world.

Owing to intense industry competition, smaller players utilize product differentiation strategies

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rather than reduced pricing methods to maintain their foothold in the market. Unique product promotions and different market strategies allow these vendors to sell their products.

Companies focusing on fewer segments tend to develop an expertise in that particular segment and have an edge over companies that offer the entire range of products.

The Road Ahead The rapidly developing healthcare systems in India provides a huge opportunity for growth of the entire medical equipment industry including the cardiovascular devices segment. The rising healthcare expenditures leading to entry of medical reimbursements and health insurance will lay down a strong foundation for this market in terms of stability and growth. Technological advancements and miniaturization of equipment is further going to add value to products in this domain. However, regulation and stringent USFDA guidelines limit, what could have otherwise been a technological explosion, but at the same time ensure the quality of products penetrating the market.

Despite intense competition in the marketplace, growth opportunities exist for participants that meet enduser demands of quality balanced with lower-costs.

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emergency departments and cath labs of hospitals.

LUCAS offers the best opportunity for effective CPR by performing consistent and uninterrupted compressions throughout a cardiac arrest. It is designed to deliver uninterrupted compressions at a consistent rate and depth (100 compressions per minute, depth 1.5 to 2 inches) to facilitate the return of spontaneous circulation in cardiac arrest patients.

By ensuring consistent blood flow, LUCAS helps emergency medical responders deliver a more viable candidate for recovery to the Emergency Department.

Furthermore, LUCAS can assist in improving the operations of an emergency response system or hospital by helping to reduce the chaos on the scene and free up staff for other emergencies.

Cardiac Arrest in the Cath Lab are not uncommon and its difficult to provide manual chest compression and continue fluoroscopy. As the LUCAS Back Plate and Support Legs are made out of plastic which is radiotranslucent (creates a shadow in x-ray). It allows for continued intervention during CPR,a bridge for LVAD, ECMO, CABG. LIFEPAK 15 monitor/ defibrillator from Medtronic is the new standard in emergency care which is most clinically and operationally innovative and technology advanced device available today.

It has large dual-mode color display, controls and speed dial for ease of use, User Configurable display and features to match customer need, ADAPTIV Biphasic, energy to 360J,Advanced Resuscitation features cprMAX, metronome, IP44 rating—will work in a steady wind and rain storm, harsh environments.

IT integrates

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Masimo Rainbow SET technology that monitors SpO2, Carbon Monoxide and Methemoglobin, includes a metronome to guide CPR compressions and ventilations and provides an option to escalate energy to 360J. An entirely new platform, the 15 is powered by Lithium-ion battery technology, incorporates the SunVue display screen for viewability in bright sunlight, and data connectivity to easily and securely collect and send patient information.

Other products in this category include LP-20, LP-1000 and LP-CR+.

Cardiac Surgery A significant advancement in the surgical treatment of coronary artery diseases recently has been minimally invasive coronary artery bypass grafting (MICS CABG). Medtronic has recently introduced stabilization and positioning devices for MICS CABG. Worldwide, approximately 675,000 patients require some form of coronary artery bypass surgery each year. Coronary Artery Bypass Grafting (CABG) is a surgical procedure that restores blood flow to the portion of the heart that has blocked arteries. Using other arteries or veins from your body, the procedure involves attaching these vessels or grafts to the heart in order to reroute the blood around the blockage, creating an alternative pathway for blood to reach the heart muscle that is not receiving sufficient bloodflow.

Growing number of patients in developed countries are receiving minimally invasive CABG procedures or MICS CABG. This minimally invasive procedure does not require cutting of chest bone (sternotomy); instead the operation is performed through a 5-7 cm under the left breast.

The potential benefits of the MICS CABG procedure include reduced hospital stay, faster recovery, invisible surgical scar, and greater satisfaction to the patient and his physician.

COVER STORY

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Cardiovascular Devices Product Matrix

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BPL Healthcare

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√

√

Clarity Medical

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Concept Integrations

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√

√

Esaote

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√

√

GE Healthcare

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√

√

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Instromedix

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√

√

√

L&T Medical

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√

Maestros Mediline

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Medtronic

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√

Metrax GmbH (Primedic)

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Mindray

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√

√

√

√

√ √

√

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Philips Medical

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√

√

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Schiller Healthcare

√

√

√

√

√

√

√

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Nasan Medical

St Jude Medical

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Peripheral Vascular devices

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Interventional Cardiology

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Electrophysiology

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Cardiovascular Surgery

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Others

Cardiovascular Prosthetic Device

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Event Monitoring Systems

ICD

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Holter Monitoring Systems

Defibrillators

Advanced Micronic Devices Ltd.

Pacemakers

Vendor

ECG Stress Testing Systems

and Diagnostic Devices

ECG Monitoring Equipment

Cardiovascular Monitoring

Cardiovascular Pacing & ICD leads

Cardiac Rhythm Management Devices

√

√

√

Trivitron

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Universal Medical Instruments

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Zoll Medical

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√ √ √

√

√

√

√ √

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March 2010

19

DEVELOPMENT DIMENSION

Cardiovascular Devices-The Trivitron Experience

A

s we enter the next phase of healthcare, there is a significant increase in demand for evidence based diagnosis and treatment. The basis of accepting ECG as a useful monitor lies in the fact that, patient’s condition under anaesthesia is well reflected by biological electrical signals. The ECG is the most commonly performed cardiac test. This is because the ECG is a useful screening tool for a variety of cardiac abnormalities; ECG machines are readily available in most medical facilities; and the test is simple to perform, risk-free and inexpensive.

Combining the information from biochemical markers, imaging, clinical parameters, ECG, and other parameters via information technology will enhance and help develop better intervention strategies.

According to the American Heart Association (AHA), arrhythmias afflict more than 4 million patients and result in approximately half a million deaths each year in the United States. Electrocardiography (ECG) measurements, which record and interpret cardiac electrical activity over time, are widely used to detect abnormal heart rhythms.

Consequently, ECG interpretation is the best way to measure and diagnose arrhythmia, particularly conditions arising from damage to the conductive tissue that transmits electrical signals in the heart.

Following myocardial infarction, an ECG can identify damage to heart muscles in some areas.

As a diagnostic tool, ECG had been around for a long time, and penetration of these systems in hospitals is very high. Despite its established nature, the market continues to evolve with new devices, including ECG monitoring systems at healthcare facilities; event monitors for subacute patient monitoring, which patients carry with them to record heart rhythm for short periods of time; implantable loop

recorders that are surgically inserted into patients and can record heart rhythms for an extended period of time; and telemetry and ECG data management solutions.

The need to observe patients for an extended period of time, while ensuring accuracy and increasing compliance, resulted in the adoption of homebound outpatient telemetry services for post-coronary artery bypass graft (CABG), atrial fibrillation, and drug management for patients.

Although these systems provide beat-by-beat recording and analysis and can store data for up to 24 hours, they suffer from one significant disadvantage – the patient has to be home-bound, as these systems do not have cellular capabilities and can not monitor patients when they are separated from the hardware installed in their homes. Mobile cardiac outpatient telemetry (MCOT) solutions overcome these handicaps by incorporating cellular capabilities, and are the latest evolution in the telemetry market for ECG devices.

Changes are afoot in ECG monitoring for onsite patient studies as well. Historically, ECG machines were confined to heart stations/ cardiology departments in hospitals.

This status has gradually changed, with ECG monitoring moving into noncardiology departments such as nursing, emergency departments (ED), electrophysiology labs (EP), and even into respiratory therapy.

ECG measurements taken in these different departments are likely to be sent to the cardiology department for interpretation. These changes have meant that different departments demand different capabilities in their devices. ED and EP labs require sophisticated devices, usually 12 lead monitors, with different algorithms that are not needed in standard cardiology departments. Adoption of ECG devices in the physician office space has increased; these users too have a different need. ECG devices targeting the physician office space

have to be more affordable while meeting the desired capabilities. As a result, vendors must now customize their ECG devices to fit the needs of different end-users.

The penetration of ECG monitors into different departments has resulted in growing demand for ECG data management solutions for collecting data and streamlining report generation. Many vendors are therefore adding an ECG data management component to their other IT products in an effort to increase the competitiveness of their technologies. Using this type of bundling solutions, customers can make just one purchase, eliminating the need to acquire a stand-alone ECG data management solution, and limiting sales of ECG data management solutions. The widespread adoption of electronic medical record (EMR) systems will contribute to expansion of the ECG data management solution market.

Finally, the launch of American College of Cardiology’s (ACC) doorto-balloon (D2B) time initiative and AHA’s complementary “Mission: Lifeline” has also increased demand from hospitals for Bluetoothequipped 12-lead ECG monitors and wireless solutions. Both of the aforementioned programs seek to reduce the time between diagnoses and percutaneous coronary interventions (PCI) performed in catheterization labs. As more hospitals strive to meet national guidelines set by these initiatives, demand for wireless ECG solutions will be further boosted. Trivitron, the largest medical technology company of Indian origin, has signed JV with global player, et Cardiette, Italy to manufacture ECG machines, Holter systems and other cardiac diagnostic instruments in Trivitron Medical Technology Park, near Chennai. This will add to its cardiology solutions drug eluting stents, balloons, cardiac rhythm management devices, patient monitors, defibrillators etc.

The author of this article is S Kalyana Raman, General Manager - Group Marketing & Corporate Communications, Trivitron.

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March 2010

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EXPERT @CORNER

40

External Cardiac Defibrillators One of the leading players in medical technology, BPL Healthcare has a significantly long presence in the cardiovascular devices segment as the first product launched by the company in 1969 was a single channel electrocardiograph.

In an interview with eHEALTH, Vijay Simha, COO and VP, BPL Healthcare, shares his perspective about the latest technologies and applications of external cardiac defibrillators.

Managing Sudden Cardiac Death

Vijay Simha COO and VP BPL Health Management Solutions Group

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March 2010

Sudden cardiac death is a prevalent and significant health problem even in developed countries. Sudden cardiac death (SCD) is defined as death due to cardiac causes, in which the time and mode of death is unexpected, in a person with or without pre-existing cardiac diseases and occurs within 1 hour of the onset of the symptoms. The definition is interpreted within combination of the various definitions of sudden cardiac death, which vary within the clinical, scientific and medico-legal context.

While the number of sudden cardiac deaths have been well documented in certain parts of the world; in India accurately and well collated information on sudden cardiac death do not exist. Estimates in the US put over 300,000 lives claimed by sudden cardiac death, annually. sudden cardiac death is mainly caused by a lethal form of cardiac arrhythmia known as ventricular fibrillation (VF) and

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has been characterized by a rapid, disorganized and asynchronized contraction of the ventricular muscle which compromises the circulation of blood in the body leading to organ failure causing death within minutes.

Terminating Ventricular Fibrillation using a powerful electric shock and maintaining the flow of blood from the heart through manual heart massage has proved beneficial in bringing many people back to normal life.

Across the world, the awareness of giving prompt medical attention and conducting Cardio Pulmonary Resuscitation with an Automated Defibrillator has become a well established practice with paramedical, security and lay persons being trained to perform basic emergency CPR thus potentially having created an environment for saving an individual afficted by Sudden Cardiac Death.

The Technology of Defibrillators Defibrillators deliver a controlled and powerful enough electric shock

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@ 40

to the heart so as to immobilize the heart muscle by depolarizing it. A number of hypothesis in the electrophysiology of ventricular fibrillation have been put since 1914 and current research has also rejected the so called “electrical paralysis hypothesis” proposed by Dudel (1968), where very strong shocks that were recommended were seen to cause extensive electroporation (rupture of the heart muscle cells) and permanent damage to heart tissue. Current thinking requires the depolarization of a “critical mass” in order to get the best outcomes (effective cardioversion, in this case) and various forms of electrical waveforms and critical parameter settings such as current density and energy settings have been the focus of research into defibrillator design.

Important findings reported strongly indicate the preference of a biphasic waveform with a controlled current density being applied.

In externally used defibrillators this is achieved by assessing the victims impedence across the chest electrodes and delivering a predefined current vs time profile.

The Battle of Waveforms Biphasic waveforms have been the subject matter of a number of outcome research. Currently divided into 2 schools of thought – the free discharge biphasically switched waveform also called the Truncated Exponential Biphasic Waveform versus the controlled current waveform also called rectilinear biphasic waveform.

Patient impedence adjustments were present implicitly in a constant current source; the truncated exponential biphasic waveform needed special current sensing in order to control the discharge. The American Heart Association recommends a maximum energy of 200 J for biphasic external defibrillators and 360J for monophasic external defibrillators.

Out of Hospital Use of Defibrillators Automatic External Defibrillators (AED) and Public Access Defibrillators

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March 2010

(PAD) are being widely recommended by various health authorities and public organizations to improve overall survivability of individuals suffering from sudden cardiac death.

This requires adequately aware and trained public service personnel, and “Good Samaritans” to act within the first 10-18 minutes of the occurrence of sudden cardiac arrest where chances for successful cardioversion is high. Afterwhich, the chances for cardioversion begins to drop very rapidly.

Designed and manufactured by BPL, this public access defibrillator is advanced-yet-easy to use, by any Good Samaritan. In order to be used by common public, this product features some relevant features such as Audio & Visual prompts in localized languages (Hindi/English), self-test protocols for “always-ready” usage, The constant current bi-phasic waveform technology is used in the Phoenix to minimize cardiac tissue damage and provide better outcomes. Past-event history review, Light weight & Long battery life make this product suitable for locating in public places.

Training and certification of laypersons, professional paramedics and police/fire rescue personnel would create an environment where awareness and speed of attention is possible. However, there are precautions in which rescuers need to keep in mind that they are exposed to the laws that are not friendly to “Good Samaritans” . Most AEDs and PADs however, are built

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in with a number of failsafe features and incorporate an intelligence backed by a substantial database to recognize ventricular fibrillation and prevent the device from delivering a shock on a normal heart. Moreover, the attending paramedic should also ensure that the procedure of CPR is appreciated and followed to ensure the overall success of resuscitation.

He has also to ensure the safety of the bystanders during the process of resuscitation

Managing Public Access Defibrillators Public Access Defibrillators are located in public places and are available for use in case an emergency arises. Distributed across various important locations; they should be accessible in minutes for use. However, it is important to also manage these defibrillators on an ongoing basis so as to ensure that they are functional when they are most needed. A number of local management strategies as well as networked strategies are implemented using wired/wireless systems monitoring of PAD health as well as by individual inspection on a regular basis. AEDs and PADs need to be maintenance friendly incorporating automatic self checks and functionality checks as well as automatic enunciators to indicate fault conditions.

Also the PADs which are driven by voice commands should provide clear and understandable commands understandable by the population at large. The pronunciation and clarity of diction, possibly even in vernacular languages would make these devices more user friendly.

A Public Access Defibrillator deployed at public places such as railway stations, bus stations, shopping malls, airports, apartment complexes should clearly display the status of its functioning, purpose, and availability so as to facilitate speed of attention. Primary health centers, physician’s clinics, sports stadia having a PAD will go a long way in saving lives.

TECH TRENDS @

40

Health

_

Just a click away T

he rapid penetration of newer technologies in healthcare has become the latest trend across the globe. Healthcare has readily adopted internet as one of the latest technology tools that can enhance the delivery and reach of healthcare to the masses. Just at the click of a button, a user can have access to a gamut of healthcare services being offered by various online healthcare providers, now-a-days. As traditional healthcare delivery models make way for alternate resources, online healthcare has unlimited scope, considering the widespread usage of internet services.

P Rammohan Managing Director HealthSprint Networks Pvt. Ltd

Perspective on the emerging online healthcare services space in India A billion plus Indian population, over the next few years, will be empowered to purchase health insurance owing to rise in state and central Government health insurance programs and penetration of health insurance in the middle class population.

The future demands increase in efficiency and decrease in cost. We have seen how online services have revolutionised delivery of services in communication, banking, trading and transport industry, which again cater to a vast population. Healthcare too needs to adopt best practices from other industries.

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March 2010

Consumers can now book air, movie, and bus tickets online, but we still need to call a hospital/ physician to book an appointment, which increases administrative cost to hospitals with service being restricted to working hours. A realtime appointment management system would offer consumers the flexibility of self scheduling their appointments reducing their waiting time. Hospitals need to adopt online services to make registration, billing, and discharge processes faster.

Access to medical records at a single click for consultants, as well as patients helps deliver quality care and avoid medication errors by quickly reviewing past medical history. The end goal of the healthcare ecosystem in India, to adopt online healthcare services, should be focused on providing benefits to the citizens at a transactional level and easy availability of personal healthcare information in a high secured way.

Online health services offered We are the largest healthcare data exchange network in India. We were also one of the 1st healthcare IT companies to offer services on a SaaS model. Healthcare has become

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very complex—payors and providers really do need to work in tandem to satisfy consumers and maintain profits. We provide a multi-payor collaborative e-health platform that reduces complexity and improves interactions and relationships.

Our health insurance claims network is aimed to obviate the administrative burden of all those phone calls and faxes. We’ve seen positive feedback and results from the 750+ healthcare providers and 8 health insurance payors in India, who use our i-sprint Cloud computing and data exchange services.

We also provide a complete hospital management solution with a connectivity to payors delivered on a cloud which reduces the burden of small and medium size hospitals investing in IT infrastructure. We presently transact 20,000 online appointments a month, and we expect this number to reach a million transactions a month by end of this year with our real-time appointment scheduler. We are confident that our e-health services will improve efficiencies as well as deliver a foundation for comprehensive national health information exchange.

@ 40

As per current statistics, there are around 1.734 billion internet users, across the world and Asia accounts for almost 43 percent of the total internet users, which is the highest compared to any other region. In India alone these numbers are growing by leaps and bounds with Department of Telecom’s target of adding 20 million new high speed internet connections by 2010. Further, the Ministry of Communication and IT is setting up community service centres at various rural locations across India. The numbers imply the immense potential that internet has in terms of being a tool for communication, and access, sharing and exchange of information. In America, also, the trend of online healthcare kicked pace much earlier and currently there are hundreds of online health providers, as per the American Health Information Management Association.

The growing awareness about such services is helping people avail faster and hassle free

Business/revenue model and major clients Our business model is a pay per use and a yearly licensing model for healthcare payors. Some of the major health insurance companies and TPAs, who use our services include ICICI Lombard, Star Health & Allied Insurance, Mediassist, TTK, United Healthcare and Dedicated Healthcare TPA. Some of the major healthcare providers are Manipal Group, Sankara Nethralaya, Fortis, Wockhardt, Columbia Asia, Global Hospitals, Ramachandra Medical College, Sagar Hospitals, MS Ramaiah, St Johns Medical College, Dr Agarwal’s Eye Care, Vasan Eye Care, etc.

Recent eHealth platform deployed for Star Health & Allied Insurance Company Ltd for the Govt. of Tamil Nadu The government of Tamil Nadu has launched one of the largest health insurance schemes in India called the “Tamil Nadu Chief Minister Kalaignar’s Insurance Scheme for Life Saving Treatments.” The scheme covers approximately 40 million population of the state and the insurance carrier for this program is

Star Health. The transaction portal was deployed for convenience of accessing medical records, claims and conducting their health insurance transactions online on a 24X7 basis.

The vision of Star Health management was to provide customers an integrated multichannel experience, completely paperless and smart card integrated for identity management. The platform increased process efficiencies leading to lower transaction cost.

The entire membership data of the population along with demographics and biometric data are stored at the central data centre infrastructure. The financial and medical data are tagged with the membership information as a record in an appropriate workflow since the program runs for a period of 4 years.

The information pertaining to any citizen covered in the program is accessed via a smart search engine built in for quick retrieval.

We partnered with IBM for designing and deploying the data centre infrastructure for high availability and disaster recovery.

The solution offers robust proven

technology, energy-smart design delivering high performance computing for the workloads for over 1000 concurrent users. The unified storage solution is deployed to have 24x7 accessibility of secure and reliable healthcare data with business continuity.

Highly efficient storage density with software management provides smarter processing of the data information with quick access over the high speed network. Since the whole program is paperless, customer web experience and user interface were some of the key attributes.

In this program hospitals using the platform range from the largest hospital chains to small nursing homes in districts and towns.

We were given the challenge of training 600 hospitals across the state and the claims management team in 45 days. We delivered, deployed and got this program running paperless in record time. Star Health has chosen us as a technology partner for a period of 5 years among other short listed large IT players in India considering our technology capabilities, team strength and passion.

March 2010

29

@ 40 for a face-to-face consultation with a doctor, at least in the short-term. Having said that, the online healthcare services fill in a lot of missing links for a discerning consumer, who is seeking health information. The key is to personalize and ‘Indianize’ the content for the user. As long as one can give the right information to the user at the right time and in the right manner, the space would continue to grow.

Online health services offered Anand Anupam CEO, Healthizen

Perspective on the emerging online healthcare services space in India The fragmented state of the healthcare services in India today leaves a lot of room for innovation and a potential for aggregation from a patient’s perspective. The online medium offers an unmatched ubiquity and convenience for people with access to the medium. The broadband penetration in India has doubled in the last year and that is good news for the industry.

The patient today has a variety of choices and needs help in making his healthcare decisions. From purchasing a car to investing into a mutual fund, most of the research today is being done online and the shift is happening in the healthcare space, as well. There is a growing trend amongst users to come online to research a particular symptom, look for treatment options, compare pricing, and make their own healthcare decisions in general.

However, I don’t expect these services to be a substitute

healthcare services. People are logging on to online health portals for scheduling appointments with healthcare providers, consultations, treatments and availing advice on various health issues. Additional services offered by online health portals range from creating and maintaining personal health records to selling health insurance policies— the list of services is unlimited. The sheer convenience of such services is one of the major factors leading to the rising popularity of online healthcare in India. There has been a gradual change in mindset as even traditional healthcare providers are now moving towards offering services through the internet. Most experts also consider online health portals as a complementary tool

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March 2010

Our venture, Healthizen, is a personalized consumer healthcare platform which enables a user to store his/ her health and medical records online (www.healthizen. com), creates unique profiles based on these records, and then provides the individual with personalized healthcare solutions including recommendations, products, services, and interventions, if required. We provide services ranging from personalized diet and lifestyle consultation to home health checkups, second opinions from medical experts, and management of diseases and conditions to our consumers, based on their health profiles.

Involvement of stakeholders We also collaborate with healthcare providers including doctors, hospitals, diagnostic and pathology labs and pharmacies to provide electronic medical record (EMR) solutions to them, which take care of the pain-points end-to-end, including digitization of their records as well as patient relationship management (PRM).

While on one hand, this helps our consumers to aggregate their data into their health account from all these healthcare providers, on the other, it provides a

for consultation rather than an alternative.

Although healthcare needs still require visiting a doctor, it is still worthwhile to have minor issues sorted out virtually.

By enabling patients to videoconference with their physicians and allowing doctors to have immediate access to the patient’s medical record, online healthcare services can become a new

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conduit for exchange of health information. In addition to the various advantages it offers to the patients, online healthcare is also

@ 40 revenue upside for the healthcare providers since our users stick to them on account of availability of such services. It also helps our network of healthcare providers to provide additional services to their patients so as to increase customer satisfaction and loyalty.

We also help some of our partnering healthcare providers to take their service offerings online so as to reach a larger base of consumers at a cost that is much lower as compared to what they would have had to spend otherwise. This is a win-win situation for both, the consumer as well as the healthcare providers.

Business/revenue model and major clients Like I have mentioned before, our core services are free for the consumer. However, the consumer pays if he/she opts for our premium services ranging from personalized diet and lifestyle consultation to home health checkups, second opinions from medical experts, and the management of diseases and conditions, based on their health profiles. We have recently launched the Healthizen Store, where the consumer has access to healthcare and wellness products from the best brands in the country.

We work extensively with regional and national healthcare brands to help them structure consumer engagement programs for a targeted set of users. Since our platform understands the consumer profiles, it provides a very good RoI for these brands. Our users are similarly benefited since these products/services fulfil their health requirements and are happy to be a part of these programs.

We also provide patient therapy management programs to large pharmaceutical companies to help

beneficial for physicians as they can put in extra hours and make themselves available from their homes, as well. For insurance companies, the benefit lies in the fact that online healthcare is able to shift health delivery from the more expensive sites, the hospital or clinic, to a cheaper online option.

Key Issues Although the benefits are plenty, yet online healthcare is faced with certain issues that cannot be ignored.

Maintaining the confidentiality of the patient data and medical records and providing patients adequate assurance on this is one of the biggest issues. It is also essential to comply with all the government requirements and regulations before

them reach out to the doctors and patients with a disease management package as compared to only medication.

To maintain footprint We distinguish ourselves by personalizing the healthcare delivery for an individual based on his health profile, which no other player is doing currently. Also, we cover a gamut of services offered to the individual as compared to certain niches that a few players are individually tapping. As a consumer, it is a matter of convenience, assured quality, and cost-effectiveness, if I can satisfy all my healthcare needs at a single place. Imagine a doctor, hospital, diagnostic/pathology lab, gym, wellness centre, preventive care centre, pharmacy, and a health & wellness store all rolled into one – that is Healthizen for you! We are looking at expanding our geographical reach in India as well as exploring services on the mobile technology platform, which will help us to target users outside the internet-accessing population in India.

Legal and regulatory issues in online healthcare in India A key issue facing online healthcare services today is that the doctor cannot prescribe online, which limits the usage and effectiveness of an online doctor consultation facility. Also, confidentiality and privacy of the health data is one of the major concerns amongst patients and healthcare providers alike. At Healthizen, we realize this and have structured our offering as well as our policies to take care of this. We have well-defined access rights built in our framework, controlled by the patient for his medical records, and by the healthcare providers for the records that they have generated and stored. We use a Microsoft Secure Server for storing the data and have built in audit logs for access to the system.

plunging into the online healthcare space, although in India this might not have such a major impact owing to the lack of standards and regulations. A big hassle would be to protect online medical frauds to ensure the credibility and quality of care being offered. Medical frauds in total account for a loss of almost USD 60 billion a year.

To keep a check on this, President Barack Obama, in the USA, has increased the budget for combating medical frauds by 50 percent. While medical frauds or quacks exist even in the real medical space, preventing them to enter the virtual medical space will be even more difficult. In fact, as per a study, patients/endusers also avoid online information coming from an unknown source as

compared to information coming from a recognized authentic source.

Undisputed Growth As the demand for healthcare services increase tremendously surpassing the availability of trained resources, online healthcare is expected to have a bright future. In such a scenario, hospital and healthcare units throughout the world will shift their focus on making more effective use of their staff to enhance their services.

Online healthcare will prove to be an easy, safe and efficient option to achieve this. All in all, the coming years will be more dynamic as the healthcare industry prepares itself to take on the changes in the way health is delivered through adopting online models.

March 2010

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1

SPOTLIGHT @

40

“Today, corporate hospitals also recognise the utility of research” In a recent initiative, Fortis Healthcare announced its plan to focus on its academics and research programme with the objective of fostering and facilitating academics and clinical research enterprise across Fortis network of hospitals. Starting with cardiology, the company has appointed Fortis Escorts Heart Institute as the Site Management Organisation (SMO) to provide services for clinical trials in Cardiology that will be conducted across the Fortis hospitals under the exceptional leadership of Dr. Upendra Kaul.

PROF. (DR.) UPENDRA KAUL Executive Director Department of Cardiology & Dean – Department of Academics & Research Fortis Escorts Heart Institute & Research Centre

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March 2010

In an exclusive interview with eHEALTH, Dr. Upendra Kaul, Padamshree and recipient of Dr. BC Roy Award, and Executive Director Department of Cardiology & Dean – Department of Academics & Research Fortis Escorts Heart Institute & Research Centre, provided insight into the major activities of Fortis Healthcare in this domain and an overview of the global clinical research market.

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@ 40 There has been a recent surge in clinical research activities in India. Please tell us about Fortis Healthcare’s recent foray into academics and research and its plan for future activities.

I have dedicated several years of my life in teaching and research activities at the All India Institute of Medical Sciences, Delhi. After AIIMS, I worked with Batra Hospital, between 1997 and 2005, where also I was mainly involved in science and research activities. Post Batra Hospital, I joined Fortis Escorts Heart Institute & Research Centre.

After joining EHIRC, I realised that corporate hospitals also recognise the utility of research. Good health delivery is not possible unless you have good evidence-based medicine being practiced in the hospital along with some teaching programmes being offered. A good hospital should have teaching programmes and research activities carried out by people, who have an experience in this field and who can further train others.

Research not only means focuses on development of new molecules, but also involves improvement of patient care, thereby ensuring the provision of best quality care.

I believe, the best way to achieve this is to identify new products being developed as a result of R&D activities and to evaluate and compare them with the existing products in a scientific way. In this way, the judgment is done by a third party and not the researcher himself, whose decision may be biased. This requires an independent group of people, who can carry out these research activities.

In terms of academics, what courses are you offering and/or planning to offer?

To provide doctors with a regular certificate or prestigious degree, a college should be involved in formal teaching activities. Private hospitals, which are not universities, can offer courses accredited by the National Board of Examinations (NBE).

L-R: Dr. Narottam Puri: President – Medical Strategy & Quality, Fortis Healthcare Ltd., Mr. Bhavdeep Singh: Chief Executive Officer, Fortis Healthcare Ltd., Dr. Upendra Kaul: Executive Director & Dean – Department of Cardiology, Fortis Escorts Heart Institute and Research Centre and Mr. Daljit Singh: President - Strategy & Organizational Development, Fortis Healthcare Ltd. at the launch of Fortis Healthcare department for Academic & Research.

Further, the hospital must ensure that a good teaching curriculum, which is academics oriented and provides all information and facilities for education in the form of teaching courses, classes, libraries, faculty, discussions with the students, etc., is in place.

Our courses recognised by the NBE include courses in cardiology and fellowships in paediatric cardiology, cardiac surgery, critical medicine and electro-physiology. We have also built our own programmes by organising fellowships that are not attached with the NBE. We also have a department of clinical research, however research projects are not easy to get and perform as they involve a lot of legal intervention.

These include going to the ethics committee or permission for recruiting patients, who need to be well informed about the study. During the study, the coordinators have to keep coordinating with the patients on various activities. We already have ten coordinators to handle

these patients. Certain projects are multi-centric and require a large patient population so that statistics can be applied to them. Such projects also need constant examination to ensure the authenticity of the figures being recorded. External observers are also required for these projects, who can keep a check on various protocols being followed properly.

Such projects come from the DCGI. All Fortis Hospitals have a common external ethics committee.

We have an institutional review board that has a chairman who is not from the hospital. There is also a member from the teaching community. The basic idea is not only to evaluate the scientific content of the study, but also the ethical part of it. The team’s job is to see whether the hospital has adequate resources and manpower to carry out the project. Also, before the project is targeted, it has to be approved by an independent ethics committee, otherwise one can not get FDA sponsored projects. The federal government is very strict and ensures that there is not even an iota

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of error in the research. The ICMR and ethics committee must also follow the ICMR guidelines.

institutions do not comply to these guidelines and policies, they will be blacklisted.

The awareness level of patients in India is low. Do you see this as a challenge in terms of convincing patients to be a part of a clinical research activity?

How do you plan to take this initiative forward? Do you also have plans for tie-ups with other institutes?

Yes, this is a challenge because awareness level is low and despite of all methods being used for taking consent, it is very difficult to recruit patients. Patients have to sign a consent form that has different angles to it. Although there is a set of patients who agree to be a part of the research without giving it much thought, there are others who are just not ready to participate in it. The investigator, also, should be convinced that the drug being used in the research should not harm the patient.

On the other hand, the patient must be compliant and so that he can revisit the hospital as and when required. Compliance should at least be 90 percent, otherwise the research activity will not bear accurate results. Being a large population, theoretically, we feel that we can get larger number of patients as compared to European countries and this is the reason why the West is looking at India and China for clinical research activities. However, the processes have now become more complex owing to the policies laid by the ICMR and the DCGI. If the

We have research projects, which are being sponsored and taken care of by various pharmaceutical companies We follow our own protocols, through which we evaluate indigenous drugs.

If the product matches our level of expectation, then we should proudly use it instead of going for its more expensive foreign counterparts and also export it to other countries.

What will be the long-term benefits of this initiative for Fortis Healthcare as well as the healthcare community?

Such initiatives provide good opportunities to the hospital. If the research project is internationally acknowledged and its results are accepted by the international authorities, then it turns out beneficial for the drug manufacturer, as well. Further, by doing these projects facility centres get stateof-the-art drugs and equipment to support research activities. Also, global research projects are funded so the facility carrying out the research does not need to spend any money on it; even the patients for that matter are funded.

Please provide an overview of the clinical research market in India and

its growth potential. How does Fortis Healthcare plan to tap this growing market?

The scope of growth of clinical reserach market is immense.

Clinincal Research plays as an important driving factor in ensuring that the new drugs entering the market are safe and efficacious.

The figures of the year 2007 suggest that approximately 1.2 lakhs clinical trials were carried out in that year and around 10 million patients participated globally in these trials.

In 2010, approximately 12 million patients are expected to participate in clinical research activities and out of these 2 million patients will be from India. Considering that approximately 4000 drugs are developed every year, the scope for these researches is huge.

Utilizing the size and strength of its network hospitals, Fortis will conduct all phases of clinical trials.

Fortis will leverage the strength of its network, cutting edge diagnostic facilities, talent and pool of patient population to provide end-to-end solution for multicenter trials.

Considering that Fortis has standardized its Research protocols, the idea is to introduce new information, observational research concepts, and technical skills by bringing the latest state-of-the art diagnostic and treatment advances to physicians both within Fortis Group of Hospitals and the larger healthcare community.

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EVENT REPORT

Healthymagination Summit 2010 The Healthymagination summit organized by GE Healthcare on February 15, 2010 in New Delhi witnessed a panel discussion comprising of eminent panelists from the healthcare industry and the launch of GE’s latest product backed by high-end technology—the Vscan.

T

he summit kicked off with a panel discussion that comprised of eminent panelists from the healthcare industry including—Dr. Narottam Puri, President – Medical Strategy and Quality, Fortis Healthcare Limited; Daljit Singh, President – Strategy and Organisational Development, Fortis Healthcare Limited, Shivinder Mohan Singh, Managing Director, Fortis Healthcare Limited, Dr. Harsh Mahajan, Medical and Managing Director, Mahajan Imaging Pvt. Ltd.; Dr Amarjit Singh, Executive Director, Population Stabilization Fund, Government of India; and V Raja, President & CEO, GE Healthcare South Asia.

Moderated by Dr. Narottam Puri, the panel discussion focussed on the three A’s that can enhance and revolutionise the delivery of healthcare services-Accessibility, Affordability and Assurance.

The panelists discussed the various impediments towards growth of the health sector in India and the major bottlenecks that limit the delivery of topclass healthcare services to the masses.

The discussion was followed by the launch of the Vscan. The Vscan is a portable, battery-operated tool that houses powerful, ultrasmart ultrasound technology that provides clinicians with an immediate, non-invasive method to help secure visual information

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about what is happening inside the body.

Speaking at the summit, Mr. S Ganesh Prasad, Director Ultrasound Business, GE Healthcare South Asia, said, “technology inventions can play a critical part in bridging these huge gaps that is deterring a healthy India.

Healthcare in India is poised for new Vscan dimensions with the introduction of Vscan pocket visualization tool. We believe miniaturization – to help physicians go beyond of technology is the need of the what they can hear to what they hour for providing rapid access can see. Vscan may become as to advanced healthcare for more critical as a stethoscope to a people at reduced costs. Recently physician in helping to detect we designed miniaturized ECG disease more quickly. We believe systems in India to provide care Vscan can reduce the need for at the doorstep of people and more tests and referrals during today we have continued to move physical examinations and could make healthcare more accessible forward with Vscan” Further Mr. V Raja, President & to people in India.

Vscan naturally echoes our CEO, GE Healthcare South Asia, added “Vscan is a breakthrough healthymagination commitment innovation from GE Healthcare to bring high quality healthcare at and has the potential to redefine lower cost to more people around frontline healthcare practice and the world” With the capability of scanning patient management with its ability to give non-invasive, visual upto 30 patients with its one hour information of the inside body in battery back-up, the expected real time. Vscan is designed to be selling price of Vscan in India will complementary to the stethoscope be around Rs. 5.5 – 6 lakh.

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Business Intelligent Open Standards for Telemedicine Open Standards

Lieutenant Colonel Salil Garg Cardiologist, Command Hospital, Pune

Squadron Leader Mudit Mathur Indian Air Force

Open standards begin when a collaboration of interested parties’ results in a consensus on specifications for implementing common requirements.

They permit open access for anyone desiring to utilize the results in a way that enables conformity across implementations.

While open standards describe openness in both the standards setting process as well as access to the specifications, industry de facto and government-led standardization alternatives are less open. The choice to use open standards over the alternatives can improve one’s ability to realize common objectives.1 Standards have historically evolved from the codification of existing practices that had achieved market dominance.

Interoperability Standards in Healthcare Recently there was a diagnostic dilemma regarding the diagnosis in a poor patient. Somehow it was arranged to get the MRI of the heart free. However, when it came to reviewing images it was found that the CD and the DVD containing the images would not run on the cardiologist’s computer, in spite of it being a high-end machine. This example classically showcases the problems of lack of interoperability. Here, you have the resources and the will to provide cheap medical care, but are unable to do so due to the lack of ability of the various machines to relate with and read each other.

This happens every day and is a major limitation in the application of telemedicine and technology in the care of patients, besides being a poor business model as it will hence forth reduce the faith of doctors on an advanced technology, as its output is not compatible to his system and does not effectively aid him in diagnosis. This case opens up a new dimension in understanding the linkage between the need for not only advanced technology in diagnosis but also underlines the emphasis on interoperability and linkage with legacy systems.

The use of IT to electronically collect, store, retrieve, and transfer clinical, administrative, and financial health information has great potential to help improve the quality and efficiency of healthcare and is critical to improving the performance of the healthcare system globally.2 Key to making healthcare information electronically is interoperability i.e. ability to share that data among healthcare providers.

This capability is important because it allows patients’ electronic health information to move with them from provider to provider, regardless of where the information originated. The answer may lie in how applications are tied into the hardware, which the information resides upon, or how the hardware locks down the data in proprietary formats.

If we look at open standards, this may be the way forward. Storing attributes such as metadata and customer metadata as a

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mechanism to decouple data from the filing application releases the constraints on data sharing3. To achieve this we have to recognize the need for public and private sector collaboration to achieve a national interoperable health infrastructure. Aptly summarized

by Health IT4 the benefits of interoperability are: (a) Complete, accurate, and searchable health information, available at the point of diagnosis and care, allowing for more informed decision making to enhance the quality and reliability of health care delivery. (b) More efficient and convenient delivery of care, without having to wait for the exchange of records or paperwork and without requiring unnecessary or repetitive tests or procedures. (c) Earlier diagnosis and characterization of disease, with the potential to thereby improve outcomes and reduce costs. (d) Reductions in adverse events through an improved understanding of each patient’s particular medical history, potential for drug-drug interactions, or (eventually) enhanced understanding of a patient’s metabolism or even genetic profile and likelihood of a positive or potentially harmful response to a course of treatment. (e) Increased efficiencies related to administrative tasks, allowing for more interaction with and transfer of information to patients, caregivers, and clinical care coordinators, and monitoring of patient care.

Needs of Open Standards in Indian Healthcare Open standards help to consolidate competing standards, increasing the aggregate pool of resources available for using them without the cost inefficiencies of a single

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vendor de facto. For suppliers, this helps to consolidate a larger customer base. Instead of picking the portion of customers using the proprietary standards you are equipped to support, you can instead offer products and services to a larger consolidated base of users.

For users, this pools vendors together, increasing competition and price pressures, yielding better quantity and quality of vendor options. This also results in consolidated pools of people skills.

Instead of looking for specialists in the proprietary standard you use, you can choose among a larger base of consolidated specialists empowered to support

“Open standards help to consolidate competing standards, increasing the aggregate pool of resources available for using them without the cost inefficiencies of a single vendor de facto.” multiple vendors using the same open standard. By reducing costs, speeding time-to-market, and increasing market adoption and acceptance, products and services developed around open standards benefit from a higher return on investment.

They benefit from lower barriers to market entry created through decreased customer risk with vendor selection as the association of support and durability with the individual vendor is transferred instead to the pool of vendors supporting open standards. The keys can be summarized as 5 :

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(a) Optimize options (b) Reduced risk (c) Durability (d) Flexibility (e) Quality (f) Improve vendor independence (g) Increase vendor choice (h) Decrease vendor cost (i) Optimize interoperability (j) Simpler integration (k) Quicker integration (l) Encourage repeatable processes (m)Increase available resources (n) Optimize communication (o) Increase return on investment (p) Increase acceptance of products and services The standards for telemedicine are more multifaceted than other similar systems due to intrinsic complexities concerning numerous technologies with their own standards. Some of these technologies include: (a) Medical practices (b) Telecommunication (c) IT (d) Wireless (e) Documentation benchmarks (f) Imaging (g) Compression (h) Data structures (i) Video streaming standards.

The telemedicine standards must adhere to these standards, and simultaneously give space for a unique open standard business model of its own for sustenance.

Fairly strong Indian Standards made by Technical Working Group (TWG) are published in May 2003, these can be downloaded.6

Business Case for Tele-health The business case for tele health in study have been found around understanding goals and challenges, provide healthcare virtually anywhere, anytime. Focus is to deliver the right mix of consulting, system integration, and managed services to enable you to get the most

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from telemedicine solutions and align technology environment to specific objectives7. This will (a) Make specialist services more accessible (b) Control costs of patient (c) More closely monitor patient health, enabling more frequent or rapid intervention (d) Increase proficiencies through continued medical education and professional collaboration (e) Understanding the Less Tangible Benefits Business study needs to conduct a comprehensive analysis of the market potential for telemedicine services using existing media with identification of opportunities and threats and specific insight on the regulatory barriers, to achieve this (a) Review of telemedicine technology, applications and services. (b) Modeling of the telemedicine service value chain. The modeling of the end-to-end telemedicine services value chains by identification of the main actors and organizational structure of the services. (c) Market analysis.

The measurement of the market size and of the opportunities for existing and potential services. The analysis of the different scenario for roll-out of such services (d) Review of the regulatory aspects.

Recent Parallels US Federal agencies are now banding together to plan for how they are going to provide this information in an open, standardized manner that enables citizens to efficiently and accurately mine data, make comparisons, and perform analytics across all government sectors. In effect on the Jan 21, US formally recognized three new interoperability standards related to electronic health records,

personal health records and electronic quality monitoring. (a) IS04 Emergency Responder Electronic Health Record Version 1, which applies to accessing and sharing patient data in emergency care situations. These standards address how emergency responders access the electronic health records of patients involved in a mass incident such as a terrorist attack or natural disaster.

It describes how to obtain a person’s lifetime medical records, including a list of medical problems and history, and transmit that information to emergency responders without compromising security or privacy. (b) IS05 Consumer Empowerment and Access to Clinical Information via Portable Media Version 1, which applies to exchanging personal health record data between patients and providers through physical medial or secure e-mail exchange. These standards relates to how individuals access their own electronic health records and transmit them using a storage device such as a thumb drive or DVD. It establishes a standard level of encryption and requires password protection to call up the records. In addition, it develops an audit trail so users can track how many times a particular record has been downloaded. (c) IS06 Quality Version 1, which is designed to enable real-time or near real-time feedback to clinicians regarding quality indicators for patients (Government Health IT, 1/22).

These standards are aimed at researchers and public health organizations seeking to use medical records to track patient care and make sure health care providers are using best practices.

The Flip SideTo our mind integration of open source methodologies is an integral part in making medical services that are bound to involve the use of information technologies. This will help in making information gathering and dissemination seamless.

However, at the same time one cannot ignore the important aspects of confidentiality that the ISO’s seem to ignore.

An open source that can access the patient’s records is good news.

But how much should be available to the various authorities at what times and if at all remains a mute question? How much is too much?

For example, if an individual is not keen on disclosing his or her vasectomy details or hysterectomy details to a prospective employer, how is the system going to protect that.

Or this information pertinent to employability as say- an Office boy? In these scenarios it is the limitations that should design the system. For example the patient doctor relationship is sacrosanct and it is also protected by law.

Accessing ones own records is fine, but accessing the Doctors evaluation and his notes at the time should remain away from unnecessary scrutiny to assist in free and unhindered decision making. Similarly, the amount of information regarding a patient’s health that the doctor may be forced to divulge remains a sacrosanct covenant, that should be left alone as much as possible and only resorted to under extreme circumstances.

Final words Most people try to understand the standards world, through their understanding of Open Source, given the human mind’s compulsory need to apply known patterns to new ones. Companies adopting this philosophy along with the standards bodies will be the change agents in the

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Healthcare sector and help to improve access to information, which is vital to improving the quality of care. Not only that, it will help to create workflow efficiencies that reduce the cost of care but also for the consumption of products and services and the creation of internal solutions, using open standards can decrease your costs, speed timeto-market, expand available options and resources, improve communications, reduce risk and create more durable solutions.

Using open standards in the products and services you produce and internal applications directed towards such efforts offers these same benefits plus increased adoption and market acceptance of solutions and lower market barriers through decreased customer risk.

It also allows you to participate in

faster growing markets. However, the commercialization of the telemedicine services has not yet reached maturity.

A number of important issues such as absence of a specific regulatory framework, lack of common standards and norms etc. are still hindering the commercialization process of tele-medicine services. As a result, a potentially large Indian market has not yet fostered telemedicine as a new method of work. An important viewpoint that

involves the medical profession involves the increased approach to medical services in commercial terms. It is looked upon an as an emerging market, forgetting the moot point that it reduces every human being including us to the level of a commodity. Therefore at the end of it, it is not profiteering for the hospitals that counts, but the provision of medical care to lowest common denominator which means the poorest human being, at the cheapest rates possible.

References 1. “Business Case for Open Standards”; Erik Sliman; 2. “National Electronic Health Record Interoperability Chronology”; Military Medicine; May 2009; Hufnagel, Stephen P 3. “Interoperability Standards in Healthcare”; Mark Clark; Vox: The EMEA Blog 4. http://healthit.hhs.gov/portal/server.pt 5. http://www.openstandards.net/viewOSnet3C.jsp 6. www.mit.gov.in/telemedicine/Report%20of%20TWG%20on%20Telemed%20St andardisation.pdf; http://www.mit.gov.in/default.aspx?id=656; 7. ESA telemedicine casestudy.

Note: This work provides the overview of the field of telemedicine practices done by various experts and institutes. Author(s) take no claim in either designing the models or its concepts, however, direct integration of isolated works in the field of telemedicine practices has been done in this article. Suitable cross references are marked.

7th International Conference on e-Governance [ICEG 2010] IIM, Bangalore, April 22-24, 2010 http://www.iceg.net/2010 The 7th International Conference on e-Governance [ICEG-2010] is being held at the Indian Institute of Management Bangalore on April 22-24, 2010. The major themes of ICEG-2010 are: • Public Health & ICT • Micro Finance & ICT • e-Government and M-Government This Conference is unique because it brings together professionals from diverse disciplines such as Public Health, Micro-finance and e-Government on a common platform to share ideas, evolve strategies and showcase solutions for good governance using ICT and mobile technologies. Researchers, academics, practicing professionals from Industry, Health-care professionals, NGOs, bureaucrats and policy makers are all expected to contribute to this effort.

Details about ICEG-2010 are available at http://www.iceg.net/2010.

Contact: ICEG Secretariat <iceg.secretariat@iimb.ernet.in> Academic Partners: Indian Institute of Management Bangalore, St. John’s Research Institute Bangalore, Centre for International Health - University of Bergen (Norway), Indian Institute of Technology Delhi Collaborating Partners: Handheld Solutions & Research Labs (HANDSREL), Indian Association of Medical Informatics (IAMI), OpenXdata Consortium, CSI SIG-eGOV, Mobile Government Consortium International (mGCI) Corporate Partners: PercipEnz Technologies Inc., Microsoft Research (India) Bangalore

Media Partners

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NEWS REVIEW

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South Asia’s first Medical Technology park to make quality healthcare affordable in India Trivitron has set up the first medical technology park in the region to manufacture an indigenous line of products designed specifically for Indian markets. This is another feather in the cap of Tamil Nadu’s healthcare system which has been the leader in healthcare delivery in the country and the choicest destination for international medical tourism. M.K Stalin, the Deputy ChiefMinister of Tamil Nadu has said that it is imperative to implement such initiatives aggressively. The setting up of the park at Chennai is in line with the government of Tamil Nadu’s initiative of promoting Chennai as a manufacturing hub. The reputation of

Chennai as a medical tourism hotspot has made the city as the obvious choice for the technology park.

Its healthcare infrastructure, which includes among other things the clinical expertise on offer, has often come in for praise. What’s more, it has the added advantage of having an eastern seaport and a well-established airport.

acres and is so designed to house ten international medical technology manufacturers. The Trivitron Medical The park is spread over an area of 25 Technologies Park is an initiative of Trivitron Healthcare Private Ltd, one of the leading medical technology companies in India.

The park aims to bring cutting edge medical technology to medical professionals across the country at affordable costs. A range of products including Ultrasound systems, Colour Dopplers, X – ray machines, C-arms , in-vitro diagnostic reagents and instruments, cardiology diagnostic instruments, critical care instruments, modular operating theatres, operating theatre lights and tables and implantable medical devices will be manufactured at the park. It is expected that the manufacture of world-class medical devices within the country will bring down the overall healthcare costs dramatically.

Inaugurated Med-e-Tel is the Meeting place with a proven potential for Education, Networking and Business

by Dr. Prathap. C. Reddy, among a global audience of medical and care professionals, healthcare institutions, patient organisations, industry representatives, researchers, educators and government agencies.

Chairman, Apollo group of Hospitals, the Aloka Trivitron JOIN US AT THE 8TH ANNUAL MED-E-TEL IN LUXEMBOURG AND EXPAND YOUR GLOBAL TELEMEDICINE AND eHEALTH NETWORK! Medical Technologies facility is a joint venture between Aloka, a Japan based company credited with pioneering the diagnostic ultrasound technology globally and Trivitron. This Technology Park is a big step towards making quality healthcare available and affordable in India.

14-16 april 2010

Med Tel LUXEMBOURG

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Carestream Health India showcases Innovative Radiology Imaging Solutions at the 63rd IRIA 2010 Congress At the recent 63rd Indian IRIA 2010 Congress held at Ahmedabad, Carestream Health India showcased its latest digital imaging products and solutions which help healthcare providers improve quality and operational performance.

The company has announced stateof-the-art systems for the capture, processing, printing and storing of images for diagnostic applications.

According to Mr Prabir Chatterjee, Managing Director of Carestream Health India, the products are designed to make life easier for the radiology community. The radiology imaging solutions of Carestream increase efficiency and integration and back-up by its world class professional services group and bring total peace of mind. The radiologist gets to concentrate on patients, not problems. Mr Chatterjee emphasized that Carestream Health has evolved technologies that provide support to the needs of radiologist in the digital world of tomorrow, with paths forward that protect the radiologists investments today.

The centerpiece of Carestream Health’s product show at the IRIA was the DRX-1, world’s first cassette sized wireless digital DR detector, which fits in to existing systems.

An extremely cost-effective digital solution, the current X ray rooms can shift to digital radiography without a complete revamp of their existing system. The DRX-1 system delivers high-quality preview images in less than five seconds, which significantly improves productivity, even for users of computed radiography (CR) systems.

Being a wireless DR detector, the DRX-1 system provides flexible positioning that enhances both efficiency and patient comfort. Its extreme compact size and light weight further enhances convenience and throughput for radiology professionals.

The Carestream DRX-1 system is

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suitable for general radiology, trauma, orthopaedics and virtually all other xray exams.

Another product showcased at the Carestream Health booth was its latest innovation – the Carestream DryView5850 high-image quality Laser Imager – which brings tabletop convenience and outstanding reliability with extra-sharp 508 pixelsper-inch resolution that makes it ideal for medical imaging applications and digital mammography. The new DV5850 laser imager addresses the need for affordable laser-quality film output from full-field digital

mammography (FFDM) and CRbased mammography systems. With a simplified user panel and capability to change films in full room light, it is easy to operate. Moreover, the DryView technology does not use thermal print heads thereby requiring minimal maintenance. Carestream also demonstrated its product model CR Classic, Point-of-Care CR 360 and the DryView 6800 laser imager.

The extremely convenient Kodak Point-of-Care CR360 system enables even smaller healthcare facilities to provide best-in-class digital imaging diagnostics to patients. Being compact, robust and affordable, the CR360 is a lightweight system that can be mounted on tabletop, enabling instant diagnosis at the patient location. Kodak Point-ofCare CR360 system has a capacity to handle through put of over 60 plates per hour (1 per minute) and the option for high-resolution scanning modes,

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the technician is able to customize the output depending upon the type of examination/diagnostics needed.

The Point-of-Care CR 360 comes with DICOM 3.0 capabilities, making it seamlessly compatible with a broad variety of printers, modality equipment, RIS and PACS systems. Mr Prabir Chatterjee who has recently assumed office, said that the company will continue to introduce innovative new products and bring the latest technology to India as fast as possible.

It will provide scalable solutions that enable growth and connectivity and thus the expandability built into our products will lead to growth.

Carestream Health will also be flexible in communicating with customers to understand their needs and develop solutions that meet those needs.

Carestream Health, Inc. markets a broad portfolio of CR and DR systems that equips hospitals, outpatient imaging centers, orthopaedic practices and other healthcare providers with digital image capture for x-ray imaging studies. Carestream Health’s laser imagers range from desktop systems designed for imaging centers, small hospitals and clinics to fully featured units designed for high volume, multi-modality output at hospitals of all sizes. These imagers offer output from CR, DR, CT, MR, US, NM, and Digital Mammography and other grayscale imaging applications.

The company originated as a business unit within Eastman Kodak Company and brings from its former owner a proud history of innovation, more than 110 years’ experience in health imaging, and over 1,000 patents in digital and film imaging and information technology. As a result of its innovative product portfolio and broad global sales, service and distribution capabilities, products from Carestream Health can be found in approximately 90% of hospitals and dental practices around the world.

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Vaccine prevents TB in HIV patients A recent study shows that a new vaccine can prevent tuberculosis in people with HIV. Phase III trials of 2,000 HIV-infected people in Tanzania found that the mycobacterium vaccae (MV) vaccine reduced the rate of tuberculosis (TB) by 39 percent. The findings have been published in the on line journal called AIDS. TB is the most common cause of death among patients suffering with HIV. The results of the clinical trials are a significant milestone according to principal investigator Dr. Ford von Reyn, director of the Dar International Programs for the infectious disease and international health section at Dartmouth Medical School, in Hanover, N.H. The development of a new vaccine against tuberculosis is a major international health priority, especially for patients with HIV infection. The next step involves improving manufacturing methods so that sufficient quantities of the MV vaccine can be produced for further studies and possible use in patients. The researchers are of the view that people newly infected with HIV should be administered with MV vaccine before they begin taking antiretroviral drugs to fight HIV infection.

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Reduction of radiation dose needed in medical imaging The US Food and Drug Administration (FDA) has published a white paper on reducing the dose of radiation during imaging.

The FDA initiative promotes safe use of medical imaging devices, supports informed clinical decision making and offers measures to increase patient awareness. A radiation alert was issued when it was discovered that 206 patients who underwent CT perfusion studies in a hospital may have received 6 to 8 times more dose than what is necessary. Some patients suffer hair loss and reddening of the skin indicating high radiation doses. The Agency found out that the overexposures were more wide-spread. FDA has asserted that there must be appropriate justification for ordering and performing each procedure, and careful optimization of the radiation dose used.

Older version of allergy drugs may be dangerous for people Global Allergy and Asthma European Network (GA2LEN) and the European Academy of Allergy and Clinical Immunology (EAACI) have come up with a finding that the older generation of HI-antihistamines that are used as allergy medicines may be dangerous to peopleâ&#x20AC;&#x2122;s health. The report says the first-generation H1 antihistamines - the most common treatment for conditions such as allergic rhinitis - that are currently available as overthe-counter drugs in pharmacies, have been linked with numerous health and social problems. The older drugs come off worse as compared with the newer ones. They are linked with myriad problems such as poor sleep patterns, reduced work performance and learning ability, aviation, car and boating accidents caused by

drowsiness, and even death as a result of accidental overdose in children and infants, and suicides in teenagers and adults.

More than 30% of the EU and US population are users or potential users of H1 antihistamines. H1 antihistamines have been used for more than 50 years to treat allergies

including allergic rhinitis (inflammation of the nasal membranes, commonly known as hay fever), urticaria (hives) and atopic dermatitis (eczema).

They are usually categorised as first and second generation: the former have a more sedative effect leading to drowsiness, but this side effect is significantly reduced in the latter. An allergy is a powerful immune response to an antigen (allergen). Allergens themselves are often harmless substances and include dust mites, pollen or animal dander (small scales shed from animal or human skin or hair). Allergic reactions occur when some people have an exaggerated reaction to an allergen which causes responses ranging from mild (e.g. running eyes and nose) to serious (e.g. anaphylactic shock).

Clinigene deploys SAS Clinical Data Management solution to accelerate clinical research SAS, the leader in business analytics software and services has announced that Clinigene International Limited, a full-service Clinical Research Organization that partners with global pharmaceutical and biotechnology companies, has deployed SAS Clinical Data Management - PheedIt solution to accelerate clinical research. SAS PheedIt is a highly efficient, cost effective and easy-to-use clinical data management solution (CDMS). According to Mr. Manoj Yasodharan, Manager Clinical Data Management & Biostatistics, Clinigene International Ltd, SAS PheedIt provides a complete solution for clinical data management and analysis. SAS is a de facto standard in the Life Science industry for statistical analysis and clinical trial reporting. SAS Clinical Data Management solution incorporates powerful Electronic Data Capture (EDC) and data management features which provide a robust data entry portal integrated with ability to handle data transformation, data imports and exports, analysis and reporting. Mr. Sudipta K Sen, Regional Director South-East Asia, CEO & MD SAS India said that the wealth of expertise and extensive track record positions us well as a leader in this field. This yet another win for SAS ensures our commitment as a partner to help organizations make a clear impact on their business goals.SAS Clinical Data Management - PheedIT comes with its own data storage thereby eliminating need for separate database. This data storage is used by the SAS PheedIT report engine to generate reports, graphs and other visualizations, and can be easily used by internal or external statisticians.

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Technology preserves cerebral health A poor diet and sedentary lifestyle that frequently result in cardiovascular illness can also badly affect cerebral health.

And the problem can be further complicated because the symptoms can be mistaken. According to Dr. Charles Olivera, a neurologist with Yuma Clinic Neurological Associates, dizziness caused by a problem in the middle ear may resemble the dizziness that causes poor blood supply to the brain. Since in 2009, Olivera has been providing diagnoses of poor blood circulation in the brain with the use of advanced technology known as Transcranial Ultrasound.

Incidence of poor circulation to the brain increases, stemming from cardiac problems the patients originally suffered. More and more, people with coronary illness are presented with cerebral circulation problems. The problem can lead to a stroke and other grave consequences. As with the blood vessels and arteries in other parts of the body, those in the brain can become restricted and blocked, preventing the free flow of blood. And without sufficient blood, oxygenation in that area can be insufficient, leading to damage to the brain tissue. The propensity of heart disease, according to Olivera has made Hispanic community in Southern Florida among the most susceptible to poor blood flow to the brain and to stroke.

Dizziness and recurring headaches can be warning signs of an imminent stroke. Persons who are experiencing dizziness, weakness or recurring numbness should be examined, rather than wait for complications to set in.

Transcranial Ultrasound to measure the speed of cerebral blood flow in the patients is an effective technology in this case. The (technology) has the advantage of being diagnostic and not invasive. It doesn’t cause pain, it doesn’t require special preparation for the patient and it’s done in the doctor’s own office.

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Rheumatoid arthritis to be detected by simple blood test A simple blood test may soon be helpful in predicting rheumatoid arthritis even before symptoms arise according to researchers. Rheumatoid arthritis is a chronic autoimmune disease characterized by joint inflammation involving the synovial (lubricating fluid of the joints) tissue and eventually leading to destruction of cartilage and bone. A research team from University Hospital in Umea, Sweden, have identified several cytokines, cytokine-related factors, and chemokines that increase significantly prior to rheumatoid arthritis (RA) disease onset. Led by Dr Solbritt RantapaaDahlqvist, researchers sought to determine cytokines, cytokine-related factors, and chemokines are up-regulated prior to the development of rheumatoid arthritis.

Blood samples of 86 individuals were analysed before the appearance of symptoms of RA. The study showed blood samples obtained from individuals had elevated concentrations of proinflammatory cytokines, cytokinerelated factors, and chemokines, indicating immune system activation prior to any symptoms of joint involvement. The findings present an opportunity for better predicting the risk of developing RA and possibly preventing disease progression. An early and accurate diagnosis of RA is crucial. Studies have shown that people who receive early treatment for RA feel better sooner and more often, are more likely to lead an active life, and are less likely to experience the type of joint damage that leads to joint replacement.

30,000 bed capacity in Hrudalaya hospital in 5 years Narayana Hrudayalaya, the Bangalore-based heart care hospital, will increase its bed capacity to 30,000 in five years across all its hospitals across India. For this the hospital has earmarked a fund of INR 1,000 crores. This hospital chain performs the highest number of cardiac surgeries each day. It also plans to set up health cities in Mexico, Malaysia and Indonesia, along with local partners, according to its chairman Devi Prasad Shetty. He was speaking to the media after announcing the launch of the 500-bed Narayana Hrudayalaya Malla Reddy Hospital. The Malla Reddy Group of Institutes chairman C Malla Reddy said 500 beds would be added every year at the Hyderabad facility to reach a capacity of 5,000 beds.

1st International conference on transforming healthcare with information technology The First Conference on â&#x20AC;&#x153;Transforming Healthcare with IT- 2010â&#x20AC;? is going to be held from March 8-10 at the Intercontinental Eros, New Delhi.

The conference is going to be a comprehensive discussion on the adoption of Healthcare IT and industry best practices for enhanced operational efficiencies and patient care. The Conference is organized by Apollo Group along with its consortium partners CISCO, IBM and TCS.

are grappling with a deep and diverse set of healthcare challenges that cut across the spectrum. According to Ms Sangita Reddy, Executive Director Apollo Hospital Group and Advisor, this conference will address the literal healthcare jigsaw and examine how technology can be applied in different

The conference brings together policy makers, healthcare leaders and technologists from across the globe, on the same platform combining the synergies of healthcare IT and mobile technology to bring about a more connected healthcare ecosystem.

It will also address the innovations, infrastructure and information in the healthcare landscape that will proliferate, promote and propagate benefits of IT to healthcare administrators, providers and beneficiaries at the grass root level. Healthcare providers and policy makers across the globe

ways to facilitate communication in a highly collaborative and mobile environment like healthcare. The conference is a 3-day event, aimed at key healthcare decision makers, hospitals administrators, doctors, IT teams. The conference will comprise of key-notes, plenary sessions, workshops focusing on Delivery in Healthcare System, Prevention & Wellness / Consumer Centricity, Emerging Markets & Emerging Technologies, Connecting the Ecosystem, Infrastructure in Healthcare System and the impact of IT and Telecom

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convergence-driven transformational solutions. The Conference will also showcase demos of technologydriven transformational approaches and solutions. Working groups at the three day meet will deliberate on various key issues including uniform standards, need for national EMR etc.

Noted speakers at the conference include industry luminaries like Mr. Sam Pitroda, Nobel Laureate Archbishop Desmond Tutu, Mr. Som Mittal, Prof. Ricky Richardson, Dr Prathap C reddy, Mr. Anjan Bose, Baron Nigel Crisp, Mr. Baljit Singh Bedi, Mr. David K. Aylward and Mr. Marc Probst amongst over 50 national and international speakers.

Another highlight of this conference is the healthcare awards that are the first independently audited awards by KPMG. Award categories include HIS Xcellence Awards, EMR Xcellence Awards, Healthcare ICT product innovation, Healthcare ICT Champion of the Year, Best Website (Association) and Solution with Greatest Market Potential.

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Doctors for the village A two day workshop will be held in Delhi to discuss an alternative model for under-graduate medical education to create a cadre of rural doctors for the villages. The model, mooted by the Medical Council of India (MCI), is to tide over the shortage of trained manpower for rural health care. It envisages creation of manpower for health care services in the notified rural areas.

This is going to be a four year course including internship and has been titled as Bachelor of Rural Medicine and Surgery. It will be institutional in character, conducted through medical schools which will be tagged with government hospitals in the districts

where there are no medical colleges as of now. The Council president Ketan Desai addressing a press conference said the proposal would be discussed threadbare with 19 vice-chancellors of health sciences and deemed universities, deans and principals of all medical colleges, state health secretaries and directors of medical education, in addition to the officers of the Union Health and Family Welfare Ministry.

Philips and VU Medical Center have signed long term research agreement An agreement has been signed between Royal Philips Electronics and the VU University Medical Centre for conducting a joint research on new multi-modality imaging solutions aimed at improving the early detection and treatment of diseases such as cancer and neurological and cardiovascular diseases. By combining data from different imaging modalities to increase the visibility of structures of interest and by mapping biological processes such as metabolism onto these images, new multi-modality imaging solutions could help clinicians to determine the presence and extent of many diseases at an earlier stage.

It is expected that such solutions will contribute to more timely and more personalized treatments for patients and thereby improve treatment success rates. Both parties will work on the development and validation of next-generation medical imaging procedures, with projects focusing on nuclear imaging, especially Positron Emission Tomography (PET), and optical imaging techniques. For these modalities, the joint research projects will explore novel imaging agents (disease-specific contrast agents and tracers) and develop dedicated software for quantitative image analysis and user-friendly data presentation. Research programs for other imaging modalities are currently being prepared.

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EVENTS DAIRY

4 – 5 March 2010 Cost-Effective Healthcare Conference The Westin Kuala Lumpur, Malaysia The Westin Kuala Lumpur, Malaysia

14 – 16 April 2010 Med-e-Tel 2010 The International eHealth, Telemedicine and Health ICT Forum Luxembourg http://www.medetel.eu

4 – 6 May 2010 Qmedic Doha Exhibition Centre, Doha, Qatar http://www.conexqatar.com/qatarmedic/

26 – 26 May 2010 HIMSS AsiaPac 2010

6 – 8 August Medicall 2010 Chennai Trade Centre, Chennai www.medicall.in

22 – 24 April 2010 7th International Conference on e-Governance [ICEG 2010]

Beijing

Indian Institute of Management Bangalore, Bangalore

http://www.himssasiapac.org/expo10/

http://www.iceg.net/2010

15 – 18 June 2010 CommunicAsia 2010 Singapore Expo, Singapore http://www.communicasia.com/

4th March 2010 Secure IT 2010 The Claridges, New Delhi

16th March 2010 Healthcare Investment Summit 2010

http://www.eindia.net.in/2010/egov/

The Claridges, New Delhi

secure_it/index.asp

http://www.eindia.net.in/2010/ehealth/

9th April 2010 Higher education summit 2010

4 - 6 August 2010

23rd April 2010 Education Investment Summit2010

The Claridges, New Delhi http://www.eindia.net.in/2010/digitallearning/higher_education_summit/index.asp

Healthcare_investment_summit/index.asp

HICC, Hyderabad, India

The Claridges, New Delhi

http://www.eindia.net.in/2010/index.asp

http://www.eindia.net.in/2010/digitallearn-

16 April 2010 Power It 2010

ing/education_investment_summit/index.asp

30 April 2010, Healthcare Insurance Summit

The Claridges, New Delhi

New Delhi

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