The Needle of Diagnos tics: March 2011

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The Enterprise of Healthcare

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volume 6 / issue 03 / march 2011 ` 75 / US $10 / ISSN 0973-8959 / www.ehealthonline.org

Dr Om Manchanda CEO Dr Lal PathLabs

Dr Sumit Dutta

Vice President and General Manager Quest Diagnostics

Dr A Velumani CEO Thyrocare

Col M Masand CEO Jaslok Hospital

Bhargava DasGupta

MD and CEO ICICI Lombard General Insurance Company

Amod Kumar Project Director MNH Project IntraHealth

The Needle of Diagnostics

An account of the diagnostic laboratory industry in India

Health IT Special Issue

April 2011 Special focus on market dynamics, emerging trends and technologies, perspectives of industry and government experts, and product profiles of the leading health IT solutions in the Indian healthcare market.

KEY SEGMENTS • EHR, EMR and PHR

• CIS

• ICT in Health Insurance

• HIS and HMIS

• RIS and PACS

• mHealth

• LIS

• CDSS

• Telemedicine

For Advertising and Branding Opportunities Arpan DasGupta, arpan@elets.in; 91-9818644022 Rakesh Ranjan, rakesh@elets.in; 91-9958848386

contents

Volume 6 | Issue 03 | march 2011 | ISSN 0973-8959 www.ehealthonline.org

Cover story

The Needle of Diagnostics Dhirendra Pratap Singh

Perspective

In Focus

profile

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30

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nova medical center

Divya Chawla

“At Dr Lal PathLabs, service, qual ity and innovation is a way of life ” Dr Om Manchanda, CEO, Dr Lal PathLabs

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“IT applications serve as the backbone of our operations”

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“We are investing `20 crore on total laboratory automation”

Dr A Velumani, CEO, Thyrocare

Bhargav Dasgupta, MD and CEO, ICICI Lombard General Insurance Company

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“ICT is a vital tool for efficient delivery of healthcare services”

Amod Kumar Project Director – Maternal and Newborn Health Project (Manthan Project), IntraHealth

Dr Sumit Dutta, Vice President and General Manager, Quest Diagnostics

“claims servicing would continue to be a key area of focus”

Power Hospital

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Moolchand 34 Medcity

“jaslok is at the forefront of medical advances” Col M Masand, CEO, Jaslok Hospital

Tech Trends Modelling the Future 26

Dhirendra Pratap Singh

Special Report Baby steps 36 towards ‘health for all’

Dhirendra Pratap Singh

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Spotlight

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“TI’s semiconductor technology makes life healthier”

Rakesh Joshi, Business Development Manager, Texas Instruments India

event report

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“Medicall 2011 at Kolkata”

hospital ceo interview

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Pg. 08 Pg.

regular columns

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news review

knowledge for change

ov

INBOX My absolute favourite periodical has to be eHEALTH, a publication put out by CSDMS in India. It provides fascinating perspectives on ehealth initiatives in both developed and developing worlds. In this regard it is one of the few publications that provides for a truly global picture of what is happening in ehealth.

By Trevor Hodge, Senior Vice President, Investment Strategy and Alliances, Canada Health Infoway

managers of the electronic data stores. But, looking at the current state of corruption and lack of individual accountability, avoiding mis-appropriation and misuse of such medical/health records is going to be the greatest challenge. I am indeed an optimist!

By Ravi Goyal on the article ‘EHR and EMR in India: Fantasy or Reality’

Thanks for coming up with great cover story... It really tells us that the healthcare sector is finally focusing on the backbone i.e.

IT for ‘Service Differentiation’ to become market leader.

By Prabhat Kumar on the article ‘MAXimising Benefits’

Thanks for an interesting story. In general everyone talks, cares, designs and reviews tertiary healthcare. Ambulatory healthcare is a good initiative for grass-root level delivery system of essential primary care with upgraded facilities.

By Dr Vidhutalai on the article ‘Innovative Healthcare Architecture and Modern Facility Design’

Implementing EMR is most important thing to do to facilitate healthcare services research and improve quality of medical care in India. No doubts it is achievable. However, one real question comes as how the government or responsible agencies would secure private patient information. This would entail dedicated accountability of every stakeholder in the healthcare- physicians to the pharmacists and to the nurses; not to exclude the data entry personnel and

The type of programmes that are being done by IGNOU are exemplary in the sense that they promote quality improvement in both undergraduate and post graduate medical education ,particularly in the field of medical teachers.

By Sarvepalli Vijaya Kumar on the interview ‘Technologyenabled programmes are crucial for continuing medical education’’

In the Right

Network

magazine reaches to all hospitals in the network of all major health insurers

For advertising opportunities: Arpan DasGupta, 9818644022, arpan@elets.in Rakesh Ranjan, 9958848386, rakesh@elets.in

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> www.ehealthonline.org > March 2011

editorial

Volume 6 | Issue 3 | march 2011 www.ehealthonline.org

A new day, a new way March 2011 began with a happy note with Finance Minister, Pranab Mukherjee’s decision to allocate `26,760 crore, for the healthcare sector, in the union budget 2011-12. This marked a 20 percent rise in the budgetary allocation for health over last year, which implies greater attention being given to the health sector by the government.

Further, the budget demanded the extension of the Rashtriya Swasthya Bima Yojana to include MGNREGA beneficiaries and beedi workers.

However, the move to bring health check-ups and 25-plus bedded AC hospitals under the service tax net has hurt the health industry, as such. eHEALTH covers a special report on the union budget 2011-12’s allocations for healthcare in this issue that provides an in-depth analysis of the pros and cons of the budget.

President: Dr. M P Narayanan Editor-in-Chief: Dr. Ravi Gupta Editorial Team: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Divya Chawla, Sheena Joseph, Pratap Vikram Singh, Dhirendra Pratap Singh Sales & Marketing Team: Debabrata Ray, Arpan Dasgupta (Mobile: +91-9818644022), Bharat Kumar Jaiswal, Jyoti Lekhi, Fahimul Haque, Rakesh Ranjan (sales@elets.in) Subscription & Circulation: Gunjan Singh Mobile: 9718289123 (subscription@elets.in) 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 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 ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.

The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided.

New age diagnostics is defined by high-end laboratory and diagnostic testing. The Indian diagnostics market is at the brink of a revolution now, which is being driven by the organised sector. The sector has worked hard to conquer its share of the market. Lack of awareness and demand for high-end diagnostics and price-sensitivity have been the major bottlenecks for the growth of the organised sector. The industry predicts a growth rate of 50 percent for this sector over the next ten years, which implies a larger market presence for these laboratories.

In this issue, we bring you a cover story on diagnostic laboratories in India with key focus on the organised sector. The story reveals that the emergence of the organised sector is probably the most persistent trend in the diagnostic industry today.

Talking about the emerging trends in the overall healthcare sector, implementation of IT in health is one of most crucial transformations.

RIS and PACS have become a mandate for the radiology departments of today. Further to its importance in the radiology department, emergence of high-end modalities in cardiology and oncology requires archiving and post-processing of images, where implementation of PACS is becoming critical. As more hospitals aim towards a paperless environment, the demand for PACS solutions will rise, which in turn will push the demand for RIS. The Indian PACS market is currently estimated at US $5.5-6 Million and is expected to grow at a compound annual growth rate of 27 percent from 2007 – 2011. Read more in this issue’s tech trends.

ehealth 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 © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org

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cover story

The Needle of Diagnostics Powered by technology, dominated by corporates and driven by new-age consumers, the diagnostic laboratory market in India has taken a giant leap forward

By Dhirendra Pratap Singh

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n the US, about 20 years back, there were at least 30 thousands laboratories, but today there are 4-5 major chains of organised laboratories, which constitute around 30 percent of the total market of pathological testing. Now the Indian market dynamics is also changing drastically the way US did.

With more than 3000 labs and 85 percent

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of the total market share currently, the unorganised laboratories are growing at the rate of 10-15 percent, while the organised corporate chains having less than 15 percent share of the total market are growing at a much faster rate at 25-30 percent, annually.

Today, in India more than 25,000 clinical laboratories carry out around 11

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lakh tests daily. These range from routine examinations of blood sugar and cholesterol levels to complicated hormonal assays and immunological investigations.

The growing middle class population, coupled with rising demand for affordable health insurance for an ageing population, is expected to translate into an exponential growth driver for diagnostic laboratories.

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cover story The International Diabetes Federation estimates that the number of diabetic patients in India has more than doubled from 19 million in 1995 to over 41 million now.

Cardiovascular diseases (CVD), cancer and stroke account for 53 percent of all deaths and 44 percent of disability-adjusted life years. Thus, the Indian population is graduating from cheaper to treat ‘infectious diseases’ to the more complex and expensive ‘lifestyle diseases’ which require greater diagnostic and therapy interventions. Lifestyle diseases are set to assume a greater share of the healthcare market.

The laboratory plays a central role in healthcare. By one estimate, 70 percent of all medical decisions are based on laboratory results. And now all the laboratories strive to use the latest in technology. However, technology is a mean to an end and not the end in itself. Optimising performance means that workflow and technology are integrated to yield an operation that best meets the clinical needs and financial goals of the organisation. High quality at low cost is another concern. Updates in technology must lower capital and operating costs and also improve turnaround time.

Market The fast growing diagnostic sector opens several avenues for partnership between the Indian and International diagnostic companies. There is huge potential in the clinical research and trials market by combining the unique strengths of Indian and US companies, US companies are the leader in pharmaceuticals and biologics research and development.

Indian companies can leverage their extensive expertise in life sciences, the large number of CAP accredited labs in India and the huge patient base to collaborate with US companies in organising large scale and complex clinical trials at low costs. There is good potential to develop training and accreditation programmes for the Indian market. There is a need to design cheap, high quality equipment for Indian markets and device creative financing options and low cost, effective solutions for the Indian market.

Do You Know?

Life expectancy has shot up in India, from 23 at the turn of the 20th century to 65 years, while death rates have come down—from 25 per thousand to eight.

The Indian healthcare market is on an unprecedented high at 16 per cent year on year. From ` 1, 02,600 crore in 2005, it now clocks `2, 00,000 crore and is projected to reach ` 3, 00,000 crore by 2012.

The healthcare industry employs over four million people, making it one of the largest service industries in the economy, reports a study by ASSOCHAM and Yes Bank.

The Indian population is graduating from cheaper to treat infectious diseases to more complex and expensive lifestyle diseases, which require greater diagnostic and therapy interventions Unorganised Sector in India Major branded players in the Indian diagnostics market are Super Religare Laboratories, Dr Lal Pathlabs, Quest Diagnostics, Thyrocare and Metropolis. Super Religare Laboratories is servicing nearly 1550 hospitals/path labs along with its subsidiary Piramal Diagnostic Services Private Limited, offering a comprehensive range of over 3,300 diagnostic tests, from the routine to the highly specialised tests.

Dr Lal Pathlabs has 65 laboratories at present in India and it is looking to add another 35 this year. The company has decided to invest `150 crore this year on acquisitions in India and abroad. The company is also looking to acquire in Middle East, Bangladesh, Sri Lanka and other South Asian nations.

Quest Diagnostics has operations in the US, India, UK, Brazil, Puerto Rico, Mexico and Ireland, it is a Fortune 500 company.

In India, it has set up facility in Gurgaon, Haryana. It has recently launched a wide array of testing for diagnosing and monitoring blood cancer in India.

Thyrocare is one among the top laboratory brands in India. It is moving at 40 percent annually. Another major player Metropolis has created an Indian Associa-

tion of Pathology Labs in view to represent the industry to the government under the umbrella structure of CII (Confederation of Indian Industry). The company has been into the process of promoting three more tests viz. He4 (Ovarian Marker – Gynecological), Hair DX (Genetic hair loss – Dermatological), DNA paternity test, for the Indian citizens.

Opportunities and Challenges Indian healthcare market is large but still fragmented and underserved. India is one of fastest growing and strongest global economies with about 8 percent growth rate. Our nation has 17 percent

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cover story

Facts that count In India, out of the 60,000 laboratories where testing is done, only 200 are accredited and only 1000 are worth being called as laboratories. By the year 2020, at least 60 percent of in-vitro business will become organised since, though slow, things are moving in right direction.

Unorganised laboratories are growing at the rate of 10 – 15 percent, while the organised corporate chains having less than 10% share of the total market are growing in a much faster rate at 25 – 30 percent, annually.

As on date only 10 percent is organised and though it has taken 40 years to move to 10 percent, this is likely to grow to 50 percent in just next 10 years.

The growing middle-class also recognises the value of pathology testing and is willing to pay for these tests.

This is reflected in the over 20 percent CAGR in the last five years in India’s diagnostics industry.

The diagnostics industry is highly fragmented with the largest players account for less than 15 percent of the total diagnostics market.

Experience has confirmed that full automation is a very gradual step towards efficiency in laboratory work and lab automation still continues to evolve. The drive or thrust for smaller, faster, and more-accessible devices is increasing.

Emerging markets have different needs with respect to the test menus, technologies used and operating procedures.

Thus, made-to-order solutions need to be developed for these markets.

Lab automation has also taken on a new level of importance in the ability to actually get instruments interfaced to various laboratory information systems (LIS).

Information technology has taken a giant leap in the IVD industry, thereby reducing

The diagnostic services in India are highly fragmented and unorganised. There is uneven penetration of services with greater concentration in South and West India and scarcity in North-East of the world’s population but poorest healthcare infrastructures among growing economies and healthcare accounts for only near 5 percent of GDP. Also, the diagnostic services in India are highly fragmented and unorganised. There is uneven penetration of services with greater concentration in South India and West India and scarcity in North-East.

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the dependence on a technically qualified individual to be present at all times during the analytical procedure without compromising on established levels of care.

In recent years, the workload on laboratory personnel has increased two to two-and-a-half times. An increase in the capacity and directions of laboratory investigations should be reflected in the quality

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of the work, or in the accuracy and reliability of the acquired data. But this is possible only when laboratories are equipped with modern technology, permitting a sharp rise in production and in the reliability of investigation results. Delivering the right data in a timely and cost effective manner while improving the sensitivity and specificity of the test is the need of the hour and the industry needs to gear up for single workstations that can carry multiple workloads.

Besides, in our country there is no regulation by the government to ensure the quality and authenticity of the pathological labs. Therefore, there is high risk of improper diagnosis by the doctors who bank upon the pathological tests’ results.

In US there is CAP (College of American Pathologies), which is one of the expensive accreditations in the world and all the laboratories abide by the accreditation.

But in India, we are still awaiting a set of regulations, and as such currently we are bound to set our own standard to match up to the quality. We have also created an Indian Association of Pathology Labs in view to represent the industry to the government under the umbrella structure of CII (Confederation of Indian Industry).

Technology has stepped in to play facilitator to improve healthcare delivery.

Issues such as systematised capture, storage and sharing of patient information, allowing faster but error free operations are now achievable. The new buzz in the air raises new hopes. Fingers crossed.

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Perspective

“At Dr Lal PathLabs, service, quality and innovation is a way of life” As the CEO of Dr Lal Path Labs, Dr Om Manchanda has been instrumental in driving the business as well as quality operations of the laboratory. Today, LPL has a strong laboratory network in more than 500 cities serving more than three million patients every year across India In conversation with eHEALTH, Dr Om Manchanda, shares insights into the current industry scenario of diagnostic laboratories in India and Dr Lal Path Labs’ presence in this space

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Perspective What is your outlook on the diagnostic industry in India? What are the key opportunities and challenges?

The Indian diagnostics market is currently valued at about `8000 crore. The market is fragmented and unorganised.

The organised sector is about `1000 crore growing at 20 percent per annum.

All the macro factors like rising per capita income and growing healthcare awareness are contributing to this growth.

The growth in diagnostics is higher than the growth in overall healthcare industry.

This is primarily because around 70 percent of the medical decisions are based on diagnostics. There is a rising trend towards evidence based medicine.

The key challenges are lack of quality regulation in this space. Today, one does not need any registration or certification of lab testing instruments/processes to start a lab. This has led to proliferation of smaller labs. Many of these labs fall short on quality standards. The second challenge is the market practices adopted by some of the players. The real opportunity in the space is to aggregate and create an organised branded player.

Please provide a brief background of Dr Lal PathLabs and its reach in India and overseas?

Dr Lal PathLabs is India’s leading and most reputed diagnostics chain. Established in 1949, today, the brand has reached the entire length and breadth of India. We have over 60 labs, 1000 centers, and we are present in 500 cities. We serve over 6 million patients every year.We have recently launched Asia’s largest diagnostics laboratory at Rohini, New Delhi. We also receive patient samples for testing from international markets like Nepal, Bangladesh, Sri Lanka, UAE, Saudi Arabia, etc.

Which are the major areas that Dr Lal PathLabs is focusing on in the diagnostics segment?

We are focusing on high-end tests, where the testing is centralised. The focus in this category of tests is on Molecular Diagnos-

The key challenge is lack of quality regulation in this space. Today, one does not need any certification of lab testing instruments/processes to start a lab tics and the promotion is through doctors.

We promote Direct to Consumer –through health camps. We also have an exclusive insurance and corporate segment.

What is the level and nature of IT applications in your laboratories?

How is it adding value to your business efficiency?

IT is at the centre of business operations both at front as well as back end. At front end, patients can download the reports from the web. At back end, all the instruments are bi directionally interfaced with Lab Information Systems thereby providing completely automated operation. It adds value in terms of providing better control in operations and enhanced customer service levels to the patients.

What is the share of organised and unorganised laboratories in the diagnostic sector? What is the market share that Dr Lal PathLabs plans to garner in the next 2 years?

The organised segment contributes around 13-15 percent of the market. Dr Lal Pathlabs currently has about 25 percent of the value share of this market. We plan to take this upto 30 percent value share in next 3 years.

What is the role of accreditation and regulations in the diagnostic sector in India? Please share your perspective on the role of information and communication technologies in these services.

There is no mandatory requirement from government and there is no regulation in this industry. Diagnostics is a very technical and precision oriented business, which needs trained hands and minds that are experts and qualified in this area.

Dr Lal PathLabs is the most accredited lab

operation in India, which boasts of the best talent in India in pathology/IT and overall in all areas of its business.

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

We built Rohini as Asia’s largest and most technologically advanced pathlab. This lab has the most advanced infrastructure in India. We invest significant amount of resources in research and development.

Our plan is to introduce some other ground breaking IT systems over and above already advanced systems. At Dr Lal PathLabs, service, quality and innovation is a way of life.

What are the investments that Dr Lal PathLabs is making and what type of benefits you want to achieve with these steps?

We are investing in customer service by making things suited to what customer wants, an outside-inside focus. Customer centrality is basis of our business strategy.

We also want to increase the speed, from sample collection to report delivery. The third most important area is convenience – how to make the service delivery convenient to patients and doctors.

What is the future growth model of the company? What are the new test facilities Dr Lal PathLabs is bringing in?

So far, we have grown organically in this market. The next phase of growth will be based on two pronged strategy of Organic as well as Inorganic route. The business is going to give very sharp focus to newer segments like Hospital Lab Management, Clinical Trials, and Public Private Partnerships (PPP).

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Perspective

“IT applications serve as the backbone of our operations”

As the Vice President and General Manager of Quest Diagnostics, Dr Sumit Dutta is responsible for creating an environment of quality, integrity and success for patients, customers and employees.

Today, Quest Diagnostics is one of the largest pathology laboratories in the world.

In conversation with eHEALTH, Dr Dutta shared insights into the current industry scenario of diagnostic laboratories in India and Quest’s presence in this space

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What is your outlook on the diagnostic industry in India?

At Quest Diagnostics, we are very positive about the opportunities for high quality diagnostic testing in India. While India is getting richer with 8.5 percent GDP growth, many in India are getting sicker. For example, India has the most number of diabetes patients in the world and is labeled as the world’s ‘Diabetes Capital’. Other lifestyle-diseases such as cardiovascular disease and obesity are growing rapidly even among the younger population.

India is burdened with various types of cancers and infectious diseases. It contributes over 132,000 cases of the estimated 500,000 cervical cancer cases globally per year, representing more than one-fourth of the world’s cervical cancer cases.

The role of diagnostics in addressing rapidly growing diseases is significant and local healthcare providers have increased their reliance on diagnostic testing to make the best decisions for their patients. The growing middle-class also recognises the value of pathology testing and is willing to pay for these tests. This is reflected in the over 20 percent CAGR in the last five years in India’s diagnostics industry.

In terms of challenges, the diagnostics industry is highly fragmented with an estimated 40,000 to 100,000 diagnostic centers around the country and currently no government regulation to ensure quality and standards. The largest players account for less than 15 percent of the total diagnostics market.

Please provide a brief background of Quest Diagnostics and its reach in India and overseas?

As the largest pathology laboratory in the world with over `31,500 crores (US $7.4 billion) in revenues, Quest Diagnostics employs over 900 medical doctors and PhDs, the largest medical and scientific staff in the industry.

Globally, Quest Diagnostics performs testing on behalf of more than 500,000 (five lakh) patients every day. With operations in the US, India, UK, Brazil, Puerto Rico, Mexico and Ireland, we are a Fortune 500 company that has pioneered many innovative diagnostic tests as well as advanced healthcare information technology solutions to help improve patient care.

In India, we have set up a state-of-the-art 65,000 square foot facility in Gurgaon, Haryana that deploys cutting edge technology, processes and quality standards to ensure bringing global best practices and the latest innovations to patients in India.

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Perspective

Dr Sumit Dutta Vice President and General Manager, Quest Di­agnostics

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Which are the major areas that Quest Diagnostics is focusing on in the diagnostics segment?

Quest Diagnostics performs around 4500 test globally and around 700-800 tests in India. We serve the high-end testing needs for hospitals and offer a full testing service for physician offices. Initially, we focused on Women’s Health from menarche to post-menopausal women, covering prenatal screening, hormonal testing, cervical cancer screening, arthritis testing etc. We were the first to introduce tests like Quadscreen to determine the risk of delivering a child with Down Syndrome, Trisomy 18, or Neural Tube Defects in the second trimester of pregnancy, and Liquid based Cytology for screening cervical cancer.

We also conduct High Risk HPV Test (Cervista), HPV Genotype 16 & 18.

Quest Diagnostics is the world’s largest cancer diagnostics company, and we recently launched a wide array of testing for diagnosing and monitoring blood cancer in India. We are in the process of making our 600+ Medical Experts with organ-focused board certification and fellowships available to offer diagnosis to patients in India. We offer pre-employment and wellness testing for large Indian companies and multi-national organisations.

Consumers can have testing performed directly with Quest Diagnostics.

Leumeta is one example of pioneering innovation by Quest Diagnostics jointly with The University of Texas MD Anderson Cancer Center to develop a less invasive, and at times more sensitive, blood test for diagnosing leukemia/lymphoma and other cancers, without a need for painful extraction of bone marrow cells with a large-bore needle through the hipbone. Another recent offering from Quest Diagnostics in India is the Hain’s Test, a new improved molecular test for multidrug-resistant tuberculosis (MDRTB), in which the results are available within just a day of testing as compared to 14-42 days with conventional methodology. In addition, Quest Diagnostics has been supporting the clinical trials needs for leading pharmaceutical, biotechnol-

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Perspective ogy and academic institutions for decades.

We perform over 3 million clinical trials tests globally each year. We have brought Quest Diagnostics’ clinical trials capabilities to our laboratory in India in order to serve the needs of the growing clinical trials market being performed in India.

What is the level and nature of IT applications in your laboratories?

How is it adding value to your business efficiency?

IT applications serve as the backbone of our operations and are involved in every step of the way—from tracking the samples via barcode, which ensures that specimens are tied to patients correctly through the entire process, to performing statistical quality control on results and delivering results securely to our customers. Without sophisticated IT applications, preserving patient privacy and delivering accurate results can be challenging.

Quest Diagnostics is a pioneer in health information technology (HIT), and we are a leading provider of technologies that are at the center of the emerging digital healthcare infrastructure. In the United States, more than 165,000 (1.65 lakh) doctors use Care360 technology platform to order lab tests, prescribe drugs, and record and share clinical information such as lab results, medication history, patient problems, and allergies, with other healthcare providers.

As physicians in India begin to adopt information technology to record patient visits, communicate with other physicians, order diagnostic testing and prescribe medications, we will be able to introduce our established platform to the India market.

This year we are making our 600+ US based MDs with organ-focused board certification and fellowships in cancer diagnosis available to render expert opinion/ diagnosis to cancer patients in India using Digital Pathology. With Digital Pathology, traditional glass slides are converted into digital images that can be viewed, managed, and analysed from anywhere at any time over high speed networks. In this way, pathologists that specialise in a particular type of cancer can provide an

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Quest Diagnostics’ recent IT investments include Gazelle, a new personal mobile health platform that empowers patients to see, store and share their medical information, and to take control of their health anywhere, anytime opinion from anywhere the expertise exists, eliminating geographical boundaries and enhancing global collaboration.

Our focus on patients combined with the Indian consumers comfort using technology, encouraged us to offer tailored packages for monitoring key diseases such as diabetes and cardiovascular via quest4health.com, an interactive consumer portal. Our website empowers customers to learn about diagnostic testing, order tests packages, receive consumer-friendly reports, and store results.

What is the average technology spend in your company and which areas have you prioritised for future technology investments?

Being the world largest pathology laboratory with a relentless focus on innovation and better patient care, we make significant investments in information technology and developing innovative applications. Quest Diagnostics’ recent IT investments include Gazelle, a new personal mobile health platform that empowers patients to see, store and share their medical information, and to take control of their health anywhere, anytime. With Gazelle, patients can directly receive their lab results on their Smartphone. It also enables patients to conveniently share vital health information with any healthcare provider. In India too, we prioritize our technology investment based on its ability to help/empower people; given that smart phone use is increasing, we are working on bringing capabilities like Gazelle to India.

What is the share of organised and unorganised laboratories in the diagnostic sector? What

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is the market share that Quest Diagnostics plans to garner in the next 2 years?

Quest Diagnostics, along with a few other laboratories and the Confederation of Indian Industry (CII), supports the requirement of accreditation and better standards for our industry. Our laboratory in India holds the same high standards as any of Quest Diagnostics’ other laboratories around world.

Nearly 80-90 percent of the diagnostic care market in India is highly unorganised and fragmented; the vast majority of these laboratories do not maintain accreditation such as The National Accreditation Board of Laboratories (NABL) or the College of American Pathologists (CAP) certification, which we maintain. We witnessed strong growth in our business in India in 2010, and expect this to continue.

What is the future growth model of the company?

Our growth model is based on serving patients, physicians, companies and hospitals with quality, innovation and outstanding service. We will relentlessly focus on quality and continue to bring new technology like digital pathology to India to drive growth.

Quest Diagnostics is committed to India and serving the diagnostic needs of its people. In 2010, we received approval as a diagnostic laboratory for the Central Government Health Scheme (CGHS) providing access to central government’s employees and retirees to Quest Diagnostics high quality testing. In 2011 and beyond, we will continue to partner with the government and private sectors to provide Indians with access to the latest innovations in the diagnostics industry.

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Perspective

A former scientist at the Bhabha Atomic Research Centre (BARC) with a focus on Thyroid research, Dr A Velumani, started Thyrocare Technologies with the objective of testing blood samples for Thyroid in 1996. Today, Thyrocare, is among the top laboratory brands in the country.

In conversation with eHealth, Dr Velumani shares his perspectives on the clinical laboratory business in India and Thyrocare’s stint in this very dynamic market

“We are investing `20 crore on total laboratory automation” 18

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Perspective What is your outlook on the diagnostic industry in India?

Diagnostics is widely classified into invitro business and in-vivo business. These sectors are almost equal in size in terms of turnovers and are growing at a 20 percent growth rate year over year. Consolidation is sensed in the in-vitro segment, where the unorganised laboratories account for around 90 percent of the business. Out of the 60,000 laboratories, where testing is done, only 200 are accredited and 1,000 are worth being termed as laboratories.

By the year 2020, at least 60 percent of in-vitro business will become organised since, though slow, things are moving in right direction.

Please provide a brief background of Thyrocare and its reach in India and overseas?

Thyrocare is among the top five laboratory brands in the country. It is different from the rest as it has managed to tame logistics in such a way that a single laboratory caters to the needs of the entire country.

Its focus, logistics, IT prowess, business model and costing model are different from the conventional pathology laboratory model. We do not do any overseas business as of now, while in India, we are present in 90 percent of towns with population of more than 1 lakh.

Which are the major areas that Thyrocare is focusing on in the diagnostics segment?

We do not do blood sugar testing, which means that we do not do what every laboratory does. Thus we focus on immunoassays largely and wellness profiles as specialisation. We have focus on tests and technologies that require higher-end automations and analyser-based testing, which can be scaled-up easily. We process, in a day, around 1,00,000 investigations, out of which 99,900 are analyserbased (bar-coded and bi-directionally interfaced) reporting.

What is the level and nature of IT applications in your laboratories?

Having accreditation is not helping adequately since common man or even medical doctors are not tuned towards the importance of accreditation How is it adding value to your business efficiency?

We call it a business of ‘front-end laboratory’ and ‘back-end IT’. We are IT focused from the day we started the business.

Our website booking and web server operations are as old as 15 days and oldest in this industry. We have an in-house software called ‘Thyrosoft, which takes care of all our IT needs including controlling, monitoring and enhancing the productivity of network, laboratory and staff.

What is the share of organised and unorganised laboratories in the diagnostic sector? What is the market share that Thyrocare plans to garner in the next 2 years?

As on date, the unorganised sector’s share is only 10 percent. Although, it took the sector almost 40 years to acquire this 10 percent share, yet, it is likely to grow to 50 percent in just next 10 years. Growing awareness on quality and brand puts the unorganised laboratory at check and thus allows the organised sector to move faster. Though the industry is growing 20 percent annually, the organised players are growing at 30 percent annually and Thyrocare is growing at 40 percent annually, which implies that market share of brands are growing faster.

What is the role of accreditation and regulations in the diagnostic sector in India??

Accreditation does help, but it is a costly exercise. For example, CAP accreditation, in which there are a lot of hidden costs in getting accredited since one has to share a lot of global 1st class travels of auditors. Having accreditation is not helping adequately since common man or even medical doctors are not tuned towards the importance of accreditation. Any labora-

tory gets even government business and that makes accreditation ‘unattractive for many’. It is just 200 versus 60,000 and it would take another 10 years to see 10,000 versus 60,000. A long way to go!

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

We spend `10 crores per year in updating our technologies. Nothing much is happening in the laboratory technologies space and since we are focused in a particular segment capital expenditures are not really demanding. However we intend to update the automations to next level.

What are the investments that Thyrocare is making and what type of benefits you want to achieve with these steps?

We are investing `20 crore on Total Laboratory Automation using Siemens Track System. This means our productivity will enhance, our capacity will grow and it would also improve our quality while reducing the turnaround time. Once the TLA is in place our capacity will increase by 5 times and we can process 10,00,000 tests a day.

What is the future growth model of the company?

More cities, better network, improved training methods, enhanced IT and good presentation could help us to continue to grow 40 percent annually for next 10 years and we feel a lot in India has to be done and can be done. Market or investments or infrastructure are not problems but to get a right man and train him to do a right kind of task still is the biggest challenge, though India has 20 crore unemployed youth.

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Book Review

Hospital Information Systems: A Concise Study ICT in healthcare is not only a big enabler and differentiator but has revolutionised the way the healthcare is delivered

By Gp Capt (Dr) Sanjeev Sood

Title: Hospital Information Systems: A Concise Study Publisher: Prentice Hall India Authors: S A Kelkar 1SBN: 978-81-203-4083-1 Price: `450.00 Edition: 2010 Pages: 774

H

ospital Information Systems-A Concise Study is possibly the only book on the subject by an Indian author and publisher and deals with an important subject of health informatics.

The book has chapters on rudimentary hospital Information system, eHealthcare, managing hospitals with informa-

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tion, quantitative techniques for decision support, hospitals & quality, people stress in hospital management, healthcare backdrop, changing world & healthcare, strategy, IT & healthcare. According to the author, managing patients and hospital together is what a hospital information system is designed for! The software ensures that the applications involved in the workflow of health services, are based on accuracy in recording patient’s demography and data, and accountability of hospital management. Thus, a good HIS serves as a backbone of the Hospital capturing, storing, accessing and transferring information amongst all stakeholders involved in patient care.

Written in a bulleted format, this book enlightens the reader to overcome the shortcomings of hospital industry such as inadequate access to medical facilities, unassessed quality, and shortage of skilled manpower. The book explains how information (like medical records or administrative records) can be stored, accessed and retrieved promptly; how a patient’s record can be generated easily based on demography, biodata,gender, age, and so on; how the system can help to monitor a patient’s treatment procedure-starting from his/her ailment history, to present health condition, to recovery.

The book also efficiently addresses the issues like security of the system and the investment strategies. Besides, the appendices on topics like new business models and applications, and overview of hospitals, add on to the applicative knowledge on the subject.

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The book has list of abbreviations in the beginning and suggested reading in the end, but no glossary of terms or an index. There are several schematic diagrams in B and W to explain the contents.

Intended readers Intended for the students of Hospital information Systems (HIS)/Hospital Administration or an equivalent training programme, the book is well-suited for the healthcare practioners (small or large organizations) so that they can streamline their workflow process. The book will also be equally beneficial for the instructor’s teaching Hospital Administration in various healthcare and management institutes.

About author The author SA Kelkar is an Adjunct Professor at Indian Institute of Technology Bombay, serving both in Department of Computer Science and Engineering and S J Mehta School of Management. He has an extensive teaching experience in the areas of Information Systems, software engineering, IT project management and has authored several books.

Reviewed By

Gp Capt (Dr) Sanjeev Sood Health Systems Administrator, Jodhpur

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Hospital CEO interview

“jaslok is at the forefront of medical advances” It is uncanny to imagine a defence officer, who once held the responsibility of operating army tanks, is now a well-known CEO of a leading hospital in the country and saving lives of thousands of ailing patients each day. With will, determination and a dream to build a hospital that is renowned and respected for introducing cutting-edge medical technology – Col M Masand has infused a ‘tech culture’ at Jaslok Hospital since it opened up to patients in 1973.

Today, as the hospital counts itself amongst the best in Mumbai, in conversation with Rachita Jha, he illustrates his tech journey and future plans

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Tell us about the changing trends in healthcare in India and how do you update yourself on the latest trends and technologies?

I am not a qualified doctor instead I am a retired army officer and used to armor defence tanks. I entered the healthcare industry without any knowledge and background. But today I can carry out a bypass surgery with a team of doctors. My journey began, when I was asked to take-charge of Jaslok in the 1970s. I took on the assignment and began to study the organisational and strategic functionalities of running a hospital. As the hospital then was ailing with outdated equipments, I was convinced that the path to success can be achieved only through technology adoption and delivery of quality patient care. Over a period of time, I have updated myself through regular visits to conferences, seminars and exhibitions to orient myself on the latest in various fields of medical technology advancements that can help me improve the quality of healthcare for my patients.

I strongly believe in the power of medical technology and it is this urge that today, the nuclear medicine department at Jaslok Hospital is one the best in the country.

What is the importance of technologies and IT solutions for a hospital? How has it helped you in raising the quality and performance benchmarks of healthcare services offered at Jaslok Hospital?

Moving away from the conventional modes of medical technology in healthcare

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industry has redefined the benchmarks of quality in healthcare services that are being delivered by hospitals today. Most of them are extremely patient-friendly that reduce the overall time spent by patients in the hospital, and have revolutionised the way diagnosis and treatment is done in hospitals. Surgeries are being replaced by procedures. The entire lifecycle of a patient for a treatment has reduced drastically. The ordeal of a patient earlier began with getting admitted, taking diagnostic tests, undergoing surgery, anesthesia etc – all combined prolonged the stay in the hospital for months. The same line of treatment today using state-of-the-art technology is completed within hours and the patient is discharged in a day.

Tell us some of the leading medical equipments that have revolutionised treatment of cancer facilities available in the western part of India?

The Tata Memorial Hospital in Mumbai offers cancer treatment technology that attracts many patients from across the country. In order to augment the treatment facilities in the region and extend high quality cancer treatment technologies to cancer patients we hold the life saving department of oncology at the edge of technology. We have long moved away from conventional long process of radiation therapy that involved many sessions and extended stay of the patients in hospitals. Today, the hospital is powered with ABVS or Automated Breast Volume Scanner that offers precise

Hospital CEO interview

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Col M Masand CEO Jaslok Hospital and Research Centre

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Hospital CEO interview diagnosis of suspected breast cancer, allowing speedy decision making. It acts as an important tool in the screening, diagnosis and follow-up care of breast cancer and drastically reduces the waiting time for patients. The IGRT and IMRT (Intensity Modulated Radiation Therapy/ Image Guided Radiation Therapy) have changed the very treatment of cancer.

Also, the new Focus MRI permits not only scanning but also treat patients with for fibroids and prostate cancer immediately thereby reducing the time gap between diagnosis and treatment.

As future plans, we are in the process to install SPET CT (Single Proton Emission Computed Tomography) with a 16 slice CT to further speedup our capability to detect the spread of cancer.

As pioneers in nuclear medicine at Jaslok Hospital, what are the various technology investments that you have made in the department?

We now have the most advanced diagnostic and therapeutic nuclear medicine facility in the country. The latest introduction of the Alcyone Technology is a revolutionary nuclear cardiology platform in India. This nuclear cardiology technology also known as the Discovery NM 530C is installed and operational at Jaslok Hospital. The impact of this technology on cardiological management could be considered a revolution in many aspects.

It offers dose reduction, the potential for more accurate identification of triplevessel cardiac disease, and a cost-effective investigation tool for myocardial blood flow. Nuclear Cardiology is the most efficient way of detecting cardiac diseases early. It will not require spending four to five hours to get a diagnostic cardiac test done; and for the hospital, the saved time can be used for diagnosing more patients.

Tell us more about the era of noninvasive technologies?

The future belongs to the non-surgical era of cancer treatment and other targeted therapies. On the eve of our 37th anniversary, we introduced the first MR Guided

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The life-saving departments need to be a priority of hospitals when planning for technology investments. These include cardiology and oncology that offer new modalities for the doctors as well as the patients in providing faster and more efficient line of diagnostics and treatment Focused Ultrasound system in India and South Asia. With this, patients, especially women in India, neighboring countries, Middle-East and African countries can now look forward to surgery without cutting the body or losing a drop of blood. Launching the era of non-invasive surgery in India, the hospital now has the capability to treat uterine fibroids as well as bone metastases, breast, prostate and other cancers. At the same time, we continuously invest in R&D and conduct research and clinical trials for breast, liver and bone cancer.

What are the key challenges that you face as CEO of Jaslok Hospital?

It is not the technology alone that scripts success for any hospital, but also an army of experienced and qualified doctors.

Unfortunately, we have been facing the problem of finding and retaining young talented doctors in the hospital. Huge attrition at various levels on a regular basis disrupts the overall functioning of the hospital, in addition to patient care. Apart from the internal challenges, the overall government machinery and administration requires a overhaul. It has been a daunting task to sustain and offer the best of healthcare as a charitable hospital in Maharashtra.

Please identify few technology trends that hospitals in India need to invest in to become more patient-friendly?

The life-saving departments need to be a priority of hospitals when planning for

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technology investments. These include cardiology and oncology that offer new modalities for the doctors as well as the patients in providing faster and more efficient line of diagnostics and treatment.

For example, the more update technology that has advanced from the C-arm is the O-arm. It is a multi-dimensional surgical imaging platform which combines the best features of the C-arm with a 3-D scanner helps in minimally invasive surgeries and is highly patient-friendly. The latest 4D Doppler allows the surgeon to execute the cardiac surgery within minutes as they can now view the video of the patient real-time thereby reducing the diagnostic c and waiting time of patients significantly. With medical technology advancing with each passing day, we have to pace up and adopt the latest to ensure our patients get the best.

What is your vision for Jaslok Hospital in 2020?

Jaslok Hospital has always remained in the forefront of medical advances and has established the reputation by introducing the best and latest medical technologies first in the country. I donâ&#x20AC;&#x2122;t wait for the machine to wear out before investing in a new one. We at Jaslok adopt the latest medical equipment as soon as we see value in the technology and benefits for our patients. The hospital will continue to lead as a trend-setter in introducing the latest and most patient-friendly technologies over the years. The foundations will be laid on trained and skilled doctors and nurses as the drivers of the â&#x20AC;&#x2DC;tech cultureâ&#x20AC;&#x2122; in the coming years.

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Tech Trends

Modelling the Future An integrated RIS-PACS solution lessens the manipulation of image manually and gives more time to the expert for faster evaluations

By Dhirendra Pratap Singh

T

he increasing proportion of imaging modalities that generate images in digital form has lead to the development of digital image management systems. Such systems referred to as Picture Archiving and Communication Systems (PACS) are emerging in clinical and radiological environments. PACS is an integrated set of information technology systems designed to provide a complete solution for image management in a film-less radiology department. Further to its importance in the radiology department, emergence

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of high-end modalities in cardiology and oncology requires archiving and postprocessing of images where PACS is becoming mandatory.

When introducing PACS to the hospital environment, it is critical to establish a Hospital Information System (HIS) or Radiology Information System (RIS) beforehand. Integration of RIS with PACS is a defining trend in the imaging market.

Gaurav Mundra, Director & Chief Operating Officer, Truworth Infotech Pvt Ltd, while sharing his perspective on this technology, said, “RIS/PACS is going to be the next big wave in Healthcare IT for

> www.ehealthonline.org > March 2011

larger hospitals. They will need special support in integration with existing systems and legacy equipment. They must look at the cloud as an option to expensive hardware and maintenance. Pricing should move to an ASP model too.”

An integrated system, which already knows certain information like patient’s history, reason for the examination, and the tests ordered, these systems can now automatically predict or rather anticipate specific views to the radiologist. It lessens the manipulation of image manually and gives more time to the expert for faster evaluations.

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Tech Trends

When introducing PACS to the hospital environment, it is critical to establish a HIS or RIS before a PACS. Often a retrospective merger of the PACS database lends itself to higher costs and data entry inconsistencies. All components of HIS or RIS and PACS must also be bidirectional and integrated fully with electronic patient records if present. If this is not coordinated, a hospital may find itself film-less in the radiology department, but resigned to copying images on costly laser film for other departments to use, which is an incredibly costly state of affairs.

“More hospitals are budgeting for technologies like PACS based on the positive experience and advantages offered to existing clients who have opted for this technology” Dr Ashish Dhawad Founder & CEO Medsynaptic Pvt Ltd

Protocols According to Frost & Sullivan technical insights, interactions between PACS and radiology RIS require compatible hardware, a common protocol for handling the data, and commensurate operational definitions. However, PACS and RIS are based on different protocols. PACS operates on the Diagnostic Imaging and Communications in Medicine (DICOM) standard, while RIS operates on Health Level Seven (HL7). DICOM is a transmission protocol that formats, stores, prints and transmits images to and from the imaging modalities and the PACS. HL7 is used to register patients, process orders, and store reports, but it cannot manage DICOM image data. In order for the PACS to do its job, it must be able to communicate with RIS. Therefore, interfaces are used to create an interface between the two systems. The interface (also known

as a PACS ‘gateway’ or ‘broker’) is a hardware- and/or software-based module that allows PACS to communicate with the RIS. However, it has its drawbacks, including added cost to the PACS, and a potential point of failure that may result in orphaned studies (studies that are ‘lost’ or inaccessible to the data system).

Common Database Although the leading vendors continue to support RIS/PACS integration through the standard HL7 interface, current developments in image management technology are leaning towards a completely integrated RIS-PACS solution that manages all radiology-related numerical and imaging data from a single database. This is known as the fully integrated RIS-PACS. Although a number of current systems use the embedded or internal PACS

Key Players • Agfa

• Medsynaptic

• Carestream

• Ashva Technologies

• GE Healthcare

• Napier (Karishma Software)

• Siemens

• Perfint Technologies

• Fuji

• Sobha Renaissance IT Ltd. (SRIT)

• Vepro

• Softlink International

• 21st Century Healthcare solutions

• Srishti Software

• Medsphere

broker and call them ‘brokerless’, a truly integrated RIS-PACS is one in which both types of data are indexed in a common database allowing immediate interaction of both types of data within the complete RIS-PACS system.

Dr Adam CHEE, Chief Advocate (Director), binaryHealth Care.com says, “There is no standard core body of knowledge in medical imaging, which is a major drawback. Further, though everybody thinks that medical imaging informatics is limited to radiology, it is not. PACS is not just limited to images—it is offers much more than that.”

Trends PACS implementation is slowly catching up in India with more hospitals aiming towards a paper-less environment. The Indian PACS market is estimated to beUS $5.5 - 6 Million and is expected to grow at a compound annual growth rate of 27 percent from 2007 – 2011.

Corporate hospitals are the front-runners with some of the mid-size and government hospitals following suit. Private hospitals are opting for PACS to provide services efficiently and have an edge over their competitors, whereas, government hospitals use it to help in keeping patient records, reduce the number of films used, and also the cost of record maintenance.

Gaurav Mundra says, “Compatibility with legacy systems is the biggest driver as

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Tech Trends

costs for new systems is very high. If there are solutions that allow using older equipment or existing pieces of software with the new RIS/PACS, we have a winner.”

Dr Ashish Dhawad, Founder & CEO, Medsynaptic Pvt Ltd says, “Market and awareness for PACS & RIS continues to grow rapidly. More and more hospitals are budgeting for technologies like PACS based on the positive experience and advantages offered to existing clients who have opted for this technology.”

The medical imaging market is currently in a transition state as healthcare facilities around the world are now opting for digital radiography solutions over conventional radiography solutions. One of the most important reasons for this is the emergence and implementation of PACS network. Subsequently, the enhancement in the clinical value of PACS has also been a result of installation of direct digital modalities.

Radiologists are using it even for teleradiology services to provide consultation and second opinion to remote areas in India as well as abroad. Technology savvy doctors are providing consultation and opinion even when away from healthcare facilities by accessing the records online from the comforts of their home or clinics.

“Everybody thinks that medical imaging informatics is limited to radiology, it is not. PACS is not just limited to images—it offers much more than that” Dr Adam Chee Chief Advocate (Director), binaryHealth Care.com

systems (RIS), a computerised system for patient registration, as text-based RIS products such as film tracking databases will be marketed with PACS solution.

Cloud computing is the holy grail of PACS/RIS. Once we have enough

DICOM PACS was launched with an idea to collect images from all modalities to a digital archive and to allow the transmission of these images to other workstations through local area network (LAN). Further, the traditional transmission control protocol/internet protocol (TCP/IP) was gradually replaced by digital imaging and communications in medicine (DICOM) protocol, which was capable of managing any sort of medical images.

The DICOM protocol hence extended from the radiology department to the entire clinical department in a healthcare facility and became the standard of clinical data transmission. The increasing popularity of PACS is further driving the sale of high-end radiology information

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“If there are solutions that allow using older equipment or existing pieces of software with the new RIS/PACS, we have a winner.”

Gaurav Mundra Director & Chief Operating Officer, Truworth Infotech Pvt Ltd

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bandwidth to put all the images and data on the cloud, the cost would go down dramatically as hospitals would no longer need the expensive storage and servers for processing. PACS in the cloud, support for handheld devices like ipad and mobiles, thin client 3D rendering, multisite Hospital connectivity and data mining are some important tech trends in RIS/PACS. Says Gaurav Mundra, “Compatibility, Integration & Data Migration are the key challenges which is why we are purely focused on this area. Managing and maintaining standards in the industry will also be key for wider user-base.”

However, Dr Ashish Dhawad Founder & CEO, Medsynaptic Pvt Ltd says, “Indian hospitals still cannot go completely filmless. Smooth Integration with HIS/ Equipment and pricing pressure are some other challenges.”

It is crucial to however note that in absence of a PACS of PACS like solutions, the advantages of a digital radiography system are lost, more or less because there is no electronic information management system to store and retrieve patient information. The printouts of digital scans offered on a film are or the scanning of x-ray films to produce digitized images are both inefficient procedures. Hence a primary requirement for installing DR and CR solutions is to first install a viable information management system to efficiently manage all the data produced in these procedures.

     



        



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       •    •     

                

                   • 

  

•   •     •   •    

•    • 

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    •      •      •     •  •               •           •    • 

  • • • • •

          

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

 

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  

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•      •     •    •    

 

  

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  

 

•  • 

      

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In Focus

â&#x20AC;&#x153;claims servicing would continue to be a key area of focusâ&#x20AC;?

ICICI Lombard GIC Ltd. is the largest private sector general insurance company in India. In an interaction with eHealth, Bhargav Dasgupta, MD and CEO, ICICI Lombard General Insurance Company shared his perspective on the emerging health insurance environment in India vis-a-vis the world.

Excerpts:

How has the health insurance sector evolved over the past years?

Health Insurance in India has evolved as the second largest segment within general insurance. It is also amongst the fastest growing with a CAGR of more than 25 percent in the last two years generating a premium of Rs. 9,210 crore in 2009-2010 contributing 26 percent to the industry.

The drivers of growth include higher affluence of the Indian middle-class, increase in various lifestyle-related diseases, rising health care costs and growing awareness about the benefits of health insurance.

A buoyant economy and the resultant increase in the workforce have also given a boost to Group Health Insurance taken up by corporates for their employees. Another key impetus has come from the government, which is increasingly taking the insurance route for implementation of its social health schemes. The liberalisation of the sector along with the entry of stand-alone health insurance companies has triggered a higher level of competitive intensity as well. This has resulted in the industry seeing advanced levels of innovation with various product offerings for different segments including senior citizens, corporates, below poverty line and the affluent class. However, with health insurance still contributing to less than 4 percent of healthcare spends, there is significant potential that is yet to be realised.

How important, from a healthcare insurance point of view, is to

30

> www.ehealthonline.org > March 2011

have a national health IT policy or standard based IT practices in healthcare?

Leveraging technology for growth has been one of the key mantras of the industry. Implementation of Rashtriya Swasthya Bima Yojana (RSBY), the government-sponsored mass health insurance scheme through biometric cards is a prime example of the same, exemplifying standards based approach to the health insurance life cycle. Standardisation in the way technology is used is a significant business enabler with wide applicability in the areas of hospital billing systems, health claims forms, sharing of claims data within the insurance industry as well as universal accessibility of health information pertaining to individuals.

Commonality of technology protocols and data structures would facilitate frictionless exchange of information between the various stakeholders leading to higher process efficiencies and a better customer experience.

What is the response that you have seen from the healthcare provider segment in terms of collaborating with insurance providers in making a seamless working environment feasible? What are the challenges that you see?

There are a number of initiatives being undertaken by various stakeholders towards a more collaborative industry environment. This includes the industry

In focus Focus in

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Bhargav Dasgupta MD and CEO, ICICI Lombard General Insurance Company March March2011 2011 < < www.ehealthonline.org www.ehealthonline.org < <

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In Focus bodies, which also have a representation from the healthcare provider segment.

The primary challenge is the implementation of agreed protocols as the health care sector is largely unregulated. Different providers follow different treatment protocols and billing practices for a given illness of injury and the final objective is to define a commonality of approach across stakeholders.

In India, the providers of care tend to over provide care. Do you see this as a bottleneck in growth of the health insurance sector?

Quality of outcomes per unit cost is a metric that can be used to benchmark healthcare providers. The experience in a number of countries also suggests that the high cost of healthcare is not necessarily correlated with quality of outcomes.

There is also empirical evidence to indicate that sharing of information on quality of outcomes with consumers helps in improving the same at a lower per unit cost. India historically has had a low-cost, high-quality health care delivery platform as compared to other nations and we must sustain this advantage.

Standardisation of treatment protocols is a part solution to this challenge.

Agreement with providers on package rates for treatment of various illnesses is another approach to address this issue.

A lot of companies in India are faced with the challenge of marketing their health insurance products as our healthcare insurance penetration is very low. Why do you think health insurance is still not working in India?

The industry has taken several significant steps in setting benchmarks of customer service for building trust. The high growth rates of the segment are an indication that these efforts are bearing fruit. There is a wider range of health insurance solutions available and the awareness and understanding of the product amongst customers continues to grow. Innovative solutions have been developed to reach

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Affordability is a challenge in making health insurance mandatory. In a large country like India, implementation of such a mandate will also be a challenge, though it could possibly be given to organized employers for permanent and temporary employees out to the under privileged segments as exemplified by the RSBY program and the provision of cashless OPD for weavers. It must be said that the health insurance industry has seen significant positive developments in the recent past towards increasing category penetration and these are in line with the stage of evolution of the industry.

Do you think making health insurance mandatory for everyone can address the issue of low health insurance penetration?

Affordability is a challenge in making health insurance mandatory. In a large country like India, implementation of such a mandate will also be a challenge, though it could possibly be given to organized employers for permanent and temporary employees. The below poverty line population would require intervention from government and the social sector for funding. For the rest, higher incentives in terms of tax benefits could partly serve the purpose.

However, the key to driving health insurance penetration in a sustainable manner lies in gaining an insight into the healthcare needs of the uninsured, developing products aligned to those needs, building robust financing models with cost-effective delivery platforms in addition to encouraging greater awareness among masses about the need for health insurance.

The experience of developed markets also suggests that policy decisions on health insurance are a definitive means of assuring affordable, accessible and quality healthcare to a large uninsured

> www.ehealthonline.org > March 2011

population leading to a significant impact on a countryâ&#x20AC;&#x2122;s economy. Needless to say, these efforts must be targeted towards improving the quality of health care outcomes per unit cost in order to build a sustainable solution to universal health insurance.

If health insurance is mandated in India, what would it cost?

What healthcare services would it cover? And, how would it be paid for?

The cost of health insurance is a function of the coverage provided and the policy terms and conditions. A basic policy would cover hospitalization and offer cashless access to health care. There are several routes to financing health insurance including employer supported, government funded, community based plans as well as self funded and would depend on the segment being targeted.

What would be your thrust areas for the coming years? What are the expansion plans for ICICI Lombard?

Technology based solutions for distribution of health insurance and claims servicing would continue to be a key area of focus. The ability to handle scale efficiently is a competitive advantage and in the last fiscal ICICI Lombard handled over 50 lakh health claims across customer segments in retail, corporate and rural. Strengthening relationships with network providers across geographies for ensuring enhanced service levels to our customers will continue be an important thrust area.

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Power Hospital

Moolchand Medcity New Delhi’s largest super specialty hospital with state-of-the-art facilities

By Dhirendra Pratap Singh

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ocated in the heart of South Delhi, Moolchand Medcity is being developed as Asia’s largest single site multispecialty hospital campus with six specialty hospitals and more than 1,000 beds.

In the era of globalisation, a massive boom in private hospitals in India has changed the nation’s health delivery landscape beyond recognition in the last decade. And Moolchand Medcity with the mantra of star facilities and bleedingedge technology is writing a new chapter in India’s healthcare services. Vision at Moolchand is to create a truly unique institution that delivers world-class healthcare with a conscience of trust.

The new Moolchand Clinic has been accredited by JCI – the gold standard in healthcare. Moolchand is now in the

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league of the world’s leading JCI accredited healthcare providers. It is India’s first hospital to receive prestigious JCI and comprehensive NABH (hospital and blood bank) accreditation.

The hospital offers a comprehensive portfolio of services all under one roof.

The patient can consult globally acclaimed physicians across more than 50 specialties teamed with key supporting facilities (radiology, pathology and 24hour pharmacy) at Medcity campus. First Minimal Access Surgery in India has emerged out of Moolchand.

Facilities Facilities at Moolchand include efficient patient concierges in the complete process of meeting the concerned doctor, Wi-Fi enabled waiting areas, essential back-up facilities (radiology, pathology and 24-

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hour pharmacy), cafeteria offering fresh and healthy food choices, second opinion service, confidentiality and affordable excellence.

At Moolchand Children’s Hospital the services include general paediatrics, paediatric cardiology, paediatric gastroenterology, and paediatric nephrology.

The heart hospital team has performed successful redo CABG surgeries. Moolchand is the first Indian hospital to introduce Streptokinase therapy for MI. The hospital’s reliability on IT infrastructure has gone up. It is currently trying to progress to the next stage by experimenting with telemedicine and other means of collaboration.

The hospital’s unit—Mother’s Nest helps to continue the tradition of delivering compassionate care in a safe and friendly environment. The hospital’s

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Power Hospital NABH and ISO 9001:2000 accreditations assure the highest standards of patient care, safety, quality and innovation.

Here the hospital’s cutting edge technologies include in-vitro fertilisation (IVF), assisted reproductive technique (ART), treatment of male and female infertility, child birth packages, antenatal classes, foetal diagnostics and therapy (invasive and non invasive), genetic and maternal-foetal medicine consultations Moolchand Orthopaedics Hospital offers a full continuum of diagnostic, therapeutic and surgical orthopaedic services for adults and children with bone, joint or connective tissue disorders. The Moolchand orthopaedics team, comprising of internationally trained and globally acclaimed super-specialists, has been a pioneer in orthopaedics care (e.g. first knee replacement in Delhi).

The hospital offers the complete range of hip replacement and knee replacement surgeries.

Technology Moolchand is focussed on continually bringing the safest technology for the patients (such as 4D ultrasound, low dose x-ray systems). The hospital’s integrated Clinic Management System helps in smooth and efficient functioning of clinic operations.

Recent advances in Interventional Radiology (IR) have enabled the radiologist to bring about direct destruction of the tumour. Moolchand Centre for Interventional Radiology offers state-of-the-art technology to perform a wide range of image guided procedures. Interventional techniques used are able to diagnose and treat many common as well as rare disorders. Interventional radiology offers an alternative to the surgical treatment of many conditions and can eliminate the need for hospitalisation, in some cases.

For inoperable liver tumours, radiofrequency ablation (RFA) offers a nonsurgical, localised treatment that kills the tumour cells with heat, while sparing the adjacent healthy tissue. Being a local treatment, it is a very safe procedure that does not harm healthy tissue.

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Major Services Offered • Medical oncology • Oncosurgery • General paediatrics • Paediatric cardiology • Anaesthesia • Centre for Cosmetic Surgery • Centre for Infectious Diseases • Interventional Radiology The hospital provides facilities of minimally invasive surgery, which is a relatively new technology and slowly becoming popular. The surgery results in less pain, fewer side-effects, a brief recovery period, and a quicker return to daily activities in comparison to traditional surgery.

Moolchand offers a huge range of minimally invasive surgeries. Here team of experts/surgeons utilises a small telescope like device (laparoscope or arthroscope) attached to a small video camera/light source to see inside the body.

The various minimally invasive procedures are utilised mostly in a particular surgical field. For example, video-assisted thoracoscopy is utilised in the chest surgery. Ureteroscopy and Extracorporeal shock-wave lithotripsy are utilised in the urological/nephrological surgery.

Gamma-knife radio surgery is utilised in the brain surgery whereas Endovascular surgery is utilised in the vascular surgery.

Stem cell therapy Stem cell therapy consists of introduction of highly potential stem cells into the blood stream or the damaged tissues of the patient. The ability of stem cells to self-renew offers a large potential to repair/replace damaged tissues in the body. The hospital offers the umbilical cord stem cells with a patented technology treatment, which allows it to be safely transplanted between unrelated and unmatched people, without the risk of rejection or side effects.

At Moolchand state-of-the-art tech-

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• Centre for Liver and Digestive Diseases • Dental medicine • Dermatology • Diabetology and endocrinology • Ear, nose and throat • Internal medicine • Nephrology • Ophthalmology • Cardiac surgery nology and critical care support have made it possible to successfully manage a complete range of surgical interventions in the case of spine tumours. Spine tumors are abnormal growths of tissue found inside the spinal column. It may impinge on nerves leading to pain, neurological problems and sometimes paralysis. Spine tumor treatment requires a coordinated multi-specialty approach.

Last year, Moolchand Medcity tied up with Indira Gandhi National Open University (IGNOU) in providing Diploma and Bachelor courses for paramedical professionals. With this Moolchand Medcity has now become a recognised learning centre of IGNOU and is now providing Diploma and Bachelor courses for paramedical professionals. The courses are Bachelor/B. Sc. in Medical Records and Health Information Technology (duration 3 years), Diploma in Medical Laboratory Technology (duration 2 years), Diploma in Radio Imaging Technology (duration 2 years).

Moolchand has received the the most prestigious quality award IMC Ramkrishna Bajaj National Quality Award 2009 for Outstanding Achievements in the Healthcare category. Modelled on the Malcolm Baldrige National Quality Award (USA), it is awarded to companies that demonstrate outstanding customer orientation and quality management systems. These awards are conferred on organisations that have adapted and promoted various quality initiatives on a sustained basis.

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Special Report

Union Budget 2011-12

Baby steps towards ‘health for all’ The boost provided to healthcare is positive but imposition of service tax on medical fees and diagnostic tests hurt the healthcare industry

By Dhirendra Pratap Singh

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or health, the Government has proposed to step up the plan allocations in 2011-12 by 20 percent amounting to `26,760 crore. This was announced by the Union Finance Minister Pranab Mukherjee while presenting sixth Union Budget 2011-12.

The boost provided to healthcare is welcome and shall continue to support the industry’s need to reach a larger population, including the people in the remotest districts. The reassurance shall provide the push for further growth.

Prof. Indrajit Bhattacharya, Professor Health Informatics, IIHMR says, “I see the budget as a healthy sign for the country as the total allocated amount for the sector has increased up to 20 percent.

In India, the increased budget can further be fruitful as it will ensure good progress at the technological aspect. With better governance and increment in health investment, health sector needed financial back up by the government.”

The corpus of rural infrastructure development fund raised to `180 billion in 2011-12 is a welcome move to sustain the economic development of India.

This combined with the hiked spend of 23 percent in the infrastructure sector is bound to help promote quality healthcare delivery to the people of India.

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Dr Neena Pahuja, CIO Max Healthcare says, “It would be great if a part of this allocation can go in monitoring the actual spend and projects being delivered.

Further boost might come if IT spends for healthcare gets subsidised, possibly by tax exemption or by extra funding.

Information technology is an enabler for reaching out to millions. Leveraging this enabler can really make a difference to converting this allocation to actual delivery. Learning from ARPA funding in US, I was hoping for some funds for hospital industry to support IT related projects

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and good tax breaks similar to what we got for Software Technology Parks.”

Union Finance Minister has proposed in the Union Budget 2011-12 that the Rashtriya Swasthya Bima Yojana will be extended to cover unorganised sector workers in hazardous mining and associated industries like slate and slate pencil, dolomite, mica and asbestos.

He said that the Rashtriya Swasthya Bima Yojana has emerged as an effective instrument for providing a basic health cover to poor and marginal workers. Presently, it is being extended to MGNREGA benefi-

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Special Report

Union Budget 2011-12

Finance Minister Pranab Mukherjee’s sixth Budget came in the backdrop of high inflation, tight liquidity and rising current account deficit Healthcare will become expensive due to increased service tax

Factsheet • Allocation for health sector up by 20 percent amounting to `26,760 crore • Service tax net extended to include health check-ups • AC hospitals with more than 25 beds under service tax • Set up national policy on psychotic drugs and narcotics • Extend National Health Scheme to workers in mining sector • Rashtriya Swasthya Bima Yojana extended to MGNREGA beneficiaries, beedi workers • Reduction of import duties on specified raw material for the manufacture of syringes and needles to 5 percent basic and 4 percent CVD • Age reduced for BPL pension eligibility • To provide `58,000 crore for Bharat Nirman projects • Plan expenditure at ` 4.14 lakh crore, 11th plan expenditure up 100 percent in nominal terms • Plan 17 percent increase in social sector spending • No increase in excise rates • Economy to grow at 9 percent, plus or minus 0.25 percent in 2012 • In current year, overall economic growth expected at 8.6 percent, agricul ture growth at 5.4 percent, industry at 8.1 percent and services 9.3 percent

ciaries, beedi workers and others.

Gautam Khanna, Executive Director, 3M Health Care, India says, “I am happy to note that Rashtriya Swasthya Beema

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Yojana is now being extended to Mahatma Gandhi National Rural Employment Guarantee Scheme beneficiaries and others. The proposal to further extends this scheme to cover unorganized sector workers in hazardous mining and associated industries like lead pencil, bromide, mica and asbestos is also a welcome step.”

Mukherjee said that social spending would rise by 17 percent in 2011-12. That includes health spending, which would rise 20 percent in the fiscal year starting April 1. Moreover, now, health checkups in private hospitals will become expensive.

Finance Minister Pranab Mukherjee’s sixth Budget came in the backdrop of high inflation, tight liquidity and rising current account deficit. Healthcare will become expensive due to increased service tax. Some experts believe that Finance Minister should have given more stress to the health sector and the demand for treatment of healthcare as infrastructure has been overlooked.

Aman Gupta, Principal Advisor – India Health Progress says, “The service tax on health check-up and treatment imposed in last year’s budget worked as a reverse catalyst for healthcare access.

Overlooking the problem of health infrastructure, its replacement in this year’s budget comes as another bottleneck in achieving the goal of healthcare access for all. This new tax will result in an increased out-of-pocket spending on healthcare at a stage where Insurance penetration is still low. This will put heavy burden over low income group population availing healthcare services in private hospitals.”

The industry also wanted an extension of tax holiday for hospitals from five years

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to ten years owing to longer pay back periods and assistance in raising capital for setting up more healthcare infrastructure. In India, the healthcare spending is limited to 3.4 percent of its total spending as compared with the developed nations who spend 12-17 percent on healthcare.

With more than 65 percent of the population in India having no access to healthcare, the experts this time were hoping for additional budgetary allocations for healthcare to take India towards its goal of universal healthcare access.

Dr Salil Garg, Senior Cardiologist, Command Hospital, Pune said, “I am not happy with only 20 percent hike in the allocation of the GDP where the healthcare sector really contributes a lot.

Although, Pranab Mukherjee has tried to give something better in the health insurance department but the increase in the cost of medical care services and kits will adversely affect the common man. The healthcare sector has to become a priority in a year or two in order to develop a good infrastructure in the country.”

The most encouraging announcements of the Budget were the fact that the fiscal deficit would be lower at 4.6 percent (with a Financial Year 14 target of 3.5 percent) and that the net borrowing of the Government would reduce in the next year and trend lower with every passing year. This combined with the focus on infrastructure development would be beneficial to the industry as it creates a more productive industrial environment and a stable liquidity and interest rate regime. Other than this, there were no significant changes for industry and the budget has continued to focus on inclusive development.

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Profile

“Day care surgical centers can be set-up at any place, at a tenth of the cost of a large hospital, thus providing access to everyone”

Dr. Mahesh Reddy Co-founder & Executive Director Nova Medical Centers

Break of the Day Nova Medical Center redefines day care surgeries with cutting edge technology and lower costs

By Divya Chawla

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ova Medical Center is a chain of day care surgical centers that deliver treatment in an out-patient setting with the help of cutting edge medical technology. The Centers bring under one roof, internationally trained physicians and advanced medical technologies to give patients easy access to quality, affordable healthcare.

Speaking about the challenges affecting healthcare delivery today, Dr Mahesh Reddy, Co-founder and Executive Director, Nova Medical Centers said, “Quality of healthcare delivery has grown leaps & bounds; still we face a lot of problems to cater to the sheer size of the population. But the biggest challenge the healthcare sector is facing is providing access to all.”

Considering the lack of hospital beds in the country, the day care surgical Centers is

an exemplary concept. An outpatient setting helps in increasing efficiency and containing costs, making this a healthcare delivery model without parallel. Elaborating on the role of day care surgeries, Dr Reddy added, “I am very optimistic here about the role of ambulatory care and short stay care surgery centers in facilitating healthcare access to all.

At these centers’ nearly 70 percent of all the surgeries can be conducted thus freeing up precious beds at the tertiary care hospitals for critical needs. For the patient, there is a saving of nearly 25 percent of the cost.

Services Patients at Nova Medical Centers have access to a hoard of medical services including state-of-the-art operation theatres, specially equipped gastroenterology procedure room, meticulous pre-op and post-op procedures supervised by physicians and nurses, a

sophisticated diagnostic laboratory with cutting-edge diagnostic equipment, outpatient department consultation rooms and a well stocked pharmacy.

Nova Medical Center offers upwards of 700 such procedures, covering various specialties. All Nova centres have 4-5 ultra-modern operating rooms. Each preoperation and post-operation bed/room is equipped with gas lines, monitoring equipment and defibrillators. These are constantly monitored by duty doctors and trained staff.

Nova mainly focuses on minimally invasive procedures, which are hugely beneficial to patients because of smaller incisions, minimal damage to surrounding tissues, lesser inflammation and negligible blood loss.

With the growing awareness about benefits of day care surgery, its affordability and accessibility, more number of patients will avail these facilities across the country.

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Spotlight

Rakesh Joshi Business Development manager, Medical Business, Texas Instruments India As the Business Development Manager at Texas Instruments, Rakesh Joshi is responsible for setting short-term and long-term strategies to develop business with new customers and expand business with existing customers in the medical segment in India.

Rakesh Joshi spoke to eHEALTH at length about the role of semiconductor technology in medical electronics and the innovative products manufactured by TI for this domain

“TI’s semiconductor technology makes life healthier” 40

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Spotlight What is the role of semiconductors in enabling design and anufacture of ultrasound equipment?

Increasing awareness of healthcare, aging population and soaring medical costs have created a rapidly growing need for innovative medical solutions which are portable, low power, have robust and powerful data processing capabilities, simpler user operation, wireless connectivity and are affordable at the same time.

Semiconductor manufacturers are rising to this challenge of designing and developing portable and affordable medical devices. The connectivity enabled by semiconductor technology (wired or wireless) will drive applications that will facilitate access to the required level of healthcare. Semiconductors like sensors, microcontrollers (MCUs), microprocessors, digital signal processors (DSPs) and analog front ends (AFEs) bring high levels of functional integration in the equipments they go into including ultrasound equipments, thereby improving their efficiency and performance levels and reducing their form factor.

Ultrasound has gone portable and has brought medical imaging into remote places such as disaster sites, accident scenes and even onto battlefields. TI with its broad portfolio of digital and analog products has been focusing on medical imaging. Given its many years of experience with rapidly evolving technologies, TI has the expertise to advance the stateof-the-art in medical imaging. Innovation is required to reduce the size and power consumption of portable ultrasound systems while still keeping them affordable and delivering superior image quality.

With Texas Instruments’ (TI) integrated analog front-end technology and powerefficient embedded processors, handheld ultrasound systems that fit into a doctor’s pocket are emerging. TI’s TX810 - integrated transmit/receive switch, speeds ultrasound design and reduces board space by more than 50%. TI’s TMS320 and MSP430 families of embedded processors drive ultrasound into portable and hand carried units where computational

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“The role of semiconductor components is becoming more critical as the medical equipment devices become portable and smaller. Increasing need for improving accessibility of healthcare in remote areas has opened up a lucrative opportunity for semiconductor manufacturers” efficiency is critical for performance and maximising battery life.

What is the approximate market of semiconductors for medical equipment in India? What is its growth potential?

In an emerging market like India, there is a lot of potential for growth and demand for medical electronics. According to a 2010 report by Indian Semiconductor Association (ISA) the Indian medical electronics market currently valued at US $853 million, is estimated to grow at a CAGR of 17 percent over the next five years and reach US $2.075 Billion. The role of semiconductor components is becoming more critical as the medical equipment devices become portable and smaller.

Increasing need for improving accessibility of healthcare in remote areas has opened up a lucrative opportunity for semiconductor manufacturers. Given the poor infrastructure in the remote parts of India, there is a need for portable, small in size, high performing, low power and affordable medical electronics. Technologies like telemedicine, e-healthcare and digitisation are fast becoming important in a country like India.

Additionally, increased awareness of healthcare, prevalence of lifestyle diseases and increasing medical costs has created a need for home-based healthcare.

Consumers are demanding cost effective monitoring and health management products that they can use at their homes.

Some of such home healthcare gadgets include blood glucose meters, blood pressure and heart rate monitors, digital thermometers and pulse oximeters. This

has fueled the need for portable and miniature healthcare solutions. Semiconductors play a very significant role in driving this home healthcare trend. Semiconductors like DSPs, MCUs, sensors, analog front ends and others bring high levels of functional integration, portability and reduction in form factor in these medical equipments. Very good examples of this are AFE5807 and AFE5808 - products developed by TI that go into ultrasound machines and optimise the receiver end of analog signal chain in a way that makes the ultrasound machine much more cost effective while meeting its imaging and performance requirements.

Please give a brief overview of your company and its footprint in the medical electronics space in India.

TI has undertaken many initiatives towards revolutionising healthcare by improving the quality and accessibility of medical equipments. TI’s semiconductor technology, with its proven expertise in developing products for the growing market, helps make life simpler, greener, healthier and safer. TI’s complete end equipment solutions for medical applications leverage our product expertise in microcontrollers, high-speed/precision analog, high-resolution imaging DSPs for personal medical devices and medical imaging products. TI is helping shape technology to improve the quality and accessibility of medical equipment to revolutionise healthcare in the 21st century and beyond.

Speaking of which, TI recently launched two new products - AFE5807

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Spotlight and AFE5808. These two products are an addition to TI’s analog front end (AFE) family. The AFE5807 and AFE5808 address ultrasound designers’ need for superior performance and image quality with the best noise performance. Also, these new devices are 25 percent smaller than competing solutions and ensure a compact system footprint for higher channel count. Another initiative by TI is TX810, an integrated transmit/receive switch which speeds ultrasound design and reduces board space by more than 50 percent, hence enabling designers to build portable ultrasound equipments.

TI’s ADS1298 for ECG machines reduces component count and power consumption by up to 95 percent as compared to discrete implementations, with a power efficiency of 1 mW/channel, enabling customers to achieve the highest levels of diagnostic accuracy at low power.

TI’s experience in diverse markets enables engineers to meet increasing needs for higher speeds, higher precision, lower power and smaller equipment, while maintaining the high standards for quality and reliability that the medical market demands.

Having a strong global footprint, how do you place Indian market in terms of size, opportunities, challenges and trends?

The Indian healthcare sector to be specific is booming. The growing hospital infrastructure and healthcare spending is fostering the need for high–end devices for accurate and fast treatment. The key drivers that are fuelling growth in medical devices include increasing population and affordability by patients, increasing prevalence of lifestyle diseases and improved hospital infrastructure.

Improving Indian economy and increasing disposable income has led to significant change in the manner an average Indian views healthcare. Visiting a hospital only when severely unwell is passé; the new Indian now undergoes regular health check–ups at periodic intervals.

Further, with the shift towards urban

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lifestyles growing at a rapid pace, the incidence rate of diseases like diabetes, chronic heart diseases, cancer and hypertension has increased significantly in India. Increased diabetic population in India is has led to more and more people taking their personal healthcare more seriously than ever.

The past decade has witnessed a significant growth in the number of highend hospitals in urban India. Healthcare has become more accessible in these areas. In the tier II and III cities which are yet to witness this growth, there is a growing demand for high-end medical equipments and quality healthcare In an emerging market like India, there is a lot of potential for growth and demand for medical electronics (of which semiconductors are an essential part).

The increasing awareness of healthcare has created a rapidly growing need for innovative medical solutions like portable & affordable ultrasound applications for use in doctors’ equipment, ambulances, mobile triage solutions and remote regions.

Semiconductors are set to play a pivotal role in designing and developing portable and affordable medical devices.

The connectivity enabled by semiconductor technology (wired or wireless) will drive applications such as telemedicine that will facilitate access to the required level of healthcare.

Also, Indian electronics OEMs are developing a number of portable devices like digital thermometers, blood pressure monitors, insulin pumps, heart rate monitors, digital hearing aids etc. in addition to hospital equipment like CT and MRI scanners, x-ray machines, ultrasound scanners etc.

The move towards the greater adoption of semiconductor technology in medical has resulted in an improvement in the quality of life and higher productivity. Areas like preventive healthcare, technology solutions for disability and high quality healthcare for diseases are also being addressed. Also, medical practices are gradually moving out of the doctors’

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chamber into other spaces like the internet and homes. Modern technologies like telemedicine, e-healthcare and digitization are enabling more people to remotely monitor ailments without physically visiting a medical facility. Patient data storage and access has become safer and easier with patient consultation & diagnosis moving to the internet. Healthcare facilities have started using data servers to monitor and access complete patient information over a common network.

What are the various products, solutions and services offered by you in the Indian market?

TI is working closely with its customers in India in a wide array of sectors such as industrial electronics (UPS, inverters, energy meters, lighting, etc.), medical electronics (ultrasound scanners, x-ray machines, ECG machines, MRI scanners, etc.), consumer, telecom and automotive.

TI sees a lot of growth coming from these areas and to address the needs of the market, they have a strong portfolio of products comprising of microcontrollers, data converters, transceivers, amplifiers and microprocessors. Some of the major products that TI launched in 2010 include MSP430 Value Line series of microcontrollers, AFE5807 and AFE5808 analog front-ends, TPS63020 buckboost converter, CC8520 transceiver and THS770006 operational amplifier amongst others.

TI sees a lot of opportunity in the country rapidly booming market for technology products and services. It has 14 sales and marketing offices across 12 cities in the country including some in small cities like Nashik, Coimbatore and Chandigarh to cater to after–sales applications support.

TI’s field application engineers also co-design with partners and customers and help them in trouble-shooting in terms of system design. Unlike earlier, TI customers no longer have to travel to US or Bangalore for any kind of assistance, the engineers at the local offices provide on-ground support.

In Focus

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“ICT is a vital tool for efficient delivery of healthcare services” Amod Kumar is an Indian Administrative Services officer of the 1995 batch, belonging to UP Cadre. He has held several positions in the UP government, some of which include, Special Secretary, Basic Education & Director, Mid-day-Meal; Special Secretary, Revenue and Special Secretary, IT. Currently, he is working in the capacity of Project Director, Maternal and Newborn Health Project (Manthan Project) at IntraHealth.

Pratap Vikram Singh, in conversation with Amod Kumar finds out details of the MNH project and the effective use of ICT in the projects that Amod has been associated with

Please elaborate on the work being done in the health sector in the state of Uttar Pradesh by IntraHealth?

Manthan Project is a US $4 million initiative funded by the Bill & Melinda Gates Foundation. It aims to improve the health of mothers and newborns in northern India. Compared to other Indian states, Uttar Pradesh has the highest percentage of maternal and neonatal deaths in India.

With a duration of four years, this project will work with the Uttar Pradesh state government to identify proven, effective mother and neonatal health (MNH) interventions; advocate at district, state, and national levels to promote the adoption and scale-up of these interventions and expand healthcare services to more mothers and newborns.

Being one of the UN Millennium Development Goals, reduction in child mortality by two-thirds by 2015, the existing state of neonatal health is not encouraging worldwide. Reports suggest out of an estimated 130 million infants born each year worldwide, 4 million die in the first 28 days of life. Three-quarters of neonatal deaths occur in the first week, and more than one-quarter occur in the first 24 hours. Neonatal deaths account for 40 percent of deaths under the age of 5 years worldwide. Two-thirds of the world’s neonatal deaths occur in just 10 countries, mostly in Asia. Almost two third of the mortality, that is 67 percent, occurring in the infant group happens with neonatal category.

Speaking India centric, there are some critical managerial and administrative gaps in the way government has dealt

with on these healthcare and nutritional issues, which have lead to the poor state of delivery of services. With intent to eliminate these gaps, the project objective is to put innovations in the plan itself so that it is completely functional, with the least error.

Another major focus is on to rope in the private sector in facilitating quality health care services. We would explore the adaptability and application of successful models like Chiranjeevi in Gujarat and Rashtriya Swasthya Bima Yojana (RSBY) at Central level. Similarly, Madhya Pradesh has got a successful model known as Janani, which has recently been evaluated by UNICEF and involves facility assessment.

How do you propose to use ICT for better delivery and monitoring of services?

We see ICT as a vital tool for efficient delivery of healthcare services. Although leveraging ICT is still at a conceptual stage, we would be using ICT in threefour ways. First is to reach to the ultimate client through SMS, educate them on remedies and initiate a behavioral change.

We plan to direct IVRS calls, giving reminders about the precautions and timely intake of medicines. We also want to educate and remind the ASHA workers (the healthcare workers in the state) through the use of multimedia-smart phones, which are now available at much cheaper prices. We can store a video on educating the workers and aiding them in better counseling. Another agenda is to improve monitoring through generation of management information systems (MIS)

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In Focus

reports. Through ICT, we can gather, deduplicates and analyse the data in a better fashion, with an ultimate objective of use of data in planning. Fortunately, because of RSBY, we have the base line data. Since the work involves research, advocacy and aiding government in planning and decision making, we have not sketched figures for assessing project outcomes. The outcome could be gauged in the degree of receptiveness in the government and the subsequent efficiency and equity created at the grassroots level.

Amod Kumar Project Director â&#x20AC;&#x201C; Maternal and Newborn Health Project (Manthan Project), IntraHealth

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Can you throw light on the ICT systems deployed for monitoring of mid-day meal scheme in UP, while your association with the state Mid-Day Meal Authority?

During my association with the mid-day meal authority, we developed a system to monitor the mid day meal scheme with the help of cloud telephony. For its monitoring in all the 1.5 lakh schools in the state of Uttar Pradesh, the department gives IVRS calls to all the teachers through which the teachers are asked for the number of students who took meals on that particular day. Almost 1800 calls are made parallely. By evening the department gets data for all the schools.

Initially, the teachers are informed that the call is being made on behalf of the mid-day meal authority. It asks the teacher to punch in the number of students who were served the meal that day. If the teacher punches in zero, he is given four reasons and told to punch in the appropriate number. The reasons are: 1. Cook was absent; 2. Non-availability of raw material for cooking; 3. Transportation problems; and 4. Other reason. The responses are simultaneously recorded on the website of the mid-day meal authority. The BSAs can go to website, choose respective blocks/district and check the daily meal reports. All this is done in Hindi language. Now, the Union Ministry of Human Resource Development is deliberating on scaling up the monitoring project across all states and UTs.

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event report

Medicall 2011 at Kolkata 6th Edition of MEDICALL organised at Kolkata 11-13 February 2011 By eHEALTH Bureau

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EDICALL – a Medexpert Business Consultants Pvt. Ltd. organised the 6th Edition of its annual conference MEDICALL. The show was inaugurated

by Dr. Surjya Kanta Mishra – Ministry of Health and Family Welfare – Govt. of West Bengal, INDIA on the 11th February 2011 at Netaji Indoor Stadium, Kolkata.

The fair consisted of 3 days from 11th February to 13th February 2011 at Kolkata and it was a comprehensive trade fair for hospital needs with concurrent medical conferences and seminars on cost control in hospitals, organising a Central Sterile Supply Department in Hospitals and Hospital Construction.

As MEDICALL 2011 – the 6th edition was planned for the first time in East India, the show attracted more than 1500 business visitors whose profile includes specialised doctors, members of medical fraternity, researchers, R & D Pharma professionals, Administration head and Medical Directors of Government and Private Hospitals and Nursing Homes, dealers and distributors, bio medical engineers, medical colleges. MEDICALL 2011 Kolkata had around 150 exhibitors from India, USA, Taiwan main sponsors were Premier Sponsor, Shuter-CoSponsor, BoC-India and Schiller. The medical equipment manufacturers met their objectives of meeting new clients

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and seeking agents in East India.

Seminar presentations were made

by Tapan Das-Manager-CSSD - Apollo Hospital, Sanjoy Das-Perfusionist-R G Kar Medical College & Hospital, Dr. Sujoy Kar-Head Microbiology & QA-Apollo Hospital, Manivannan-Parama Healthcare, Venu Isukapalli-AVP Healthcare Material Management, Genpact, Ananthapadmanaban-President-Kovai Medical Centre & Hospital, Ravikumar-Bio Vedas, Alok Roy-Chairman & M.D. Medica Synergie, Ayanabh Debgupta-CEO-Projects & Consultancy Division – Medica Synergie, R N Basu-Advisor Projects & Consultancy Division Medical Synergie and Anirban Das Principal Architect-Projects & Consul-

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tancy Division-Medica Synergie, Kolkata.

There were positive strategies towards return on investment which drew enthusiasts and visitors to do business & network.

MEDICALL 2011 catered from the humble to the hospital consortiums & chain with a pro-active pledge to offer the best the customer could desire. Of course further establish & develop footprints in the market. In the MEDICALL 2011, both the medical equipment manufacturers as well as the business visitors could network and had an opportunity to facilitate informal referrals and exchanges. The 7th Edition MEDICALL 2011 will be held from 12th to 14th August 2011 at Chennai Trade Center, South India.

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news review

Corporate

Bihar plans health cards for Kids Bihar is set to become the first state in the country to issue health cards to 3.4 crore children in the age group of 0-14 years. Besides offering OPD facilities and free medicines, the health card, which will be valid for five years, will also facilitate specialised medical treatment in premier hospitals like AIIMS, PGIMER Chandigarh and SGPGI Lucknow. According to WHO, 55 per cent of Indian children suffer from malnutritionrelated diseases before attaining the age of three years. The percentage is higher in Bihar. The scheme seeks to bridge the gap in the ratio between the two sexes by encouraging the birth of baby girl. On the birth of two baby girls in BPL families, a sum of Rs 2,000 each is invested through Children Career Plan of UTI Mutual Fund. The maturity amount is paid to the girl when she attains the age of 18 years. While some states already have health card schemes for school-going children in the age group of 6-14 years, Bihar is the first to include those less than six years old. The scheme — Nayi Pidhi Swasthya Guarantee Yojana — will also include adolescent girls below 18 years to focus on malnutrition. While medical camps will be organised every year — for which the government has earmarked an annual budget of Rs 125 crore, the health cards will enable

parents to seek follow-up treatment for their children at PHCs or block hospitals. Moreover, serious medical complications will be referred to the country’s premier institutes, with the government bearing the expenses. The health card will have full data including weight, height, ENT and dental records. Skin disease tests will be mandatory.

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ONC Announces New Project for EHR Systems Office of the National Coordinator for Health Information Technology (ONC) has announced the launch of an industry project to consolidate and harmonize required health information exchange specifications that support meaningful use of electronic health record (EHR) systems. The project, called the “HL7/IHE Health Story Implementation Guide Consolidation Project,” is a collaboration of Health Level Seven (HL7) International, Integrating the Healthcare Enterprise (IHE) and the Health Story Project. Through the consolidation and harmonisation effort, the project will address minor areas of ambiguity within the specific Standards Final Rule requirement to implement HL7 Clinical Document Architecture (CDA) Release 2, Continuity of Care Document according to HITSP C32. In addition to securing support from the ONC S&I Framework, HL7, the Health Story Project and IHE, a number of EHR, clinical document management, infrastructure, middleware and natural language processing vendors will contribute volunteers.

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Drugs

Schiller India launches a new MRI Monitor – High Dose of Folic MAGLIFE Serenity Acid is Unsafe in Pregnancy critical patients.

Schiller India, a leading Swiss Joint Venture Company in the field of Medical Diagnostics, has launched a new MRI compatible monitor called MAGLIFE Serenity. It offers complete and safe solution for monitoring high risk patients, undergoing MRI examination or MRI surgery. It has a large 12.1” colour TFT display which is widely adjustable for various viewing angles.

Featuring monitoring of ECG, SpO2, and NIBP as standard, additional parameters such as temperature and CO2 allows the system to monitor

According to Mr Hormazd Cooper, Vice President, Sales, “Its combination of monitoring basic / vital signs plus additional parameters such as CO2, temperature monitoring ensures that the Serenity system becomes the monitor of choice for small diagnostic MRI centres, as well as, full fledged hospital MRI departments, where critical & high risk patients are scanned. A major advantage of the Serenity system is that all optional parameters are field upgradeable and can be purchased

individually thereby negating obsolescence and protecting the hospitals investment.” Features of MAGLIFE Serenity are Large 12.1” colour TFT display, widely adjustable color display for various viewing angles, Compatible with 0.2 to 3 Tesla scanners of all manufacturers and non magnetic trolley provided as standard.

High doses of folic acid (vitamin B9) can lead to pregnancy problems, says a study from the McGill University. Folate reduces the chances of neural tube defects which later become the brain and spinal cord. It decreases the occurrences of birth defects like spina bifida (spinal cord protrudes through an opening in the bone.)

Researchers studied the effects of high doses (about 8mg per day) of folic acid on pregnant mice and found that they experienced embryonic delay and growth retardation.

The daily recommendation of folic acid is 0.4mg 3months prior to conception and 3months after conception i.e. the first trimester.

Lead researcher, Ms. Rima Rozen said, “Just because a small amount of something is a good thing, doesn’t mean more is better.”

Product

Post-Processing Capabilities of PACS Revealed Live The CARESTREAM PACS workstation was put through its paces at the recent 5th Scanner Volumique Conference held in Nancy, France. This annual event provides the technology platform for live demonstrations of the very latest versions of CT image post-processing software, which this year for the first time included a PACS console. Dr Orly Goitein, Head of Cardio Vascular Imaging at the Sheba Medical Center, Tel Aviv, Israel, carried out three live demonstrations using the CARESTREAM PACS, which included cardiac, vascular and oncology cases. These case presentations fully demonstrated the latest improvements to the console, some of which are still undergoing development.

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“The capabilities of the Carestream PACS workstation are impressive,” said Dr Orly Goitein. The automatic volumetric multimodality registration of prior exams allows fast, easy and efficient study comparison, which are daily tasks radiologists deal with. The dedicated post processing packages (for example: the cardiac, vascular and oncology packages) offer advanced reconstruction tools inherent within this PACS workstation system.”

Carestream Health was one of the first in the industry to integrate 3D image processing and image analysis tools into its PACS workstations; this innovation has led to marked enhancements in workflow since radiologists no longer need to go to

> www.ehealthonline.org > March 2011

a special workstation dedicated to postprocessing. Likewise, the CARESTREAM PACS architecture enables the use of 3D functions via its intuitive user interface from any workstation, inside or outside the facility. Advanced processing capabilities of the CARESTREAM PACS platform comprise: automatic segmentation of all vessels (including cardiac vessels), automatic volume synchronisation of different exams, MPR (MIP/MinMIP/CurveMPR), volume rendering, Stenosis quantification and aneurysm assessment, measurement of cardiac ejection fraction, CT/MR/PET image fusion, lesion detection and quantification and specialised measurement tools for mammography and orthopaedics.

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Life Sciences

Diet Low in Omega 3 May Trigger Disorders

New Vaccine for TB Developed

Insufficient omega-3 fatty acid in diet may cause harmful consequences on synaptic functions and emotional behaviours, a new study found. These fatty acids are â&#x20AC;&#x153;essentialâ&#x20AC;? lipids because the body cannot synthesise them from new. They must therefore be provided through food and their dietary balance is essential to maintain optimal brain functions. Researchers from Inserm and INRA and their collaborators in Spain collaboration, studied mice fed on a diet low in omega-3 fatty acid. They found that omega-3 deficiency disturbed neuronal communication specifically. This neuronal dysfunction was accompanied by depressive behaviours.

The results can now corroborate clinical and epidemiological studies.

Contrast-enhanced ultrasound can safely improve the diagnosis of a variety of medical conditions in children, according to a study by researchers at Jena University Hospital, Germany. In the study, researchers used contrast-enhanced ultrasound to image 50 paediatric patients. They found that the procedure was not associated with any adverse safety events in children, and they were able to successfully differentiate between a benign cyst and a perfused tumour. According to the researchers, unlike CT and nuclear imaging, contrast-enhanced ultrasound does not expose patients to ionising radiation, and it can be used to assess kidney infections, organ blood flow and internal abdominal injuries. The researchers have called for additional clinical trials to validate the use of contrast-enhanced ultrasound in paediatric patients.

Corporate

Dr Sudarshan K Aggarwal conferred with Lifetime Achievement Award Dr Sudarshan K Aggarwal of DCA Imaging& Research Centre has been honoured with K.R. Gupta Lifetime Achievement Award by the Indian Radiological and Imaging Association (IRIA), New Delhi. The award was presented to Dr Aggarwal at the 64th annual conference of IRIA held recently. He was felicitated for his contribution to the growth of

Radiology and for introducing advanced diagnostic technologies in India. Dr Aggarwal joined DCA Imaging & Research Centre in 1959 with a specialisation in Gastrointestinal and Uro-radiology. He took over management of the centre in 1989 and under his guidance the centre made remarkable progress in technology and expertise becoming one of the largest

standalone private radiology clinics in this region. DCA centres across Delhi offers a host of imaging modalities under one roof. He is the founder President for the SAARC society of Radiology and has been rewarded fellowship by the American College of Radiology, Royal College of Physicians & Surgeons, Glasgow) and the Royal Society of Medicine, London.

Product

Device in the Pulmonary Artery could Reduce Heart Failure An implantable device that monitors fluid build up in the lungs of heart failure patients and alerts doctors when intervention is needed can significantly reduce hospitalisations, according to a study published in The Lancet.

The device, manufactured

by CardioMEMS, is placed in the pulmonary artery in the lung using a catheter in a minimally invasive procedure. In a study conducted by researchers, 550 patients with moderately severe heart

failure were randomised to receive the device plus standard of care or standard medical care only. During the first six months, 83 patients with devices were hospitalised for heart-failure related problems, compared to 120

patients who did not receive the device, a 30 percent reduction in hospitalisations.

During 15-months of followup, patients with devices had 39 percent reduction in hospitalisations, compared to those who did not.

March 2011 < www.ehealthonline.org <

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