The Sound of imaging

asiaâ&#x20AC;&#x2122;s first monthly magazine on The Enterprise of Healthcare

volume 7 / issue 03 / March 2012 / ` 75 / US $10 / ISSN 0973-8959

www.ehealthonline.org

The Sound of imaging Powered by technology, new innovations and driven by new age hospitals, Ultrasound technology has taken a giant leap forward

visionary Dr Prathap C Reddy Chairman, Apollo Hospitals Group p-36

expert speak Dr Harsh Mahajan Director, Mahajan Imaging Centre p-12

in focus Conrad H Smits Senior Vice President and General Manager, Philips Ultrasound p-18

volume

issue

ISSN 0973-8959

contents

cover story The Sound of Imaging

We are witnessing a huge rise in the popularity of noninvasive ultrasound procedures, as the techniques are fast and inexpensive. Armed with an array of impressive tools and techniques our ultrasound professionals are offering quality healthcare service to large numbers of patients

Mahajan Imaging From X-Rays to Molecular Imaging

expert speak Ashwani Raina

General Manager- UIS and Radiology, Mindray India

13 14

Pranay Upadhyay

Dr Sushil Shah

S K Raman

Dr SS Doda

Business Development Manager, Scientech Technologies

Founder, Metropolis Healthcare Ltd General Manager, Marketing, Trivitron

Director, Dr Doda’s Diagnostics and Healthcare

Dr T B S Buxi

Dr Jignesh G Thakker

Head, Department of CT scan and MRI, Sir Ganga Ram Hospital Secretary General, Indian Radiological & Imaging Association

Chandrasekharan Suraj

K N Vijai Shankar Raja

Business Head, X-ray Products, Siemens

Managing Director.CURA Healthcare Pvt Ltd

Krishna Prasad

President, Prognosys Medical Systems

Dhirendra Pratap Singh and Shally Makin

MD, Lab India

Visionary “Technology will be the Force Multiplier for Health Delivery”

“I am in Healthcare by Default, not by Design”

A leader, who is determined to bring about positive changes in India’s healthcare scenario, Rajendra Gupta has done a lot for creating awareness among the masses. Here is a look on his journey that has led to his becoming the president of DMAI

India is an “Idea Factory”

“We Lead Pharma from the Forefront”

“Go Organic”

31 48 50

in conversation V S Upadhyaye

Conrad H Smits

Dr Prathap C Reddy, the most respectable name in Indian healthcare talks heart to heart with eHEALTH magazine about his journey of bringing world-class healthcare to the masses in India

tech trends The Digital Twist in Diagnostics

In focus Senior Vice President and General Manager, Philips Ultrasound

By Shally Makin

featured profile

Annaswamy Vaidheesh, who is known as an exemplary business leader, talks about the innovative ideas through which he plans to drive the future prospects of J&J

With strong entrepreneurial spirit and localised strategies, Kewal Handa, Managing Director, Pfizer Ltd, has so far guided three major mergers

Krishan Guptaa, Managing Director and Global Chief Executive Officer (CEO) at Organic India, has been having lot of fun as he overcomes new obstacles while leading his company to success

GUEST ARTICLE Radiology and Its High-tech Tools Dr Amar Jain

Ring of Healthcare Dr Ruchi Dass

DOC TALK Heart Ache to Heart Age Dr Hygriv Rao

EXPERT CORNER

Instant-on Cloud Enabled Healthcare Infrastructure Solution Dr Jaijit Bhattacharya, Ritu Ghosh and Dr Anjali Nanda

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volume

issue

asia’s first monthly magazine on The Enterprise of Healthcare

President Dr M P Narayanan

Editor-in-Chief Dr Ravi Gupta

gm Finance Ajit Kumar

dgm strategy Raghav Mittal

programme Dr Rajeshree Dutta Kumar specialist product manager Divya Chawla partnerships & Sheena Joseph Alliances Shuchi Smita Editorial Dhirendra Pratap Singh, Anand Agarwal, Pragya Gupta, Shally Makin (editorial@elets.in) Sales & Delhi ncr Marketing Rakesh Ranjan Mobile: +91-8860651635 Fahimul Haque, Jyoti Lekhi, Ragini Shrivastav (sales@elets.in) Mumbai: Rachita Jha Pune: Shankar Adaviyar Bangalore: Puneet Kathait Hyderabad: Amit Kumar Pundhir Ahmedabad: Sunil Kumar Circulation & Jagwant Kumar, M: +91-8130296484, Subscription Gunjan Singh, M: +91-8860635832 subscription@elets.in Design & Bishwajeet Kumar Singh, Creatives Om Prakash Thakur, Shyam Kishore Web Ishvinder Singh, Anil Kumar IMG Gaurav Srivastava IT infrastructure Mukesh Sharma, Zuber Ahmed

Events Vicky Kalra

human resource Sushma Juyal

legal R P Verma Accounts Anubhav Rana, Subhash Chandra Dimri Editorial Correspondence eHEALTH Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th floor, Tower - 2 C-25 , Sector 62, Noida, Uttar Pradesh 201301 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. 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 Vinayak Print Media, D-320, Sector-10, 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.

march / 2012 www.ehealthonline.org

inbox It is a good concept and also be concentrated on rural people and skilled workers in urban area. The product should be sold manually also (without online submission) for which the pharmacy staff may be trained. Murugaiah K, CEO, Karpagam University Coimbatore on “Health insurance plans at pharmacies in near future” This yojana is best for poor families. I hope Maharashtra govt will implement this scheme honestly but what about old persons who are living alone with their kids grown up and living separate. They need also medical help. Are they entitled to get these facilities? Shaikh Abdulrab on “Rajiv Gandhi Jeevandayi Arogya Yojana launched in Maharashtra” The suggestion given by Deputy CM is most needful looking towards fast growing population which becomes the serious problem. So the sweet family 2+2 should be beneficiary only when the policy of birth control will be well encouraged. Sakha Nilawar on “Rajiv Gandhi Jeevandayi Arogya Yojana launched in Maharashtra”

A good innovative conceptual model for providing health information education and counseling Manoj Kumar on “e-Swasthya Kutir” Over a 100 Pneumatic Tube Systems (PTS) are installed in healthcare facilities in India. Lack of available skills in operations and management of PTS is a critical impediment that continues to foray trouble and inconvenience to the users. Although the PTS enhances healthcare logistics to event up to 70-80 percent but due to lack of adequate and skilled knowledge the operations of the systems are affected. A.C Gangadharan on “Accreditation is Need of the Hour” With the advancement of technology on radiology over the last decades, almost about 60-70 percent diagnosis depends upon radiological investigation. Even The radiologists are close to tissue diagnosis as reveled in many studies. Thanks to industry revolution. Prof Satish K.BHargava, Past National President, Indian Radiological Imaging Association on “eHEALTH magazine celebrates March as the Radiology Month”

eHEALTH magazine now available at Magzter for iPhone and Android

editorial

Medical Miracles Like any rainbow shining out of the mists of the horizon, the ultrasound technology has started spreading its true colours. The journey from the Black and White era to the vibrant colour Doppler system is now complete. A favourite with healthcare professionals, the ultrasound system has become an inseparable part of the medical industry. Such is the demand for ultrasound systems, that the growth of this sector remains completely unaffected by the economic downturn in foreign nations. The Indian ultrasound market is on a high growth path. It is expected to clock US$ 200 million by 2015 and is forecast to grow at a Compound Annual Growth Rate (CAGR) of 13 percent. Today analysts are valuing the Ultrasound Market in India to approximately ` 500 crore. Digital radiology is one of the greatest technological advancements in medical imaging during the last decade. Enormous benefits are accrued from this technology. The use of radiographic films in xray imaging is on its way to becoming obsolete. In digital radiology images are no longer held in a single location, they can be viewed simultaneously by physicians who are kilometres apart. In addition, the patient can have the x ray images on a compact disk to take to another physician or hospital. In the current issue of eHEALTH we have conducted an in depth exploration of the Digital and Computed Radiography industry. A profound determination, spirit of working together backed by the enthusiasm of a “can-do” spirit can assure the success of mission. There are some personalities in the field of healthcare who have made the impossible possible through their vision and spirit. The March issue of eHEALTH is also dedicated to action heroes in healthcare sector during last decade. Dr Prathap C Reddy, the founder of the Apollo Hospital Group, India’s first corporate hospital group has revolutionised the whole health care scenario of India. In an interaction with eHealth, Dr Reddy talked about his journey. Other leaders featured in this issue are Rajendra Pratap Gupta, Krishan Gupta, Annaswamy Vaidheesh and Kewal Handa. We hope you like this compilation!

Dr. Ravi Gupta ravi.gupta@elets.in

march / 2012 www.ehealthonline.org

Cover Story

We are witnessing a huge rise in the popularity of non-invasive ultrasound procedures, as the techniques are fast and inexpensive. Armed with an array of impressive tools and techniques our ultrasound professionals are offering quality healthcare service to large numbers of patients

The Sound of Imaging By Shally Makin, Elets News Network (ENN)

ltrasound is now revealing its true colours. The journey from black and white to colour doppler system is now complete. A favourite tool for healthcare professionals, this diagnostic tool shows tremendous growth in spite of the economic downturn in foreign nations. The ultrasound market is segmented into three broad categories, black and white machines, colour doppler units and laptop systems. The market has acquired a large customer base. There is a movement towards the usage of miniaturised ultrasound probes and evolution of four-dimensional capabilities. This equipment is now being used in various fields including ob-

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stetrics/gynaecology, surgeries and cardiology. Highest usage is in obstetrics/gynaecology. One of the cheapest diagnostic tools in the medical equipment industry, the installation of ultrasound systems has become a priority for hospitals. It is a great investment for hospitals. Pioneering technology advances through cardiac imaging to 4-D neonatal imaging in a portable ultrasound system to real-time image viewing. Ultrasound started its career from foetal imaging and today the technology is regarded as the best tool for foretelling the development of the foetus through myriad stages. During ultrasound evaluation, the foetus is completely safe from ionizing irradiation. The live-action 4-D technology offers 3-D views

Cover Story

to enable physicians and sonographers have a closer view of foetal development. The Indian ultrasound market is on a high growth path. It is expected to clock US$ 200 million by 2015 and is forecast to grow at a Compound Annual Growth Rate (CAGR) of 13 percent. With the advent of various schemes from the government, the reach of ultrasound can only rise. It is spreading across the healthcare market and making seminal contributions in the reduction of mortality and morbidity rates during pregnancy. The National Rural Health Mission initiative of the government makes use of ultrasound systems to promote safe pregnancy and motherhood. Apart from the major players including GE Healthcare, Philips, Siemens, Sonosite, Mindray, Esoate Healthcare, Aloka Inc and Toshiba generating 70 percent of total market revenue market, a whole lot of companies are now venturing into the ultrasound sector with Samsung medicine and the industry also entertains companies which focuses on ultrasound applications for womenâ&#x20AC;&#x2122;s health in obstetrics, perinatol-

Dr Devlina Chakravarty

COO & Medical Director, Artemis Health Institute

ogy and so forth. The market majorly has Chinese and Korean manufacturers who import low-cost machines blended with latest technology. There are various technological trends taking place in the market and that includes fusion imaging, fourdimensional imaging, elastography and miniaturisation.

â&#x20AC;&#x153;Interventional radiology is the need of the hour today as it provides a simplistic, cost effective model of treatment leading to lower mortality and morbidity rate.â&#x20AC;? The radiation free technique has emerged profitable in terms of its versatility, advancements in technology and wider clinical application. Ultrasound market in India is valued at approximately `500 crore today. Colour Doppler segment sharing 90 percent of the total Indian ultrasound equipment market dominates with 13 per-

Amit Bana, Manager, Medical Electronics Department, Blue Star Limited (INDIA) The ultrasound market has suffered in terms of increased expense on importing machines as the dollar has gone up. Over the recent years, the Indian ultrasound industry has witnessed a tremendous growth, in spite of the economic downturn in foreign nations. The company offers the latest technology in the healthcare industry. From PACS to the best of MRI system, Blue star offers high end colour Doppler used in elastograghy for breast cancer. Ultrasound has created its niche in oncology treatments. The strength of Blue star lies in MRI of 0.5 to 1.5 and 3 Tesla. The black and white ultrasound system costs around 1-5 lakh and the market remains stable used in standalone centres. A Colour Doppler costs between 10 to 50 lakhs and the mid segment products range from 15-16 lakhs. The purchas-

ing power of the buyer is also increasing and so does the high end systems costs around 20-40 lakhs each. The high end segment with the latest technology will dominate this financial year. MUS 8400 is a fully digital ultrasound system with latest signal processing technology and sophisticated transducer design; Blue Star brand colour Doppler system, 17-in flat panel display with four active ports MUS 602, B/W; Blue Star brand B/W portable ultrasound scanner with highresolution display for all applications . Other products are ultrasound bone densitometer, ultrasound scanners (B/W and colour) and many more. Blue star was presenting Hitachi before and today Aloka has created very good name along with Trivitron where ultrasound dominates the market. Blue Star happens to be in the field from past three

decades. The company now plans to import a machine from international supplier under Blue Star India Limited. With advancement in cardiac imaging CT scan can replace angiography which are 64 slices and above. The primary diagnostics are now changing their equipments to 64 slices as they are better in imaging. The cardiac CT scanner market is growing at the rate of 10 -20 percent per year. march / 2012 March www.ehealthonline.org

Cover Story

Dr Rajesh Kapur Vice President, IRIA

Today ultrasound gives a clearer view of the body parts which further help in monitoring and developing treatments for conventional surgeries cent growth in revenues with 3D and 4D imaging in cardiology and radiology. GE Healthcare has revolutionised ultrasound products with its new range of portable ultrasound system. It has worked to simplify ultrasound reporting and image management with its flexible and intuitive system. The solution provides the ability to integrate ultrasound with HIS, RIS, EMR and PACS systems, and communicate across departments, hospitals and enterprises to help reduce dictation and transcription. It is possible to utilize 4D view for offline processing and creating preliminary and final reports easily using new “quick reports” templates. Dr Rajesh Kapur, Vice President, IRIA, opines, “New additions in radiology are the contrast feature in ultrasound which was earlier seen only in MRI and now we see in ultrasound as it can pick up infection with greater degree of confidence. Ultrasound equipments need to be registered with the authorities before use. There are 35,000 systems registered so far which are catering to more than a million people along with unregistered systems further gratifying the whole country.” He believes, “Today ultrasound gives a clearer view of the body parts which further help in monitoring and developing treatments for conventional surgeries.” Sonosite has introduced a suite of specialised products for point-of-care visualisation in medicine with brilliant image quality and simplified controls that enable clinicians to focus in on their

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target areas in a matter of seconds. For overall improved detail and contrast resolution, the EDGE ultrasound system is engineered with new proprietary imaging algorithms that reduce speckle noise. The system also boasts a high luminance LED, high resolution 12 inch display, making it easier for clinicians to see the ultrasound image from across the bed during procedures. Philips offers an innovative product with superb image quality and sophisticated workflow solutions that helps in healthcare through the eye of radiowaves including technologies such as Xmatrix and HD 15 ultrasound systems. Soft tissue navigation, instrument tracking, image fusion, increased visualization during catheterbased procedures, transesophageal imaging, and sophisticated quantification is creating a mark in the industry. In combination with their comprehensive suite of elastography applications, Siemens highlighted its new strain imaging application Virtual Touch tissue IQ imaging, reinforcing the company’s role as a leader in strain elastography imaging last year. The new ultra-premium ACUSON S3000 ultrasound system advances Siemens’ pioneering ultrasound technologies with its proprietary eSie Fusion imaging, which enables the automatic fusion of 3-D computed tomography (CT) volumes with real-time ultrasound via a single click. Current fusion techniques require time-consuming manual registration of CT or magnetic reso-

nance (MR) images. They also require the patient to lie motionless throughout the entire exam to avoid elaborate manual realignments. Focused ultrasound (FUS) could be the ultimate form of non-invasive surgery to destroy tumours without making any incisions and without harm to other organs. It can replace the need for most radiation treatments and transform pharmacological therapy by delivering drugs precisely where needed without harm to the rest of the body. It can also dissolve blood clots and restore flow through blocked vessels. Just like a converging beam of light, converging radiowaves can concentrate up to 1000 intersecting beams of ultrasound energy with extreme precision on a target deep in the body as small as 1 mm in diameter and thereby treat the tissue. Ultrasound can also be useful in cardiology providing a tomographic orientation of coronary arteries and offer qualitative information on plaque composition and response to interventional strategies. The frequency of the ultrasound used is typically centred at 12.5 - 50 MHz. Researchers are exploring new and creative areas of IVUS with Doppler capabilities to allow for simultaneous hemodynamic assessment of the stenosis. Continued improvements in transducer design and technology will allow for better resolution and penetration of ultrasound waves. Dr Devlina Chakravarty says, “Interventional radiology is the need of the hour today because so many procedures require diagnosis of the disease initially and then radiology equipments including ultrasound can now be of therapeutic use in some cases. It thus provides a simplistic, cost effective model of treatment leading to lower mortality and morbidity rate.” Neurosurgery is at an experimental stage and this may further help in treating cancerous cells with an integrated special MRT treatment table acting as a probe head whose sound waves can melt tissue with precision at specific points. A local temperature of 60 to 80 degrees Celsius is created, thereby melting the myoma but sparing the surrounding tissue. The therapeutic use of ultrasound is now being done to remove excess sub-

Cover Story

Dr Brij Bhushan Thukral, MD, HOD, Department of Radiology, VMMC and Safdarjung Hospital Brief us about the Radiology market and its role in the healthcare industry. Radiology market is set to grow in leaps and bounds due to rapid advancements in information and nano-technology. In next few years molecular imaging is going to give the field of medicine a very big surprise. The industry will play a much greater role in providing the technology to the radiologists and clinicians alike. I see a huge growth in the market share of radiology. Tell us about the latest trends in the ultrasound market and in the digital and computed radiography. Latest trends in DR/CR include advances like transmission of high quality images to the treating clinician within no time. This will not only bring efficiency in the process of providing treatment, it will also help in saving the film expenditure as electronic medical records will get generated. In the field of ultrasound, the reduction in price and addition of new technical advances to the system is going to raise expectation of the end users i.e. Radiologists.

Do you think the industry needs well trained technicians to adapt new systems and technologies? Yes certainly. We do need well trained technicians to handle advanced equipments. To fully exploit the potential of technology, the training of the technicians has to go hand in hand. If trained technicians are not there, the benefit of advancement in technology will be lost. Digital radiology will be lagging behind in market share if the costs are not brought down soon as CR technology is competing well in terms of price despite inferior technology and relative slowness of the system. What are the challenges and opportunities faced by the ultrasound market presently? There are many challenges and opportunities . We need to integrate the new technology. We also need to improve transmission to the radiologists. The inclusion of colour Doppler will add to the quality of the diagnosis. Also inclusion of elastography and contrast studies is going to give it a boost. There is a need for more research in the field of contrast development to make it cheaper and better.

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Cover Story

cutaneous fatty tissue using high-energy sound waves which is a bloodless and anaesthetic-free procedure.

Challenges Although the spread of ultrasound technology is not the root cause of increase in incidences of female foeticide, the compact, portable and relatively low-cost nature of this technology does increase the complexity of administratively overseeing and prosecuting medical practitioners, companies or other individuals who misuse the technology to assist in sex-selective abortions. With booming population, and increased awareness about the portable ultrasound systems, there has been an increase in the misinterpretation of the Pre-Natal Diagnostics Techniques (PNDT) Act. Manufacturers must confirm that their customers have valid PNDT certificates and have signed affidavits stating that the equipment shall not be used for sex determination. Given the multiple uses for ultrasound in obstetrics and gynecology, restricting access to the technology would conflict

with the human rights goal of reaching the highest standards of health. The market today is witnessing increased competition and lack of awareness. The ultrasound industry has advanced to incredible heights, not only as a diagnostic tool, but also as a therapeutic device to become a more engrained part of the cancer industry. From a sole practice of ensuring babyâ&#x20AC;&#x2122;s health in the womb, ultrasound shows great potential in the healthcare industry. With unlimited use in healthcare, the demand for the latest ultrasound trends is literally changing with the seasons.

Policy Watch The healthcare industry is facing deficit of trained professionals especially in the field of radiology. The misuse of the technology can lead to punishment, as per the PNDT act. Any newcomer from college cannot use such machines. Requisite permission is needed for using such equipments and certified PNDT act. Today, the process of certification is very strict, even if the radiologist is ex-

Dr Harsh Mahajan, Director, Mahajan Imaging Centre Ultrasound waves were first used for medical purposes in 1940. The concept is simple, high frequency sound waves sent into the body bounce back off the surface of the organs. The fundamental principle being used is the same as in case of Sonar, and an image of the organ gets created. Ultrasound, which is a universally available and inexpensive tool, is mainly used for diagnostic purposes. Most cases done today are for pregnancy evaluation and abdominal scanning. Other applications include scanning of the joints, muscles, blood vessels (by Colour Doppler), breast and other organs. At Mahajan Imaging, we have been using ultrasound for taking biopsies of lesions at difficult locations with great accuracy. Recently at one of our centres, we started fusing ultrasound data with MRI and CT data of patients for better visualisation of diseased tissues. Also, we have started doing elastography of the breast, thyroid, prostate and liver. We are in the process of collaborating with the biggest liver hospital in India to evaluate the potential usefulness and accuracy of ultrasound liver elastography. In the next few months, we are coming up with the countryâ&#x20AC;&#x2122;s first stand-alone image guided therapy centre where we would be treating uterine fibroids and bone tumours using MR Guided High Frequency Focused Ultrasound (MR-HIFU). In the near future this same technology will be used for treating cancer of the prostate, breasts and even diseases of the brain. The medical ultrasound is an ever evolving modality whose applications are increasing day by day.

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perienced. The vendors are thus facing a shortage of certified and trained technicians in the industry. Policies are now becoming stringent when it comes to monitoring medical equipments such as ultrasound since the State governments would be now responsible for monitoring the disposed ultrasound machines. The use of unregistered machines will lead to a three-year jail term with a fine of up to `50,000. The fee for registration of the machines has increased substantially. MCI now accounts for registration and cancellation of doctors convicted under the Act. The Ministry had appointed a nodal officer to coordinate issues relating to the implementation of the Act. Portable ultrasound machines were banned, except those in hospitals and mobile-care units of the National Rural Health Mission. As the country travels on the path of economic reforms and prosperity, there is demand for quality healthcare. Quality healthcare needs installation of top class ultrasound facilities. Hence we can rest assured that the industry will remain on a high growth path for a long time to come.

featured profile

Mahajan Imaging

From X-Rays to Molecular Imaging One of the leading imaging centers, Mahajan Imaging has a history of bringing new technologies into the private sector in the country

n the year 1988, a young doctor returned home after spending one year in the United States of America having learnt about a new diagnostic modality called the MRI (Magnetic Resonance Imaging). This was a time when the common perception of a radiologist was that of one who reads only X-Rays. He left the greener pastures of the West with a dream to provide world class diagnostic facilities to the people of India. In 1991, one of the first few MRIs in the country was set-up in Delhi by this young doctor, Dr Harsh Mahajan, the founder of Mahajan Imaging Pvt Ltd. From that day, there has been no looking back and his dream to bring to India, the latest and best technology in

Radiodiagnosis, is slowly but surely being realised. Over the years he was able to successfully build a team of highly skilled and dedicated imaging specialists, who were equally passionate about their work. The entire team strives for perfection and provides the highest level of diagnostic care to patients, rich and poor alike. The reliability and authenticity of the quality of work done is borne out by the fact that doctors and their families usually prefer to get their own scans done at these centres. Mahajan Imaging has a history of bringing new technologies into the private sector in the country, for example, functional MRI, MR Tractography, MR mammography, CT coronary angiography,

4D ultrasound with tomography, PET-CT, CT-guided robotic biopsy, digital mammography, DEXA bone densitometry and Cone Beam Dental CT. Continuing the said trend, they have recently become amongst the first to offer the standing open MRI (G-Scan) for spine and musculoskeletal applications. Always giving patient-interest the highest priority, Mahajan Imaging has recently invested in two DR X-Ray systems which significantly decrease the radiation dose supplied by X-Ray scanning and hence decrease the radiation exposure to the patient. There are currently six centres in New Delhi, with the flagship standalone centre in Hauz Khas and other centres located in prestigious hospitals including Sir Ganga Ram Hospital, Fortis Hospitals and Dr BL Kapur Memorial Hospital. They have recently got into the first ever Public-PrivatePartnership with the Ministry of Health & Family Welfare, Government of India, and set-up a world-class high-end radiology department in the Sports Injuries Centre in Safdarjung Hospital, New Delhi. All tests done at this centre are at very low government approved rates, without any compromise on quality. Their department of PET-CT and nuclear medicine at Sir Ganga Ram Hospital, New Delhi is one of the most experienced such departments in India and many patients routinely come for second opinions from other parts of the country. Mahajan Imaging conducts postgraduate teaching at the Department of PET-CT and Nuclear Medicine, Sir Ganga Ram Hospital, New Delhi and Department of Radiology, BL Kapur Memorial Hospital, New Delhi. Apart from routine clinical imaging, Mahajan Imaging is also involved in advanced clinical and applied research and their partners include Massachusetts Institute of Technology (MIT), Boston, USA, All India Institute of Medical Sciences, New Delhi and Indian Institute of Technology (IIT), Delhi. Mahajan Imaging is also involved with a number of software development companies and aims to integrate information technology with healthcare to improve patient-care and streamline and simplify access to medical services. march / 2012 www.ehealthonline.org

in focus expert speak

“Mindray has Grown at 50 Percent During Last Two Years” Ashwani Raina General Manager- UIS and Radiology Mindray India

What are the ways by which Ultrasound Technology leads to improved diagnosis? Brief us about your products. Ultrasound has been the basic diagnostic tool in healthcare delivery for a long time, primarily due to its cost effectiveness and affordability. Ultrasound Market is a very dynamic market. The market is moving from ‘value for money’ paradigm to ‘value for many’. The latest technology breakthroughs like 4D, elastogrpahy, contrast, fusion is adding lot of value to this modality in a big way. Clinicians are getting more and more tools on ultrasound, which is conducive for making clear diagnosis. Ergonomics and user comfort also is becoming an important factor on deciding the product. Our DC-7 Colour Doppler system has advanced features like 4D, multslice imaging and contrast imaging, with easy workflow and is available at affordable cost. DC-8 premium Colour Doppler has been recently launched. It has unique shell function and multi -parameter quantification in elastography. This provides more diagnostic confidence. Stress echo and TEE probes are available now and that opens new areas of clinical diagnosis for us. Ineedle software is really good for deeper biopsy procedure available

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with us. Mindray has a complete range of products from black and white to premium colour doppler in its offering. How do you think the market is growing? What is your market share in the industry? I believe market is growing at 16-18 percent. Thanks to the tremendous support and confidence that our customers have on Mindray, we are growing at approximately 50 percent for last two years in ultrasound business. There is steep increase in mid segment of colour doppler business. Black and white ultrasound market looks as if it is flat. Customers see in Mindray a very good alternative - high end technology, easy to use systems. Feedback from market positions us close to number three in the ultrasound market in India and our target for 2012 is to be the clear number three. Ultrasound systems have seen shift from a diagnostics product to a screening tool. In such a competitive market, how do you think you plan to strengthen yourself in the near future? India remains a high focus area for Mindray. We have increased our head count both in terms of quality and quantity in a big way and will continue to do so as

our needs modify over periods of time. We will increase our reach in the entire country by strengthening our channel partners too. Offices are scheduled to be opened in different regions to allow us to be more close to customers. Indian customers are getting involved in our product evaluation so they will have a say in new product development that is how we look at this market. We have strengthened our product range for cardio vascular segment, anaesthesia and premium colour doppler segment by releasing series of new equipments, which gives us lot of opportunity to cater to a larger market segment. What are the challenges faced by the ultrasound market presently? High interest rates on loans towards the purchase of Ultrasound equipments, and the appreciation of US Dollar, are the few challenges we face in the Indian market. Also we could see a lower number of financial institutions providing funding for purchase of equipments in rural / tier 2 towns. The number of financial players funding for smaller hospitals/diagnostics centres should go up. Overall Indian market is a growth story; if there are challenges, then there are also the opportunities.

expert speak

“Investments in High-end Ultrasound Equipment is Needed” white 2D machines to machines with colour doppler, 3D and 4D modality, and very high-end equipment which provides elastography and ARFI. Probes have become very specific with high resolution capability example multi-frequency probes, matrix probes and high frequency probes for specific organ imaging. The equipments are varying from large stand alone machines to light weight laptop versions. The latter permits a greater reach of ultrasound into operation theatres and ICU’S. In such a competitive market, how do you plan to strengthen yourself in near future? In case of ultrasound equipments, this can be achieved by imbibing the best of technology, keeping abreast of latest trends and always being on top of the learning curve. New investments in highend USG equipments are necessary, as this helps to increase diagnostic accuracy and brings more patients into the practice.

Dr Sushil Shah, Founder, Metropolis Healthcare Ltd Tell us about the latest trends in the ultrasound market. Ultrasound has expanded from B/W 2D modality to a dynamic modality with 3D and 4D capability. This has revolutionised the field of obstetric ultrasound, which has now become a more patient friendly and interactive experience. 3D ultrasound has also expanded new planes of imaging, which enables multisite viewing and visualisation of organ of interest in greater detail. High-end ultrasound

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equipment permits tissue elastography, which is based on stiffness of tissue and is conducive for evaluation of lesions. It has extensive role in breast, liver and thyroid imaging. ARFI helps in early evaluation of liver fibrosis. Do you think ultrasound technology has improved the diagnosis process? The equipments now available have a scalable range from routine black and

What are the challenges faced by the ultrasound market presently? Ultrasound has to keep up with more dynamic imaging modalities such as CT and MRI, where there are rapid scientific advancements. It has been brought under ambit of PC PNDT act and current legislation restricts use of ultrasound as a portable modality of investigation which otherwise is an excellent, non-invasive bed-side tool for quick diagnosis. A lot of young radiologists now want to pursue CT/MRI imaging, which is leading to shortage of qualified and well trained sonography doctors. Keeping costs of high end equipment in an affordable range so that the newer techniques can be made available to larger population also has to be addressed.

expert speak

â&#x20AC;&#x153;Hand-carried Ultrasounds are Becoming Increasingly Popular Among Cliniciansâ&#x20AC;? Pranay Upadhyay Business Development Manager, Scientech Technologies

Tell us about the latest trends in the ultrasound market. The ultrasound market is similar to the computer and mobile market. The ultrasound device segment has adopted this trend with the introduction of laptop-size and hand-carried ultrasound systems. Windows PC-based architecture and device miniaturisation are making it possible to pack increasing amounts of processing power into smaller and smaller medical devices. Notable trends include a push towards portable ultrasound devices, vascular ultrasound, and cardiology ultrasound. How the healthcare industry is playing with Ultrasound technology for improved diagnosis? Brief us about your products. The ultrasound technology has proven boost to the healthcare industry because of its variety of technological advancements such as 3D/4D-imaging, color doppler techniques, user friendliness, cost-reduction, new miniaturised technology, lower manufacturing costs and more advanced use of ultrasound in medical diagnostics. The understanding of various technologies, correct implementation and proper training of ultrasound devices is very important for the health care industry. Scientech Technologies Pvt. Ltd. presents a variety of Ultrasound Training System such as CT Scan, Medical Ultrasound, Doppler Sonography, Ultrasonic

TM Mode, Ultrasonic investigation with the eye are some of our unique products especially designed for educational and research purpose for biomedical engineering colleges, science colleges, medical institutes and research institutes. Caddo 10 E Computerized Tomography (CT) Training System is an important method to investigate inner structure of objects not only in medical diagnostics but also testing materials in different fields. Caddo 11E Ultrasonic investigation with the eye is used for ophthalmology studies using ultrasound application. Its largest importance lies in the area of bio-metry, in the measurement of distance in eye. Caddo 12 E Ultrasonic TM Mode is used for studies in echocardiography. How do you think the market is growing? What is your market share in the industry? It is quite clear that the market of ultrasound machines is growing rapidly. The demand of ultrasound in market is because of its advantageous and features. These are painless diagnostic procedure, absence of ionizing radiation (xray), decreasing prices, grooming population, portable & user friendly machines and few others. Currently, one of the fastest growing segments in the ultrasound equipment market is hand-carried ultrasounds that are becoming increasingly popular among clinicians throughout the world. Our products have significant share in the industry.

In such a competitive market, how do you plan to strengthen yourself in the near future? Scientech is an Indian company with a Global vision. Scientech products and services are in the market from decades. We are playing a small but an important role in making the lives of people better and this planet happier. We have excellent & unique ultrasound and imaging training systems that helps and trains medical professional & engineers. Our competitors are far behind in our educational training systems. We are the number one education solution provider. What are the challenges faced by the ultrasound market presently? There are certain factors and barriers for the growth of ultrasound machines in India. Strict implementation of pre-natal diagnostics tests act that would prevent deliberate abortion of fetus after determining the gender of the baby. This unjust practice has led to seriously-skewed male-female sex ratio. Hospitals, Nursing Homes etc. that carry out ultrasound tests are made to register and obtain a certificate to be allowed to do the testing. This certification is a tedious process that could take up to six months and more and becomes reason for withdraw of orders. Another reason is lack of awareness, skills and knowledge about the machines. A user should undergo a proper training before operating on ultrasound machine. march / 2012 www.ehealthonline.org

In Focus

Conrad H Smits Senior Vice President and General Manager, Philips Ultrasound

march / 2012 www.ehealthonline.org

In Focus

“Technological Advances taking place in Ultrasound are Unbelievable” As the diagnostic capabilities of ultrasound technology continues to grow beyond imagination, equipment manufacturers are bringing out state-of-the-art products. In India, Philips Healthcare has taken the lead in offering Radiologists ultrasound machines that are second to none Conrad H Smits, Senior Vice President and General Manager, Philips Ultrasound, in a candid conversation with Divya Chawla, shares a complete low-down on Philips’ ultrasound business How do you see the developments in ultrasound technology over the years? Currently, the two most important modalities in healthcare are Ultrasound and MRI. Somebody termed the MRI as the rich man’s ultrasound. Conversely, ultrasound is the poor man’s MRI. Both of them are radiation free and are growing fast. Ultrasound has been around for many years and is now seeing resurgence to a number of reasons. The technological advances that are taking place in ultrasound are unbelievable—for instance Philips’ xMatrix technology and ClearVue. Ultrasound has been playing a very interesting role in healthcare across the globe. In India it is because of the development of pressure on healthcare costs. In the US, it is because of the amount of money being spent on healthcare and in Europe, because of the rising healthcare pressure. Further, there is tremendous growth of emerging markets. The first responder technology like ultrasound plays an important role in emergency situations. In past, ultrasound was a domain of radiology limited to obstetrics/gynaecology. It was a technology that was operator dependent and needed trained manpower, for manipulating the transducer and reading the images. However, technological advancements make ultrasound much more accessible

to other departments including anesthesiology, emergency care, critical care, traditional radiology, women’s healthcare, and so on. There is a proliferation of use of ultrasound across the globe. Ultrasound is addressing the demand for better clinical results, more patient access and more affordable healthcare.

and white ultrasound systems used to be the best possible imaging solutions earlier. However, gradually they will fade out and more technologically advanced systems will takeover, because clinicians will realise that they can give better services to their patients at better economic value with the newer systems.

Compared to the developed world, is the Indian ultrasound market making enough progress? The pressures and the market demands are same in the US and India. If there is a larger demand or larger patient population that needs to be addressed in India, there are 40 million uninsured people in the North America. Echocardiography is growing in India and in North America and Europe. An ultrasound is an interesting modality that can fulfil the demands of emerging markets, as well as, very mature markets, because of the changing trends.

What are the roadblocks that impede the growth of the ultrasound market? What are Philips’ strategies for overcoming these challenges? Lack of training and education is the major reason for limited use of ultrasound in India, as well as North America. Since the technique is operator dependent, it requires skilled workforce for scanning. There is a need of systems with high level algorithms that understand the anatomy of a body, thereby helping the sonographers in making decisions. Anatomical intelligence is one of the areas that Philips is focusing on, together with bringing in highend technologies. It is fascinating to see how Philips’ ClearVue system performs.

Despite the technological advancements, black and white ultrasound systems continue to account for a major market share in India. What are your views on this? I think India is one of the most competitive healthcare markets in the world. There are many markets that rely on insurance or government involvement, but India is virtually a private market. Black

Can you tell us more about the ClearVue systems that Philips has recently launched? ClearVue was developed in India for India. We realised that if we want to be relevant in the Indian market, we have to develop in India and with Indians in a march / 2012 www.ehealthonline.org

In Focus

different way than what we have done in other parts of the world. The technologies can be developed there and these can eventually trickle through the Indian market as well. There is an interesting convergence of development waves that will benefit India, both in the highend and lower end segments. We want to participate in the growth of emerging markets by using high-end technologies and delivering better clinical results. The ultrasound business in ClearVue has been able to bring extremely high-end technology into transducers. Do you think ultrasound can replace the stethoscope? Somewhere in 1988, an article was written of ultrasound replacing the stethoscope. Today, I believe the biggest competitor for ultrasound is the stethoscope. If we want to truly help the Indian environment, we have to look beyond the boundaries. We are all visually oriented and play with iPads, etc., then why are we still checking the health of human body with our ears! Doctors need visual equipment as well and that’s where we need to focus and make a breakthrough. What are Philips’ future plans for ultrasound? What products are in the pipeline? In future, the ultrasound machines will definitely get smaller, but we have to ensure that smaller means better. While we are going in the future, bringing better clinical solutions that are more patient and operator friendly with better economic value and outputs is important. Philips Healthcare is looking at clinical benefits, patient benefits and economical offerings. We want to bring solutions such as Ingenia MRI that brings significant clinical benefits better economic value because of the throughput. If a machine has to bring better clinical value, it has to be less operator-dependent. Philips Imaging Systems, such as CT, MR, ultrasound and DXR, are all focusing on these pillars to bring better healthcare to the populations around the world. I think, Philips has, without doubt the best echocardiography equipment in the

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Recently launched ClearVue Ultrasound by Philips on display at IRIA 2012

In future, the ultrasound machines will definitely get smaller, but we have to ensure that smaller means better. While we are going in the future, bringing better clinical solutions that are more patient and operator friendly with better economic value and outputs is important

world. XMatrix technology allows real time imaging, where a surgeon can replace a heart valve with real time imaging without radiation or any patient issues. Our IU systems bring the highest level of performance for body imaging, breast imaging, etc. The machine fits academic hospitals, private hospitals, regional hospitals and nursing centres. ClearVue is a product that brings better healthcare at more affordable costs because of its high-end technology. What is Philips’ USP that sets it apart from others in the same business? If there is one word that can be used to describe Philips, it is people-focus— whether it is towards our patients, clinicians or for the organisation, on the whole. We have a people focus in business – we are for people, by people and of people - and that is what sets Philips apart. The people in Philips bring extremely oriented towards using high-end technology to make healthcare better and more accessible.

expert speak

â&#x20AC;&#x153;Ultrasound is one of the most sound medical technologies for diagnosisâ&#x20AC;? SK Raman of Trivitron shares his perspectives on the Ultrasound business in India and Trivitron stint in this very dynamic market SK Raman General Manager, Marketing Trivitron

Tell us about the latest trends in the ultrasound market. During the past decade, ultrasound has become an all-important screening tool. It is certain that ultrasound will replace stethoscope as it provides a holistic view for diagnosis. From 2D imaging to 4D real time elastography, ultrasound has made a long and fruitful journey making it one of the most sound medical technologies for diagnosis. How is ultrasound technology leading to improved diagnosis? Brief us about your products. Ultrasound technology has become an inseparable diagnostic technology as advancement in the technologies has empowered the specialists for better and quicker diagnosis. As compared to past decade, today ultrasound has expanded its usage in other areas of diagnosis including Breast, Cardiac, Prostrate, Musculoskeletal, Volume and Fusion imaging. In terms of technology, ultrasound has progressed from 2D imaging to harmonic detection, multi frequency imaging, digital image management, image enhancement, compound pulse wave generator, spatial compound imaging, real time elastography, etc. Trivitron is the number three player in the market with over 13 percent market share. It is the only company manufacturing and exporting to Japan from India. We are the first to set up state of the art Aloka Trivitron Medical Technologies in Sriperumbudur, near Chennai, to manufacture ultrasound and colour Doppler in India. Aloka Trivitron is a joint venture between Aloka Japan, a global inventor of Ultrasound and Trivitron Healthcare, the largest medical technology company of Indian origin. Our Ultrasound product ranges include Prosound 2 ( B&W), Alpha

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6, 10 to advanced technologies to Prerius, Ascendus, Avius etc. that have unique features including best 2D imaging, harmonic detection, multi frequency imaging, digital Image management, image enhancement, compound pulse wave generator, spatial compound imaging, real time elastography etc. How do you think the market is growing? What is your market share? The market is growing fast at around 18-20 percent and we enjoy market share of around 13-14 percent. In such a competitive market, how do you think you plan to strengthen yourself in the near future? Science, service and support are the three mantras to out beat competition and stay ahead in competitive market. Trivitron is continuously innovating in the imaging space, we discover stateof-the-art and sustainable solutions for India and the emerging markets. Trivitron goes beyond the horizons and explores new avenues to bring the best in technology that can transform lives. Our aim is to provide the best in class service and after sales, academic support etc. What are the challenges being faced by the ultrasound market presently? There are a few challenges in this market mainly obtaining PNDT certificate, lack of government support for manufacturing in terms of tax incentives, high cost of custom duty, lack of ultrasound registration system. This creates difficulty for new companies to enter the market.

Tech Trends

The Digital Twist in Diagnostics Because of its capability of optimising each function of radiographic imaging, digital imaging poses as a technological improvement over analogue film imaging By Dhirendra Pratap Singh and Shally Makin , Elets News Network (ENN)

â&#x20AC;&#x153;T

he empires of the future are the empires of the mind,â&#x20AC;? said Winston Churchill. If anything, the advent of digital and computed radiography, which has miraculous potential in radiology, is a prime example of a beneficent empire conjured by the labours of the mind. Hence if we take a leaf out of Churchillâ&#x20AC;&#x2122;s words of wisdom, we can say that such digital techniques are also the empire of the future. Digital radiology is one of the greatest technological advancements in medical imaging during the last decade. The use of radiographic films in x-ray imaging might become obsolete in a

few years. Digital radiology provides enormous benefits. It can make a radiological facility or department filmless. The referring physician can view the requested image on a desktop or a personal computer and in most cases submit his report in just a few minutes after the examination has been performed. The images are no longer held in a single location, they can be seen simultaneously by physicians who are kilometres apart. In addition, the patient can have the x ray images on a compact disk to take to another physician or hospital. Computerised radiography is a digital imaging science that march / 2012 www.ehealthonline.org

Tech Trends

Size of the Detectors One can choose from the following sizes: 14 x17 / 17 x 17 (some companies offer smaller sizes also) a. 14” x 17” FPD - Cassette sized solution which is ideal for retrofit solutions or for mobile DR set up. Such detectors come in both wired and WIFI platforms. They are light weight and are easy to handle. Choice of scintillator material is also available depending on the manufacturers. b. 17 x 17 Full size FPD: These detectors are more suitable for a full room DR set up or a fixed set up. These detectors can also be retrofitted into existing x-ray systems. A full size detector has a few advantages in that it offers the larger imaging area – hence eliminating the need to move between portrait or landscape formats. However,

they are heavier and hence recommended to be fixed to either a Vertical bucky / under a table or fitted onto a Universal Stand. 2) Choice of Scintillator material: There are two types of scintillator material available in the market. GOS – Gadolinium Oxy sulphide and CSI Cesium Iodide. Both have their own advantages. GOS is a highly used photostimulable phosphor material that offers fairly high contrast – but has a lower DQE (Detective Quantum Efficiency) as compared to CSI. Typical DQEs of detectors using GOS scintillators are in the range of 35 percent. Whereas CSI based detectors offer 65 percent - 70 percent DQE. CSI based detectors seem to be more popular in the recent market trends.

*As per the views of Krishan Prasad, President, Prognosys Medical Systems Pvt Ltd

uses photostimulable phosphors to create images rather than photographic screens and film. In this module we will discuss the characteristics of these phosphors, and how CR images are formed as well as discuss the various components of the computed radiography system. Computed Radiography uses standard X-Ray machines. There is no need to change existing X-Ray machines as is required in digital radiology. In CR rather than a film, the image is exposed on a digital plate. The digital image is then transferred to a reader, where the image is displayed on a monitor. This image being digital can be modified to adjust the exposure. Once the quality is approved the image may be printed on film in a laser camera. The images may also be stored in an electronic format on CD or sent to a remote location in the hospital via a local area network or even emailed to any location in the city, country or world. The images may also be transferred to a workstation similar to a CT or MRI workstation.

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Benefits Conventional X-Rays are still a manual procedure; the technician sets the exposure depending on the size of the patient. Sometimes, this could be faulty resulting in an over or under exposure. When this occurs it will need to be corrected by repeating the X-Ray after readjusting the exposure factors. Such retake results in additional radiation to the patient as well as loss to the institution, as the first film will need to be discarded. With Digital X-Rays the exposure factors do not need to be so accurate, variations in exposure can be adjusted on the monitor after the image has been obtained. Thus a perfect image can then be printed. Spoil film rates range from 10-15 percent, similar to most top class institutions obtaining X-Rays using conventional means. Digital techniques will result in a saving of 10-15 percent on the film bill. Occasionally in very busy departments films may get misplaced. These films need to be repeated, again resulting in additional radiation exposure and loss of revenue. Images can be documented

on CD, high quality paper or viewed on a monitor. The benefit of this is as film is an expensive medium; cheaper options to cut cost can be explored.

Market Kalorama Information estimates that digital x-ray system sales will exceed those of traditional x-ray systems used for a medical (non-dental) purpose in 2011. According to the healthcare market research publisher, revenues for digital x-ray systems are the largest component of the US $12 billion radiography market, slightly higher than the firm’s projection for traditional systems. The report states that it is initially expensive to purchase a digital x-ray system such as the Philips DigitalDiagnost, the Siemens AXIOM Multix, or products from several other companies. But with continued use, operating costs are lower than standard radiography. Digital systems don’t require film and processing, the annual cost of which can be as great as the capital cost of standard radiographic equipment. Once a digital system is installed, large film storage facilities are no longer needed. Technavio’s analysts forecast the global digital radiography market to grow at a CAGR of 3.3 percent over the period 2010–2014. Key vendors dominating this market include Philips Healthcare, GE Healthcare, and Siemens Healthcare. The report, which covers the Americas as well as the APAC region, also covers the current landscape and growth prospects of the global market for high-end digital radiography equipment. The report also includes a discussion on the key vendors operating in this market.

Image Segmentation The process of enhancing the raw image data is called image segmentation. The CR image is acquired over four decades of exposure, light release from storage phosphors, conversion to an electronic signal by the PMT tube, identifying the collimated image border, and tone scaling the image. These are the post processing functions that must take place before the image is presented on the CR reader monitor. The image must then be fixed before the data is sent to PACS, to

Tech Trends

â&#x20AC;&#x153;Various Combinations of DR are Availableâ&#x20AC;?

Dr Roma Lal, Metropolis The field of conventional radiography has now been replaced by digital imaging. Digital radiographs permit higher resolution and sharper images and allow for post processing such as magnification, FOV and zoom. The initial introduction was CR, which has now been

the workstations, or is printed. The raw data is subjected to various algorithms and LUT that define areas of interest and collimated areas. The average density and LUT control the overall density and contrast of an image. The final image is first available on the CRT monitor at the reader or on remote operator panels (ROP). What is important for the technologist to understand is that the image released from stimulating the phosphor plate is not a readable diagnostic image and requires post processing. Specific software algorithms must be applied to the image prior to presenting it as a finished radiograph. These modifications of the image occur in the reader programmes and at the workstation using look-up tables as references. Depending on the workload and the type of x-ray room space available, one can choose the ideal DR set up. If the x-ray workload is about 100 x-rays per day or lower, one can choose a single detector solution. There are three types of solutions available: Universal or U-Arm DR system: This is a single detector solution with the x-ray source (Tube â&#x20AC;&#x201C; Collimator) on one side and the FPD on the other, Floor Mounted DR system: The floor mounted systems

replaced by true digital imaging wherein the radiograph plates directly connect to the reader to generate images. A digital radiography unit comprises a reader into which the CR cassettes are loaded. The image then acquired is sent to a work station where contrast adjustments, sharpness and brightness can be edited and subsequently this digital data is sent to a digital camera to obtain hard copy prints. With this system soft copies of images can be created for storage and transportation through PACS system, compact disc and e-mail. A Digital radiography unit requires trained radiographers who are not only able to take radiographs, but are also well versed with usage of the reader and the workstation. The initial penetration of CR/DR was slow primarily

are more like conventional x-ray systems, Ceiling mounted units: Ceiling mounted solutions are available in Single or Dual detector combinations. A characteristic that is unique to CR imaging is that there is only one screen type for all studies so that the same cassette is used for portable radiography, bucky radiography, tabletop radiography, and other such systems. There is no need to look for special detailed cassettes for extremity work, or high speed screen with low scale contrast for chest radiography. These functions are handled by the software performing algorithm functions. Even the grid lines commonly seen with screen-film imaging can be removed from the digital image using LUT for that specific function. Digital computerised radiographic imaging (CR) has achieved technological improvement over analogue film imaging by optimising each function of radiographic imaging from production and its subsequent communication layers of image display, archiving, and image retrieval as independent developments that enhance the total diagnostic process. The basic advantages of CR and direct digital radiography over analogue

due to high capital cost. Due to greater demand from clinicians this has changed and various combinations of systems are available at varying costs making it a decision based on patient throughput. The advantages are several starting with enhanced image quality helping in better diagnosis. Soft copies can also be made available which can be put on PACS. The radiation dosage is also lower. But the system also has some disadvantages. One major issue is the higher cost per x-ray due to higher film and equipment cost, requirement of trained personnel, requirement of UPS and a good back up from the service providers to ensure no down time creates a few challenges in accepting this technology.

imaging lies in the optimisation of image acquisition, optimisation of image display, optimisation of image transmission, and optimisation of image storage as independent but closely networked functions. The key word here is optimisation. Existing radiographic equipment can be used with CR and PACS with minimal modifications. Computerised x-ray is not unique to radiography; it is used throughout the scientific community in areas like molecular biology and chemistry for autoradiography and pulsed-field gel electrophoresis. Its wide spread use is due to the sensitivity of photostimulable phosphors and improvements in light detector technology. Modern detectors can differentiate light emission by photostimulation for electromagnetic radiation exposures of slightly greater than 100 milliroentgen (mR), and as low as 0.195 alpha particles per square millimeter equivalency for particulate radiation. This makes photostimulable phosphor technology a very useful and powerful tool in resolving radiation patterns traditionally captured in radiographic film from X-ray diffraction, protein crystallography, and electron microscopy techniques. march / 2012 www.ehealthonline.org

expert speak

“One Stop Facility for all Diagnostic Investigations” Dr S S Doda shares his views on the latest trends in radiology. He provides information on state-of-the-art equipment currently available at his diagnostic set-up Dr S S Doda Director, Dr Doda’s Diagnostics and Healthcare, Pusa Road, New Delhi

Please brief us about Dr. Doda’s Diagnostics and Healthcare. Our centre made a humble beginning 25 years back.Considerable expansion has taken place over the last few yearswith manifold increase in the number of patients, and now it is one of the largest spread over 10,000 square feet of space in the heart of the city. The set up initially concentrated on ultrasound and CT, whereas now many more advanced imaging equipments have been incorporated along with addition of a stateof-the-art laboratory making it a one stop diagnostic facility for the patients. A faculty of 12 doctors and 50-60 technical staff assure quality services to the patients. Tell us about the medical systems that you have at your facility. Presently, the diagnostic centre has some of the most advanced ultrasound colour Doppler systems, digital X-rays for routine and special investigations, multi slice CT, digital orthopantomogram(OPG) and mammography, TMT / HOLTER, ECG

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/ EEG, EMG / NCV, along with a stateof-the-art laboratory. The laboratory is equippedwith fully automated hematology, biochemistry, microbiology, immunology and serology testing tools. Apart from radiology and imaging which involves a myriad of investigations, we have a list of other tests conducted at our centre that include cardiology, neurophysiology, pulmonology and laboratory work-ups. Guided interventional procedures are also carried out with quick pathological correlation available under the same roof. How have you seen the advancement in the field ofradiology over last few decades? Over the years, the spectrum of diagnostic facilities has widened and constant upgradation of highly sophisticated equipments has been carried out. There is a tremendous growth especially in the private sector with the advent of so many standalone set-ups in hospitals. Patient awareness has also raised resultant to technology and equipment

information made available through education and internet. In such a competitive atmosphere, it is advantageous for the masses as this competition has led to better quality of investigations at affordable prices. Do you think the industry needs well trained technicians to adapt to new systems and technology? Adequate manpower is available in the country. There always exists the potential for young and fresh technicians to get absorbed and trained in the field.The young generation has a lot of enthusiasm and fervor to learn new trends with the changing times. What are your views on interventional radiology? Interventional radiology is a remarkable field and has gained popularity all over the globe. Interventional radiology has diagnostic as well as therapeutic benefits attached to it. It cuts down the misery and cost and thus acts as a good alternative to surgery.

expert speak

“High quality diagnostic imaging is available to only a limited population” Dr T B S Buxi, Head, Department of CT scan and MRI, Sir Ganga Ram Hospital talks about the new imaging techniques

in healthcare The field of radiology has gone a long way in the last decades. All segments of healthcare have benefited from new inventions in radiology. The field of neurology, neurosurgery, oncology, orthopaedics and cardiology/cardiac surgery have gained immense benefits with the technologies that are part and parcel of radiology. The medical fraternity is becoming aware of the advantages of using these systems and the benefits in terms of timely diagnosis leading to faster patient recovery. For many years, the medical devices

industry has been concentrating on improving the quality and sensitivity of imaging to increase the diagnostic confidence of the doctor, but this tends to increase cost. Hence high quality diagnostic imaging is available to only a limited section of the population. As for as the field of digital radiology is concerned, an appropriate analogy that is easy to understand is the replacement of typical film cameras with digital cameras. Images can be immediately acquired, deleted, modified, and subsequently sent to a network of computers. There are tre-

mendous benefits of digital radiology in healthcare. It can make a radiological facility or department filmless. A doctor can view the required image on a desktop or a personal computer and provide his report in a relatively shorter span of time. Recently, Sir Ganga Ram Hospital has launched a low radiation CT scanner that reduces the risk of cancer through controlled radiation. This innovative technique uses special X-ray equipment to scan internal organs, soft tissues and blood vessels and diagnose medical conditions.

“A digital Radiography System is Technologically More Advanced than Analogue Systems” Dr Jignesh G Thakker, Secretary General, Indian Radiological & Imaging Association explains the market of digital and computed radiography Healthcare infrastructure is developing rapidly across India. The new inventions in the field of radiology are contributing a lot in the way of better diagnostics and imaging. Ultrasound systems are mostly used in cardiology, radiology and gynaecology departments. But increasingly a number of other departments - critical care, emergency medicine, regional anaesthesia, operating theatres – have started showing interest in offering ultrasound services for clinical applications. This is because imaging can give immediate answers to spe-

cific medical questions. Hospitals are purchasing units for different departments. A digital radiography system is technologically more advanced than analogue and computed radiography systems, which is one of the factors contributing to the growth of this market. The global digital radiography market has been witnessing the trend of film-free radiology departments. However, the increasing adoption of computer radiography systems could pose a challenge to the growth of this market. In post bypass patients, the physician

prefer to conduct examination through soft exposure X-Rays so as to see how wet the lungs are. The cardiac surgeon would like to have an X-Ray with a harder exposure so as to see inserted hard ware, drains, etc. In one exposure with a conventional X-ray it is difficult to achieve both. This results in one of the two being unhappy with the quality. This problem does not occur with digital X-rays as the images can be manipulated to provide a softer and harder image with the same exposure thus keeping both the physician and cardiac surgeon satisfied. march / 2012 www.ehealthonline.org

expert speak

“DR/CR shows a good prospect for teleradiology” Doctors have used both conventional and digital radiography for several years, but one can conclude that because of its advantage of immediate image viewing, digital radiography is highly desirable Chandrasekharan Suraj Business Head, X-ray Products, Siemens

How do you think the digital imaging market is creating its space into the industry? There is a clear and gradual shift in imaging from analog to digital, with the advent of new inventions in the digital detectors, imaging chains and this trend is in sync with the increased demand of digital storage, archival and sharing requirements in the industry. Brief us about the latest trends in DR/CR. The main demand in this segment is to have a better workflow and faster throughput of patients, films, and diagnostic reports. The new trends focus on faster patient positioning, automated organ programming and motorised movements of the X-ray tube and detector and faster and robust image processing software’s. Since the workflow in CR is still more like a conventional X-ray machine, the digital radiography system with its direct readout is becoming more popular. DRs with high resolution detector, fully integrated with the X-ray generator to ensure that minimum radiation dose is given to patients are increasingly popular over the CR or Retrofit DR solutions. The latest trends in developed countries shows that more and more users prefer to have a dose display and other measures which ensure safety of the patients and users are given the utmost importance. What do you think an ideal digital radiography imaging system consists? An ideal DR system should have the facility of sophisticated X-ray generator, which works in tandem with the other components of DR system like detector, image processing system etc. It is important to have a powerful but well designed X-ray generator system, which ensures that the optimum dose is produced to get the best image quality. The latest high resolution detector systems, preferably the size of 35 x 43 cm wired, which ensures that

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the important anatomies are covered, either in the landscape or portrait mode is essential for a comprehensive coverage. A good feedback loop which monitors the X-ray dose, records the dose for future reference, and pass a real time feedback to the X-ray generator is a vital part of the DR system. The digital radiology industry is growing slowly, list down the pros and cons of digital and computed imaging? Only some digital radiography devices provide immediate viewing. However, phosphorous-plate technology requires placement of the irradiated sensor in a processing device to scan it and put the information into a computer so that the image can be viewed. Immediacy of viewing the image is a significant clinical advantage in accomplishing many X-ray based procedures. Digital radiography allows the clinician to change contrast (to lighter or darker), enlarge images, place color enhancements or superimpose various textures on images. Pulling up specific stored radiographic images from a computer database is easy because of the highly organised nature of computer file storage. The problems of odors and stains from the developing and fixing solutions and the space occupied by the developing devices are eliminated when digital radiography is incorporated into a practice. The reduction in radiation offered by digital radiography— usually 70 to 80 percent, and at times even more—allows multiple images for the same radiation exposure involved in a single image obtained via conventional radiography. However, after a short learning period, accompanied with frequent use, the simple software necessary for use of digital radiography is easily mastered. They are based on clinical usage and research and they may or may not be the same conclusions as those reached by other clinicians.

expert speak

“Government Policies Should be Designed to Favour Quality and Standards” Prognosys believes that government policies should encourage local manufacture of international quality products. Tell us about your views on the space that digital imaging market has carved for itself in the industry. With majority of recognised x-ray rooms, both private and government owned, large and mid-sized, shifting from analogue to digital, the market dynamics is fast changing. The market for Digital X-ray in India has been growing significantly for the last 5 to7 years. If one uses China as the yard stick to measure market potential, India’s diagnostic imaging market is slated to grow by ten times from current levels. Prognosys Medical Systems has already established its foot hold, in both the Telemedicine and Diagnostic Imaging spaces, as one of the leading solution providers in India. Brief us about the latest trends in DR/CR. Computed Radiography has led to growth of digital x-ray. Typical cost per CR set up has consolidated itself to very competitive levels in India. The cost is much lower as compared to what we have in international markets. The average cost of an entry level CR package, which includes a CR Reader, workstation, 6 to 8 cassettes and a 3 tray (online) DICOM film printer of about 300 DPI will be less than INR10 Lakhs. Five years ago a similar unit would cost at least five times more. This consolidation in prices has clearly changed the mindset of x-ray room owners to move to a more convenient and efficient digital technology. There are two types of approaches to this – retrofit DR Systems and full room DR systems.

Krishna Prasad President, Prognosys Medical Systems What do you think should go into an ideal digital radiography imaging system? Digital Radiography, unlike Computed Radiography, is a more comprehensive and fully integrated solution. In an ideal DR set up, the x-ray source and the xray receptor (detector) is fully linked and integrated and should work as one comprehensive unit. Flat Panel Detectors (FPD) based on Amorphous Silicon technology has now emerged as the preferred technology of choice. One can choose size of the detector as 14 x17 or 17 x 17. Modern DR X-ray systems involve a HF generator with an AEC (Automatic Exposure Control) device that ensures x-ray dose that does not go over recommended limits. Most international

safety standards highly recommend this and have also made AEC mandatory in x-ray systems. The x-ray generator – tube – detector combination is controlled by the OPU – or the operating system of the DR system. Modern DR systems are more efficient and have pre-programmed factors / x-ray techniques, such as pre-fixed kV – mAs depending on the body part being x-rayed (APR) and the size of the patient. Most standard or internationally acclaimed DR systems offer DICOM 3.0 Compliant systems with DICOM work lists and HL7 compliance as standard which can be linked to the HIS / RIS / PACS. Some of the options are Universal or U-Arm DR system, Floor Mounted DR system and Ceiling mounted units. How do you see DR/CR market five years from now? The Digital Radiology industry will show significant growth in the next few years. However, government and its policies should be designed in such a way that local manufacture of international quality products and standards are encouraged. Local manufacture need not necessarily mean “cheap” products or “low quality” products which is the current mind set. International industry standards already defined and wetted are available as bench mark measures to ensure quality. In time as the market matures, costs become more reasonable and the industry learns the right processes, we are confident that the Indian Digital Radiology business will see significant growth.. march / 2012 www.ehealthonline.org

expert speak

“Cura Leads With the Maximum Number of Installations”

K N Vijai Shankar Raja Managing Director, CURA Healthcare Pvt Ltd Please give us an overview of the digital imaging market. What is your market size? The market for digital imaging is spurring up. We find that most companies that were earlier into film based radiology are now entering digital imaging market or slipping into oblivion. India, with about 60,000 analogue X-ray machines already in use, is slowly witnessing a metamorphosis. The digital imaging market in India is all set to explode with many institutions and corporate hospitals exploring the viability of these systems. The day is not far when analogue X-ray systems will become obsolete. Digital imaging technologies will lead to positive and disruptive change in the imaging industry, not only in India, but globally. CURA is a pioneer in Indian DR market. A winner of Frost & Sullivan “Digital Radiography Company of the Year 2010 Award” and “Product Innovation Award”, CURA is a market leader with more than 50 percent share and maximum number of installations.

march / 2012 www.ehealthonline.org

Brief us about the latest trends in DR/CR. Computed radiography, which was in vogue till recently, has now become a transit technology. CR is almost a three decade old technology with no significant technological advancements ever since DR made its debut. CR adoption and sales have been progressively dipping across the globe. Digital radiography is the future of imaging technology. Newer entrants in the DR space are coming with product innovations. The DR market and adoption is on the upswing. Unlike the industry’s outlook portraying CR and DR as competing technologies, CURA considers CR and DR to be complementary technologies. DR will take the lead in digitising with the advantage of better throughput and image quality. The CR will basically be used for the bedside applications. DR system is definitely cheaper and more viable as compared to a CR system. DR systems are being designed with higher pixel rates. Digital Imaging technology seems to run in parallel with digital camera technology. 16 MP detectors are available now, and features such as Image stitching and dual energy subtraction is being bundled with DR software. What do you think an ideal digital radiography imaging system consists of? For the Indian market, the ideal DR system will be a single detector system capable of supporting both erect and supine studies. The DR system should be inbuilt with safety features including a fixed detector to avoid accidental drop or mishandling or even theft of the detector. In the case of a mobile detector

there can be intentional damages to the detector being passed off as unintentional drops. An ideal DR system has to produce the best quality images, consistently. It must be designed to handle high patient throughputs, while being easy to use by semi skilled technicians. It is also necessary for it to be elegantly designed with good aesthetics and backed up by reliable service support system. Do you think the industry needs well trained technicians to adapt new systems and technologies? The technicians must know about the basic computer operations. They have to have a basic understanding of the DR technology from an operational perspective. They should endeavour to acquire additional knowledge on DR through experience. Please list the pros and cons of digital and computed imaging? While awareness on the features and benefits of DR systems is on the raise, high initial investment currently required for a DR system slows down the market. In case of CR system the X-ray dosage for the patient and operator is higher than what we have in analogue X-rays systems. CR involves continued dependency on cassettes and imaging plates (IP), which are consumables with a limited shelf life and are prone to wear and tear. The distinctive benefit of a DR system is the superior image quality with wider latitude. The system also offers very high throughput to handle peak hour patient flow. There is lower radiation dosage to the patients as well as operator.

guest article

Radiology and Its High-tech Tools A workstation without tools will be like a soldier sans his armour radiology has not been untouched by the rapid advances in technology. Our radiologists are able to serve the needs of many people by using the high-tech tools in their workstation By Dr Amar Jain

zoom tool enlarges the entire image and then one needs to pan to the site of interest, whereas eth magnifying tool will only magnify the region of interest. There are also orientation tools like flip tools, rotate and invert tools to enable us to carry on the examination in whichever position we desire. We can also flip, rotate or invert in the desired position of view. The bookmark tool helps us to store the annotations (measurements) applied to the image and retrieve it back as and when required. A radiologist, who reads a particular image highlights the abnormality, marks the measurements and bookmarks it. All modalities have a ruler, line, text, free hand tools as basic tools to measure standardised length, breadth and depth and highlight their specifications. The layout tool compares different studies, series done at the same time or over a period of time. Hanging protocol allows consistent viewing of images based on body parts and modality type. As the word explains,

this tool ‘hangs’ the images on different monitors rather than view boxes, as used to happen with developed films. While training over 60 radiologists during implementation of RIS-PACS by HealthFore implementation team, a number of questions came up, regarding the tools and their clinical relevance. Probe showing h.u. Value is a tool found in modalities such as plain CT images, contrast enhanced, CT images, HRCT images and CT angiography images. It is used to differentiate blood from dystrophic calcification, to assess the different stages of bleed if it’s acute or chronic and to see h.u. Value changes before and after contrast injection to evaluate mass lesions. Such modalities also have tools like window width and level tool to select appropriate window for appropriate study. There is mediastinal window to study bronchogenic CA and its mediastinal extensions for staging. CT images, MRI images, CR and DR images, DSA images endoscopic and virtual bronchscopic images have

tools such as zoom and pan to see a nidus and feeder artery in an arteriovenous malformation and detect aneurysms. Cline tool helps see all images in a video mode by setting appropriate speed. Coronary analysis tool for cardiac CT provides a number of multi-planar reformat (MPR) views. The 3di PET/CT viewer contains different viewing sections for the PET and CT, MPR images, and for the fused MPR images of each series. 3di brain perfusion feature highlights optimised colour display of results maps for CBV (cerebral blood volume), CBF (cerebral blood flow), MTT (mean transition time) and TTP (time to peak). These maps provide invaluable clinical information to assist clinicians in stroke assessment and treatment planning. About Author Dr Amar Jain works as a clinical radiologist for HealthFore – Religare Technologies. He is an IT evangelist who is working with the aim of syncing technology and diagnostic radiology. He can be contacted @ amar.jain@religaretech.com.. march / 2012 www.ehealthonline.org

featured product

MRI Imaging enters a new era with Ingenia - World’s firstever digital broadband MRI

use for greater efficiency in a radiologist’s daily operations.

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Channel-free coil system Unlike conventional MRI systems, Ingenia is channel-independent, which gives excellent scalability: for example, simply by adding a multichannel receiver coil having more elements and capturing high-quality images. This plug-and-play capability means it’s easy to keep up with advances in coil technology, without requiring major upgrades. Apart from convenience, it also directly translates into economical benefits for the users.

Maximizing Patient Comfort

Ingenia MRI-the first-ever digital broadband MR for clarity, speed and expandability delivering up to 40 percent increase in SNR, as much as 30 percent improvement in workflow and up to 50 percent reduction in costs due to clinical expansion with channel independent system. All with industry leading magnet homogeneity delivering the largest field of view

The benefit of Ingenia goes beyond technological advances. Ingenia’s 70cm wide magnet bore with largest FOV and Patient Adaptive MultiTransmit creates the excellence in scanning patients of all sizes and shapes. Notably, despite the larger bore the homogeneity of the magnetic field is enhanced, considerably reducing the image distortion found with conventional scanners. The patient also benefits from the speed at which the exams can be performed, and the system’s ability to scan more body parts. The high SNR, Digital Broadband technology, and largest homogeneous FOV can be leveraged to perform most of the time consuming examinations in less than 8 mins for routine imaging. Also, the Multi station screening for oncology with Ingenia is one of the hall mark of the power of imaging@ 3.0T. march / 2012 www.ehealthonline.org

In conversation

“Gamma Imaging for Better Diagnosis” Tell us about the new technology that is creating ripples in the industry. Gamma imaging is relatively new in the industry. Currently when there is suspicion of cancer in the breast, traditional treatment options are recommended such as Mammography. Normally Mammography is not 100 percent specific, therefore Ultrasound is suggested. In certain cases MRI examination might be advised. The Dilon 6800 camera (manufactured by Dilon Technologies, USA and introduced in India by Labindia Healthcare) for Molecular Imaging is an imaging technique that reveals cancerous lesions even in women with difficult to diagnose incidents. The Gamma Camera makes imaging possible with a compact detector for optimised examination. Dilon 6800 has the power to detect and diagnose various other cancers such as Thyroid, Kidney, Gall Bladder, Liver and Spot bone analysis. In clinical trials, BSGI (Breast Specific Gamma Imaging) has demonstrated the ability to aid in the diagnosis of cancer in patients with factors limiting the utility of mammography such as: dense breasts, implants or injections for augmentation. What are the advantages of using Dilon 6800? The advantages being that the patient is comfortable, as she doesn’t have to lie down and go through a painful examination like Mammography. This small instrument is designed with high sensitivity and specificity and is capable of multiple acquisition angles. It relies on advanced imaging technol-

march / 2012 www.ehealthonline.org

ogy and superior positioning to get optimal results. The other advantage of this equipment is being a portable and mobile system; it eliminates installation and facility costs thus being an overall affordable option. How do you think this technology can cut down costs for diagnosis in India? The cost analysis of Dilon shows that it will be quite acceptable in the Indian scenario. Compared to the cost of all three techniques, the cost of buying the Gamma Camera comes down to around one and half crore with affordable examination charges. In India, this technique is being introduced for the first time by Labindia Healthcare. The cost of the equipment is dictated by the Indian hospitals. We do not have too much competition in the industry, as there are bigger players selling huge machines that cannot be compared with other technologies. Where do you see Labindia five years from now? Our company is presently focussing on Medical Imaging, Molecular Imaging, Diagnostics, Critical Care and Wound Management products. In Medical Imaging we basically sell Ultrasound and Colour Dopplers from Mindray exclusively in a few states of the country. The market is growing and there are a lot of players in every vertical pertaining to Medical Imaging and Diagnostics. Some of our very niche segments such as Molecular Imaging and Molecular Diagnostics would be the area of expension in the coming years. With

VS Upadhye, MD, Labindia Healthcare, talks about a new technology in the field of Molecular Imaging, which has the potential of being accepted as a better cancer diagnosis tool, thus providing a better alternative to traditional Ultrasound, MRI and Mammography. The cost analysis by Dilon Gamma Camera (a product from Dilon Technologies, USA) introduced for the first time in India by Labindia Healthcare, shows that the system will be quite acceptable and affordable in the Indian market for early cancer detection

nationwide presence and approx 400 employees, five years from now I look to achieve a share of `400-500 crores in the industry. Everybody is excited about this new technique and some of the government hospitals are looking forward to explore this new equipment.

In conversation

V S Upadhye MD, Labindia Healthcare

march / 2012 www.ehealthonline.org

Visionary

“Technology will be

the Force

Multiplier for Health Delivery” Dr Prathap C Reddy, the most respectable name in Indian healthcare talks heart to heart with eHEALTH magazine about his journey of bringing world-class healthcare to the masses in India

he journey from the Mango orchards of my village in Aragonda to Medical School in Chennai and then the US has been an eventful one. I always had a sense of empathy towards people and it was my desire to help people in need that prompted me to start thinking about becoming a doctor. Having said that, the real turning point came when I was practicing as a Cardiologist in the United States, leading a comfortable life, and then I received a letter from my father that triggered a new decision. He wrote that though he was proud of my achievements, he questioned as to what my current practice was doing for the health and wellbeing of my own countrymen. That question set me thinking and put me on a plane back to India to start a practice in Chennai and then ultimately I set up the first Apollo Hospital in Chennai in 1983. I agree with philosophers when they say that the journey is more important than the destination. When I started out to build the first Apollo Hospital in Chennai in 1983, the con-

march / 2012 www.ehealthonline.org

cept of a private hospital providing high-end care was only a concept that was never conceived and much less attempted. The laws, regulations and economic environment were entirely obtuse to investments in healthcare or to even look at healthcare as an industry, for that matter. I always say that the number of bricks that it took to make the hospital in Chennai is the number of problems I had to face to start it. Much has changed in the intervening 28 odd years. We have 54 hospitals that, today, provide the best of the very best in medical care the world has to offer. Today, India has become the global healthcare destination and I cherish the role that my team and I have played in this growth. But more than that, the journey of Apollo has helped us touch millions of lives and saved people who are productive individuals contributing towards the rise of a strong India. I do not think the journey has ended or the destination reached as we continue to have ambitious plans to touch a billion Indians in the years to come.

Dr Prathap C Reddy brought the concept of world-class corporate hospitals to India with the launch of Apollo Hospitals Group in 1983. Over time, the Apollo Hospitals Group became not only the most coveted name in healthcare, but also brought the best healthcare services to the country. Dr Reddy popularised the concept of preventive healthcare, which is the only way to curb the burden of diabetes, heart diseases and cancer in the country. Apollo Hospitals Group also took lead in establishing telemedicine, a concept less known and understood, by setting up world’s first V-SAT enabled village in Aragonda for bringing healthcare to the masses. By setting up group companies including Apollo Telemedicine Networking Foundation, Health Super Hiway, Apollo Munich Insurance Co and the Apollo Reach Hospitals, he has established a modern healthcare network that reaches out to millions of lives throughout India. Dr Reddy has been conferred with the Padma Bhushan in 1991 for his contribution towards emergence of the private healthcare sector in India and Padma Vibhushan in 2010 for his unparalleled contribution to Indian healthcare.

Visionary

Dr Prathap C Reddy Chairman, Apollo Hospitals Group

march / 2012 www.ehealthonline.org

Visionary

Providing access to quality, world class care was the intent of Apollo in 1983 and it continues to be our focus even in 2012 to take healthcare to all. No one organisation or person can provide the solutions to the myriad health needs of our country which it faces, be it the challenges of geographies, economics, access, inequities and costs. We at Apollo have adopted multiple models to reach to every Indian – be it through standalone hospitals, Joint Ventures with governments and its agencies, health insurance, pharmacies, eHealth, telemedicine or more recently mHealth. I firmly believe that technology will be the force multiplier for health delivery in the years to come. When we conceptualised telemedicine, it was seen as a step too far; today it is part of every health provider’s bouquet of services. Similarly, when we brought in health IT enabled solutions by way of hospital information systems, knowledge management or ehealth solutions, a new paradigm in standardisation and delivery of healthcare services was achieved. I believe tomorrow is a reflection of what we do to-

march / 2012 www.ehealthonline.org

I firmly believe that technology will be the force multiplier for health delivery in the years to come. When we conceptualised telemedicine, it was seen as a step too far; today it is part of every health provider’s bouquet of services. Similarly, when we brought in health IT enabled solutions by way of hospital information systems, knowledge management or ehealth solutions, a new paradigm in standardisation and delivery of healthcare services was achieved

day. And in this present day at Apollo, IT and IT-enabled services are the key drivers for all our future plans. We believe the elusive triad of providing access, equity and affordability to a billion Indians, who are part of our healthcare system can be dealt to a large extent by the use of technology. Health has to become a priority for governments at both the Union and State levels. While schemes like the RSBY and NRHM are good; capacity building and creating a productive health human resource can only happen if healthcare is given an ‘infrastructure’ status. Look at what it constitutes for an industry to be accorded the infrastructure status. As per the Rangarajan Committee’s Report, eight criteria are used to accord infrastructure status to any industry. We meet all eight, so it is high time that this good deed is done, as it will provide tremendous off-shoot benefits to the Indian economy. Capacity building in health infrastructure and human resources will increase employment and aid in providing health services to Indians. A healthy India is the cornerstone of a progressive nation.

In Conversation Visionary

“I am in Healthcare by Default, not by Design” A leader, who is determined to bring about positive changes in India’s healthcare scenario, Rajendra Gupta has done a lot for creating awareness among the masses. Here is a look on his journey that has led to his becoming the president of DMAI

ajendra Gupta’s mother had a T4 stage cancer and the family was fast running out of funds to continue her expensive treatment. The only choice he had was to leave his studies and get into a job. As a graduate in science, he applied in pharma and healthcare companies and ended up being in the Healthcare Sector. Over the past 15 years, he has had the rare opportunity of working for pharmacy retail chains, hospital chains, pharmaceutical boards, telemedicine companies and diagnostic companies. He still continues to learn and make contributions to the diverse verticals of the healthcare sector. He has advised the policy makers, not just in India, but across UAE and Europe, on issues related to healthcare and reforms. He is filled with the belief that starting point has to be the creation of mass awareness. This can only be done through the coming out of local studies, evidence based guidelines for all

march / 2012 www.ehealthonline.org

age groups and all major and minor treatment for chronic as well as acute ailments. India needs to implement the work force and wellness guidelines. India still lacks an epidemiology study which was provisioned in the budget of 2010, but is yet to be implemented. Preventive care with POC and instant diagnostics need to be focused. Also, our policymakers need to redefine the role of private players and the government. The government needs to move from being a provider of care to regulator and a part-financier for healthcare. When it comes to healthcare, the focus should be on child health, women’s health, and ‘Fix’ the chronic care delivery and rural healthcare system. Rajendra Gupta believes that, ‘Healthcare without technology is like a human body without a nervous system’. Policy makers need to work with solution providers and come out with technology applications for the entire healthcare delivery system. Unfortunately, the country

does not even have a ‘qualified technical person’ in the Union Ministry of Health & Family welfare. “This needs to change,” says Rajendra Gupta, “the Government must appoint a CTO (Chief Technology Officer) for Health, like Aneesh Chopra in the USA and Nandan Nilekeni in UID. The nation can do wonders with healthcare implementation if we use technology in healthcare delivery with systems from mHealth and telemedicine”. “Healthcare for all has been talked about since the Bhore committee report in 1946 and then in 1980’s. We wanted to achieve the healthcare for all by the year 2000, and now, in 2012, we are still talking about Healthcare for all (Universal Coverage). But the strategies and the people driving the plan are the same. Unless we change the very scheme of things, ‘Healthcare for all’, will remain an elusive dream. 65 years have passed and we seem to be repeating the same statements. We are failing even on the MDGs,” says Rajendra Gupta.

In Conversation Visionary

Rajendra Pratap Gupta is an original thinker and an innovator. He became the Chief Operating Officer of a MNC chain within 7 years of starting his career. In his 8th year he became the member of the Board of Directors, and in the 9th he was the CEO. In the 10th, he got appointed as the Vice Chairman. One can certainly draw the conclusion that he has climbed the corporate ladder really fast. He is the first non USA citizen to be nominated to the prestigious board of the Care Continuum Alliance, USA. Often, policy makers across political parties reach out to Rajendra Gupta to seek his inputs, not just on healthcare policy but on diverse issues concerning the economy. In 2009, he had the unique distinction of being the youngest author of the first draft of the election manifesto of a leading political party for the general elections. He has also advised policy makers on implementation of healthcare in India, Middle East and Europe. Healthcare reforms agenda that he authored in 2009 has been implemented by the state of Chhattisgarh and appreciated by Planning commission and the Ministry of Health & Family Welfare. Most of the new healthcare policies are picked up from the document. In 2009, he became the youngest Chairman of the International Telemedicine Congress. A recipient of the Young Global Achiever award and many other awards in India, Rajendra Gupta sits on the boards of major industry organisations and several healthcare and retail boards across USA, Europe and India.

In his opinion, government’s strength is in ‘’Conceptualising’ and the ‘Formal Authority’ to write the laws, but certainly, the strength of ‘Execution’ lies with the private sector. It would be wise for the government to start implementing the PPPs in Healthcare without any further delay. Private sector is willing to work with the government - be it in diagnostics, rural health, generic medicines or pharma research. Government needs to build in confidence and inspire the private sector by setting up an independent PPP authority with equal representation from the government and the private sector, for the continuity in policies. Merely doubling of the GDP will not go any good to our healthcare system. “Look at the failures of Europe and USAs healthcare system, and the government will realise that higher GDP spends does not guarantee better healthcare,” says Rajendra Gupta. DMAI (Disease Management Association of India) recently organised a mega healthcare camp for about 50,000 people in Ajmer. The success of the camp provides a good template for the government to implement mass screening plan nationally. In the plan the resources could be allocated to the private sector. This could be the single best step in the interest of preventive care and mass screenings that government has already announced, but failed to successfully execute as the 20 crore (200 million) diabetes and hypertension screening to be done as announced by the Union Health Minister. Insurance industry for healthcare needs a re-look to create monetary faith in the healthcare industry. “It is time to be more innovative in rural healthcare delivery,” says Rajendra Gupta. “Currently the healthcare system is not yielding the right results. However, a new Health CTO may revolutionise the way healthcare processes run in India.” march / 2012 www.ehealthonline.org

Visionary In Conversation

Annaswamy Vaidheesh Managing Director, Johnson & Johnson Medical India (JJMI) and Vice president, Asia-Pacific- Lifescan

march / 2012 www.ehealthonline.org

In Conversation Visionary

India is an

“Idea

Factory” Annaswamy Vaidheesh is the Managing Director of Johnson & Johnson Medical India (JJMI) and Vice president, Asia-Pacific- Lifescan. He has more than 30 years of diverse and broad functional and business experience in FMCG, and healthcare industries. Commitment to talent development, innovation, strategic leadership and social contributions are his strengths. He holds a Masters Degree in Management Studies. He is an Honorary Fellow of The Association of Minimal Access Surgeons of India. Vaidheesh joined Johnson & Johnson India in July 1986 as Product Manager and over a period of time held various leadership positions of increasing responsibilities in Asia-Pacific Region.

Annaswamy Vaidheesh, who is known as an exemplary business leader, talks about the innovative ideas through which he plans to drive the future prospects of J&J

rom the age of Hippocrates, kindliness, concern and love of the art and science of healing have been considered to be the qualities that the healthcare community is expected to be brimful of. When the patient reaches out to the healthcare system at the time of sickness, this becomes a critical moment. It is cause of serious emotion, not only for patient’s loved ones, but also for the healthcare provider. It is the chance of experiencing such emotions that inspire Annaswamy Vaidheesh to remain a part of the healthcare sector. Starting career in a relatively high profile industry of those times, namely FMCG, and having worked for around for five years in handling some of the leading brands, there is lot of experience that Annaswamy Vaidheesh has brought to J&J. He has been fortunate to have got regular breaks in Johnson & Johnson, gaining new competencies ranging from marketing, sales , new business development, supply chain, operations in India as well as in Asia-pacific and shaping the environment for the betterment of humanity like health insurance. He is proud of the fact that he is equipped to leave behind a legacy of having developed new brands, products, procedures, techniques, talents for the company as well as for the industry. India is in the early stage of healthcare development. He believes that majority of the people in the country will have access to

global standard of healthcare delivery in the next 10 years, irrespective of their economic status. Business model disruption is waiting to happen and India will become a role model. Technology is enabling significant shifts in the approach to disease management. Convergence of embedded technology and IT is accelerating lab- to bed-side monitoring and also bringing shifts from traditional lab monitoring to home/ remote monitoring. Embedded technology applications are opening doors to breakthrough therapies; robotics is aiding shifts from open surgeries to minimally invasive surgery even for complex procedures. Nanotechnology advances are enabling superior sensor technology and body powered batteries. Advanced diagnostics is bringing shifts in how practitioners approach disease management. The possibilities are endless and countries like India and China will require enabling technologies more than any other country. Create space for innovation and co-creation with the eco-system. We need Silicon Valley kind of environment for health care innovation. Quite obviously it is easier said than done but could be well within the realm of achievement if we put a think tank in place comprising of leaders from Government as well as from private space from all over the world who have had experience in innovation. Let’s create innovation hubs and support them competitively. march / 2012 www.ehealthonline.org

Visionary In Conversation

“We Lead

Pharma from the

Forefront”

With strong entrepreneurial spirit and localised strategies, Kewal Handa, Managing Director, Pfizer Ltd, has so far guided three major mergers

t Pfizer each member bears a responsibility to make a difference and they take great pride in it. This was the reason why Kewal Handa chose to join Pfizer even if it meant a step down in position from a Finance Director to a Finance Controller. He was sure that the shift from engineering to healthcare was a significant move, but it was the opportunity to touch lives that drew him to Pfizer. During his twenty years with the company, he has been entrusted with positions of high responsibility. He had the opportunity to rise above his portfolio as Chief Financial Officer (CFO) by being a key contributor to shaping the future of Pfizer. Pfizer, as an organisation, has presented him with several opportunities to broaden his exposure, in departments as diverse as animal health team, pricing, strategy and commercial. Each stint has given him a greater understanding of the marketing and sales challenges – lessons which he continues to use even today. He has also demonstrated leadership and excellence in strategically guiding Pfizer Limited through three mergers with Parke Davis - Warner Lambert (India) Private Limited, Pharmacia and Wyeth Ltd respectively. Today, Pfizer India is one of the top ten pharmaceutical companies in India. The company has been growing at rates that have consistently remained above that of Indian companies and MNCs. This success is due to new initiatives and innovative strategies implemented in the last two years. He believes in challenging the rules of the game – whether in making Pfizer India the first MNC to enter into the branded generics space in India or exploring a unique part-

march / 2012 www.ehealthonline.org

nership with FMCGs to increase access. From launching just one product a year, Pfizer India is now launching over 40 products in one year. As part of his contribution to the region, Kewal Handa developed an Asia strategy to tap growing opportunities in generic pharmaceuticals and helped implement it across the region. Balancing the scale with its strong work ethos and policy framework, he exhibited a strong entrepreneurial spirit with very high quality products and localised strategies. A game changer in every sense, Pfizer India has led from the front to address issues that rocked the industry – whether it was the patent law in 1995 or the recent concerns with pricing. Pfizer India stands apart due to its conviction and determination to address regulatory issues not only as a private company but also as an industry representative. Kewal Handa has strongly represented the industry’s views as a member of the Drug Price Review Committee. The company certainly faces a huge challenge in addressing India’s diverse healthcare needs. Increased awareness coupled with modern medicines will go a long way in addressing the healthcare needs of the country. The government has to be open to innovative partnership models with the private sector and increase healthcare spends. Government must make an attempt to increase healthcare spend to at least 3 percent of the GDP. There has to be improvement in healthcare infrastructure to cater to both rural and urban poor. Pro-pharma industry policies are needed. We need to train large number of healthcare workers. Industry should partner with government to develop innovative PPP models.

Kewal Handa is recognised as an industry expert on issues concerning the pharmaceutical sector. As the Vice President of the Organisation of Pharmaceutical Producers of India (OPPI), he has been at the forefront of the industry’s efforts to resolve issues pertaining to the pharmaceutical sector. Kewal continues to be part of several industry associations and governing boards of institutes like IIM Ahmedabad and Raipur. Kewal was awarded the ‘India CFO 2004 – Excellence in Finance in an MNC’ by International Market – Assessment Group, the Bharat Shiromani Award in 2007 and the Pharma Leaders Pharma Professional of the year 2010 and 2011

In Conversation Visionary

Kewal Handa Managing Director, Pfizer Ltd march / 2012 www.ehealthonline.org

Visionary

“Go Organic” Krishan Guptaa, Managing Director and Global Chief Executive Officer (CEO) at Organic India, has been having lot of fun as he overcomes new obstacles while leading his company to success.

After passing out as Gold Medalist from LIT Nagpur in Chemical Engineering, Krishan Guptaa started his career in India with Colgate-Palmolive in May’88. He has worked in companies like Gillette, Godrej, Benckiser in India, and he has also handled few critical assignments in Europe and USA. From 1999 to 2001, he worked as project manager for a multinational company in Brussels, where his agenda was to improve the levels of efficiency in the company. He is a hard taskmaster and he believes in leading from the front. He delegates responsibility effectively to deliver time bound results. Krishan always believes in win-win situations. Krishan Guptaa is a firm believer in God. He is a simple and down to earth individual. He loves to read and play golf. He has written a book “Clear Your Bottlenecks,” which is basically devoted to describing his recipe of success. The book, written in a refreshingly simple, flowing style, is well punctuated with relevant anecdotes, and is a quick and absorbing to read. Krishan Guptaa has won many Awards like The Mother Teresa Excellence Award, Indira Gandhi Sadbhawana Award, PHD Chamber Distinguished Entrepreneur award, The Royal Leader Award , Young Achievers Award, Transformation Leadership Award, Lufthansa Pioneering Spirit Award and FedEx Emerging champion award.

march / 2012 www.ehealthonline.org

rishan Guptaa believes in sharpening his skills regularly. He has picked up the following qualifications - MBA (Masters in business administration) from Amity Business School, Lead Assessor (ISO 9000) and Instructor in Gemba Kaizen (AOTS Japan). He has developed a unique form of Kaizen for Organic India, with splendid results in productivity and quality improvement. He enjoys working in a multi cultural environment. At ORGANIC INDIA, his business strategy is based on enabling everyone in the chain, starting from mother earth, farmers, employees, associates, end consumers and plant as a whole to win. Mother earth wins when we use traditional method of farming (no use chemicals or pesticides), farmers win because they are paid premium prices over the market price as well as assured of buying all the produce in addition to medical support and planet wins as we use only recyclable packaging material (glass). He has also initiated scholarship for meritorious children of farmers for higher studies and to provide them jobs. Under his leadership a new initiative of stitching classes for farmers wives and daughters is initiated to support them in earning their livelihood. This concept has helped thousands of farmers and their families in India to live a life of dignity and converted thousands of acres of land abused with chemical to Organic Land. Krishan Guptaa delivers motivation-

al lectures at various public forums and business schools across the globe. It is easy to be inspired by his magnetism. Krishan Guptaa says, “We at ORGANIC INDIA totally believe in our culture. We have realised the importance of using authentic organic products. We started with Tulsi tea as Tulsi is the queen of herb and then added total range of formulations, spices and commodities with the latest addition being Desi Ghee from Tension free cows and Chaywanprash.” People need to take responsibility of their own health. The focus must shift from drugs / medicines to a natural way of living. Recourse to drug should be taken only in extreme cases. “I feel the key is to start including it in schools to catch young minds. Teach them the right basics and not get their minds corrupt towards use of drugs / medicines instead taking health in their own hands. I feel this is the right way forward and doesn’t require any investment from government,” says Krishan Guptaa. Technology could play an important role in ensuring that people start living in a natural way in India and across the world. Government should have good education system for our schools so that they learn the basics of India’s wisdom of over 5000 years and feel proud of our history while industry need to produce only authentic products so that they are effective to develop trust of the consumers on our ancient wisdom which we lost and started aping the west.

Visionary

Krishan Guptaa MD & Global CEO, ORGANIC INDIA Pvt Ltd

march / 2012 www.ehealthonline.org

guest article

Ring of

Healthcare Mobile health apps bring about improvement in overall patient satisfaction by fostering a connected system of care. The overall cost of care is also reduced By Dr Ruchi Dass

Health addresses some of healthcare industry’s biggest concerns. It has the potential to tackle issues like the billions of dollars being spent annually in inappropriate or wasteful care, or the shortage of primary care physicians in India. So it should come as no surprise that mHealth is attracting the attention of not only the healthcare community, but also the investor community. Patients and Physicians alike are increasingly turning to mobile devices to help monitor, track and manage healthcare outcomes. There are 20,000 plus mHealth applications in the major app stores today, and by 2015, it is projected that there will be 500 million mHealth app users worldwide. The smartphone penetration in India is increasing with 40 percent consumers accessing internet daily through smartphones; 34 percent of these users log in for more than half an hour each day. Smartphone users have, on average, downloaded 13 apps with 12 currently on their phone. Of these, eight are used regularly. It is obvious that apps are fast becoming commonplace in every smartphone owner’s life. However, although consumers are investigating an increasingly wide range of apps, they will only use those which offer them real benefits, which can range from functional,

march / 2012 www.ehealthonline.org

social or entertainment oriented. Compared to a decade ago, we are highly “connected” population today – from email to facebook to news on the go; information is accessible anytime, anywhere. Operators laid the “foundation” upon which businesses built millions of widgets for consumption by all of us. In a similar sense, the progression of mHealth will largely be dependent on innovations in telecom and the speed of implementation of the same. 4G /LTE (Long-term evolution) will revolutionise the way data is sent over wireless networks. In the near future, we envision a scenario where a consumer can set up a tele-health appointment and consult a physician by leveraging the high speed wireless connection and high-definition video conferencing capability available from his handset. However, these applications need to work seamlessly with other systems with defined processes in place to achieve adoption and to be self- sustainable. There is a little value in creating apps that can’t connect to clinical workflows, other providers, common man and their specific networks. HealthFore (www.healthfore.com), with support from HealthCursor Consulting Group (www.healthcursor.com) is focused on creating the common pipes

through which data will flow. We understand the real value that is subsumed in healthcare data. On the other side, mobile health apps provide D2C connect which empowers the end users with customised information, advice and also helps drive qualified referrals to the providers. It helps increase the overall patient satisfaction through follow ups and connected care all while reducing the overall cost of care. Unfortunately, most of today’s mHealth applications are limited in their ability to both access and share information because the data is sitting in silos, typically locked away in disparate, proprietary, redundant systems that are hard to integrate. After the successful launch of our Doctor on Call service, HealthFore intends to launch continuous---> collaborative---->connected point of care mechanisms. mHealth applications will be an integral part of this novel approach for offering quality healthcare on an anywhere, anytime basis.

About Author Dr Ruchi Dass mHealth Advisor, Healthfore ( A Division of Religare Technologies)

Doc Talk

Heart Ache to Heart Age

Technological advances have contributed to decline in cardiovascular mortality rates globally, but unfortunately the same is not the case in our country By Dr Hygriv Rao

ardiovascular diseases (CVDs) are a major developmental threat for India. A recent WHO report, entitled â&#x20AC;&#x2DC;Global atlas on cardiovascular disease prevention and control,â&#x20AC;&#x2122; states that CVDs are the leading causes of death and disability in the world. Although a large proportion of CVDs are preventable, they continue to rise mainly because preventive measures are often found to be inadequate. An ageing population and increased focus on cardiovascular diseases have led to surge in popularity of cardiovascular devices. The industry has contributed by refining the software and making it more user-friendly, particularly the multiple programmable vectors in Cardiac Resynchronisation Therapy (CRT) and telemetry options. Hardware tailoring to different anatomies has aided in easier implantation. Similarly the hardware available for complex arrhythmia ablation has improved. Programmes directed to

march / 2012 www.ehealthonline.org

physician training in arrhythmia related areas have helped to bridge the gap between medical curriculum and practice. There has been an increase in device implanting centres, some of which have come up outside the metros. There is also an increase in number of implanting physicians with a number of interventional cardiologists doing implants. Programmes of third party payment for the underprivileged have been taken up in Andhra Pradesh, Karnataka and possibly some other states, where there is increase in number of pacemaker implants. The advantages of using the interventional cardiology approach include the avoidance of the scars and pain, and long post-operative recovery. Besides this, the hardware for CRTâ&#x20AC;&#x2122;s has considerably improved making these procedures less time consuming. Overall there has been a significant growth. Therapeutic advances have contributed to decline in cardiovascular mor-

tality rates globally, but the same is not the case in our country. This is largely because of lack of accessibility to emergency healthcare services; majority of patients with cardiovascular diseases are unable to get basic drugs like aspirin, statins and beta-blockers. Government has to come up with policies that will address these issues. The regulatory regime must functions more effectively to make medical care affordable, medical expenses transparent, and medical education more relevant. Besides this, our country needs more healthcare professionals, to help create more awareness about the disease and the ways by which it can be controlled. The polypill has been hailed as the magic bullet to heart problems. In future we can expect to have a combination of polypills for primary and secondary prevention. The concept of a polypill for everyone over 55 to cut heart disease by up to 80 percent was mooted over a decade ago, but the progress on this aspect has been rather slow. Physician and patient friendly devices with limited algorithms, that are also cost effective, are a must. Remote monitoring is more efficient than scheduled office visits for picking up the kinds of arrhythmic events that physicians want to know about. Several studies have strengthened the evidence base built primarily on large registries suggesting that remote monitoring makes the following of device patients more efficient and potentially less costly. It cuts reliance on in-office visits, and is no less safe than conventional care. Scheduled device checks in the office can be many months apart, and further visits can be organised in the event of symptoms or device discharges. In future, plans to incorporate remote monitoring technology will become more popular in centres in major metros. This kind of technology will also assist in diagnosis and treatment of patients residing in peripheral areas. About Author dr hygriv rao is a Cardiologist and associated with CARE Hospital, Hyderabad. His areas of expertise are Cardiac Electrophysiology, ICD, Pacemakers, PTCA and PBMV.

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expert corner

Micro Health Centre

Instant-on Cloud Enabled Healthcare

Infrastructure Solution Micro Health Centre mitigates ground-level issues of delivering healthcare to villages in India and in other economies that are challenged by the inadequacy of health infrastructure By Dr Jaijit Bhattacharya, Ritu Ghosh and Dr Anjali Nanda

ommission on Macroeconomics and Health of the World Health Organisation (2001), have argued that better health care is the key to improving health as well as economic growth in poor countries. However, healthcare delivery at the village level is constrained by lack of basic healthcare infrastructure including inadequate supply of electricity, lack of doctors, non-functional equipments, lack of supply-chain with no appropriate monitoring of the existing healthcare infrastructure and manpower. The aim of the Micro Health Centre (µHC) is to mitigate these ground-level issues of delivering healthcare to villages in India and in other economies that are challenged by the inadequacy of health infrastructure. The cloud enabled infrastructure of the “Micro Health Centre” solution by Hewlett Packard provides access to specialist medical consultation at affordable cost and provides support for disease surveillance by tracking disease patterns and risk factors. Given that µHC is a rapidly deployable infrastructure, it is also appropriate to support disaster relief operations. The µHC proposes to provide preventive, curative and emergency services, also acting as a tool for creating public awareness.

Current Healthcare Scenario in India India has nearly 741 million rural people (72 percent of the total population, source: census of India, 2001).The Ten-

march / 2012 www.ehealthonline.org

dulkar Committee report states that 42 per cent of rural people in India are below the poverty line. In India, about 75 percent of health care infrastructure, medical manpower and other health resources are concentrated in urban areas where 27 percent of the population lives. Contagious, infectious waterborne diseases and reproductive tract infections dominate the morbidity pattern, especially in rural areas. Moreover, non-communicable diseases are also on the rise. The basic nature of rural health problems is attributed to poor maternal and child health services. Every year, 1.8 million persons develop Tuberculosis in India, of which about 800,000 are infectious and until recently 370,000 die of it annually–1,000 every day. However, the reach and quality of the Primary Health Centre (PHC) needs to be

enhanced in order to cater to the healthcare requirements of the last mile. The primary health care infrastructure in rural areas in India is based on the population norms of having one PHC for every 30,000 people and one sub-centre for every 5000 people. There are 24,375 doctors serving the PHCs, which imply a doctor population ratio of 1: 34,000 in the rural areas. This is much below the global standard set by the World Health Organisation (WHO) of 1: 250. The timely availability of appropriate drugs and equipment is much needed in the existing PHC. Efficient management of data is difficult in the currently existing manual system, and often involves duplication of efforts and wastage of time. The existing physical infrastructure in PHC’s and the number of existing public health facilities needs to be enhanced to

expert corner

meet the health care demands in large remote areas of the country.

Concept of Micro Health Centre The better reach and quality of the Primary Health Centre is much required to cater to the healthcare requirements of the huge population. This calls for a need of a rapidly deployable self sustainable infrastructure, backed by the robust healthcare services accessible from anywhere. The solution is equipped with built in electricity, built in connectivity, medical equipment, telemedicine services and requires minimal training to operate. In rural areas, a simple, correct and timely diagnosis of the fever could be a challenge, yet life saving. The difficulty of reaching a blood sample to a lab and getting the report back in a reasonable time frame for the villager, who may have already travelled long distances for medication, is a serious concern. Especially in case the patient is suffering from a disease like malaria. The µHC acts as a solution in similar scenarios as it provisions the availability of laboratory facilities and specialist consultations through tele health services. The continuous remote monitoring of equipments, data, medical staff and the stock of medicine through techniques like biometric surveillance and “cloud enabled medical devices” ensures the availability of health services without interruption at all times.

Figure -1: Micro Health Centre structure

The sms based services will act as an enabler to the vaccination camps of the government ensuring a higher volume of enrollment even in rural areas. µHC can effectively address the challenge of health work force shortage in rural areas and the issues of quality and accountability in healthcare. Through a unique simple interface, it enables community ownership of the health care services being provided, thereby acting as a self sustainable solution.

Health Cloud – Linkage to Centralised Backend Cloud computing provides tremendous opportunities for the health sector to improve the delivery of services and reduce the cost of operations. Using cloud technology in healthcare can aid in disease surveillance by tracking disease patterns and risk factors and disaster management.

The cloud enabled µHC infrastructure can help solve some of the most pressing issues facing the health care industry today such as dismal quality of health care provided, shortage of drugs, equipments, trained personnel and specialist medical care in remote areas. A health data base gets generated by electronic reporting of data using rapid and reliable diagnostic tools and remote sensing for the collection, storage and analysis of health data. Services provided in µHC are OPD services, tele health services: real-time support to physicians, tele consultation, information dissemination, research, video conferencing, availability of essential drugs, mother and Child healthcare services including family planning services, referral services, in-patient services, education about prevention and control of locally endemic diseases, Health Education and Behavior Change Communication (BCC) and laboratory services such as all general tests, including blood, urine and sputum tests, record of vital events and reporting and disease screening for diabetes, hypertension and COPD (chronic obstructive pulmonary disease) and ambulance on call. The µHC will increase the reach of healthcare and will lead to improved communications between healthcare providers separated by distance through Tele consultation and video conferencing. It will address basic health issues and deliver preventive healthcare such as immunisation to the rural masses. It can act as a tool for public awareness and disaster management and provide accurate reporting of health indicators of the community. march / 2012 www.ehealthonline.org

expert corner

Conclusion Thus, µHC presents an affordable solution proposed by HP (Hewlett Packard). It is an intelligent Telemedicine Health Centre, designed to meet the local needs and conditions without any infrastructural constraints. It proposes to provide essential health care services with Health Cloud connectivity services, thus providing invaluable data for research and can act as a tool for disaster management, disease surveillance and public awareness.

Thus µHC can dramatically increase the reach of healthcare with the following benefits rapid deployment of nation-wide healthcare, remote monitoring of functioning of the micro-PHC and its equipment through transducers, improved ante-natal and post-natal care, addressing basic health issues and delivering preventive healthcare such as immunisation, invaluable data for research on better drugs, reduced mortality and enhanced quality of life for patients, reduced IMR and MMR, easy

Components of a cloud connected µHC infrastructure: • Equipped with Cloud based network architecture • Web based EMR with CPOE (computerized physician order entry), • CDSS (clinical decision support system) • Data storage and transfer to expert centre • Video conferencing with medical experts • Medical Equipment Connectivity: Equipments with sensors • Automated reminder of vaccination and TB drug administration • Monitoring of the patient visit, doctor and medical staff attendance. • Centralised health record management • Training and health awareness program

march / 2012 www.ehealthonline.org

access to primary healthcare facility and better quality of care, affordable healthcare, enable citizens to avoid unnecessary travel for health care needs, access to family welfare services and laboratory services, low cost diagnostics tools and methods for diseases requiring immediate attention, patient data available in EHR and counselling and teaching for preventive healthcare.

About Authors Dr Jaijit Bhattacharya, PhD Director,South Asia, Global Government Affairs HP India Sales Pvt Ltd Adjunct Professor, Department of Management Studies, IIT Delhi Ritu Ghosh Specialist - Education Health Environment, Global Government Affairs, HP India Sales Pvt Ltd dr aNJALI NANDA Social System Specialist, Global Government Affairs, HP India Sales Pvt Ltd