Telemedicine-Geared for Giant Leaps?: May 2007 Issue

v o l ume 2 | issue 5 | m ay 2007

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Telemedicine-

Geared for Giant Leaps?

cover story

indiaâ&#x20AC;&#x2122;s tryst with telemedicine interview

chris s. thomas, intel corporation INTEL: WEDDED TO INTEGRATED TECHNOLOGY SOLUTIONS IN HEALTHCARE focus

ASSOCHAM SUMMIT ON CORPORATE HEALTH TAKES UP VITAL ISSUES CASE STUDY

DESIGN GUIDELINES FOR TELECARE SERVICES development

e-HEALTH and its challenges for the african media industry profile

digital imaging on a high after spurt in demand www.ehealthonline.org

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w w w . e h e a l t h o n l i n e . o r g | volume 2 | issue 5 | May 2007

Cover story

Indiaâ&#x20AC;&#x2122;s Tryst with Telemedicine

Jagjit Singh Bhatia, Mandeep Kaur Randhawa, Harpreet Kaur Khurana, Sagri Sharma

opinion

Telemedicine Adoption in India; the New Drivers

Sanjay P. Sood

in conversation

Intel: Wedded to Integrated Technology Solutions in Healthcare

Interview with Chris S. Thomas, Chief Strategist, Intel Corporation

focus

ASSOCHAM Summit on Corporate Health Takes Up Vital Issues 17

industry profile

Digital Imaging on a High After Spurt in Demand

Book Review

The Economics of Healthcare Spending

case study

Design Guidelines for Telecare Services

Development

e-Health and its Challenges for the African Media

perspective

Integrated Healthcare Management System

Project Showcase Emergency Care Redefined

NEWS REVIEW

india update

world news

May 2007

â&#x20AC;˘

business news

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Volume 2 | Issue 5 | May 2007

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Dr. M P Narayanan

EDITORIAL Can Telemedicine be the Elusive Cure?

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Ravi Gupta sr. editor

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ndia has come a long way since the introduction of the concept of telemedicine in its healthcare scenario, about less than a decade ago. Some of the major players in fostering the progress of telemedicine in the country are Apollo Hospitals group, Fortis Healthcare, ISRO, C-DAC, Sanjay Gandhi Postgraduate Institute of Medical Sciences(SGPGIMS), Narayana Hrudayalaya and Manipal Hospitals, etc. who are together endeavouring to make a difference in the lives of underserved population, by helping them get access to world class healthcare. We have explored the possibility of telemedicine initiatives in India and the role of C-DAC in fostering this medico-technological progress in the Cover Story of our magazine. Today ISRO’s exhaustive telemedicine network has 165 hospitals in its ambit, which include 132 district/rural hospitals, and 33 specialty hospitals located in major cities, and DIT telemedicine network covers 75 nodes. But what is more noteworthy is the proactive stance of the private players. Apollo Telemedicine Networking Foundation(ATNF), which pioneered India’s private enterprise in the nascent domain of telemedicine way back in 1999, with the setting up of telemedicine network in Aragonda village of Andhra Pradesh, has significantly spread its telemedicine network in India and abroad. However, Apollo is by no means alone in this road ahead... Such examples are many, and they are hogging newspaper headlines with alarming regularity, creating a feel good atmosphere in the process. So much for the growth, but is this growth really getting translated into development? Though implementation of telemedicine initiatives in India has been a success story, did it yield positive outcomes for its practitioners in a big way? Can distance healthcare really bridge the yawning divide in Indian healthcare, between its selected haves and plethora of havenots, notwithstanding the myriad infrastructral and human resource lacunae involved? I think we all know the simple answers to these simple questions, but effective solutions elude us. We must also realise that telemedicine, like all other branches of e-healthcare, has great potential to catalyse healthcare of a society, but it cannot function effectively on the edifice of a poor IT and healthcare infrastructure, which has been the bane of India, despite being an IT superpower. We are speeding through a technological run, but we must not forget that we have to walk many miles too...

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May 2007

Ravi Gupta Ravi.Gupta@csdms.in

CO V ER s t o r y

India’s Tryst with Telemedicine Indigenous efforts by C-DAC paying up! Telemedicine can bridge the existing divide in terms of healthcare between the urban and rural India. Thankfully, today telemedicine has become increasingly possible due to a confluence of ongoing technical advances in multimedia, imaging, computers and information systems, as well as in telecommunications. Telemedicine would enable the population of remote and rural India to avail the facilities and expertise of big super-specialty hospitals in the metros. The timely diagnosis and advise by specialists would in many cases avoid the aggravation of conditions of patients, thereby saving the lives, money and time. Succinctly, the advantages that telemedicine can accrue for the population can be manifolds.

elemedicine, as the name suggests, is the application of communication and information technology for remote consultation and diagnosis of diseases by medical professionals. It is a procedure through which medical services are made available remotely, through a combination of telecommunications, multimedia technologies and medical expertise. India is one of the largest producers of doctors and nurses in the world, and is not far behind in terms of providing science and technology support, required for successfully setting up the stage for telemedicine in India. Telemedicine is the hope for a common villager for a better access to healthcare. Now it is the duty of the medical professionals, engineers and technologists to spread the awareness among the general population and make this promising venture a success in India. Here we will discuss how telemedicine adoption can help to improve the healthcare conditions of rural and remote population in India and how Center for Development of Advanced Computing (C-DAC) is contributing in telemedicine field. The Indian scenario

Being heralded as one of the several possible solutions to some of the medical dilemmas facing many developing countries, telemedicine has already brought a plethora of benefits to the populace of India, especially those living in the rural and remote areas (constituting about 70 percent of India’s population). One of the many reasons for the huge potential of telemedicine in India is because a large chunk of India’s rural population doesn’t have access(or have very limited access) to even primary healthcare facilities. We should accept the fact that India has a large population and providing quality healthcare to such a large population is not an easy task. The lack of funds is a major hindrance }

towards setting up of as many medical facilities as are needed. Specialists are stationed at these limited medical facilities, and patients have to travel to these centers, even to simply get diagnosed. The alternative being that of specialist making periodic visits to the patient. Such approaches are implemented in various rural and other parts of India with mobile clinics, mobile specialty hospitals, etc. However, the response time in either case is generally high. Moreover, in some challenging cases, often doctors and specialists need to consult other specialists to ensure that all aspects of a complication or patient disorder have been taken into consideration. Besides wastage of precious time(in case of some critical illness every minute can be precious) in commuting to the health centers from remote areas, other important dimension is the financial implication of making visits to a health center or the patient site for a diagnosis. The associated costs of travelling, staying, equipment movement, etc. are high. If the patient has to travel to the referral facility, not only will it cause him discomfort (the situation is much worse in case the patient is under trauma), it will also cost him time and lots of money. If the specialist has to travel to the site (which is not generally done), then the cost is much more, as his time is very valuable – not only in terms of money, but also because other patients will be deprived of his services while he is travelling. In such a scenario, which is very much prevalent in India, telemedicine can emerge as a welcome alternative to supplement conventional healthcare. One of the biggest benefits telemedicine provides is the death of distance. Deploying it can reduce unnecessary travel, expense and even strain. Once the virtual presence of a specialist is acknowledged, a patient can access medical resources without the constraints of distance. It also solves the problem of retaining specialists in non-urban areas. www.ehealthonline.org

Moreover in our country, where a large population lives in rural and semi-urban areas, the telemedicine holds a great promise for the masses at large, as the hospitals and the health centres located in these areas are in general ill-equipped in terms of medical expertise or the diagnostic equipments. According to the available healthcare statistics, about 75 percent of the qualified doctors in India practice in urban areas, and 23 percent in semi-urban areas, so this leaves only 2 percent of the doctors to cater to the health needs of a whopping 70 percent of the Indian population, living in villages. The most unfortunate outcome of this distribution is that 80 percent of the medical facilities in India are being channelised to the urban areas and a meager 20 percent comes to the rural areas. In such an otherwise depressing scenario, telemedicine has the promise to revolutionize this lopsided delivery of healthcare in India. Telemedicine can bridge the existing divide in terms of healthcare between the urban and rural India. Thankfully, today telemedicine has become increasingly possible due to a confluence of ongoing technical advances in multimedia, imaging, computers and information systems, as well as in telecommunications. Telemedicine would enable the population of remote and rural India to avail the facilities and expertise of big super-specialty hospitals in the metros. The timely diagnosis and advise by specialists would in many cases avoid the aggravation of conditions of patients, thereby saving the lives, money and time. Succinctly, the advantages that telemedicine can accrue for the population can be manifolds. They include

One of the biggest benefits telemedicine provides is the death of distance. Deploying it can reduce unnecessary travel, expense and even strain. Once the virtual presence of a specialist is acknowledged, a patient can access medical resources without the constraints of distance. It also solves the problem of retaining specialists in non-urban areas.

timely availability of expert medical services and opinion at affordable cost, thereby preventing the aggravation of illness and disease among the patients,maintenance of database with respect to various diseases and locations, and remote training of medical students by experts in the field. Telemedicine has added a new dimension in modern clinical practice of medicine in western countries where it is now a matter of routine. In western countries, telemedicine is now being utilized as an advanced facility for providing specialty services for hospitals and medical centers where experts are not readily available, thus eliminating the impediments of time and distance. However clinical practice with modern technology is an expensive proposition and needs highly experienced experts in interpreting the imaging technology. Moreover, in India the patients at small hospitals including the hospitals in medical colleges are not given the facilities of May 2007

expert opinion in the clinical practice through usage of modern technology in diagnosis and treatment. Thus the best way and perhaps the most economical method of extending telemedicine facilities in India is through referral centers. The referral centers should be equipped with all the necessary equipments and should be directly connected via satellite to the user-hospital/institution. Here it deserves a mention that C-DAC initiated the program of development of telemedicine technology in India, way back in 1999, with an aim of demonstrating and evaluating its feasibility in the Indian context. Timely help during mega events and disasters

Telemedicine services can also be of great aid during times of crises or disasters, such as earthquakes, devastating fires, and other natural disasters, to provide backup services. Some recent events in India point to telemedicineâ&#x20AC;&#x2122;s role in tackling unforeseen disasters. On 26 January 2001, due to the devastating earthquake in Gujarat, some 40,000 lives were lost, and over one lakh people were badly injured. The need at that point of time was to immediately treat the injured and provide healthcare facilities to prevent further deaths. The earthquake also decimated many hospitals and other medical facilities. In this gloomy scenario the promising technology of telemedicine made its presence felt. The day after the earthquake, the Ahmedabad-based Online Telemedicine Research Institute (OTRI) came to the rescue and established the first communication link from Bhuj, which was close to the epicenter of the quake. Specialists were able to provide consultations from far-off places, thanks to the established telemedicine links. For example, after the telemedicine center was set up at Bhuj hospital, an X-ray facility was provided to the people, whereby a specialist provided online consultation from Ahmedabad. During the subsequent days, quake victims could get medical advice from

cover story

india’s tryst with telemedicine

other doctors, based at Ahmedabad and Bangalore. Over 750 sessions were conducted in a period of 30 days, thus saving many lives. Apart from Gujarat, there are a couple of other cases that show the potential of the technology. For example, during the last Kumbh Mela, which drew over 25 million pilgrims to the banks of the Ganga for the holy dip, telemedicine was deployed successfully. OTRI, together with a team of tech-savvy doctors, transferred data of over 200 ailing pilgrims, besides sending microscopic images of microorganisms, in order to monitor the levels of cholera-causing bacteria in the river. Another pertinent example is the Asia Heart Foundation that has been successfully practicing telecardiology between Bangalore and the cities in eastern India. C-DAC’s Initiatives

Centre for Development of Advanced Computing (C-DAC), Mohali, formerly known as Centre of Electronics Design and Technology of India (CEDTI), is a premier institute of the Ministry of Communications & Information Technology, Govt. of India, involved in R&D, design, development and deployment of advanced information technology prod-

developed in-house, under the expert guidance of the doctors in these hospitals. A pilot project on ‘Development of Telemedicine Technology and its Implementation’ was approved for implementation by the Department of Information Technology, Ministry of Communications and Information Technology, Govt. of India and it has been implemented over the ‘telemedicine network’ connecting PGIMER, Chandigarh, SGPGIMS, Lucknow and AIIMS, New Delhi on ISDN lines. The objectives of this pilot project are outlined below:

•

To run and implement successfully the telemedicine technology over the telemedicine network, connecting the three locations at PGIMER, Chandigarh, AIIMS, New Delhi and SGPGIMS, Lucknow. • To establish a dedicated satellite communication facility using very small aperture terminal and thereby networking medical centers in northern part of peninsular India. • To establish a telecommunication technology network, which can provide a comprehensive range of high-quality health services to rural and remote areas in India. • To purchase cost-effective hardware needed for transmitting data and images of adequate diagnostic quality. • To enable well-established image & data archiving, printing for graphics, images and video data. • To train the doctors and patients to use the telemedicine technologies effectively and optimally, with a view to develop their faith and confidence in these technologies. • Documenting the technology and extending it to specialty centers within India and worldwide. Our subsequent effort was on establishing telemedicine sites at different locations in the state of Himachal Pradesh, which is a remote and hilly state of India. C-DAC is further working on implementation of telemedicine technology in rural areas of Punjab, and in Chandigarh. (i) Telemedicine in Himachal Pradesh

ucts and solutions. The centre also specializes in embedded & VLSI technology, bio-medical, electronics, telemedicine and entrepreneurship development. We, at Centre for Development of Advance Computing, are working in the field of telemedicine since 1999, and have successfully developed state-of-the-art telemedicine application packages namely, ‘Sanjeevani’ and ‘e-Sanjeevani.’ We have, as a pilot project, established telemedicine technology at six major locations in India. These locations were subsequently connected to nearby districts and primary health centers to make a telemedicine hub. Our first endeavour was on establishing telemedicine sites at All India Institute of Medical Sciences, New Delhi, Post Graduate Institute of Medical Education and Research, Chandigarh and SGPGIMS, Lucknow. We have expanded it in the second phase to connect three more medical colleges namely, Indira Gandhi Medical College, Shimla, Medical College, Rohtak and Medical College, Cuttack. The telemedicine software package was

The project envisages the customized development of telemedicine application titled ‘Sanjeevani’ and its subsequent deployment in the rural areas. ‘Sanjeevani’ is an integrated telemedicine solution based on ‘Store & Forward’ concept of telemedicine. As many as 24 locations have been identified for deployment of the project. These range from community/ primary centres to civil / regional hospitals and IGMC, Shimla. The telemedicine application will comprise the basic tele-radiology, tele-pathology and tele-cardiology modules. This telemedicine application will deliver specialized healthcare to the patients of underserved rural areas of Himachal Pradesh, at very low cost. At present, the position of healthcare in these rural areas is not good. The number of primary healthcare centers in the state of Himachal Pradesh is less and most of the vital medical infrastructure are not in proximity to the section of its popuwww.ehealthonline.org

lation. In the rural areas of Himachal there is a high prevalence of untreated curable diseases, which remains untreated due to lack of resources. The application will enable the provision of specialized medical care, services and treatment to the patients in the far flung, remote and inaccessible areas of Himachal Pradesh. They live far from the specialty hospitals, to where it is difficult for these rural patients to commute. The objectives of the project are as follows:

•

To develop a customized telemedicine application in the rural and remote areas of Himachal Pradesh for providing specialized medical care and support to the patients at their convenience, and at an affordable cost. This will involve connecting the community health centers/primary health centers and block level/district level hospitals in the rural areas to IGMC, Shimla for expert advice. As many as 14 such centers / hospitals are being connected in Phase I and rest in Phase II. The connectivity will be further extended to PGIMER,Chandigarh over the existing telemedicine linkage. • To establish seamless connectivity over diverse communication environment in the state. • To develop software interfaces with low cost medical diagnostic equipment so as to offer a very low cost telemedicine solution for rural areas. • To introduce new software/hardware features in the existing telemedicine technology for developments not covered already. • To give a boost to the production of low cost medical diagnostic equipments for telemedicine technologies in India. • To spread medical education among the medical professionals for their continuous upgradation at a very low cost, even to far off places in rural areas. • To develop it as a pilot project for subsequent implementation all over India. Telemedicine set up implementation at various health institutions in Himachal Pradesh will be based on the network that can be classified into the following categories: Phase I: Installation of the identified equipment and to link two medical colleges in the state; Phase II: Linking with all the identified hospitals; Phase III: Integration with Hospital Information System (HIS). May 2007

Implementation of telemedicine application software ‘Sanjeevani’ in Himachal Pradesh will be providing benefits to the population in the following ways: • A best possible healthcare facility will be available to all of them. • They need not move the patient to specialty hospital at far away places unnecessarily. • Since majority of the potential population for this telemedicine application earns their livelihood through daily wages, they will not only be saving time, but also their hard-earned money, if they avail of this facility. • The cost involved in the treatment using telemedicine technology shall definitely be manifold less than the healthcare cost now being borne by this population. (ii) Telemedicine in Punjab

The aim of this C-DAC project is to deploy the customized telemedicine application at a wider network, covering the rural areas of Punjab. The application will enable the provision of specialized medical care, services and treatment to the patients in the far flung, remote and inaccessible areas of Punjab, from where it is extremely difficult for the patients and their families to commute to specialty hospitals. The browser-based telemedicine application named ‘e-Sanjeevani’ is an outcome of the advancement over the existing desktop application ‘Sanjeevani’. This telemedicine application will deliver specialized healthcare to the patients of underserved rural areas of Punjab at very low cost. This package has been lab tested on LAN (10/100 Mbps) and is running on a public website named http://www.esanjeevani.in/ The main outcome of the project is to deploy ‘e-Sanjeevani’ in all the districts of Punjab but the intermediate output is to deploy and test it at as many as 20 locations, which have been identified with Punjab Health Systems Corporation Punjab. Deployment of ‘e-Sanjeevani’ will help the poor and needy sitting at remote and urban places where specialized treatment is not available. With this, the poor can easily have the advice of the specialists and suffer less. Hereby the deployment of this project by C-DAC, Mohali will effectively help the underserved and underprivileged community of Punjab.n

Jagjit Singh Bhatia Director, Center for Development of Advanced Computing Email: jsb@cdac.mohali.stpi.in Mandeep Kaur Randhawa Project Associate, Center for Development of Advanced Computing Email: mandeeprandhawa@cdac.mohali.stpi.in Harpreet Kaur Khurana Design Engineer, Center for Development of Advanced Computing Email: harpreet@cdac.mohali.stpi.in Sagri Sharma Assistant Engineer, Center for Development of Advanced Computing Email: sagrisharma@cdac.mohali.stpi.in

opinion

Telemedicine Adoption in India; the New Drivers Implementers’ domain or practitioners’ regime? India is an unusual country. It is enjoying booming software exports and is a major destination for business process outsourcing (BPO). As a result its economy is on the rise, and it is at the crossroads of being transformed into an IT leader. However, the demographics of its population are not reflecting this IT and BPO revolution. It is changing, but at a leisurely pace. And that is one of the reasons why despite being a global hotspot in information technology, diffusion of information age tools like telemedicine and e-Health in India are still far-fetched dreams. Sanjay P. Sood

pectacular strides in mobile communications, rapid developments in Internet technology, application of efficient information management techniques and widespread adoption of information technology have propelled healthcare delivery systems from clinics and hospitals right into the households of its consumers. One of the key factors responsible for this paradigm shift in the nature of the healthcare delivery organizations is the changing demographics of the consumers. Agrarian societies have transformed into industrialized societies, which in turn are upgrading to information societies. Owing to this milieu of technological and societal changes, the demand for timely, accurate and portable health information is on the rise. The concept of ‘pervasive healthcare’ i.e. healthcare for anyone, anytime and anywhere is gaining ground. This is not fiction, in fact we are talking about pragmatic traits of information age healthcare delivery systems, which are already servicing the privileged populace in Scandinavia, North America, western Europe and even in a couple of countries in the Far East i.e. the developed world. However, we should not get too carried away by this rosy picture so as to forget the teeming multitude of have nots,who are lying on the other side of digital divide. Their gloomy world is characterized by looming threat of pandemics; limited medical personnel;unrealistic expectations due to strict economic regime; exodus of medical professionals; faltering social infrastructure coupled with unreliable means within their own frontiers; all of which are averting their progress on the healthcare highway, and making their access to affordable medicine a highly challenging issue for them. The above mentioned imageries are a depiction that acutely matches the ground realities in developing countries with respect to their healthcare services. Solutions for these daunting challenges have to be extraordinary from all perspectives 10 }

and one of those definitely is e-Health. However, there are some pragmatic problems towards the success of e-Health technologies in a typical developing country like India. India is an unusual country. It is enjoying booming software exports and is a major destination for business process outsourcing (BPO). It is at the crossroads of being transformed into an IT leader. However, the demographics of its population are not reflecting this IT and BPO revolution. It is changing, but at a leisurely pace. And that is one of the reasons why despite being a global hotspot in information technology, diffusion of information age tools like telemedicine and e-Health in India are still far-fetched dreams. It has been close to a decade that first attempts to embrace telemedicine were made in India, but still their positive outcomes for the Indian healthcare industry are at a nascent stage. However, considering the state of IT in India a decade earlier, the introduction of telemedicine in India was nothing short of commendable. In 1998, PC penetration in India was 1 per 1000 and teledensity was 1.2 per 100. High speed data transfer services www.ehealthonline.org

like ISDN were commissioned only in 12 cities. Tariff for a national long distance (beyond 1000 kilometers) telephone call was hovering around 0.7 USD, an international telephone call to the US costed close to 1.5 USD. Depending on such an underdeveloped IT infrastructure, the launch of telemedicine almost a decade earlier was a commendable task for the then Ministry of Information Technology.

• • • • • • •

Development of indigenous telemedicine technology Test beds for clinical trials Availability of world-class platforms (technological and clinical) for enabling and practicing telemedicine Laying guidelines and standards for practicing telemedicine in India Finalizing framework for IT infrastructure for healthcare Availability for expertise for task forces International conferences, etc.

Commendable progress in implementation

Despite roadblocks, India has witnessed some noteworthy progress in telemedicine, as far as the implementation of telemedicine infrastructure across the country is concerned. Between then and now, launch of e-Health initiatives in India have been gaining ground, in both the public and the private sector. Pioneering national telemedicine project funded by the Department of IT, Ministry of Communications and IT, saw its completion, wherein the information superhighway was laid between three tertiary level hospitals (AIIMS at New Delhi; PGIMER, Chandigarh and SGPGI, Lucknow). Indian Space Research Organisation (ISRO), with its initiative of space-based telemedicine launched in 2001, has surfaced as another flag bearer for telemedicine in India. Today ISRO takes pride in providing satellite-based linkages to around 200 healthcare set ups across India. In order to build up on this foundation for practicing telemedicine in India, the agenda for e-Health was shared by His Excellency President Kalam in his address, while inaugurating Commonwealth Connects: International e-Partnership Summit on 23rd March 2007 in New Delhi. His vision paints a promising IT infrastructure for Indian healthcare. Indian Ministry of Health and Family Welfare too has opened up to e-Health; a task force for telemedicine has been set up to advise on key aspects. The scene has been equally encouraging in the corporate healthcare sector. Very few, even amongst those who have been following the evolution of telemedicine in India for almost a decade, know that the cardiologists at Escorts Heart Institute and Research Centre Institute in Delhi are the unsung heroes. They have implemented telemedicine in their practice. It is intriguing to note that while Indian telemedicine pioneers were drafting proposals for their maiden telemedicine projects, the cardiologists at this world-class super specialty healthcare set up had already published their experiences as telemedicine practitioners, while using Escorts Heart Alert Service (EHAS) i.e. a trans-telephonic ECG system that enabled them to receive SOS signals from ailing hearts. The case of Apollo’s Aragonda (2000) has been good enough to impress President Clinton, who praised Apollo for its efforts to provide healthcare services by using hi-tech medicine, for the population of this Indian village in Andhra Pradesh. Since then Apollo’s telemedicine network has spread across the length and breadth of India. Today, India can take pride in hosting 500 telemedicine nodes across the country and many more are in the pipeline. This seems to be an unparalleled accomplishment in the developing world. Presently, India experiences the following with respect to telemedicine : May 2007

Dismal outcomes

In other words, from time to time, policy makers, administrators and implementers’ in the government sector have been synergizing their efforts to come up with a reasonably good foundation for establishing telemedicine infrastructure in India. As a result telemedicine in India has grown up to take some load off from country’s historically dilapidated healthcare delivery system, by extending the reach of clinical practitioners’ expertise to isolated communities languishing in far flung areas. However, though implementation of telemedicine in India has been a success story, the positive outcomes for its practitioners are limited. Unfortunately, successful outcomes still elude Indian telemedicine practitioners in the public sector in a big way. Announcements about successful outcomes, proportionate to the intellectual and financial investments, are yet awaited. There are a few instances of using off-the shelf components for tele-education and video conferencing, but this has never been the prime objective of setting up pricey telemedicine nodes, which are progressively mushrooming in the world’s most populous and biggest democracy. True character of telemedicine lies in telediagnosis and teleconsultation that is centered around exchange of clinical information. If we browse through the telemedicine practitioners’ & users’ literature or read clinicians’ account of e-Health in India, we find that these are highly promising and future oriented accounts stuffed with sweet dreams, but with very little or no evidence of success in their real life e-Health endeavours. Owing to their observations, many clinicians have come to the realization that telemedicine potential in India is largely underutilized. The technology that was all set to display an enormous network-effect in India appears to have missed something. Implementers too have been waiting untiringly to witness the outcomes of their efforts. Considering these facts, it may not be highly challenging to find an answer to the query whether the first decade of telemedicine in India belongs to the implementers or the practitioners. Time has come for all the stakeholders to look back, introspect and ensure that Indian telemedicine doesn’t go the Indian cricket way; something that could not fire despite world-class ingredients.n Sanjay P. Sood Director C-DAC School of Advanced Computing Quatre Bornes, Mauritius sood@spsood.com

in conversation

Intel: Wedded to Integrated Technology Solutions in Healthcare Making deep inroads in home healthcare

The Seventh Annual Baramati Initiative on ICT and Development, which took place during 15-17 March in Baramati, Maharashtra, gave eHealth the opportunity to interact with a cross-section of experts, who are doing significant work in the field of e-Health. During the high-powered meet, eHealth met with Chris S. Thomas, the Chief Strategist of Intel Corporation, for an exhaustive one-to-one interview. The interaction not only helped to shed light on Intel’s multiple endeavours in the healthcare sector, but also gave an insight into the tremendous potential that e-Health holds in the years to come. Excerpts from the interview.......

Chris s. Thomas : Chief Strategist, Intel corporation e-mail: chris.s.thomas@intel.com

indly tell us something about Intel’s initiatives in the domain of healthcare in general?

hris S. Thomas: For years, Intel has been proactively researching on healthcare needs and working on integrated technology solutions to address healthcare challenges. It has been Intel’s mission to enable individuals, their families, and clinicians to connect to the right information at the right time, which can facilitate them to make better and more informed healthcare decisions. Utilizing Intel’s technologies in healthcare solutions is allowing digital infor12 }

mation to be shared securely among hospitals and healthcare systems, pharmaceutical companies and other stakeholders of healthcare community. From powerful, reliable and energy-efficient (and thus cost-efficient) servers for the hospital data center, from mobile devices for remote monitoring to decision support devices at the point of care, our technologies are becoming more and more relevant to healthcare. Having the right information at the point of decision is critical to improving patient safety, reducing errors and easing workloads. To support those goals, Intel Corporation’s Digital Health Group has combined the insights of eth-

nographers, technologists and clinicians to pioneer a new category of mobile computing platforms, designed specifically for clinical hospital environmentsmobile clinical assistant platforms. As far as the road ahead is concerned, we have conceptualized some inroads in home healthcare, which has the potential to change the face of healthcare of tomorrow. Our innovations could help the chronically ill and ageing patients, who need day-to-day monitoring. Intel is developing personal health solutions, which could help people to monitor their chronic ailments from home on a continual basis by keeping a tab on their various health parameters like temperawww.ehealthonline.org

ture, heart rate, blood pressure - relayed in real-time to their doctors/clinics for continuous remote monitoring and ontime intervention. This can give a much needed impetus to the hitherto neglected area of preventative care. Can you tell us something about the background of Intel’s commitment in healthcare? Intel’s commitment to healthcare started way back in 1999 with the formation of the Proactive Health Research project. It is a multi-disciplinary team, engaged in the research of people’s healthcare needs and integrated technology solutions. Today, the Proactive Health Lab has evolved into Intel’s Health Research and Innovation Lab, which comprise an integrated team of social scientists, designers and systems engineers. The members of this interdisciplinary team go to homes, hospitals, and doctors’ offices, living or co-locating with patients, doctors and nurses, over long periods of time, to observe and understand their specific needs. They then respond to those needs by designing and developing prototypes of new technology solutions, which are tested in a variety of healthcare settings, from hospital to home. This work serves as the focal point for platform development by Intel’s product teams, helping ensure that product design centers on real needs of people. Could you please elaborate on the World Ahead initiative of Intel and tell us how this initiative can have ramifications in the Indian healthcare scenario? World Ahead initiative of Intel aims to bridge the digital divide by connecting an additional one billion new users of IT in the next few years. One of the chief objectives of Intel’s World Ahead Program is to provide greater accessibility of IT to the world’s underserved population, by rapidly creating access to affordable PCs that are tailored to meet their needs. In addition to developing specialized platforms, Intel is also working with governments across the globe to deliver affordable PC purchase programs that give citizens and businesses easier access to trusted Intel-based comMay 2007

puters, as well as to develop localized content for the next one billion new users. In order to achieve these objectives, World Ahead Program is founded on four pillars of Accessibility, Connectivity, Education and Content. In India’s healthcare sector, the rippling effect of this mammoth endeavour just cannot be overstated. We want to make World Ahead Program a success in India, but for that we need comprehensive healthcare infrastructural support and strategic facilitation from government. Intel is fostering connectivity (primarily via WIMAX broadband deployments) to reach cities, suburban and rural communities across the globe in a cost-effective manner, and India is high on our agenda in this regard. Though I agree the execution of WIMAX technology is still in its nascent stage in India, but there is a positive attitude towards WIMAX in the country. With the spread of WIMAX, telemedicine will get a fillip in India, and percolate from urban elite echelons to rural areas. Without WIMAX, it is hard to make telemedicine an effective tool, as broadband connectivity is crucial to the transmission of medical images. What do you think are the impediments towards fast implementation of WIMAX technology in India? I think it is more a political and business issue than a technical issue. Intel has strong advocacy for WIMAX standard as it is a relatively inexpensive proposition, at the same time entailing more bandwidth to cater to the singular needs of the healthcare sector. We are looking for initiatives from both government and private players to make this innovative technology augur development dividends. It should be borne in mind of policy makers, that world over, WIMAX is poised to bring wider and better Internet connectivity, boost economic activity, bring new livelihood options and deliver greater quality of life. Can you elaborate on the much acclaimed Baramati initiative of Intel, which has not only accrued significant development dividends to the people of this small town, but has also helped it to find a niche position in the world’s IT map?

The pilot project in Baramati has been a great success story. The pilot was commissioned in November 2006, under which the community health centre was virtually connected with the Bangalorebased cardio-specialty hospital - ‘Narayana Hrudyalaya’ and the Madurai-based ‘Aravind Eye Hospital’. This has helped people of Baramati to remotely avail the expertise of specialists from Madurai and Bangalore at very affordable rates. This facility of tele-diagnosis from Baramati has so far addressed the heart and eye problems of more than 2000 people living around this area. Thanks to ICT and committed clinical partners, now it takes only about eight minutes for the ECG results to come from Bangalore to Baramati, while it takes just about an hour for reports to come from Aravind Eye Hospital in Madurai. The partners who helped make this happen include SN Informatics-the software partner, Schiller Healthcare-medical equipment partner, Vidya Pratishthan’s Institute of Information Technology (VIIT)-technology and local coordination support. The tele-diagnostics solution is the first step towards automating the operations of the community hospital. Automation with a bit of business process change would bring about a significant improvement in the productivity and transparency of the working of the hospital. In turn, this would translate to improved quality of care. This is one pertinent example of tele-diagnostics reaching the grass roots levels. Besides conceptualizing this initiative, Intel has also provided the technological support, which includes computing infrastructure, medical equipments and training. How do you assess India’s future in telemedicine and what are the lacunae to be tackled in order to achieve greater success in the near future? India, which is emerging as a knowledge economy to reckon with, has great prospects in the domain of telemedicine. Sustained research on development of peripheral medical devices which can be linked to a PC, and the cost-effective connectivity (for transmission of images with high bandwidth) are the key to its success in the years to come. n 13

Industry profile

Digital Imaging on a High After Spurt in Demand Digital technology for perfect diagnosis The use of digital imaging by healthcare organizations provides advantages over the use of other imaging techniques. Though the initial cost of investing in digital imaging systems might be higher, it provides cost savings over a longer period of time. The savings include the purchase of film and chemical as well as the processing costs, which are not incurred with the use of digital images.

n the last four decades, digital imaging has become the base for most radiological diagnoses. The big strides in computer based imaging techniques in the last twenty years is aided by the introduction of modalities such as Computed Tomography Imaging (CT Scan), Magnetic Resonance Imaging (MRI), digital angiography, ultrasound and nuclear medicine imaging. Digital images are represented by large rectangular grids comprising of individual pixels or picture elements, each with its own bit-depth value that informs the computer, which color the pixel, should it display. The digital image thus created is the culmination of all the pixels. The issues arising from the storage and retrieval of digital images in hospitals led to the development of the Picture Archiving and Communication Systems (PACS) and Radiological Information Systems (RIS), where the images are stored in computed formatted memory discs that can be viewed from computer screens across a hospital or local area network. This transfer of digital images across a network is made possible by a standard called by DICOM or Digital Imaging and Communication in Medicine. The standard allows imaging systems to connect a central storage or health information system in a consistent manner. Benefits galore

The use of digital imaging by healthcare organizations provides advantages over the use of other imaging techniques. Though the initial cost of investing in digital imaging systems might be higher, it provides cost savings over a longer period of time. The savings include the purchase of film and chemical as well as the processing costs, which are not incurred with the use of digital images. In terms of the usage of space also, they score. Digital images take up less storage space than less conventional photography, and are easier and less time consuming to sort out and 14 }

retrieve for viewing. Digital images also tend to last longer as they do not degrade or lose colour over a period of time. Agfa HealthCare

Agfa HealthCare (www.agfa.com) is a member of the AgfaGevaert Group, which is a leading provider of IT enabled clinical workflow and diagnostic image management solutions, and state-of-the-art systems for capturing, processing and printing images in hospitals and healthcare facilities. The group is quite strong in the development of e-health solutions, including Electronic Patient Record technologies, for governments and regions. Agfa HealthCare today operates in 100 markets worldwide. Agfa HealthCare is committed to helping customers implement solutions that enable them to become more efficient, leading to enhanced patient care and better utilization of resources. With more than 700 PACS or Picture Archiving Communication Systems, (PACS) installed worldwide, Agfa has demonstrated its ability to help customers move from film to digital based imaging. Agfa HealthCare, according to observers, offers one of the most comprehensive image and information solutions on the market today, providing customers with solutions to seamlessly and smoothly manage patient data, from initial creation to final archiving. Imaging systems developed and implemented by Agfa HealthCare capture, process, and print diagnostic images from a multitude of sources within and beyond the healthcare enterprise. These systems are designed to bring vital information to medical practitioners regardless of their location. BRIT Systems, Canon Medical Systems, DR Systems, Eastman Kodak, Fuji film Medical Systems, General Healthcare,IBM, IMCO Technologies, Philips Medical Systems, StorCOMM Inc, Intelerad Medical Systems, McKessonâ&#x20AC;&#x2122;s Medical Imaging Group, Philips Medical Systems, Siemens Medical Solutions are other important players in this domain. www.ehealthonline.org

Rising Demand

Cardiology equipments account for 20 per cent of total market; followed by imaging systems, which constitutes about 15 per cent of the total market. The demand for medical imaging products in the US market will go up 6 percent annually to touch $21.4 billion in 2010, says a study published by The Freedonia Group. The main causes of the rise are technological advances, along with an ageing population and changing trends in healthcare approaches. New scanners and consumables with expanded testing capabilities are also being adopted widely by hospitals and outpatient facilities to improve quality of care. Medical imaging equipment will post demand of over $16 billion in 2010, which is 6.8 percent higher than the annual growth happened two years ago. Picking up the biggest pace will be multi-slice CT scanners, due to investment in the systems by hospitals and outpatient facilities replacing older systems. It is estimated that high field machines will account for the largest share of new MRI installations through 2010 and the coming years. Due to the popularity of new hybrid PET/ CT systems, these systems offer dual anatomical and metabolic scanning capabilities. Other drivers of the demand include the ongoing replacement of conventional analog machines with digital x-ray and radiographic fluoroscopy systems . Faring better will be nuclear medicine and ultrasound equipments. New four-dimensional (4D) imaging systems and new laptop and handheld devices for point-of-care systems will also abet the overall growth for diagnostic ultrasound equipment. Worldwide, medical imaging consumables will expand 3.6 percent annually to $5.3 billion in 2010. Finally, the market for contrast agents will see moderate growth in x-ray, CT and MRI studies on body regions where the targeted organ or tissue needs visual enhancement due to its masking by nearby invivo matter. In this product group, nanosized compounds hold the best growth prospects as they are expected to greatly improve MRI-generated images. The growing awareness about cardiovascular disorders (CVD) is leading to a rise in the number of diagnostic procedures, resulting in a spurt in interventional cardiac catheterization procedures. A growing focus on efficient and non-invasive techniques of diagnostic cardiology such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) also augments the use of cardiovascular X-rays in catheterization procedures. Accordingly, revenues in the European cardiac catheterisation imaging systems market alone are expected to reach $196.6 million by 2009 from an estimated $144.1 million in 2004. The single plane cardiovascular imaging systems is expected to dominate the overall market. At the same time, the biplane systems segment is also likely to boost market revenues. Despite the decline in prices, cardiac catheterisation imaging systems still remain highly priced gadgets to many healthcare institutions and imaging centres. Ensuring compatibility of cardiac imaging equipments with existing IT solutions in hospitals will also prove vital in easy integration. Sustaining May 2007

product demand will depend on evolving a digital workflow to optimise the cardiology data management system (CDMS). Refurbished imaging equipments

A report by Frost & Sullivan research offers a comprehensive analysis of the European markets for refurbished medical imaging equipment, segmenting it into cardiovascular X-ray, fluoroscopy, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).

It is estimated that high field machines will account for the largest share of new MRI installations through 2010 and the coming years.

The increase in medical procedures in Europe has stimulated demand for greater number of imaging equipment in hospitals. Many institutions which require a second or third equipment to cope with the increasing demand opt for low-cost refurbished equipment as they are unable to invest in new equipment due to limited funds. The escalating need to procure high-end but inexpensive medical imaging equipments promises further growth of refurbished medical imaging equipment market, notes the analyst of this research. The prevailing healthcare systems in Europe, especially the public hospitals, are equipped with excellent medical facilities due to constant investment of government bodies in technologically upgraded products. Public health care institutions sell off older systems to vendors to create room for more efficient and technologically advanced equipment. The local vendors and original equipment manufacturers (OEMs) refurbish these old, well-maintained systems and sell them to private health care institutions. As this trend continues, the European market for refurbished medical imaging equipment is poised to grow. The reinvigorated market for medical imaging systems employing x-rays is being propelled by the explosion of digital technology. The expanding role of imaging modalities in a whole host of clinical applications from trauma to cancer to cardiology has increased the profile of radiography while enabling computer technologies to expand the usefulness of traditional x-ray techniques. This obviously augurs well for all players in digital imaging.n G. Kalyan Kumar, kalyan@csdms.in

book review

the Economics of healthcare spending Trends in EU Health Care Systems by Gooijer, Win de 2007, XXIV, 504 p., 13 illus., Hardcover ISBN: 978-0-387-32747-1

in de Gooijer makes a candid effort to bring immense clarity to the complex issue of economic demands adversely influencing access to health care. For decades, the nations of the European Union harped on universal health coverage. De Gooijer with his dual background as an economist and the CEO of Dutch health care corporations, looks at the new dichotomy in the unfolding scenario with a unique understanding of the subject. The author sees concrete linkages between world economic currents and the issue of access to health care throughout the EU. The early trends, starting from the nineties are now coming to rapid fruition. The inclination of governments in both Europe and the US towards transferring social responsibilities to market-driven agencies is bothering the author. Recent economic developments have created lot many problems in healthcare sector-ranging from widening inequities of care to growing numbers of the uninsured. The book takes a critical view of expansion versus reform dilemma with a fourty-year analysis of Europe’s health care systems. It studies the ethical and medical issues arising from the continent’s changing politics and tries some predictions about the future directions in EU health care as to how change is possible, and how much change can be possible. There may not be too many takers for all the ideas from De Gooijer, the book will certainly hold the interest of health care managers and policymakers, politicians and insurers, advanced students of public health –or for that

16 }

To sum up, the book is an effort at dealing with the matter of economic principles dominating the debate on healthcare and the consequences thereof. The author tries to bridge the gap between economic and healthcare developments, making it an essential reading for all policy makers and healthcare managers. Gooijer argues for a larger role for professionals and states that “the future development of European health policy should not be left entirely to the political managers”. matter, anyone looking to Europe for the next phase of this far-reaching evolution. Brian Edwards, President of the European Hospital and Health Care Federation (HOPE) has described the book as a very important contribution to the debate about the future direction of health policy in Europe. In his view, “It captures the economic and social trends that underpin health systems with a keen and objective eye and poses some very challenging questions about the future.” To sum up, the book is an effort at dealing with the matter of economic principles dominating the debate on health care and the consequences thereof. The author tries to bridge the gap between economic and health care developments, making it an essential reading for all policy makers and health care managers. Gooijer argues for a larger role for professionals and states that, “the future development of European health policy should not be left entirely to the political managers.” Hospital managers will have to be actively involved, in regard to the design and organization of present and future European hospitals. For this purpose, this book is a robust manual. It not only amplifies the dangers, but also puts us every one on eternal alert to the emerging challenges and the available opportunity for possible alternative policy options. n

EU prepares for crossborder healthcare

he European Union health ministers in a meeting agreed on the introduction of guidelines for cross-border health care services among the bloc’s 27 members. “Europe must guarantee that everyone has access to medical services, that the quality of care does not depend on the size of one’s wallet and that all patients receive high-quality health care should they fall ill,” German Health Minister Ulla Schmidt said. EU Health Commissioner Markos Kyprianou said the commission would draw up concrete proposals by the end of the year. “We want to give patients a greater degree of security, without creating disadvantages for the national health systems,” he said at the end of a day-long conference.

The patient will initially have to foot the bill himself, but is entitled to a refund from his local health provider, provided he obtained advance approval for treatment abroad. At present there are only guidelines for cross-border health treatment in emergencies. In such cases the costs are paid by the local health service, which can recover them from the health service in the patient’s native country. The new plans lay down who pays for elective surgery or other treatment outside a patient’s native country. The patient will initially have to foot the bill himself, but is entitled to a refund from his local health provider, provided he obtained advance approval for treatment abroad. “An open and social Europe needs a reliable framework in which it can ensure the provision of necessary health services even beyond the borders of the individual state,” Schmidt said. Schmidt, whose country holds the current presidency of the EU, said there was a great deal of willingness by the ministers to solve the problems of cross-border healthcare in favour of the patients. Dutch Health Minister Ab Klink said patient mobility was important “because it gives people the chance to choose what kind of treatment they want.” Tackling AIDS and ways to improve prevention activities were other issues discussed by the health ministers. n

www.ehealthonline.org

FOCUS

Assocham summit on corporate health takes up vital issues Optimization of lifestyles can contain stress and enhance well being The corporate honchos have realized that if the health of their employees is not sound, it may translate into absenteeism and reduction in productivity, which in turn may adversely affect the bottomlines of the company. This realization has resulted in increasing importance for corporate healthcare in the recent times.

oday a section of the corporate world of modern India is harangued by chronic and lifestyle disease burden, which can be attributed to irregular eating habits coupled with intake of junk foods, mental stress at workplace, and sedentary lifestyle devoid of any exercise. With India’s corporate world facing stiff challenges of mental stress and burnout in their work arena, the new dimension of occupational healthcare has proffered efficacious answers. A perceptible change has consequently taken place in the way employee fitness is being perceived in the past couple of years as the pronounced need to keep employees’ fit is being increasingly realized by the corporates. The corporate honchos have realized that if the health of their employees is not sound, it may translate into absenteeism and reduction in productivity, which in turn may adversely affect the bottomlines of the company. This realization has resulted in increasing importance for corporate healthcare in the recent times. The mantra of investing in employees’ health is beginning to find a foothold in the Indian corporate hub, as it assures a return of investment. Measurable in terms of employee and company benefits, employee wellness demonstrates a real contribution to company bottomlines since promoting employee health is a proven key to controlling healthcare costs. Moreover, increasing curative health public expenditure has stymied public spending on preventive health services. In a resource constraint environment, despite 21 percent increase in the outlay for health in the current budget, corporates do have an important stake in optimally using their health budget for minimizing absenteeism, reducing attrition, building team spirit and enhancing productivity. In this context, the relevance of ASSOCHAM’s initiative in organizing a National Health Summit titled ‘Enhancing Corporate Health: The Global Perspective’ cannot be overemphasized. The conference, which was

May 2007

held on 17th April 2007 at Hotel Oberoi, New Delhi, attracted a galaxy of dignitaries from the medical fraternity. The event was also distinguished by the presence of central / state government officials, representatives from multilateral agencies such as WHO, World Bank, USAID, etc. corporate honchos, NGOs and pharamaceutical companies. eHealth had the honour of being the official magazine for this high-profile conference. The top medical luminaries who participated in this conference included Dr. B.K. Rao, Chairman, ASSOCHAM Expert Committee on Health and Chairman, Sir Ganga Ram Hospital; Dr. H.K. Chopra, Co-Chairman, ASSOCHAM Expert Committee on Health and Chief Cardiologist of Moolchand Medcity; Dr. Ashok Seth, Chairman and Chief Cardiologist of Max Devki Devi Heart and Vascular Institute; Dr. M.C. Misra,the Co-Chairman of ASSOCHAM Expert Committee on Health and Professor and Head(Surgery), AIIMS; Prof. D. Prabhakarn,Additional Professor, Dept. of Cardiology, AIIMS; Dr.Shikha Sharma, nutritionist and a noted entrepreneur, running the show at Dr. Shikha’s Nurti-Health Systems Pvt. Ltd.

Some of the focal areas of this one-day conference was the role of physical activity and exercises, stress management and corporate health,abstinence from tobacco consumption and smoking, public-private partnership in healthcare, heart fitness, how to cope with the burden of diabetes, role of yoga in health, facing the threat of the global epidemic of obesity and how to manage it, healthy diet in the prevention of non communicable diseases, etc. The high-point of the conference was a united effort by the doctors at large(who were present at the summit on ‘Enhancing Corporate Health: The Global Perspective’) to dispel the myth that red wine is good for heart. The debatable issue sprung up from an innocuous question raised by a member of the audience that whether red wine was good for heart, and all the doctors in the discussion panel were unanimous in voicing their expert advice against wine intake. The doctors dismissed the popularly held theory that red wine is good for health, and asserted that there had been no proof to substantiate the positive side of either the red wine or

focus

the extent beyond repair. They advised that wine consumption ought to be avoided to keep one’s heart absolutely fit. Dr. Chopra, Dr. Prabhakaran, Dr. Ashok Seth, Prof. Misra and host of other medical practitioners sought to discourage the pub culture that is taking roots in Delhi, and particularly those that serve liquor, as they are lurking killers of human organs. During the conference, Prof. Misra also pointed out that emergency health facilities even in a city like Delhi are grossly inadequate and its hospitals are ill-equipped to take on the collective load of patients. He also lamented the fact that chronic diseases are becoming more rampant not only among corporates but within ordinary people, for which he blamed their faulty eating habits and stressful lifestyle.

Eminent cardiaologists such as Dr. H K Chopra, Prof. D. Prabhakaran, Dr. Ashok Seth, Dr. B K Rao and Prof. M C Misra unanimously echoed sentiments that it is a myth that wine consumption would support the smooth functioning of heart. All these medical practitioners warned that wine intake adds toxic content in the human body and damage and decay heart to the extent beyond repair. They advised that wine consumption ought to be avoided to keep one’s heart absolutely fit. Dr. Chopra, Dr. Prabhakaran, Dr. Ashok Seth, Prof. Misra and host of other medical practitioners sought to discourage the pub culture that is taking roots in Delhi, and particularly those that serve liquor, as they are lurking killers of human organs. any other alcohol on human heart. Eminent cardiaologists such as Dr. H K Chopra, Prof. D. Prabhakaran, Dr. Ashok Seth, Dr. B K Rao and Prof. M.C. Misra unanimously echoed sentiments that it was a myth that wine consumption would support the smooth functioning of heart. All these medical practitioners warned that wine intake adds toxic content in the human body and damage and decay heart to

“Their eating habits and lifestyle, which are influenced by the western world, is also one of the causes for chronic diseases in India, the health facility for which are not adequate,” warned Prof. Misra who justified that health could be provided to all by 2020, provided communities support to this effect would be forthcoming. During the discourse on disaster management, Prof. Misra also hit upon the growing accident rates in India, and the inadequate facilities available to tackle such emergency situations. Talking about Delhi and its accident rate, Prof. Misra said that in Delhi alone, 2000 persons are being killed on road accidents per year as against 100,000 average across the country, for which golden hour facilities are totally inadequate. He advised that prevention of injuries would be best recommended to as it is cost effective and saves life. Dr. BK. Rao also stressed on preventive healthcare and opined that India needs more of health clubs and wellness centres than hospitals. In his welcome address, the immediate past President of ASSOCHAM, Anil K Agarwal called for “optimization of lifestyles”, to maintain a routine and disciplined way of life. n

India’s Public Health Expenditure is Simply Dismal

ndia is far behind Bangladesh, Pakistan and China in terms of public health expenditure. India’s public health expenditure as percentage of its total health expenditure is only 20.7 percent as against 25.2 percent of Bangladesh, 34.9 percent of Pakistan and 33.7 percent of China. These findings were revealed by a joint study conducted by Associated Chambers of Commerce and Industry of India (ASSOCHAM) and PriceWaterhouseCoopers (PwC) titled ‘Working Towards Wellness: An Indian Perspective.’ The study also says that India’s per capita expenditure on health is estimated at $23 and its total health expenditure as percentage of its GDP stands at a poor 6.1 percent. The study says that India will have to increase its public expen-

diture on health to prevent it to become a centre for chronic cardiovascular diseases. It also reveals that percentage of cardiovascular patients who succumb to death in India is currently estimated at 30 percent within the age group of 35-64, as compared to 12 percent in the United States, 22 percent in China, 25 percent in Russia, 34 percent in Brazil and 40 percent in South Africa. The study recommended that the increased pressures of globalisation will have to be met through, provided India accelerates its health budget by manifolds. The reason as to why the public expenditure on health in countries like Pakistan, Bangladesh have risen much more than India is because of two specific reasons. One, the economies of Pakistan and Bangladesh are

emerging for development and that is why their governments have been making higher health allocations for their people to partake in global competition. Secondly, on population front, Pakistan and Bangladesh are at competitive edge because of their size, which is not the case with India. India after 2000 onwards, paid less attention towards health. The study however adds that in the budget proposals for 2007-08, India realized the neglect of its health sector in the past and made good health budget proposals for the current fiscal; the impact of which will be realized later on. The study also unearths the sordid fact that India today bears the burden of both communicable and non-communicable diseases. Along with the existence

of infectious diseases like tuberculosis, malaria, pneumonia, HIV/AIDS, hitherto neglected diseases like diabetes are likely to take endemic proportions in India. It is expected that the country would have a population of around 57.2 million diabetic patients by the year 2025, many of whom would be adults of working age. In India, diabetic nephropathy is expected to develop in 6.6 million of the 30 million patients suffering from diabetes. The study has also recommended that the wellness programmes should be conducted in leading work places to spread awareness for healthcare, so that chronic diseases do not plague most of our workforce, as a result of which a great deal of productivity suffer adversely.n

www.eHealthonline.org

news review

BUSINESS

Belgium hospital gears up to deploy Agfa’s solution

gfa HealthCare, a leading provider of IT enabled clinical workflow and diagnostic imaging solutions, has announced that the Heilig Hartziekenhuis Mol hospital in Belgium has awarded it a significant contract to unify its medical workflow through the company’s ORBIS solution. ORBIS is Agfa HealthCare’s integrated hospital and clinical information system, specifically to manage the entire patient-centric information flow through all hospital departments. The implementation of ORBIS is expected to start in April 2007. Explains ICT Manager Benny Peeters, “Teaming up with a provider of solutions that we know to be of high quality will help us to position our hospital at the forefront of modern medicine in our region. We were the first hospital in the region to implement PACS, and now ORBIS will help us to strengthen our pioneering approach. We are proud to be among the first hospitals to implement the ORBIS platform, adapted to the specific healthcare needs in our country”. Agfa HealthCare’s ORBIS solution will provide the Heilig Hartziekenhuis Mol hospital a

comprehensive view of clinical information processes, including medical and nursing records, scheduling, order management, results reporting and medication workflow. The hospital has worked with Agfa HealthCare for almost 4 years, successfully using its Picture Archiving and Communications System / Radiology Information System (PACS/RIS) solution.

The Heilig Hartziekenhuis Mol hospital’s nine-month decision process involved information scouting, several medical workgroup meetings, and an elaborate request for proposals, as well as a field visit to the Troisdorf hospital near Bonn, Germany and interviews with users. Says Benny Peeters, Heilig Hartziekenhuis Mol’s ICT Manager, “With ORBIS, we will be able to address the needs of our entire healthcare enterprise. We have chosen ORBIS because it offers us a complete hospital-wide solu-

tion, which allows us to integrate advanced functionalities more easily. Agfa HealthCare’s vendor neutral solution was the ideal choice for us as it allows us to integrate our existing solutions with ORBIS.’’ Informs Hans Vandewyngaerde, Cluster Manager, Benelux & France: “Supporting our customers over a longer period, by helping them enhance and improve their overall solutions offering, is a key priority for Agfa HealthCare. We have always treasured our positive relationship with Heilig Hartziekenhuis Mol and we look forward to further enhancing and evolving our leading solutions with them, for the benefit of the hospital and its patients.” Heilig Hartziekenhuis Mol provides a comprehensive range of health services to the eastern ‘Kempen’ region of Belgium’s Antwerp province. The hospital has positioned itself as a modern healthcare provider, applying significant resources to staff education and advanced infrastructure. Its 500 staff members and 60 doctors manage approximately 18,000 hospital stays per year. n

New version of CareXML solution announced

talis Ltd, a leading player in the information and data management solutions to the NHS and private healthcare organisations, has released its CareXML® data migration, cleansing and reporting platform. CareXML® is established within NPfIT as the most advanced solution for extracting data from any legacy system, cleansing the data and migrating the data to the Care Record Service (CRS). Data profiler ‘unlocks’ access to the source data from legacy Mumps based systems, allowing Trust users to identify data quality discrepancies and anomalies and providing seamless access with no additional log on back to the source systems for updates and amendments. Trusts have estimated that this approach saves considerable man time when carrying out a data migration project. Following constraints experienced in placing the amount of legacy data that

May 2007

can be moved to the CRS, CareXML® has been developed to provide the Data Repository for maintaining legacy data. The new version of CareXML® introduces several new features as a result of joint working with Stalis customers. The features include, Integrated case note tracking. It also supports and stores updates to patient case note locations for all non migrated data from the legacy system. Web based browser access to the patient case notes allow users access from anywhere in the hospital to amend and update historic case note locations. Fully configurable to allow administrators to filter delivery of reports by GP surgery and/or GP. Electronic transmission of reports speeds up the delivery of diagnostic reporting to the referring doctor. Automated integration of patient records from disparate systems. n

iSOFT completes RIS project in London cluster

SOFT has installed its RadCentre radiology information system (RIS) at Chelsea and Westminster and Ealing NHS trusts as part of its contract with BT under the National Programme for IT (NPfIT). iSOFT is one of the UK’s largest providers of radiology information systems. RadCentre has been installed at 43 NHS trusts currently. The systems played an important role in helping BT meet its target of delivering picture archiving and communications systems to 21 trusts across the capital by the end of March this year. Linked to Philips picture archiving and communications systems (PACS), RadCentre is now running at the 660-bed Chelsea and Westminster Hospital and 350-bed Ealing Hospital. Eight more NHS trusts in London use iSOFT’s RadCentre outside the NPfIT. These include early adopter Mayday Healthcare NHS Trust. Other non-NPfIT RadCentre customers in London are St Georges, Lewisham, Royal Free, Kingston, North Middlesex, Whittington, Great Ormond Street Hospital, Epsom St Helier and West Middlesex. iSOFT is a leading player in Europe in the area of healthcare software applications with a strong presence and experience in the Asia Pacific region. Its core strategic application, LORENZO, is noted for the technology revolution taking place in healthcare globally. iSOFT products are used to manage patient information in more than 8,000 organisations in 27 countries. With annual revenues of £180 million, the company has offices in 12 countries and more than 3,000 employees, over 1,400 of whom are engaged in software development and design. n 19

business news

Effective searching solution offered for Health Professionals

etting the right information from a sea of infinite information in the Internet is indeed a big task. It is pretty hard to sort out the right information. However, this problem is addressed by Transinsight GmbH in Dresden, a company that develops knowledge-based search technologies in cooperation with the Technische Universität Dresden. Now, after a development period of only six months, Transinsight GmbH has created MeSHPubMed, the worldwide first knowledge-based search engine for the medical sciences to be made available on the Internet. The search platform www.MeSHPubMed.org intelligently searches and, thus, finds the desired results much faster and much more precisely than a standard search engine can. For the first time, the technology for the intelligent search developed by Transinsight GmbH, in cooperation with the TU Dresden, has been used on the well-known search engine for molecular biologists-www.

Australia’s health providers pitch for e-health

report by the Australian Centre for Health Research has suggested a broadband network of health services to allow patients to be tracked, no matter where they go for medical services. Monash University e-health research unit director Michael Georgeff has said that about onequarter of all Australians suffered from a chronic illness and many had complex health needs. According to Professor Georgeff, “Complex illness requires close monitoring and, often, intensive management by a team of health professionals. But because of the way our health system currently operates, one doctor will often not know what tests or medications have been prescribed by another doctor even when they are members of the same team.” n 20

GOPubMed.org. Says Dr. Michael R. Alvers, CEO of Transinsight, “Now, medical professionals will be able to work much more efficiently, because they will be able to utilize the search engine MeSHPubMed which sorts the 16 million presently available scientific articles in such a way

as is intended by the knowledge network MeSH (Medical Subject Headings), an initiative of the National Library of Medicine, USA,” The search engine allows the search time for relevant scientific information to be drastically reduced. For example, a search for the tumor suppressor protein P53

delivers about 10 million articles through conventional search engines and more than 40,000 articles in the case of standard medical search engines like www. PubMed.org. For the user, it is impossible to browse this quantity of texts. However, with www. MeSHPubMed.org, by means of interactive navigation in the knowledge tree of the MeSH, clicking the hierarchical entries “Diseases” -> “Cardiovascular Diseases” -> “Heart Diseases,” means the search results can be restricted so that only six relevant articles are shown. This is a great time saver indeed. Prof. Dr. Michael Schroeder, co-founder of Transinsight and Professor of bioinformatics at the Technische Universität Dresden, is enthused to see the practical use of technologies developed partly within European research projects such as REWERSE, Sealife and EFRE. “We are proud to have developed technologies that reach a speed and precision that currently cannot be achieved by

anybody else in the world. Our ultra-fast and very precise algorithms provide an enormous customer benefit: the noticeable shortening of search times! Having already two products online is a good example of a great knowledge transfer between university and industry,” says Schroeder. This fruitful cooperation between Transinsight and the Technische Universität Dresden is based on a cooperation contract. “In Dresden, there is an atmosphere like at Stanford University, at MIT in Boston or at Cambridge University,” says Alvers. On this fertile ground, Transinsight GmbH wants to open new horizons. To that end, two new search platforms are already in the beta test. Moreover, with a partner, Transinsight wants to address other areas such as the job search field, because the technology of sorted searching is global and can be used in non-biomedical areas as well. Transinsight is also focussed on software solutions.n

Voicemails to enable patients to pick up medicine

message system that enables pharmacists to leave an automatically-generated voicemail for patients whose prescriptions are ready for collection is getting ready. To be offered by a major pharmacy systems supplier, Message Dynamics has reached a heads of agreement to integrate its messaging system with Cegedim Rx’s Pharmacy Manager and Nexphase. The agreement covers two Message Dynamics products: the Repeat Rx prescription reminder and the MUR [medicines use review] Reminder. Message Dynamics director, Richard Jackson, explain that that the system’s facility for leaving voice messages on both landline and mobile phones made it very useful.

Text messaging to communicate with patients is getting more common - and Message Dynamics includes this function - but Jackson points out: “The main users of the service are over 65 and most don’t have mobiles. Those that do tend to keep them for emergencies and don’t use SMS text messaging very much.” The voice-mail facility is expected to bring immediate benefits but should be especially useful in helping to keep patients in the loop when Release 2 of the Electronic Prescription Service starts to make the paperless prescription a reality later this year. “Under Release 2 the doctor will automatically send repeat prescriptions to the pharmacy. Patients may be less sure of what will happen next,” Jackson ex-

plained. An automatically generated message from the pharmacist’s system will aim to make the process work more smoothly by reminding patients that their medicines are ready and saying which pharmacy they need to go to. From the pharmacist’s perspective, the number of uncollected prescriptions – many containing expensive medicines - should be reduced. The MUR reminder will also help to cut the number of reviews forgotten by patients. Message Dynamics says that the service is available in 47 languages, manages patient consents for use of the service and maintains accurate and up-to-date details. Using secure servers and PIN access patients can maintain phone numbers, PIN, contact times and preferences. n

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WORLD

Cogknow project for the dementia affected

ementia refers to a combination of symptoms which includes impairments of memory, speech, thought, perception and reasoning. It is a common ailment among the elderlies of Europe, afflicting about 1.9 million elderly people in the continent. They tend to lead a muddled life, but now a pan-European research project is endeavouring to make a marked improvement in their quality of life. The project, named as CogKnow project, is funded under the EU’s Sixth Framework Programme (FP6). The project, which commenced in September 2006, aims to be a breakthrough with research that addresses the needs of those with dementia, particularly those with mild dementia in Europe.

The University of Uster in the UK is the technical coordinator of this project, which is striving to develop tangible home-based solutions for persons who are plagued by memory loss problems. The role of the university will be to research and prototype assistive technologies for supporting people with memory loss; through providing easily recognizable prompts that would facilitate them to navigate through their day. Some of the other esteemed partners of this project include names like Norwegian Centre for Telemedicine, Belfast City Hospital, Telematica Instituut and Across Limits Technologies. The singular element of this

Cogon Systems to develop clinical decision support tools for hand-held computers

S. Army’s Telemedicine & Advanced Technology Research Center (TATRC) has awarded Cogon Systems, Inc. a research, development, test and evaluation contract to develop advanced clinical decision support tools for hand-held computer use. Here it deserves a mention that Cogon Systems, Inc. is a Floridabased healthcare software company, which is engaged in providing hospitals and community based organizations with leading edge information technology solutions. Cogon Systems raises the standard for patient safety and clinical efficiency through data integration and mobile technology. The primary goal of the project is to determine if using mobile technology in an inpatient setting to deliver clinical decision support through rapid retrieval of clinical data, intelligently filtered clinical knowledge, and appropriately generated alerts and

May 2007

reminders, will positively impact patient care while concurrently achieving physician’s acceptance, efficiency and education. The project will rely upon technology provided by Cogon Systems Mobile MOMENT OF CARE(R) software application. Cogon’s product leverages data, already residing within a hospital’s inpatient information system, thus preserving existing infrastructure investments, and will serve as the foundation to which advanced clinical decision support modules will be appended. The project’s overarching objective is applicable to all medical treatment facility or combat support hospitals. The project’s beta site will be DeWitt Army Community Hospital, located at Fort Belvoir, VA and will run for a period of fifteen months. DeWitt’s Family Practice Residency is the second oldest family practice residency in the Army. n

innovative project is that here both patients and carers will provide their inputs to the design of the technology, a technology which will be discrete and userfriendly. Following the results of a first study where people with dementia described their unmet needs, the project partners have now commenced their work on a portable cognitive prosthetic device which will facilitate information, communication, safety and reminders. For example, the first function, currently in development, is called ‘picture dialling’, where the user need only to press a button with a picture on the device for a phone connection to be made to a carer

or a member of the family. Another function being considered uses radio frequency identification (RFID) technology, for tracking the movements of patients and sending out an alarm, if they forget an appointment or their medicine. The aim of the project is to develop solutions that help ageing people with early dementia to experience greater autonomy and feelings of empowerment, and to enjoy an enhanced quality of life. However, in its first year, the project will confine itself towards developing of this lowlevel technology with the aim of graduating to ambient intelligence and its enhanced possibilities, for contextual awareness and automated support functionalities. n

Brain-powered wheelchair in the offing

esearchers involved in the EUfunded project titled Mental Augmentation through Determination of Intended Action (MAIA), have shown how a person can control, using only his/her brain, the wheelchair on which he/she is sitting. This requires tapping into the person’s neural network, interpreting the cerebral signals in real time and then developing a mechanism that could respond to these instructions and steer the wheelchair with a high degree of accuracy. MAIA endeavours to develop non-invasive prosthesis, in particular, a braincomputer interface that recognizes the subject’s voluntary intent to do primitive motor actions on the order of milliseconds and conveys this intention to a robot that implements the necessary low-level details for achieving complex tasks. Funded under the Information Society Technologies (IST) programme of the Sixth Framework Programme (FP6), the wheelchair is one of several non-invasive applications that could be controlled

by the brain interface software, developed by researchers. Other applications include a robot for reaching and manipulation tasks, and handling emergency situations such as when the wheelchair or robot arm breaks down. Human thoughts create impulses in specific areas of the brain. Simply thinking about moving left, for example, creates such an impulse. Using a portable electroencephalogram and electrodes placed on the scalp of a user, the brain interface picks up on these impulses, which are then digitised and analysed. The software is capable of distinguishing between different mental states that the user is experiencing. Sensors are also attached to the wheelchair in which the user is sitting, so that as it moves, it can perceive a doorway to its right or an obstacle ahead. The project consortium has run several successful experiments, including two sets of trials involving users who were mentally able to drive the wheelchair in a maze-like corridor. n 21

W O R L D NEWS

Intel’s endeavour to improve Lebanon’s e-Health Following the announcement of a collaborative effort with other corporations to help revitalize Lebanon, Intel’s Chairman Craig Barrett has dedicated new projects to improve education, healthcare and computer access to the Internet for its citizens.”It’s gratifying to see concrete results at advancing the economic and social foundations of Lebanon thorough Intel’s work with the US and Lebanese private sectors,” said Barrett. This collaborative initiative is titled ‘ Partnership for Lebanon.’ Barrett’s trip is the latest on behalf of the Partnership for Lebanon. Through this initiative, Intel Corporation, Cisco Systems, GHAFARI Inc., Microsoft and Occidental Petroleum are providing critically needed resources to bring long term economic growth and stability to the country. Since the start of the program in 2006, the Partnership for Lebanon has supplied critical resources for reconstruction efforts. The group is focused on job creation, workforce training and education, rebuilding the country’s communications and computing capabilities,

providing connectivity to communities and government, and responding to crisis. As part of the programme, Intel is installing state-of-the-art wireless networks to accelerate the use of technology and highspeed computer connections to access the vast knowledge resources of the Internet. WiMAX systems are getting deployed

tor of the country. At a stop in Beirut, Barrett announced that Intel is increasing technical and doctor training support for a telemedicine program at one of Lebanon’s top hospitals- American University of Beirut Medical Center (AUBMC)- and the Nabatiyeh Governmental Hospital in Nabatiyeh. The telemedicine systems provide the hospitals with realtime video consultation between physicians kilometers apart, the ability to share data and to diagnose patients from afar. Without telemedicine, Nabatiyeh citizens needing a specialist would have to travel to Beirut, a trip that can be long and arduous. “The Nabatiyeh-Beirut Telemedicine Program could not come at a better time,” said Dr. Nadim Cortas, Vice President for Medical Affairs, and Dean of the Faculty of Medicine and the American University of Beirut Medical Center. The innovation gives local doctors the ability to access the latest medical data and get second opinions from specialists and medical centers, located hundreds of kilometers away. n

at two hospitals, one school and two community centers in Burj Al Barajneh, Nabatiyeh, and Beirut. The longer-range wireless technology is considered a more efficient way to bring connectivity to rugged and remote areas, less suited for installing cable or phone wires. Among other things, Intel’s development work in Lebanon also involves the health sec-

Israeli device enables mobility in cardiac data

his can be music to the ears of cardiac patients. A team of Israeli scientists have introduced a portable electrocardiograph machine, which through mobile phone, can transmit highly detailed data on heart activity to physicians. The electrocardiograph is named as CardioSen’C. SHL, the Israeli company, has developed the CardioSen’C machine to provide heart activity through mobile phone.The CardioSen’C can help in the diagnoses of arrhythmia, ischemia and myocardial infarction. Patients can use the CardioSen’C, by attaching 12 electrodes to their chest and upper body and strapping the battery-powered unit on the front

of their chest. Automatic digital transmission enables the electrocardiograph (ECG) to transmit the highest quality data at a high speed to the patient’s cardiologist, enabling instant diagnosis. The machine is small in size, so readings can be taken virtually anywhere. The unit is automatically connected through digital mobile phone to a medical control centre. The company has also developed a system, named double transmission monitoring, which enables the control centre to direct the operation of the ECG and the transmission, and download of data by remote control. Thanks to this innovative machine, the cardiac patients will be able to travel in the

near future without the nagging apprehension of being away from the doctor or clinic. With CardioSen’C, they will themselves be able to measure their cardiac condition and if need be, could immediately contact their doctor for expert opinion, who will be reading the data in real time. Through this machine, patients who are suffering, recovering or recuperating from heart disease, or patients who feel they are vulnerable to cardiac problems, are now in a position to measure their heart activity. SHL plans to market the CardioSen’C first in Israel, followed by Europe. The company plans to market the unit later in the United States. n

Gates Foundation grant for IDRC for fighting vectorborne diseases

DRC has received a project support grant from the Global Health Program of the Bill & Melinda Gates Foundation (the Foundation). The grant of US$997,397 over a three-year period, will support ecohealth research on communicable diseases in Latin America and the Caribbean.

This is the first grant of IDRC from the Foundation. IDRC’s research program on the use of ecosystems approaches to human health in Latin America and the Caribbean focuses on controlling and preventing communicable, vector-borne diseases, notably Chagas disease, dengue, and malaria. The ecology and transmission of these diseases, which disproportionately affect the poor, are closely related to environmental resource mismanagement and social interactions. The Foundation grant will enable IDRC to fund up to eight projects to tackle these diseases, in collaboration with the Inter-American Development Bank, the Organization of American States, and the Pan American Health Organization. The projects will be selected on the basis of scientific merit and relevance from 11 proposals, now being developed by multi-disciplinary teams. The winning projects will be announced by May 7, 2007. n

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Fortis HealthWorld to improve the health of rural India

ortis HealthWorld, the one stop healthcare retail chain in India, has announced its plans to reach rural India through its tie up with Hariyali Kisaan Bazaar, a unit of DCM Shriram Consolidated Ltd. in New Delhi. By setting up FHWL health stores in conjunction with Hariyali Kisaan Bazaar, Fortis HealthWorld seeks to empower rural India in general and the farming community in particular, by providing all encompassing health needs under one roof. With the endeavour of reaching out to the remotest corner of rural India and providing the best of products and services for all health needs to the farmers and their family, Fortis HealthWorld will have a comprehensive array of key features at the stores, which include OPD facility (doctor’s consultation); telemedicine; routine pathology

INDIA UPDATE tests collection centre (SRL Ranbaxy); prescription, OTC, alternate medicines ( Ayurveda & Homeopathy) and also veterinary medicines; and a wide range of fast moving health good and support systems. Ashish Kirpal Pandit, CEO, Fortis HealthWorld said, “This alliance with DSCL Hariyali Kisaan Bazaar is an integral part of our commitment of providing world class pharmacy and allied services to rural India. Quality services ranging from doctor consultation, well stocked pharmacy with genuine medicines, pathology tests and telemedicine will now all be available under one roof and within easy access to the rural population. We are sure that through this alliance we will be able to provide cutting-edge pharma products and services to all corners of the nation.” Fortis HealthWorld will leverage the

already operational and successful 70 outlets of the Hariyali Kisaan Bazaars across India. The reach will be further strengthened with the next 200 outlets, in the next 15 months, that DCM Hariyali plans to set up. For continuous healthcare support and consultation, the farmers will also have the option of using the telemedicine facility at all these stores. An ailing farmer can now avail the expert advise of specialized healthcare experts and doctors from the Fortis Hospitals. Rajesh Gupta, Business Head, Hariyali Kisaan Bazaar, added, “We are delighted to partner with Fortis HealthWorld in providing quality health services in rural India. Hariyali Kisaan Bazaar with its extensive reach in such areas is uniquely positioned to provide a platform for products and services for rural areas. We hope that this partnership would help our customers access to much needed health services.” n

Telemedicine bridging the medical divide

t seems India’s digital revolution is slowly shedding of its elitist tag, and reaching the remote and the underserved. At least a beginning has been made in this regard.. Recently a telemedicine centre in Bongaigaon, lower Assam was opened. This will serve as a boon for thousands of patients of that remote area, who are not privileged to have the best of medical care at their doorsteps. Lower Assam, which primarily comprises districts of Nalbari, Barpeta and Bongaigaon, is one of the neglected areas of this country and does have an acute paucity of good hospitals. Thus for advanced treatment, here the patients have

24 }

no option but to travel all the way down to the state capital. Now this telemedicine centre will help them get world class care while staying in lower Assam. The telemedicine centre was inaugurated at Bongaigaon Refinery and Petrochemicals Ltd (BRPL) Hospital, Dhaligaon. The Bongaigaon Refinery and Petrochemicals Ltd had teamed up with Apollo Telemedicine Networking Foundation(ATNF) to launch this centre. Here it deserves a mention that ATNF has been a pioneer of sorts as far as fostering the progress of telemedicine in India through private initiatives are concerned. n

Britain showing interest in Indian healthcare

ndia’s healthcare sector is all set for a boom with British companies showing a growing enthusiasm for tie-ups with the healthcare firms in the country. The focal point of these tie-ups is going to be West Bengal and the IT firms in this region. The forecasted boom in Kolkata’s healthcare sector—with people from Bangladesh and other neighboring countries seeking treatment here—tie-ups with the IT firms for medical software, opportunities for the SEZs, and low salaried, highly skilled manpower are some of the major attractions drawing British firms towards India. However Britain, in return, is willing to contribute in advanced research in medicine and cuttingedge technology, which comprises of telemedicine and surgical expertise.According to Kevin McCole, British Deputy High Commission, Kolkata, NHS (National Health Service) of Britain was also eager to invest in PPP ventures with India’s healthcare system. n

A tele-relief for remote West Bengal and Tripura proposed

he government is sitting up and taking notice of the tremendous potential of telemedicine in fostering healthcare in India. Recently the union government has sanctioned a whooping sum of Rs. 30 crores for the state governments of West Bengal and Tripura, for creating telemedicine zones in these two states. This ambitious project endeavours to connect remote hospitals of these two states to the state-of-the-art hospitals located in the cities. Till date many district and subdivision hospitals in Coochbehar, Baharampur Purulia,Habra, Arambagh,Raiganj have been connected to the top-of-the line city hospitals like School of Tropical Medicine, Nil Ratan

Sarkar Hospital(in Kolkata), Burdwan Medical College(in Burdwan) and Calcutta Medical College(Kolkata). The linkages also include video conferencing, through which remote doctors can administer proper diagnosis to the patients. The enhancement of telemedicine links in these two states will greatly help the people living in the remote areas of West Bengal and Tripura to avail cost-effective specialized treatment from state-of-the art hospitals in cities. Though presently Microsoftbased software is being used, in future there are plans to connect the entire network through Linux-based or open source software (OSS). n

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Design Guidelines for Telecare Services Case for automated health systems In developed countries, telecare is emerging as a strategic enabler for the provision of independent living to older people in their own homes, driven by demographics and new technologies. The number of elderly people and people with special needs is growing rapidly, and so is the requirement of dedicated supportive efforts for those unable to carry out the activities of daily living. The changing demographics of Europe indicate a development towards a population getting older and living longer than ever before.

evelopments in technology are enabling seamless and more continuous access to fixed and mobile broadband networks. Likewise, new technologies and efficient production methods continue to drive down the manufacturing costs of silicon memory and processors, whilst simultaneously improving their performance. The result is that ICT resources are becoming evermore ubiquitous and are able to support new applications, such as telecare, which can significantly improve the quality of life for older or vulnerable individuals. In developed countries, telecare is emerging as a strategic enabler for the provision of independent living to older people in their own homes, driven by demographics and new technologies. The number of elderly people and people with special needs is growing rapidly, and so is the requirement of dedicated supportive efforts for those unable to carry out the activities of daily living. The changing demographics of Europe indicate a development towards a population getting older and living longer than ever before. The ageing of our society has unveiled the problem of dependency, as the number of dependant citizens is increasing, especially at the higher levels of the population pyramid. The majority of the dependant population receives informal care, but the population of informal carers is decreasing and ageing. These facts may result in decrease of family support to elderly people and people with disabilities, and therefore demanding new paradigms to provide support for their independent living. Telecare can help health and social care service providers to meet the challenges of an ageing society, but these systems can sometimes fail to provide a positive user experience, due to poor design or poor implementations. AGEING POPULATION

Responding to the demands for better healthcare raised by an ageing population can increase the cost pressure at a time 26 }

when healthcare spending is already on the rise. In 1970, the healthcare related spending of the Organization for Economic Co-operation and Development (OECD, www.oecd. org) countries averaged 5 percent of GDP. This increased to 7 percent in 1990 and exceeds 10 percent in Germany, Sweden, Switzerland and the United States. More than 75 percent of all OECD health spending is publicly financed. Based on an assessment of experiences, analysis of underlying issues and a review of evidence, the OECD recommends that to control the increasing pressure we will need to implement automated health data systems, and strategies making use of new technologies and improved quality of care through better information. The European Commission encourages EU member-states to seek a balanced status among the detected needs of providing quality care and social services to citizens- being compliant to standards, containing costs at a national level, and managing services at a local level. A key ambition is better care services at the same or a lower cost. Human factors and the user experience related to the delivery of health and social care to individuals within the home or a wider community, with the support of systems enabled by ICT, is a complex and in most dimensions, a largely unexplored area. It involves a large number of influencing elements, including the establishment of human confidence, device setup, configuration, calibration and maintenance, data collection, user procedures, cultural issues such as the use of language and illustrations, the organization of the care provisioning process and communication with diagnostic systems and carers, human communication and confirmation and decision making, the presentation medium and accessibility issues. In addition, as telecare services may be required both inside and outside of the home, usability aspects relating to the specifics of mobile environments and equipment and service use need to be covered. Last but not the least, these services will largely be used by older, impaired and disabled people and should be designed accordingly. www.ehealthonline.org

Telecare services

Telecare should clearly be distinguished from telemedicine, which is customarily defined as the use of ICT to support cooperative work between health professionals: a business to business service. For the purpose of our work and in accordance with TR 102 415 [1], the following definition applies for telecare: “Telecare is the provision of health and social care services to individuals, within or outside of their homes, with the support of systems enabled by ICT.”

More than 75 percent of all OECD health spending is publicly financed. Based on an assessment of experiences, analysis of underlying issues and a review of evidence, the OECD recommends that to control the increasing pressure we will need to implement automated health data systems, and strategies making use of new technologies and improved quality of care through better information. The main aim of telecare is to reduce the need for hospitalization and institutionalization and refers to cases where services are provided to an end user; it can thus be classified as a kind of business to consumer service. In a historical perspective, medical treatment, cure and care until the mid 1900s used to be provided by trained (or at least, experienced) physicians within the client’s home; family and neighbours often acted as nursing and supportive staff. During the development of modern life of the 20th century, this healthcare model has changed quickly and dramatically. Medical care is nowadays most often care unit centric, often requiring access to advanced medical equipment. A general practitioner’s visit to the client’s home has become an unusual service. There is no denying the fact that in the 1990s, digital technology enablers (infrastructures, terminals and services) became available to the mass market. At present, demographic changes, limited resources, high user expectations, globalization and technology are transforming medical and social care systems in many countries. The penetration of ever smarter devices connecting to mobile communication networks and the World Wide Web through fixed and mobile Internet, combined with society oriented, Europe wide initiatives, health and social care service providers’ support, evidence of the existence of demographic and economical feasibility enablers, accepted changes in the delivery of health and social care services and the progress achieved in the area of medical technologies, pharmaceuticals and disposable products have together facilitated the deployment of telecare services. Our approach

We have introduced user experience guidelines addressing trust, user interaction (including usability and accessibility) and service aspects, applicable to the research, design, deMay 2007

velopment and deployment of telecare services. The work, co-funded by the European Commission and EFTA, is performed in European Telecommunications Standards Institute (ETSI) and is entering its final phase of development. Here it deserves a mention that ETSI is an independent, non-profit organization, based in Sophia Antipolis in France, whose mission is to produce telecommunications standards for today and future. In our approach to telecare services, personal monitoring, security management, electronic assistive technologies and information services are used to support personal health and wellbeing. The overall methodology, used to produce the ETSI Guidelines (EG), consists of three main components: the approach and structure of the document itself; the bibliographical review of related scientific, technological or standardization references; and the procedures followed by the team to identify and document the guidelines. Several approaches were considered and were carefully analyzed for structuring the guidelines: (i) The Human Factors Approach

The Human Factors approach would require the guideline clauses of the EG to be divided into five main sections, with each section addressing a major human factors topic, which are: • Interaction with telecare equipment; • Operational issues; • Reliability; • Privacy; and • Service related issues.

The number of elderly people and people with special needs is growing rapidly, and so is the requirement of dedicated supportive efforts for those unable to carry out the activities of daily living. The changing demographics of Europe indicate a development towards a population getting older and living longer than ever before.

The advantage of this approach was that the human factors issues would have been given a central role and a high visibility within the document, which is important given the fact that the guide is aimed at addressing human factors issues related to the user experience of telecare services. However, it would not have been easy for individual stakeholders to have identified which of the guidelines were most relevant to them. 27

case study

Design guidelines for telecare services

(ii) The Lifecycle Approach

The Lifecycle approach would require the guide to be divided into four main guideline sections, with each section addressing a specific part of the telecare service lifecycle: • Research; • Development; • Manufacturing; and • Service deployment. The advantage with this approach was that specific stakeholder groups would have been able to easily locate those guidelines most relevant to them. However, frequent repetitions of guidelines would have been likely.

Human factors and the user experience related to the delivery of health and social care to individuals within the home or a wider community, with the support of systems enabled by ICT, is a complex and in most dimensions, a largely unexplored area. It involves a large number of influencing elements, including the establishment of human confidence, device setup, configuration, calibration and maintenance, data collection, user procedures and cultural issues...

(iii) The Hybrid Approach

The Hybrid approach would require this EG to be divided into the four sections listed within Lifecycle approach above. Each section would contain subsections, focusing on the human factors issues described above. Stakeholders would be able to easily locate the guidelines most relevant to them, whilst the human factors issues would still be given a high profile. Alternatively, the human factor issues could be promoted to become the higher level sections, with the lifecycle stages as subsections. (iv) The Approach Chosen

The approach chosen is based on the Hybrid approach with some further modifications: the Human Factors issues were grouped and expanded into specific sections under the themes of ‘Trust’ ‘User Interaction’ and ‘Service Aspects.’

The specific design guidelines provided are grouped around three main themes:

•

Users’ trust covers aspects of privacy and confidentiality, ethics, legal aspects, availability and reliability, integrity and safety; • Users’ interaction addresses usability and accessibility, localization, customization and personalization and user education; • Service aspects cover organizational aspects, servicing and maintenance, interoperability and roaming issues, and the development process and testing. Each of the above clauses are further divided into three sub clauses, providing generic guidelines, research, design and development related guidelines and service provisioning related guidelines. Stakeholders should be easily able to identify the corresponding lifecycle phase and select the relevant set of guidelines applicable to their needs. Note:

The development of the guidelines is performed in collaboration with stakeholders of the telecare industry, in a most transparent way. The most recent public draft version of the current document, as well as our time plan for the progress of this work and public events we organize are available at http://portal.etsi.org/ STFs/HF/STF299.asp. We strongly encourage the submission of comments and contributions until 1 September 2007, when this project will end. Please submit them by sending an e mail to the STF leader: bruno@vonniman.com. References:

•

ETSI TR 102 415: “Human Factors (HF); Telecare services; Issues and recommendations for user aspects”. ETSI references are available free of charge at www.etsi.org. CENELEC Guide 6: “Guidelines for standards developers to address the needs of older persons and persons with disabilities.” Bruno von Niman vonniman consulting, Saltsjö-Boo, Sweden bruno@vonniman.com Alejandro Rodríguez-Ascaso

Structure of the guidelines

aDeNu, UNED, Spain arascaso@dia.uned.es

Initially, the draft ETSI Guide provides a number of highlevel, context-independent, common user experience design principles or meta-guidelines, not specific for any area but applying in general to most of them. These are generic to the widest possible extent and applicable to a large variety of user interface design, user interaction and accessibility aspects. By applying these common user experience principles across the elements and lifecycles of telecare services, combined with a user centered development process, the human factors of telecare services will be properly addressed. 28

Steve Brown BT Group, Ipswich, United Kingdom steve.j.brown@bt.com Torbjørn Sund Telenor ASA, Fornebu, Norway torbjorn.sund@telenor.com

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development

e-Health and its Challenges for the African Media Need to demystify e-Health issues as answer to access quality healthcare The lack of transparency in the health sector always impedes the reportage on e-Health. In most of the cases, the health officials in Africa need to get clearance from their bosses before talking to journalists. Moreover, e-Health initiatives in Africa are mainly at the project level and ICT policies are still in draft form, which leaves very little room for the growth of newsworthy e-Health news. Furthermore, e-Health is a novel concept in Africa and the continent has only a handful of e-Health professionals, most of them being men. Brenda Zulu

t is true that e-Health is gaining currency in the developed countries of the west, but the awareness of its enormous potential seems to be very limited in Africa. Reporting on information and communication technologies (ICTs) is not on the agenda of many news rooms in Africa and thus e-Health stories are seldom reported in the mainstream media. Moreover. journalists in Africa, by and large, are not in any way specialised in reporting on ICTs and therefore find e-Health stories to be difficult to follow and cover. Political stories still overtake ICT stories in the African media with alarming regularity. Besides, editors feel ICT stories do not make news. At the end of the day, both journalists and editors in Africa play proactive roles in not allowing e-Health stories getting their due coverage in the media. The journalists in Africa need to get basic ICT training, and those with interest in ICT and health should specialize in the subject area of e-Health reporting. This will enable them to analyse ICT issues and share knowledge; thereby amplifying marginalized voices, organizing political action, empowering participation and sustainability, and celebrating cultural and intellectual diversity . Finally the lack of transparency in the health sector always impedes the reportage on e-Health. In most of the cases, the health officials in Africa need to get clearance from their bosses before talking to journalists. Moreover, e-Health initiatives in Africa are mainly at the project level and ICT policies are still in draft form, which leaves very little room for the growth of newsworthy e-Health news. Furthermore, e-Health is a novel concept in Africa and the continent has only a handful of e-Health professionals, most of them being men. It is therefore still more difficult to have a womanâ&#x20AC;&#x2122;s voice on e-Health related issues unless when e-Health applications directly and obviously benefits the women eg. in the area of reproductive health. Journalists reporting an e-Health story should include the voices of the 30 }

consumers (women and men). Gender issues also need to be incorporated in the e-Health reporting of Africa. Moreover, new e-Health technologies should not be imposed on a community because many times there is a social and cultural resistance towards change. For this we need to make the consumer aware of e-Health, which is a new concept in Africa, and in this regard media can play a very proactive role by sensitising the uninitiated to the benefits of new technology, through dissemination of factual information, coupled with forceful analysis. In Africa, the media at large also lacks active ICT media networks, specialised ICT publications, and there is little exposure to e-conferences. These are effective platforms where e-Health stories stand a chance of being reported in the media. There is an urgent need to popularise this innovative initiative called e-Health in Africa, especially among journalists, and also demystify e-Health issues as it is the answer to making quality healthcare accessible to the teeming multitudes of Africa, which is still a predominantly rural continent; characterized by constraint in healthcare infrastructure. The fact that Africa has suffered brain drain in the field of health, should also get due coverage in the African media. In a nutshell, there is a need for a concerted media campaign on e-Health issues, which would include production of visual printed materials in comprehensible languages, that share information on issues affecting men and womenâ&#x20AC;&#x2122;s daily health. There are many infrastructural constraints towards the smooth progress of e-Health in Africa, which should get adequate coverage by the African media. For example, many rural areas in Africa do not have electricity, and moreover electricity supply in rural Africa, by and large, is simply erratic, because of frequent power cuts. Other constraints towards e-Health include very limited accessibility to Internet among the African population, language barriers and lack of knowledge on e-Health in the society. Moreover, the equipment for www.ehealthonline.org

Is Global Health Exchange a remedy? There is greater realization that the developed countries including the UK should give increased emphasis to the use of ICT and other new technologies in improving health and health services in developing countries. According to Lord Crisp, the former NHS’ Chief Executive, the UK should do more to help support the health systems in developing countries as southeast Asian and African nations are struggling to tackle diseases due to a shortage of health workers and equipments. In his Global Health Partnerships report, Crisp suggests that new technology and approaches are still not central to international development and more needs to be done to encourage local entrepreneurs to use ICT to improve health services themselves. Crisp writes: “International agencies in developing countries are already working with commercial organizations in ‘emerging markets’ to provide investment in, for example, medicines, technology and infrastructure. There needs to be a parallel emphasis on supporting entrepreneurial activity at the local level, improving health as well as helping the people steeped in poverty.”

The report acknowledges that ICT and telemedicine are making some impact in developing countries. An example is the Swinfen Charitable Trust, which offers free medical advice based on images they receive from a digital camera in a medical centre. Another example cited was Computer Aid, which provides refurbished computer hardware. However, the report also raises concerns about limitations on the use of ICT: “Broadband is still not widespread and is frequently of low density, suitable only for text and not images. Computers are not robust, maintenance is difficult, satellite expensive. In the health sector alone, the WHO has estimated that 50% of technology imported from developed countries is unused in developing countries, simply because there has not been any training.” An unpublished paper, prepared for the Global Health Workforce Alliance, has shown that where “there are a wide variety of modalities for communication available – paper, phone, fax, video, e-mail, discs and DVDs – there is still a tendency to make most use of the traditional means and least of the

telehealth is too expensive for poor African nations, which is another lacuna that needs adequate media attention. Besides, more African journalists should get better exposed to the global e-Health scenario. They should be invited to global conferences on e-Health, which besides giving them the opportunity to cover the event, can endow them with added knowledge and information about e-Health related issues. These conferences can also give them an effective platform to interact with other media people and keep abreast about this fast evolving arena, and also hone their reporting skills in covering e-Health issues; by getting acquainted with the nuances involved. There is also the need to identify journalists who are interested in reporting on ICT applications in the health sector and encourage them to cover such events. More importantly, there is also a need to form a dgroup, even a blog or wiki, where journalists, in collaboration with health personnel in e-Health, can exchange questions and share knowledge and information about e-Health. All these initiatives can channelise African media’s attention towards e-Health. The media in Africa has a role to play in e-Health reporting by educating and informing the public on e-Health related issues. Health personnel in the continent also need to partMay 2007

new.” Despite these, Crisp believes that the potential for ICT in the future, as knowledge and experience grows, appears enormous-people in developing countries are trained to understand the benefits such technology can bring. “I recommend the UK should give increased emphasis to the use of ICT and other new technologies in improving health and health services in developing countries by bringing the innovators in digital technology and its application to health, together with experienced development professionals, to understand the potential impacts and work with international partners to pilot and evaluate applications,” Crisp said. The UK already contributes over £1bn a year to Africa for health and education, excluding regular charity collections. Crisp believes a more co-ordinated approach is needed and NHS hospitals should offer redundant equipment to these countries. Crisp adds that he would like to see an eBaystyle website, called Global Health Exchange, established so that developing countries can advertise the need for certain resources. n

ner with media and educate and inform them on e-Health issues and developments at national, regional and global levels. Journalists in Africa need to be trained in order to demystify e-Health issues in their writing so that the ordinary person can understand what e-Health means, as these technological terms simply put off readers who can be the potential consumers of e-Health. There is also a need to develop an e-Health tool kit for both print and electronic media in Africa, which can be given to media houses for production of news stories, radio programmes and television programmes. The African media also needs to develop a resource on the Internet where journalists can get info on e-Health reporting, as currently we have access to very few relevant materials, pertaining to ICT applications in healthcare. n

Brenda Zulu Journalist & Writer, Zambia e-mail: brendazulu2002@yahoo.co.in

perspective

Integrated Healthcare Management System The much-needed requirement to enhance standards in India’s healthcare industry The trend of providing integrated healthcare systems seems to be increasing in the developed countries as healthcare providers are realizing the multifarious advantages of it. Another project worth noting in this scenario is the latest project being implemented by Aetna. Aetna Inc. a US based insurer, is launching a new application to allow its 15 million members access to their healthcare information online. Aetna is offering the Aetna Care Engine Powered Personal Health Record (PHR) to 15 million of its clients, over the next year A.M. Sheshagiri

he Indian healthcare industry has grown manifold during the last few years; with spends of Rs. 1030 billion on healthcare, which translates to 5.2 percent of the GDP. Of this, Rs. 860 billion belongs to the healthcare delivery market with 63 percent comprising the market for private healthcare providers (source: McKinsey Report, 2002). Although there is an yawning divide between the healthcare facilities available in the rural and urban India, overall the Indian healthcare infrastructure is fast improving with initiatives by the government and the private sector. The entry of private players has further spurred the development of the healthcare sector. An important fallout of the development of the Indian healthcare industry has been the rise of medical tourism in the country. The fact that hospitals in the country are able to provide world-class procedures and healthcare at nominal rates(as compared to international standards) has proved to be a boon for the Indian healthcare industry. According to CII, India has the potential to attract 1 million tourists per annum, which could contribute up to US$5 billion to the economy. Clinical outcomes in India are at par with the world’s best centres, with India having internationally qualified and experienced specialists. Indian must leverage its competitive edge to emerge as the world’s healthcare hub. However, at the same time, there is a serious lack of standardized systems and procedures across the healthcare industry in the country. The need of the hour is to integrate the healthcare sector in India, starting with integrating human resources and technological excellence with global accreditation systems, resulting in increased efficiency, thereby saving more lives. This can be effectively tackled by deploying IT extensively to enable the graduation to an integrated healthcare management system. However, there is still a largely preconceived and misconceived notion prevailing among the sections of bureaucracy and the medical fraternity that IT implementation can be a costly and cumbersome task. 32 }

Scenario in India

But despite the recent advances in Indian healthcare scenario, the comparison is marked when looking at the developed countries, where healthcare systems are much advanced and better managed than that of India. Countries like the US are much advanced on the technology front and the reason for this is the understanding of the benefits of IT implementation, and the support of the government for building a comprehensive healthcare infrastructure. Developed countries realize that better health management system is essential in today’s day and age. This fact can be underscored from the recent initiative undertaken by the U.S Department of Health and Human Services. As a part of the Federal government’s objective of creating a Nationwide Health Information Network (NHIN), the Dept. has commissioned Accenture to develop a prototype network for secure information sharing among healthcare communities. Accenture, along with Oracle, will be developing a fully integrated health information www.ehealthonline.org

system prototype whereby they will be building an interoperable, standards-based network. Projects like these are being fueled by the publicâ&#x20AC;&#x2122;s need for a comprehensive healthcare solution and the healthcare industry in these countries will transform by way of projects like these. The trend of providing integrated healthcare systems seems to be increasing in the developed countries as healthcare providers are realizing the multifarious advantages of it. Another project worth noting in this scenario is the latest project being implemented by Aetna. Aetna Inc. a US based insurer, is launching a new application to allow its 15 million members access to their healthcare information online. Aetna is offering the Aetna Care Engine Powered Personal Health Record (PHR) to 15 million of its clients, over the next year. In addition to allowing patients online access to healthcare information obtained from Aetna, the PHR will also allow users to update records with their own submissions, such as blood pressure readings taken at home. All these will be possible on a Microsoft SQL Server database and Oracle database, to add advanced analytics. These projects are a realization of the need of better health management systems and they only be actualized with the effective use of information technology. With the maturity of the IT sector in India, the time has come for healthcare organizations in the country to look at solutions that can automate and integrate business processes, accelerate staff hiring and training, lower supply chain costs, improve financial information, enable information sharing across the organization, enhance service to consumers, and ensure the security and privacy of patient information. The challenge is to do all these while still increasing the quality of care. Today, healthcare organizations across the world, be they large ones or mid-sized, private or government, confront enormous challenges, which include spiraling costs, staffing shortages, increasingly strict regulatory requirements, rising patient expectations, constrained reimbursements and more. Healthcare organizations in India need to realize the importance of implementing IT into its core operating systems. Not only will it enable an increase in efficiencies and reduction in costs, but will also provide for a uniform standard based system across the country. The Indian healthcare industry has to work extensively towards this end, as today, only a handful of private sector hospitals in the country have deployed IT to increase efficiencies. IT Adoption

Mid-sized hospitals and clinics can either adopt IT in a phased manner depending on their immediate needs or go in for the entire healthcare segment offerings, thereby adopting IT across the different departments of the hospital at the same time. They can go in for the Patient Data Management System in case their requirement is to integrate business and clinical information for improved decision-making. To enable secure patient and provider collaboration they can go in for the Collaboration System along with the patient data management. In order to recruit, develop and retain their much in demand healthcare workforce, they can opt for the HR Management System, while in order to increase administrative and material May 2007

management efficiencies, they can opt for the Procurement, Materials Management and Accounting Systems. Whatever be the case, mid-sized healthcare organizations should seriously look at world-class solutions instead of restricting their search to low-end packages. This is possible by the fact that vendors like Oracle have tailored solutions to the needs and concerns of the healthcare segment. The other factor to be considered is to go for trusted solutions from reliable vendors, something they arenâ&#x20AC;&#x2122;t getting from smaller vendors who may shut shop in a downturn. Oracle, with its powerful combination of technology and comprehensive business applications is well poised to cater to the needs of the healthcare industry. Numerous healthcare organizations across the world are already relying on Oracle products and services to achieve an integrated healthcare management system for improved patient care, reduced medical error, improved research and regulatory compliance and reduced costs, by consolidating all clinical, administrative, and financial information into one integrated healthcare data infrastructure. Oracle is a leader in the healthcare industry with over 300 healthcare providers around the globe running Oracle applications; its presence spans across the globe and includes both private and public sector. Oracle is able to provide not just specific healthcare solutions but also helps them implement an integrated healthcare management system. Oracle solutions are tailored to meet every requirement of healthcare institutes; the applications enable them to speed implementation, optimize performance, streamline support, and maximize their ROI. Leading hospitals across the globe like Hospices Civils de Lyon of France, Cardiff & Vale NHS Trust of UK, Valley Baptist Health are already utilizing Oracleâ&#x20AC;&#x2122;s offerings for the healthcare sector and are experiencing the benefits of a truly integrated healthcare management system. Developed countries like the US are on the fast track to integrated healthcare systems. However, a country like India still has a long way to go in terms of achieving this set-up. The hospitals here have to start with basic IT infrastructure, then only can they consider migrating to an integrated management system. For the Indian healthcare sector to achieve its true potential and for India to emerge as a global healthcare hub, there is an urgent need for healthcare institutions across the country to adopt IT. Today hospitals, be they private or government, need to go in for integrated healthcare management solutions to address the needs of the entire organization and create a standardized framework of treatment. This would not only help in improving the patient experience, but also would improve efficiencies and reduce costs across the entire organization. The Indian healthcare industry has a great advantage on its side with medical tourism booming; all it needs is increasingly adopt IT to be at par with if not go ahead of the developed countries, in the healthcare segment.n

A.M.Sheshagiri General Manager - Sales, Government, Education & Healthcare Oracle India. sheshagiri.anegondi@oracle.com

project showcase

Emergency Care Redefined As a result of EMERGE, quality of life for elderly to improve

he ongoing demographical and social changes in most European countries, which include low death rates and high longevity among other things, have some ramifications from the medical point of view as well. Over-ageing, increasing number of single households, decreasing age of chronically disabled people, will result in a dramatic increase in emergency situations and missions in Europe, within the next few years. Already today, 44 percent of emergency medical services (EMS) system resources are dedicated to patients over 70 years. On the downside, this will result in higher costs for the EMS, which already have to cope with cost restrictions today, and in substantially diminished service quality, or, in all probability, in both of these. Unfortunately, a high quality and affordable EMS in case of an emergency medical assistance has emerged as an essential prerequisite for the independent life of elderly people in their preferred environment. Delayed calls of emergency medical services - in case of physical or mental disorders resulting from strokes or falls, for exampleâ&#x20AC;&#x201D;lead to increased incidence of hospitalization among elderly people. This greatly diminishes their quality of life and escalate their costs on health. The European Microsoft Innovation Center (EMIC) is starting the project EMERGE(Emergency Monitoring and Prevention), which has the aim of supporting elderly people with innovative emergency monitoring and prevention. Here it deserves a mention that the European Microsoft Innovation Center (EMIC) in Aachen, Germany is one of the Microsoft facilities dedicated to research and development in Europe. It is unique to Microsoft in its focus on collaborative applied research, and its goal of contributing to European Commission and other public-sector research 34 }

programmes. It focuses its activities on security, mobile technologies, and web services. The goal of EMERGE is to improve emergency assistance through early detection and proactive prevention, as well as unobtrusive sensing. The projectâ&#x20AC;&#x2122;s objectives are to identify and model the most promising application scenarios for integrated emergency assistance, transfer the emergency model into an application design, identify and engineer suitable ambient information technology, engineer an adequate

system architecture and platform, and validate the models and the engineered system in laboratory models and field trials. Besides European Microsoft Innovation Center(EMIC) the other project partners are Fraunhofer IESE, Siemens Corporate Technology, Westpfalz Klinikum, e-ISOTIS, Bay Zoltan, Art of Technology, National Research Centre Demokritos, and Medical University of Graz. The project, which commenced in February 2007, is scheduled to be completed by 31 October 2009. As a result of this EMERGE initiative, quality of life for elderly people is likely to improve, and costs for emergency medical services(EMS) can be leveraged for the elderly as well as for society. The main innovation of EMERGE is to

provide a model for recurring behaviours and experiences of elderly people following a holistic approach, in order to detect deviations from their typical behaviour and to reason on acute disorders in their health condition. This problem is addressed by the EMERGE project by supporting elderly people with innovative emergency monitoring and prevention. The innovation is to algorithm this behavior by a holistic approach to detect deviations from typical behaviour patterns and to reason on acute disorders in their health condition in case of strokes, falls, or other similar emergencies. The approach is to use ambient and unobtrusive sensors to monitor activity, location, and vital data. Daily routine is tracked in order to detect abnormalities and to create early indicators for potentially arising emergencies. EMERGE engineers a prototypical solution that treats emergencies with stepwise assistance. First, it provides early proactive assistance to the elderlies. Next, it integrates their friends, family, or caregivers. In case of an emergency that cannot be handled in the first two steps, an integrated emergency medical service (EMS) is called and informed about the case and the personal situation of the affected person. The integrated EMS can resolve the situation through medical care, telemedicine counselling, activation of social services, or sending a rescue team. The success of this project will lead to medical and technological guidelines for emergency monitoring and prevention for elderly people with ambient and unobtrusive sensors. It is expected that the success of this EMERGE project will have a positive impact on the standard operating procedures in medical science, where medical guidelines for diagnostics and therapeutical treatments are provided. For more information visit: http://www.emerge-project.eu/

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INDIA

2007

31 July - 03 August 2007 Hotel Taj Palace, New Delhi

Your gateway to Indiaâ&#x20AC;&#x2122;s booming healthcare sector

The LARGEST e-Health Conference & Exhibition in INDIA Join and get involved!