Healthcare EXCELLENCE..a 'CLICK' away: May 2008 Issue

v o l u m e 3 | issue 5 | mAY 2008

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

Cover Story: Healthcare Industry Challenges & IT Solution Offerings Faisal M. Paul, Country Manager - HPC & Healthcare Business Development, Hewlett Packard, India

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Perspective: Challenges in implementing a Hospital Information System Dr. Karanvir Singh, Consultant Surgeon, In-charge of Hospital Information System, Sir Ganga Ram Hospital, New Delhi

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Spotlight: Pioneering Cardiac Care Dr. T. S. Kler Executive Director Escorts Heart Institute & Research Centre

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In Conversation: Achieving Integration A. K. M. Nazrul Haider, General Manager - IT Apollo Hospitals Dhaka, Bangladesh

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Applications: ICT takes on the Herculean task of Cardiac Care through Innovations Aniruddha Nene Director & Principal Consultant - Imaging, 21st Century Health Management Solutions Pvt. Ltd.

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ISSN 0973-8959

Rs. 75

w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 5 | May 2008

CONTENTS Cover story

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Healthcare Industry Challenges & IT Solution Offerings

Faisal M. Paul Country Manager - HPC & Healthcare Business Development Hewlett Packard India (Sales) Pvt. Ltd.

PERSPECTIVE

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Challenges in Implementing a Hospital Information System

Dr. Karanvir Singh Consultant Surgeon, In-charge of Hospital Information Systems Sir Ganga Ram Hospital, New Delhi

SPOTLIGHT

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Pioneering Cardiac Care

Dr. T. S. Kler Executive Director Escorts Heart Institute & Research Centre

IN CONVERSATION

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Achieving Integration

A. K. M. Nazrul Haider, General Manager - IT Apollo Hospitals, Dhaka, Bangladesh

power hospital

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Apollo Hospitals, Dhaka

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w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 5 | May 2008

APPLICATIONS

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ICT Takes on the Herculean Task of Cardiac Care Through Innovations

Aniruddha Nene Director and Principal Consultant - Imaging 21st Century Health Management Solutions Pvt. Ltd.

eXPERT CORNER

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Connected Healthcare - Concept and Feasibility

Anurag Dubey Industry Analyst, Healthcare Practice, Frost & Sullivan

EVENT REPORT

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Medical Technology Conference: Interactive Partnership - Accelerating Sustainable Healthcare

15 April 2008, New Delhi

1st India Health Conclave 2 - 4 April 2008, Mumbai

Launch of www.myhealthrecords.in

27 March 2008, New Delhi

ZOOM IN

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Reinventing Wellnes - Manipal Cure & Care

eHEALTH RE G U L AR SE C T I O NS india news

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pRODUCT pROFILE

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BUSINESS NEWS

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wORLD NEWS 44 NUMBERS events diary

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IN-BOX Thanks again for another copy of the eHealth magazine. You are putting a very good magazine together!!

Frederic Lievens International Coordinator, Med-e-Tel

It was a pleasure going through the magazine. I would like to congratulate you on this great initiative.

Dr.Anupam Sibal Group Medical Director, Apollo Hospitals Group I have been a very regular reader of your wonderful maga- & Sr. Consultant-Pediatric Gastroenterologist and Hepzine. It has helped me immensely & using the wealth of atologist, Indraprastha Apollo Hospitals, New Delhi information in it I have been giving Lectures in Health Care Delivery.

Kudos to your venture in the form of EHEALTH and sucProf. C .V. Raghuveer cessfully continuing to make a difference.

Dean, Kasturba Medical College, Mangalore Best wishes to your endeavour.

Sandip Nayak Congratulations to all those sweating it out to bring out an Sr. Manager, excellent magazine.

Smile Foundation Saneesh M.V. We do check ur website time and again and think it is an Good to see that ehealthonline is making an impact in the excellent effort put by ur team. Hope u people continue the online world. good work.

Saji Salam MD, MBA Rituraj Clinical Transformation Group Management Trainee, Cognizant Business Consulting & Chairman, NM Virani Wockhardt Hospital, HL7 India Rajkot

Editorial Guidelines eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and wellresearched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and international case studies, research outcomes, policy developments, industry trends, expert interviews, news, views and market

intelligence on all aspects of IT applications in the healthcare sector.

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

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

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

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

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

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

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

All contributions are subject to approval by the publisher.

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

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Volume 3 | Issue 5 | May 2008

president

Dr. M P Narayanan editor-in-chief

Ravi Gupta group directors

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

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

Susan Thomas Sarita Falcao Sales executiv e

Arpan Dasgupta mobile: +91-9911960753 email: arpan@ehealthonline.org Sr Graphic Designer

Bishwajeet Kumar Singh Graphic D esigners

Ajay Negi Chandrakesh Bihari Lal (James) Om Prakash Thakur web

Zia Salahuddin Santosh Singh subscriptions & circul ation

Manoj Kumar (+91-9210816901) manoj@ehealthonline.org editorial correspondence

eHealth G-4 Sector 39, NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org printed by

Vinayak Print Media, Noida Gautam Buddha Nagar (U.P.) India does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. is published by Ravi Gupta on Behalf of Elets Technomedia Pvt. Ltd. in technical collaboration of Centre for Science, Development and Media Studies

EDITORIAL Decline of Public Sector = Rise of Private Sector A recent report released by Planning Commission once again brought forth the sloth in our ailing public health system. Citing non-availability of medical and paramedical staff, lack of diagnostic services and acute shortage of medicines in government-run hospitals and medical centres, the situation has been said to be in ‘serious decline’. While highlighting that quality of hospitalised treatments have gone down in government hospitals, the report says that organised private healthcare is faring much better in comparison. Further, it has been observed that, inspite of higher costs more and more people are actually preferring to opt for private care.

The report also gives out some startling figures in terms of percentage shortfall of doctors (as of March 2006) across 3,910 community health centres in the country.

It was found that there is a shortage of 59.4% of surgeons, 45% of obstetricians and gynaecologists, 61% of physicians and 53% of paediatricians across these centres.

Further, it has been observed that essential therapeutic drugs are not supplied in most public health institutions with the exception of a few states.

To stall this spiralling crisis, the Planning Commission has urged an increase in public health allocation from the previous level of 1% of GDP (as at the end of tenth five year plan) to 2% by the end of eleventh five year plan. Whether simply increasing allocation will suffice or not is quite debatable. However, in the wake of this reality, it continues to erode public belief in government health services.

Of late, the government seem to be realising that encouraging private healthcare players and partnering with them might be a much better option to ensure quality and reliability of service delivery. Government of Delhi is already working in this direction, by contemplating the launch of a emergency medical service in the capital city, in collobartion with some of the reputed private healthcare providers.

Keeping in mind the increasing number of road accidents and resulting loss of life due to excessively long response time of government run ambulances, private players are being roped in to provide speedy ambulatory services and emergency care by deploying ambulances in different parts of the city. The state government will create a special purpose vehicle (SPV) for this initaive and private players are expected to join in.

Keeping in mind the competetive environment in urban centres, lack of business viability in new geographical territories and high investment burden in green field projects, private healthcare players are eyeing public-private partnerships as key growth strategies. Corporate healthcare providers are increasingly coming forward to offer their services for running and managing public hospitals under the PPP model. For instance, Wockhardt is already managing a government hospital in Gujarat and Fortis is reported to be in talks with various state governments in north India about offering their services.

The above equation holds good!

Printed at Vinayak Printers E-53, Sector 7, Noida, U.P. and puiblished from G-4, Sector-39, Noida, U.P. Editor:Ravi Gupta © Elets Technomedia Pvt. Ltd.

Ravi Gupta Ravi.Gupta@ehealthonline.org

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COVER STORY

Healthcare Industry Challenges & IT Solution Offerings Faisal M. Paul, Country Manager - HPC & Healthcare Business Development, Hewlett Packard India Sales Pvt Ltd shows us what HP has to offer in terms of IT solutions for life sciences and healthcare industry.

Industry forces are converging the Life Sciences and Healthcare Value Chain - the industry convergence is driven by bioscience innovation, increasing healthcare costs, the aging population and technology adoption .

Over and above this, there are changing expectations as patients and individuals want more control and empowerment over their health management.

The life sciences - healthcare value chain is also transforming and the key factors driving the transformation are cost burdens, inefficiencies, quality of care, individual wellness and regulations / compliance.

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Technology is at the heart of improving business & health outcomes, and this can be achieved by the following: 1. Acceleration in business growth & speedy innovation to transform health: Some of the areas which can help accelerate business growth being bridge information gap between research and clinical care, power biosciences (genomic and proteomic) research and discovery, speed time to market of new pharmaceutical agents, enable “personalized medicine” through value chain collaboration and empower individuals to manage their health.

2. Lowering costs & Improving operational efficiencies: Lower operational costs increase efficiency in the healthcare business and this can be achieved through reduction in waste—over US$ 1 trillion of health expenditure is waste. Automation of analog manual processes, help address the staffing shortage through improved information capture and sharing. Manage growing data/images driven by eHealth initiatives.

3. Mitigating risks & Improving quality of care: Safe and quality care can be ensured by enablement of right information at the right place at the right time. Improvement of patient safety can be ensured by avoiding medical mistakes which account for over 100,000 deaths per year, combating drug counterfeiting and adhering to increased compliance and regulation mandates.

Digital Hospital Digital Hospital is a more comprehensive solution that is continuing to grow, addressing safe and quality care and health management. Digital Hospitals are delivering business outcomes today by extending information-enabled process, consolidation and integration of technology and integration and simplification of the processes.

The Digital Hospital solutions overview is as follows: • Clinical information automatically captured and fed into electronic patient record.

• Electronic decision support - accelerating and improving treatment decisions.

• Interactions between patients and staff are radically improved.

• Changes in patient conditions can be communicated in real time enabling faster response.

• Location-based services and WiFi tags helps staff locate resources faster and manage assets better.

• Bar coding and RFID technologies greatly improve medication administration - one of the most error-prone care procedures.

• Portable devices and wireless communication extend the organisational boundary, leading to better, more efficient care for chronic-condition patients.

• Vast amounts of data can be captured for medical research, speeding the creation of new treatments and healthcare delivery options.

HP-HCIS is designed on an open architecture concept, meaning it can use any of the standard Operating Systems and can be based on any of the main data bases.

Key challenges faced by the healthcare industry today are: • Patient safety in hospitals • Infrastructure availability and proper deployment • Information Lifecycle Management (ILM) HP over the last decade has developed various solutions to address healthcare industry challenges.

Some of the solutions are as under : 1. HP Healthcare Information System (HCIS) 2. Patient safety by using RFID technology 3. Infrastructure by Digital Hospital Implementation (DHI) 4. ILM by Medical Archival Solution (MAS) 5. Mobility for Health Solutions 6. Electronic Health Record 1. Healthcare Information System: HP-HIS is the Healthcare Information System that has been developed since early 1990’s. It comprises a series of modules in the different activity areas of a hospital.

HP-HCIS is designed on an open architecture concept, meaning it can use any of the standard Operating Systems and can be based on any of the main databases.

The end result is that the patient has a good experience and s/he is happy.

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HP-HIS is modular and flexible, and has powerful integration capabilities, which makes it suitable for very different kinds of hospitals and healthcare organisations.

The HP design in Healthcare Information Systems is based on a series of principles that can be summarised in five main areas : • The first one is the configuration of the Electronic Health Record as the articulation element of all the value chain of the healthcare system. The basic concept is understanding clinical decisions as the trigger of resource consumption.

The health record understood in that way articulates:  The patient and his/her needs as center of the system  The main process of the healthcare organisation: prevent, diagnose, treat and rehabilitate  The relationship between the main process and the supporting processes.

• The design of the functional processes of the organisation and the requirements of the Information System that must support it and facilitate it. Care process that must respond to the needs of the care continuum, base of a high quality integrated care, with no risks for the patient.

• The vision of Clinical Management as convergence point between good care and management practices. The in-

formation requirements for clinical management are very complex and sophisticated, because they must include information for clinical and management decision making and require, among other things, guaranteeing the reliability of the data that identify a particular patient, his/ her diagnosis, treatment and the professional that makes the clinical decision. The reliability of these systems is therefore, a critical factor in Clinical Management.

• The information system as a generator of decision support information for the different agents that constitute the system or the healthcare organisation: population, patients, professionals and management.

• The security of the entire system, without doubt is the most critical point of all healthcare information systems.

The product is very modular and flexible, and has powerful integration capabilities, which makes it suitable for very different kinds of hospitals and healthcare organisations.

This can be verified because there are installations of big public hospitals (more than 1300 beds), medium sized hospitals and foundations (around 500 beds) and smaller public and private hospitals (between 100 and 200 beds), altogether more than 100 references using some HP-HCIS version.

Its modularity allows customers to keep modules of their information system from vendors different from HP and still have a very solid and integrated system. This integration features also allows us to insert independent modules in installations where the main system is from another provider.

2. Patient Safety during care delivery in Hospitals Patients safety is a major concern in Hospitals across the world hence JCAHO (Joint Commission on Accreditation of Healthcare Organization ) had come out with goals to keeping patients more safe in all healthcare institutions.

The seven goals proposed by JCAHO are: • Accuracy of patient identification • Better communication between medical staff • Prescriptions of high-risk medicine • Reduce mistakes of location and procedure for patients • Usage safety of transfusion liquid pump • Clinical alarm system • Lower the risk of infection through healthcare These can be achieved by implementing some simple solutions like Patient Verification, Bedside Clinical Process and Medicine Management.

Medicine Management

Patient Verification

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3. Digital Hospital Infrastructure The Digital Hospital Infrastructure solutions include: • IP platform that include access to patient data at point of care, digital dictation, web collaboration, soft phones and telephones used as paging systems.

• Wireless delivery of X-ray and other data to physicians tablet and laptop PCs. • Radio-TV systems, AV equipment, HP Infopaq medical terminals and HP PCs for the Medical School.

• Network design, architecture, security, testing and implementation all managed by HP. • Integrate HP Medical Data Assistance system to all the Hospital Departments .

• 99.999% availability of the core system.

4. Information Lifecycle Management - HP Medical Archiving Solution The HP Medical Archiving Solution provides long-term archiving to imaging centers, hospitals, hospital networks and research affiliates for retrieval and transmission of medical images and documents.

Healthcare organisations are looking for solutions that will help them deal with growing volumes of image data. For many, medical image management and picture archival communications systems are the answer.

The HP Medical Archiving Solutions offer real-time diagnostic image systems with storage, retrieval and communications systems for archived images, reports and exam results.

The solutions provide economical, petabyte-scalability for secure and reliable transmission of digital images and other information .

These solutions enable your organisation to: • Accelerate patient care while complying with ethical and regulatory requirements for privacy and security.

• Obtain affordable long-term storage of patient studies, regardless of size.

• Share your infrastructure to house image types used in different picture archiving and communication systems (PACS) applications.

• Integrate data from health information systems, such as patient records and insurance data, into your solution.

• Migrate images from other vendor PACS to a centralised, consolidated, single repository.

Patient Portal Setup: When patients come to the hospitals for getting life saving medical treatment, they expect transparency and information sharing on what care is being provided to them .

The patients also feel the need for entertainment, communication, and access to own patient information or other hospital information.

A secure and efficient way for the clinicians to use the same terminal for accessing clinical systems like EPR or Patient Chart.

5. Mobility Solutions for Healthcare HP mobility solutions for the healthcare industry enable organisations to get the information you need, whenever and wherever you need it.

Few things are less mobile than paper medical records.

They are cumbersome, bulky and awkward to use. And they drain precious time from your practice.

HP wireless networking solutions enable health professionals to stay connected and productive anytime, anywhere, using intelligent, secure, automated functionality.

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HP wireless technologies for healthcare industries allow your organisation to: • Access, share and update information securely wherever you are – home, hospital or office • Connect to printers, scanners and other peripherals without cords or cables.

6. Electronic Health Records The HP solutions for Electronic Health Records help healthcare organisations use their data to improve health and streamline operations.

Healthcare and research organisations generate tons of data each year. Preparing these patient records and administrative data so that they can be shared, can delay access to information by days, sometimes weeks.

HP and its partners offer secure, easy-to-deploy solutions for electronic health records that transform the way data is gathered and processed.

These solutions enable your organisation to: • Handle, compile and share information simply and more efficiently.

• Make certain that data is available whenever and wherever it is needed.

HP’s Maharashtra State Government Project

HP has begun providing HIS solutions for the public sector. In January 2007, the Government of Maharashtra began a 8 year automation project to connect public hospitals in the state. The project, worth INR 180 crores, will network 19 major government hospitals and 14 medical colleges.

HP Healthcare Solutions, is partnering with Amrita Technologies to implement the HIS of these facilities. It is also training the doctors and other medical staff as part of the solution.

When a doctor wants an X-ray to be done on a patient, he can acquire the report on his desktop as soon as the X ray report is generated in the lab.

The HP HIS solution was first installed and used at the registration desk of JJ Hospital, Mumbai. Since then, it has interfaced the solution with existing solutions and software. The project is expected to be launched in May in JJ Hospital and Grant Medical College, also in Mumbai.

JJ Hospital treats over 30,000 in-patients and more than 5,00,000 out-patients annually. It ensures better inventory control due to ready availability of stock status. Requisitions for stock are made through the online network after the necessary approvals are obtained. This increases efficiency and ensures proper control. Reporting of epidemics, birth rates, mortality rates and non-communicable diseases are all just a click away with the HIS.

Faisal M. Paul Country Manager - HPC & Healthcare Business Development Hewlett Packard India Sales Pvt Ltd

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PERSPECTIVE

Challenges in implementing a

Hospital Information System

Dr. Karanvir Singh MBBS, MS, FRCS (Glasgow) Consultant Surgeon In-charge of Hospital Information Systems Sir Ganga Ram Hospital, New Delhi

Compared to other industries, the healthcare industry has been relatively slow in adopting information technology. Currently, computerisation of medical care is in the process of evolution, being hampered to some extent by technology, since no perfect interface exists between medical care providers and computers. Medical care personnel are usually on the move, while computers tend to tie them down. PDAs and mobile notebooks have been tried but they have not achieved widespread adoption as yet. This is a big hurdle towards implementation of a HIS, since it requires care providers to start working differently than what they are used to. Although this is most obvious for clinical information system adaptation, it does affect the ease of implementation of other components of a HIS. HIS implementations fail more often than hospital administrators would like to acknowledge. There are three common scenarios of HIS implementation failure. An implementation may start well but may never be completed. The common reason for this is inflexibility of the HIS software, inexperienced implementation teams or a weak administrative will.

Another scenario is where the HIS implementation has been completed but only part of the HIS functionality has been implemented. It is also not uncommon to find that a year or 14

so after a ‘successful’ HIS implementation, the hospital staff have stopped using the software. This might be either because the software was not user friendly or the workflows were not well planned and configured.

Pre-implementation assessment A hospital administrator who is planning to implement a HIS software in his hospital may thus be apprehensive that the implementation may end in a complete or partial failure.

Prevention of this eventuality starts even prior to purchase of the software. The software, the vendor, as well as the hospital need to be well assessed.

Software assessment Many popular HIS software, have a common development cycle. Very often a software begins life as computerisation of a single hospital, either by an in-house team or by a local developer. Successful implementation leads to a vision of exporting this software to other hospitals. For this, some ‘decustomisation’ is done to allow the software to adapt to workflows that may be different in other hospitals. However, in spite of this, the second implementation site does experience problems. In order to get over this problem, developers www.ehealthonline.org

tweak the software and apply multiple patches, which though it solves some of the problems, but only at the cost of disrupting the software structure. While the second site still struggles, a third and a fourth hospital get roped in. At some stage, usually years down the line, the developer, if he is still financially sound, decides to rewrite the entire software from scratch so as to increase its flexibility and customisability. This is the ‘second generation’ software. Hospital administrators shopping around for a HIS software should try to discover if their software is a ‘second generation’ one.

Another aspect for consideration is whether the software customisation during implementation is done primarily via master tables or it is via programming code. The former allows the hospital to make some alterations to the software setup on its own, should it be required later on.

Programming code, on the other hand, necessitates the hospital to approach the developer each time they want to alter the software functionality.

A warning sign is if the vendor promises to implement a HIS software in an unusually short duration of time. Is the software being offered akin to Microsoft Office, which can be installed very fast but allows only limited flexibility?

A proper implementation takes time and the hospital may do itself harm by trying to unnecessarily hasten the process.

Vendor assessment Assessing the vendor is also not easy. Only a few vendor of national or international repute may easily be trusted, but with the drawback that a large vendor may not go out of the way to accommodate all the requirements of a small hospital. In case of smaller vendors, the hospital administrator may need to assess the vendor by indirect means, since vendors may not be direct about revealing their shortcomings.

A good way to assess the long-term stability of the vendor is to try and discover their staff attrition rate. This can indicate whether the current implementation team will last the entire implementation cycle. Often, vendors have other business interests; HIS implementation being only one of the side businesses.

Visits to other implementation sites need to be properly planned to gain a real insight. Usually the vendor is interested in showcasing only the successful implementations.

The hospital administrator would do well to get a list of all hospitals that have purchased the software and visit even the ones that the vendor is not keen on showing. It is here where actual problems are likely to come out in the open. During site visits, it is simply not sufficient to see what the software has achieved, but it is necessary to find what the site hospital wanted to implement but could not. This requires meeting the person who actually planned and spearheaded the HIS implementation, since others are unlikely to know what was planned that could not be achieved.

A good way to assess the long-term stability of the vendor is to try and discover their staff attrition rate. implementation are a multi speciality hospital, an ‘old’ hospital, a hospital with multiple power centres, a work overloaded hospital, a hospital with a physical space crunch and a fund starved hospital. Multi-speciality hospitals, in comparison to single speciality hospitals, tend to have more varied workflows, requiring very flexible software. An ‘old’ hospital, i.e. one that has been in existence for a very long time, tends to develop complex and varied workflows over time and hence is more difficult to computerise. Multiple power centres, with each departmental head running the department the way he wants to, introduces complexities for the same reason. Once HIS is implemented, certain processes may become slower, especially one where more data has to be entered than in the manual process.

HIS users expect to see more detailed information on their screens than during the manual phase and someone has to enter this ‘extra’ information; hence processes may be slow at points of data entry. The most affected area is the clinical information system where care providers may be expected to type in clinical data in a structured format where they were previously used to simply penning down sentences on paper.

If the workload of the hospital prior to HIS implementation is such that it is heavily straining the resources, the hospital may not be able to withstand the excessive demand placed on it by the HIS. Care has to be taken to make necessary provision for this well in advance. A hospital that is short on space may find it difficult to find space for the additional computers and rooms that may be required to offset this excess workload demand. Hospitals that have allocated funds just enough to purchase the HIS software may run into problems when demands are created to recruit more staff for the above reasons.

These expenses can be expected to be more than double the initial budgetary estimate. While software purchase is a onetime cost, the salary of additional staff inducted becomes a recurring cost.

What to expect from hospital computerisation It is important for hospital administrators to have their priorities right when they go in for HIS implementation. Very often administrators, care providers, stakeholders, etc. have very different, and often incorrect expectations from the software. A common myth is that computerisation reduces workload and makes processes faster. In a well implemented system this is true to a certain extent. Even though the overall workload may become less, there are areas where the workload may be more than before, especially where extensive data Hospital assessment entry is performed. Typing is always slower than writing and Even if the software and the vendor appear to be satisfacto- it takes time to get used to new user interfaces. ry, issues in one’s own hospital could lead to implementation Stakeholders may be under the impression that computerifailures. Hospital related factors that could point to a difficult sation will reduce running costs. The reality is, unfortunately, May 2008

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Unless it is a very small implementation, it makes sense to roll out the HIS in phases. This causes the least disruption to the working of the hospital and also places the least strain on implementing teams. very different. Very few hospitals have been able to show a realistic return of investment on the money they have spent on the entire computerisation process. Hospital computerisation is more about better communication and data availability and about better patient care as a result – something that is not easy to quantify in financial terms. Even these may take a very long time to realise. The banking industry spent a large amount of money on computerisation in the 1980s and has started reaping the benefits fairly recently.

In addition to computerisation of the hospital, the software must allow exchange of data across hospitals. This inter-operability aspect of the software must always be considered by hospital administrators. This is something that needs to be spearheaded by the government or national bodies.

Preventing a failed implementation Once a software has been purchased, the implementation strategy must be worked out to prevent delayed or failed implementation. Often, it is only during the implementation phase that hospitals realise the ad hoc ways that had been in practice. Implementation often helps to redefine workflows and make them more efficient. At the helm of a HIS implementing team there need to be a person who not only has domain knowledge of the software, but also of the processes and workflows in the hospital. He is also required to be a visionary, lest the manual workflows be literally translated into inefficient computerised ones - something that happens too frequently. Workflows in a computerised setting may have to be different to achieve full benefits of computerisation.

Once new workflows have been charted, the biggest hurdle is collection of data to populate the master tables of the software. At that time, hospitals usually realise that they do not have complete data of almost anything. Hence, data collection becomes an important factor for delay in HIS implementation process. Hospital staff place low importance on submission of data pertaining to their department; their daily work comes first. The way out is to get a person from each department seconded to the HIS implementation team till the work is over. This is not as easy as it sounds, since departments may be facing staff crunch as such. It requires a very strong administrative commitment to achieve this – something that should be stressed early in the planning phase. Departments moreover tend to second their most dispensable 16

person, one whose absence is least likely to cause disruption to the work in the department. Unfortunately, such a person is also least likely to know the workflows in the department and be able to redesign them for computerisation. It must be made clear to all concerned right at the beginning that the person in charge of the implementation team should have the right to chose who he wants from each department to work on the team. The implementing team should be lead not by a committee but by a single person. Unless there is a single person who takes ‘ownership’ of the entire process and is accountable for its failure and success, the implementation is likely to falter.

Managing resistance In any venture, there are persons who resist change. It is important to deal with this by ‘triaging’ all persons who are involved as users of the HIS. The first category in this ‘triage’ is of persons who are supportive of the entire venture.

Especially, if they are physicians they should be encouraged to spearhead a movement to gain support for the venture.

The second category is comprised of persons who are neutral to the entire process. They can be safely ignored. The third category consists of persons who are opposed to the process.

These people have the capability of upsetting the entire planning if not handled carefully. Ignore them at your own risk!

HIS implementers need to spend extra time with them to truly understand and resolve their issues. Often there are genuine issues that need to be resolved during the implementation. At other times they are as trivial as a ‘fear’ of computers, especially amongst senior staff. A little extra care and a few extra training sessions can turn them from being the most opposing to one of the most vocal supporters.

Managing it in phases Unless it is a very small implementation, it makes sense to roll out the HIS in phases. This causes the least disruption to the working of the hospital and also places the least strain on implementing teams. On the other hand, implementation of some functionality, but not of others, can cause both computerised as well as a manual workflow to exist side by side.

This will require staff to perform duplicate data entry and put an extra load on them. It is the responsibility of the administrator in charge of the implementation to plan the phases so as to minimise this issue. This is where in-depth domain knowledge of the software as well as of the hospital workflows is most useful. As far as possible, parallel runs should be performed at each location when that section is computerised. This allows for a fall back manual system, in case the implementation runs into initial problems and will prevent bad publicity, which could lead to internal resistance in other sections of the hospital.

At the end, HIS implementation is a collective responsibility of the entire hospital staff. A system that is configured by involving all users of a department is more likely to be accepted by the department users, than one where most see the system for the first time at the time of ‘go-live’.

Successful implementation is as much an exercise in public relations as in technology management. www.ehealthonline.org

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spotlight

Pioneering Cardiac Care

Dr. T S Kler Executive Director Escorts Heart Institute & Research Centre

How has been your experience since you took over as the Executive Director of EHIRC last year? What were the key challenges in the initial days, particularly in the wake of public controversy in relation to the exit of the former ED? When some eminent personalities leave, it becomes very challenging for the people left behind to keep the hospital’s image at the same plane or take it forward. The real challenge is to keep the institution at the pre-eminent level it had always remained, divorced from any individuals’ identity. We had to work hard with the people in the hospital devising methodologies and strategies to keep the hospital at the top.

When some people with great renown leave, it becomes very difficult for the remaining people and it is a great challenge to keep the institution’s eminence at the same level or take it forward. However, the ideal situation is when we concentrate keep working hard on the clinical and research aspects, and deliver the same quality in patient cure so that the public May 2008

perception of the hospital remains the same or is better than before.

Escorts Heart Institute & Research Centre (EHIRC) is known to be a world-renowned pioneer in cardiac care and research. Kindly give us a overview of major innovations and achievements of EHIRC since its inception.

EHIRC was one of the first major state of the art hospitals in the country and indeed is world-renowned. It introduced many new procedures - interventional cardiology, non-invasive cardiology. It was the first to focus on Angioplasty, new technologies of Angioplasty and so on. Apart from that, we were the first to make a separate lab. Then I was the first one to implant an ICD in the country in 1995. Again, in the year 2000, I was the first one to implant a heart failure device (cardiac resynchronisation therapy - CRT). In 2002, I was the first to implant a combo device - a cardiac resynchronisation therapy with a defibrillator. We introduced these things 17

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in the Electro physiology. On the surgical side too, we have many firsts such as minimal invasive surgery.

EHIRC remains one of the major paediatric cardiac surgery speciality facilities with the largest number of patients - we have a dedicated team of paediatric cardiologists and surgeons. This kind of surgery is a challenge because of the fragile condition of the small and very ill babies flown in from all over India and even neighbouring countries such as Bangladesh and Pakistan.

EHIRC too has introduced in the country what we call the community outreach programs. We see the patients free of charge, do free investigations and give educational lectures on how to prevent heart disease. We cover mostly the northern and central parts of India. However, it is a huge area that we have covered, having gone as far as Assam and the southern-most part of Madhya Pradesh and Rajasthan. We have even gone up to Kargil, and the remote villages of Jammu & Kashmir.

sation process? What new medical technologies and IT systems are you deploying?

We have already purchased a new, fully equipped Electro physiology Lab, one of the latest in the country. We also had a new gamma camera installed last year, and are in the process of upgrading the Cath Labs to the latest levels.

We are moving towards a more paperless environment by using Electronic Medical Records. Our Labs are connected to the patient wards and nurses stations; all the results are put on the computer systems right away, which, gives access to the staff, so nobody has to go from one place to another to see the reports.

Kindly brief us about your role as the ‘Chief Patron’ of the Association of Clinical Biochemists of India’.

I do not have any direct connection with the Association as such, but of course clinical biochemistry is a new area, if the biochemists also interact with the patient they understand the value of the tests, EHIRC would like to see our BiochemEHIRC is known to be providing tele-cardiology and re- ists take the lead in the systems, education, research, and inmote consultation services for other hospitals across the creased interaction with the clinicians. country. How many hospitals and patients are currently benefiting from your services and what is the operational How do you foresee the healthcare domain as a market? model for tele-consultation?

I definitely see a huge need for investments in the healthWhen we talk of ICTs, there are two uses of it in telemedi- care field. If you look at the possible future requirements, they cine. One is when we monitor patients from a different geo- are large. Medical services have developed in the main metrographical location, using devices that can be placed on the politan cities, now there is a shift in focus for hospital to move chest, which record the ECG and have that data sent to the into class B and C cities.

EHIRC central terminal, where one doctor is always available Therefore, one sees a great necessity for investments and I to diagnose the data, and the patient too can speak with the think big hospitals have already seen the opportunities and doctor. the big industrial houses too have already started investing Another is when someone wants to take an opinion from in healthcare. Even people have realised the need for better our doctors; in this case, we have an audio as well as video services. Medical requirements are permanent and this service conferencing facility, so there is a direct real time interaction faces no seasonal effect of course. Thus it makes sense being between the doctor and patient. These are two tele-medical part of it also. projects we try to provide in our network hospitals as well as I feel the biggest challenge is to provide Medicare to the others. We use trans-telephonic ECG monitoring systems in lower middle class and the class below that, since these classes these tele-consultation projects, manufactured in Israel. will not be able to afford the private hospitals, which provide the quality. So until there is some sort of insurance for all, that What according to you is the scope of using telemedicine will remain a big challenge. in India? And what has EHIRC planned to do to make it more widely available?

What is your vision for the future of EHIRC in terms of There is much more scope of using telemedicine in India attaining the next level of excellence? Do you have plans than other places, since the patients in the far-flung areas of to expand to other parts of the country?

India will then have access to good quality care without havKeep this hospital par-excellence in terms of clinical reing to travel far. search and development; take it from strength to strength.

In fact, if this can be done with some kind of a Public We already have an Escorts-Fortis network around the counPrivate Partnership model, where the government provides try, such as in Amritsar, Jaipur, Mumbai and Chennai. We some kind of help to acquire the equipment at the primary are also looking at opportunities in other regions across the healthcare centre which can be linked to the bigger hospitals, country. There is a possibility of starting a hospital in Jammu then we can advice the local doctors about the diagnosis and & Kashmir and one in Lucknow… perhaps, a Medicity with procedures. This has not happened so far but now could be a medical institute as well. good time to start. We have thought about approaching the I would also like to go to the rural areas and increase health Ministry of Telecommunication regarding this. awareness, by way of education through the camps, which we hold regularly.

Last year EHIRC announced a total outlay of INR 30 Last, but not least I wish to remain a humble human being crores for modernising technology infrastructure and and doctor more than anything else and not chase monetary facilities. How did you plan to embark on the moderni- gratification.

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news review

INDIA

Customised health cover launched

Trauma care centre at RML hospital

A new health insurance package, focused on people who prefer a customised solution, was launched recently. The United Health Solution, a joint venture of United Bank of India with Tata AIG Life, is said to be tailored for Indian customers.

Health expenses are a major cause of concern amongst individuals, especially when budget increases for the treatment of diseases like cancer, stroke and coronary bypass surgery, since these treatments come at a high cost.

United Health Solution offers reimbursement services. If the sum is not used, customers do not have to pay the premium and they can get back the entire amount they have invested on this solution package.

“We have witnessed a significant growth over the years and United Bank of India (UBI), holds a larger share of the company. We are ready to partner with other commercial banks in the near future,” said Mr Trevor Bull, the company’s managing director.

According to Mr. P.K. Gupta, chairman and managing director of UBI, “Our marketing team is already strong enough and our prime motive is to honestly explain the features of this solution and if customers think it to be a positive investment then they would definitely purchase our product.”

Speaking at the inaugural function of the Trauma Care Centre Building at the Dr. Ram Manohar Lohia Hospital in the capital recently, the Union Minister for Health & Family Welfare, Dr. Anbumani Ramadoss said that even though trauma victims were being treated in this hospital earlier also, the quality of care will now make giant strides because of provision of all the modern facilities and availability of doctors belonging to different specialties round-the-clock.

This Trauma Care Centre is only the third of its kind in Delhi.

In terms of equipment, it will have the latest state-of-the-art gadgets for providing world-class services. One of the exceptional components of this Trauma Care Centre is the ICU with most advanced monitoring equipment, which will be available for the care of the critically injured patient.

There has been a long felt need of comprehensive Trauma Centres in Delhi to take care of emergencies arising out of modern day road accidents, the number of which is ever increasing because of the busy and fast paced life of Delhi compounded by the increasing number of vehicles.

Manipal Hospital receives NABH in over 50 specialities Bangaloreans have yet another reassurance for having access to quality healthcare at their preferred Manipal Hospital. The hospital has been accredited by National Accreditation Board for Hospitals (NABH) for the delivery of high quality patient care in more than 50 specialities.

In a NABH accredited hospital, there is strong focus on patient rights and benefits, patient safety, control and prevention of infections in hospitals and practising good patient care protocols like special care for vulnerable groups, critically-ill patients and better and controlled clinical outcome. “Manipal Hospital with its sound, systembased operations and structured process improvement programme, met all the criteria set by NABH,” added Basil. The assessment of a hospital is done against 500 criteria set by it. The NABH standards relate to the local culture and systems, yet at the same time, are benchmarked with the best international standards.

“The whole accreditation process, which had been developed and implemented in house by Manipal Hospital reflects the capability, depth of knowledge, effectiveness and management commitment in driving an effective quality management system. Strong emphasis was laid on strengthening policies, procedures and protocols, reviewing performance through patient satisfaction, conducting audits and training the staff including clinicians, nursing, management and outsourced staff,” added Dr. Murali.

May 2008

Govt to improve cancer control strategy The government is working on a comprehensive cancer control strategy that will more than double the number of cancer hospitals in the country, create a national institute for research and set up a fund to assist poor patients.

With more than 800,000 new cases detected and 300,000 deaths every year, cancer has already become one of the 10 leading causes of death in India.

Around 1.5 million patients require facilities for diagnosis, treatment and follow up at a given time, states the health ministry -the nodal ministry for administering and designing all public health programs in the country.

Y.K. Sapru, president of the Cancer Patient Aid Association, is unenthused. “The government is once again missing out on the essentials and unless we attack the essentials, which is affordability and availability of cancer drugs, any programme will not give effective results,” he says. Cancer treatments, coupled with the newer patented drugs, are prohibitively expensive for 98% of the patients, he says. A year’s breast cancer treatment, for example, costs INR 5-6 lakh.

India currently has 23 regional cancer care centres and plans are now afoot to add 30 more in the next four years.

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MeraMD.com launches revamped doctor & hospital recommendation service MeraMD.com, an online health portal, focused on providing relevant medical information to users, has relaunched its community driven doctor and hospital recommendation service. This service allows users to recommend a health service provider (doctor, hospital, clinic) to others in the community.

The major changes in new avatar of this service are: Registered Medical service providers are now informed whenever a recommendation is received for them.

• Negative/Offensive comments are now displayed to medical service providers for their comments, leading to a possibility of 1to-1 dialogue between the service provider and the user.

• Users are informed about the action taken on their comments.

Comments can be rejected, forwarded to medical service providers or made visible to community at the discretion of meraMD.com The new version of this service is expected to be more useful to the community. It is still a free service and there is still no registration required to add or view recommendations. Additionally, users can search for doctors, hospitals in their local area based on recommendations from the community.

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More integrated hospitals soon: govt The federal government of India is planning to construct as many as 8 integrated health facilities across the country in the next few years. They will be modeled after the All India Institute of Medical Sciences at New Delhi.

The project is considered extremely ambitious, even unrealistic, given that even the six announced two years ago are yet to get off the boards. The proposal for setting up AIIMS-like institutions was first made in 2003, but finally given the cabinet nod three years later.

Patna, Raipur, Bhopal, Bhubaneswar, Jodhpur and Rishikesh, all in the more backward pockets were to have such sophisticated hospitals. The idea was to take state-of-the-art healthcare to regions that have failed to make much of a progress since Independence.

More hospitals for Kolkata Dhoot Developers Pvt. Ltd. has tied up with Columbia Asia to set up seven hospitals in the east, three of them in Kolkata.

“Each hospital will have around 200 beds and entail an investment of INR 40 crore. The charges will start from as low as INR 1,200 a day,” said Pawan Dhoot, managing director of the Kolkata-based company.

Trusts, societies may be kept out of hospital PPPs The government’s proposed scheme to invite private players to run hospitals and schools in partnership with it might not be open to the most preferred business vehicles in these sectors - trusts and societies.

The preferred partner would be a registered company. The essential reason is the scalability of a company, a quality that trusts lack.

Greater transparency in reporting financial performance is another reason to prefer companies. While the government is yet to work out the regulatory and legal changes that would have to be made to operationalise its public-private-partnership (PPP) plans for health and education, it contains within it the possibility of India’s education system shedding its current hypocrisy that commercial motives play no role in education. The PPP model would work by allowing companies to generate returns, if not directly from the running of the educational institution in question but by utilising some under-utilised asset of the educational institution.

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Columbia Asia specialises in healthcare and has allready set up several speciality hospitals across the continent. It has tied up with DLF for establishing a presence in India, but for its hospital project, it has chosen Dhoot Developers as its partners.

The other cities where the hospitals will come up include Ranchi, Bhubaneswar and Guwahati. “If a patient does not get proper treatment at a particular Columbia Asia hospital, he or she can be easily transferred to any other hospital in the country and, if required, to an overseas facility” Dhoot said.

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Report: Manipal hospital most patient-friendly The country’s first customer (patient) satisfaction study of hospitals across the country has revealed that the silicon city’s Manipal Super-specialty Hospital is the best. The premier All India Institute of Medical Services ranks fourth in the overall rating. The study was conducted by Voluntary Organisation in the Interest of Consumer Education (VOICE) in collaboration with Indian Council for Medical Research (ICMR).

For instance, the famous Lilavati Hospital of Mumbai, known for treating film stars is at the 15th position. The least recommended was the Apollo Gleneagles.

Unfortunately the study has found that not many hospitals are transparent. A little over 30% feel that the super-specialty hospitals are transparent as far as their financial dealings are concerned. Wockhardt Hospital of Mumbai was found to be transparent as all its patients said they saw the charges displayed clearly. As for the charges for various services, Wockhardt Superspecialty hospital of Bangalore led the way with 91% of its patients reporting that their charges were higher than that of other hospitals.

The AIIMS seems to be the most problem- ridden, as one out of every four reported having faced a problem. The study also focused on other facilities for the disabled, provision for parking and waste disposal systems.

Medical parks across the country - Ramadoss Medical parks will soon be built across the country for makers of diagnostic equipment to set up plants thereby reducing manufacturing costs and making it easily available, announced Union Health Minister Anbumani Ramadoss recently.

“Diagnostic equipment will be manufactured at these parks all across the country,” Ramadoss said on the sidelines of a CII conference on diabetes and obesity.

This will help reduce the cost of diagnostic equipment most of which is presently made abroad, he said.

The manufacturers of these products had also given a commitment to ensure prices stayed low, the Minister said.

Speaking on the increasing cost of healthcare, Ramadoss said the country already had among the lowest cost of pharmaceuticals and medical treatment in the world but would like to see it reduced further. “Health insurance which will be addressed in a very big way and is expected to take care of the problems associated with individual health spending,” he said.

Meditec Clinika 2008 1st - 3rd March 2008, Chennai

Meditec Clinika 2008, one of the largest medical equipment and technology trade fairs in South India was held recently between 1st to 3rd March 2008 at Chennai, and attracted world-class exhibitors and professional visitors under one roof in large numbers.

132 Exhibitors from India, USA, Germany, Taiwan and Pakistan showcased a comprehensive range of world-class products to over 2500 serious business visitors from India, UK, Canada, Malaysia, Taiwan, Srilanka, Nigeria and Pakistan. The profile of the visitors distinguished Meditec Clinika from other medical fairs, comprising of Medical Doctors, Hospital technicians, Managers & HODs, Nursing Homes, Healthcare Services, Medical Professionals, Diagnostic centers, Trade Dealers and distributors, manufacturing executives etc. Doctors, hospital administrators and medical equipment distributors in the country are sure to benefit from the success of this fair, since the entire range of medical equipment, devices and services was on display under one roof.

Meditec Clinika 2009 will once again provide the largest platform for the medical equipment and technology industry, to congregate under one roof.

This time however, the scope of Meditec Clinika would be further extended by the inclusion of Bio Meditec 2009 an exhibition showcasing the Application of Biotechnology in Healthcare. This umbrella event would now also draw international decision makers from the key sectors of Medical Biotechnology. Meditec Clinika 2009 is scheduled from 21st to 23rd February 2009 at HITEX Exhibition Center, Hyderabad, India.

May 2008

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in conversation

Achieving Integration Apollo Hospitals Dhaka What has been your overall strategy in adoption of IT for gaining operational and business efficiency at Apollo Dhaka?

Established in 2005, Apollo Hospitals Dhaka is a recognised provider of premium private healthcare in Bangladesh, and the first-of-its-kind in the country that redefines healthcare delivery system with a paper-less environment by introducing a robust IT system and infrastructure. Since inception, our IT system has created an environment that allows our doctors to practice medicine in the best way possible and create a good relationship with their patients through information sharing. We wanted clinical information at the fingertips of our doctors to enable quick diagnosis. Like most world-class hospitals, Apollo Hospitals Dhaka is also focused on maximizing patient safety, quality and value with the adoption of IT. We focused first on the fundamental technology needs in our hospitals - EMR [electronic medical records], CPOE [computerized physician order entry] and BPOC [bar-coded point of care] interface solutions. To accomplish the goal of unique identification of our patients at the time of registration, we opted for a combination of bar code and RFID [radio frequency identification] technology so that we can create electronic records that ensure the right patients received the right medication at the right time.

To manage safety and improve quality, the system ensures that all clinicians have the information they need to support optimal decisions and actions at every point of the medication cycle.

A.K.M. Nazrul Haider, General Manager - IT Apollo Hospitals Dhaka, Bangladesh

solely using Microsoft 2003 server and Microsoft SQL2000 database platform technology. The database server is dual HP DL380 Clustered with Fiber Channel storage in the form of HP MSA1000. The hospital’s network infrastructure was designed to cater to the high-volume data/image traffics with fiber-optic backbone and structured cabling with state-of-the-art Cisco switches under certification from Systimax Engineers.

Most of the Lab equipment are connected and interfaced with the HIS system and the data flows communicate with the host without manual interventions. We have also introduced RFID technology to track the doctors and staff, and this will soon exPlease elaborate on some of the technological and clinical tend to track patient movement and mobile life-support equipinnovations at Apollo Dhaka. ment on a real time basis to increase operational efficiency and We had started operations by implementing the Hospitals improve quality of patient care delivery.

Information System (HIS) from Akhil System Pvt. Ltd, based in New Delhi, India, a professional software company specialising Apollo Dhaka has been a pioneer in developing a fully IT in delivering total health care IT solutions for hospitals. The integrated hospital in Bangladesh (near paperless environsystem was developed over decades under supervision of prac- ment). How have these and other innovations enhanced the ticing medical professionals and domain experts with a spe- hospital’s workflow?

We have been using IT system in the form of HIS across cialised IT team, who have successfully computerised a large number of hospitals with a wide range of functionalities. Dur- various functions to enhance patient safety and reduce the ing implementation period, the system went through a variety risk of medical errors through seamless integration of clinical of changes to accommodate the unique nature of our health information. It helped us introduce a paper-less and film-less care delivery system, especially in the area of high volume Out- workflow for achieving error-free healthcare environment. The patients and management of Pharmacy, single dose concepts HIS system network will soon be expanded for supporting teleand use of generic drug names. The system is an integrated health by creating a connected community encompassing the enterprise software solution that integrates virtually every de- patients, families and clinicians for improved care, greater conpartment. It is unique in the fact that it is an integrated solution venience and less expense for all. Medical records including that combines both healthcare (front-office) and back-office the radiological images of all registered and referral patients are operation in a single database, which works virtually 24 hours archived in an optical jukebox for future retrieval. a day throughout the year.

By implementing PACS (Picture Archive and Communication The HIS system architecture was based on a single-server System), we have achieved an efficient digital workflow, which and single-database model containing the entire facility’s data, enhances radiologists’ productivity because current and prior 22

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imaging studies are available instantly for side-by-side viewing.

In addition to efficient review, storage, and distribution of images, a digital imaging and information platform enables new clinical tools such as computer-aided detection to be efficiently employed. This can enhance efficiency and accuracy, especially in screening efforts.

What is your average annual IT spend? What areas of technology do you plan to invest more in near future?

The biggest obstacle in healthcare’s attempts to fully embrace IT is it’s funding. Healthcare organisations have traditionally under-invested in information technology, and the reason is obvious. Investment focus goes to direct revenue generation equipment than support services. The ROI for some of the projects is questionable when you start to look at soft benefits like enhanced patient safety and increased clinician productivity. The healthcare industry is at least a decade behind other information-intensive industries, like the airline industry, retail and banking. In Asian countries, the healthcare industry invests some 1 to 2% of revenues in IT as opposed to 5% in the banking industries. Enterprise level IT projects require a sizable capital outlay and a multi-year commitment from the organisation. Apollo Hospitals Dhaka is a fairly new establishment and the investment on IT systems is on the higher side as compared to similar but older setups.

We are currently focusing on disparate systems that need to interface with the main HIS system. To cope with the projected rise in patient volumes, we are looking for an exclusive storage system in the form of SAN, this will not only increase the capacity of the progressive storage but also efficient handling of data to reduce the response time of a vastly integrated system.

Tele-Medicine is the other priority area where our focus will be to reach remote patients and linking patients and clinicians to create a connected continuum of care that leads to better quality of life for patients at minimal cost.

Who are some of your major technology vendors for different application areas? What is your expectation from the vendors in terms of customer support and future offerings?

We do not interact with many vendors for our different application needs. We like to depend on a single vendor for all of our software and hardware needs and support. As far as hardware is concerned, we have HP products catering to our computing needs and CISCO products for our networking equipment and support. We depend on Akhil Systems for HIS, and also expect HIS as a central point for all peripheral interfaces irrespective of 3rd party integrators and hence HIS vendor should have collaborative tie ups with all those integrators and peripheral suppliers to support their clients as single point of contact.

Interoperability is an issue confronting all aspects of healthcare. Even in traditional modes of healthcare, when we consider electronic health records, we have problems in terms of sharing the patient information across the various provider silos and making them interoperable. It is no longer just the electronic health record that needs to be interoperable; it’s the entire system incorporating various patient monitoring devices that needs to talk to each other. In this scenario, there is a May 2008

pressing need to bridge all islands of information and decision support tools to aid clinicians so they can seamlessly traverse these independent silos of information. Vendors of all healthcare system providers have to form an alliance to set up standards for creating interoperability between devices operating in the healthcare space. Until these standards are in place, harmonized and adopted universally we will bear the burden of the lack of seamless information flow.

How have you handled issues of technology awareness among doctors and clinicians? What is the level of technology interface for doctors and nursing staff in your care delivery process?

One of the biggest challenges healthcare organisation face is providing appropriate incentives to adopt new technologies.

Hospitals need to implement systems that are easy to use, integrate with clinician daily workflow easily, save clinician time and improve the quality of care. Younger clinicians are technology savvy. They grew up with the Internet and video games.

Older clinicians, on the other hand, are comfortable with the paper-based systems they have been using for the past many years.

We introduced “PACT” [Physician Adaptation with Computer Technology] program which consists of hands-on training with the HIS system which they use on a daily basis in their OPD and other clinical activities. Every new doctor and employee of Apollo has to attend an intensive 3 day IT adaptation training along with HIS operation where they are provided with an overview of the system and specific modules s/he has to use on their job. In addition to this, there are a series of IT-refresher training programs organised for all stakeholders through out the year.

All our clinicians are familiar with the HIS system they use on a day-to-day basis. The OPD system is clinician-centric and integrated with pharmacy and investigation modules. Doctors use the system at the point of service and select the medicines and investigations required through a drop-down menu; the system provides a powerful search engine for locating any type of information related to patients. Currently, we do not have any plan for remote patient monitoring (RPM); but we see a potential benefit in the future to provide this service, as the increased access of mobile phones in remote and rural areas increases.

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Watch out for August 2008 issue for an exclusive survey on IT usage and automation in Indian Hospitals.

For advertising opportunity in this issue, get in touch with - Arpan (arpan@ehealthonline.org, 9911960753)

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POWER HOSPITAL

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Dhaka

Apollo Hospitals Dhaka is a colossal 400,000 square feet structure on 4 acres of land. It houses a 450-bed super speciality facility delivering advanced tertiary care of international standards to the people of Bangladesh. The hospital is a recognised provider of premium private healthcare in Bangladesh, and the first-of-its-kind in the country redefining healthcare delivery system in a paper-less environment by introducing a robust IT system and infrastructure.

The hospital has cutting-edge facilities like advanced cardiology, cardiac surgery, neurology, neuro-surgery, urology, uro-surgery, endocrinology, gastroenterology, critical care, orthopaedics, and other secondary cares, along with fully equipped surgery units for all of them. The hospital provides a complete range of the latest diagnostic, medical, and surgical facilities for the care of its patients. The hospital has all the characteristics of a world-class facility with a wide range of services and specialists, equipment, technology, ambience and service quality. www.ehealthonline.org

Apollo Hospitals Dhaka is an example of the perfect synergy of medical technology and advances in IT through paperless medical records. The skilled nurses, technologists and administrators, aided by state-of-the-art equipment, provide a congenial infrastructure for the medical professional in providing healthcare of international standards. The strategic objective of the facility was to achieve integration and interoperability through a system that can satisfy the requirements of clinicians and at the same time, satisfy all back office users with functionality that includes billing, material management and other ancillary departments’ needs. The hospital is now concentrating on introducing tele-medicine, to have a pool of health care professionals from across the world.

As part of Apollo’s network of 37 hospitals and 6,400 attached beds, the Dhaka set-up has 450 beds attended to by 250 doctors and 450 nurses. So as not to deprive the lower income bracket of the population from the world class health care facility, 10% of the total beds will be reserved for poor patients, who will receive care either free of cost or at a token fee. Apollo Hospital Dhaka also operates as a referral hospital for high volume of cases from other hospitals and nursing homes including government hospitals, which might not have the same quality of labs or specialised consultants.

The hospital has also undertaken several quality initiatives such as the Apollo Clinical Excellence (ACE), Division of Innovation and Clinical Excellence (DICE) and in the areas of Infection Control Protocols, Disaster Management, Golden Hour Emergency Management, Medical Ethics and Telemedicine. Under preventive care, the Master Health Check Clinic of Apollo offers a number of health screening packages customized to patients’ needs for different times in their life.

Each package offers a carefully selected panel of tests chosen to screen for the presence of disease or help in identifying the cause of ongoing minor ailments. Health screening serves as

May 2008

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The Hospitals Information System (HIS) from Akhil System Pvt. Ltd, New Delhi, India system is based on a single-server and single-database model containing the entire facility’s data, solely using Microsoft 2003 server and Microsoft SQL2000 database platform technology. The database server is dual HP DL380 Clustered with Fiber Channel storage in the form of HP MSA1000. The hospital’s network infrastructure is designed to cater to the high-volume data/image traffics with fiber-optic backbone and structured cabling with state-of-the-art Cisco switches under certification from Systimax Engineers.

HP products cater to the hospital’s hardware needs.

CISCO products for their networking equipment and support needs.

For EMR there is a combination of bar code and RFID [radio frequency identification] technology.

Most of the Lab equipment are connected with the HIS system.

They have introduced RFID technology to track the doctors and staff; it will soon extend to track patient movement and mobile life-support equipment on a real time basis.

PACT [Physician Adaptation with Computer Technology] program provides hands-on training for the HIS system to every new doctor and employee of Apollo.

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an important part of a personal medical record and is useful for future reference.

The Apollo Neuroscience Institute within the hospital premises has a Stroke Centre, which is a dedicated 24-hour centre equipped with: • 10 beds including high dependency units (step down) • In house Neuro-Imaging facilities (1.5 Tesla MRI machine, 64 slice CT scan machine and latest ultrasound machine) In its quest to provide cutting edge cardiac care, Apollo Hospitals Dhaka introduced the path-breaking Insta Heart Scan, for the first time in Bangladesh. The very latest in diagnostic

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equipment, this state-of-the-art 64-Slice CT Angio Scan gives the most accurate picture of the heart. The scanner, which has four times as many detectors as a typical multi-detector CT scanner, combines unrivalled image quality with remarkable speed. It can produce detailed pictures of any organ in a few seconds and provide sharp, clear, 3-dimensional images, including 3-D views of the blood vessels, in an instant. At that rate, a 64-slice scanner can gather a high-resolution image of a heart, brain or a pair of lungs in about five seconds. A scan of the whole body, (in search of a blood clot, for example, that has become a source of emboli) takes about 30 seconds.

With 60 different departments, the Apollo Hospital Dhaka relieves the tension of another pressing problem in health care – diagnostics. Equipped with a self-sufficient laboratory, the hospital has Biochemistry, Haematology, Microbiology, Histopathology, Transplantation Immunology, Transfusion Medicine and Clinical Pathology facilities.

Over 90% of the patients don’t have any health insurance coverage and have to incur out-of-pocket payments. This forces the hospital to become cost effective both in terms of process re-engineering to achieve high productivity / efficiency, instantly capture cost at the point of service and to develop a consumer-centric focus on billing to improve patient satisfaction. A recent survey on service delivery under the Health and Population Sector Programme shows that 60% of health service users visit unqualified medical practitioners and a huge amount of foreign currency is spent for treatment of Bangladeshis abroad. In such a scenario, Apollo Hospital Dhaka is a beacon of hope. www.ehealthonline.org

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product profile

t3000 Laptop Ultrasound System

Trivitron Medical Systems, one of the top 10 Medical Technology companies in India joins hands with Terason to introduce - t3000 Laptop Ultrasound System.

Trivitron now makes it easy and comfortable for doctors and patients alike; to set new standards for imaging performance, ease of use, size, and cost.

The system runs on a standard Apple Mackintosh laptop computer, which is integrated with Treason’s Fusion Processor, a unique, custom-designed, integrated ultrasound chip set. The familiar Windows graphical user interface makes the system intuitive and easy to use. The t3000 is designed for general, vascular, and breast imaging, interventional radiology, image-guided intervention, endocrinology, laparoscopic, neuro-sonography and nephrology. The significance of the system lies in its best-in-class image quality and function that are comparable to the high-end cart-based ultrasound systems.

The flexible design allows the system to be instantly converted from a normal Laptop to a cart-based Ultrasound system. Doctors will not have to go through the cumbersome process of carrying a portable ultrasound machine

alongside a laptop. The t3000 is the world’s only ultrasound system powered by an off-the-shelf commercial PC. Weighing about 8 pound, the t3000 can operate on batteries for more than two hours. The system also features: • Modern scanner design with 15-inch TFT monitors with XGA image quality • Electrocardiogram & DVR Capability • Built- in Hard Drive & J2K Board for efficient video clip recordings • Imaging modes include 2-D, tissue harmonics, M mode, color Doppler, spectral Doppler (CW/PW), and power Doppler The Teratech Architecture enables simple and frequent software and Laptop up-gradation. An extended warranty program makes it easy and inexpensive to keep your hardware up to date. This includes latest advances in PC processing, communications, data storage and display technologies. An investment (price on request) in the Terason t3000 Ultrasound System will maintain its value for years to come.

Rotor Gene 6000 (6 Channel multiplexing system)

The ROTOR GENE 6000 is a multi-filter system that can detect all available real-time chemistries including Sybr-Green, dual-labelled and MGB probes, FRET and Molecular Beacons. Most DNA amplification enzymes/ buffers can be used on this system to generate Quantitation/Melt data.

This system also provides high-sensitive readings without the need for specialized reaction vessels (that is, optical clear caps). Each unit comes with the flexibility of an interchangeable rotor system to allow for the throughput needs of the day. The provided standards are a 36 well rotor (0.2ml thin walled reaction vessels) and 72 well high throughput rotor (0.1ml strip tubes). The rotors are interchangeable for easy transition from moderate to high throughput applications. The unit is designed to take data at high speed. All 72 samples can be detected in one revolution, equivalent to 0.15 seconds.

Due to the optic and thermal design of the system, there is no need to use an internal passive ROX reference. Even without a reference, the standard devia-

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tion between replicates is typically 0.05. The system uses a Photo-Multiplier Tube (PMT) that can detect a single Photon of light. This gives excellent sensitivity even when amplifying a single Copy of DNA. After amplification, the samples are heated and the change in fluorescent energy is monitored to generate a melt curve. The differential of this curve reveals the melting temperature for each amplicon and allows automatic calling of the genotype. There is no need to use expensive proprietary dyes to minimize cross talk for multiplex applications.

The system uses a 16-bit analog to digital converter, which has a broad dynamic range. This results in linear quantitation over a wide range of sample concentrations, typically 12 orders of magnitude. Simple optic design, together with ultimate temperature uniformity (due to centrifugal design) results in a highly accurate and reproducible system. This can be best demonstrated when looking at a 2-fold dilution series where each sample concentration is run in triplicate.

No internal passive ROX reference is required to generate this data.

The ROTOR GENE 6000 is the only real-time system available that offers an automated temperature calibration feature. A report is automatically generated which is e-mailed to the service support centre for validation. If temperature calibration is required, a file is returned that automatically re-calibrates the unit.

Regular temperature checks of the system can be performed by anyone in the laboratory using this simple method. This is the only real-time system that can be validated remotely.

Fabius plus anaesthetic device

Lübeck – The new Fabius plus anesthetic device completes the Fabius family. Dräger Medical AG & Co. KG, a subsidiary of Drägerwerk AG & Co. KGaA, phased out Fabius CE, which has been in the market for over a decade. The modular design of the Fabius plus supports its use both in simple clinical environments and in highly sophisticated technical ones – be it in the short phase of initial anesthesia, during different operations or in specialized out patient centres.

In line with current customer requirements, the GUI has been modified to match the general Dräger standard. The operating philosophy of the Fabius family is now uniform. An optional color monitor is available, enabling the user to differentiate alarm levels by color. Other ventilation modes, such as pressure-controlled and pressure-supported respiration and SIMV/PS, are also available as options. The Fabius plus with the Dräger E-Vent® piston ventilator, delivers proven ventilation quality as standard, supporting its use in various patient groups and in pediatrics. As a result of the E-Vent technology, driving gas is no longer required, offering potential savings from reduced consumption of medical gases. In addition, the user also has the option to work without nitrous oxide.

May 2008

The Fabius plus also includes the trusted “COSY”(Compact Breathing System) compact breathing system, which is part of the complete Fabius family. This breathing system with fresh gas decoupling avoids the influence of the set tidal volume if the fresh gas flow changes, thus continuously ensuring the patient’s set ventilation parameters.

Fabius plus has a standard trolley that includes a writing surface and three drawers providing ample storage. A wall model will be offered in future. The trolley construction permits individual positioning of patient monitors to the left, right, or on top of the unit. Today the Fabius plus can be combined with the Infinity® Delta, Infinity® Delta XL, Infinity® Gamma XXL, and Infinity® Vista XL monitors, and in future will be compatible with other Infinity® monitoring solutions. Hereby the connection to patient data management systems is given. The product is thus a trueand-true, practical, entry-level device that can also be adapted to future technical and clinical requirements. In addition to the Primus and the Zeus® high-end anaesthetic system, the Fabius plus rounds off the anesthesia portfolio of Dräger Medical.

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INDIA

Opportunities for Digital India

2008

Technology Infrastructure for Public Health Transformation Challenges, Success Stories & Solutions IT@Healthcare Delivery – improving clinical outcomes, levaraging business performance Connected Healthcare – network infrastructure, information access & remote care delivery EMR Best Practices & Information Sharing for Integrated Healthcare Emerging Frontiers & Best Practices in Medical Imaging, RIS & PACS Innovations in Medical Electronics & Bio-Medical Engineering Presenting Publication

National Accreditation Partner

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APPLICATIONS

ICT takes on the Herculean task of Cardiac Care through Innovations

Aniruddha Nene Director and Principal Consultant - Imaging 21st Century Health Management Solutions Pvt Ltd

If there is one growth indicator in India rising faster than the stock market Sensex in India, it is the ballistic rise in chronic lifestyle diseases. Amongst these killer diseases, cardiac diseases have taken the leading position. More than 8% of India’s population i.e. a whopping 80 million are estimated to suffer from cardiac diseases. Genetic predisposition compounded by rapid urbanisation, economic prosperity, changes in diet and lifestyle amongst Indians is expected to further aggravate this situation.

It is a well-known fact that there is a major shortage of healthcare facilities, clinical skills and other resources to contain this national level crisis. New innovative treatments such as genetic and stem cell therapy are still in their infancy. Prevention and Chronic Disease Management programs to fight these diseases have a long way to go before they can make any impact - hence we have to depend on conventional cardiac care treatment.

If we just focus on ‘coronary vascular diseases,’ which cause a heart attack, the figures will speak for themselves.

Angioplasty is a minimally invasive procedure that clears the cholesterol block in the arteries supplying blood to the heart, while open heart surgery (CABG or OHS) bypasses the block by grafting some other healthy blood vessel. The estimated number of angioplasties per year is set to cross 50,000 whereas the figures for CABG are 32000+ in India.

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Challenges It is obvious from the above that, it is not possible to meet the humongous demand-supply gap of over 95% of the cases going untreated, just by increasing the number of cardiac hospitals, cardiologists and cardiac surgeons or by simply working longer hours. Add to this, the factors of affordability and availability of these expensive surgeries.

New hospitals with cardiac speciality are sprouting up all over the country. Skilled surgeons and cardiologists are burning out trying to cope up with the ever-burgeoning patient load. This though, is not enough to meet the huge gap between demand and supply.

Information & Communication Technologies (ICT) have transformed our lives in every conceivable area from banking to stock markets and from travel to entertainment, not to mention mobile communication. What is stopping ICT technologies from being used extensively in sophisticated knowledgebased clinical applications like Laboratory Systems, Imaging Systems, Electronic Medical Records and Telemedicine?

Important Issues to be addressed by ICT solutions for clinical applications: • They must deliver critical information in a manner that simplifies the job of overworked clinicians and paramedics. This is possible only if these applications are designed and validated by healthcare domain experts and not IT experts.

• They must be first implemented, incorporating innovative and improved processes by champions willing to change conventional mindsets. This is a big change management exercise and unless this is handled effectively, no improvement is possible.

• They must be a seamlessly integrated with all the other relevant systems like HIS and not behave like islands of super-efficiency.

• They must be cost effective and improve quality of patient care. www.ehealthonline.org

• •

They must help to improve the productivity of scarce & expensive resources like Cathlabs, Cardiac OTs and cardiac surgeons and cardiologists.

To illustrate these facts it will be appropriate to study the impact of innovative use of ICT in Cardiology Information Systems with Advanced Imaging & iEMR. This clinical information system touches all information related to the patient and the episode. Demographics and administrative data is captured mostly in the hospital information system and is linked to the clinical system of CIS. Specific clinical history and subsequent OP encounter details such as examination, medication, prescription, diagnostics etc. get appended in the course of time. Finally, inpatient treatment details such as coronary intervention / surgery is added to the patient record.

Benefits It is a reliable and structured way to store and retrieve clinical and patient information in a structured manner in a very short time. Faster data access can reduce wait and search time, which is an obstacle in quality healthcare in India. Early diagnosis with fast and accurate treatment can save a huge cost that our country cannot afford today. Needless to talk of benefits when this saves lives.

It is a powerful tool to analyze the information for Education, Academics, Quality initiatives, Research and Performance measurement.

May 2008

Indians suffering form cardiac diseases: 8 crore Newborns with cardiac diseases: 2.25lacs/yr Average age of Indians suffering heart attacks: 45 years Average age of people suffering heart attacks in Western countries: 65 years Heart attacks in those under 40 years: 25%

It is integrated with administrative processes to improve overall patient management and satisfaction.

Innovation is the Key All these benefits are not possible without innovative use of technology, which support Commonsensical requirements.

Let us see how all these points apply to applications in a typi-

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cal cardiac care. Three pillars of innovative use of technology giography images. The imaging viewers need to be specially on which such a system rests: designed from integrated access to address holistic healthcare.

Build clinical intelligence into the system. Archival without planning storage and addressing efficient retrieval will create Flexible EMR engine Electronic Medical Records present an unprecedented chal- more problems that it aims to resolve. If one has to include the imaging records, clinically intelligent storage needs to be lenge to the software professional.

On the one hand is the need to provide a system that is planned. rule driven, structured and with a need for outputs and Management Information System that is fairly standardised, while Intelligent storage policies It is easy to understand clinically important imaging data is on the other hand is the need for flexibility dictated by the esoteric body of knowledge and a structure that does not fit very little as compared to the total data produced. For examany precise standard. All this at the lowest possible prices! It ple, a normal chest X-ray has very limited or no clinical value therefore makes no sense to develop and design a system that after 30 days from the interpretation. A chest X-ray of the fits the requirements of each doctor separately and individu- patient in cardiac ICU if normal loses value may be in 2 days.

On the other hand a chest X-ray of a VIP or medico-legal case, ally.

The way out of this complicated problem is to have an EMR even if normal, may have to be preserved for long.

The system has to incorporate clinical intelligence to plan engine which can empower the doctor to define his own inputs with validations and outputs and statistical reports. The the lifespan of the imaging data. In fact, without such intelEMR engine design therefore puts into the hands of the end- ligent storage planning, 2D echo tests are often repeated in user a powerful tool, which he can use to customize the input most of the hospitals. Just before a procedure (Angioplasty or mechanisms, the output formats and a methodology to be Surgery) review of 2D echo is highly necessary. 2D echo test able to extract information into standardised reports. is always done on a patient during OPD before the procedure Such engines should integrate with popularly used technol- takes place and it is just 2 -3 months old data. Unfortunately, ogies such as software like Microsoft Word, Microsoft Excel, lack of intelligent storage results in repeated 2D echo test. It that require little or no training, have clinical standards based has been observed that in a 500+ bedded cardiac super speon texts such as Lowe and Bailey Surgical Notes etc. So that, cialty hospital this could mean saving of up to 3 hours of a while the users have an option to choose, it should not be ‘a senior cardiologist and the machine for repeated procedure. start from scratch’ approach. It should also follow integrated health standards and talk to other systems through HL7 mes- IEMR sages.

Clinical intelligence can be extended further to extract clinically important portion from the imaging data. This auInnovative approach to image distribution tomatically highlights pathology for the consultants viewing Conventional approach of PACS will not work in the Indian summary. It also reduces the size of the data without losing context. In case of cardiac diagnostics and procedures, we any clinical information. Thus, iEMR reduces traffic on the typically do not deal with films. Naturally, we cannot talk of data network and improves efficiency! A huge Angio loop of benefits of film-less environment from a radiology perspec- 250MB containing only one block reduces to 1MB as the cartive. Most of the viewers that are available as satellite console, diologist can store only the details about block and ignore provided by modality vendors, confine the focus on specific other details which has little or no clinical significance. modalities where commercial interest lies and do not easily integrate the information as needed ideally by the clinicians Conclusion The bottom line is that appropriate use of ICT technology across the hospital.

A cardiologist has to deal with diversified clinical data such can dramatically improve patient management and enhance as OP consultation, ECG strips, 2D echo / angiography loops, the efficiency of utilization of the scarce / expensive resources procedure plan etc. Clinically, every data is important as it through a properly structured Cardiology Information System collectively impacts the decision making. However, the re- that integrates with the Imaging Electronic Medical Records cords are all scattered. OP consultations are usually handwrit- system.

All this is meaningless if it is not made affordable for the ten paper records and quite often, no system can interpret or classify the contents. ECG strips are added to paper records. masses. While the innovations typically are aimed to bring 2D echo loops most of the time are trapped in the machine down the cost of the solution, it is important for the healthitself and are rarely available as records in the form of video- care sector in India to realise that the outlook towards ICT cassette or a CD. Angiography loops are typically provided in also needs reforms. We do not have to burden the treasury by what is called as DICOM CD, which needs its own specific putting 4-6% of the top-line on ICT budgeting like developed viewer software. No one can blame a cardiologist for interpre- countries do, but we must take a call on at least allocating a tation based on limited data available in the middle of a huge modest 2-3% for ICT in India. The healthcare sector is at the OP wait list. point of exponential growth as discussed in most of the health All these details need to be digitized and united under one conclaves today, but this transformation rests on ICT. So lets roof to demolish barriers for communication. Advanced im- start looking at ICT as a strategic investment rather that an age archival that integrates ECG waveforms, 2D echo and an- overhead to mainstream healthcare.

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www.ehealthonline.org

INDIA Opportunities for Digital India

National Accreditation Partner

2008

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news review

BUSINESS

Pharma RFID market expected to hit US$ 1 trillion by 2020 The market for Radio Frequency Identification (RFID) applications in pharmaceuticals is conservatively estimated to reach US$ 600 million by 2012 with a compound annual growth rate of 60%, according to a new market research study.

A quarter of the major pharmaceutical companies are expected to implement large-scale RFID projects to reduce costs, improve inventory control, track clinical trials and manage samples, claim the authors of “RFID in Pharmaceutical Manufacturing”, a study by the market research firm Kalorama Information.

Kalorama notes that the total pharmaceutical market is expected to hit US$ 1 trillion by 2020, doubling from 2005 levels. The Food and Drug Administration and state governments are requiring additional product tracking to curb counterfeit drugs and improve patient safety and product integrity. As a result, RFID is positioned to be a top solution to help companies efficiently cope with the changing structure of the industry.

The adoption of RFID is being driven by two important factors: a huge drop in hardware prices (about 80% since 2000) and the promise of major cost-savings. The report states that as much as 40% of inventory can be managed more efficiently.

Siemens unveil new radiology solutions Siemens Healthcare unveiled a new portal of IT software for radiologists and other hospital personnel who work with imaging staff, known as the syngo Portal.

Siemens has developed three different strands of the system for radiologists, referring physicians and for senior executives. The solutions have been developed to offer role-based access to applications and information critical to their daily functions.

Syngo Portal Radiologist is intended to help radiologists with specific tasks, such as checking requests, reading images, signing report functions. It allows radiologists to organise their work according to the workflow step. It will include integrated intelligence, providing the user with access to the next logical application according to the workflow step he or she is carrying out. For referrals, Syngo Portal Referring Physician is also a role-based solution and supports the referring physician in communication with the radiology department. The portal enables physicians to schedule appointments directly from the ward or referring physician’s office.

Syngo Portal Executive is designed especially for executives in hospitals and clinics. The user interface can be individually customised to fit the requirements of the hospital or the radiology department - enabling proactive decision management and better strategic planning.

Panasonic introduces Toughbooks with Intel’s Menlow platform Panasonic introduced two new Toughbook models recently. These were a mobile clinical assistant (MCA) device purpose-built for the healthcare market and an extremely-rugged handheld ultra mobile PC (UMPC) for fielduse.

Both devices will use Intel’s Menlow platform based on its new low-power architecture - consisting of the Silverthorne processor and the Poulsbo chipset.

The new computing devices, which are currently under development, are aimed at healthcare, government, military and commercial applications.

Panasonic claims the MCA is the first of its type in the world to use the Menlow platform.

Designed for hand-held use, it is is a lightweight, spill-resistant, drop-tolerant and easily disinfected mobile device, that meets the highest demands for mobility and networking within an existing IT landscape. The MCA will allow wireless connection to hospital IT systems, giving mobile access to patient records and enhancing clinical workflow.

The UMPC is aimed at customers within the PDA/handheld market who have a high demand for extremelyrugged PCs. It will offer a combination of concept, technology and ergonomics designed to give computer and network access to field-based professionals. It is designed for those working in areas such as public safety, healthcare and construction.

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ICW to integrate PHRs with iPhone InterComponentWare (ICW) has announced plans to integrate the Apple iPhone and other smartphones with the Life Sensor personal health record to transmit vital emergency medical information to hospital staff.

Patients who have access to ICW’s web-based LifeSensor system can print out a personal emergency card with a one-time use personal identification number to carry in a wallet or purse. ICW says it is now in discussions to make the information available from the website - www.sos-lifesensor.com - in a format readable by smartphones.

An ICW spokesperson said “The goal of the Life Sensor personal health record is to provide medical history in an online format anytime, anywhere.”

The integration would only work in situations which were not time-sensitive, but if the patient was able to present their records to emergency staff, it would mean they could receive the right treatment immediately, ICW say.

“Many ambulance workers often concentrate on stabilising the patient during transport but they will call in the emergency information to the hospital so that the information about blood type, allergies and pre-existing conditions are ready and waiting when the patient arrives. Having the information immediately will make care for the patient swifter and ensure patient safety” the company said.

Changes in pharma CFOs roles: Ernst & Young survey A latest Ernst & Young survey of Chief financial officers (CFOs) in the Indian pharmaceutical sector underscores important changes in the role of the CFO and the finance function in driving the success of pharmaceutical companies. Respondents of the India CFO survey envisaged a change in their responsibilities, with an increased focus on serving as business partners and managing growth.

A key challenge in the next three years cited by 42% of all respondents was ‘ability to maintain and drive growth’. To address this challenge, 70% of MNC and one-third of IPC CFOs would like to increase time spent on business partnering - to be a proactive partner in decisions relating to value creation by way of strategy, governance and cost management.

48% overall respondents are seeking an enterprise wide cost reduction. CFOs in both groups cited bottom-line pressure as a key concern here (76% overall). 57% respondents believed supply chain as a focus area for cost reduction; however CFOs of India-headquartered pharmaceutical companies are more concerned about cutting costs in the supply chain (67%) compared to 44% of MNC CFOs.

Misys Healthcare to merge with Allscripts Misys, the UK-based IT software group, is to merge its healthcare division with smaller US rival, Allscripts to create a larger specialist provider of clinical software and services for the US primary or ambulatory healthcare market.

In a deal worth almost £500 million, Misys will combine Misys Healthcare with Allscripts to create Allscripts-Misys Healthcare Solutions Inc. Misys will have a 54% controlling stake in the new company, which will be listed on the Nasdaq. Although currently UK-based, the majority of Misys Healthcare’s customers are in the US market.

According to the two firms, the merger will combine Misys Healthcare’s strength in practice management software and Allscripts’ strength in electronic health records.

The number of physicians using electronic health records in the US is growing, with the market expected to grow to about US$ 5 billion by 2015. Under the terms of the deal Mike Lawrie will become Executive Chairman of Allscripts-Misys and retain his role as CEO of Misys and Glen Tullman, CEO of Allscripts, will become CEO of Allscripts-Misys. Allscripts is headquartered in Chicago and distributes medications to 40,000 physicians in the US and more than 700 hospitals.

May 2008

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Microsoft renames its enterprise health care software The new Amalga brand is now the umbrella name for all Microsoft enterprise health care industry software, including products formerly known as Azyxxi and Hospital 2000, which were products Microsoft acquired. Microsoft’s Amalga brand offering spans clinical, operational and financial functions in health care. In addition to its Amalga product line for hospitals and other health care providers, Microsoft entered the consumer health care market with HealthVault, a platform that provides free web-based health-related search and personal health record tools. Amalga helps health care providers access information to make better clinical decisions.

In addition to Microsoft Amalga, another key product under the new Amalga banner is the former Hospital 2000, now renamed Microsoft Amalga Hospital Information System. This integrated health information system is built around an electronic medical record system, and includes software for hospital labs, pharmacies, radiology, pathology, financial accounting, materials management, human resources, and bed management. Microsoft is primarily targeting this software in emerging global markets, such as India and Brazil.

iSOFT enters agreement with Sentillion IBA Health Group company iSOFT has signed an agreement with US-based Sentillion to become its first healthcare channel partner in Europe for its single sign-on (SSO), context management, and user provisioning solutions.

The move coincides with the launch of Sentillion’s UK Channel Partner Program and enables iSOFT to become the first partner to offer its customers the market-leading Vergence SSO/context management suite and Sentillion’s next-generation SSO solution, expreSSO™, which are all developed exclusively for healthcare.

With Sentillion’s SSO/context management solutions, users can quickly authenticate and switch between iSOFT and other clinical applications while retaining patient context. The software also provides fast access and added security and is scalable so it can be installed on a departmental or enterprise-wide basis.

Sentillion’s applications are already proven in the UK at Great Ormond Street Hospital, Portsmouth Hospitals NHS Trust, and City Hospital Sunderland, and proven worldwide at another 560 hospitals.

The affordable, ‘plug-and-go’ expreSSO supports NHS Smartcards to swiftly authenticate to local and national applications. It also speeds the implementation of a trust-wide single sign-on solution. With expreSSO, Sentillion has streamlined the once complex process of introducing single sign-on solutions through innovative technology reducing implementation times to days.

Suven Life ties up with US-based Eli Lilly Pharmaceutical firm Suven Life Sciences has signed an agreement with US-based Eli Lilly to collaborate on the pre-clinical research of molecules used in the treatment of Central Nervous System(CNS) disorders.

Suven will receive research funding as well as potential discovery and development payments of up to US$ 23 million per candidate plus royalties on net sales of products that may be commercialised from the collaboration. Earlier in 2006, the company had signed a similar agreement with the US-based pharmaceutical firm for CNS disorder.

Under the agreement, Suven was to receive payments from Lilly and also potentially downstream payments if the identified candidates are selected by Lilly for further pre-clinical research and development, the company had said.

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Voice Technologies wins £2m Scottish digital dictation contract Healthcare digital dictation and speech recognition integration experts Voice Technologies have been selected as the supplier for the National Framework for Scotland by National Services Scotland.

This means implementing these solutions has become significantly easier. Services available for the National Framework do not need to be tendered for, making procurement processes simpler and cheaper.

Voice Technologies were selected above numerous other providers because of their proven track record in deploying successful systems in NHS trusts across Scotland, developing innovative solutions, delivering tangible improvements through their commitment to customisation and extensive customer support.

Digital dictation and speech recognition can deliver significant savings and create efficiencies in healthcare. These technologies are helping medical teams to improve turnaround times, become more efficient, reduce costs and, as a consequence, get results to patients sooner.

This contract has a projected value of over £2 million, and competing against international firms to keep this contract in Scotland has assured us of one thing: that our innovative solutions will help bring about reductions in waiting times and helping patients to get their results sooner.”

Lifeline Group of Hospitals signs MoU with Zambian govt India’s Lifeline Group of Hospitals has signed an MoU with the Government of Zambia to set up a 100-bed medical facility at Lusaka, Zambia at an initial investment of INR 40 crore. Group Chairman Dr Rajkumar told reporters that Lifeline would also provide surgical expertise to Zambia and train medical personnel to equip them on the latest medical treatments and procedures.

As per the MoU, the Zambian Government would provide fiveacres of land and building for the proposed facility, which was expected to commence operations in nine months. He said the hospital would have a team of 300 medical personnel, of which 80% would be from the Lifeline team and the rest to be recruited locally. Besides providing treatment at an affordable fee, the Hospital would also offer 10% of major procedures free of cost, he added.

www.ehealthonline.org

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Parkway to expand in Malaysia Singapore’s Parkway Holdings Ltd., which both manages and has a stake in the Pantai Hospital Group, may buy rivals or grow existing hospitals to expand in Malaysia.

Parkway, a leading healthcare group in Asia owning a network of hospitals and medical centres around the region, also has two Gleneagles hospitals in Malaysia under its ambit.

In fact, Gleneagles Penang is building another hospital, to be completed in 2011, which will add 230 beds, Parkway said at the presentation of its 2007 financial results. Gleneagles Kuala Lumpur will add 30 beds, while Pantai Ayer Keroh will expand to accommodate more clinics. Pantai Batu Pahat will have more beds on its fifth floor.

Parkway, through its stake and management contract, currently operates eight Pantai Hospitals, Gleneagles Medical Centre, Penang, and Gleneagles Intan Kuala Lumpur. In the fourth quarter of 2006, Parkway restructured its interest in Pantai. Pantai ceased to be a subsidiary and became a joint-venture company.

Shalby Hospitals in INR 450 cr spread The tax holidays offered in the Union Budget for the healthcare sector has prompted Ahmedabad-based Shalby Hospitals to check into various newer destinations for setting up multi-speciality hospitals. Shalby has chalked out plans to add about 1,500 beds in the next five years for an estimated investment of INR 450 crore.

“As per the tax holidays offered in various tier 2 cities of India, we aim to enter Mehsana first followed by Nadiad and Surat.

These will be 150-200 bed hospitals,” said Vikram Shah, chairman of Shalby Hospitals. Shalby has set up a 200-bed multi-speciality hospital on the SG Highway with a built-up area of 1,80,000 sft.

The company aims to fund its expansion plans through debt. It has been registering a compound annual growth rate of 60 per cent.

Shalby has invested close to INR 100 crore in its facility on the SG Highway. “We have chalked out our growth plans and as of now do not intend to dilute our equity,” he added.

Apollo Hospitals to invest INR 100 mn in R&D wing Apollo Hospitals group will soon be branching out a separate R&D wing. The group aims to form a full circle in the healthcare segment by forming a separate R&D wing, which is expected to have collaborations with premier global research organizations including the US-based National Institutes of Health (NIH). The group will be setting aside about INR 100 million from its revenues, to be pumped into the R&D wing. Besides, the group will build up a team with scientists from the US and India to focus primarily on cardiac-related diseases initially.

The group has over nine centers of excellence and the centre for cardiology and cardio thoracic surgery, is claimed to be the largest cardiovascular groups in the world. The group is also planning to have collaborations with the US-based NIH and a decision towards this is expected soon.

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Mindray to acquire Datascope’s Patient Monitoring business

Mindray Medical International Ltd. has announced a definitive agreement to acquire Datascope Corp.’s patient monitoring business.

The company plans to continue Datascope’s existing branded product lines. The existing management team is anticipated to continue postclosing without major changes in addition to the rest of the patient monitoring division staff.

Referring to the agreement, Mr. Xu Hang, Chairman, Mindray, said, “Datascope customers should also benefit from the combined company’s expanded product lineup and enhanced ability to tailor product functionality for specific end-user requirements, and Mindray’s customers in the United States and Europe will enjoy the support of an established direct sales and service network.”

TietoEnator wins Swedish national electronic healthcare record contract with InterSystems InterSystems Corporation announced that the Swedish national electronic health record, known as the National Patient Overview (NPO) will be supplied

by TietoEnator using InterSystems HealthShare™ software. The contract is valued at approximately US$ 19 million for the first 5 years, with an option to extend for an additional 2 years.

The NPO is designed to enable the sharing of patient information between regional and local care providers in both the public and private sectors.

InterSystems HealthShare is a health information network platform that plays an important role in the project as the core software with which the NPO will be delivered. The solution should be ready for production within 12 months.

HealthShare is a comprehensive solution for aggregating and sharing clinical data across multiple organisations. This enables the creation of a summary view of a patient’s medical record on a regional or national basis. It has the flexibility to support a variety of architectures and includes a rapid development and customisation environment. The healthcare market is characterised by valuable existing systems that medical professionals are accustomed to using. HealthShare allows customers to retain these systems and transform them into connected regional or national solutions.

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EXPERT CORNER

Connected Healthcare Concept and Feasibility

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he Indian healthcare industry currently estimated at around US$ 34 billion is growing dynamically.

In this growth, the private sector is taking the lead with more than 70% share of the market. The industry is currently going through a transition phase where on the one side there is a dearth in the number of facilities to serve the population adequately and on the other side, there is higher demand for quality care services. This has become a challenge for healthcare providers in the country.

The healthcare system today is complex, with various stakeholders involved such as hospitals, insurance companies, diagnostic facilities etc. In addition, it is critical at this stage to standardise the processes of these industry stakeholders.

The healthcare system generates enormous amounts of information everyday, and managing it is a big challenge for all the healthcare entities. Over time, healthcare entities have understood the value of technology-based systems to support their processes, functions, streamline operations and manage information generated. For this, all entities have made significant investments in IT in order to improve efficiency and productivity.

Being part of the common system, all the entities interact with each other and share information at various stages, but this critical coordination process was not part of the IT applications being used by each. Their applications were designed such that they were not able to exchange information online on a common platform. The applications did not account the future need of data integration for the benefit of the consumer.

Today, the consumer deals with different departments of various entities and some form of information related to the consumer is generated, but this largely remains in the individual facility’s system unless a request for sharing it is received. Moreover, when the system has to share information with another entity it is mostly in a paper format.

These limitations need to be dealt with to enable doctors, patients and others to leverage the benefits of integrated information Systems. On a daily basis, healthcare organizations face a challenge of keeping medical records without compromising their privacy and security and maintaining them for the stipulated time (as required by law).

is produced by a healthcare delivery system on a regular basis.

The increasingly felt need to access all related medical information for the purpose of research, improve clinical outcomes and gain knowledge - is driving many IT majors to develop Integrated Healthcare applications.

The concept of a ‘Connected Healthcare System’ can be defined as an environment involving all the healthcare entities – the providers, payers, law makers and regulators and the professionals - interacting with each other using IT systems designed on standards-based common platform to allow easy access, sharing and exchange of information at all levels.

For this environment to take shape, various health IT applications involved in the system need to provide robust and flexible base for all information based interactions and transactions keeping in mind the key players in the system namely, patients, doctors, decision makers, and other healthcare professionals.

Apart from flexibility, the other key areas of concern would be data security, privacy, interoperability, authorization levels, workflow capacities and above all data integrity.

This concept of connected healthcare has its own stages of evolution, which can be described as follows: Stages of Evolution for Connected Healthcare Stage 1 - Fragmented traditional systems existed, which maintained paper records, without using any kind of IT solutions.

Stage 2 - Automation of individual systems happened, generating some form of electronic records.

Stage 3 - Applications within the organization were integrated, bringing all records into single package Stage 4 - Current scenario – Some form of information exchange and system integration amongst entities like hospitals, insurance providers, Third party administrators etc. has started.

Stage 5 - Completely integrated systems will exist, sharing and exchanging information across standards-based applications on a common platform improving efficiency and accessibility - “Connected Healthcare”

Feasibility The big question for the Indian healthcare system is related The Concept to its preparedness for this kind of collaboration to share inToday there are solutions in the market to deal with the formation amongst all healthcare entities. Currently, majority complexities of managing huge amounts of information that of the healthcare entities are still struggling to put their IT 42

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solutions in place and streamline operations. nectivity between them.

Thus, it will be a long way to reach ‘Stage 5’ of the evolu- • Patient Identification across systems - How will patients tion for Connected Healthcare systems. Moreover, each of the be identified across systems? If the solution has to be stakeholders of the system will have numerous challenges to some sort of a universal identifier number then designface before finalising the blueprint. ing, it would again be a major challenge for the entities in Though, Microsoft has designed a “Connected Healthcare the entire healthcare system.

Framework Architecture and Blueprint” for the organisations • Acceptability and adoptability amongst various entities to follow, there cannot be any progress towards the Connect- The law makers and regulators have to make sure that ed Healthcare System unless the there are standards in place the idea of implementing new systems for providing infor healthcare providers and payers of the Indian healthcare tegrated services is accepted by all the healthcare entities ecosystem. and later adopted by all.

Nevertheless, some of the key drivers for the growth of this connected healthcare system would be: Key Benefits • Data accessibility - anytime, anywhere availability of paDrivers tient information - patient information could be accessed • Standardiszation - set of standards for - healthcare proby doctors, patients, and others anytime through the use viders, payers and other entities - for their processes and of handheld devices, wireless technologies and even refunctions, in place would definitely serve as a key driver mote access. for moving towards an integrated system.

• Improved efficiency and streamlined processes - as the • Service oriented approach - adoption of service-oriented systems will have a standards-based platform for mainarchitecture for development of healthcare applications taining and sharing information it will reduce time: as would bring down the challenges of interoperability and in waiting time, reporting time, administrative functions application integration. etc., making processes more efficient.

• Reliability and Transparency - all the stakeholders in the • Improved decision making - with patient information system must adhere to best practices and maintain trustavailable across the system doctors would have an edge worthiness to make the entire system work efficiently in making clinical decisions thus improving quality of and transparently. care.

• Advantages for research and development - integrated Key Challenges information would be advantageous for researchers in Some of the key challenges to put connected healthcare hospitals, pharmaceuticals, insurance companies etc. for model in place are: designing new products and taking decisions for better • Low IT budgets - hospitals have a very low budget for clinical outcomes.

IT investments and do not spend more than 2 percent of • Reduced costs - integrated information will help all entitheir revenues on IT solutions. ties in reducing costs by avoiding data redundancy, better • Attitude towards IT adoption - implementing IT applicamedical records management, saving over administrative tions is still not accepted as a good change for the sysand infrastructure costs for physical record maintenance, tem. reducing medical errors and thus saving on duplicate • Higher investments - High investments will be required tests and admissions etc. to replace legacy systems with the new applications com- • Increase in Medical tourism - quality services and effipliant for an integrated systems model. cient processes would help hospitals serve more foreign • Data transformation from legacy systems - transforming patients at low costs thus promoting medical tourism. data from legacy systems into new ones is a mammoth task and it would be critical to maintain data integrity.

• Data security and privacy - medical information related to patients is highly confidential so maintaining its privacy and security is a critical factor.

Anurag Dubey • Interoperability and interconnectivity between diverse Industry Analyst, Healthcare Practice systems - All healthcare entities are currently using diFrost & Sullivan verse systems and it is not feasible to provide interconMay 2008

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INDIA Opportunities for Digital India

National Accreditation Partner

2008

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news review

WORLD

European IT project to detect adverse drug reactions

Wireless tracking for mobile diagnostic imaging systems

A project recently approved by the EU, aims to exploit data from electronic healthcare records (EHRs) and biomedical databases to foster the early detection of adverse drug reactions (ADRs).

The scheme follows a number of high profile cases where adverse drug reactions have been reported in patients too late, when millions of patients had already been exposed.

The project, called ALERT, aims to develop a computerised system, better and faster than spontaneous reporting. ALERT will use clinical data from the EHRs of over 30 million patients from the Netherlands, Denmark, UK and Italy. Text mining, epidemiological and other techniques will be employed to analyse the EHRs to detect suspected adverse events and combinations of drugs that warrant further study.

The project will emphasise the detection of ADRs in children, using paediatric data from all the countries represented, given the relative lack of knowledge of such events. It will also discriminate between signals pointing to a genuine ADR, and spurious signals, which can create unease in both patients and physicians and can result in the removal of a useful drug from the market. The project is funded by a euro 4.5 million grant from the European Commission.

A product has been developed for the optimised repair and tracking of mobile diagnostic imaging systems.

The tracking system aims to address the problem of locating and making repairs to such imaging systems, especially when their routes around the hospital change.

Philips Remote Services (PRS) uses global positioning system (GPS) location technology, internet data connectivity and standard voice service to diagnose and potentially repair the imaging equipment remotely.

The manufacturers said that PRS was developed to counteract issues such as delays caused to patient treatment following equipment malfunction.

“With the PRS for Mobiles, we can contact the units and diagnose problems more efficiently,” said Ketan Shah, senior manager of mobile enterprise for Philips Healthcare.

Diabetes telemedicine system tested A hospital is piloting an innovative system which allows diabetic patients to monitor their blood sugar levels remotely. Patients at the Royal Bournemouth Hospital in Dorset, UK, can now carry out the tests at home and send their results back to be analysed over the Internet. Healthcare professionals then examine the data, and give 24-hour advice on how to manage the condition. Professor David Kerr, a senior consultant at The Bournemouth Diabetes and Endocrine Centre, said: “In the first instance, we have used the system to help people already established on insulin pump therapy, allowing them to wirelessly download data from their glucose meter or insulin pump into their home PC. Axon TeleHealthCare developed the system, in partnership with the Royal Bournemouth Hospital centre. The device was launched in November last year, but the Royal Bournemouth is the first hospital in the UK to try it and it is not currently available on the NHS.

Sectra’s next-gen PACS goes live at Swedish hospital Sectra’s new diagnostic workstation for radiologists, the IDS7/dx, has gone live at its first Swedish hospital.

The workstation at Södertälje Hospital is part of Sectra’s next-generation PACS and is optimised for distributed reading of radiology images and handling extremely large datasets.

Rapidly increasing data volumes are being produced by new radiology equipment. New modalities, such as multi-slice CT scanners will soon provide up to terabyte datasets for single radiology examinations.

Swedish firm Sectra said its PACS was optimised to handle these large datasets and to enable distributed reading - when examinations were performed at one hospital and reviewed at another location. This makes it possible, for example, for a radiologist to review images from a home office, a routine that is becoming increasingly common.

Peter Svozil, Head of the Radiology Department at Södertälje Hospital, said: “With Sectra’s new workstation, our radiologists can review images at a location that best suits his or her individual situation, even from home. “This enables us to use our resources in the most efficient manner.

NHS health board to run telemedicine trial A telemedicine initiative first piloted in the NHS Grampian area, is now to be tried in Perthshire by NHS Tayside.

It involves the establishment of an out-of-hours GP video link between the minor injury and illness unit at Blairgowrie Community Hospital and specialists in Dundee.

The service, which will allow a patient’s blood pressure, temperature, pulse rate, weight and lung function to be assessed at a distance, is aimed at reducing the need for patients to travel to Dundee for face-to-face consultations and to reduce patient anxiety.

A spokeswoman for NHS Tayside said: “The pilot is being run in conjunction with the Scottish Centre for Telehealth. The national centre works towards preventative, anticipatory care in local communities rather than in a hospital setting, and improving the standard and speed of care. If successful, the trial will be rolled out to Crieff and then Pitlochry.”

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Digital patients replace humans for drug testing Scientists have used supercomputing power to create “virtual physiological humans” (VPH) to serve as test subjects for a new HIV drug, which might lead to the concept of testing drugs on digital patients in the future.

According to a report in the Journal of the American Chemical Society, University College London scientists developed these VPH to serve as test subjects for the new HIV drug Saquinavir, that is designed to block one of the virus’s key proteins.

Their goal was to one day be able to create a unique VPH for each HIV patient, on which doctors could test different medications to determine their potential effects (on the organs, tissues and cells of real patients) and use the information to tailor the best treatments.

Such a move would be a dramatic improvement over today’s testing methods, which largely involve trial and error because doctors have no way to match the drugs to the profile of the virus as it changes in individual patients.

According to the scientists, the human body is so complex that they had to tap into several supercomputers running off national computer networks comprising both the UK’s National Grid Service and the U.S. TeraGrid to be able to create the digital patients.

iPhone could soon become a tool for doctors Experts say version 2.0 of the popular iPhone’s firmware, which is due to be launched in June this year, could turn the device into an indispensable medical tool in hospitals.

Doctors are quite optimistic about the new version of the mobile phone as it could serve as an electronic alternative for the oldfashioned clipboard and X-ray light box.

To date, such a feature has remained an impossible dream due to most smart phones’ inability to handle the sophisticated compression techniques used on large medical images. Also, most phones lack the requisite memory and imageprocessing capabilities.

But the iPhone’s reasonably powerful Samsung ARM processor, 8 GB or 16 GB of flash memory and intuitive, visual interface seem well suited to medical imagery. Hospitals are however wary of beaming medical images all over the place via WiFi because of security concerns. But, the iPhone’s new business-friendly security features may ease privacy fears, according to physicians, and could even turn the device into an indispensable medical tool if hospitals approve the device. Physicians, particularly radiologists, are also excited about the prospect of accessing medical images directly on their iPhones.

German govt unveils smartcard costs The German ministry of health has issued details on recent and estimated future costs of the healthcare smartcard project in response to a parliamentary inquiry, initiated by the Liberal Democrats (FDP).

According to the ministry, the annual Gematik-budget has increased close to threefold, from euro 26m in 2006 to an estimated euro 70m in 2008.

The rise partially reflects the progress of the smartcard project, an increasing number of tenders, the establishment of seven test regions co-financed by the Gematik and rising marketing costs.

The biggest share of costs for the smartcard project lies not with Gematik, but with the health insurance companies.

The ministry of health states that it expects a maximum of euro 669m of costs for the rollout of 80 million smartcards.

In total, costs of the smartcard project are expected to reach euro 1.4 billion. Additionally, about euro 150m of annual running costs are forecast once rollout is complete.

Apart from information about costs, the ministry of health has also provided some details on the progress of the smartcard tests.

The ministry re-iterated that the rollout of the smartcard readers for doctors and pharmacists would begin in early summer 2008.

Austrian hospital gets staff admin system A personnel administration system has been implemented at Allgemeines Krankenhaus Wien (AKH), Austria. AKH in Vienna is one of the country’s biggest hospitals with 2,100 beds and 9,000 staff, including around 1,500 doctors. The software package, called “on duty”, will be provided by Systema, a subsidiary of German IT firm CompuGROUP, and is aimed to increase personnel administration and duty scheduling, thereby increasing the efficiency of the clinic.

“Therefore, it is important to be able to use modern electronic tools in scheduling and administration which create optimal results approximating utmost efficiency. This is why we have high hopes regarding the implementation of Systema’s solution.” Willibald Salomon, CEO of Systema, said: “This success of “on duty” emphasises once more that our products fit the Austrian hospital segment. We will insistently and step by step work on further establishing this solution as a motor for improving the operational situation of clinics.”

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Oman plans healthcare city Oman’s Majan Development Company (MDC) is planning to develop a healthcare city near Muscat with an estimated investment of US$ 774 million to US$ 1.03 billion.

“An international consultancy agency has conducted market research for the project in the GCC region. The result was positive. A feasibility study for the project is going on now” said Bashar al Tuwaijri, senior manager for direct investment at Gulf Investment House, which is initiating the project with a 20% stake in MDC.

Oman’s Ministry of Tourism has agreed to allot land of 1 million square meters near Blue City, which is 100 kilometres away from Muscat.

Al Tuwaijri said the healthcare city would include medical colleges, hospitals, conference halls, hotels and shopping malls. “The project will be funded by way of equity and term loan from banks” he said.

MDC was formed by a group of investors in the Gulf region to develop real estate projects in Oman. It is 20% owned by GIH, 10 by Commercial Real Estate, 10 by Sharjah Islamic Bank, 30% by other non-Omani investors and 30% by pension funds and other institutional investors in Oman.

Voice-based information capture soon in Norwegian hospital Royal Philips Electronics’ SpeechMagic was rolled out in Ulleval University Hospital in Oslo - Norway’s largest clinical centre to more than 1,000 physicians across all medical specialties.

Upon completion at the beginning of 2009, the implementation is expected to be the world’s largest deployment of front-end speech recognition at one single hospital site. The hospital expects to increase the quality of medical reports, speed up documentation workflows and reduce administrative costs.

“We see patient safety as the most important advantage of this technology,” said Jens Grøgaard, Ulleval University Hospital’s clinical manager. “Every department will have full access to critical patient information, which helps to significantly improve the quality of care.

Since the report is printed instantly, the entire team involved in delivering care to a patient can rely on accurate, written information.”

The hospital-wide deal, which came through the local Philips Speech Recognition Systems partner Max Manus, was triggered by a successful implementation in Ulleval’s radiology department, where report turnaround time was reduced by 96%.

“We are expecting to save tens of millions of Norwegian crowns each year thanks to more accurate, convenient and efficient information capturing. By allowing our physicians to directly dictate into the electronic medical record, the entire hospital will benefit from a streamlined flow of information,” highlighted project manager Andreas Atteraas Grønbekk.

SpeechMagic is implemented in more than 8,000 sites worldwide.

Philips Speech Recognition Systems recently received Frost and Sullivan’s 2007 Global Excellence Award in healthcare speech recognition.

TI, IIT-Kgp in medical tech pact Texas Instruments (TI), the global information technology company, has signed a four-year collaborative agreement with the School of Medical Science and Technology of Indian Institute of Technology Kharagpur (IIT-KGP), to develop semiconductor technologies that will help improve the quality, comfort and accessibility of healthcare in India.

This is TI’s first partnership with an IIT on research projects devoted to medical electronics innovation. The project is a part of TI’s recent announcement to spend US$ 15 million towards funding research work in the field of medical technology.

According to Ajoy Kumar Ray, head of school of medical science and technology at IIT-KGP, “In India alone, about 800,000 patients undergo coronary bypass surgery every year, while one in every 12 women develops breast cancer. The TI-IT KGP technology partnership will enable devices that could help address some of these pressing healthcare issues.”

The research team will develop semiconductors for medical equipment for cancer and cardiac-related treatment. TI’s was supporting this research to help develop new semiconductor technologies for personal medical devices, implantables, medical imaging, wireless healthcare systems and bio-sensor technology.

The IIT-KGP research collaboration reflected TI’s keenness to develop the next generation of innovators. The outcome of the research would be intellectual property of TI, which will use the technology globally, said Bishwadip Mitra, managing director of TI India Ltd. Other research focus areas would be detection technology for cancer and heart problems by use of imaging technology and micro electromechanical system (MEMS) based biosensor technology. “The research will be essentially on TI platform, as the company has an arsenal of about 17,000 analog chips, which can be used for imaging techniques,” Mitra said.

The collaborative research with IIT-KGP, which would involve 15-20 researchers, would be divided into three groups - biological research team, image processing team, and doctors, said Mitra. This apart, specialists from TI would also work with the IIT researchers, and the research would be reviewed every six months, Ray added.

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EVENT REPORT

Medical Technology Conference Interactive Partnership - Accelerating Sustainable Healthcare 15th April 2008, New Delhi

Indian healthcare is poised to become the largest service sector in the country, at INR 140,000 crore in five years. Medical equipment logically forms the backbone of the healthcare sector. Thus, the tremendous growth opportunity in the healthcare sector automatically translates into a similar and even greater opportunity for the medical equipment sector, which is now valued at over US$ 900 million.

The Confederation of Indian Industries (CII) recently organised a day - long conference in New Delhi on Medical Technology based on the theme of ‘Interactive Partnership for Accelerating Sustainable Healthcare’.

In his welcome note, Mr. Alok Mishra, Chairman, CII Medical Equipment Division & Area Manager International – South Asia, Johnson & Johnson Medical Asia Pacific, set the tone for the conference by stressing on the urgent need to understand and regulate the complex medical technology industry and said the conference was “aimed at bringing together all the stakeholders to discuss issues of technology, manufacturing, financing and above all, ethics.” The conference Chairman, Mr. Anjan Bose, Senior Director & Business Head, Philips Electronics India, in his opening address said that the medical services and devices industry must “tap this emerging market and explore the potential of India as a future production hub while focusing on improving the quality of healthcare, R&D and ethical issues.”

The inaugural session saw a dynamic set of representatives from the government, the medical practitioners and the medical devices manufacturers, share their views about the growing enthusiasm in this sector. Debasis Panda, Joint Secretary, Ministry of Health and Family Welfare, said that the Government is in the process of creating a new and better regulatory structure for the medical devices industry as part of its effort towards achieving quality healthcare for all. He added that, “the Health and Family Welfare Ministry is working towards a switch from a control regime to a regulatory regime to cope with the new technologies and treatments that are now available.”

India’s healthcare sector is in a dynamic phase of growth but the technology being provided must work towards providing affordable healthcare to all, stressed Dr. Naresh Trehan, President, Indian Healthcare Federation and Immediate Past Chairman, CII National Committee on Healthcare. He added that it is imperative to accelerate growth through collaboration with the key stakeholders. “CII’s National Healthcare Committee has made huge strides by bringing the industry and the government together on several issues relating to providing sustainable healthcare to the masses and this 48

interactive conference will work towards taking this process forward,” said Dr. Trehan.

Mr. Rohit Mehta, Vice Chairman, CII Medical Equipment Division & General Manager, Larsen & Toubro stressed on the fact that healthcare is among the largest sectors and the largest employers in the country and the medical devices industry looks forward to the regulatory structure that is coming up.

The conference saw a lively exchange of ideas between the eminent panelists and the floor after each session. Where issues otherwise swept under the carpet were raised by the present members of the industry, such as, competing companies driving up foul-play by giving soft bribes to those in the healthcare services, the need for private sector to engage more in the training and education of the nurses and paramedics, further incentivisation and reduction of state duty on medical equipment, and reduction of prices etc.

The focus of the first session of the day was the need to accelerate growth through partnering and aligning with the key stakeholders - healthcare service providers, medical technology industry, and insurance providers. The discussion led us over many issues from the need for more research and development and innovation to the necessity to grade the available technology so that recent technology does not become out-dated simply because of newer technology. Dr. Narottam Puri, President- Medical Education, Fortis Healthcare, drew attention to the fact that the Indian healthcare industry currently faces a serious talent-cum-technology crunch since, hospitals are having to re-train nurses and paramedics who have not had any exposure to high-end medical technology devices used in the private hospitals. Dr. Kushagra Kataria, CEO, Artemis Medicare Services spoke of how in 1965 US spent 5% of its GDP but today it spends 16% and a major chunk of it- about 65% on medical technology, thus proving “good health care comes at a cost and that India must prepare itself to spend similarly.”

There is need for greater collaboration between industry and academic researchers, he added. Mr. C. Chandrasekhar, CMO, Apollo DKV Insurance, said that the current scenario in India was not the most conducive for pure health insurers, since there are regulatory and standardisation issues related to healthcare practices and available medical technology in India. And in the ensuing discussions suggestions for incentive-based preventive care came up, such as having an outpatient insurance scheme or tax sops in the shape of vouchers claimable at select hospitals for family preventive health check-ups. www.ehealthonline.org

L to R: Mr. Rohit Mehta, Vice Chairman, CII Medical Equipment Division & General Manager, Larsen & Toubro; Mr. Alok Mishra, Chairman, CII; Medical Equipment Division & Area Manager International–South Asia, Johnson & Johnson Medical Asia Pacific; Dr. Naresh Trehan, President, Indian Healthcare Federation and Immediate Past Chaiman, CII National Committee on Healthcare; Debasis Panda, Joint Secretary, Ministry of Health and Family Welfare; Mr. Anjan Bose, Senior Director & Business Head, Philips Electronics India

The rapid GDP growth of over 9% per annum that India has recorded for three years, has created a new, affluent middle class, estimated at 250 million, that is demanding access to better healthcare, thus pushing up the demand as well.

Increasing uptake of health insurance policies raises the standards to be met by the Indian manufacturers, who now need to meet international quality standards, and it also makes it difficult for the international sellers to dump the low quality and out-dated equipment in their stock in India. In the session Managed Healthcare- from Prevention to Cure, the panel discussed how prevention ought to be integrated into healthcare. Focusing on the paradigmatic shift towards innovative care models like ‘illness to wellness,’ and the way forward to reverse the thrust from curative to preventive aspect of healthcare. Ms. Rekha Khanna, Managing Director, bioMerieux India, presented an overview of the crucial role laboratory diagnostics and screening play in overall healthcare practice especially in the preventive care model. She claimed definitive diagnostics lead to cost reduction in the longer run. In a similar vein, Mr. Srivathsan Aparajithan, Head – Healthcare Business Solutions, IBM India, giving an impressive presentation on the need for data and systems integration thorough analytics, stressed on the need for a fully connected, patientcentred, collaborative future environment, with greater adoption of electronic medical records reducing the need for doctor visits and possibility of constant monitoring based on the electronic records.

The valedictory panel discussed the opportunities, realisations & solutions faced by the Medical Technology Industry May 2008

in India. The chair Mr. Alok Mishra, Chairman, CII Medical Equipment Division & Area manager International - South Asia, Johnson & Johnson Medical, Asia Pacific, drew attention to some serious statistics such as how, in India average hospitalisation costs 58% of the individuals annual income.

“Nearly 25% of patients get pushed below poverty line due to medical costs; yet Indian costs are the lowest in the world,” he added. Panellist Dr. Anupam Sibal, Group Medical Director, Apollo Hospitals Group said, “ 70 - 80% of public health is covered under the private sector, and they are also most likely to opt in for newer technology.” Dr. Gautam Sehgal, CEO ADS Medical Systems, suggested some clear initiatives required of the public and the private sector. He insisted that the current high duty in imports at 21.35% be capped at 5% across the board; that the private sector engage more in education and training of the human resources; and that both sectors should encourage research and innovation. Mr. Ajay Pitre, Managing Director, Sushrut Surgicals Pvt. Ltd., too was of the view that Indian manufacturers need to be recognised and their future research and manufacturing be provided with incentives. He added that India needs to open up like China to invite foreign manufacturers to manufacture in India, thus reducing costs.

Overall, the conference was a much needed platform for the medical equipment manufacturers and other service providers engaged in this industry. The key suggestions shared by most participants were mainly need for more R&D, innovation, greater public private partnership and cooperation, especially in training, education, and most importantly pricing and regulation.

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EVENT REPORT

1st India Health Conclave ‘08 2-4 April 2008, Taj Mahal Palace & Tower, Mumbai

Healthcare in India is increasingly getting refined and redefined. With a vibrant economy, an unupwardly mobile middle class, higher service demands and a positive investor perception, healthcare is one of the most promising growth sectors of the recent times. Like many emerging sectors, Indian healthcare is getting ready for a long haul dream run for achieving excellence and capitalising global opportunities in the calling.

To cater the need for stakeholders to come together and forge partnerships through knowledge exchange and networking, Technopak Advisors (one of the leading healthcare

man, Apollo Hospitals Group highlighted the challenges facing the Indian healthcare sector at present. While appreciating the quality of doctors and healthcare professioanls in India, he urged for better organisation of the sector and adoption of higher service standards. In this regard, he underlined the value of forums like the ‘India Health Conclave’ to bring together domestic and international players and seek successful collaboration and business opportunities.

Bringing an international perspective into the deliberation, Steven J Thomson, Vice Chairman, Johns Hopkins Health Systems, USA, spoke about standards of excellence and best

consultants of the country) organised the 3 day long 1st India Health Conclave ‘08 in Mumbai. Beginning with a pre-conference workshop day, followed by two days of conferencing, the event conjured healthcare entrepreneurs, investors, insurers, practitioners, technocrats and analysts under a series of power packed sessions and panel discussions.

The industry workshops were designed around some of the most pertinent business issues facing the healthcare sector at present. With eminent professionals brought together from a cross section of business domains, the workshops focused on issues ranging from financing, capacity building, clinical protocols, best prctices, brand building, business models, facility design and IT planning. With innovative use of interactive sessions, simulation models and case solving techniques the workshops served as a crash course for people to hone criticial business skills and benefit from expert opinions.

The second day of the event marked the beginning of the conference, starting off with a welcome address by Arvind Singhal, Chairman, Technopak. Emphasising the opportunities that lie ahead of the Indian healthcare sector, Mr. Singhal stressed upon the investement worthiness of the industry and expressed his confidence in witnessing Indian healthcare reach global standards.

Delivering the keynote address, Dr. Prathap Reddy, Chair-

practices in healthcare. Drawing from his experience of working in the US health system, he highlighted the need for setting quality benchmarks and service standards, in order to take Indian health system to a global level. While service excellence is surely an essential criteria for success, capital investments are pre-requisites for building any world class infrastructure.

In this regard, Dr Jack Shevel, President, Global Healthcare Investments & Solutions, USA, delivered a low down on foreign investor perception for Indian healthcare sector and spoke highly about the opportunities lying ahead. While corporate healthcare in India is getting all the attention, there is surely a widening supply-demand gap for investments in the public and social healthcare sectors. Sharing the ADB funding model, Ms Sujata Gupta, Senior Economist, Asian Development Bank, Phillipines, highlighted the need for evaluating social dividends of healthcare investments. Corporatisation of healthcare sector leads to higher demand for managing and maintaining multi-locational network of hospitals. Challenges in the form of operational management, quality compliance, skill sharing, capacity building and business performance often become major deterrents for a large network. Michael Neeb, President, Hospital Corporation of America International, USA, delivered an insightful presentation on how HCA manages and maintains a robust network of nearly 1300

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hospitals and 3000 ambulatory surgery centres. Keeping in mind the dearth of medical colleges in India and the growing demand for trained medical personnel, major players in the healthcare industry are already feeling the need to open up academic medical centres. “At least, this is what Fortis Healthcare is planning take up on a serious note,” said S. M. Singh, Managing Director, Fortis Healthcare in his presentation focusing on this topic. While VCs and PE firms are already making a beeline for Indian healthcare players, attracting right invetment requires due dillegence on part of service providers with the development of clear business plans. In his eloquent presentation, A K Purwar, Managing Director, India Venture Advisors Pvt. Ltd., brougth to light some of the critical evaluation criteria for investors. In a video conferencing session with Dr Devi Shetty, Founder, Narayana Hrudyalaya, micro health insurance scheme for poor and marginalised sections, and its efficacy in the face of a crippling rural health system was discussed at a length. The model followed at Narayana Hrudyalaya with five rupee per month group insurance scheme and Yesheswini health cards for rural farmers seem to be doing

day. Starting off with an impressive presentation on consumer-centricity in healthcare business, by Dr. Rana Mehta from Technopak, the morning progessed with back-to-back presentations by some of the most prominent personalities of the industry. While Suneeta Reddy shared the growth story of Apollo Hospitals since its inception in 1983 till formation of the modern day international healthcare brand; Vishal Bali from Wockhardt Hospitals charted out a strategic path for extending managed healthcare for non-metro cities and towns across india.

Commenting on the issue of reversing brain-drian from India, Dr. Kushgra Katariya, CEO, Artemis Health Institute emphasized the need for providing better infrastructure, facility and pay package for doctors. Citing his own example, Dr. Katariya expressed his belief that reverse brain-drain will catch up very fast in the coming days. Facility design is increasingly finding prominence in India and is fast becoming an important differentiator in the healthcare market. David Watkins from WHR Architects, USA, came up with a lively presentation on essential elements of designing hospitals and

wonders for people deprived of quality healthcare. Dr. Shetty is confident of expanding the coverage of the scheme and bringing more number of rural population under the ambit of the service. Talking of medical tourism, Thailand is undoubtedly the prefered destination in Asia, with Bumrungrad International Hospital in Bangkok enjoying a majority stake.

What can be better than to learn the best practices of healthcare delivery from the people who made it happen? Curtis Schroeder, CEO, Bumrungrad International shared his ideas on global standards in care delivery and the often overlooked linkage between hospitality and healthcare industry. Speaking generously about the opportunities for India to become a global healthcare hub and the growing competetion in this region, he said, in a lighter vein – “I am almost feeling , as if, CocaCola CEO is being invited in a convention of Pepsi.”

The concluding presentation of the day delivered by Arvind Singhal, Chairman, Technopak, gave a statistical overview of opportunities for healthcare sector in India. While the growth numbers were exciting enough, those indicating supply-demand gap in terms of facilities, infrastructure, human resource and capital investments in the sector seemed to have taken the audience by surprise reason enough to indicate what is left to be done.

The third day of the conclave was yet another power packed

how it translates into better patient experience while rendering a hallmark of quality. Bringing perceptions of middle east venture capitalists and investors, Dr. Anwar Ali Al Mudaf, Chairman & CEO, Al Razzi Holdings Kuwait, expressed the willingness of GCC firms to invest in India. Citing strategic advantages of India in terms of healthcare industry opportunities, coupled with the rising economy, Dr. Mudaf ended his presentation on a high note.

Adding special value to the event, were two high-level panel discussions designed around healthcare investments and policy reforms. While the investment panel looked into the overall worthiness and investment landscape (with participants from Actis, Apax Partnerns, Rothschild India and Yes Bank) the panel on policy reforms (comprised of representatives from Maharashtra state health department, Phillips Medical, Johnson & Johnson, Max Healthcare & IRDA) deliberated on regulations, pricing, malpractice mitigation and access challenges in public and private healthcare delivery.

The event concluded on a high note, with valuable learnings for participants and delegates. In addition to the highly engaging industry workshops, insightful presentations and interesting panel discussions, it served as an ideal ground for business networking, collaboration and knowledge exchange.

May 2008

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EVENT REPORT

Launch of www.myhealthrecords.in 27th March, 2008, India Habitat Centre, New Delhi

www.myhealthrecords.in, a personalised wellness and health management system targeted mainly at the Indian market, was recently inaugurated at the India Habitat Centre on the 27th of March, 2008, by Member of Parliament, Mr. Kirti Vardhan Singh. Mr. Singh is a member of the standing committee on Science & Technology, Environment & Forests and the Consultative Committee on Information & Technology.

The web portal is a brainchild of Mr. Manish Bhatnagar and Mr. Anil Joshi. It is easy to access, manage and share. One can share their own or their family’s health records with their doctors for consultation and even other doctors for a second opinion. The service would prove useful in remote diagnosis and telemedicine. Besides this, keeping in mind the growing instances of the modern day life style diseases, the website helps in keeping track of a person’s sugar, lipid, liver profiles, BMI and other vitals like BP and pulse rate.

An interesting tracker is the vaccination scheduler, which automatically calculates the expected date of the next vaccine as soon as the date of birth is keyed in. This is a safeguard against loss of immunisation cards or misplaced records.

The web portal is one of the latest entrants into electronic personal record maintenance services which are set to greatly impact the health sector. There have been several entrants into the healthcare sector of late - be it medical insurance companies, state of the art hospitals, medical tourism industry etc. The event was well attended by bureaucrats, doctors, radiologists and health service providers.

This service is especially useful for frequent travelers, both inbound and especially outbound since no health records

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would need to be carried in person. They can be stored in a digital format on a web portal, protected by a classified password, chosen by the user. The portal not only assures an online digital repository of medical history all in one place, but also allows the user to instantly share these with their own chosen doctor through a secure dedicated online communication channel. Payment for the doctor’s consultation can be done through credit card. This communication channel will soon be equipped with a voice tagging facility. Electronic health records and consultation services could potentially revolutionise healthcare in rural India where access to qualified doctors and especially specialists, is difficult.

The USP of www.myhealthrecords.in is the access to the latest digitization techniques, which facilitates conversion, compression, collation and meta data creation for paper and DICOM data as per international digital archiving standards.

Dr. (Col.) C.S. Pant, former President of the Indian Radiological and Imaging Association and Dr. Bharat Aggarwal of Diwan Chand Imaging Centre, while complimenting the organisers said, “It is now possible to have a multiple diagnosis done by various doctors anywhere in the world just by viewing patients’ digitised medical data just a click away.”

Mr. Manish Bhatnagar, CEO and co-founder of the web portal said that the portal will be upgraded every 45 days with features like SMS/e-mail reminders, customized alerts, voice tags to give it a personal touch. Another upgradation plan includes offering the service in regional Indian languages.

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ZOOM IN

Reinventing Wellness [

Manipal Cure and Care was presented the prestigious Golden Peacock Award for Innovative Product/Services this year

Manipal Cure and Care (MCC), India’s first retail health care centre, was presented the prestigious Golden Peacock Award for Innovative Product/Service Award 2007 in January this year.

This is the first time that the Golden Peacock Innovative Product/Service award has been bestowed to a health and wellness retail brand. Moreover the achievement comes just five months after the brand was launched.

The MCC Group was awarded the GPNQA in health care delivery in the year 2005 for the first time. The focus from the beginning was on offering innovative service under Xpresscare, harnessing of new medical technology; bringing in world-class health products - each having a USP, incorporation of international clinical practice guidelines, unique bottom up HR initiatives and IT technology, enabled the MCC to bag this prestigious award, said Somnath Das, Chief Operating Officer, Manipal Cure and Care.

Manipal Cure and Care is an initiative of the Manipal Education and Medical Group (MEMG). Sub-brands include Mask, Smile, Xpresscare and Foot Solutions.

Xpresscare is a preventive health care service aimed at busy, working professionals with a demanding lifestyle. It is a set of health packages with a turnaround time of just 45 minutes from billing to completion of checking the diagnostic results by an Internal Medicine Consultant. The packages offered are: LiverCare, KidneyCare, LungCare, DiabCare, RheumaCare Post Exposure Care.

MCC plans to open 50 centres by 2011 and is looking at foreign markets too. MCC centres have consultant doctors in general medicine, dermatology, dentistry, paediatrics, gynaecology, opthalmology, endocrinology and laboratory medicine amongst others.

Its operations are spread across India, Middle East and sevMay 2008

]

eral Southeast Asian countries. Plans are underway to open hi-tech Manipal Cure and Care centers throughout India beginning with cities such as Ahmedabad, Bangalore, Pune, Mumbai, New Delhi, etc. and gradually spreading to other parts of India.

The integrated Manipal Cure and Care (MCC) centres offer a mix of world-class products and services in preventive, wellness and beauty care. Comprehensive Health Checks are available for men, women and children that take less than half the usual time taken by other hospitals. Wellness services include immunisations, antenatal care, baby care, adolescent care, eye care, hormonal management, dietary counseling and sexual health advice.

Additionally, there are specialized dietary counseling and weight management services. Beauty services include skin care and dental care as well as skin piercing. They are the first in India to provide qualitative monitoring of health care driven by well-trained doctors and paramedical staff.

MCC offers health services that are customised, based on each individual’s lifestyle and family medical history. It follows award winning protocols and processes along international best practices and employs staff trained by the Oscar Murphy Institute to deliver highly personalised in-store experience for each and every guest. The pharmacies are also well stocked.

A salient feature of MCC is that it offers a new product every 90 days and technologically advanced services every 180 days.

MCC has introduced many new things for the first time in India. These include A-M-P-L-E Card (Allergies, Medical History, Past History, List of Medication, Emergency Number), EMR (Electronic Medical Record), Integration of CIMS (Cumulative Index of Medical Specialties - pharmaceutical 53

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A large number of companies compete for the Golden Peacock awards.

What, according to you, were the key reasons for MCC bagging the Innovative Product/ Service award?

Wellness and Preventive health market is fragmented and is unorganised.

MCC has remodelled the health care delivery for this segment by redesigning and retooling the health care delivery in such a way so as to address the requirements of the target group. This, amalgamated to the world class products, will deliver a compendium of services and products hitherto unseen in the medical world. This remodelling of services and merger of medically driven products created a new opportunity for health care which met the criteria for the award, hence, we were successful in getting the award.

MCC is committed to launching a new product every 90 days and innovative technologies every 180 days. How do you go about this?

We look at our service requirements; see opportunity for deployment of state of the art technologies, carefully identified by professionals from the world over. We ensure that the technology is adapted to the Indian conditions and relevant to the health care needs of the population. In this way we get the cutting edge technologies and deploy them in our centers. In addition to this, you will find that once the service is set we identify a product which complements or supplements the service. This would ensure that the product is perfect for the service.

Is MCC integrated with Manipal Hospitals in any way?

This is a new business vertical by MEMG, the parent body. We focus on Preventive care, Wellness and Beauty as core business and target the “Healthy citizen”. Our integrations is limited to other than using the learning’s of more than five decades of health care delivery for planning India’s preventive health care and wellness and beauty store. We want to give a new dimension to the emerging Health & Wellness model by giving our guest the freedom to choose their way forward for referral or curative aspect.

Are the MCC centres inter-linked? Can patients receive test results online?

Yes, it is in the process and will be deployed shortly. In addition, the online linkages are on the anvil.

Could you elaborate on your R&D team structure and infrastructure?

We have an advisory committee who looks at the emerging trends in the market and advises our personnel on the need to deploy new technologies and products. In addition to this advisory panel, we use our association with vendors who come and talk to us about the emerging technologies and products which makes it easy for our team to look at and shortlist the deployable ideas for use in MCC.

Somnath Das, Chief Operating Officer – Manipal Cure and Care the areas of cosmecuticals and neutricuticals which has ensured our leadership in the field of wellness and preventive care coupled with the beauty business.

The synergy appears to lie in each category [Preventive, Wellness & Beauty] complementing each other.

Could you throw light on some of the protocols and best practices followed at MCC? We use international best practice guidelines published by medical institutions and research models in the deployment of the clinical practice. We are the first movers in health & wellness category to get our centres certified by ACHSI. We also ensure that our products are aligned to the requirement of the Indian population.

• We error proof our practices.

• We integrate medical databases like CIMS and ICD. • We use international quality system protocols for our betterment of health practice.

• We select products which have a clinically proven efficacy.

• We use only technologies and instruments which are FDA or CE marked so as to ensure that we give only the best to our guest.

For which products/services do you see the fastest growing market/demand? What are the products and services you have lined up at the moment?

We see the entire range of services of MCC growing exponentially. In fact, all our services carefully culled from our experience in health care are doing well.

The choice of products has ensured that we could identify over 400 products in

What is the level and nature of IT applications used? How does it enhance the quality of services?

Our records and the entire working is IT enabled so as to allow our managers and doctors to monitor and realign the services and product inventories and sales. Our IT use is one of the most extensive both in the health care and the retail industry. We are currently working on the ERP which will be deployed soon.

drug interaction alert) with EMR, Customer Charter and error proofing methodology to name a few. This is drawn from the rich experience of MEMG in health care delivery spanning over half a century and spread over three countries.

MCC builds on the experience, know-how and socially ben-

eficial vision of the Manipal Education and Medical Group itself. This pioneering venture introduces to India the concept of holistic Health and Wellness care in a retail format, providing superior clinical services with related product offerings, all under one roof.

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NUMBERS

India’s IT market is expected to grow at a rate of the fastest in Asia.

22% Import duty on life saving equipment has been reduced from 25% to

5%

263%

There has been a increase in private ‘out-of pocket’ spending on health during 1996-2006.

60% 56

10

The number of medical tourists to India has grown more than fold since 2000.

of health resources are focused in urban centres.

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EVENTS DIARY

27 - 28 May, 2008 World Health Care Congress Asia Jeju Island, South Korea, China http://www.pccs2008.com

6 - 7 June, 2008 National Symposium as Exploring Microbes for Nanoscience and Technology 4 - 6 May, 2008

Tiruchengode, India http://www.ksrcas.edu/

EGYMEDICA 08 Cairo, Egypt http://www.egymedica.com/index.htm

9 - 11 June, 2008 ICMCC Event 08 London, UK

10 - 11 May, 2008 1st International Online Medical Conference (IOMC 2008)

18 - 22 June, 2008

Online, India http://ala.ir/iomc2008

9 - 11 May, 2008 1st International Conference on Healthcare Transformation: Primary Care Focus Singapore, Singapore http://www.pca.sg/

13 - 15 May, 2008 HOSPIMedica Australia 2008 Sydney, Australia http://www.hospimedica-australia.com

14 - 17 May, 2008 Kazakhstan International Healthcare Exhibition (KIHE) Almaty, Kazakhstan http://www.healthcare-events.com

18 - 20 May, 2008 Symposium on Health Informatics and Bioinformatics, HIBIT ‘08 Ýstanbul, Turkey http://fens.sabanciuniv.edu/hibit08/

http://2008.icmcc.org

Syrian Medicare 2008 Damascus, Syria http://www.syrianmedicare.com/

11 July, 2008 Research Methodology & Dissertation Writing Pondicherry, India adithan50@gmail.com

8 - 11 July, 2008 15th International Meeting on Advanced Spine Techniques Hong Kong, China http://www.imastonline.com/

29 - 31 July, 2008 eHEALTH India 2008 New Delhi, India http://www.eindia.net.in/2008/ ehealth/index.asp

20 - 22 August, 2008 Conference on Biomedical Electronics & Informatics (BEBI ‘08) Rhodes (Rodos) Island, Greece http://www.wseas.org

25 - 28 May, 2008 Geneva Health Forum

24 - 28 August, 2008 28th World Congress of Biomedical Laboratory Science

Geneva, Switzerland http://www.genevahealthforum.org

New Delhi, India aiimt@vsnl.net

58

24 - 27 September, 2008 Azerbaijan International Healthcare Exhibition (BIHE) Baku, Azerbaijan http://www.healthcare-events.com/

9 - 12 September, 2008 World Medical Tourism & Global Health Congress San Francisco, USA http://www.medicaltravelauthority. com/Upcoming-Events.htm

30 September - 2 October, 2008 Hospital / Pharmatsiya St. Petersburg, Russia http://www.primexpo.ru/hospital/eng

13 - 14 October, 2008 3rd Annual GlobaL Healthcare Expansion Congress Dubai, UAE http://www.healthcareexpansion.com

10 - 14 November, 2008 3rd Annual International Medical Travel Conference (IMTC) Seoul, Korea http://www.medicaltravelconference. com/index.php

14 - 16 November, 2008 4th National Conference of Telemedicine PGIMER, Chandigarh, India meenusingh4@rediffmail.com

14 - 17 November, 2008 TELEMEDCON ‘08 Chandigarh, India e-Mail: meenusingh4@rediffmail.com

5 - 7 December, 2008 Medifest 2008 New Delhi, India http://www.vantagemedifest.com/

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