The Enterprise of Healthcare www.facebook.com/ehealthmagazine
volume 6 / issue 05 / MAY 2011 ` 75 / US $10 / ISSN 0973-8959 / www.ehealthonline.org
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Vital for
Healthcare Next Generation Patient Monitoring
SHINING Armour
Health insurance offers hope for a healthy living ...pg22
ajay singla
Addl Secretary, H&FW, Govt of NCT of Delhi ...pg18
Jagannath MS
CFO, Columbia Asia Hospitals ...pg39
Contents Volume 6 > Issue 05 > may 2011 > ISSN 0973-8959
in focus
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“We need ethics and equity in the health sector” Dr Ajay Singla, Additional Secretary, Health & Family Welfare, Government of NCT of Delhi
in conversation
28
“ICT plays a very vital role in implementing Rajiv Aarogyasri in Andhra Pradesh” Babu Ahamed, CEO, Aarogyasri
specialty
35
Autism- The Invisible Disabilty Needs Technology
08
There is a need for technical or programming expertise to assist in developing or modifying tools to integrate technology in the treatment of autism
COVER STORY Patient monitoring systems
spotlight
‘Vital’ for Healthcare
39
By Dhirendra Pratap Singh
22
32
“We aim to create an IT enabled network of specialised hospitals” Jagannath, M.S, CFO, Columbia Asia Hospitals
tech trends
42 The Information of Growth
Clinical information systems have come of age and the technology is fast bringing about a revolution in healthcare
regular feature
special feature
in conversation
SHINING Armour
“IT solutions play a major role in operationalising the Kalaignar Scheme”
One of the fastest growing segments in the non-life insurance industry, health insurance offers hope for a healthy living
By Divya Chawla
4
Dr S Vijayakumar, Special Secretary, Health & Family Welfare Department in Tamil Nadu
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45 Corporate News 46 Research News 48 Technology News
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INBOX “An informative and insightful interview. It’s good that Indian healthcare system is learning lessons from the past mistakes of USA” Prof NG Rao, Founder, IAMI on EMRs - An Odyssey to Holy Nirvana “With the unique ID system (Adhaar) coming up soon it would be encouraging to move in the direction of EHRs. Implementation at village level will require some training and time. All healthcare courses should include ICT as a compulsory subject. Dr Soods contribution is great.” Dr RP Pareek on EMRs - An Odyssey to Holy Nirvana “Patient safety is the most important of all the roles and responsibilities of
a Hospital Administrator. We need to appraise all the stakeholders/healthcare providers about patient safety to avoid medical errors. A special focus on risk management in hospitals is important to look for patient safety.” M Veera Prasad, Medical Superintendent on Digital Hospitals Enhance Performance and Patient Safety “Ayursundra is a marvelous concept for upgradation of health sector. “ Kishore Talukdar on Ayursundra to open first-of-its-kind lifestyle clinic in Guwahati “Thank you for this article. It is very nice and helpful to me.” Ekta on Connected Healthcare
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In the Right
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Editorial Correspondence eHEALTH, G-4 Sector 39, NOIDA 201301, India, Tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.
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Editorial
Volume 5 > Issue 05 > may 2010 ISSN 0973-8959
Opportunities galore
T
he patient monitoring market is an expanding and profitable sector in the global healthcare industry. Driving growth in this segment are wireless and ambulatory monitoring and micro electromechanical systems, promoted by an increased desire for flexibility. Globally, the US remains the largest patient monitoring market. In 2008, it was valued at US $2.4 billion and is forecast to grow by 4.3 percent annually during 2008 to 2015, to reach US $3.6 billion. Most of the demand, in the global market, is originating from the emerging economies. India and China are forecast to grow faster than the average, driven by rise in the number of hospitals and large chronic disease populations. In India, estimated market size is roughly around `230 crores. The Cover Story in this issue provides extensive market data in addition to the key opportunities and challenges and the latest trends and technologies in patient monitoring. In India, health insurance has been the fastest growing segments in the non-life insurance space. The sector is now, also emerging as a significant line of business for the life insurance companies and all the major life insurance companies are now rolling out health insurance products into the market. At present, 17 general insurance and three health insurance companies are selling health insurance. As per reports, during 2009-10 the total gross premium is expected to have touched `8100 crore. This issue covers in length about health insurance industry in India with a focus on government initiatives in this space. With an objective to capture the leaders’ thoughts, this issue also covers interviews with Dr S Vijayakumar, Special Secretary at the Health and Family Welfare Department in Tamil Nadu and Babu Ahamed, CEO, Aarogyasri Health Care Trust. Dr Vijayakumar talks about the Kalaignar Health Insurance Scheme, which has saved the lives of several poor people in Tamil Nadu. Launched in July 2009, the scheme today covers around 1.35 crore BPL families in the state. An overview of Aarogyasri , which is a unique insurance scheme launched by Government of Andhra Pradesh to provide free treatment to BPL population of the state providing cashless treatment for 938 identified surgeries/therapies, is provided by Babu Ahamed. In the Spotlight section, Jagannath MS, CFO, Columbia Asia Hospitals, discusses the innovative design of Columbia Asia Hospitals and its aim to become the future hub of healthcare. Hope you enjoy reading this issue.
Dr. Ravi Gupta ravi.gupta@elets.in May 2011 < www.ehealthonline.org <
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cover story
Patient Monitoring Systems
â&#x20AC;&#x2DC;Vitalâ&#x20AC;&#x2122; for
Healthcare Patient monitoring systems are tailored to meet the individual needs of care units and care providers, helping them deliver high-quality patient care By Dhirendra Pratap Singh
T
he patient monitoring market is an expanding and profitable sector in the global healthcare industry. A new report by Global Data, Global Patient Monitoring Market Analysis and Forecasts to 2015, shows the global patient monitoring market was valued at US $4.9 billion in 2008. Driven by the rise of the chronic disease population, the mar-
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ket is forecast to grow by 3.8 percent annually until 2015 to reach US $7.2 billion. The growth in the patient monitoring market is driven by wireless and ambulatory monitoring and micro electromechanical systems, promoted by an increased desire for flexibility. Together, these accounted for 24.9 percent of the overall market in 2008. Globally, the US remains the largest patient monitoring market. In 2008, it was
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valued at US $2.4 billion and is forecast to grow by 4.3 percent annually during 2008 to 2015, to reach US $3.6 billion. However, with most of the demand originating from the emerging economies, the centre of the global patient monitoring market activity is up for a huge shift. India and China are forecast to grow faster than the average, driven by rise in the number of hospitals and large chronic disease populations.
cover story In India, estimated market size is roughly around `230 crores. In all, five crucial product segments have been identified in this market, which include—multi-parameter patient monitors, wireless and ambulatory patient monitors, remote patient monitoring, noninvasive blood pressure monitors and microelectromechanical systems. Growth in the market for patient monitoring is also driven by increasing awareness among medical professionals and growing incidence of diseases.
Technology Trends Remote patient monitors are a massive area of growth. They are used in conjunction with a device that is implanted in the body. This is a recent technology that has been commercially applied only to the cardiovascular market, specifically to pacemakers and ICDs. This category exhibited double-digit growth in the past and is expected to continue with this trend in the future. Though currently restricted to the cardiovascular market, this will soon expand to gynaecology and the diabetes market. A significant feature of the patient monitoring market is that certain segments within patient monitoring are developing rapidly,
tivity and cost-efficiency these systems offer. Says Nikhil Rao, Draeger Medical, “One of the major trends in healthcare today is towards less invasive care. And another trend is toward continuous, rather than intermittent monitoring. If we take basic parameter monitoring, all parameter are non-invasive and continuous except for blood pressure monitoring. If one wants to measure continuous BP, then going for invasive technique is mandatory which is specialized procedure and involves pain. expertise as well as expense.” He adds, “When used in conjunction with other continuous, noninvasive monitoring technologies such as ECG, SpO2 or etCO2, the CNAP SmartPod offers a continuous and truly comprehensive cardiovascular monitoring concept – without the risk of invasive methods such as arterial lines.” Dräger product range includes Infinity® Monitors, Pick & Go®, Infinity® Omega, Infinity® Gateway, Innovian® Solution Suite, Infinity® OneNet, Infinity® M300. Mindray’s product range includes Patient Monitor, Anesthesia machine, OT table, light and pendant; Black&White Ultrasound, Color Doppler; In-Vitro Di-
Novel technologies in patient monitoring are emerging to meet the increasing demands of an aging population. A few of these latest technologies include wireless communication systems that ‘sort’ the vast amount of data collected as compared to others, and are expected to follow similar growth patterns in future, as well. However, there are other segments that have yet not reached that level of growth and development. This has created unequal development of different segments as some are progressing faster than the others. Reports identify, wireless and ambulatory monitoring and micro-electromechanical systems to be the key segments driving growth globally. Wireless multi-parameter patient monitors are currently the hottest selling products in this market. Reasons being the multiple benefits they offer in terms of allowing the healthcare professional to monitor patients from anywhere and the increased produc-
agnostic (Chemistry analyzer, Hematology analyzer). Novel technologies in patient monitoring are emerging to meet the increasing demands of an aging population. A few of these latest technologies include wireless communication systems that ‘sort’ the vast amount of data collected in order to put it into the context of a patient’s condition, portable and ambulatory monitors, web-based access to the patient record, systems that transfer data to an electronic medical record (EMR), and full-service outsourcing that includes a clinician to evaluate data and send a report to the attending physician. There is also a constant rise in demand for continuous pulse oximetry monitoring.
Patient Monitoring Systems in ICU
Dr Narendra Rungta President-Elect, Indian Society of Critical Care Medicine
W
hen we talk of patient monitoring systems, it would generally mean monitoring the vital data of the patient in ICU or ICU like location in hospital, The monitor should be able to give at least 6 parameters like ECG recording with heart rate, Blood pressure (NIBP), Respiration, Pulse Oxymetery ( SPO2) and temperature of the Patient. Out of these ECG/ BP and SPO2 are more important when we are talking about monitoring of a stable patient. Other parameters needed in level III ICUs and advanced surgeries may be ETCO2 with invasive BP (IBP), CVP monitoring and beat to beat cardiac output. This completes the list of parameters, by and large, that are needed in an unstable patient who may be in Multiorgan failure and receiving multiple vasopressors and/or mechanical ventilation. An ideal paramonitor should provide at least the first six parameters and should be up gradable, I would always place the endurance, dependability and after sales service above the capital cost of the equipment. Each medical center should decide what kind of patients, they are going to handle and therefore what kind of monitors in terms of number and specification they need Not unusually, over-enthusiastic selection may lead to purchase of specifications and numbers of monitors which they may never need. Select sturdy, reliable, your need based monitors which have proven tract record of after sales service record.
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cover story
Emerging technologies in this segment Future of patient monitoring is clearly based on IT integration, data access and capture from across hospitals and remote access from any point within the hospital or across globe. Protocol based standardised charting solutions saving on time and effort of care giver, recording the information flawlessly for future access and meaningful interpretation for clinical as well as costs evaluations. Todayâ&#x20AC;&#x2122;s technologies talk about information access at bedside bringing together Vital signs, Infor-
Nikhil Rao General Manager, Dräger Medical
mation from HIS/CIS, Laboratory results, Radiology images, etc at Acute Point of Care to accelerates clinical decision-making, improve care delivery and facilitate consultation between clinicians at the bedside including industryâ&#x20AC;&#x2122;s best technologies. Patient monitors should be standardized, scalable and mobile across all care units. This enables flexibility in staff utilization, reduces training time. Scalability of patient monitors accommodate all acuity levels and patient types
Technologies such as sophisticated algorithms, reduced level of false alarms, easeof-use and flexibility of the remote alarm management solutions, ability to adjust the alarm levels on a patient by patient basis and easy to follow patient vital sign display at the central nursing station enables healthcare workers to provide better care with existing resources in this segment.
Impediments Certain key impediments to growth in the developing countries include old equipment and hardware, trend of maintaining records on paper, lack of proper communication channels, and shortage of information and skills. These countries are required to make an effort to address these issues through developing low cost monitors, re-engineering cheap electronics to monitor crucial parameters in a cheap and efficient way, and developing and implementing solutions for maintaining and retrieving data provided by these systems. It, therefore, becomes imperative for developing countries to focus on developing their internal infrastructure to be able to achieve the optimum level of growth they are capable of. Latest developments in patient monitoring equipment are now focused on enhancing interoperability within various departments within a clinical setting. Development of IT-integrated patient monitoring systems is already taking place and vendors across the
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globe are rolling out such products into the market. Although, some research papers also suggest that manufacturers are limiting market growth because of their reluctance towards interoperability, yet there is availability of products which are able to communicate with each other within a clinical setting. Suggested reasons for vendors to limit interoperability options include lack of incentives to allow this to happen more quickly than technology permits and have a con-
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trol over the market by making customers dependent on proprietary systems that do not integrate with systems manufactured by other vendors.
European efforts While the US market remains the biggest sector, the European remote patient monitoring market is being driven by the vast proportion of individuals with chronic diseases. However, the limited reimbursement
cover story
within and across departments, upgrades and expands with ease, supports the sharing of assets, helps build a tailored solution as the demands grow – smoothly and without redundancy. Standardisation, Scalability and Mobility also saves time preparing patients for transport and for their return, monitoring same parameters in transit as at the bedside, optimizes staff and equipment utilization. This increases patient safety and productivity Patient Monitors should have device Integration to consolidate monitoring and therapy informa-
provided by the government presents a challenge to device manufacturers. To combat this, the European Commission has started a mobile healthcare project called MobiHealth. The MobiHealth consortium consists of 14 partners from five European countries. Partners include hospitals and medical service providers, universities, mobile network operators, mobile application service providers and mobile infrastructure and hardware suppliers. The MobiHealth system enables patients to be fully mobile while undergoing health monitoring. The patients wear a lightweight monitoring system – the MobiHealth BAN (Body Area Network) – which is customised to individual health needs. Trials have been carried out throughout Europe. In Netherlands there has been intense monitoring of high-risk pregnant women where paramedics wear the BAN systems to enable faster communication. In Germany, telemonitoring of patients with cardiac arrhythmias has been carried out to allow detection of arrhythmic patterns without the need for hospitalisation. Meanwhile, Spain has focused on patient rehabilitation in the homecare scenario. This has provided information on patient exercise and vital sign information to the online physiotherapist, who in turn provides feedback and advice. Demand for effective monitoring products and increased acceptance of technologies aimed at the homecare setting will be the
tion for a better view of patient’s care state at a single point, providing a more complete view of decision-relevant patient data, supporting rapid treatment and generates more comprehensive chart-ready documents, automatically. They should be IT enabled and open a pathway between patient monitoring and hospital IT systems which delivers highest performance, builds on existing, nonproprietary hospital infrastructure , offers literally infinite connectivity through open architectural design, connects effortlessly across multiple sites and finally allows system
growth through a partnership between hospital IT department and Medical equipment supplier’s professional Services. To summarise, “Bring Patient Care and Patient Information System closer and help to reduce workplace complexity and support building of efficient care processes.” Opportunities and Challenges for Vendors Growing IT demand in Indian Healthcare Market is a great opportunity but at the same time understanding the right need of information is a great challenge.
In Germany, telemonitoring of patients with cardiac arrhythmias has been carried out to allow detection of arrhythmic patterns without the need for hospitalisation. Meanwhile, Spain has focused on patient rehabilitation in the homecare scenario key factors influencing and driving the penetration of products currently in pipeline. The market opportunity being significantly high, the products and technology landscape could see the emergence of multiple new companies with a stronger pipeline portfolio. Reimbursement, lack of awareness and limited innovation remain the key challenges but awareness, affordability and an ever-improving health infrastructure in the emerging economies (coupled with ageing population growth) should ensure that the global patient monitoring market continues to grow at a steady pace.
Future Sales of patient monitoring products that are currently in the pipeline, will be driven by effective monitoring parameters and increased acceptance of technologies aimed at home care settings. Factors such as awareness, affordability and an ever improving
healthcare infrastructure in developing economies will drive the global market for patient monitoring equipment. The challenges that will always remain include reimbursements and lack of awareness and limited innovation issues in certain segments of the society. Device manufacturers across the globe are struggling because of limited reimbursements being provided by the government. While the government is required to take an initiative, the industry must look at including the best technologies in their products and make them available at the best possible price. In the future, patient monitor system should provide more ideas for the doctors as well as the patient for the real body checking and suggestions. More parameters would be implemented for the doctors to know the patient condition better. More medical facilities should be combined to give the comprehensive suggestions for the patients.
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product matrix
Patient Monitoring Devices Product Matrix
Single Parameter Monitoring
Pulse Oximeters
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Allied Medical
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Advanced Micronic Devices Ltd
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Bangalore Medical Systems
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BPL Healthcare
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Micro-Electromechanical Systems
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Remote Patient Monitoring
Multi-Parameter Patient Monitoring
Akas Medical
Vendor
Wireless and Ambulatory Monitoring
Central Monitoring Stations
Non-Invasive Blood Pressure Monitors
Product Categories
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Clarity Medical
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Criticare Systems
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Concept Integrations
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Draeger Medical
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EMCO Meditek
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GE Healthcare
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Hospimedica International
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Huntleigh
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Instromedix
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L&T Medical
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Life Plus Medical
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Maestros Mediline
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Maquet Medical
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Medical Engineers
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Mindray
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Nasan Medical
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Philips Medical
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Recorders and Medicare
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Schiller India
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Trivitron
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Zeal Medical
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Spacelabs Healthcare
*This list is not exhaustive
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Featured Company
Addressing the need of quality Patient Monitoring in India Philips is the global leader in patient monitoring and the path-breaker in converting patient monitors into full fledged clinical aiding tools By Jitesh Mathur
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ndian healthcare industry is coming of age. There is overall growth in healthcare industry and it is driving the growth in the patient monitoring segment, as well. From new green field projects to expansion in Intensive Care Units (ICUs) and smaller ICUs adding multi parameter patient monitoring, the market is growing at a fast pace. Patient monitors enable critical care in ICUs and anaesthesia areas of any hospital and the requirement
Jitesh Mathur Director Patient Care, Clinical Informatics and Ultrasound Philips Healthcare India
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is growing along with awareness and the improvement of healthcare infrastructure across India. The patient monitoring market in India is divided in 3 tiers. Tier 1 being the top level has tertiary care and this segment uses highend modular patient monitoring systems connected in networks. In patient monitoring market, trends are moving towards clinical decision support, improved connectivity and networking in tier 1.
Featured Company
The patient monitoring market in India is divided in 3 tiers. Tier 1 being the top level has tertiary care and this segment uses high-end modular patient monitoring systems connected in networks
In tier 2, the trend is clearly towards moving from basic monitoring to more advance monitoring with higher parameters and features. In tier 3, ICUs of 4-6 beds are being created in small hospitals, where critical care or anaesthesia care was absent before. Overall, the patient monitoring market is moving towards clinical decision support. Clinical decision making is about getting the right information at the right place, and having clinical decision support (CDS) tools built into the patient monitors, which enable faster and better clinical decisions. That is what is driving the marketâ&#x20AC;&#x2122;s needs toward more interpretative tools and information systems linked to patient monitoring. The patient monitoring market is growing largely in the mid-end segment and the upcoming new ICUs are triggering this growth. Philips is the global leader in patient monitoring and a dominant market leader in India. One of our strengths is that we have the largest portfolio of products, which includes high-end modular and flexible patient monitors to basic functionality monitors. Hence Philips patient monitors can be used in all clinical settings, in all kinds of hospitals, in any city across the country. Technological advancements are a core of Philips patient monitoring and we have released more than 50 products internationally and in the Indian market in the last two years. The leading product innovations that Philips has introduced areâ&#x20AC;&#x201D;MX800 patient monitor, IntelliVue X2, IntelliVue XDS, SRR Telemtery, MobileVue, CI Solutions like ICIP and PACS, 12 lead transmission, IntelliVue MP70, 50 and 30 for wireless ICU, SureSigns and G-Series value segment monitors, TC 30 and 50, TM Vue and Holter and Avalon FM, MobileVue Patient monitoring, Cable-less Patient sensors, Avalon wireless Fetal transducers, etc. Philips is also the path-breaker in converting patient monitors into full fledged clinical aiding tools instead of just merely display patient data through the use of clinical decision support tools which improve the patient care and also help standardising the patient care procedures. These recently introduced solutions were well appreciated by over 500 customers, who visited our IntelliHospital show in Mumbai in April. Our major installations include the best hospitals in India and small and medium size hospitals in tier 2 and 3 cities.
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report
Trivitron employees come together to ensure clean and hygienic learning for Uthandi school children 300 employees paint St Thomas government school
T
“As a key healthcare player for the masses, we believe in a healthy and a stress-free environment. Looking at the impact caused by a dusty habitat upon children, it was necessary for the school to renovate the school beams and walls and thus create clean and airy surroundings. We are happy to contribute to the healthy progress of these children and let them breathe in a disease-free environment”
he students of St Thomas school in Uthandi were indeed a happy lot when the government school got a colourful facelift. Around 300 employees of Trivitron Healthcare visited St Thomas government school located on the outskirts of Chennai and volunteered to beautify the school campus by painting the school walls with different hues. Dr GSK Velu, Founder and Chairman, Trivitron Group of Companies said, “As a key healthcare player for the masses, we believe in a healthy and a stress-free environment. Looking at the impact caused by a dusty habitat upon children, it was necessary for the school to renovate the school beams and walls and thus create clean and airy surroundings. We are happy to contribute to the healthy progress of these children and let them breathe in a disease-free environment” The 300 employees who came from various divisions of Trivitron Healthcare cleaned the campus, thereby reinforcing the statement–“A healthy school means a healthy mind”.
Dr GSK Velu, Founder and Chairman, Trivitron Group of Companies
About Trivitron Healthcare Pvt Ltd Founded in 1997 by Dr GSK Velu, Trivitron Healthcare has grown to become the largest medical technology provider of Indian origin. The company offers premium diagnostic products, medical imaging systems, medical instruments, medical devices and surgical products and consultancy services. It understands the medical technology market across India and other emerging
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countries. At Trivitron, it’s their mission to produce quality solutions for the industry through a combination of indigenous manufacturing capabilities and key partnerships with the best multinational medical technology companies and research institutes from around the world. An established brand in medical technology, Trivitron today covers 15 medical
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specialties with over 400 products. Spread across 15 locations all over the country, Trivitron reaches India like no one does. With a customer support wing that is fabled for its promptness and expertise, thousands of healthcare institutions across India trust Trivitron with their technology requirements. Trivitron continues to grow and expand in its quest to provide the healthcare industry with the best and most cost-effective technology and solutions available. The company has a customer care which is accessible 24/7 throughout the year on the helpline, +91-98400 80008.
in focus
“We need ethics and equity in the health sector” Dr Ajay Singla, Additional Secretary, Health & Family Welfare, Government of NCT of Delhi and CEO, Aapka Swasthya Bima Yojana is one of the most dynamic healthcare leaders and visionaries in the country. In conversation with eHEALTH, Dr Ajay Singla, shared his views on the key bottlenecks that are hampering healthcare delivery in India What is your assessment of the health sector in the last years? In the last fifty years, we have seen a paradigm shift from public to private sector medical institutions. The other shift is the decay in the standards of medical education. Funding in the private sector is no less than the public sector. However, we all know about the capitations and corruption that is prevalent these days. If we leaders do not accept this reality and capture the regulator, the decay in medical education probably cannot be corrected. We need to accept the sickness, let the diagnosis come and then there will be treatment. We need to strengthen the regulator. The medical profession is inherently self regulatory. There are three self regulatory sectors— medicine, chartered accountancy and law. Medicine is the most self regulatory profession in the world. It’s up to the leaders in the healthcare sector, the doctors, who need to look within. In medical education there has been decay but there is a rise in healthcare delivery due to efforts by private sector. To the extent of that people are coming from various countries to India for treat-
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ment. Twenty years ago somebody would have gone out for transplant or bypass. But, people now are coming from outside. Kudos! On the other hand, for medical tourism, there might be equity issues that we are not able to treat our population but people are coming from outside. That speaks of quality. This is the paradigm shift, the change. Still India has not achieved the goal of ‘Health for All’, especially for rural and poor population. What should be the roadmap to achieve this goal? Equity issues are taken care of by the public sector for those who can’t afford. Private sector is more or less a differentiator. Sixty to seventy percent of work is left on the public sector. We need to increase the healthcare spending from present 4 percent to at least double of that. We need to cover the population by health insurance, surely. But in the private sector, there are few examples where there were low cost leaders like Narayana Hrudayalaya. These institutions provide reasonable quality health in profit oriented domain at very low cost.
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I would expect in the coming decade, rise of such leaders. The country probably needs such low cost leaders and differentiators in another 30 -40 years. Then probably we can address the equity in a much better way. We need to look at ethics which dominate the profession. What are the challenges faced by public sector in healthcare? Public sector institutions continue to slog or rather decay on account of lack of monitoring mechanisms, lack of management controls systems and lack of accountability. In India, public health sector sees highest absentees. Still their incentives are very high. We need to have very strong management controls and IT enabled mechanisms to monitor the output. Just deploying thousands of doctors in the rural areas such as Gujarat is not enough. What do you think ails public hospitals in India? The reality is that there are only, 5-10 percent medical professionals, who do not accept kickbacks. Few months ago, my friend’s mother was diagnosed with carcinoma and her expected life was
six months. The prescribed drug cost `3300 per tablet. On the other, I could get the same drug for `210 from a reputed pharmaceutical company. People have told me that prescribing a drug to a patient makes a trip to America for a doctor. We need to pace up to the ethics and equity. While the healthcare costs in India are lower as compared to the world. Still our own population cannot afford it. In your opinion where do we need to focus more and what directions would you like the health sector to take? The cost of catheter is known to be `80,000 per cardiac stent, which otherwise is for `8000. We need to think and intervene in some way by providing jan aushdhi but even that is not enough. We need to give the power to the people and that is where IT can help. Let people know. Say a patient prescribed with amoxicillin must have details of the products of different companies so that he can make an informed decision. Let the people decide according to their affordability.
in focus
Dr Ajay Singla Additional Secretary Department of Health & Family Welfare Government of NCT of Delhi May 2011 < www.ehealthonline.org <
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THE PREMIER GLOBAL PLATFORM FOR E-DEVELOPMENT Presents
1-3 August 2011 | The Ashok, New Delhi, India track Highlights l The most definitive event on ‘enterprise of healthcare’ l Sessions on policy initiatives in healthcare; public private partnerships; telecommunications, wireless and mobile applications in health; country case studies on eHealth projects and implementations; medical equipment and diagnostics; health insurance, and more l Opportunity to meet and network with key domestic and international government influencers l Platform to explore new business avenues in health l Awards for excellence in health standards all across the globe
Why participate? l Meet top level decision makers, experts, leaders and stakeholders in ICT arena on governance and health from across the world at one platform l Great networking opportunity with policymakers from different countries, analysts, experts, ICT entrepreneurs l A platform to engage with colleagues and experts handling similar ICT projects from all across the world l Expo to showcase cutting edge developments in ICT l Sharing of best practices and knowledge
delegate profile l Ministers of different countries from world over l Secretary/Chief Secretary level officials from various departments from India and abroad l Key Decision-makers from governance and health institutions l Officials from bilateral and multilateral agencies
CO-Organisers
supporting partner
l Representatives from NGOs and civil society organisations l ICT entrepreneurs, Industry representatives and experts
EXPO eWorld Forum expo will feature an elaborate exhibition and demonstration area where leading international ICT4D players in eGovernment and eHealth sectors, manufacturers, suppliers and service providers will present their latest products and services. Professional service providers, IT vendors, consulting firms, government agencies and national/ international development organisations involved in e-Government, e-Agriculture, Telecentre, Municipal IT and e-Health domains are encouraged to participate in the exhibition.
Launch of the eWorld Forum 2011 by Shri Kapil Sibal, Hon’ble Minister of Communication and Information Technology on 20th April 2011 at The Claridges, New Delhi
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Award Categories ICT Innovations in Governance • Best Government to Citizen (G2C) Initiative • Best Government to Business (G2B) Initiative • Best Government to Government (G2G) Initiative Theme based Awards in Governance • ICT enabled Financial Inclusion Initiative • ICT enabled Agriculture Initiative • ICT enabled Municipal Initiative • Innovative Grassroots Telecentre Initiative • Best m-Governance Initiative • Best Practices in Electronic Delivery of Services (EDS) • Best Cloud Computing Initiative • Best Rural Broadband and Connectivity Service Provider • Best Public Safety and Security Agency • Best Urban Governance Initiative • Best Power IT Initiative • Best State Data-Centre • Best Intelligent Transport System
Provider • Best Innovation/ invention in Taxation (including GST) Policies through ICT • Best use of ICT for Public Sector Units (PSU) • Best e- district Initiative • Best Information Security providing Agency • Most Effective Food Security (including PDS) providing Agency • Best Rural Governance Initiative ICT Innovations in Healthcare • Best Government Policy • Best Civil Society/ Development Agency Initiative • ICT enabled Hospital • ICT Enabled Diagnostic Service Provider • ICT enabled Health Insurance Initiative • Most Affordable Healthcare Provider • Best Medical Technology Innovation • Best PPP Initiative • Best m-Health Project/Programme • Green Hospital Initiative
• Green Laboratory Initiative • Best Use of Social Media in Healthcare • Best online Healthcare Provider • Most Innovative Technology for Healthcare Inclusion • Excellence in Care Delivery through Innovative Use of Technology • Healthy State ICT Innovations further Millennium Development Goals • Best ICT initiative in Eradicating Extreme Poverty and Hunger • Best ICT initiative in Promoting Gender Equality and Empowering Women • Best ICT initiative in Reducing Child Mortality • Best ICT initiative in Improving Maternal Health • Best ICT initiative in Combating HIVAIDS, Malaria and other diseases • Best ICT initiative in Ensuring Environmental Sustainability • Best ICT initiative in Developing a Global Partnership for Development
Key Speakers at eworld forum 2011
Walter Fust Chairman of UNESCO’s International Program for the Development of Communication (IPDC) and President of Globethics.net Geneva
R Chandrashekhar Secretary Ministry of Communication & Information Technology Government of India
R S Sharma Director General Unique Identification Authority of India (UIDAI) Government of India
Brendan Doyle Head of Institutional Relations Line Center for Information Technology & Communication
Oleg Petrov Coordinator, e-Development Thematic Group, The World Bank
Sharda Prasad Joint Secretary and Director General Employment & Training Ministry of Labour and Employment Government of India
Professor Michael Blakemore Emeritus Professor of Geography, University of Durham, UK
Shankar Agarwal Joint Secretary Department of Information Technology Government of India
Dr.Amirudin bin Abdul Wahab Head of ICT Policy Cluster Ministry of Science, Technology and Innovation (MOSTI) Malaysia
Ranjith Siyambalapitiya Minister of Telecommunication and Information Technolog Government of Sri Lanka and many more...
For Programme Enquiry Contact: Ankita Verma, Mobile: +91 8860651646, ankita@elets.in For Business Enquiry Contact: Arpan Dasgupta, Mobile: +91 8860651633, arpan@elets.in, Bharat Jaiswal, Mobile: +91 8860651636, bharat@elets.in (for further details visit our website www.eworldforum.net)
www.eworldforum.net
special feature
SHINING
Armour One of the fastest growing segments in the non-life insurance industry, health insurance offers hope for a healthy living By Divya Chawla
T
he healthcare expenses in India are financed through general tax revenue, community financing, out-of-pocket payment and social and private health insurance schemes. Out of pocket expenses, however, contribute for the major chunk of healthcare expenses made. Protecting households from high out-of-pocket expenses for healthcare is a key issue that needs to be addressed to protect households from being pushed into poverty and be made vulnerable to catastrophic health expenditures. As per a recent study, the analysis of nationally representative data from India shows that 3.5 percent of the population falls below the poverty line and 5 percent of households suffer catastrophic health expenditures. The
poverty deepening impact of out-of-pocket expenses was at a maximum in people below the poverty line in comparison with those above. Owing to shrinking public healthcare budgets, escalating healthcare costs coupled with demand for healthcare services, and lack of easy access of people from the low income group to quality healthcare, health insurance is emerging as an alternative mechanism for healthcare financing. Health insurance was introduced in India in 1912, when the first insurance act was passed and witnessed little change until 1972, when the insurance industry was nationalised and 107 insurance companies were brought under the umbrella of the General Insurance Corporation (GIC). Further, in 1999 the enactment of Insurance Regulatory Development Act (IRDA) took place, which
“Insurance and healthcare are the mantra for a healthy India” Surgeon Rear Admiral (Retd) VK Singh Director – Healthcare Asia Simpler
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allowed private and foreign entrepreneurs to enter the insurance market in the country. The bill also facilitated establishment of an authority to protect interest of the insurance holders by regulating, promoting and ensuring orderly growth of the insurance industry. According to the bill, foreign promoters are expected to hold paid up capital of up to 26 percent in an Indian company and requires them to have a capital of INR 100 crore along with a business plan to begin operations.
Indian scenario In India, health insurance has been the fastest growing segments in the non-life insurance space. The sector is now, also emerging as a significant line of business for the life insurance companies and all the major life insurance companies are now rolling out health insurance products into the market. Healthcare insurance in India may be categorised under: • Voluntary or private-for-profit schemes • Employer-based schemes • NGOs/community-based schemes • Mandatory/government-run health insurance schemes According to data published by the Insurance Regulatory Development Authority (IRDA), the gross premium underwritten by non-life insurers in the health insurance space, for the period April – September
special feature
“The latest incident of application of RSBY is in the German embassy, which is implementing the scheme for all its casual workers working for them” Anil Swarup Director General for Labour Welfare Ministry of Labour and Employment
2010, amounted to `5532.6 crore. Of this, the stand alone health insurers accounted for `663.49 crore, while the remaining `4869.11 crore was contributed by the remaining non-life insurers. For the same period in 2009, the total gross premium underwritten in the health insurance space was `3904.79 crore. Hence, 2010 marked a growth of almost 29 percent over 2009,
for the period April – September. The high growth rate reflects the phenomenal rate at which health insurance is being adopted by more and more people in India. At present, 17 general insurance and three health insurance companies are selling health insurance. As per reports, during 2009-10 the total gross premium is expected to have touched `8100 crore. The number of
stand-alone health insurance companies is gradually increasing. Star Health insurance was the first health insurance company, followed by Apollo Munich in 2007. Max Bupa, initiated its operations in April 2010. Owing to the growing healthcare costs, the assured insurance limit has also increased from `500,000 to `10,000,000. Max Bupa has introduced a product which provides coverage of `50,000,000 and has no age limit. The latest trend is that hospital and pharma companies are now becoming promoters of health insurance companies and are investing in these companies. The latest projections suggest that by 2015 health insurance will become a `35,000 crore industry and by 2025 the value of this industry will be worth `400,000 crore.
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• • Source of graph: www.irda.gov.in
Less than 15 percent of people in India have some form of health insurance coverage More than 40 percent people, who get hospitalised have to borrow money/sell assets to cover expenses A quarter of these people fall below poverty line because of high costs Medical care is one of the three main causes of impoverishment in the
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special feature
IT in Health Insurance trative processes and medical care, the market is ripe for IT solutions that reduce a company’s operating costs and improving customer experience during a claim process. For those considering adopting technology solutions, the decisions range from identity management, automating claims processing and using intelligent adjudication and score card systems. Among the high priorities are predictive analytics as a tool for underwriting processes.
P Rammohan Managing Director & Co Founder Healthsprint Networks
P
ayers around the world share the same concern—how to stay competitive while healthcare costs are on the rise. In the past, many companies approached this challenge by trying to roll out premium rate increases to their customers. This strategy is being met with resistance from employers and retail consumers. With a growing backlog of claims and continually rising costs of adminis-
Industry analysts believe the level of automation in a payer’s business processes is now becoming the key success or failure factor within the sector. In addition to outdated paper processes, studies show that many payers are affected by a high inefficiency factor in the automated systems they currently use. Often, they achieve less than 50 percent of the possible efficiency in their back-office systems simply because they are unaware of benchmarks and what they should be able to accomplish. Buyers, therefore, must understand not only what technology solutions to adopt, but also how to mitigate risks in those business solutions as existing technol-
ogy evolves or new technology emerges. The internet is a vital link to increasing functionality and interconnectedness for sharing data and information. Hospitals and physicians need quick response to verify health benefits coverage of their patients and status of transactions. vIn addition, Internet functionality of a business process and its related data facilitates a payer’s ability to increase customer satisfaction by providing Web access to health care providers to submit pre approvals and claims electronically. Initiatives by government of India like legalising digital signatures for use in e-commerce bring in credibility and accountability in enabling web transactions for health insurance. Payers in India, Central and State governments rolling out social insurance programs have adopted to paperless claims processing solutions to mitigate customer relationship issues and faster turnaround time at the point of care. The Health Insurance eco system is moving towards customer centric outcomes of IT deployment.
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country A large share of consumption expenditure is made on health
Government Initiatives
Source of graph: www.irda.gov.in
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Government run health insurance schemes such as Rashtriya Swasthya Bima Yojana, Andhra Pradesh’s Aarogyasri, Tamil Nadu’s Kalaignar Health Insurance scheme, Gujarat’s Chiranjeevi scheme, and so on have empowered the below poverty line and weaker sections of the society with better healthcare. Sharing the success of RSBY, Anil Swarup, Director General for Labour Welfare, Ministry of Labour and Employment said, “Almost every state of the country is now offering RSBY scheme to its BPL population. As on date 23 million smart cards are active in the country and more than 1.5 million people have already availed treatment
special feature
May 2011 < www.ehealthonline.org <
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special feature
Source of graph: www.irda.gov.in
IRDA Data on the Gross Premium Underwritten by Non-Life Insurers in Health Insurance (April – September)
Insurer
Royal Sundaram
2009 (`crore) 60.24
2010 (`crore) 88.64
TATA-AIG
36.78
64.61
Reliance
124.08
128.53
60.67
81.19
IFFCO Tokio ICICI Lombard
414.1
751.97
Bajaj Allianz
162.58
167.37
HDFC ERGO
123.69
154.41
Cholamandalam
90.78
85.88
Future Generali
29.12
51.01
7.53
11.78
13.66
34.29
New India
785.16
1112.69
National
457.02
716.56
United India
589.64
825.81
Oriental
476.45
596.37
Star Health & Allied Insurance
428.73
573.37
45.06
81.87
0
8.25
3904.79
5532.6
Universal Sompo Bharti Axa
Apollo MUNICH Max BUPA Total
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> www.ehealthonline.org > May 2011
at various hospitals. The scheme has been chosen by the World Bank as one of the top 18 social security schemes. Countries like Bangladesh and Maldives have also taken decision on replicating a similar scheme in their countries.” Dr S Vijayakumar, Special Secretary, Health and Family Welfare Department, Government of Tamil Nadu and Project Director, Tamil Nadu Health Systems Project said, “Kalaignar Insurance Scheme for Life Saving Treatments has converted the dream of the people to access to quality medical care and has provided financial protection against huge medical expenses for high-end treatment into a reality for the BPL or low income population.” Babu Ahamed, CEO of Aarogyasri, an equally important government-run health insurance scheme in Andhra Pradesh said, “The scheme has screened and provided treatment for common ailments for 42 lakh patients in 25,000 health camps.” In future, the health insurance industry will continue to follow the growth trajectory and will play a crucial role in hospital payments. Health insurance providers will not only come up with product innovations, but also delivery innovations. The industry will bring specialisation and professionalisation in the system. It will also bring quality, standard and cost optimisation in healthcare delivery.
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in conversation
â&#x20AC;&#x153;ICT plays a very vital role in implementing Rajiv Aarogyasri in Andhra Pradeshâ&#x20AC;? Rajiv Aarogyasri, a government initiated health insurance scheme (working on a public-private partnership model) running in Andhra Pradesh is providing cashless treatment to almost 90 percent of the state population. Use of ICTs for monitoring the project has been a huge success and the enthusiasm of the government can be observed by its consistently growing financial allocations. In an interaction with eHealth, Babu Ahamed, CEO, Aarogyasri Health Care Trust shared his perspective on this health insurance scheme and threw light upon the role of IT in streamlining its processes. Excerpts:
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ould you detail upon the remarkable achievements of Aarogyasri in recent years? The scheme has screened and provided treatment for common ailments for 42 lakh patients in 25,000 health camps. It has spread health education and awareness among rural and urban masses on preventive care, early detection etc, through vibrant IEC activities monitored and documented online. Nine lakh beneficiaries for major health needs in last 4 years have been treated. The scheme has proved that tailor made policy based on local health needs is the need of the hour. Aarogyasri is financially sustainable and replicable as it is able to provide coverage for `2.00 lakhs at an average premium of `450/for 938 identified procedures including pre-existing diseases. The scheme has proved that there is no need for standard exclusion of certain conditions such as congenital malformations and HIV associated patients. Through the scheme, coverage for vulnerable population can be provided by total funding by the
> www.ehealthonline.org > May 2011
Government rather than collecting a small premium from poor as a matter of principle. It has demonstrated the efficiency of IT system in reaching the rural poor in transparent manner. For the first time, Aarogyasri has provided protocols for confirmation of diagnosis, treatment mode and outcome based claim settlement in insurance mode. The schemeâ&#x20AC;&#x2122;s well orchestrated empanelment procedure through robust online system propelled hospitals to upgrade services to the best quality levels. It as infused growth in health industry in the state, increasing number of well equipped hospitals even at district level. With the implementation of this scheme, first time selection guidelines were framed to help hospitals identify proper beneficiary and avoid adverse selection. First time authenticated medical data was also made available, which can be used for various studies including disease trends to help insurance companies assess the risk properly. Moreover, controls such as medical audit, field verification, social audit and in-house vigilance concepts were effectively used and monitored through IT for fool proof out come and quality services. Motivated govern-
ment hospitals upgraded their infrastructure and work more efficiently to provide quality care even in specialties hitherto not performed. The scheme established the fact that due awareness, penetration and orientation of the scheme among the various stakeholders is as important as that of implementation. How has the implementation of IT helped in developing and facilitating various processes of the scheme? Aarogyasri is a unique Insurance scheme launched by Govt. of Andhra Pradesh to provide free treatment to BPL population of the state suffering from identified diseases covering 1.98 crore BPL families of the state spread across 23 districts, providing cashless treatment for 938 identified surgeries/therapies. The scheme handles socioeconomic data and medical data of 1.98 crore BPL families spread across 23 districts of the state. In order to meet various requirements of the scheme, the Trust has developed an online solution capable of handling 1200 pre-authorisations, 20000 transactions, medical records and 1200 claim payments in most
in conversation
Babu Ahamed CEO, Aarogyasri May 2011 < www.ehealthonline.org <
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in conversation tient to all the services rendered at camps and hospitals, coordination of various departments, monitoring of overall scheme experience, call centre, grievance redressal solutions etc., ICT is playing crucial role in accomplishing SLAs as per the schedules even in implementing such a massive scheme. It is also helping to gauge the infrastructure in network hospitals through online empanelment and professional expertise available with them. The ICT solution developed for this unique scheme has absorbed all the complexities of the scheme and made it user friendly thus help implement the scheme in efficient manner involving various end users and stake holders. Aarogyasri web portal/workflow is repository of information consisting of various components including database of work flows 80 million people and 20 million
The ICT solution made possible to establish clear identity of the beneficiary through 2.04 crore card data base consisting socioeconomic, biometric and digital photo data of 8 crore people transparent and efficient manner, providing a mechanism for minute to minute monitoring. ICT plays a very vital role in implementing Rajiv Aarogyasri in Andhra Pradesh. The ICT solution made possible to establish clear identity of the beneficiary through 2.04 crore card data base consisting socio-economic, biometric and digital photo data of 8 crore people, transmission of electronic medical records and multilevel online scrutiny of each patient details before preauthorisation, monitoring quality of treatment and outcome, claim verification, registration of pa-
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families with digital photograph, socio-economic data and iris biometrics; general information on the scheme; details of patients reporting and referrals from the PHC/CHC/government hospitals/district hospitals on daily basis; e-Health camps system and daily reporting of health camps; details of patients reporting and getting referred from the health camps; e-Empanelment system; emergency approval system; patient registration by Aarogyamithra in network hospitals; details of in-patients and out patients in the network hospitals; costing of the tests done in the network hos-
> www.ehealthonline.org > May 2011
pitals; electronic medical records of all patients screened and treated; real-time reporting, active data warehousing and analysis system; claim settlement; Aarogyasri messaging services; enhancement workflow; and many more. Who is the vendor? Trust after due consideration decided to use ICT solution in view of enormity of the scheme both in content and coverage for transparent and efficient implementation. The uniqueness of the scheme and having no parallels demanded the development of vast knowledge base for application of ICT solution. Accordingly, Trust provided the knowledge domain of the solution and the technical and maintenance support is provided by the TATA Consultancy Services Ltd. Do you think that this Aarogyasri Scheme is able to fulfil the goals of inclusive growth in India? Yes, definitely. Aarogyasri scheme unlike conventional insurance is based on inclusive principle whether it is coverage in terms of eligible population or disease coverage. Around 82% of state population is now covered under the scheme. In fact to enable more number of families to avail these benefits, government raised the financial limit of the BPL criteria from `20,000 to `65,000 per annum. The concept is that such type of health needs even middle class families require financial assistance. Trust packaged the procedures rather than diseases, thus actually expanding the coverage to more patients as the procedures are approved irrespective of aetiological factors. Even procedures are defined broadly, thus enabling coverage for more number of related procedures for assistance under the coverage. It is first community based scheme to allow
pre-existing cases to be allowed to be covered from day one. The scheme certainly proved that inclusive concept in insurance scheme is viable and replicable with proper control mechanisms. The transaction system and implementation strategy helps to providing health financing to the poor by government keeping cost under control. How important, from a healthcare insurance point of view, is to have a national health IT policy or standard based IT practices in health insurance? The robust ICT solution adopted first time by Aarogyasri Trust in running the health financing scheme in efficient and transparent manner and the appreciation received through various agencies for its implementation methodology establishes a clear need for a national health IT policy for health insurance. It has helped in scaling of the scheme in a short span of one and half years to cover 70 million people. It also helps in assessing the disease load and risk pool scientifically based on empirical data and hence it can be only method in which health insurance for universal access to health can be achieved. What are the plans ahead? In order to take the scheme to its ultimate goal of universal coverage in terms of disease coverage, Trust is considering extending the coverage for more and more new diseases for the uncovered areas. Trust in consultation with the specialists and on analysis of the scheme and representations received from various quarters identified certain diseases for coverage in areas of Obstetrics, Paediatrics and Paediatric Surgery, General Surgery, Surgical Oncology, Micro Vascular Surgery, Vascular Surgery and Medical specialties.
Incorporating HIMAA 2011 National Conference
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20-23 September 2011 melbourne Convention and exhibition Centre www.himssasiapac.org/11 For inquiries Mr. Gabriel Sim, HIMSS Asia Pacific | +65 9299 0802 | gsim@himss.org For HIMAA Corporate members Ms. Rose Wong, HIMAA | +61 2 9887 5001 | himaa@himaa.org.au
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in conversation
â&#x20AC;&#x153;IT solutions play a major role in operationalising the Kalaignar Schemeâ&#x20AC;? Kalaignar Health Insurance Scheme had saved the lives of several poor people in Tamil Nadu. Launched in July 2009, the scheme today covers around 1.35 crore BPL families in the state. Dr S Vijayakumar, Special Secretary at the Health and Family Welfare Department in Tamil Nadu, in an interaction with Dhirendra Pratap Singh, shared his perspective on this scheme and threw light upon the role of IT in streamlining government-run health insurance schemes. Excerpts:
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hat is the background of the Kalaignar Health Insurance Scheme and how did the genesis of the scheme take place? In Tamil Nadu, though we have 16 Government medical colleges, yet only three to four hospitals provide high-end surgical treatments like cardiac surgeries, cancer treatment and neurological treatment. This leads to a huge waitlist over a period of time. High-end surgeries are not performed in many Government medical colleges and hospitals, though a lot of people approached the government facilities only. To fill up the gap, we took the decision to operationalise the Kalaignar Health Insurance Scheme in Tamil Nadu. This scheme is implemented on a public private partnership mode involving the insurance company, the network of empanelled private sector hospitals and the state agencies. This model along with other mechanisms institutionalised in the scheme makes it an efficient and cost-effective programme. Private insurance company namely, Star Health & Allied Insurance Company, contracted to implement the scheme, has entered into MoU with a number of hospitals in private healthcare and hospitals throughout Tamil Nadu. The entire premium to the tune of `600 crore (approximately) annually is borne by the Government of Tamil
> www.ehealthonline.org > May 2011
Nadu at `469/family + service tax. Totally, 1.34 crore families have been enrolled and smart cards have been provided. Could you detail upon the remarkable achievements of Kalaignar Health Insurance Scheme in recent years? In this scheme, one of the important factors, is the availability of a good private sector network. Another is the IT enabled mode of operations, which helps in providing cashless treatment and binds all aspects in implementing the scheme, which is a major success of this scheme. Fund transfer becomes easy because of IT enabled solutions. It has really helped us make the scheme effective and efficient. Any family whose annual income is less than `72,000 is enrolled as beneficiaries. The insurance scheme provides cashless insurance protection against a host of identified high-cost medical contingencies that require surgical care and hospitalisation. About 700 identified surgical and medical procedures are covered and treatment is available to the beneficiaries. Modern and sophisticated hospitals are tied up and networked exclusively for attending to the insured population. Kalaignar Insurance Scheme for Life Saving Treatments has converted the dream of the people to access to quality medical care and has provided financial protection against huge medical expenses for high-end treatment into a reality for the Below-Poverty-Line (BPL) or low income population.
in conversation
Dr S Vijayakumar Special Secretary at the Health and Family Welfare Department, Tamil Nadu May 2011 < www.ehealthonline.org <
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in conversation
Many people still do not understand the concept of Health Insurance. Health Insurance also has to be regulated properly. If the linkage is not proper, then it can be detrimental to the hospital, insurance companies and importantly, the buyer How has the implementation of IT helped in developing and facilitating various processes of the scheme? Each beneficiary is given a biometric smart card bearing the biometry and photographic details of each member of the family to avail the service. At the hospital, the doctor records all the requirements of the patients and sends to the Star Insurance office for pre-authorisation. All the important pre and post diagnostic details like X-rays, lab test reports are sent on the net
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and processed by a team of doctors in Chennai. The smart card gives the beneficiary easy access to the hospitals and allows only the correct eligible beneficiary to avail the treatment. Camps were held across the State and a door-to-door campaign was also launched to identify and enroll beneficiaries, who belong to the Welfare Boards and people satisfying the eligibility criteria. Similar camps were also organised by the health department to identify eligible people for the treatment.
> www.ehealthonline.org > May 2011
In the scheme, there are dedicated taluk kiosks for the people, who did not enroll initially for a period of three months and subsequently at the district health quarters for enrolling the people during the entire period of the policy.
in other states wherever there is a gap, we should try to fill the gap by purchasing services. It can be done through insurance or in partnership. Public private partnership model can play better role in this regard.
Could you explain how Indian healthcare system be reformed if the government becomes a health insurance provider than a healthcare provider? I personally feel that preventive health taken to control various communicable and non-communicable diseases should still be the primary work of Government. At the same time, for high-end tertiary healthcare sector where there is a lack of specialists and the requirement is very high, we can use an appropriate public-private partnership model as done in Kalaignar Health Insurance Scheme.
Do you think that this scheme is able to fulfill the goals of inclusive growth in India? Certainly, it has the ability and so far has fulfilled the goals of inclusive growth. The scheme that kicked off in 2009 July is now covering a mammoth size of 1.35 crore of BPL families. We are not only covering the poorest of the poor but also lower-middle income group from urban areas who, if falling into catastrophic illness, would get relegated to the poor category.
Do you think making health insurance mandatory for everyone can address the issue of low health insurance penetration in India? Many people still do not understand the concept of Health Insurance. Health Insurance also has to be regulated properly. If the linkage is not proper, then it can be detrimental to the hospital, insurance companies and importantly, the buyer. It should be managed efficiently and effectively. IT solutions play a major role in operationalising it. Individuals could be managed according to their health requirements. Kalaignar Health Insurance Scheme has brought down market rate to a large extent. We have minimised the cost of investments made and the whole scheme is cost-effective. Tamil Nadu has done very well in primary and secondary health but
In India some of the traditional healthcare companies have ventured into health insurance. Do you think they may be able to run the business better? If everybody behaves responsibly, the insurer would be benefitted, insurance company would be benefitted and everybody would be benefitted. For any insurance scheme to succeed, it should have following thingsâ&#x20AC;&#x201D;it must provide good access to people, maintain quality of care and cost-effectiveness in the system. In Kalaignar Health Insurance Scheme, we are able to control the market and bring down the cost of healthcare delivery. In this scheme a lot of quality control mechanisms have been built-in. What are the plans ahead? We want to work efficiently and ensure that there should not be any backlog of cases for any high-end tertiary healthcare requirements in the State.
specialty
Autism
The Invisible Disability Needs Technology There is a need for technical or programming expertise to assist in developing or modifying tools to integrate technology in the treatment of autism By Shally Makin
L
ooking at her one year old child, a mother thought “Am I just being paranoid because I’ve only dealt with atypical children all these years?” On the other hand, paediatricians took it very normal for an infant to have issues such as an act of latching on or feeding problems, a domino effect such as trouble sleeping, crankiness or not being able to hold up her head even
after four months. With regular checkups, the child was now confirmed with autism spectrum disorders (ASD). The parent of the child was not sure if she will be able to make the two ends of the rope meet for her daughter. With every milestone she completes, she is not sure if the struggle is about to complete or rather start with her increasing years. The long-term prognosis is not clear for a child living with autism, which is generally referred to as an invisible disability.
Autism is shaping into an epidemic, with the staggering number of autistic patients reaching to one in every 110 children today. The surveys also show that there are 67 million people, who are suffering with autism worldwide. Autism is used to describe a group of complex developmental brain disorders. The individuals don’t properly understand and respond to what they see, hear and sense, which can result in problems with social relationships, communication and behaviour. Mostly people don’t understand why the child behaves absurdly or has a temper tantrum, which concludes that he is guided under bad parents. Mythily Chari, Founder Trustee, Commandur Foundation, defines autism as “A condition and not a disease, so the very outdated terminology borrowed from medical field, treatment, patient, etc need to be deleted. In this context what I propagate is teach; do not treat Autism. There is no cure, one lives with the condition. However training, those who fall in the spectrum will, to a great extent, decide whether the child will attend college later in life or fall by the way side.” There’s not a direct cause of autism that is supported by evidence or research study. There is a whole range of treatment options, medications and behavioural therapies, but they lack in solid evidences. There are a number of interesting studies around genetics but they too as well don’t lead to any conclusion. There are presently two drugs lined up for treatment, risperidone and aripiprazole, which show benefit in reducing some behaviours, including emotional distress, aggression, hyperactivity and self-injury.
May 2011 < www.ehealthonline.org <
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specialty
“One take home message for parents and caregivers is ‘use technology and assistive devices’ to unleash the potential of your child” Mythily Chari Founder Trustee, Commandur Foundation
Dr Roma Kumar, Senior Consultant, Clinical Psychologist, Sir Ganga Ram Hospital, believes in “Educational and communication focused interventions for treatment of Autism. With more than 35 years of empirical data supporting its efficacy Project TEACCH (Treatment and Education of Autistic and Related Communication-Handicapped Children) is an intervention programme model that integrates behavioural and cognitive theory, includes parents as cotherapists, and emphasises long-term treatment and support from early childhood through adulthood.”
There are various seminars being conducted across the globe along with a number of technological advances, which offer courses for such patients. Out of the numerous such programmes, one was funded by Autism Speaks Foundation in 2010 – “Innovative technology for Autism Spectrum Disorders” which united the fields of engineering, occupational science, neuroscience, psychology and anthropology to give a full view of the technological advances in the world of ASD. Such courses give a ray of hope to parents as they open up a whole new world to explore, learn and be optimistic to understand the lives of individuals with ASD. Teachers of autism patients are required to determine trends and monitor progress to
It is vital for behavioral clinicians and researchers to partner with programmers and engineers to create a technological product for revival and treatment for autistic patients. Teachers of autism patients are required to determine trends and monitor progress to document and analyse disturbing behaviour over weeks or even months document and analyse disturbing behaviour over weeks or even months. Dr Roma Kumar further adds, “The PECS helps autistic children spontaneously initiate communication, while learning the function of communication (Frost & Bondy, 1994). Impairments in
“Technology, the practical application of knowledge to a particular area, a core human ability aids in diagnosis and treatment of children with autism to lead satisfying and fulfilled lives” Dr Jitendra Nagpal Senior Consultant Psychiatrist Moolchand Medcity
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language development and communication are primary features of autism, and inadequate child communication can result in extreme frustration and serious maladaptive behaviours (e.g., head banging and tantrums). PEC has recently gained popularity because it promotes functional communication.” There is a device, called Selective Archiving, which records video of a classroom and saves the section of video to be analysed for behavior of the patients later. Another device, Visual Scheduler (vSked for short), which automatically helps students to point to an answer and if they pick the wrong one, the correct button shakes and turns colors. This further eliminates the need for a teacher to physically point to the right answer. The other
> www.ehealthonline.org > May 2011
such application is the Picture Planner, which is basically an icon based personal organiser to teach individuals with autism and other developmental and intellectual disabilities. Dr J Nagpal Senior Consultant Psychiatrist, believes that “There is a diverse application of technology-based interventions with children with autism, introduced as a temporary instructional aid to be removed once goals of behavior change have been met, such as tactile and auditory prompting devices to direct behavior; video-based instruction and feedback; computer-aided instruction to recognise and predict emotions, enhance problem solving, enhance vocal imitation and improve reading and communication; virtual reality affords incomparable control over the environment to promote learning; and robotics used to teach basic social interaction skills.” The latest in the league is the fully functioning prototype capture and access applica-
specialty
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specialty tion called ‘Abaris’. It is specially designed to support therapists conducting Discrete Trial Training therapy. This application increases the accuracy of data collection and reduces the amount of time the therapist spends doing manual calculations. The PECS Training Manual provides all of the necessary information to implement and guide readers through the six phases of training and provides examples, helpful hints, and templates for data and progress reporting. The LENA (Language Environment Analysis) system is digital language processor and language analysis software. It enables automatically labeled infant and child vocalizations from recordings and thereafter an automatic acoustic analysis designed by the researchers to show that pre-verbal vocalizations of very young children with autism are distinctly different from those of typically developing children with 86 percent accuracy. It is a supplement language enrichment therapy which allows parents to use technology at home. True Object Based Icons (TOBIs), cut outs of actual
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“Picture Exchange Communication System (PECS) helps autistic children spontaneously to initiate communication while learning the function of communication” Dr Roma Kumar Senior Consultant, Clinical Psychologist Sir Ganga Ram Hospital
shapes or outlines with printed word labels, is another application being used by educators to make autistic patients understand. Mythily Chari adds “Somehow children with autism are hardwired for machines. They take to the physics and mechanics like duck to water. Parents should introduce the children to the print or lexicon, be it through educational CDs, TV or the mobile phone.
> www.ehealthonline.org > May 2011
They can communicate by typing rather than speaking. We are indeed lucky to be in this age of technological innovation at every step to augment communication it can be utilized with innovation and imagination.” It is vital for behavioral clinicians and researchers to partner with programmers and engineers to create a technological product of revival and treatment for autistic patients.
spotlight
“We aim to create an IT-enabled network of specialised hospitals”
As the CFO of Columbia Asia Hospitals, Jagannath MS, delivers healthcare through the best model of hospitals and medical excellence. In conversation with Shally Makin, he discusses the innovative design of Columbia Asia hospitals and its aim to become the future hub of healthcare
What is your perspective on the healthcare providers’ industry in India vis-a-vis the world? ‘Ageing population’ and the challenge to meet their healthcare needs is perhaps the greatest challenge being posed to Government and healthcare providers worldwide. The ‘older population’ is the fastest growing segment in developed countries like USA and the most populous country like China. The population in the developed countries have good access and availability of healthcare. Post the recession recovery and the corresponding market changes the biggest challenge, the industry is facing is of keeping medical costs under control. The healthcare industry is therefore on the throes of innovation, with the advent of low cost equipment, effective and cheaper drugs (due to innovative clinical research), better medical methods and practices, effective systems including information technology enabled systems, etc. Most industry analysts estimate the growth of the sector to average 13-15 percent over the next few years. This has kindled the private sector and the government to invest in hospitals, laboratories, pharmacies, equipment manufacture, distribution and retail. Health insurance penetration and the growth of the middle class have significantly improved
and this will aid in bringing more hospitals into the business. The healthcare providers see this as a growth opportunity in India, given the global nature of this industry and the availability of high degree of medical expertise and lower costs in India; the west is increasingly seeing India as a quality medical destination. Please give us an overview of Columbia Asia Hospitals and its presence in the Indian private healthcare sector? Columbia Asia is an international healthcare provider operating a chain of modern hospitals across Asia. Columbia Asia hospitals are clean, efficient, affordable and accessible. The innovative design of Columbia Asia hospitals, from their manageable size to their advanced technology, is focused on creating the most positive experience for patients. Patient service, efficiency and medical excellence are all part of Columbia Asia’s model to deliver the best medicine. Columbia Asia has a total of 19 facilities across Malaysia, India, Vietnam and Indonesia, and there are plans for 15 new hospitals by the end of 2013. The company’s first hospital in India commenced operations in 2005 in Hebbal in Bangalore. Currently the company operates 7 hospitals and a clinic with presence in Bangalore, Mysore, Kolkata,
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spotlight Gurgaon, Ghaziabad and Patiala. How is Columbia Asia Hospital model unique as compared to other corporate hospitals? Columbia Asia offers high-quality & affordable health services to the middle class population of the country. An average hospital is about 100-beds and offers multi-speciality care to its customers. The optimum size of the hospital, well-defined medical program coupled with quality customer service and at an optimal price makes its model quite unique to be the preferred choice of businesses and families. Our average length of stay of our patients is approximately 2-2.5 days. This significantly helps to contain the cost of medical care for the patient and in turn the insurance companies and third party payers. We ensure that the communities around could enjoy the affordable medical care with uncompromising excellent medical care and services. What are the various technologies installed at Columbia Asia Hospitals? Columbia Asia has adopted a decentralised client server architecture platform enabled through Microsoft Technologies. Citrix is used as a platform to present our applications for remote usage inside intranet, LAN – Gigabit LAN with both Wired and Wifi, WAN – MPLS Mesh network subscribed from a single ISP; Security Layers are implemented via RSA (SSL VPN) for remote connectivity and usage from internet. Columbia Asia has developed its own Hospital Management System named ‘Care 21’. Care 21 is a Hospital Information Management Systems Software developed in-house by the Columbia Asia Hospitals. Columbia Asia Hospitals (CAH) utilises proprietary
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flow of radiology imaging and reporting and in-house blood bank management system. The company’s proprietary hospital information system operates at each of its hospitals, enabling seamless record-keeping and accurate billing. The doctors have the ability to call up patient medical records electronically and to make diagnostic and progress notes during a consultation. Doctors are able to order by computer lab tests, radiology scans and prescriptions from their office. All the above features enable an excellent patient experience – by enabling faster and accurate process.
operating software and service protocols in the management of its facilities. The Hospital management and Electronic Medical Record System of Columbia Asia is a comprehensive, Integrated and an advanced ERP (Enterprise Resource Program). The Software was developed using Microsoft’s Dot NET (.NET) Framework 2.0 which is quite a robust framework and expandable. What are the various health IT solutions installed and how are they benefiting you? The delivery of effective healthcare service to the customer requires the hospital’s systems and processes to be of a very high order. IT is used in every part of healthcare delivery to patients. Seventy percent of healthcare delivery is through IT enabled systems and environment-We have our own ERP application that helps us to manage our HIS, EMR, Administrative and Finance Functions, Lab Information Management Systems with Bi-directional communication to lab equipments, Completely integrated RIS and PACS that helps seamless work-
> www.ehealthonline.org > May 2011
Indian healthcare is struggling because of a huge lack of hospital beds? How can private entities like Columbia Asia help in bridging this divide? In India the lack of supply in terms of medical facilities is primarily in the Tier 2 and Tier 3 cities. As part of its strategy to have a national footprint, Columbia Asia is looking at such cities to expand its presence. The group is planning to have 17 hospitals established by 2013-14 which will result in an operating inventory of 2000 beds. The private sector has played a huge role in shaping the Indian healthcare industry. In such a scenario, the responsibility of leading corporate hospitals like Columbia Asia is huge. Please comment. The private sector accounts for 70-80 percent of the total healthcare expenditure in India, which is amongst the highest proportions of private healthcare spending in the world. The sector which is growing at over 15 percent CAGR is expected to be US $75 billion in 2012. Healthcare expenditure in India is expected to increase by 15 per cent per annum. This segment
is expected to constitute 6.1 per cent of the country’s GDP and employ around nine million people in 2012. As private players, the biggest issue is high capital expenditure incurred in our projects – especially land and building. Apart from this the private sector requires support in obtaining various clearances for obtaining land for hospitals and for other licenses for operating the hospital. Given the enormity of the numbers, the government’s role in establishing a framework for such growth is a key for private industry to grow. Government’s support in appointing single window agencies for land clearances and operational licenses besides providing finance and fiscal benefits for such projects would help bring in higher investment in this sector. Please provide the details of your expansion plans across the country and abroad. Columbia Asia has a total of 19 facilities across Malaysia, India, Vietnam and Indonesia, and plans for another 15 new hospitals by the end of 2013. What is your vision for Columbia Asia Hospitals in 2020? We aim to achieve electronics and IT enabled network of specialised hospital capable of handling patient care at their homes through technology. There will be advanced diagnostic capability through tele- networks at patient homes installed in the near future. The Columbia Asia group will introduce standard medical protocols which are capable of being enabled by equipment through tele-networks. Also, in patient care surgery, with advanced robotics we will deliver care, seamlessly across geographies with enabling technology.
Tech trends
The Information of Growth
Clinical information systems have come of age and the technology is fast bringing about a revolution in healthcare By Dhirendra Pratap Singh
T
he proliferation of information technology (IT) and other high technologies into medical imaging and diagnostic equipment in the last decade has resulted in the evolution of powerful new systems in the field of medical diagnostics. Clinical Information Systems (CIS) is information technology system which applied at the point of clinical care. These are healthcare information systems used by doctors, nurses and other healthcare providers to provide clinical care to patients.
Functions and utilities The CIS enables doctors to have a quick review of the previous medical history of patients. It also facilitates storage of digitised images of films and patient photographs album for each patient with patient’s date sequence. The system can be integrated with laboratory, diagnostics imaging, appointments, OPD billing and A/T/D modules. The availability of pre-defined medical record formats for each discipline makes easy storage and retrieval facilitates in maintenance of electronic record of the patient medical history, family history, diagnosis and treatment advised to the patient during each visit. All the departments, for instance, blood bank, pharmacy, laboratories are interconnected and linked to the system. Sharing the benefits of CIS in healthcare delivery, Sarath Anand Jupalli, Managing Direc-
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“The CIS sector is at the stage from where it will grow in leaps and bounds over the future course of time” Rothin Bhattacharyya Executive Vice President, HCL Infosystems
Tech trends tor, Shivam Software Solutions, says, “Clinical information system, today, is an essential component of hospital functioning system. It integrates all the hospital work flow processes—registration to outpatient, in-patient data storage to billing, scheduling of operations, duty rosters, biomedical functioning processes, purchase, finance to security.” The secret of success in implementing a CIS lies in designing and configuring the system to optimally suit the clinical workflow and processes of the concerned clinical environment, rather than trying to completely redesign the clinical workflow and processes of the concerned clinical environment to suit the CIS. Of course, this transition period presents an opportunity to improve and streamline the clinic’s workflow and processes for better efficiency. Rothin Bhattacharyya, Executive Vice President, HCL Infosystems says, “The sector is at the stage from where it will grow in leaps and bounds over the future course of time. On the provider side we are geared up to provide complete ICT solutions including HIS, LIS, RIS, ERP, PACS, Telemedicine and the IT infrastructure required by the provider segment. We are especially focusing on providing solution for clinical excellence and working towards solutions, which will allow collaboration among various care providers enabling a one patient one record scenario in the country.” He adds, “Our solutions will be hosted on HCL Cloud Ozone or private cloud of a healthcare provider and we believe that optimal care and patient safety are prime concerns of most of the providers and good clinical information systems would help to overcome these. This would lead to accountable care organisations towards which the provider segment is moving.” Experts advise health organisations to first implement the ambulatory EMR, get a
“CIS based on global standards, which are easily customisable for a region or country, would allow care delivery organisations to expand ensuring the same high level of care delivery efficiencies and reliability” Pankaj Vaish President – Healthcare IT, Religare Technologies Limited
Major Clinical Information Systems • Ambulatory or Outpatient CIS including the Ambulatory/OPD EMR • Inpatient CIS including the Inpatient EMR and CPOE systems • Speciality systems like the Emergency Department Information System, ICU Information System, CIS, and Oncology Information System • Ancillary Information Systems like LIS, PIS and RIS
feel of the electronic culture and the change it brings about, before going in for the more intense implementation of an inpatient EMR. From the patient’s perspective also it makes more sense, as normally a patient takes many more visits to the clinic or doctor’s office, than admissions into a hospital.
Standards and regulations The healthcare organisation must make sure the CIS implemented is compared to standards like HL7, DICOM, so and on, so that they can exchange data with other systems within the organisation. It will invariably be found that in due course of time, any standalone CIS system will have to start exchanging information with other systems in the organisation or even in the region. Pankaj Vaish, President – Healthcare IT, Re-
The CIS enables doctors to have a quick review of the previous medical history of patients. It also facilitates storage of digitised images of films and patient photographs album for each patient with patient’s date sequence
ligare Technologies Limited says, “Healthcare, which has been a leader in embracing science and technology to provide innovative ways to diagnose and treat diseases has been slow in leveraging IT. CIS including clinical pathways, care plans, electronic health records and CPOE help improve efficiency and accessibility of healthcare delivery. Huge investments on ambitious national EHR projects by countries like US and Canada is to ensure better quality of care at affordable price to all. The data from this initiative will help drive chronic disease management and research programs.” In conclusion, CIS have come of age and this technology is fast bringing about a revolution in healthcare, just like information technology brought about a revolution in other fields like finance, banking and travel. Those healthcare organisations that wish to be of international caliber will have to embrace this technology and implement it, as this technology will be a benchmark criteria in qualifying as a healthcare organisation of international standards. Pankaj Vaish says, “CIS that are based on global standards and easily customisable for a region or country, would allow care delivery organisations to expand ensuring the same high level of care delivery efficiencies and reliability. CIS systems will soon be the backbone of the healthcare IT systems, globally.”
May 2011 < www.ehealthonline.org <
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corporate
Lisinopril recall may not affect the company financially Drug-maker Lupin’s hypertension drug Lisinopril, in the US, recall will not have a major financial impact on the company. Lupin had recalled Lisinopril tablets of 30 mg in 100-count bottles, whose expiry date was October 2013, the US Food and Drug Administration said. The company-initiated recall was because of the “adulterated presence of foreign tablets.” The batch is recalled all together for one complaint whose total value of the batch is less than $15,000. The Indian drug companies have come up against quality-related concerns. The quality concerns could kill joy as the agency had indicated, as local drug-makers seek to tap the $96-billion-worth opportunity emerging from drugs going off patent between 2011 and 2013. There have been drug recalls from Aurobindo and Claris. There have also been quality concerns raised on the manufacturing facilities of companies including Sun Pharma and Lupin.
Rain Concert technologies chosen for public health project by Tanzania Health IT in India is increasing gradually with the number of players jumping in to the market place. Techopark-based Rain Concert Technologies has been selected as the technology solution provider and implementation partner for one of the largest public health projects of the Government of Tanzania. The whole program needs a unique Management Information System by the Rain Concert Technologies, flexible, web-mobile convergent technologies for effective implementation, management and analysis of this programme. The initiative of the National Institute of Medical Research, Tanzania is expected to be the largest m-health initiative in the African region.
Fortis healthcare accorded to acquire 86% in Religare Fortis Healthcare has accorded in-principal approval to acquire 86 per cent stake in SRL for an undisclosed amount. Super Religare Laboratories, which is one of the largest diagnostics providers, acquired Piramal Diagnostic Services Pvt Ltd (PDSPL) in August 2010 for Rs 600 crore to strengthen its presence in the radiology services. The board at its meeting also approved setting up of standalone dialysis centres and foray into standalone and in-hospital diagnostic centres. It has a stated target of opening at least 25 hospitals in India’s tier-II and tier-III towns over the next two years.
news
Vanguard health systems files for $600 million IPO Healthcare company Vanguard Health Systems, Inc. has filed for an initial public offer to rise up to $600 million, according to an initial Form S-1 regulatory statement filed with the U.S. Securities and Exchange Commission. For the fiscal year ended June 30, 2010 the company generated total revenues of $3.38 billion. The company generated revenues of $3.19 billion in fiscal 2009 and $2.78 billion in fiscal 2008. Vanguard Health intends to use the anticipated net proceeds from the offering to pay down some of it’s nearly $2.0 billion of debt and will use any remaining proceeds for general corporate purposes, including for acquisitions. The company also expects to retain future earnings, in the operation and expansion of our business.
India shares the highest vaccine market globally
Vaccines have emerged as one of the growth drivers of the global pharmaceutical industry India produces 60 per cent of the global health vaccines, emerging as one of the leading vaccine manufacturer in recent times. India generates revenue of $ 665 million in this space which was expected to reach $ 800 million soon. The Indian vaccine market is forecast to grow at 23 per cent from 2009-10 through 2011-12 registering revenues around $ 2 billion. The scare of the avian influenza, bioterrorism organisms and new emerging infections like SARS and the introduction of cancer and rotavirus vaccines have led to phenomenal growth in the vaccine market in the last few years. The Indian vaccine market share 70 per cent vaccines being exported with the total
domestic market, the private sector’s share stood at $ 120 million or at 40 per cent. The Indian market includes foreign majors like GSK, Sanofi, Eli Lily , and Merck to name some, essentially dominated by Green Signal Bio Pharma based in Chennai who have gained significant expertise in manufacturing practices for macromolecules with quality but at low cost and have capitalized on the rising global demand for affordable vaccines.
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news
Research
More kids exposed to ionizing radiation with CT scan
CT scans are being used on more and more children in the United States and this trend has concerned some health experts about the effects of radiation on this patient population. Repeated exposure to ionizing radiation emitted by CT scans can increase the risk of developing cancer. A study published this week in the journal Radiology said that in 1995 there were 330,000 children who were given CT scans in emergency departments of U.S. hospitals. But by 2008, the number has ballooned to 1.65 million. While specialized hospitals adjust the radiation dose for younger patients, general hospitals usually do not apply special CT scan protocols for children which can be subjected to adult-sized radiation doses. Modern health care technology has allowed clinicians to diagnose a condition quicker and better. The findings suggest that we may have to step back and consider the potential effects of CT scan tests and have them done only when absolutely necessary to reduce risks.
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Better bone health with green tea Drinking green tea and practicing Taichi may promote bone health of postmenopausal women and reduce the risk of inflammation, a new study suggests. The study findings by the American Association for the Advancement of Science (AAAS) focused on postmenopausal women and investigated the potential for green tea to work synergistically with Taichi in enhancing bone strength of postmenopausal women. Originating as a martial art in China, Taichi is a mind-body exercise that utilizes slow, gentle movements to build strength and flexibility, as well as deep breathing and relaxation, or vital energy, throughout the body. Carried out as a double-blind, placebo-controlled, intervention trial (the â&#x20AC;&#x153;holy grailâ&#x20AC;? of scientific studies), this experiment involved 171 postmenopausal women with the average age of 57 who had weak bones but not full-fledged osteoporo sis. Participants taking Taichi classes also reported significant beneficial effects in quality of life in terms of improving their emotional and mental health.
New trial can reduce cost and length of studies
Doctors at the Veterans Affairs Boston Healthcare System are testing a new kind of clinical trial thatâ&#x20AC;&#x2122;s not only less costly but guides doctors to switch to the best treatment even before the trial is completed. The new approach - called a pointof-care clinical trial - was developed by Stanford University biostatistician Philip Lavori, PhD, and a Boston-based team as an alternative to expensive, lengthy, double-blind, placebo-controlled clinical trials to compare drugs and procedures that are already in regular use. The high cost of medical care has spurred interest in weeding out costly, ineffective medical care, and in 2009, the economic stimulus package included $1.1 billion for studies, known as comparativeeffectiveness research, that pit one treatment against another.
Superbug research initiated by ICMR The scientists in Indian Council for Medical Research (ICMR) have invited research proposals from scientists across the country to study the superbug or the drug resistant bacteria. The Ministry of Health and Family Welfare announced a national antimicrobial policy to help address the issue of superbug which became international news after the presence of such bacteria (NDM1). This study was reported in the British medical journal The Lancet, to check the presence of such bacteria in India. It will jointly conducted by the Ministry and a special task force set up for the purpose. The project coordinator and the surveillance team setup for the purpose in selected tertiary care hospitals will implement the surveillance of antimicrobials.
> www.ehealthonline.org > May 2011
Research
Non-Invasively technology to monitor glucose levels Researchers at Freedom Meditech are developing devices that can non-invasively scan the eye to monitor glucose levels in people with diabetes. The devices are based optical polarimetry, a technique that measures the concentration of glucose in the aqueous humour, one of the fluids in the eye. The company has successfully completed a study involving rabbit models, in which the optical polarimetry technique was used to non-invasively measure glucose levels. Freedom Meditech chairman and CEO Craig Misrach said the company is pleased with the promising results of the study and is planning to move the research to the next phase of human clinical studies. “We believe that our proprietary technology could someday become a standard of care for quick and convenient glucose monitoring for people with diabetes,” Misrach said.
news
Early emphysema blood test developed Researchers at New York-Presbyterian Hospital’s Weill Cornell Medical Center, US, have developed a blood test which can detect emphysema well before symptoms occur. The test measures the levels of endothelial micro particles, which are particles shed by capillaries that surround alveoli (air sacs) in lungs. In a study, researchers enrolled three groups of people — healthy non-smokers, healthy smokers, and smokers with early evidence of lung destruction — and conducted a DLCO test. The researchers found a 95 percent positive correlation between elevated EMPs in the blood and an abnormal DLCO test result, which means that the test detected nearly all cases of early emphysema patients. According to researchers, as most cases of emphysema are caused by smoking, the test can warn smokers about impending development of the disease. Emphysema and chronic bronchitis are the twin disorders that constitute towards chronic obstructive pulmonary disease, the fourth leading cause of death in the US.
Product
Savina 300 – Made to Meet Healthcare Needs For more than a century, Dräger has been manufacturing innovative respiratory support systems. Its outstanding reputation in ventilation therapy has been built on this tradition of innovation and the quality and reliability of its ventilators. The Savina has already established an excellent reputation for dependability all over India with more than 1500 units installed all over the country. The Savina 300 has utilised Drager’s expertise in developing a ventilator that provides protective ventilation in your patient’s best interest, whereby it meets the users requirements of being easy to operate in any situation. Even when the going get’s tough, be it clinical challenges or infrastructural deficiencies, Savina 300 steadily work at your side. Savina 300 offers a range of ventilation modes that enables to provide protective ventilation to patients of any acuity level. The turbine system eliminates the need for a central gas supply or an external compressor. Stress-free spontaneous breathing at any time and at any pressure level helps to stimulate the patient’s respiratory drive, thus reducing weaning times. With its large touch screen, patient data is easily visible from any angle. The Savina 300’s modern and friendly design contributes to a healing environment and results in the kind of reliable “workhorse” need for everyday clinical routine.
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news
technology
Health Application in Demand
Straub Clinic and Hospital and Kauai Medical Clinic becomes the first healthcare facility centre to allow patients to access their medical records from an iPhone, iPad or iTouch using a new, free mobile app called My Health Advantage. This application allows patients to view test results, send secure messages to their physicians, manage appointments and review a list of their medications. They can also receive health reminders and manage their families’ healthcare information. The aim of this application is to change the way healthcare is provided and to really put patients in control of their own information. The best advantage of this application My Health Advantage is to improve communication between patients and physicians. Patients with a medical question can send messages directly to their doctor and could receive a response in minutes. The problem still lies that the application is expensive, so the providers have to find ways to reduce the cost and improve efficiency by making it more convenient and accessible for patients and doctors. This application “My Health Advantage” can be downloaded for free from the iTunes App Store.
Digital patient records implemented A health information technology provider, Verizon and MEDfx, announced to implement a digital format for paper records. This program although faced a lot of issues regarding the complexity and cost of adopting an electronic system, and the incompatibility of many health IT systems. Whereas, the main aim of the program was to undertake health information exchange-based demonstrations to integrate two key federal government health IT initiatives to improve care management through secure, two-way exchange of patient health information. The federal guidelines for health IT adoption and secure electronic data exchange actually work; this pilot program is leading the way to the widespread adoption of electronic medical records and the transformation of the U.S. health care system. The portal transfers the caremanagement documents, making them accessible on a wide variety of health IT systems.
High Speed network for telemedicine The broadband network has now promised to provide high speeds to meet day to day healthcare needs. The telehealth experts are waiting for the new technology to save a lot of money and time. The tech savvy people will now get their healthcare facilities with the upgrading technology. Local nurse uses broadband technology to get an urgent online consultation from a specialist in Melbourne for a seriously ill nine-month old baby boy. There was a huge decrease in white cell count has come through as 20,000 over the video link-up, with the baby visible to a specialist on his screen. Based on the symptoms seen and heard down the line, the specialist decides to take no chances. The specialist now advises the parents about the serious infection treatment and is to be taken to a specialist as soon as possible. Even with the current slower speeds, doctors can already see the benefits in saved travel time. The technology has got to a point in telehealth where you can have a high definition video conference; you can have it stay up. It won’t drop out and you basically end up in a situation where the clinicians are starting to accept it as a technology, as a tool of trade.
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Patient Info goes online Google and Microsoft let NHS patients in England to host their medical records with companies under proposals detailed by the Department of Health’s CIO. The patients can view an electronic version of their medical records are generally restricted to viewing their Summary Care Records through the NHS Healthspace website. The use of private services to store health records made healthcare services a commercial entity such as Google Health and Microsoft HealthVault as a cheaper alternative to viewing records through the NHS Healthspace website. The market is expected to provide these tools rather than the DoH. The Healthspace site was criticised earlier this year after figures revealed that fewer than 3,000 people were using the portal to view their medical records. Department of Health will publish an information strategy setting out how the department would bring about a “free flow of information in the health system”. Another way of improving information sharing that is being considered, to share information online about their experiences of a particular hospital, GP surgery or medical procedure.
technology
Carestream Sells 100th DIRECTVIEW Vita CR System
Carestream Health India sold its 100th DIRECTVIEW Vita CR System, which was launched in Oct., 2010. Carestream Health’s engineers used innovative design methods and components for the desktop Vita CR platform, which combines high image quality with reliability, a compact footprint and an affordable price tag. Globally, Carestream Health has shipped 1000 DIRECTVIEW Vita CR Systems till date & counting “Sales have exceeded our expectations and our company has boosted production capabilities to keep pace with worldwide demand. The company’s Vita CR system is being purchased by independent imaging centers, clinics, multi-physician offices and orthopedic facilities who want an affordable, compact CR system that is also easy to use. “These facilities want to implement digital imaging technology and many are choosing the Vita CR platform to make that conversion,” Mr. Chatterjee added. Carestream Health features a comprehensive portfolio of CR.
Sun Pharma joins with Merck for Drug Delivery Systems Sun Pharmaceutical Industries and U.S.-based Merck & Co. of a joint venture has nearly tapped the increasing demand for affordable high-quality medications for chronic diseases, such as heart ailments, diabetes and hepatitis in emerging market countries. The companies will develop certain drugs which will be manufactured and Merck will help in clinical development through a global network. The companies say the opportunity is huge. And 75% of that growth is expected to come from branded forms of generic drugs–the kind that the joint venture plans to sell. The new delivery systems for copies of existing drugs allows them to sell them under their own brands in emerging markets where intellectual property laws which develop markets in US and UK. For its drug delivery system projects the firm needs about two billion rupees ($44.85 million).
news
Sonography, a useful diagnostic method
Soft tissue foreign bodies are a common cause of orthopedic consultation in emergency departments. It is difficult to confirm their existence because conventional radiology only detects radio-opaque foreign bodies. Sonography can be a useful diagnostic method. The aim of this study is to evaluate diagnostic accuracy of sonography in detection and localization of non-opaque foreign bodies. A single radiologist performed all examinations with six years’ experience in musculoskeletal Sonography. We detected and localized the presence of the foreign body in the soft tissue as guidance for facilitating the surgery. Surgery was performed in 39 patients and 44 foreign bodies were removed. Sonography is a useful modality in detection and localization of radiolucent foreign bodies in soft tissue which can avoid misdiagnosis during primary emergency evaluation.
Bio medical procedures reinvented Scientists have discovered that low energy electrons could damage the DNA. The experiments were conducted on liquid face of thin films of DNA indicated that low energy electrons may cause single strand or double strand breaks in the DNA. Researchers shot ultra-short pulses of high-intensity laser light through a quartz tube containing a mixture of DNA molecules and water. The strong laser light created hot plasma (like in the sun) and broke water molecules into various constituents including electrons and hydroxyl (OH) radicals, which reacted with the DNA to alter it. The DNA, on exposure to the laser beam got fragmented and became a linear entity showing breaks in the DNA structure. Such experiments are giving good results as per researchers as the findings would have implications in reducing the damage caused by lasers used in biomedical applications, genetic engineering and biotechnology.
May 2011 < www.ehealthonline.org <
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