asia’s first monthly magazine on The Enterprise of Healthcare
eHealth Magazine
volume 9 / issue 05 / May 2014 / ` 75 / US $10 / ISSN 0973-8959
Best of West
New Era in Urology Mobile Health Dials In Telemedicine Market Booms
Hospitals
Dr Hafeez Rahman Chairman, Sunrise Group of Hospitals
Sid Nair VP and Global General Manager, Dell Healthcare Services
Kanchan Jeswani Product Manager, Transasia Bio-Medicals Ltd
Dr Rajeev Boudhankar VP, Kohinoor Hospital
Bomi Bhote CEO, Ruby Hall Clinic
Dr Ramakant Panda, VC & MD, Asian Heart Institute
Making Healthcare A Reality for All Page-34 Printers Still Hold the Sway... ehealth.eletsonline.com
27th June, Pune, Maharashtra
volume
09
issue
05
ISSN 0973-8959
Contents
cover story
12- New Era in Urology 14- Urogynaecology Miles to go… Dr Amita Jain, Consultant Urogynaecologist, Medanta
16- Robotic Surgery Promises
better Outcome Dr Rajesh Taneja, Senior Consultant, Urology, Apollo Hospital
18- Holmium Laser Unfolds a new Era in Urology Dr Anil Kumar Varshney, Director Urology, Max Healthcare
special focus
20- Making Healthcare a Reality for All
22- Boutique Hospital that adds Comfort to Care Bomi Bohte, CEO, Ruby Hall Clinic
24- Messiah of Cardiac Shrine… Dr Ramakant Panda, VC & MD, Asian Heart Institute
25- Keyhole Surgery will be
Mainstay across all Specialties Dr Hafeez Rahman, Chairman, Sunrise Group of Hospitals
28- Mecca of Surgeons Dr Rajeev Boudhankar, VP, Kohinoor Hospital
30- Evolving trends in
Hematology Automation Kanchan Jeswani, Product Manager, Transasia Bio-Medicals Ltd
32- 7 Billion Medical Images on Cloud Platform
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Sid Nair, VP and Global General Manager, Dell Healthcare Services
46- mHealth will be a `3,000
tech trend
Crore Market Dr Ruchi Dass, CEO, HealthCursor Consulting India
36- Delivering health in your
48- Mobility - A Paradigm Shift
hands
39- mHealth Benefits People
who have Little Access to Services Dr M Beena, MD, NRHM Kerala
42- The Service is No Different
than Seeing Your General Practitioner Nitin Goyal, Operation and Business Head, mHealth, Healthfore Technologies
for Indian Healthcare Girish Murti, Director Consulting and Pharma Vertical Leader, Capgemini India
50- We Provide Second Opinion from Specialists Shekhar Sahu, Co-Founder, HealthcareMagic
Specialty
44- Curing Sickness to Ensuring 58- Every Child is Our Child Wellness Harish Natarajan, CEO and Suresh Sarojani, CTO, HCL Avitas
Dr Neelam Mohan, Director, Dept of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta
in person
56- Alleviating patient’s Suffering in a Caring Way Dr Sushma Bhatnagar, Professor and Head of Anesthesiology, AIIMS
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asia’s first monthly magazine on The Enterprise of Healthcare volume
09
issue
05
may 2014
President: Dr M P Narayanan
Partner publications
Editor-in-Chief: Dr Ravi Gupta
Editorial Team
WEB DEVELOPMENT & IT INFRASTRUCTURE
Health Sr Assistant Editor: Shahid Akhter Correspondent: Ekta Srivastava governance Sr Correspondent: Kartik Sharma, Nayana Singh Research Associate: Sunil Kumar education Sr Correspondent: Mohd. Ujaley, Ankush Kumar Correspondent: Seema Gupta
Team Lead - Web Development: Ishvinder Singh Executive-IT Infrastructure: Zuber Ahmed Executive – Information Management: Khabirul Islam Finance & Operations Team Sr Manager – Finance: Ajit Sinha Legal Officer: Ramesh Prasad Verma Executive Officer – Accounts: Subhash Chandra Dimri Manager Events: Nagender Lal
ICE Connect Assistant Editor: Rachita Jha Correspondent: Veena Kurup Sales & Marketing Team Assistant Manager: Vishukumar Hichkad, Mobile: +91-9886404680 (South) Manager - Sales: Douglas Digo Menezes, Mobile: +91-9821580403 (West) Subscription & Circulation Team Sr Executive - Subscription: Gunjan Singh, Mobile: +91-8860635832 Design Team Assistant Art Director: Shipra Rathoria Team Lead - Graphic Design: Bishwajeet Kumar Singh Sr Graphic Designer: Om Prakash Thakur Sr Graphic Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th Floor, Annexe Tower, C-25 , Sector 62, Noida, Uttar Pradesh 201309, email: info@ehealthonline.org Phone: +91-120-4812600 Fax: +91-120-4812660 ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media A-29, Sector-8, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.
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editorial
Technological Advancements set to Usher in a Sea Change India has emerged as one of the superpowers with huge potential for growth on several fronts. The country is one of the key catalysts for global economic and social changes. The latest trends in healthcare industry speak volumes about its promising new landscape with ICT being the cornerstone of its rapid growth trajectory. Healthcare industry is swarming with a new crop of entrepreneurs entering the dynamic macrocosm of healthcare to make it up to the snuff. Nearly 80 percent of the total healthcare expenditure comes from the private sector. India’s healthcare sector is expected to advance at CAGR of 15 percent during 2011-17 to reach USD 158 billion. India’s 1.7 billion people look to public service for all their healthcare needs. Public-private partnership is all-important for healthcare services to reach far-off areas in India. Telemedicine has come as a bucolic boon in our country. The high penetration of mobile phone technology in our country has boosted up mHealth initiatives. With an EHR, lab results can be retrieved much more rapidly, thus saving time and money. Technological advancements have affected a sea change in almost all verticals of healthcare, including urology. Today, every aspect of urology has braced a shimmering change. Thanks to the technological miracles that have affected the breakthroughs and changed the course of action. We take a look at some of the makers and shakers in urology. Advent of robotic surgery and induction of laser are two of the most prolific ice breakers today. We discuss these issues in depth with the pioneers and stalwarts in the respective fields. The issue is a special focus on the multispecialty hospitals of the western region. Through series of interactions, we have analysed the work done by the private hospitals. Moreover, we have insights from an array of mHealth providers along with a special survey report on the use of printers and papers in today’s paperless technology -driven world.
Dr Ravi Gupta ravi.gupta@elets.in
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news
World’s first artificial Heart Transplant For the first time, an artificial heart that may give patients up to five years of extra life has been successfully implanted in a 75-year-old French man. The artificial heart, designed by French biomedical firm Carmat, is powered by Lithium-ion batteries that can be worn externally. The heart that was put into the patient at Georges Pompidou Hospital in Paris uses a range of “bio-materials”, including bovine tissue, to reduce the likelihood of the body rejecting it, The Telegraph reported. This device is intended to replace a real heart for as many as five years, unlike previous artificial hearts that were created mainly for temporary use. The heart weighs as little as less than a kg almost three times as much as an average healthy human heart. The device mimics heart muscle contractions and contains sensors that adapt the blood flow to the patient’s moves, the report said.
Environment an important factor to understand Autism
The study led by researchers at King’s College London, Karolinska Institute in Sweden and Mount Sinai in the US, looked at over 2 million people and found that environmental factors are more important than previously believed in understanding the causes of autism, and equally as important as genes. The study also shows that children with a brother or sister with autism are 10 times more likely to develop autism. Environmental factors are split into ‘shared environments’ which are shared between family members (such as family socio-economic status), and ‘non-shared environments’ which are unique to the individual (such as birth complications or maternal infections or medication during the pre and perinatal period). In this study, factors which are unique to the individual, or ‘non-shared environments’ were the major source of environmental risk.
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Robotic surgery Preserving Kidney Function In a ground-breaking study, researchers at Henry Ford Hospital’s Vattikuti Urology Institute in Detroit, Michigan, found that patients who received robot-assisted partial nephrectomy to treat kidney cancer had minimal loss of kidney function - a smaller amount even than patients with normal kidney function. Partial nephrectomy or kidney-sparing surgery removes only the diseased part of the kidney sparing the healthy, functioning kidney tissue.The researchers collected data from nearly 1,200 patients who underwent RPN between 2007 and 2012. Outcomes of patients who had pre-existing chronic kidney disease with decreased kidney function before surgery were compared against those with normal kidney function. The researchers found that patients with chronic kidney disease had a lesser amount of decline in kidney function after RPN than those with normal kidney function, when measured at their first followup exam and later visits, concluded the study.
New aggressive strain of HIV found in West Africa
Researchers at Sweden’s Lund University have discovered that a new and more aggressive strain of HIV which was discovered in West Africa causes significantly faster progression to AIDS. The new strain of AIDS is called A3/02 and was discovered in 2011 and is formed when two of the most common strains fuse together. So far, the strain has been restricted in the West African country of Guinea-Bissau. HIV-1 and HIV-2 are the two mains trains of HIV with HIV-1 being the most common. But within those two categories, there are numerous subtypes. The HIV virus can even mutate inside an infected person, according to the WHO.
news
TB patients in India face increasing threats of Diabetes According to International Diabetes Federation estimates, there are 382 million people living with diabetes worldwide and it would increase to nearly 600 million by 2035. About 80% of these people are living in low and middle income countries. In India, about 64 million people are affected by diabetes and more than 70 million are at risk of developing diabetes in the near future. 10 among 100 people in India are living with diabetes. A study was conducted by Prof M Viswanathan Diabetes Research Centre among TB patients registered in selected 5 tuberculosis units in India for DOTS treatment. More than 800 TB patients were screened for diabetes using 2hr OGTT test under this The key findings of the study are 25.3% of TB patients had diabetes and another 24.5% had pre diabetes. Out of 25.3%, more than 9% were newly detected and 16% were already diagnosed with diabetes. Nearly half of the subjects, who had TB and diabetes, had infectious form of pulmonary TB.
Text technology tracks vaccine safety quickly A text messaging system that delivers near real-time monitoring of adverse effects from vaccinations has the potential to make the administration of vaccines safer and more effective, according to research published in the Medical Journal of Australia. A group of researchers led by Perth-based general practitioner Dr Alan Leeb used prototype software called SmartVax to send vaccinees an SMS asking if they had experienced an adverse event following immunisation (AEFI) and requesting a reply. Of 3281 patients vaccinated over 19 months, 3226 (98%) had a mobile telephone number in their record and were sent a text. Over 72% responded, with 11% (264) reporting an AEFI, mostly minor systemic or local reactions. Over 80% of the responses were received within 2 hours of transmission of the query SMS. The high response rate and timely response could be valuable when an urgent investigation into potential vaccine safety issues is necessary”, wrote researchers.
Thwarting counterfeiters with new type of barcode Counterfeiters, beware! Scientists are reporting the development of a new type of inexpensive barcode that, when added to documents or currency, could foil attempts at making forgeries. Although the tags are easy for researchers to make, they still require ingredients you can’t exactly find at the local hardware store. Their report appears in the Journal of the American Chemical Society. Xiaogang Liu and colleagues explain that scientists have used fluorescent and DNA-based barcodes, or tags of known composition and sequence, in attempts to develop tests for cancer and other diseases. But their high cost and faint signal have hampered their application in security inks. One estimate states that about $220 million in counterfeit bills are currently in circulation just in the U.S., and there’s no way to tell how many other “official” documents are fake.
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FDA announce proposal to regulate e-cigarettes As part of its implementation of the Family Smoking Prevention and Tobacco Control Act signed by the President in 2009, the U.S. Food and Drug Administration proposed a new rule that would extend the agency’s tobacco authority to cover additional tobacco products. Products that would be “deemed” to be subject to FDA regulation are those that meet the statutory definition of a tobacco product, including currently unregulated marketed products, such as electronic cigarettes (e-cigarettes), cigars, pipe tobacco, nicotine gels, water pipe (or hookah) tobacco, and dissolvable not already under the FDA’s authority. The FDA currently regulates cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. “This is an important moment for consumer protection and a significant proposal that if finalized as written would bring FDA oversight to many new tobacco products,” said FDA Commissioner Margaret A. Hamburg, M.D.
in focus
STERRAD Changes the
Face of Sterilisation “Products like STERRAD have changed the face of sterilization practices in hospitals. On the one hand, there is a need to have an assurance of sterility, on the other it is needed to have a method that can protect delicate instrumentation that is invariably part of advanced medical care. STERRAD scores on both counts,” says Dr Venkatesh Krishnamoorthy, Chairman and Chief Urologist, NU Hospitals, Bangalore
M
edical institutions, while striving to save lives, risk passing infections to patients themselves. In spite of efforts to keep hospitals sterile, Hospital Acquired Infections (HAI) or Nosocomial infections do happen. The risk of HAIs for urologists is even more, as they do invasive procedures involving delicate instrumentation. A study of hospitals in Goa revealed that one-third of the patients contracted HAI during their stays, with urinary tract infections being the most common. But Dr Venkatesh Krishnamoorthy, Chairman and Chief Urologist, NU Hospitals, a leading specialty Nephro Urology hospital in Bangalore remains upbeat about combating HAIs even in the face of such dismal statistics.
Dr Venkatesh feels urology has been in the forefront of technological advances in medicine, and urologists have adapted to newer instrumentations quickly. He conceded that the practice of urology has changed from when he was a post-graduate about 20 years ago, adding that research into understanding how the urinary tract works has changed the treatment of many diseases. Not only is the pace of change rapid, he says, but new fields like stem cell research and its applications in urology are promising and exciting. Dr Venkatesh feels hospitals have realized that their reputation hinges on how successfully they prevent HAI, and they boast of technological advances to that extent, since there can be no greater embarrassment to professionals than to face the consequences of HAI. He says HAIs complicate a patient’s recovery, at the same time increasing recovery costs for the family manifold. Speaking of HAIs at NU Hospitals, Dr Venkatesh said they have has focused on its prevention for nearly two decades. He points out that NU Hospitals was the first to introduce hand hygiene at all points of patient care. Not only did they implement it, but they also ensured its compliance by nearly 95 percent.
STERRAD, helping patients Urology involves the use of sensitive and delicate instruments. Dr Krishnamoorthy says STERRAD has helped NU Hospitals’ sterilization practices with its rapid turnaround time and unprecedented in efficacy. NU Hospitals was among the first in Karnataka to use the plasma sterilization method. He says the reliability of the equipment and the fact that STERRAD immediately points out an incomplete cycle in the sterilization process provides a sense of security. He further says that STERRAD protects the delicate instruments that are a part of advanced medical care, at the same time providing an assurance of sterility. Also, STERRAD helps reduce the use of antibiotics in treatments.
Changing face of HAI Dr Venkatesh feels the benefits of preventing HAIs far outweigh STERRAD’s initial or operational costs, if the instrument is used optimally and judicially. He says that as urology as a discipline inducts more delicate instrumentation, the use of plasma sterilization must go parallel with these acquisitions. STERRAD is an indisputable accompaniment to advances in instrumentation, he says.
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cover story Health IT
urology
New Era in Urology
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T
echnological advancements have affected a sea change in almost all verticals of healthcare, including urology. Every aspect of urology has changed the way the specialty is practised. Da Vinci has taken surgery beyond the limits of human hand. Laser promises precise, char free and virtually bloodless incision. Immunologic mismatch will no longer be a barrier between living kidney donors and recipients. ‘No Touch Technique’ in conjunction with the antibiotic and lubricious coating are the latest penile implants. To relieve blocked urine flow in the elderly, permanent implants (FDA-approved) have been developed. The list of medical miracles and breakthroughs in urology is simply endless. In Uro-oncology, the most common major surgery was and continues to be radical cystetctomy. The incidence of various tumours in this domain has remained the same and the bladder cancer forms the most common tumor. Until 1980, it was the era of radiotherapy and cystectomy was simply a salvage procedure. Ureteroscopy has almost replaced surgery in the treatment of ureteric stone. Calculi in the upper tract lies within the reach of traditional extra corporeal shock wave treatment, ureteroscopy has gained wider popularity for stones situated in the iliac. Again, ureteroscopy has an edge in patients who have larger calculi. Earlier, ureteric stones required blind basketry and open surgery but this has been replaced by ESWL (Extra Corporal Shockwave Lithotripsy ). Ureteroscopy with laser lithotripsy has emerged as first line therapy for ureteral calculi. Despite all advances, men’s health in India continues to be in shambles. It is yet to be included in the national programme! With a load full of urological problems in a country of 1.3 billion, we have just a handful of urologists. Prostate cancer continues to be the second most common cause of cancer in men. Globally, it is the sixth
Infertility is a Male Factor too Diabetes and hypertension are the commonest causes of organic erectile dysfunction. Due to a large number of diabetic men in India, erectile dysfunction is very common but very few men receive treatment, either because they do not know that treatment is available or because they are too embarrassed to seek help. Infertility affects 1 in every 7 couples and in more than half of these cases the male factor is responsible, solely or partially, for the problem. Despite this, men are reluctant to get tested and often the women are pushed in for medical investigations.
Urology has always been at the vortex of minimally invasive procedure that has changed the face of surgery leading cause of cancer-related death in men. In India, it is growing by 1 percent every year and people are caught unaware. Prostate cancer is mostly a very slow progressing disease. Men who die of old age, may not have realized that they had prostate cancer. Studies indicate that nearly fifty percent of all 50 year old men have PIN (Prostatic intraepithelial neoplasia).
Prostate Cancer One new case of prostate cancer occurs every 2.5 minutes and a man dies from prostate cancer every 17 minutes. As it is a slow growing cancer, the survival rate is high
It all begins with tiny alterations in the shape and size of the prostate gland cells. It remains confined to the gland, progresses slowly and may not cause a serious harm. However, the cancer may escalate at an alarming rate and require urgent medical assistance . In May 2013, the US FDA approved radium Ra 223 dichloride for metastatic castration-resistant prostate cancer that has reached bones but not other organs. In India, every seventh couple is infertile and male factors account to 50 percent of the infertility. Male infertility is labelled only after semen analysis. The causes may be as simple as stress and smoking, while other reasons may be infections, hormonal disorders or genetic issues. Proper diagnosis is required to arrive at a conclusion. Other sex-related problems like erectile dysfunction, premature ejaculation and hypogonadism are emerging at an alarming rate. Other uro issues like frequent urination, bladder problems, kidney disease, incontinence, etc deserve an early detection and treatment. Nearly 1.5 lakh people in India suffer from renal failure but only 4,500 renal transplants are done each year. There are still challenges and loopholes in organ transplant programm. It is time to address them so that we can develop an ideal networking for organ retrieval and sharing.
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cover story
urology
Urogynaecology -Miles to go... Dr Amita Jain, Consultant Urogynaecologist, Medanta Institute of Kidney & Urology, discusses with Shahid Akhter the surge in genitourinary complaints What is urogynaecology all about? Urogynaecology is a sub-specialty which deals with conservative and surgical management of women with urinary or faecal incontinence, persistent genitourinary complaints and disorders of pelvic floor supports.
Why do we need a dedicated setup for this? The life expectancy for women has almost doubled through the 20th century and around one-third of all women suffer with these problems, at least once in their lifetime. These conditions are more common than commonly known disorders like hypertension, depression, or diabetes. Moreover, a dedicated urogynaecology clinic provides complete one-stop care to patients, helping them avoid too many visits to other specialists like gynecologists, urologists and colorectal surgeons for treatments.
What intricacies did you face in establishing this subspecialty setup? Contrary to common notion, lack of money, education or resources is not a constraint for private sector in India. There are some common myths both among care seekers and care providers that these are just natural part of aging. Either nothing can be done about it or only surgery is the solution, which is not justified for these minor ailments. Next challenge is lack of reporting. Associ-
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ated social stigma makes sufferers feel ashamed of mentioning their problems. In Indian scenario, as for the other functional disorders not involving the immediate threat to life, the patients are usually resigned to the fate of bearing the dysfunction, due to an extreme sense of modesty and considering the malady as relatively insignificant probably due to lack of education and the low priority of these disorders impacting their quality of life. They land up doing other measures just to hide these, rather perhaps will come to take treatment of intolerable consequences like Urinary Tract Infections (UTI) and sometimes fractures, but will be reluctant to reveal their actual problems. This results in lack of data. In India, we do not have substantial data, as only few small-scale studies covering small set of local population are available. Therefore, we largely depend on world statistics. These data represent only tip of an iceberg, due to under reporting at outpatient clinics. For example, most women live with their Urinary Incontinence for approximately seven years before reporting symptoms. That’s the reason W.H.O. declared incontinence as an international health concern i n
1998. Other issue is lack of responsibility. Age-old territorial conflict between urologist and gynaecologist has delayed the implementation of initiatives and impeded the growth of this specialty. In nutshell, due to these intricacies and lack of substantial data, hospital administrations are not sure whether investing money in this specialty will give revenue in future. Also the new breeds of doctors do not feel confident about choosing this specialty as a career because dedicated structured training programmes are not available. This results in shortage of manpower.
How did you deal with these challenges? We targeted two of these challenges. First, lack of awareness, which is common between both care seekers and care providers and secondly, lack of data. To spread awareness among care seekers, we put attractive standees with eye catching information at Out Patient Department (OPD) area and other different crowded locations. We targeted every specific ailment separately by organising a dedicated internationally recognised week and kept special programmes like free consultations, patient awareness sessions to promote patients’ confidence in seeking help. To spread information, we used posters with small catchy slogans. We pasted them at the back of toilet doors to make sure that these should be noticed. We took help of media by publishing news articles regarding the disease in newspapers of various cities of India targeting different set of population. We asked our previously treated patients to come forward and to share their experiences with other sufferers. It is easier for new patients to shed the taboo of social stigma by clearing their doubts with already treated patients. We also initiated a social group with these patients to provide telephonic conversation, whenever required. We organised workshops and dedicated
UTI - A Global Concern In 2003, around 34 million women worldwide were estimated to have prolapse and about 50% of postmenopausal women had some degree of prolapse. Similarly, Urinary Tract Infections (UTIs) affect 40 percent of females in their life time and incidence increases from 1—2 percent to 20 percent as they grow old. Incidence of urinary incontinence also increases from 10—25 percent to 15—40 percent beyond the age of 60. camps all over India. Next challenge was the awareness among care providers. For which we conducted various workshops and CME, targeting both urologist and gynaecologists. We also established advisory panels with dedicated doctors working in this field to plan future strategies. To convince administration for funds an internal study was done on young newly recruited hospital staff, maximum between 21 to 30 years age
The concept of Urogynaecology is not new for western countries, but the situation is very disappointing in developing countries group. A set of questions both in English and regional languages was distributed among them. A noticeably high prevalence of all kinds of incontinence was found and it was significantly higher in women as compared to their male counterparts. All these efforts resulted in gradual increase in numbers of OPD patients in Urogynaecology Clinic, specially the referrals.
What is the future scope of this field in India? The concept of Urogynaecology is not new for western countries, but the situation is very disappointing in developing countries. As you have understood, it is not that urogyneacological problems are less common, but doctors not doing dedicated practice in this field generally consider these patients as out of their scope. Hence, these conditions have been inadequately treated and poorly addressed by medical professionals, despite available treatments substantially improving health, self-esteem and quality of life of patients. However, over the last decade there has been a remarkable change in the attitude of patients in our society due to education and improvement in socioeconomic conditions. Patients are now demanding relief from functional disorders such as incontinence. Surgical interventions for genuine stress incontinence are becoming more and more frequent, but due to the lack of highly sophisticated investigation facilities like urodynamics or dynamic MRI at remote areas, failures are still considerable. Though we are able to overcome most of the hurdles, but still we require attention of our designated registered societies run by most acknowledged authorities, which can support us in fulfilling our aims of introduction of subject in medical curriculum at graduation level, well structured hands on training programmes in collaboration with recognised organisations and also the dedicated funds to run specialty units both at public as well as private sector.
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cover story
urology
Robotic Surgery Promises better Outcome Dr Rajesh Taneja, Senior Consultant, Urology, Andrology and Robotic Surgery, Apollo Hospitals, New Delhi, in conversation with Shahid Akhter, ENN, shares his da Vinci thoughts on Urology What are the latest advancements in Urology? Urology is one of the fastest evolving branches of clinical medicine. In last two decades, the advent of lasers, induction of Robotic system of surgery, miniaturization of ‘uro endoscopes’ and improvements in laparoscopic equipment have caused a paradigm shift in the way the surgical procedures were carried out earlier.
How does the robotic surgery impact and influence urologic conditions like kidney disorders or cancers of the kidney, bladder and prostate? Robotic surgery has changed the way the surgery of cancers of urinary tract are dealt with today. Cancer of prostate which is localized to the confines of the organ, needs to be treated by surgical removal of entire prostate along with its coverings. The reconstruction of the urinary tract involves stitching of the bladder neck with the exit pipe called urethra in the deep confines of the pelvis. This was very difficult during open surgery or even laparoscopic surgery. The presence of ‘endo wrist’ instruments have ensured that the reconstruction remains as close to the original. It is a great improvement when compared to the earlier procedures.
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The ability of the surgeon to save the nerves responsible for sexual function during this procedure has also been improved with better and earlier return of male sexual function in the patients. Better vision and precise cutting apparently result in better cancer control also. The recovery from operation is quick as most patients are walking and taking light meals by the next morning. Regarding the cancers of the kidney, if a small cancer is detected it can be safely removed from the body using Robotic surgery while saving the kidney behind. This can be done effectively because of the better vision and maneuverability of the robotic camera along with quick and precise stitching technique used for repair of the defect in the kidney caused by removal of tumor. This is technically termed as ‘Nephron sparing surgery’. The drainage system of the kidney called ‘pelvi-calyceal system’ needs to be meticulously closed in order to avoid the leakage of urine in the post operative period. If the tumor is located in certain critical locations of the kidney, it may not be possible to perform Nephron sparing surgery by any modality including Robotic surgery. Robotic system has been used with advantage to treat the cancers of the urinary bladder, testes and penis. For muscle invasive cancers of urinary bladder,Robotic assisted Radical Cystectomy with totally intracorporeal reconstruction of urinary diversion or ‘Neaobladder’ using intestinal segements
is possible with currently established technique. Robotic surgery for cancers of testes and urinary bladder is useful to remove the lymph nodes which have got involved by the disease process. The advantage of Robotic surgery can be delivered to the patients in more useful manner when the disease is detected at an early stage. Therefore, public education and cancer screening programs have a long way to go if the benefits of robotic surgery are to be fully utilized. The idea of these screening programs is to detect cancer before it announces itself by way of symptoms. Usually, if the symptoms have already appeared, the disease has transgressed the boundaries of the organ of origin, making it incurable.
precise with good out comes while inflicting minimum pain to the patient.
Please throw some light on the advantages and disadvantages of robotic surgery.
How about the trained surgeons who can successfully handle the da Vinci procedure in India ?
The advantages of Robotic surgery are: Better3D vision as the camera has a twin objective lens installed at the inside end and the vision is captured digitally and transmitted to the consol as a high definition 3D picture. This gives the feeling that the surgeon is actually sitting within the huge cavity of abdomen and can precisely handle the structures which need to be treated and avoid disturbing the other normal structures. This results in quicker recovery of the patient as this in effect is a ‘local’procedure done within the abdomen. The other major advantage of robotic surgery is the use of ‘endo wrist’ instruments. The human wrist is almost 6 cm wide where as these instruments have a wrist which is less than 6 mm in width. The endo wrist has multiple dimensions of movements as compared to the limited dimensions of human wrist. This turns into several advantages as stitching in otherwise inaccessible areas becomes precise and quick. Various reconstructive procedures like repairing birth defects like PUJ (Pelviureteric junction) obstruction, megaureter ,vesico ureteric reflux (VUR) become more
Any Surgeon who has been perform-
How do you see the advent of da Vinci in India and the scenario today? In India we have almost 27 installations of this Robotic system and I am sure more are in the pipeline.
What is the minimum volume (of surgeries) required to make robotic surgeries viable in any Indian hospital ? This is a difficult subject as there are various models of investment. However if there is a multispecialty use, then it becomes easier for the institute to break even.
surgeries in urology, how do you compare the outcomes when compared to conventional minimally invasive laparoscopic surgery? The outcomes are really better as the stitching is superior. As the surgeon is more comfortable performing these procedures, he is less tired and makes fewer mistakes. The stitches can be placed as ‘correctly’ rather than ‘nearly correctly’
Do you think robotic surgeries will become a norm in future? Yes, I am quite sure of this. There are already other specialties looking at the use of Robotic system for treatment of surgical diseases. Gynecology, transplant, gastro intestinal surgery, bariatric surgery and other surgical specialties have literature documenting these recent successful attempts on the same lines.
“Robotic surgery has changed the way the surgery of cancers of urinary tract are dealt with today ing these operations as open procedures with an exposure to laparoscopic techniques should be able to take up robotic surgery. It only improves the skills and the capability of the operating surgeon.
What is the minimum experience required before a surgeon can consider himself adequately trained for robotic procedures? Training involves a vet lab training after familiarization of the equipment and then assisting almost 20 cases as first assistant. After this a surgeon could be mentored into a matured robotic surgeon by trained mentors.
As you have been conducting the most advanced robotic
Your most memorable case that you think and thank da Vinci, which would not have been possible otherwise? Recently a man was diagnosed to have a kidney tumor and he was told by many doctors that the kidney needs to be removed along with the tumor. However, after carefully evaluating his CT scan films, I decided to take up the challenge of saving the healthy part of the kidney while completely removing the tumor ( Nephron sparing surgery). With the help of Robotic Technology, it took almost three hours of surgical procedure to achieve the desired goal. The greater challenge was to take the decision of doing a ‘partial nephrectomy’ for a relatively large cancerous tumor of the kidney than actually doing it. The patient and the family are a grateful lot.
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cover story
urology
Holmium Lasers
Unfolds a new Era in Urology Dr Anil Kumar Varshney, Director Urology, Max Healthcare, New Delhi, in conversation with Shahid Akhter, ENN, discusses the advent and progress of lasers in Urology When did laser enter the medical mainstream and more precisely, urology ? When did it arrive in India ? Lasers are an invaluable technology and in medical devices, it has several applications. It can be put to a wide range of use, which may vary from eye care to sophisticated surgeries. It was Einstein who first thought of ‘stimulated emission’ and the first laser was developed in 1960 by Theodore Maiman. It was in 1966, when Parsons thought of using it in animal bladder. Lasers have come a big way in surgical therapy of benign enlargement of the prostate (BEP). Holmium Laser enucleation of the prostate represents a paradigm shift in the endoscopic management of benign prostatic hyperplasia (BPH). Holmium Lasers were first introduced in India in 2000.
How has high-power holmium laser influenced the practice in Urology ? High-power holmium laser has revolutionized the practice of urology in ther last three decades. Earleir open surgery was the dictum. ECSW lithotripsy was the first major advance, and then 1996 witnessed the advent of lasers. The introduction of holmium laser was a major boon to the armamentarium of the urologist. It has proved to be the most multifunctional urological
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tool for treating a wide range of conditions from all kinds of stone, prostate, tumors to strictures. With increasing number of patients with large prostates, patients on anticoagulants and patients demanding minimally invasive treatment, the need for the laser is on the rise. This laser has revolutionised the BPH and stone disease treatment.
What are the applications of high-power holmium in urology ? High-power holmium laser is a good standard treatment for a host of diseases from the kidney to the ureter to the urethra. Holmium laser has a specific role in enucleation of prostate. The largest I have done is a prostate weighing 539 grams. Holmium laser is the endoscopic equivalent of open
surgery. There is complete enucleation without blood loss. No blood transfusion is required and there is no cut. You can discharge your patient in 1-2 days. It can also treat all kinds of stones. It can be combined with RIRS in complex kidney stones. It is flexible and can reach any part of the kidney. Soft tissue diseases can also be treated with holmium laser. These tumours of the bladder, kidney and ureter, urethral and ureteral strictures, diverticulum and PUJ obstruction. It is also used in interstitial cystitis, a very stubborn disease. You can fulgurate the ulcers with high-power holmium laser. Hence, this laser will only strengthen the armamentarium of the urologists as it is one laser, which has multiple applications.
How does the high power holmium laser compare with other lasers ? The Lumenis 100-Watt holmium laser offers more than 200 combinations of different laser settings. Different permutations and combinations of energy and repetition rate are thus possible and you can choose the energy and the frequency according to your need. The unique power settings allows for a high frequency of 50 Hz, which in combination with high pulse energy pulverizes the hardest of the calculi into small fragments. It plays a versatile role in treating all kinds of stones. 4 generator laser engines is another USP of the system which is not available with any other laser. In addition, this laser is time tested. All over the world this technology has been sued for more than 15 years. Lumenis 100 Watt Holmium Laser is undoubtedly the most precise and efficient tool in urology practice.
How do you foresee the future of high-power holmium laser as a technology in urology?
High-power holmium laser has a huge potential to replace all other lasers. There are around 250 holmium laser installations in India. There is a lot of demand for this laser worldwide. This technique has stood the test of time and is here to stay.
What are the basics steps one should take to achieve the best results? Before initiating the procedure, the urologist should consider a detailed cystoscopic examination to evaluate the following: • Anatomy of the prostate prostatic anatomy varies from patient to patient and the technique is modified
How does one identify the capsule and how to remain in the capsular plane ? The surgical capsule is the landmark of the HoLEP technique. It is identified as the circular fibers running transversely. It is a fixed structure and can easily be distinguished from prostatic adenoma which mostly gives a cotton wool appearance in the endoscopic view. The biggest challenge in initial cases is to remain in the right capsular plane. It is very common to go superficial leading to incomplete removal and sometimes too deep into the capsule leading to perforation. To avoid this, initially we should always define the depth of enucleation in each incision.
“The increasing number of patients with large prostates, patients on anticoagulants and patients demanding minimally invasive treatment, the need for the laser is on the rise” accordingly. • Identification of landmarks – sphincter, verumontanum, bladder neck and ureteric orifices. • Identification of proximal and distal margins of the gland. It is also important to evaluate the length of prostate gland at 6’o clock and 12’ o clock position, especially in large glands.
What are the indications of bi-lobed and tri-lobed techniques? The classical three lobe or tri lobar technique is the standard technique for enucleation of prostate. Initially, the urologist should always prefer trilobe technique. The bi-lobed technique should be used only when there is no median lobe or when the surgeon has mastered the enucleation techique.
Later, we should always move from the defined area to an undefined area in small movements of 1 cm length.
How about the bleeders ? Haemostasis can be obtained by defocusing the laser fiber few millimeters from the bleeders and by adjusting laser energy by increasing the Joules and decreasing the frequency.
Please tell us about the workshops and young urologists trained by you. I have trained over 300 urologists in the country. Often we organize workshops where we use stimulators to train the young urologists. The next session is scheduled in June 2014. We have invited urologists from South East Asia and other countries to participate.
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special Special focus Focus
Best of West
Hospitals
Maharashtra Making Healthcare a Reality for All W
ith a population of more than 115 million, Maharashtra is the second largest state in India. A proactive public and private sector dominant in the state is driving new models of healthcare delivery. The contribution of private players has been primarily in strengthening the quality healthcare in the metro cities with installation of state of the art technology and design elements that appeal to the high-networked individuals as well as middle class section of society. The state government on the other hand
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has introduced many schemes and extended support programmes to uplift the public healthcare pyramid in the state. The latest being the introduction of quality standards for all government hospitals to upgrade the level of care and engrain the concept of processes, documentation and standards. The state has also seen adoption of new technologies and IT as a tool for bringing quality and efficiency in healthcare. The smaller towns and cities are also emerging as investment and excellence centres as many hospital chains
are now opening hospitals to tap the potential in these markets. In terms of nature of hospitals, the state has seen arrival of both multi-speciality and single specialty hospitals especially in eye and orthopedic care in recent times. Lifestyle diseases have been on the rise and many hospitals are now expanding to new dedicated clinic services for obesity, breast cancer, diabetes, asthama and many more. As a series of special focus section, we will explore the new models of healthcare emerging across the state.
Special Focus
Best of West
Hospitals
Boutique Hospital that adds
Comfort to Care In an interaction with Bomi Bhote, CEO, Ruby Hall Clinic, Rachita Jha, ENN, finds out more on the launch of new boutique hospital in Pune
Tell us the details of the latest achievements and upgradation on the cards. We have recently got a US certificate for Centre for Excellence for our Bariatric surgery unit and Centre for Excellence for Cardiology Unit. This was a pleasant surprise for us, as the respective organisations got in touch with us for the certification. They have been tracking us for the last five years, and based on their feedback from the patients and consultants the recognition was given to us. We have also won many awards and accolades for our Cancer hospital and are now taking a leap into the next generation of cancer treatment by setting up a dedicated cancer hospital at AmanoraPark in Pune, where we already have land available.
Please share your views on scope of improvement for healthcare scenario in West India.
Please share with us your vision for the Wanowarie Hospital. We have recently inaugurated our new facility - a multi-specialty hospital having 120 beds including a 22-bedded critical care unit. The reason to launch a new set-up was that we were looking out for a separate hospital that caters to our medical tourism patients, giving them exclusive services and insulating them from the general patients that come at our main hospital. Thus our Wanowarie hospital is typically for individuals, who want to avoid crowd, want exclusivity and experience luxury amenities and comfort. Our Catch line is ‘We add comfort to CARE’. So we take one step ahead.
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The facility also has modular stateof-the-art operation theatres, chemotherapy day care unit, surgical day care suite, dialysis lounge, endoscopy suite, cathlab and radial lounge, sports medicine, physiotherapy and rehabilitation unit among other services. Fully digital systems of electronic medical records, real-time access to reports of patients, radiology imaging systems that provide transcribed reports, round-the-clock monitoring in patient rooms, easy registration and digital surveillance are also provided at the facility.In future, we aim to strengthen our focus and expertise in obesity surgeries, breast clinic, cosmetic surgeries, robotic surgeries, foetal medicine, minimal invasive surgeries among others.
We need to have quality infrastructure that offers health for all its patients. The government should strengthen its programmes and processes to ensure every patient gets the best of healthcare. Also the universal challenge of having quality doctors and nurses on-board is a challenge. Retention is a challenge. We have strong expectations from the new government to extend support to healthcare infrastructure and disease programmes in future.
What is your plan for this financial year? This year, we want to take the Wanowrie hospital in full capacity, and hope to attract many patients from overseas under our medical tourism programme. To cater to the unique needs of overseas patients we provide multiple international cuisines, foreign language interpreters, trained nurses and international tie-up with foreign hospitals, etc.
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Cloud Technology
A Boon for Hospitals
A messiah for heart, Dr Ramakanta Panda, VC & MD, Asian Heart Institute, Mumbai, in conversation with Rachita Jha, ENN, talks about his future plans and shares his pearls of wisdom for the next government
What is the next exciting phase for the Asian Heart Hospital in 2014 -15? The Asian Heart Hospital is recognized as one of the best heart care hospitals in the country. Our target is to upgrade our benchmarks. We have tied up with one of the leading consulting companies and have revamped our practices in order to bring it at par with the best practices in the world. As a result, our patients’ satisfaction has significantly improved. Almost 80 percent of the patients have rated us excellent this year. We are the first cardiac hospital in the country to have implemented American Heart Association’s guidelines. We have also adopted Comprehensive Unit-based Safety Programme. It is a five-step program designed to change a unit’s workplace culture—and in doing so— bring about significant safety improvements—by empowering staff to assume responsibility for safety in their environment. Today, we don’t have a single Methicillin-Resistant Staphylococcus Aureus (MRSA), which is a bacterium responsible for several difficult- to-treat infections in humans. It is a major problem in Indian hospitals. This has all happened, because of the safety programme we adopted.
Tell us about technology platforms that can benefit a hospital? Digital technology revolution is changing the way hospitals are run and is playing a major role in streamlining operations and bringing down costs. Technology is now the backbone of
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hospitals and helping them connect with their patients and giving a personalised information and care. We hope to make major investments in IT as our next year targets are streamlined to bring in efficiencies in all that we do. We are 100 percent on Health Management Information Systems (HMIS) and have Electronic Medical Records (EMR) in place. Cloud technology is an exciting platform that we are also looking to explore this year. Mobile applications, on the other hand, have made all information readily available in the hands of people and their convenience. We hope to explore this platform for doctorpetient interactions. The doctors can have patient data access even before the patient walks into his room.
How much will Robotic surgery cost? The cost of surgery will be marginally
more than a laparoscopic surgery, but this cost is offset by the reduced cost of a shorter hospital stay and an early return to work. Apart from this, robotic surgery has minimal or no blood transfusion, the advantage of lesser pain compared to a normal surgery, superior results and better cosmetic results.
What would be your key recommendations to the next government? In India, the healthcare industry is at par with international counterparts. While the only point is that there is lack of trained people. There is huge gap in terms of the percentage at which the healthcare industry and the trained population is growing. Also, to make healthcare an investment friendly industry, I recommend the Government to announce attractive tax benefits or incentives similar to hospitality and IT sector.
Special Focus
Best of West
Hospitals
Keyhole Surgery will be Mainstay across all Specialties Driving force behind Sunrise Hospitals, Dr Hafeez Rahman, Chairman, Sunrise Group of Hospitals, is one of the pioneers of this medical procedure. With his visionary outlook, he shares his excitement with Rachita Jha, ENN as he plans to launch the first hospital in Mumbai open surgeries will only be limited to trauma.
Please tell us more about the Sunrise Group of Hospitals presence and expertise in healthcare delivery.
Please share the scope of (laparoscopy) keyhole surgery and its scope and applications in India. My expertise has been in key-hole surgeries and I have performed the largest number of key-hole surgeries in the world that is more than 70,000 surgeries. There is a huge scope of key-hole surgeries across all speciality and today in our Kochi hospital alone there are close to 30 keyhole surgeries performed each day. In the coming future, considering the medical technology advancements and trends, it is imperative that key-hole surgeries will be the mainstay and
We are a chain of multi specialty hospitals conforming to international standard and acclaimed as the apex centre for minimal invasive surgery in Asia. Keyhole surgery has becme prevalent in every speciality We have one of the largest number of keyhole surgeons in the world under our group. Our centres are spread across India and in the international space, primarily located at Delhi, Mumbai, Kochi, Dubai and Congo. For over ten years Sunrise Group of Hospitals has been defining the future of Minimally Invasive Surgeries in Asia with a steadfast vision to transform surgical care and make it a painless experience with faster recovery time. The Sunrise Group of Hospitals has the objective of providing immaculate healthcare facilities matching international standards.
Tell us about the first Sunrise Hospital that is coming up in Mumbai. Located in the heart of Bhandup,
Sunrise Hospital is about 2 minute away from the station, located on LBS Marg, one of the arterial roads of Mumbai. One of the first hospitals in Asia to be located within the premises of a mall, it incorporates more than 175 in-patient beds occupying an area of over one lakh sq ft. It is collectively run by a dedicated medical team, comprising of eminent doctors and equally proficient medical, paramedical and administrative personnel; constantly updated on the very latest medical developments to bring you world class medical expertise and patient care. Key features include 40+ bedded critical care zone ICCU, MICU, SICU and NICU, Multiple centers of excellence incorporated in an area of over one lakh sq ft on a single floor, Built in conformance to internationally accepted standards, highly qualified consultants with global expertise, Specializing in keyhole Surgeries, Mother and Child Care.
Please elaborate on the technology and infrastructure of the upcoming hospital in Mumbai. Our technology are latest Karl Storz 3D High definition on Monitors, latest Ultra Sono Mammography equipments and 5HD Cameras and hi-end recording systems from Karl Storz. We have 520 InnovaG, the latest in Cath Lab Technologies, 5 Modular O.T.’s with laminar air flow systems and HEPA flters. 100 Watt Holmium Laser for any size of Stone and Prostate work is also there. Our infrastructure includes 175+ bedded tertiary care hospital, 40+ bedded Intensive Care Units including NICU, five Modular Operation Theaters, six Dialysis Units, Special Labour Delivery Suites and the space of over one lakh sq ft of hospital area in a single floor that makes the hospital unique in its design in conformance to international quality standards.
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In Person
New Models
of Healthcare Delivery
T
here is a need of healthcare infrastructure in any form - be it single specialty, multi-specialty, hospitals or specialized clinics that have come up in many cities. The demand and supply is definitely a skewed one in healthcare. In addition, the accessibility to healthcare is also a challenge. At times, the funds are available but there is a lack of infrastructure, or if the infrastructure is available, there is a lack of quality doctors and manpower to run the hospital.
Novel Trends Multi-speciality is the mainstay now for delivery of traditional healthcare formats across multiple speciality and super-speciality. However, as these are usually a large set-up, there are many barriers of entry points from a real estate perspective. Usually, the real estate should take 20 – 30 percent of the overall project cost, however, in metro cities especially in Mumbai, the real estate itself takes about 60 – 70 percent of the funding. Therefore, the newer models that come in are in usually in the form of joint venture, wherein one partner owns the land and the other runs the brand of the hospitals similar to the hotel model. This can be applicable to both multi-specialty and single specialty. This model of ownership will take its own shape in the coming years, and more investors and real estate players will explore this format in various forms. Single specialty model of hospital chains is a model that has been extremely successful in the western countries especially the US. There are top ranked hospitals, and there are specialty center of excellence for orthopedic, spine, hernia, or eye centers. They bring-in profit-
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ability from an investor point of view and bring-in efficiencies by standardizing the processes thus saving on investments, energy, consumables, manpower, etc. Hence, specialty focused hospitals becomes a promising proposition from the investor’s point of view and the physicians’ point of view. The benefits should pass on to the patients. One of the similar model has already been launched by Sunridges specialty Hospital, Juhu. The other format which comes as the specialtyfocus is more possible in the future, as the investments that a multi-specialty demands in terms of real estate, bigger infrastructure, will take 5 – 7 years as the turn-around time. Moreover, if one considers the end-to-end timelines from planning to return on investment, it takes close to one decade. In addition to the timeline, there is a limitation of the promoters, as the statutory requirements take its own time. Thus, overall, the hospital model has three major challenges, one is to have the promoters and investors ready, second is to have a planning and design efficiency, and third is operational efficiency, which again are challenges today. So, all these three
factors will ensure the success of the model. If one takes the models of the United States and implements them in India, there is lot of localization elements that needs to be incorporated to make the venture successful.
Growth Positive Developing cities are more attractive for the promoters for healthcare investment, as there is a balance between real estate and equipment infrastructure investment. In addition, doctors from in and around the region of the developing cities would like to settle due to lower cost of living. The best examples arethose of Pune, Aurangabad and Nasik. A large corporate centre would usually get into the tier-II cities, set up an optimum size hospital infrastructure with multi-specialty and then try to grow. This model is more stable as EBIDTA margins are promising. The major reasons for its success will be that the government is not investing much in these areas for healthcare and India has an affordability advantage. Thus, overall, the challenges in healthcare are huge, however at the same time it is a promising area for investments.
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Kohinoor Hospital
Mecca of Surgeons
Kohinoor Hospital is Asia’s first and the world’s second LEED platinum rated Green Hospital certified by the Green Building Council of the United States. Dr Rajeev Boudhankar, Vice President, in conversation with Rachita Jha, ENN What steps did your hospital take to get the accreditation? Like other hospitals, we did not engage the services of a consultant. We formed a core team with a quality officer at its helm to oversee the whole process. We first arranged a training programme for all our staff members through the NABH, for the third edition of the NABH accreditation. The faculty visited our hospital and conducted interactive training sessions. The staff was encouraged to ask questions and raise doubts, if any. The NABH had given certificates of participation and booklets of the third edition to all the participants. This certificate encouraged our staff a lot as they were ‘officially’ certified as NABH trained. The next step was percolation of all that was taught from the departmental heads to their subordinates. Internal sessions were conducted for consolidation of the training and closing the gaps in the departmental SOPs, infrastructure, etc., by the HODs and the quality officer in close coordination. Everyday a mail was sent summarizing and highlighting one standard. We organised
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quiz competitions during our monthly “Dhammal” programmes, as per NABH standards, for our employees. Prizes were given for the right answers. HODs
and the Quality officer went around the hospital on surprise rounds and asked questions to the staff related to their departmental SOPs and other aspects of accreditation. Surprise audits were conducted. We also included a separate module on NABH accreditation in our induction program for new employees. This way we identified our weak areas and made course corrections. We conducted surprise drills for various emergent situations like code blue, code red, etc. We also encouraged our consultant doctors to be the part of the accreditation process by sharing with them all the NABH requirements during our monthly town hall meetings with them. They, too, actively participated and started following all the NABH guidelines in the IPD, wards, OT, cath lab, audit committees, etc. This helped us gain confidence, even without the help of any quality consultant. All along the way our CMD and Director kept the morale of our
staff high by providing help required for closing the gaps and encouraging us all.
What latest services have been introduced for patients? We have introduced many clinical programmes which are unique in their own way. For example, our ENT department is fully-equipped with stateof-the-art gear. We have introduced cochlear implant programme recently. We have introduced a ‘Vertigo Clinic’, which is the first of its kind in Mumbai city. We had observed that patients complaining of vertigo are referred from one department to another and they get fed up touring the entire hospital! So, we have taken care to see that the patients are treated by one team at the Vertigo Clinic. The “Sleep Apnea Clinic� was introduced for patients who have symptoms of snoring or somnolence in the day time. The common practice is to put these patients on BIPAP machines and broncho-dilators. But this would be temporary and hence a permanent surgical cure is offered to these patients. We have also introduced a “Speech Correction Programme�. This is a boon to males with effeminate voice and vice-versa, and which can be permanently corrected by surgical intervention. The next clinical programme is the “Acute Stroke programme�. The importance of ‘golden hour’ cannot be over-emphasized in acute neurological stroke. We have, therefore, implemented this programme to save lives and also minimize morbidity. We have introduced a very affordable “Bariatric Surgery Programme. The common misunderstanding is that it is meant for rich patients due to the cost factor. However, we have burst this myth and the hospital has surgery packages which help common patients. Recently, we also got the renal transplant license and we are now an authorized centre for kidney transplants. We have introduced the ‘LESS’
State-of-the-art Technologies
24x7 casualty having all monitored beds with emergency OT Latest Endoscopy equipment CT scan with “enhance software� capable of doing CT Angiography, calcium score, 1.5 Tesla MRI Fully-equipped Non-Interventional Cardiology Lab with 2D ECHO, Stress test, Holter Imaging department having PACS, Mammography, DEXA Scan, OPG, digital X-ray, portable X-ray Physiotherapy and occupational health Delivery of pathology samples through “chute� hands free and RFID-enabled Full-fledged Blood Bank with Plasma-pheresis component lab Pathological Lab with all automated equipment State-of-the-Art CSSD with OT access via dumb waiter 24x7 pharmacy with home delivery facilities Dental services Ophthalmology services with A scan, B scan, Perimetry (field of vision tests), automated acuity of vision tests, colour vision tests, depth of vision tests, tonometer, etc. 24x7 dialysis NICU PICU (very few hospitals have this facility) Labour ward, LDRP suite ICU with isolation rooms Cath lab capable of all Interventional procedures Day care Chemotherapy suite Lithotripter for non-surgical removal of kidney stones Best OT in Mumbai “Mecca of Surgeons� Best Deluxe Suite of Mumbai All clinical programmes and specialties are available except nuclear medicine, burns and pediatric cardiology.
(Lower End Sternal Split) surgical intervention for patients requiring CABG surgery. The small single incision approach will revolutionise cardiac surgeries. This is helpful, especially, to female patients as the surgical scar is hardly visible. We have introduced “HIPEC� (Hyperthermic Intraperitoneal Chemotherapy) oncology programme for cancer treatment. Very few hospitals here have this programme and Kohinoor Hospital is one of the few centres to have this modality in cancer care.
What kind of emergency services do you have in place? Cardiology emergency services have the state-of-the-art ICCU with 24x7 Intensivists, Cath Lab for PAMI (primary angioplasty for acute myocardial infarction) .
What are the modern equipments you have deployed in diagnosis and treatment? We have mammography, Dexa Bone Densitometry and Super Specialty ENT programme as the latest additions in our bouquet of equipments.
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????????? Special Focus
Best of West
Hospitals
Evolving trends in Hematology Automation Kanchan Jeswani, Product Manager-Hematology, Transasia BioMedicals Ltd
T
he CBC count - the most frequently requested clinical laboratory tests is processed accurately in automated hematology analyzers. During the last two decades, automated blood cell counters have undergone a formidable technological evolution owing to the introduction of new physical principles for cellular analysis and the progressive evolution of software. The results have been an improvement in analytic efficiency and an increase in information provided, which, however, require ever more specialized knowledge to best discern the possible clinical applications. Today’s analyzers are able to provide much more information, both quantitative, such as the extended parameters and qualitative ie. suspect flags. Scatterplots and histograms of the real-time data provide an insight regarding abnormal population of cells and disease patterns which can be identified by the hematologist. These advanced features help in reducing manual reviews, thereby improving the turnaround time for the physicians. The correct interpretation of results requires extensive knowledge of the analytic performance of the instruments and the clinical significance of the results reported.
Complete Blood Count –The 3D Approach Traditional parameters of the CBC count and Differential count. These are the conventional, essential parameters reported since time immemorial.
l
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used for clinical decision making. It is important to establish reference ranges locally, and sites wishing to utilize these parameters need to ensure that their analyzers are fully optimized and standardized before use. Laboratories with more than one instrument of the same type need to standardize settings between instruments as well on a regular basis.
Futuristic Automation Advanced Clinical Parameters The new generation analyzers’ technology have developed advanced clinical parameters to assess their clinical utility and are approved for routine use in almost all cell lineages. Some of the high end hematology analyzers are equipped with a body fluid mode for reporting red cell counts, total nucleated cell counts and differentials. Rerun/reflex testing is done automatically without user intervention based on decision rules incorporated in the system. .
l
Quality Assurance Internal Quality Control and External Quality Assurance Schemes are readily available for conventional parameters. It is good laboratory practice to have accredited External Quality Assessment Schemes (EQAS) for the reportable clinical parameters as well. For a number of parameters,on some instruments, there is no internal quality control, which brings into question whether these parameters should be
Automation is going the modular way with multiple units of hematology analyzers, integrable slidemaker/stainer, digital morphology system,tube sorters, automated ESR systems, HbA1c system linked to the middleware and LIS, making it a true walkaway one lavender top system.
Conclusion Automated blood cell counters are becoming more sophisticated and the range of reportable parameters available is ever increasing. There are increasing amounts of data provided, which require specialist knowledge to interpret as well as understand the limitations in the measurement of the parameters. Both hematologists and clinicians need to remain updated with new parameters and interpretations . Good laboratory practice ensures that reliable results of clinically relevant laboratory tests are reported to the clinician. This expanding range of parameters does allow for novel applications and introduces an element of research and development into routine laboratory hematology practice.
Special Focus
Best of West
Hospitals
7 Billion Medical
Images on Cloud Platform Sid Nair, Vice-President and Global General Manager at Dell Services for Healthcare and Life Sciences, elaborates on the company’s vision of building futureready IT platforms. In conversation with Rachita Jha, ENN Tell us on the transformation journey of Dell from hardware to end-to-end service provider in healthcare. In the last four years, it has been quite a transformation at Dell from, a healthcare perspective. We have moved from a hardware organisation, to a service and systems software provider. And we are looking forward to becoming leaders in services and software. We can now manage the entire end-to-end services. From a vertical perspective, healthcare is one of the major business verticals at Dell. In addition to our previous bouquet of solutions, we have also introduced solutions that help them get faster to market and focus on regulation and compliance issues and business analytics and intelligence. We have the 5Cs that is changing the healthcare market globally, first is capitation and re-imbursement model that is changing that is driving the market, there is lot of consolidation and collaboration, all this is leading competition that is between not just hospitals but also physicians. The fifth C is consumerism as we have new generation of American citizen that will buy insurance.
Has ICD 10 version acted as catalyst for Health IT providers such as Dell in the US market? This is a major project and has tremendous scope for IT incorporated in the healthcare sector. Consider that ICD 9 had 18,000 and the ICD 10 has 160,000 diseases listed. This results in complexity, therefore the doctor has more de-
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tails to submit in the new format, and this is designed to ensure that for reimbursement the right medication and procedure is followed. Our contribution in this project has been to help them migrate from ICD 9 to ICD 10. We have also built test case databases that helps them cut down the cycle time. We also offer medical code changes for them. Lot of our growth in healthcare was in the EMR implementation. As we move forward, the future is about EMR optimization and ways to get ROI from these EMR systems. Also, there is a need to rationalize some of the old EMRs. The future is also about data as clinical data that is now available, tools such as data analytics and predictive analytics. For the health plans, HIS continues to be big because the consumerism in healthcare is leading them to new markets. This demands them to move away from a legacy claims processes systems and business systems to a more state of the art health. So, we have seen the health insurance business grow drastically in US. Almost 60 percent of our business comes from the providers’ space that includes hospitals and physicians, as we move forward social media, cloud, analytics and mobility are our focus areas.
Please share your thoughts on the new cloud platform for healthcare sector and your major focus markets for the same. We have been partners for many hospitals and with our new services and
software products on offer, we can manage your mess for less. We have a lot of services hosted on our cloud platform and this is just one small part. We have 130 hospitals that use our cloud services in the US, and we have 750 physician practitioners, we have close 7 billion images archived on our image archive solution and continue to grow. We recently acquired a company StatSoft that has a product called Statistica. This has predictive analytics solutions that we plan to integrate in our healthcare business. The Dell Secure Healthcare cloud has the critical patient data and is a HIPAA compliant. The big market for us remains to be US that contributes 80 percent of our business. The remaining 20 percent comes from Middle East and UK. India is the fourth market that we plan to enter and are excited to explore opportunities.
Health IT
Printers
Still Hold the Sway
As healthcare providers gear up for handling challenges on day-to-day basis, they should need to be equipped with modern technologies. In its bid to find out whether printers and papers are still relevant in today’s paperless technologydriven world, the Elets News Network (ENN) team recently conducted a survey in hospitals across the country
T
oday’s healthcare industry is more proactive in maintaining accountable health management. This emerging model is based on digital health framework that enables to coordinate care across the healthcare ecosystem. Emerging healthcare technologies like Electronic Health Record (EHR) and Electronic Medical Record (EMR) have ample potential to improve patient care by managing their medical and personal information efficiently and effectively. However, implementation of EMRs and EHRs across Indian hospitals is appallingly low because of the high cost, lack of training, past experience of users, interoperability, security and privacy, fear, user interface, communication, incentives and leadership issues involved in the same. According to our survey, around 70 percent of the hospitals outsource their printing and imaging tasks due to higher costs. They, however, believe that having in-house printers results in the reduction of turnaround time-it saves the time involved in transporting the documents back and forth.
Challenges As printed/scanned documents pass over a network, the patient’s privacy gets compromised-those can be viewed, shared or even tampered with at the will of the staff. Security and
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Challenges in Printer Use (sample size: 500 Hospitals) 90 80
83 71
70
63
60
52
53
50 40 30 20 10 0 Threat to privacy
Cost Factor
Lack of standard Imcompatible with technology
“We have electronic system for flow of information but still we require printers because even paperless office cannot do without documentation. The major challenge with the printers is that it is difficult to secure the information on the network. We use multifunction printers and we have a planned budget for them.” Dr Dilpreet Brar, Regional Director, FMRI
Decline in Workflow
HER in Maintenance of Health Record EHR in Maintenance of Health Record 19%
Mostly, we use paper charts, but maintain electronic record sometimes
21%
We keep patient information in both paper chart as well as EHR system We are Fully Electronic 16% WE keep paper charts but HER is more suitable 5%
39%
Not sure
privacy has always been a concern for the hospitals, and the need for the physicians to have their patients’ information secure is considered sacrosanct in the trade. But a major barrier in implementing in-house printing and imaging solutions is its high cost. Then there is no uniformity in standards while procuring printers. This sometimes works as a deterrent for the administration in going for quality printers. Most printers are not compatible with the HIS / HMIS software.
Way Forward Despite the fact that healthcare service provider comes across rising operational costs and new regulatory requirements on day-to-day basis, it has to be more efficient while ensuring
quality patient care with utter safety. Hospitals are increasingly handling enormous amounts of documentation in the form of referrals, consultation reports, historical patient data, diagnostic reports etc. All this data fed into the EMR further creates documents like prescriptions and handouts for patients and doctors. With such an increasing need for documentation, choosing the right printer and scanner becomes crucial. In order to find out which technology solution hospitals prefer to get efficient, tangible and improve outcome data, 66 percent of hospitals voted for HP Printers. To help the healthcare industry realize the goal of delivering collaborative care, HP has developed inno-
“I believe printers and papers will remain in market for long time as a lot of communication is still done in the papers. Cost efficiency, leading to savings and efficiency are the major parameters which we look for while buying these products.” Alok Khare, Vice-President, JAYPEE Hospital
vative solutions that give healthcare providers around the world the opportunity to achieve process efficiencies, tangible cost savings, and improved patient solutions. Reducing human error and costs, increasing user productivity and the return on investment, HP has consolidating many functions like faxing, printing, scanning and copying into cost-effective multifunction printers. Rather than offering a single product, HP offers a wide variety of imaging and printing solutions falling across three tiers. These solutions are built to optimize your infrastructure. HP provides solutions to monitor the use of printers in a network to monitor the usage. HP also helps connect the various hospital facilities like hospitals ambulatory clinics, rehabilitation centers, nursing homes and physician’s offices to deliver integrated care. Because of close collaborations with leading healthcare software providers, HP machines are also built with future Health Information System (HIS) and clinical software applications in mind thus minimizing the need to upgrade the hardware. For further queries: Hotline Numbers: 18004254999, email: in.contact@hp.com
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tech trend
mhealth
mHealth
Delivering Health in Your Hands From a shaky start a few years ago, mobile health or mHealth has grown up as a sector, and today has many companies Plying innovative healthcare solutions. ENN’s Rajesh K Sharma takes a telescopic view of the industry and talks to a few industry movers about the journey of mHealth
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he healthcare scene in India is one of extremes. : while we have internationally well -known premier institutes that make India a popular medical tourism destination, vast sections of Indian don’t have access to even basic healthcare. Rural India still lacks basic healthcare. Even in urban areas, while the rich can afford the best treatments, the poor have to contend with overcrowded hospitals and a creaking infrastructure. The Government of India allocated `3,00,018 crore
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towards its various health schemes in the 12th Five Year Plan in 2012. Though the total spending on healthcare by the government and private players has been rising steadily, it is still not enough to meet the demand. But while the government struggles to meet the challenges of universal healthcare, technology has made it increasingly possible. Technologies like telemedicine and mHealth are giving a fillip to the demands for healthcare. Though the two terms may sound simi-
lar, they have different connotations. As Dr Ruchi Dass, CEO of HealthCursor, explains, “mHealth encompasses acquisition, transport, storage processing and securing the raw and process data to deliver meaningful results. Telemedicine, on the other hand, is the science of using similar wireless channels and networks to provide clinical healthcare at a distance.” mHealth, plainly speaking, is the delivery of healthcare services or information on mobile phones. It began in
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tech trend
mhealth
its earnest around 2008-09, in the form of mobile carriers giving medical advice on their networks as a value added service, for a fee. Later, SMS services were also added to the mix and people could have their queries answered by a doctor. The introduction of 3G services around that time provided more avenues for the disbursal of medical services, with mobile websites and later apps doing the needful. This belief in the power of mobile-based solutions was powered on the basis of India’s increasing mobile coverage. However, TRAI later had to correct its numbers, when it was found that the number of active connections was less than what it had earlier stated. But in spite of this corrections, the faith in mHealth remained, and the sector still showed a growth. Flash forward to 2014, and the mobile health scenario is abuzz with activity. In addition to mobile carriers, newer players are providing mHealth services through voice, SMS, mobile websites as well as apps. The maturing of the mobile environment has led to the players offering a bouquet of solutions over the mobile phones that have become ubiquitous in their presence. Starting from basic services like finding a doctor or a specialist nearby to fixing up an appointment with a doctor, there are solutions available that allow the patient to connect to a doctor immediately, irrespective of the location. mHealth solutions have made it possible for persons seeking a second opinion to get it from specialists. The government too has been actively hitching on the mHealth bandwagon. It has launched ‘Dial a Doctor’ services in states like Kerala, which connect rural people to doctors in urban areas under its National Health Mission (NHM) scheme. This has proved to be beneficial to the rural people. Some notable innovations in mHealth are mDhil, a start-up that provides healthcare information through SMSes, mobile web and apps; Sana, that enables community health workers on how to screen
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and diagnose patients and link that data to doctors through OpenMRS via open source mobile apps; mPedigree, a mobile platform to track and check the validity of medicines to combat drug counterfeiting; E-Health Points, that provide families in rural villages with clean drinking water, medicines, comprehensive diagnostic tools, and advanced tele-medical services; World Health partners, a multi-level service delivery network which leverages the latest in telemedicine and point-ofcare diagnostic technology to improve access and quality of care; and ZMQ software systems, that develop mobile games to combat HIV in India. In addition, there are players like the Bangalore-based HealthcareMagic that provide mobile based healthcare solutions to corporate clients. Such is the belief in the promise of this sector that a PricewaterhouseCoopers (PwC) report
in their understanding and taking of precaution against the disease. But while there is optimism about mHealth, a few words of caution are to be noted here. Though the mobile penetration has been growing, the uptake in mHealth services has not been proportional. In fact, such services are still seen as a value added service rather than a necessity. A common complaint among mobile healthcare providers is that people don’t have enough money on their mobile phones, and as a result, very calls get connected in spite of a huge volume of people calling. mHealth also faces a problem of perception, as in India, the majority of calls received are from rural areas, leading to many associating it as a service for the poor, which it is not. In fact, mobileenabled services can be used by urban people to solve minor ailments, thus saving a trip to the doctor. At the same time,
“Maturing of the mobile environment has led to the players offering a bouquet of solutions over the cell phones that have become ubiquitous in their presence has predicted that the mHealth market will eventually be worth Rs 3,000 crore. mHealth is also promoted as a means to combat epidemics. Though the mHealth service providers agree that they may not be able to provide treatment in case of a spread, their services are very useful in disseminating information to the people so that they can entertain caution and prevent a sudden outbreak. Dr Dass adds that mHealth leveraged applications can help in disease surveillance, tracking, monitoring, prevention as well as management. Shekhar Sahu of HealthcareMagic adds that if a service like mHealth is available to even a small portion of people and they get regular tips, then it will make a lot of difference
mHealth is also a suitable way of reaching out to the urban poor, who may not have the money to visit the swanky new hospital or clinics in their areas. As things stand today, mHealth, after a shaky start in 2008-09, has managed to deliver on its initial promise. The introduction of 3G services only aided in its growth. A patient wishing to use such a service today would be spoilt for choice. The exuberance being witnessed in the sector today is a culmination of the vision of universal healthcare by the early adopters. Though the uptake remains low in comparison to mobile penetration, it is being readily accepted by the people, and the prediction by PwC may soon become a reality.
tech trend mHealth
mHealth Benefits
People who have Little Access to Services Dr M Beena, MD, National Health Mission, Kerala talks to ENN’s Rajesh K Sharma about the mHealth initiative launched by state government recently What has been the cost involved in running such an initiative? The installation costs for the service were Rs 27 lakhs. The running costs of the service are Rs 83 lakhs per year
What were the guiding principles behind this initiative?
Please explain in brief the initiatives taken by the Kerala government to provide healthcare through mobile networks. The Government of Kerala has launched DISHA (Direct Intervention Service for Health Awareness) in March, 2013. The service initially started as an exam help line, immediately after the exam period of March, 2013 was scaled up as a Psychological Help line. Two months back the programme was scaled up as a 24 hour Doctor on Call.
The mHealth has the following major objectives • Ensure quick access to reliable information for health-related issues. • Offer patients clear directions on how to access medical care locally or otherwise • Ensure clear instructions for emergency care of an individual in remote areas • Ensure wide coverage of information for Health Programmes including national programmes • Simple health advice for common health problems • Establish a mobile framework which can be activated and accessed for public in case of any widespread medical emergency like an epidemic etc.
Who have been the biggest beneficiaries of the program, the rural or the urban people? Is this service being used by poor as well as the rich?
The service is most beneficial for people who have little access to services, but currently it appears that many people accessing this service have begun to recognize its anonymity and have used to discuss issues which require confidentiality. The earlier appraisal of the programme had suggested that most calls came from districts which are relatively underserved by public health services including Idukki, Palghat, Wayanad etc.
Do you feel the mHealth services are effective in fighting epidemics, or they can only treat minor lifestyle cases? Since the establishment of Mhealth there has been no major epidemics, but it appears that the system can be scaled up or down as required by the Health services ie. It can serve us for epidemics and also for minor lifestyle cases offering reliable, accurate and standardized information.
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tech trend mHealth
Please highlight some positive outcomes from your mHealth initiatives. How do you plan to replicate them in other areas of telemedicine? The most positive outcome is the number of calls the telephone helpline has received since inception. At last count almost fifty thousand people have accessed this service, 24 hours and 365 days. In many areas hospitals still work only during the morning sessions especially in the rural remote areas and as reported earlier most calls have been received from these areas. The cost would approximately work to Rs 7 per call to the government which would include cost of the call, staff expenses and infrastructure expenses. The economic benefits are not accounted here. Replication to other areas can be planned for training health personal, helping medical professionals treat complicated patients in the periphery etc.
“The most positive outcome is the number of calls the telephone helpline has received since inception. At last count almost fifty thousand people have accessed this service, 24 hours and 365 days
In your opinion, what needs to be done from a policy perspective to improve the impact of mHealth? mHealth has not been given the focus in mainstream medicine. Though established it remains a fact that very few people actually know about the availability of the service. It is only if the mHealth model is mainstreamed and repeatedly brought into focus will the reach and usage become common practice.
What are the biggest challenges that you face in providing the mHealth services. Though the programme is in its second year there is still a scope of increased capacity utilization. It is important to highlight this programme as reliable, accessible, essential and cost effective adjuvant to community health care which will improve usage among general public.
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NRHM at a galance The National Rural Health Mission seeks to provide effective healthcare to rural population throughout the country which have weak public health indicators and a weak infrastructure. The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9 percent of GDP to 2-3 percent of GDP. It aims to undertake architectural correction of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme and promote policies that strengthen public health management and service delivery in the country. It has as its key components, provision of a female health activist in each village; a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat; strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards (IPHS); and integration of vertical Health & Family Welfare Programmes and Funds for optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare. It seeks to revitalize local health traditions and mainstream Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) into the public health system.
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?????? ????????? Tech trend mHealth
The Service is No Different than Seeing Your General Practitioner Nitin Goyal, Head of Operations and Business Head, mHealth, HealthFore Technologies, explains about the company’s MediPhone service for providing medical assistance through mobile networks to ENN’s Rajesh K Sharma On the reach of the MediPhone service since its launch Our primary service, MediPhone, which is in collaboration with Airtel, is pan-India. When we started this service in 2011, it was only in northern states. But by the November the same year, it was available across the country. Currently, it is available to all Airtel subscribers in three languages – Hindi, English and Kannada. When we started in 2011, we began with certain projections, based on the kind of subscriber base that existed. Our response has been in line with those projections.
Challenges faced when the service was launched The biggest challenge that we faced
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was education and awareness – how do you reach out and make people aware of such a service. The second challenge was inculcating a change in people to get them to understand how such a service can be used. Another problem we face is that people don’t have balances on their phones. We get a very large number of calls every day. However, because the callers have a very low prepaid balance on their mobiles, the calls get disconnected before they can speak to a health advisor.
On future challenges The same challenges remain. India is a large country, and people need episodic care. Unless there is awareness and recall of the service, the uptake is always going to be low. The
rious ailments like cardiac issues, cancer and people wanting to know about IVF treatment. In such cases, we do provide general help, but always tell them to go and see a specialist.
On providing medical advice in absence of medical history In my opinion, the service is no different than seeing your General Practitioner (GP). When you visit a general practitioner, you talk about your medical history. During consultation, if you do not give enough information, the doctor will not be able to detect certain issues. It is the same for a telephonic conversation. The difference is that our health advisors are trained to follow a certain protocols. For example, for every
“When we started this service in 2011, it was only in northern states. But by the November the same year, it was available across the country. Currently, it is available to all Airtel subscribers
our calls come from rural areas, but that’s what we would expect.
On the mobile density When we started the service in 2011, people used to talk about there being 900 million subscribers. After TRAI came out with a new policy, a recalibration was done and the active numbers turned out to be lower.
On distributing content through SMSes and 3G services SMS was been a part of the service since 2012, we had started distributing content through SMS and it is still continuing. As far as 3G is concerned, we are working on new initiatives to utilize digital content.
Scope of mHealth in India Tremendous. But certain things need to happen first like regulatory changes. The government came out with a draft on ehealth standards a few months back, but it is still under discussion. That needs to be released, so that there is acceptance of mHealth by the players.
On mHealth being used to combat epidemics usage is always a factor of the promotions that are being done.
The most common queries that MediPhone receives Most of the calls are for minor ailments like allergies, fever, cough, cold, abdominal conditions. We also get calls for sexual concern, that people are comfortable talking on the phone.
Whether this service can treat serious ailments Not really. It is not a service that can be utilized for something serious or chronic. For chronic ailments, we do run other services outside of MediPhone. In MediPhone, we frequently get calls from people with more se-
call we receive, the health advisors always ask for medical history and enquire about certain ailments like hypertension, diabetes, cardiac issues etc. and based on those, they give the advice. But the underlying fact is that MediPhone is for minor ailments. If the doctor taking the call anytime feels that the situation requires a face-to-face discussion, they will redirect the person to a physician.
As a preventive measure, absolutely. Dispensing education through these lines can be very useful. Educating people about epidemics that are happening in their areas can help in controlling epidemics tremendously. Such servises can also keep the citizens informed on health initiatives and camps in their areas, which can help combat diseases.
On whether rural or urban callers use the service more
There are bodies like the Telemedicine Society of India (TSI) that facilitate exchange of ideas regularly, but we could be doing far better. A part of that has to do with regulatory support. Once there is a formal acceptance, there will be more exchanges.
In our experience, the response has been balanced. We do track the demographic of the callers, and we do get a fairly large number of calls from rural areas. About 60 percent of
On the sharing of info among mHealth players
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focustrend tech
mhealth
Curing Sickness to
Ensuring Wellness
HCL Avitas, in collaboration with Johns Hopkins Medicine International, is the healthcare delivery arm of HCL Healthcare. Started as the country’s first nationwide networked multi-specialty clinics, HCL Avitas aims to provide complete continuum of care for chronic and acute diseases. Harish Natarajan, Chief Executive Officer and Suresh Sarojani, Chief Technology Officer, HCL Avitas, in conversation with Ekta Srivastava, ENN, talks more on this new initiative...
Harish Natarajan Chief Executive Officer
Suresh Sarojani Chief Technology Officer
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India’s healthcare industry has seen an exponential growth over the last decade with the number of private multi-specialty hospitals, clinics and diagnostic centres mushrooming in major cities and towns of the country. India is a large country with a population of over a billion. So, reaching out to such a vast population is not a child’s play. Today, multi specialty hospitals in urban areas are able to provide specialist services to patients in remote areas, thanks to technological advances in the field of medicine. Though, much needs to be done to improve the healthcare statistics of India, the efforts by India’s new crop of healthcare entrepreneurs will not go in vain. With a similar mission, HCL Corporation, the parent company of HCL Technologies and HCL Info systems, has recently announced their entry into the healthcare sector with the launch of HCL Healthcare. Aspired to be the nation’s leading healthcare company by addressing the entire spectrum of healthcare needs, providing healthcare delivery, innovative medical services, products and training to meet the growing need for
quality healthcare, HCL is all set to perform. With a vision on what is that going to impact larger number of people and at the same time curing sickness and ensuring wellness, the team of HCL top-notch intellectuals have come together and built a business model. As Harish Natarajan, CEO, HCL Avitas said, “Not only that we want to build a scalable business model, but also we want to operate it within a large number of people where it ensures ‘curing sickness and ensuring wellness.’ It’s a business chain which will address a large population of about 50 million people. In order to achieve our target of touching the large part of the population, we have to do it at the outpatient-care level and HCL Avitas is all about that.’’ In affiliation with Johns Hopkins Medicine International, the company is in a frame of mind to offer a wide range of healthcare delivery. Starting with the country’s first nation-wide networked multi-specialty clinics, they are willing to provide unmatched patient experience and outcomes by adopting global best practices for medical quality and training, using
evidence-based systems and integrating advanced technology.
Thought behind HCL Avitas India has a shifting disease burden that is influenced by changing lifestyles. This need is grossly underserved. Technological expertise and the ability to create scalable institutions will help HCL Healthcare institute create new benchmarks in the healthcare delivery in India. “Creating an organised technology-led health system that will be the long-term care partner is our immediate goal. HCL Healthcare intends to be that partner and provide patient-centered care for over 20 million people by 2020,� Suresh Sarojani, Chief Technology Officer (CTO) HCL Avitas said. Following the philosophy of patients come first, the clinic with its team believe to give the patient 24x7 healthcare assistant and try to address their healthcare needs. Giving the access to help locate the closest clinic closest, schedule appointments, connect to care coordinator, all HCL Avitas will be networked and support each other to provide the highest standard of care and provide operational support Elaborating more on the technical side Suresh Sarojani, Chief Technology Officer (CTO), HCL Avitas said, ‘’Your assigned care coordinator is your one point contact for all your health-related issues. The care coordinator will guide you through the clinic, help digitise your health records, set appointments and follow ups, monitor your self-management goals, answer queries on medication and coordinate referrals when needed.’’
Plan of Action Speaking on what Avitas does and how, Natarajan said, “We actually use technology which is very important just like the World Wide Web and the internet plays such a large
Three Pillars To set up India’s largest healthcare network with a robust technology backbone and electronic medical records To provide long-term patient care through evidence-based medicine To bring clinical expertise and global best practices to India in association with Johns Hopkins Medicine International
role in terms of how we build a network. Similarly, we have been trying to use the technology in the networks of healthcare. India has a very different healthcare system than those in developed nations. The philosophy in India is very different. And if I look it from the patient’s point of view, then there are four aspects which need to be addressed: First part is about treating the patient-- patient wants to be treated well. Secondly, they want to be involved in decisions related to the healthcare. Thirdly, they want to feel that there is a certain system and science about what all that is happening. Fourth is in terms of gaining trust. Patients should trust us in whatever we do. Clearly, these are few things which we are trying to achieve.�
Differentiator Commenting on impact HCL’s innovations will bring in the market, Natarajan said, “First our connection with John Hopkins Medicine International, which is acknowledged as the best hospital in the world. Secondly, we are going to have first large scale Electronic Health Record system, through which patients can consult specialists in our network through video consulting anywhere, anytime. Finally, technology-enabled disease management systems ensure that you get consistently high quality personalized care.� Adding on the same CTO Sarojani, said, “We will begin with a network of multi-specialty clinics across the country starting with the National Capital Region. We will offer the best
of patient-centric care in our clinics – addressing their long-term care needs. Technology is our strength – our clinics will all be networked giving patients access to their medical history and to the best specialists available in our system. Through our association with Johns Hopkins, we will bring in global best practices and the best evidence-based systems. In the next 5 years, we expect to have over 1,500 doctors in our employment drive across various cities in the country.�
Strategy to Follow Intend to become the nation’s leading healthcare company, this new venture is committed to providing innovative medical services, products, training and information to meet the needs of patients, physicians and organizations. While speaking on the strategy, the group is looking after to follow, the CEO of the organization said, “Now what we intend to do during the next 10 years is to have a pan-India presence with a whole network of multi-specialty clinic. In terms of core specialty, we are looking at diabetes, gastroenterology, pulmonology and dermatology. We will also add on the pediatrics and gynecology. Next is multi-specialty clinic, it is not a ‘network of multi-specialty clinic’ but it is a ‘networked multi-specialty clinic’. The difference, we are trying to set up here, is that we will have expertise at some level or the other, but all the clinics will be networked to each other. None of the clinics will operate s in isolation and we expect a lot of sharing.�
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tech trend
mhealth
mHealth will be a
`3,000 Crore Market Dr Ruchi Dass, CEO, HealthCursor Consulting India and mHealth evangelist talks to ENN’s Rajesh K Sharma about the growth of mHealth sector in India How do mHealth and telemedicine differ, or are they the same? There is a diffence between healthcare and Medical care. While the former deals with overall wellness, preventive, promotive and rehabilitation perspective; the latter means providing clinical care, surgical and chemo interventions. mHealth as a term is used for making healthcare accessible to masses using wireless devices. mHealth encompasses acquisition, transport, storage, processing, and security the raw and processed data to deliver meaningful results. Telemedicine is the science of using similar wireless channels and networks to provide clinical health care at a distance. Both telemedicine and mHealth are a subset of E-health.
Mobile penetration in India has increased, with mobile companies offering Dial-ADoctor services. Are mHealth solutions taking root? mHealth solutions made headway in India around 2006-2007. Since then, more than 100+ mhealth projects are piloted every year and currently we have 20 large private and public funded and managed projects in the country. The sudden surge of Dial-A-Doctor services is not a surprise. We run a mhealth consulting company and our revenue has almost doubled in the past few years. India’s healthcare infrastructure is pretty skewed, and doctors are in demand in far flung areas. Dial-a-Doctor hence becomes a popular choice.
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In metros and urban areas, such services provide convenience and save a trip to the Doctor’s o ffice for common diseases. However, mHealth has evolved much beyond this. Now, an app that can diagnose you have flu or not if you just sneeze close to your mobile device. Bluetooth and wireless enabled medical devices talk to your phone and transmit health related data to doctors and caregivers in real time. Though a lot has been achieved, there is still a long way to go.
Has mHealth’s growth been proportion to the mobile growth? Have 3G services helped, or is SMS-based help still the best solution? The uptake of mHealth services is still low. I haven’t witnessed any near proportionate growth of such health services with increasing mobile penetration in India. But it is the same story with banking, education, entertainment apps as well. 3G services are available in certain circles only but it is expected to cover around 270 million subscribers by 2017. SMS based help use cases are definitely plenty in the country but mHealth is about end-to-end care. Increased penetration of mobile technology in India will bring with it many socio-economic benefits.
mHealth is touted as a solution to getting healthcare services to rural
and hard to reach areas, but what about urban areas, where healthcare is within reach? It is a myth that mHealth is made to support only rural health initiatives. Our study conducted in the year 20102011 indicated that mHealth supports all cadres and strata of people. Today, telehealth built into primary, secondary and tertiary care provides advantages of cost, convenience, efficiency, quality and time. Also, younger, affluent classes are most likely to use telehealth services, not just in India but across the
world. mHealth has also been equally popular in urban areas and developed nations contrary to the popular belief that such solutions only target developing nations or poor countries.
How much is the lack Electronic Health Records (EHR) impeding the spread of mHealth? Tele-consultation and remote prescriptions in India relies on patient’s memory and knowledge in the absence of medical records. Yes, there are issues with EMR in India but then there are other issues as well. With the advancement in mobile technology, there are lots of prospect for the health domain. Specifically, the accessibility of the electronic health record (EHR) can be extended using mobiles to promote remote healthcare delivery; this is known as mHealth. However, supporting real-time access and services synchronization in highly distributed mobile environments can be challenging due to the fact that mobile devices rely on wireless communication mediums to exchange data. These mediums can be unstable due to bandwidth fluctuations and the mobility of the healthcare professionals. In this work, we examine how to provide real-time accessibility of the medical record in the mobile environment by overcoming the network-level limitations. With UID and National Health portal (NHP) projects coming up, there are hopes that we shall soon have a unique identification based centralized repository of records related to the individual including healthcare. A centralized eHealth advisory team will put in place standards and make EMR mandatory for Pharma, Medical Insurance, quality audit and disease surveillance use.
unprecedented amount of information. As health care organizations put their data online, they are starting to recognize the opportunities available to leverage that data to lower costs, deliver better patient care and meet regulatory mandates. The outcome that consumers, providers, and payers are looking to see is higher quality care at a lower cost. In order to achieve that, providers are beginning to leverage analytics based on clinical and administrative data to more effectively predict the health outcomes of their patient population, measure health trends, and establish
mHealth and eHealth are set to enter India’s primary health centres and subcentres, as the Health Ministry goes hi-tech meaningful correlations to help make more informed healthcare decisions. But data is only valuable when you can turn that information into actionable insight. The need is of a mHealth platform that helps health care organizations gain deeper insight into patient behaviors and outcomes, fueling their clinical efforts to improve care delivery and achieve more successful outcomes.
Please tell us about the importance of analytics of in mHealth.
Can mHealth help in fighting epidemics like dengue, or is it limited to healthcare disorders?
With mobile health solutions that integrate mobile devices, web, and sensorbased technology, health care organizations have an opportunity to gather an
Yes. From a simple data collection to HIE (Health Information Exchange), mHealth leveraged applications can help in disease surveillance, track-
ing, monitoring, prevention as well as management. Coupled with technology based cognitive intelligence, Healthcare organizations are increasingly using analytics to consume, unlock and apply new insights from information. We have seen several case studies where Malaria control was done using mobile phones by raising awareness, distributing mosquito nets and managing logistics and campaign wirelessly. Newer methods of analytics can be used to drive clinical and operational improvements to meet business challenges. From a traditional baseline of transaction monitoring using basic reporting tools, spreadsheets and application reporting modules, analytics in healthcare will bring a paradigm shift in healthcare sector. It will soon move towards a model that will eventually incorporate predictive analytics and enable organizations to “see the future,” create more personalized healthcare, allow dynamic fraud detection and predict patient behavior.
How much is the mHealth sector in India worth, and how much growth do you foresee? What are the challenges it faces? mHealth will be a Rs 3,000 crore market in India by 2017 (source PwC). mHealth and eHealth are set to enter India’s primary health centres (PHCs) and subcentres, as the Health Ministry goes hi-tech. India has a unique pattern of adoption and push that needs to be understood. Telehealth in India has grown over the last decade due to government funding. The government is now promoting mHealth as a major policy initiative. However, in pursuing the broad initiative there is a danger that some of the smaller components can get lost, and this is probably what has happened to telehealth. Many government-driven telemedicine programmes have failed as they do not have a successful business model and die after the government grants run out.
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tech techtrend trend mhealth mhealth
We Provide Second
Opinion from Specialists Shekhar Sahu, Co Founder of HealthcareMagic, a mobile healthcare services provider talks to ENN’s Rajesh K Sharma about the company’s foray into mHealth and shares his opinion on the journey so far Please tell us about the Doctor on Call service that you ran earlier. We ran the Doctor on Call service in collaboration with Tata Teleservices, BPL Mobile (in Mumbai), Vodafone and Docomo around 2008-09. If one dialed 54487 on these services, the call landed to HealthcareMagic, and one of our doctors answered the health questions. If it was a general query, then a General Physician answered the call, but the doctor felt that the query was slightly serious or if a specialist was required in consultation, he used to connect the call to one. This was a pilot service that ran for one year with these companies. At that time, people didn’t have a smartphones, and the market for value added services wasn’t as lucrative as it is now.
Do you still provide this service? We don’t provide this service now, as people have moved to mobile apps, and we too have moved our services to mobile apps. But we do provide healthcare service over the phone to our corporate customers. Around 200 companies use our health services. We provide services like Ask-a-Doctor, Ask-a-Specialist, Ask-a-Dietician and Ask-a-Counsellor to our customer, online and over the phones as well. This was a strategic decision for us because we are an internet company, and our focus was growing
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our healthcare business over the internet and mobiles – not on calls, but through mobile websites and apps.
What was the kind of volume that you dealt with during you pilot phase? We used to get around 300 calls per day from the vendors. But with value added services, the catch is that there is not much profit for the service provider. We were making only about 25 percent of the billed charges. This was not very profitable for us. Moreover, Doctor on Call was not our primary business, since our focus was shifting to mobile platform and web.
What are the most common queries that you receive? The most common queries are related to women’s health. Women are more active than men in healthcare. Roughly, around 60 percent are active online on health related websites and the remaining are men. So, most of the queries we receive are women centric, like pregnancy related queries, beauty and skin related questions, and childbirth related questions. Then we get queries related to cardiology and oncology. Then we get general health queries like headache, flu, viral fever etc. Then come the sexual queries. All these queries consume around 60 percent of the questions that we receive. The remaining questions are related to various medical conditions.
Do you feel that such a service is apt for treating serious ailments? If someone has a serious medical condition, we give them a second opinion. People always look for a second opinion in any serious health issue. Our service provides a second opinion from a specialist. For example, if someone has a heart condition, then he can get a second opinion from renowned doctors on our board. We have the chiefs of cardiology from Apollo Hospitals, New York Medical
Centre and San Francisco General Hospital on our boards. These kinds of doctors are able to provide a much personal second opinion. But ultimately, meeting a doctor face to face is absolutely necessary. In India, we have partnered with hospitals. So, after giving a second opinion, the specialist too asks the patient to visit a doctor, and we fix an appointment for him if the patient agrees. But many a times, a patient may not be aware that the symptoms point to something serious.
demand for doctors, and if we have the required doctors, then definitely we will be able to respond to such a situation. But when an epidemic occurs, the only things that matters is awareness and precaution. If people have mHealth services they can have proper information at the right time available to them.
What, according to you, is the size of the mobile health industry right now, and what is its potential? Potential is very good in India. Till 2011-
“If someone has a serious medical condition, we give them a second opinion. People always look for a second opinion in any serious health issue That is true. Because of such a scenario, we do not prescribe any medicines because that is not recommended worldwide.
Do you plan to offer your services to the general public? That is in pipeline. We are in talks through one of our partner companies. Many NGOs and state government are putting up kiosks that can reach people in rural and tribal areas. Noting much has developed, but we are willing to reach as many people as possible through as many medium as possible.
Can mHealth be used to fight cases of epidemics? If there is an epidemic, then its awareness becomes very important. If such a service is available and even if a small portion of people using mHealth service get regular tips and suggestions from the doctors, then I think it will make a lot of difference in their understanding and taking of precaution. Also, an epidemic calls for a huge
12, not many people used smartphones. Now, everyone from a schoolboy to a grandmother has a smartphone with an internet connection. Mobile has become the primary medium to reach people and communicate. Penetration of healthcare into these kinds of communication devices is that best thing that can happen.
The mHealth field has a substantial number of players now. Do you share ideas and best practices among yourselves? We do not believe in sharing any kind of medical information. Any kind of question asked by the user should be strictly confidential. It is against our policies to share any kind of medical questions or practices. Statistics about out service may be shared, but we don’t share individual patient histories. But nobody has asked about any trends, and we have not shared it with anyone. You are the first person to ask such a question, actually!
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Health IT ?????????
Telemedicine has
Come as a Boon…. Despite ‘progress’ in bridging urbanrural healthcare divide, most Indians continue to bear the brunt of inadequate healthcare system. Subash Deb, ENN, writes a treatise on Telemedicine in India
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he thought that doctor is a second God and medical is heaven on earth is utterly true. However, in India there is an acute shortage of doctors with 1 doctor for every 1,000 population—a sordid reality which India has been reeling under since a long time. Doctors may not be the panacea for all problems, but the fact remains that they definitely can provide cure for all diseases. Doctors view that patients suffering from several life-threatening diseases can be saved by early detection and timely intervention. However, a large chunk of India’s population, which still resides in rural India, has been deprived of such medical facilities and infrastructure. India, with its grotty health care network and dearth of doctors, faces a daunting challenge of providing quality health care to its citizens. More to the point, doctors’ coyness to serve in the boondocks is actually creating a blot on India’s
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health care landscape. A total of 74 percent of the qualified doctors inhabit urban areas, serving only 28 percent of the national population, while the rural population remains mostly neglected. Besides that, the public health care system is not only pathetic, but also under-utilized and bungling. “There is a need to increase our spending in the health sector. Public expenditure on health in India is 1.2 per cent of the GDP, which is lower than four per cent in Australia, Britain, Norway and the US,” President Pranab Mukherjee was quoted as saying in many national dailies. As per the Planning Commission of India’s Report (2012-13), public health care expenditure has increased from 1.27 per cent in 2007-8 to 1.36 per cent in 2012-13. On the contrary, private sector is quite prevalent in India’s healthcare system. Nearly 80 percent of total spending on healthcare in India comes from the private sector. However, accessibility and availability of these optimum medical facilities is largely skewed towards urban areas which make up only 28 percent of India’s population. The remaining 72 percent who live in the hinterland continue to bear the brunt of insufficiencies in public healthcare services as well as higher costs at private hospitals. As a matter of fact, there is a high degree of disparity in quality and access to health care service between urban and rural regions. The quality of patient care and access to healthcare services are disproportionately low in rural areas. In such a scenario, telemedicine has come as a boon for all—to improve the country’s healthcare system.
Telemedicine, in simple words, means use of Information and Communication Technologies (ICT) to provide medical services from distant locations.
Telemedicine in India In India, telemedicine activities started in 1999. It was formally launched on March 30th, 2000, when Bill Clinton, the then president of the United States, commissioned the first telemedicine unit in the village of Aragonda in Southern India. Telemedicine has been increasingly making strides in the country with the vigorous involvement of both the public and private sectors which have initiated various path-breaking steps to bring a sea change in the rural healthcare statistics of the country. Telemedicine is a desideratum considering the fact that a large chunk of India’s population live in difficult to reach, inhospitable terrain and have to travel long distances and also incur additional expenses to have access to super-specialty medical care. The advantages of telemedicine are multifold. It virtually takes doctors to regions where there are no doctors. It has made medical help a reality in areas where no help existed before. Tele pathology, teleradiology, teleophthalmology are some ways of accurately diagnosing diseases from a distance. With the objectives of extending quality healthcare facilities to the rural and isolated parts of the country, various government agencies like Department of Information Technology (DIT), Ministry of Health and Family Welfare, state governments, premier
medical and technical institutions of India have taken various game-changing and executable initiatives in recent years. The Indian Space Research Organization (ISRO) is also delivering health care services to the remote, distant and underserved regions of the country through a satellite communication-based telemedicine network. The Government of India has initiated and executed various national-level projects and also taken telemedicine services to South Asian and African countries. A number of institutions which have been actively involved in telemedicine activities are also running curriculum and non-curriculum telemedicine courses. In order to shore up telemedicine activities within the country, the Department of Information Technology has set the standards for telemedicine systems and the Ministry of Health and Family Welfare has formed the National Telemedicine Task Force. There are various government and private telemedicine solution providers actively engaged in creating awareness about telemedicine within the country. Some private players who are also in play include the Asian Heart Foundation, Apollo Hospitals, SGRH, Fortis, Max etc. It is estimated that 1.5 lakh people are benefited from telemedicine every year.
Market India is an ideal setting for telemedicine activities. Here, telemedicine is not only trumpeted as a bucolic boon but also as a boom sector for various stakeholders. With the sudden spurt of telemedicine network within the country, the market for medical diagnostic, healthcare providers, drug manufacturers, telecom equipment manufacturers, software has increased manifold. According to a study by Technopak Advisors, the Indian telemedicine market is valued at $7.5 million and is expected to grow at a CAGR of 20 percent over the next five years
to around $18.7 million by 2017. A London-based market intelligence firm, Infiniti Research in its report published in 2009, titled “Global Telemedicine Market:2008-2012”, pegged the size of the global telemedicine market in 2008 at US$9 billion. As per this report, Asia is the fastest growing region for the telemedicine market with India and China leading the growth.
India is an ideal setting for telemedicine activities. Here, telemedicine is not only trumpeted as a bucolic boon but also as a boom sector for various stakeholders Key growth drivers • Inadequate disease management framework • Derisory healthcare facilities in far-off regions • Low technology cost and availability of qualified technical personnel • Paucity of qualified medical professionals • Government’s vision of healthcare for all • Disparity in medical services between urban and rural areas • ISRO’s dedicated satellite for health communication • Development of ICT as a sector
Challenges remain Despite the fact that telemedicine deployment is moving at a steep rate
in India, it hasn’t yet gone on a giant scale. Around 75 percent of our rural population are reeling under poor infrastructure and lack of computer knowledge. For the implementation of telemedicine one must be computer literate. Moreover, rural India faces power cuts of 12 to 15 hours a day, where even a battery backup system does not work out. Language and communication is another impediment. In India with over 22 officially recognized languages and over 1,600 mother tongues, linguistic diversity is a major hurdle for patients living in one region being able to talk to a doctor in another region. Though telemedicine technology advantages and benefits are well recognized but still many healthcare professionals are unenthusiastic to engage in telemedicine practices due to unsettled legal and ethical concerns. Last but not the least, most of the government and private doctors are not willing to participate in telemedicine activities since they view it as a direct challenge to their livelihood.
Conclusion In spite of the progress, there is much to be done on the policy front. Even as Government of India has made attempts to set guidelines and standards for telemedicine, the country doesn’t have a proper policy in place. India deserves kudos for setting up the Pan Africa Network and South Asian Association for Regional Cooperation (SAARC) telemedicine network, but the public expenditure on health which is counted as one of the lowest globally cannot be ignored. While the Indian medical community and private hospital networks may take pride in country’s medical tourism and rare surgeries that save precious lives, but the fact remains that rural India is prodigiously deprived of this very advantage.
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????????? in focus
Right for Today Ready for Tomorrow Amit Singh, General Manager - Computed Radiography Solutions, Carestream Health India
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adiologic technology is advancing at an extraordinary and ever-accelerating pace – with ongoing advances that empower radiology departments to continually increase their standard of care and efficiency. At the same time, however, this rapid evolution poses a serious issue: it’s not uncommon for equipment to become outdated well before it reached the end of its useful life. This can force facilities that want to remain on the cutting edge to replace technologically obsolete equipment on an all-too-frequent basis – incurring costs that no department in this age of tightening budgets can afford. So – in light of this serious challenge, how can you run a facility with the best and latest technology... and at the same time avoid a financial breakdown? You need to go with technology that’s future proof – technol-
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ogy that’s designed to be scalable and grow along with your needs. This can minimize worries about technology obsolescence, extend the life of your existing equipment and continue to leverage your current investments. This is what it means for your technology to be Right for Today, Ready for Tomorrow.
Getting Started To move forward, the first step is to identify and incorporate growth scenarios into your long-term planning and design. For example, you need to analyze the projected growth of your enterprise, both short- and long-term. You need to examine any shifting trends in the demographics and needs of your patient base. Assess where you are now in the imaging contin-
uum; that is, are you imaging on film? Have you upgraded to Computed Radiography (CR)? Or, have you stepped all the way up to the benefits of full Digital Radiography (DR)? Whatever your current technology, you’ll need to establish a timeframe and budgetary parameters for progressing to the next level. You will also need projections for your service and uptime requirements over time, based on your facility type and degree of equipment redundancy. These can be tough challenges. But, you don’t have to tackle them on your own; the right vendor can partner with you to evaluate your present needs and help lay out a plan for the future.
The Guidance You Need is Close at Hand Carestream is just such a vendor – helping you to look beyond a single product at a specific point in time – and working with you to design a forward-thinking solution that will remain viable and fulfill your evolving requirements. The foundation of this strategy – an initiative that emphasizes modular capital purchases and professional services to reduce risk and increase flexibility and adaptability to change. Carestream’s broad portfolio of X-ray solutions can provide the answer wherever your facility is on the imaging continuum. And, offer a bridge to the next level of X-ray technology and services that you can cross as soon as you’re ready.
Modularity and Scalability Carestream’s imaging solutions are based on an exceptionally modular platform. The benefits of this are compelling. For example:
• If you’re currently using film and plan to continue this for some time, you can look to Carestream for analog X-ray systems and X-ray film that represent the gold standard for the industry. • When you’re ready, Carestream can help you upgrade to CR image capture – without the need to purchase all-new components for your X-ray room. • In the future, you can move into DR imaging while protecting your current X-ray investment. Carestream’s DRX-1System and DRXMobile Retrofit Kits allows you to convert existing CR mobile units or full rooms to DR with a state-of theart wireless, digital detector – which is fully compatible and sharable with the other DRX equipment across your entire enterprise. • Moreover, you can then expand your DR systems on an ongoing basis, continually advancing your ca-
pabilities, while still leveraging your legacy technology. • Carestream’s Right for Today, Ready for Tomorrow design philosophy is not limited to hardware. Both our CR and DR solutions are driven by the same Carestream DirectView Software and feature the same user interface. A consistent platform that works across all products means there’s no need for techs to learn multiple user interfaces, minimizes training time, and makes it easy to move from one piece of equipment to another. Carestream’s worldwide services team works alongside your professionals, keeping your equipment running at peak performance. A comprehensive scope of service solutions offers the right solution for facilities of any size level of in-house resources. Radiology IT solutions from Carestream are designed on similar principles. They enable upgrade from film or early-generation systems without a prohibitive investment – and with no interruption of services.
The Road Forward As Radiology departments and imaging facilities navigate their future, the need to tap advancing technology while containing costs will continue to be a formidable challenge. To succeed, the smartest strategy is to invest in imaging solutions that will adapt to your needs as you progress along the imaging continuum.
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in person
Alleviating patients’
Suffering in a Caring Way Recognizing the need for, a full-fledged pain and palliative care programme, it was started at Dr BRA Institute Rotary Cancer Hospital (IRCH), AIIMS. Dr Sushma Bhatnagar, Professor and Head, Unit of Anesthesiology, All India Institute of Medical Sciences (AIIMS), in conversation with Ekta Srivastava, ENN, talks about the need for palliative care for cancer patients What is the need for pain and palliative care in India? There is an urgent need for pain and palliative care in India. In our country, the worst part is that the patients come during the advanced stage of the disease which is quite painful for the patients. Most of the time, the pain management is either inadequate or is not treated at all. Patients feel that pain and cancer are synonymous, may be because of the inadequate knowledge of the physicians and among the medical professionals. In India, less than one percent of cancer patients get pain therapy. Most patients die in severe pain. It has a huge demand considering the need of the terminally ill patients. We have to address it aggressively.
What is the supply and demand situation across the country? There is a big community of pain physicians. There are sufficient numbers of pain physicians in India but most of them are concentrating on the interventional pain management. As a matter of fact, not
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all cancer patients can be treated with interventional pain management because patients can benefit from it only when the pain is localised. However, if the pain is diffused over the entire body, as it happens in metastatic cancer patients, then the interventional pain management is unproductive. It has been my observation that very few pain physicians are treating patients holistically. Not only does the pain have physical aspects, but it also has social, psychological, and spiritual aspects. Therefore, we have to treat the patients holistically. At present, there are pain physicians who ignore holistic treatment of total pain. They do not give emphasis on oral opiates like oral morphine which is the mainstay of cancer pain management. Perhaps because of non-availability or misconception about oral morphine, they don’t treat pain adequately.
How is the system planning to meet the demand? Indian Association of Palliative Care is working hard to spread this message amongst the various part of the country by doing annual conferences. Simultaneously, we conduct Palliative Care Course twice in a year in many cancer centers all over the country. We have a fixed curriculum for that course. We conduct this course in almost 30 to 40 centers all over the country. Also, we have Diploma and Fellowship programmes in the country. In 2012, MCI recognized MD in Palliative Medicine and also planning to include this in undergraduate and postgraduate teaching curriculum. Besides that the government of India recognized and incorporated the palliative care as an integral part of medical care of the patient and included this in the 12th Five Year Plan.
Is government engaging the NGO’s as well? NGOs have a big role to play too. It is not just the doctors’ job. In palliative medicine, there is a lot of nursing involve-
ment. In India home care is the best answer of increasing demand which can be taken care by NGOs and volunteer groups. Volunteers can help in giving counseling. In our course curriculum, NGOs role have been emphasized.
case we have to give oral medication, then we are also working on treating side-effects aggressively like constipation, nausea and others. We keep on explaining the side-effects of the drugs and its treatment to the patients.
Tell us something about the WHO’s Pain Ladder.
Are we using it for treating diseases other than cancer and HIV?
WHO’s Pain Ladder of 1986 was basically a simple protocol giving directions on how to go about in cancer pain management. In this ladder, there are three steps. If a patient’s pain is mild, there are fixed group of drugs, if the pain is moderate, there are mild opiates and if the pain is severe, then we
Palliative care is not only for cancer and HIV, but its principles can be incorporated in the treatment of chronic and incurable diseases like heart failure, liver failure, renal failure, stroke patients and patients with multiple sclerosis. These patients also need complete
“The main difference from India to west is that With less number of doctors and nurses, we are treating more number of patients” give strong opiates. In every steps role of adjuvant drugs and adjuvant analgesic have been emphasized. If the patient’s pain cannot be controlled, we do some intervention. In all the steps, importance is given to counseling and communication. The principle of WHO’s pain ladder is that medication should be given “by mouth”, “by the clock”, “by the ladder”, “for the individual” and “attention to detail”. This therapy is key to managing pain in the majority of patients with cancer.
What about the implementation of the WHO plan? What is the scenario of palliative care in India? It is already implemented worldwide. In India, people who are aware of it are using it and geting benefit from it. At Dr BRAIRCH we adopt a holistic approach. We give total care to the patients. We keep balancing between interventional therapies and opioids. If the patient’s pain is localized, we give interventional therapy However, in
care and psychological support. They too need long-term care. This is the only branch of the medicine which offers patient and family-centered care. Patients suffering from chronic diseases are not the only ones suffering but also their family members. In our course curriculum it is mentioned that palliative care principle should be incorporated in the treatment of all the incurable disease and it should start from the diagnosis of the disease.
How is palliative care in India different from the international standards? Well, principles of treatment almost remains the same. We are developing in area of palliative medicine and have come a long way. In western countries palliative medicine is well developed and its part of the teaching curriculum with well established courses. In India lots of myths and misconception exist about palliative care and opioids medication for pain relief which we have to improve by awareness programs.
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specialty pediatric
‘Every
Child is our Child’ Dr Neelam Mohan, Director, Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta - The Medicity, in conversation with Shahid Akhter, ENN, delves into her passion in pediatrics that has finally evolved as one of the busiest centres in Asia for pediatric liver transplantation
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Why pediatrics? What prompted you to chart your career in this uneven territory?
How and where did you gain proficiency in pediatric gastroenterology?
I was keen to pursue a career in medicine that was something new, different and unique. After obtaining Post Graduation in Pediatrics, I had three choices before me – Cardiology, Gastroenterology and Genetics. Cardio was a bit crowded and complicated, genetics was exciting but there was not much interaction with the patients, so I opted for Gastroenterology (GI). Liver was one organ that fascinated me a lot. Unlike heart, it was not much talked about, there was no awareness in the 90s so I settled with liver and also wanted to continue with endoscopic procedures which were beyond the purview of the surgeon. This field of Pediatric Gastroenterology, Hepatology and liver transplant was totally new domain in healthcare in India, and I was very happy in settling with this.
During the 90s, there was no such training in gastroenterology in India. At best, AIIMS offered some training in GI where I worked for more than a year and then decided to leave for the UK to master GI. Between 1997 and 1999, I was trained in Pediatric GI and liver transplants that had just started taking shape. I returned to India in 1999 after learning more about motility, manometry and chronic diarrhoea and liver transplant. Finding a job was an arduous task as no one was interested in my precise domain of gastroenterology and hepatology. I stood by my resolve to create
Achievements Performed more than 150 (the highest in India) pediatric liver transplants in the country 8 Country’s first doctor to start therapeutic endoscopic work in newborns and young infants 8 Established India’s first oneyear fellowship in pediatric gastroenterology, hepatology and liver transplantation, certified by the Indian Academy of Pediatrics 8 Honoured with awards like DMA “Vashisht Chikitsa Ratan Award”, Swastha Bharat Samman 2012, Distinguished Service Award , Most Popular Doctor , Fellowship of American College of Gastroenterology , Fellowship of Indian Academy of Pediatric and SGRH Alumni Award and many more. 8
Having grown vertically at Sir Ganga Ram Hospital, I was seeking horizontal expansion at Medanta. Here, we have spread into various verticals like motility, endoscopy, capsule endoscopy, endoscopic retrograde cholangiopancreatography and our goal is to add and improve in all dimensions of liver treatment including stem and Hepatocytes transplant. Today we have the highest number of successful pediatric liver transplants in India and we can claim to be at par with America and UK, if not better in living related cases.
As clinical science is your forte, what are your areas of interest and research?
“Unlike heart, liver was not much talked about in the 1990s and this organ fascinated me awareness in gastroenterology and liver. Finally, I was lucky enough to get a break at Sir Ganga Ram Hospital where I worked for ten years. We were pioneers in liver transplant at Sir Ganga Ram Hospital at that time. I was the first in the country to initiate endoscopic procedure in 2.5-kilo babies. I worked not only in diagnostic but also in therapeutic endoscopy. All this boosted to my confidence and morale immensely.
Your current role and activities in pediatric gastroenterology? Being associated with children and able to save their lives gives me immense boost in life. My adrenaline simply soars. I find it difficult to compare this happiness with anything. Even a Ferrari ride won’t give me that adrenaline surge as saving someone’s life does. Moreover the blessings and wishes that I receive from parents. They adore me as the second mother and this gives me a sense of fulfillment in life.
I strongly believe that one day stem cells may be the solution for metabolic liver disease and this makes my first point of interest. Though it is at an early stage but there is a lot of hope and expectations are high.
How common is IBD (Inflammatory bowel disease) in children? IBD is an idiopathic and chronic intestinal inflammation. Ulcerative Colitis (UC) and Crohn’s Disease (CD) are the two common types of IBD. Among children is a matter of concern and it varies with geographical areas. The United States and Europe account for the highest incidence while. Asia accounts for the lowest incidence along with Africa and Latin America. However, IBD is catching up with Indian children, possibly because of Western influence and greater awareness. IBD can be observed in toddlers but ideally the peak age of onset is during adolescence and young adult
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specialty pediatric
hood. Children from urban areas and higher socio-economic classes have higher prevalence of IBD than those from rural areas and lower socio economic classes. IBD may run in families. The risk of developing IBD to first degree relatives of an IBD patient is 10 percent If both parents have IBD each child has 36 percent chances of being affected. Ulcerative Colitis (UC) is a mucosal disease that involves rectum and extends proximally in continuity to involve most of the colon. Around 50 percent children have disease limited to recto sigmoid, 30 to 40 percent have disease extending beyond sigmoid but not involving whole colon, and 20 percent have pan colitis. Children with ileocolitis typically have cramping, abdominal pain, and diarrhea, some times with blood. Ileitis may present as right lower quadrant abdominal pain alone. Crohn colitis may be associated with bloody diarrhea, tenesmus, and urgency. Systemic signs and symptoms are more common in Crohn disease than in ulcerative colitis. Fever, malaise, and easy fatigability are common. Children may present with growth failure as the only manifestation of Crohn disease.
What are the common indications of liver transplant in children? This may include cholestatic liver disease (most common of which is biliary atresia), metabolic liver disease and acute liver failure. Add to this some rare conditions. The indications for liver transplant include : • Cholestatic liver disease • Metabolic liver disease • Hepatitis • Metabolic and Genetic disorders • Liver tumors
How is the liver transplant scenario in the country ? How much does a transplant cost? Today, there is a need of over 20,000
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“Compared to adults’ liver transplant, pediatric liver transplants are more successful. Following the transplants, children live longer. This translates into greater life expectancy of a child with liver transplant”
I strongly believe that one day stem cells may be the solution for metabolic liver disease. Stem cell transplant is very promising and equally fascinating liver transplants in adults and around 2,500 in kids. We, at Medanta have conducted over 1600 transplants in adults and more than 150 in children. The need for organ transplant is much more than what we are doing. Liver fails only when 60 – 70 percent of it is damaged. The new liver comes from only two sources – cadaver organ transplant or living relatives. India accounts for less than 1 percent cadaver transplant while the rest comes from relatives who donate their liver. In a child the liver transplant costs around 15 to 17 lakhs and in adults it may vary between 20 to 25 lakhs.
Your future plans and the road ahead. In India we find super specialty and organ specific hospitals but how about children? Hospitals for children are few and far. I am keen to see the birth and growth of a full fledged hospital for children. I am consistent and focused in my mission. Today, in India we have around 40 percent of the population that is below 18 years of age but how many hospitals are there to address their cause? Dr Trehan has accepted
The Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation at Medanta 8 A to Z facilities for Newborns, Children and Adolescents with Gastrointestinal
and Liver Diseases including the highest level of care that is Liver Transplantation. The Department offers the highest standard of healthcare delivery to equate with the best in the world and at an affordable cost in India. 8 The busiest pediatric liver transplant team in the country 8 The department is credited with several firsts in this field in India and a few in the world such as youngest domino liver transplant in the world and the first infant in the world to be cured of factor VII deficiency by liver transplantation. 8 The Department is equipped with highly advanced endoscopes and equipments looking into pH metry, impedence manometry and motility studies.
my plans about a dedicated Children’s hospital, replete with all the specialty sections. Initially, we need to create a system that will sustain itself. Profit is not the motive. I am very much interested in clinical science, and therefore, do not want to leave my clinical work because that is my forte.
Please tell us about your social activities. How do you manage your passion and profession? There is a very thin line that demarcates my passion and profession. I feel preventive medicine and creating awareness makes a lot of difference. I love to visit schools and colleges and talk about Hepatitis, particularly B and C which are more
dangerous. Not less than 300 million people are suffering from Hepatitis B alone. More than 70 percent of them get Hepatitis in their childhood. We run free paediatric gastroenterology and hepatology clinics and free clinic for the thalassaemics. Hepatitis is one area that I hold a lot of interest in. Way back in 2008, I was the group leader for Guidelines Management of Hepatitis C presented at the World Congress in Brazil. Besides, we have the Cherry Hill Educational Society which aims to provide free basic education to a certain sections of people. Besides this, I run a ‘CHILD’ society which looks into providing free healthcare, conducting awareness camps, CME
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SPECIALTY DENTAL
Dr Anand Tuteja, Country Head, India, ClearPath Orthodontics
A beautiful Smile
without TrainTrack Braces Dr Anand Tuteja, Country Head, India, ClearPath Orthodontics, in conversation with Shahid Akhter, ENN talks through the state-of-the-art invisible aligners that are all the rage in orthodontics
When was ClearPath aligner developed and how does it differ from conventional braces? ClearPath was incorporated in the year 2008 in USA after 8 years of Research and Development. In India, it was introduced for the first time in the year 2012. The common issue that detracts people from the smile they want is crowded teeth. It worsens even more with clunky metals on their teeth like metal braces which are worn to correct the condition. Whereas, ClearPath aligners are transparent, i.e., made from medical grade plastic that cannot be seen easily. In other words, they are virtually invisible. Another benefit is that it is removable. At the time of brushing teeth or while cleaning these plastic trays, one can easily remove them as and when required. This is however difficult with the metal braces which can be removed by the dentist only. As a result, the oral hygiene deteriorates. However, align-
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ers effectively eliminate any chance of developing gum problems. Braces are unsightly and uncomfortable, but dental aligners are just the opposite. With aligners, one’s desire of a beautiful smile and healthy teeth becomes a reality without making it obvious to the world and without even affecting the daily routine. ClearPath provides comfortable, easy-to-use and most importantly the affordable orthodontist appliances like Invisible aligners that take care of your teeth. This dental aligner is flexible in design and is suitable to be used by all age groups and can be customized as per individual’s need.
What technology goes into the making of ClearPath aligners? Is it patented and FDA approved? The latest technology that is being used in the processing of ClearPath aligners is through CAD/CAM technique which is computerised designing and automated
production of aligners is done through specialised software that results in the fabrication of custom-made appliance to suit your unique requirement. The automated system increases the predictability and accuracy of the treatment adds to the preciseness of the whole procedure as it becomes possible to ascertain the number of aligners that a patient will require during the whole treatment. The plastic used in the manufacturing is FDA approved and the aligners have smooth edges that prevent your gums and cheeks from unwanted irritation. This computerised and digital clinical system is used in hundreds of clinics in the USA, India, Jordan, UAE, Lebanon, Oman, Qatar, Kuwait, Syria, Egypt and across the Middle East.
When was ClearPath launched in India and how do you foresee it in the Indian market? ClearPath is about this breakthrough technology which revolutionizes the
way we treat malocclusion (straightening the teeth). The venture was started on a pilot scale in Dec 2010 and after its grand success, we launched in Jan 2012. We have seen a 250 percent growth year-on-year for the past two years. We anticipate the same growth for the next four to five years also. The Orthodontic market in India is vastly untapped and there is acute paucity of convenient and aesthetic treatment measures.
Who is your target audience? Is there any age bar? Our target audience is all who are aesthetically conscious. People above 14 years of age are our target customers.
What challenges did you face in initial years? The biggest challenge we faced was to convince the doctors for using this technology. Since they have been using wires and brackets for years, this idea of wireless dentistry moved at a snail’s pace. However, gradually, we have been able to convince most of the top practitioners in all the cities. Today, we have a good pool 1,000 plus doctors in India prescribing ClearPath.
What is your market presence in India and how easily is the ClearPath aligner available? Our 1,000 plus doctors are located across five to seven Indian cities. It is easily available even in smaller cities. If someone needs to find a ClearPath practitioner, he can also visit our website and check ‘Find Your Doctor’ section. Our market presence is 100 percent market share in India as we are the only company in India and one of the only two in the world.
What other teeth problems are addressed by ClearPath aligners? None, straightening of teeth is the only indication for ClearPath Aligners. It does have certain side benefits like it relaxes the jaw joint and gives relief
“Unlike metal braces, ClearPath Aligner is virtually invisible. Hardly anyone gets to know you’re straightening your teeth from traumatic occlusion and bruxism. Also act as habit breakers.
How prevalent is malocclusion in India? Thirty-five percent of India’s population have visible deforming malocclusion.
How many dental visits are required for ClearPath aligner’s procedure? As few as one visit is required for the entire procedure. However, we recommend follow-ups every three months.
Please explain the modus operandi? The dentist takes precise impressions of the patient’s teeth and customises the aligners for his teeth. The impression is sent to the ClearPath. The digital set up is shown and approval is sought. Aligners are then dispatched to the dentist. The patient starts wearing the aligners set by set (two weeks each). The treatment concludes, retention follows.
Who can use ClearPath aligners? Any dentist registered with the Dental Council of India can prescribe Clear-
Path. And among patients groups, anyone above 14 years of age is eligible for its usage.
How do you ensure that the ClearPath aligners are perfect and the dentist has done his job as expected? The physical intervention required by the dentist is minimal. He has to make a perfect set of impressions and do some optional procedures like IPR (Inter Proximal Reduction) or Extractions etc. The dentist gives his treatment plan, which is evaluated by ClearPath experts for feasibility. If anything is off the track, a detailed discussion takes place through the portal between production experts in the backend and doctor.
Do you keep a tab on the treatment process? Is it easy to procure a replacement in case of loss or damage to the aligner? The subsequent aligner fitting properly onto teeth is itself an indication that treatment is progressing smoothly. It will fit only when previous aligner in series has done its job. Each aligner moves the teeth bit by bit in a series fashion.
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IN focus
Putting the Tough in Toughbooks Gunjan Sachdev, General Manager & National Business Head, Toughbook, Panasonic India Pvt. Ltd., in conversation with Shahid Akhter, ENN shares his insights on the Panasonic Toughbook tablet that makes it an indispensable healthcare product What is really tough in healthcare tablet, Panasonic Toughbook CF H2? Toughbook CF H2 is a rugged tablet designed for the field. It can be used with ease and comfort even in the worst of conditions. Imagine a drop or a spill that is so natural in a hectic hospital or during outside health camps. The magnesium alloy chassis ensures that it remains light and can withstand a drop from a height of one meter. Add to this violent shocks, vibrations, dust and water resistant features that sets a very high level of durability amidst the most challenging environments. Powered by dual hot swappable batteries, it can endure upto seven hours.
Toughbook CF H2 is referred to as a mobile clinical assistant. What makes it an indispensable healthcare solution? Healthcare hinges on two basic pivots – improvement in patient care and fast track delivery of medical services. Panasonic Toughbook has been specifically designed to cater to the needs of healthcare segment. Be it operation theatre, waiting room, patient’s home or emergency room, Panasonic Toughbook CF H2 is geared to play a crucial role by way of connectivity and software solutions that healthcare professionals rely upon. This translates into better delivery and best possible care to patients. Besides delivering the industry’s highest reliability rate, Panasonic Toughbook assures high performance and security features to help work more smartly. Blood banks can bank upon reliable wireless con-
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nectivity that helps in the transmission of crucial donor inputs and information in real time. Nursing home or day care centers use the Toughbooks to enhance the efficient and effective care that they render. Compared to the bulky computer on wheels moving around in the hospitals, the compact Toughbook is a real health gadget to adore ! Today hospitals are cutting down on paper work and emphasizing more on paperless office. Paper based operations create silos which ends up in slowing down the delivery rate of vital data, inputs and information. Besides cutting down on time, it enhances the workflow. In this direction, the Toughbook stands out by way of 500 GB of standard storage with an optional 128 GB SSD. It comes with 4 GB of RAM but can be extended upto 8 GB.
What other health specific features have been incorporated? To a healthcare professional, time is the most valuable asset and keeping this in mind, the Toughbook incorporates Fast Boot Technology that ensures that the system starts up in less than 25 seconds. The integrated mobile broadband allows the caretakers to stay connected to critical data at the office even when visiting patients.
Can the Toughbook be used in telemedicine? The Toughbook can be an ideal player in telemedicine, where it can connect the remote and inaccessible health centers to the top notch frontiers of healthcare. Moreover, the integrated barcode reader option make it a useful tool for the medics in hospitals to maintain the patient’s record. More and more hospitals in India are adopting HIS application and digitalizing the data, it is gathering momentum. Multiple authorized users in different locations can simultaneously
Superior Ergonomics With superior ergonomics, a brilliant 10.1” sunlight-viewable LED screen capable of up to 6000 nit in direct sun and sealed allweather design, the H2 lets you work virtually anywhere. Besides, swappable twin batteries that promise a maximum uptime, there is integrated GPS and SmartCard reader. Putting the features together, you’ve got an unmatched handheld tablet PC. and securely connect multiple Toughbook Wireless Displays to a single PC and obtain inputs or information in real time. It comes connected with a camera. Weighing less than 1.6 Kg, the Toughbook is easy to move from one place to other and it comes with extremely bright 10.1’’ transflective plus LCD screen with Dual Touch ( up to 6.500cd/m2) reflective brightness, depending on light conditions. To make it more handy, it comes with hand free ergonomic strap that helps to handle it more easily.
How about the security features embedded in the Toughbook ?
Besides, a bar code scanner and RFID reader, the Toughbook has other optional features like fingerprint reader, contactless SmartCard reader and an insertable SmartCard reader. Keeping in mind that 80 percent of infectious diseases are transmitted by touch, the Toughbook keeps the viruses and bacteria at bay by way of sanitization. It can be cleaned and disinfected completely anytime and without much effort.
What is the market share of Toughbook? Globally, the Toughbook commands a market share of 65 percent.
When was the Toughbook launched in India? The Toughbooks were launched in 2008 along with a complete range of 14 products that included laptops, tablets and convertibles. It is widely used in most of the hospitals across India. The unmatched performance of Panasonic Toughbook CF H2 makes it a star performer that has created its own niche in the world of tablet technology in healthcare.
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launch pad
Elpas Infant
Protection
E
lpas Infant Protection from Tyco Security Products helps hospitals prevent baby abductions and unintentional baby mismatching in maternity environments .This is done from the time of delivery to the time of discharge. Elpas Infant Protection permits the regular movement of mothers, staff and visitors in and out of the maternity ward, while preventing the protected infants from being removed from the ward unnoticed or without supervision. In addition to monitoring the physical whereabouts and safety of the infants, Elpas Infant Protection can log the authorized transfer of the infants throughout the hospital, preventing any illicit attempts to move infants to and from wards and treatment centers. At the time of birth the infant is issued an Infant Protection Bracelet, which is placed on the baby’s ankle and later can be adjusted should the baby lose weight before discharge. Should an attempt occur to move the protected infant from the secured area without approval or authorized escort, the Bracelet will trigger the System to alert personnel of the occurring security threat. Elpas Baby Match has useful feature-benefits such as Tamper protection, Exit protection, Alert & paging options and Flexible escort options. It involves easy to use software and supports incident logging/reporting.
ECompression stockings finds distributor in India Sigvaris, an international medical device company in compression garments including hosiery and socks today officially appointed NovoMed Incorporation Pvt Ltd exclusively as its distribution partners in India. Sigvari, manufacturer of graduated compression stockings which are clinically proven to be preventive as well as therapeutic in the treatment of Deep Vein Thrombosis (DVT), varicose veins, help improve circulation and revive tired, achy legs. In layman terms, DVT is a clot that develops in the peripheral veins of the limbs. It is often a precursor to a potentially fatal condition known as Pulmonary Embolism (PE) where the blood clot in the peripheral circulation breaks loose, travels to the lungs, lodges In the circulatory system and compromises heart and lung function. DVT today is a widespread problem boasting of mortality rates that are higher than those of breast cancer and HIV combined.
Ceiling Light
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TL Lemnis has launched highly efficient Pharox LED ceiling lights that meet various requirements of workspaces and recreational areas in Hospital. They are aesthetically pleasing and distribute light evenly in all areas. These LED Ceiling tiles are available in 3 different types of diffusers viz. Milky, Micro linear and Prismatic. LED ceiling light save more than 50% energy. Other features include: system efficacy > 75 lm/W, glare-free, wide operating voltage range –110-270 Vac.
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