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May 2018 | Volume 13 | Issue 05

COVER STORY

medECUBE

Next-Gen Healthcare Delivery System

08

Dr Dilpreet Brar

Founder, CEO & MD medECUBE Healthcare

Focus-Haryana Healthcare

Leader’s speak 26 Chander Shekhar Sibal Senior Vice President

Fujifilm Medical

industry perspective 14

16

Dr G Dewan

Amneet P Kumar

Mission Director National Health Mission Chandigarh

Secretary, Health and Mission Director National Health Mission

Technology Perspective 20 Dr Ganni Sandeep Managing Director

18 Dr Shuchin Bajaj Founder Director, Cygnus Hospitals 36 Dr Rajesh Gulia

44 Dr Priti Nanda Sibal CEO, Medi-Skool and Medical Director AB Hospitals

GSL Healthcare institutions and GSL smart LAB

22 Ayush Mishra Co-Founder

Director of Tattvan E-Clinic

46 Zoya Brar Founder & Managing Director

CORE Diagnostics

48 Dr P N Kakar Medical Director and Chairman-Quality Park Group of Hospitals

Hospital Perspective 24 Inder Davalur CIO, KIMS Hospitals 30 Dr Sunil Sharma Head IT

Jindal Institute of Medical sciences

40 Dr Vandana Bhardwaj Head, IP Revenue Services,

Sarvodaya Hospital & Research Centre, Faridabad

Chief Urologist and Director Mayo Hospital, Mohali

Healthcare Perspective 28 Dr N K Pandey Chairman and Managing Director

Asian Institute of Medical Sciences

38 Chandrakant Lahariya National Professional Officer, Universal Health Coverage, World Health Organisation, India

special article

Ayushman

Bharat Scheme Cheers Private Players

32


Editorial India Refining Its Definition of Healthcare Delivery With new innovations and technological advancement, healthcare providers in India are scaling new heights at a steady pace. They appear to be leaving no stone unturned to cater to people with their top-class solutions and services in this healthcare ecosystem. Today, even help is available to verify the logic behind medical attention being given to us. We can understand and question the genuineness of treatment being prescribed to us at big hospitals. Through our cover story “medECUBE Next-Gen Healthcare Delivery System” we have tried to understand how such kind of vital help is available. medECUBE is a next generation healthcare delivery system that makes clinical coordination central while utilising existing hospitals and doctors for what they are good at – clinical excellence. Carrying forward the rich legacy to propagate about ICT and innovations’ surging role in the healthcare domain, our magazine’s latest issue has tried to focus on how some healthcare brands have given new meaning to patient care. We have carried a host of interviews and write ups in this light. We have a special interview of Dr G Dewan, Mission Director, National Health Mission, Chandigarh “Robust Health Adding Glow To The City Beautiful’s Charm” in which he shares insightful information about how the Government has improved healthcare accessibility in the Chandigarh region. The city’s Government hospitals have all the state-of-the-art facilities and technology to cater residents. These hospitals have set an example for private players to take inspiration from. Our special article “Ayushman Bharat Scheme Cheers Private Players” throws light on how this national health protection scheme will prove to be a big boon for people. At the same time, it will bring new opportunity to private players by turning focus on Public Private Partnership. Our 8th edition of ‘Healthcare Leaders Forum (HLF)’ in Chandigarh brings together leading healthcare brands to deliberate upon various aspects of building a quality healthcare ecosystem with special focus on the healthcare scenario in Chandigarh and north India. Considering the importance of Chandigarh as the city strategically situated in north India, Elets has reached the ‘City Beautiful’. Another interesting write up is “Taking the IT Route to Better Healthcare” on Haryana healthcare which deals with e-initiatives is giving real time benefit to the people at the grassroots level. We have featured interviews of many healthcare leaders including, Ayush Mishra, Co-Founder, Director of Tattvan, Chander Shekhar Sibal, Senior Vice President, Fujifilm Medical and Inder Davalur, CIO, KIMS Hospitals who shares viewpoint on various facets of healthcare delivery. They throw light on healthcare challenges and how it can be overcome with modern advanced technology. We also have special feature and articles on Healthcare insurance, a vital element in today’s life. We cannot turn oblivion to the fact that India still fares very low in terms of healthcare insurance penetration. With such a wide variety of insightful articles and interviews and much more, we hope to evoke an invaluable feedback from our esteemed readers.

Dr Ravi Gupta Editor-in-Chief, eHEALTH magazine & CEO, Elets Technomedia Pvt Ltd ravi.gupta@elets.in


cover story

medECUBE

Next-Gen Healthcare Delivery System

medECUBE is a next generation healthcare delivery system that makes clinical coordination central, while utilising existing hospitals and doctors for what they are good at – clinical excellence, says Dr Dilpreet Brar, Founder, CEO & MD, medECUBE Healthcare in conversation with Elets News Network (ENN). patients and their families. That was the first full year of the company’s existence

Q

Q

Give us an overview of the medECUBE’s role in healthcare. It is an everyday story of yours and mine. For instance, Baljit, a 16-yearold boy from Bhatinda, in Punjab, was diagnosed with epilepsy 10 years ago. He had been on medication since then, yet regularly suffering from seizures. Last year. medECUBE sought a second opinion from a Stanford neurologist, who decided to involve a psychiatrist because the symptoms, when studied in detail, did not fit into the usual diagnosis of Epilepsy. The result: diagnosis was not epilepsy at all, but rather a psychological state. The parents of the child trusted the second opinion, discussed with their physician in India and decided to

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May 2018

follow the advice they got from Stanford. The patient is off the medication completely, and is on psychotherapy. Most importantly, he is seizure free for the past one year. Clearly, in this case, the second opinion was not just a good idea. It was essential. What can be seen from this instance is that there is need for an independent coordination – at a clinical level – to ensure that all the dots are connected. Patients are not equipped to do that. Their families are not equipped to do that. Hospitals, while they do have the ability, do not have the processes to do that. In 2017, medECUBE coordinated healthcare – at a clinical level - for 9000

How did idea of medECUBE originate? I spent my entire career either in direct clinical practice, or in managing hospitals. In seeing the system – upclose and personal - from the inside, one thing became obvious to me: while clinical excellence was central, coordination of clinical was incidental. Yet, most of the frustration of consumers, and a majority of the mishaps happen because of lack of clinical coordination, and not lack of clinical excellence. I asked myself what if we could flip the system, and make clinical coordination central. And do it without losing what’s working well - clinical excellence. That would be an entirely new way of delivering healthcare That is medECUBE: the next generation healthcare delivery system that makes clinical coordination central, while utilising existing hospitals and doctors for what they are good at – clinical excellence.

Q

How significant is medECUBE’s role in healthcare? We deliver only one service – clinical coordination of healthcare for people:

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We have agreements with over 150 hospitals across the world – in India, Thailand, Singapore, USA, UK, Turkey, Eastern Europe, Central Asia, MiddleEast and Africa. We also have over 100 Key Opinion Leader (KOL) clinicians on our global panel of second opinion providers. For people specifically looking for alternatives to Western medicine, we have 10 wellness retreats and alternative medicine facilities. These partners ensure clinical excellence. And medECUBE ensures clinical coordination.

Q

How gratifying has been the journey? Most importantly, we have helped over 10,000 patients and their families by doing the one thing that we do like no other – clinical coordination. And we have achieved excellent clinical outcomes for them. That’s the real impact. To be accessible to these patients, we have opened regional offices in 12 countries. In addition, we have outreach programmes in 25 more countries. Let me tell you a poignant story from a patient from one of these

countries – Cameroon. At 8:30 PM one night in late December last year, a query popped up on medECUBE’s dashboard. It was a cry for help from a brother in Cameroon whose sister Helen had been diagnosed with a brain aneurysm. The skill required for surgical intervention was not obviously available locally. On January 4th, Helen got treated at Max Super Specialty hospital in Saket, New Delhi. Sounds simple enough? A total of 50+ steps, everything from the first query – that resulted from a Google search by the brother – until the patient returned to Cameroon safely, were coordinated by medECUBE. What’s more important is that some of the most immediate steps – of speaking with multiple hospitals, selecting the right one, and getting a visa invite letter to Cameroon, as well as several anxiety-calming phone calls between a medECUBE physician and Helen’s family -were all completed within hours of the initial query.

cover story

FROM— Anywhere (they could be anywhere in the world) TO — Anywhere (their healthcare could be provided anywhere in the world) IN — Wellness, sickness and in emergency AT — Home, hospital, or in alternative care facility Clinical coordination across multiple specialists and providers is complex, and requires clinical knowledge beyond the reach of a non-doctor. It entails solving several underlying friction points: • Helping the consumer in selecting the right hospital and doctor, getting the necessary appointments, and navigating the healthcare system. • Getting a second opinion when needed, and reconciling it with the first opinion • Managing records and alerts because health records of people are fragmented, and scattered across multiple places • Connecting the dots while anticipating the pros and cons of every step in the chain of delivering healthcare to the consumer (as opposed to reacting, after the fact).

Q

What is this medECUBE dashboard? medECUBE uses a system – comprised of people and information technology tools to perform clinical coordination. It is a “high-touch” system, where the clinician plays a central role in coordinating care for the consumer and is supported by a strong backbone of information technology. medECUBE app is available on both Android and Apple platforms. These are tied to a back-end that manages the entire gamut of data through a variety of dashboards.

Q

What is your long-term goal? My goal is to redesign healthcare by flipping it a full 180 degrees. I want to make clinical coordination central to healthcare delivery. And I want medECUBE to touch 10 million lives as soon as possible.

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eHEALTH Magazine

May 2018

9


cover story

medECUBE

A Novel Approach to Delivering Healthcare Offering a new definition to healthcare, medECUBE, which serves as a “Clinical Coordination Concierge”, is focussing on delivering a crucial service — coordinating healthcare for people.

Who delivers the care that we coordinate

medecube Products medECUBE services are available in form of seven “products” - customized to the specific needs of specific type of consumer medECUBE GLOBE: Coordination of care for patients globally – from anywhere, to anywhere medECUBE CIRCLE Coordination of care for parents of NRI’s – adding a trusted doctor to the family “circle” medECUBE DOTS: Coordination of care for patients domestically – connecting the “dots” – between the patient, family, and doctors medECUBE LINK: Coordination of care remotely, via teleconsultation, tele radiology, tele pathology, tele genetics,

and many more...

Who provides the second opinion that we coordinate

medECUBE VITALITY: Coordination of care for patients seeking alternative medicine, rehab, and rejuvenation medECUBE SPACE: Help define, build, and operationalize assets (hospitals, etc.) when there is a shortage of supply medECUBE AFFINITY: Help specialists create awareness about their clinical programs amongst public and physicians medECUBE also got empanelled with NABH Medical Value Travel Facilitator (MVTF) Certification.

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May 2018

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and many more...


cover story

An Illustrious Life Sketch At A Glance F

Dr Dilpreet Brar Founder, CEO & MD medECUBE Healthcare

ounded and led by Dr Dilpreet Brar, medECUBE today is an ‘asset-less’ Clinical Coordination Concierge, which makes healthcare a hassle-free experience for their consumer.

She shifted to Delhi to join the Indraprastha Apollo Hospital as a Resident Medical Officer and thereafter ascended the corporate ladder to hold many prestigious management positions.

Enriched with an in-depth knowledge and experience gained over two-and-a-half decades, both on the clinical and management side of the profession, Dr Brar has a first hand understanding for all the key pain-points of consumers and healthcare practitioners, making her ideally suited to pioneer this concept.

At Max Healthcare, she served as an Executive Director for 10 years and then moved to Fortis as Regional Director. She steered FMRI (Fortis Memorial Research Institute) from its inception to it becoming a $100 Million business in mere three years. Meanwhile, she also completed the General Management Programme at Harvard Business School in 2010.

After decades-long professional journey in the healthcare field, Dr Brar has to her credit successful conceptualisation, launch and management of over a dozen hospitals across Delhi-NCR and Punjab. Having completed her medical education from Punjab University, Dr Brar immersed herself into clinical practice in Chandigarh and Ludhiana.

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Dr Brar today understands the people’s pulse, especially of helpless patients requiring a genuinely caring and healing hand. Her work ethic is relentless, her style of leadership hands-on, and her approach to clinical care, trans-disciplinary.

@ehealthonline

eHEALTH Magazine

May 2018

11


state healthcare Perspective 12

UP Wages War Against Tuberculosis #UPvsTB campaign is one of India’s largest digital campaigns after Swachh Bharat undertaken by the Government of Uttar Pradesh to create social awareness about Tuberculosis (TB), observes Arpit Gupta of Elets News Network (ENN).

T

he VIDI Foundation, a digital intelligence think tank, has extended its support to make this campaign viral on social media. TB is one of the deadliest diseases affecting nearly a quarter of the world’s population. It is pertinent to mention that India alone accounts for 25 per cent of the infected population. “Awareness is the key for eradicating TB. This campaign would help raise the muchneeded awareness about TB and its treatment,” according to G S Naveen Kumar, Special Secretary, Medical, Health and Family Welfare, Government of Uttar Pradesh. “I would thank all the celebrities, sportspersons, doctors, and others for showing unconditional support to the #UPvsTB campaign,” he adds. The Government of India, with support from World Health Organisation (WHO) has pledged to completely eradicate TB by 2025. With the #UPvsTB campaign, the Government of Uttar Pradesh aims to support the country in this mission. Planned around the WHO theme ‘Wanted: Leaders for a TB-free world’. This campaign went viral on social media garnering 20 million impressions till date. As part of the campaign, digital overlay/frames have been created on

May 2018

Facebook for people to change their profile picture to show their support towards this cause. And thus, help in spreading awareness among their friends and family. Thousands of people have already joined the campaign by changing their DP. Celebrities from different fields like Shabana Azmi, R. Madhavan, Pooja Bhatt, Ravi Kishan, Huma Qureshi, Kanika Kapoor, Kailash

With the #UPvsTB campaign, the Government of Uttar Pradesh aims to support the country in this mission. It has been planned around the WHO theme ‘Wanted: Leaders for a TB-free world’.

Kher, RP Singh, Ashwini Ponnapa, Anas Edathodika, Vartika Singh, Alankrita Sahai, Disha Pandey and Arthi Venkatesh have also endorsed this cause on social media to help create maximum awareness. “We are hoping that in the coming days, many more celebrities and people will be joining the campaign on social media,” says Kiran Hegde, President, VIDI Foundation. “For maximum impact, we’re also using WhatsApp platform extensively to promote the message. Our aim is for people to get tested in time and pursue a complete regimen of treatment. TB is curable with full treatment,” he added. Gozoop, one of India’s leading integrated marketing agencies, has also extended its support to further boost the campaign digitally. Speaking about the campaign, Ahmed Aftab Naqvi, CEO and Co-Founder, Gozoop, said, “As entrepreneurs in India, I believe we have a larger responsibility towards serving the nation which goes beyond just pure economics.” “#UPvsTB is one such opportunity to create positive change at large and we are looking forward to leverage our expertise on digital & beyond to achieve the same,” Naqvi added.

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focus - haryana healthcare 14

Robust Health Adding Glow To The City Beautiful’s Charm The Chandigarh Administration has ensured quality and accessible healthcare facilities to people of Chandigarh. With a state-ofthe-art faculty and technology-equipped facilities, the city’s government hospitals have all amenities to cater people. Faring well on various healthcare parameters, the city is setting good example for others to learn from, says Dr G Dewan, Mission Director, National Health Mission, Chandigarh, in conversation with Priya Yadav of Elets News Network (ENN).

Dr G Dewan

Mission Director National Health Mission, Chandigarh

A

surprising thing about this beautiful city, that sets it apart from other cities in the country, is that services, across verticals, in the Government sector are superior to those being offered by the private sector. This is true for health services in Chandigarh. Residents are spoilt for choice as even your neighbourhood Government health centre is far more efficient, effective and cheaper than any private health clinic. Chandigarh administration has left no stone unturned to provide the best health services to its residents at the cheapest possible rates, providing state of the art diagnostic facilities to the poorest of the poor and the best patient care. The density of health centres, workers per person is the highest in the country in this city, thanks to

May 2018

the stupendous upgradation of old infrastructure and the addition of new. This has ensured that the health facilities are ahead of times and they are so good that Government hospitals, health centres are not just the obvious choice of the poor but of the senior most bureaucrats, VVIPS and their families as well. On visiting a Government hospital in Chandigarh, you don’t get to see broken beds or dirty toilets. Instead, a swank, salubrious set up will greet you, complete with efficient staff and advanced diagnostic facilities. The registration card is made free now keeping in view difficulty to have Rs 2. Dr G Dewan, the Director, Health Services of Chandigarh Administration, who is also the Mission Director National Health Mission and Chief Registrar, births and deaths, has been instrumental role in shaping the Government healthcare in the city. The last three decades have witnessed Dr Dewan conceive, plan, execute meticulously most ambitious of health plans of the Chandigarh Administration. Speaking to eHealth magazine, Dr

Dewan traces the journey down the decades and the road ahead. Excerpts:

Q

How has the health landscape in the Government sector changed in Chandigarh over past few decades? Chandigarh was conceived to cater to population less than two lakh but the high standard of living here has attracted people from across the city and the population has grown phenomenally. Over the time, a number of people seeking health services also increased. The numbers of patients queuing up in and out patient departments have gone up 100 times over. So have the facilities that the health department provides. The general hospital has been upgraded hugely, in terms of infrastructure, services, number of departments and facilities. A new administration block has been constructed at Government Medical Speciality Hospital Sector 16 at a cost of Rs 17 crore. A sixbedded intensive care unit is being set up which will be equipped with state of art equipment for highly morbid patients. A blood component separation unit is being set up to make

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Q

 What are the e-initiatives taken to streamline the functioning of health department? Chandigarh has implemented the Reproductive and Child Health Portal, a Government of India initiative, to track timely delivery of maternal and child health services in Chandigarh. Chandigarh has been selected for piloting of Reproductive and Child Health portal by Ministry of Health and Family Welfare, Government of India. We have launched Aadhar Enabled Civil Registration System for newborns and infants. We are doing 100 per cent facility based data reporting under Health Management Information System. An eHealth kiosk has been made functional at Dhanas with teleconferencing and tele-consultation facility along with three Electronic Health Centre sites.

All the details of chemist shops and manufacturers of drugs have been uploaded on National Health Mission (NHM) website for public information. An eHospital module has been made functional at two city hospitals, GMSH, sector 16 and CHC at sector 45. We are doing 100 per cent DBT for ASHA and contractual staff.

New initiatives have been implemented for improving the immunisation - first of its kind initiative where during the national immunisation day of pulse polio teams are sent across the city to vaccinate the children of the homeless, beggars and ragpickers.

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Q

How has efficient delivery of health services impacted the health of city residents? When effective health services are delivered, timely and at no great cost, it works for the betterment of the society at large besides off course impacting the residents. There are several initiatives that have paid off well. For instance, we successfully implemented an action plan to improve maternal health. This has resulted in reduction of home deliveries to 1 per cent in Chandigarh, the lowest in the country. The infant mortality rate has been reduced to 14 from 21 as per Sample Registration System. New initiatives have been implemented for improving the immunisation - first of its kind initiative where during the national immunisation day of pulse polio teams are sent across the city to vaccinate the children of the homeless, beggars and ragpickers as Night Vigil teams under Project Taare Zameen Par was a great success whereby more than 250 children were vaccinated at night hours. Chandigarh has reported 100% prevention of parent to child transmission of HIV. The RNTCP (Revised National Tuberculosis Control Programme) Cure rate was 90.65% for 2017 and 93.3% in 2018 till date while the case detection is 72%. Chandigarh has been ranked first among the union territories for achieving the targets the institutions’ cure rate and case detection rate.

eHEALTH Magazine

May 2018

focus - haryana healthcare

available platelets for dengue patients and other needy patients. And we are just adding more and more services with passage of time. A 100-bedded hospital is being built in Sector 48 which will provide multi-speciality services to people in the southern sectors. A 50-bedded hospital is coming up at Village Maloya and another 50-bedded hospital at village Dhanas. An AYUSH hospital is coming up at Sector 34 in Chandigarh. Civil hospital Manimajra has been upgraded to 100 beds. The Polyclinic at Sector 45 has been upgraded to the Urban Community Health Center which is in-operation 24 hours a day. A 100-bedded hospital has been constructed in sector 48 at the cost of Rs 38 crore. Â A new Civil dispensary has been made functional at sector 49. This is besides upgrading the existing infrastructure. Two Community Health Centres - one in Manimajra and the second in Sector 22 have been grouped under the category of five-star ratings.

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focus - haryana healthcare 16

Taking the IT Route to

Better Healthcare

Amneet P Kumar

Secretary, Health and Mission Director, National Health Mission

From dilapidated, dysfunctional health centres to delivery of advanced health care, Haryana has come a long way in very short time. Encouragement to the use of e-initiatives is giving real time benefit to the people at the grassroots level, changing the very landscape of healthcare services being offered by the Government, writes Priya Yadav of Elets News Network (ENN).

T

he State is being lauded for its innovative initiatives, being implemented effectively, that are setting an example for other states to follow. The most recent example is the State’s achievement to become the first State in the country to launch High Risk Pregnancy (HRP) Portal. Amneet P Kumar, Secretary, Health and Mission Director, National Health Mission says, “Haryana is an innovative state and has launched several online applications in health including portals that were run by Government of India like Health Management Information System (HMIS) and Reproductive and Child Health (RCH).” An enormous amount of data is generated that is most useful at the Primary Health Centre level as it aids

May 2018

Medical Officer In-charge (MO-IC) for evidence-based decision making for better performance of his or her PHC area. “There are many state specific portals, which were devised as per the requirements of the State like Single reporting system, District Health Information System (DHIS), Human Resource Information System (HRIS), Maternal and Infant Death Reporting System (MIDRS), Anaemia Tracking Module (ATM) and Supportive Supervision Software for better monitoring of health delivery programmes.” The Secretary, Health said that from Census 2011 to now, the urban landscape has changed very fast. Villages have become towns, towns have turned cities and cities are

becoming metropolitan. The cities are unprepared for the challenge to tackle all the population that is coming in. If you look at what the world is doing for health. Neighbouring China, which is building cities, is following an integrated model. From home to hospital there will be cloud integration and every person with a ehealth card, his or her health data will be online monitored by a core group of doctors sitting far away in facilities. For us, in India, it means that the issues of mental health and adolescent health can be tackled with the aid of telemedicine and in Haryana we are doing that increasingly. She said we have taken initiatives like advanced queue management system and are working towards opening a 24x7 call centres that will

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made to reduce the IMR which was 42 in 2014, to zero,” he said. An attempt is being made to identify 100% name-based highrisk pregnancy cases, and ensure their delivery by specialists at civil hospitals. Amneet P Kumar, said, “The Union Ministry of Health and Family Welfare and NITI Aayog have acknowledged the portal as a good practice to be implemented at the conference held under the chairmanship of Prime Minister Narendra Modi.” A birth companion strategy is being implemented in the State for respectful maternity care and improving the quality of care in labour rooms for better maternal and neo-natal outcome, she said, under which one female attendant would be allowed during delivery in the labour room. The web application tracks every high risk pregnant woman till 42 days after delivery so that she receives adequate treatment during the antenatal period for healthy outcome of pregnancy. The State government is set to roll out Auxiliary Nursing Midwife Online (ANMOL) tablet-based application, The Haryana Government has launched daily regimen for tuberculosis (TB) patients under the Revised National Tuberculosis Control Program (RNTCP) to achieve the goal of TB elimination by 2025. The State has moved ahead to shift to daily anti-TB treatment regimen from the current intermittent regimen for treatment of the disease. TB patients availing themselves of health services in the private sector would also be provided free diagnostics and drugs from RNTCP to reduce out-of-pocket expenditure by TB patients and better control of the disease.

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ANMOL, in seven districts on a pilot basis. The idea is to try make healthcare paperless and effectively register, update and track the services being provided to pregnant women, mothers and newborns in the State. Amneet P Kumar, Mission Director, National Health Mission, Haryana, said the application aimed at bringing awareness to the remotest population, underserved communities and urban slums through images and videos, and educating them about the initiatives on health, maintenance of good hygiene, basic health care and precautions. For heart patients, a new cath lab has been set up at Civil Hospital Ambala Cantt, a facility that is being made available in a government hospital in the country on pilot basis for the first time. The facility will be provided in Faridabad, Palwal and Gurugram, in the first phase and then throughout the state. Within one week of its being functional, 13 patients got stents implanted, 20 patients got angiography done and three patients were suggested open heart surgery. The centre has facilities such as echo, TMT, holter, angiography, angioplasty and pacemaker and the facility of ventilator has been made available in the ICU alongwith 11 beds. It is offering procedures at onethird price as compare to private hospitals. Stent is being implanted at only Rs 46,000 which costs about Rs 1.5 lakh in PGIMER, Chandigarh. Its free of cost for people belonging to Scheduled Castes and BPL families. The focus on alternate medical care is also increasing with the state government is looking at every hospital in the state having a floor of Ayush system of medicines and healthcare so that patients coming to hospitals could also avail the facility of alternative system of medicines such as Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy.

eHEALTH Magazine

May 2018

focus - haryana healthcare

be providing tele advisory to patients and grievance redressal. The overall use of IT in health sector is helping us with huge data that we are using to monitor online the progress of health programmes, identify the gaps and fill them effectively. The High Risk Pregnancy portal is helping in two ways -early identification of high-risk pregnant cases up to the grassroots level and ensuring their timely referral to the civil hospitals for further management and delivery by specialists. Health Minister Anil Vij said, “This initiative has been lauded by the NITI Aayog and the Union Ministry of Health and Family Welfare. This will definitely increase the pace of decline in Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR) and Still Birth Incidence as morbidity and mortality is quite high in high risk pregnant cases, if not managed timely.” “Unprecedented improvement made in the health sector by the present government had led to the infant mortality rate (IMR) in Haryana getting reduced to 24, child mortality rate to 33, and maternal mortality rate to 127. Efforts are being

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Industry Perspective 18

Well-Equipped Primary Healthcare Centres Needed Despite many programmes, healthcare delivery has not improved in rural areas. Our primary healthcare centres are in tattered state. Facilities at these centres must be improved to achieve the aim of Universal Healthcare Coverage, writes Dr Shuchin Bajaj, Founder Director, Cygnus Hospitals for Elets News Network (ENN).

I

ndia is a land of vast inequalities. On the one hand we are sending probes to Mars with the latest cutting edge technology, on the other, we are struggling to provide reliable public transport to our teeming urban swathes. On the one hand, we have condominiums, villas and gated communities, on the other we have urban slums sprawling out as far as our eyes can see. On the one hand we have arguably the best technology minds in the world, on the other, we are struggling to make digitisation an integral part of our healthcare scenario. As we stress on globalisation and privatisation, a quarter of our population is slipping through all safety nets, to land in debt and resultant poverty. Almost 50 million people slip below the poverty line every year due to healthcare costs. We have more than a quarter of a billion people living with a burden of disease estimated at $30 billion, about 5 per cent of our GDP. About 60 per cent of our healthcare expenses are out of pocket, which is one of the highest in the world. Such is the lack of trust in the public health system that not only do 80 per cent of the wealthy seek treatment in the private sector, but a similar percentage of the poor also goes to

May 2018

private practitioners, even though the treatment may be of low quality and provided by untrained practitioners. Some unfortunate statistics reflect this state of affairs: • One quarter of hospitalised Indians slip below the poverty line because of hospital expenses alone. • Hospitalised Indians spend more than half of their annual expenditures on healthcare. • More than 40 per cent of those hospitalised borrow money or sell assets to cover expenses. • The poorest 20 per cent Indians have more than twice the rate of mortality, malnutrition and fertility of the richest 20 per cent. To address this gap in our healthcare delivery, the perception would be to first take care of the affordability, and thus the budgetary provison of the National Health Plan providing Rs five Lakh insurance cover to 50 crore Indians seems the panacea that we have all been waiting for. But is it really the answer? Rather than spending the little money that is available for the health budget on insurance schemes that benefit only corporate hospitals, wouldn’t it be more prudent to spend it on improving our primary healthcare system? Has digitalisation made this onerous task, which earlier involved

Dr Shuchin Bajaj

Founder Director, Cygnus Hospitals

sending reluctant doctors into far flung villages, easier? We are spending about 1.1 per cent of our GDP on healthcare. Regardless of the growth numbers paraded by the various agencies to us, be it 6% or 8% or 9%, the health budget always remains the same. We have left the cores of our development, i.e health and education, at the mercy of the easily corruptible and frequently incompetent, private sector. Countries like Thailand, Brazil, Sri Lanka, Turkey etc., which were way behind us at the time of independence, have surged ahead of us in all outcomes and indices, by their focus on primary healthcare in their initial years of development. Why have we not been able to do it? Have we been spending the wrong way? Have we forgotten that the foundation for development is not airports, flyovers or roads, but health

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up a Cardiac Cath Lab in a small town, I always ask this question from the people who are at the inauguaration. “Would you want to have a heart attack and be treated really well at our centre, or would you rather not have a heart attack at all?” Unsurprisingly, the answer is always the same. Nobody wants to have that heart attack but expectedly, our Government machinery refuses to see this. We have a large scheme offering free dialysis to many communities, but we forget that more than three quarters of kidney failures are caused by uncontrolled diabetes and hypertension, which can easily be treated at the primary health centre level, if we have the will to do it. We can look at the example of the National Health Scheme (NHS) of the UK, where more than 85 per cent of diabetics, hypertension and COPD (Chronic obstructive pulmonary disease) patients are treated at the primary care level. This figure was less than 15 per cent in the early 1980s. The progress made by the NHS is largely due to the focus on primary healthcare and empowerment of general practitioners and nurse practitioners. So what is stopping us from treating people at the village level. Infrastructure is one of the major reasons. It is very difficult to attract doctors to work in villages when more than 25 per cent of our PHCs don’t even have electricity and

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water connections. Absence of overall urbanisation, lack of schools and recreation facilities also are a dampener to the relocation plan of doctors to small towns and villages. So how can digitalisation help in this scenario? We have to forget the doctor centric healthcare scenario, and focus on the patient centric one with the doctor available for consultations digitally as per need. We should keep in mind that for our 650 thousand villages, we have more than one million ASHA workers. Why can’t we upskill them and give them the support of diagnostic and pharmaceutical decision making through digital means? Digiceuticals is an upcoming field which has the potential to transform healthcare delivery completely. If the ASHA worker can impart nutritional education to school girls, we can prevent a lot of malnourished children, which later, go on to suffer from various disorders like obesity, hypertension and diabetes. Digital platforms can easily help in this endeavor. We should also look at upgrading our nurses into nurse practitioners and involving the Ayurvedic and Homeopathic practitioners in healthcare delivery to underserved communities. Digital platforms can help in upskilling these health practitioners moving them from the periphery of healthcare delivery to the centre of the action. We have to flip the balance of healthcare from curative, which takes up more than 80 per cent of the total health expenditure of the country, to preventive healthcare, which currently uses only nine per cent of the total health expenditure. Sustainable development goals lay a lot of emphasis on health, but the sheer size and scale of our country means that the success of global goals to a large extent depends on the progress made by India.

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May 2018

Industry Perspective

and education, which all Governments have been neglecting completely? We have also forgotten that poverty has a multi-dimensional impact, related to sanitation (including access to clean drinking water), nutrition and housing. Lack of these things will continue to create an unsustainable disease burden for the community. An unhealthy community, suffering from diarrhea and malnutrition, cannot lead to a fast growing healthy economy. Our contribution to inclusive healthcare development agenda and commitment to ‘universal healthcare for all’ mission, have to be an integral part of our service delivery within the entire healthcare ecosystem, by ensuring free medicines and discounts on pharmacy, consultancies and surgeries to the economically weaker population of the society. We also have to mobilise the larger community on various facets of health awareness through health/medical camps for rural outreach on issues such as diabetes, joint replacements, emergency medical first-aids, maternity, cardiology, preventive care etc leading to socio-economic justice and poverty alleviation. Our limited amount of money has to be invested intelligently in a way that we get maximum returns. Primary healthcare, which focusses on preventing people from getting sick, is the only way out. Every time we set

19


technology perspective

CLINICAL SIMULATION LABS: A BOON FOR NOVICE MEDICAL PRACTITIONERS Simulation replicates substantial aspects of the real clinical world in a fully interactive manner. The past two decades and especially the last five years have seen rapidly growing interest in using simulation for the purpose of improving patient safety and patient care through a variety of applications, writes Dr Ganni Sandeep, Managing Director, GSL Healthcare Institutions and GSL smart LAB (Simulation Modules for Advanced Research and Training Laboratory) for Elets News Network (ENN). WHY THERE IS INCREASE IN OF MEDICAL SIMULATION’S ROLE There is a need of a model in which the structures and systems of healthcare are optimised for safety and quality where it does not conflict with these goals for efficiency. Present systems around the world are working to accomplish this with new innovations. The concern is on how personnel are educated, trained and sustained for providing safe clinical care. Therefore, the healthcare system places focus on basic science education and leaves most clinical training to a relatively unsystematic apprenticeship process. Thus a fundamental part of the vision is that clinical personnel, teams, and systems should undergo continual systematic training, rehearsal, performance assessment, and refinement in their practice. FUTURE OF SIMULATION The future depends on the commitment and ingenuity of the healthcare simulation community to check whether improvement in patient safety using this tool becomes a reality. Simulation appears to be here

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May 2018

to stay. More studies and research are needed to determine whether simulation improves patient outcomes. Biomedical engineers and different medical professionals should work in harmony to improve the technology of virtual reality to make experiences as seamless as possible. The increase in demand will make the logistics cost effective. CONCLUSION Simulation-based training has opened up a new educational application in the field of medicine. The clinical faculty must be engaged early in the process of development of a programme. Early adopters will see the potential in virtual reality learning and will invest time and energy in helping to create a curriculum. They can then help to engage the wider medical community. Teamwork training conducted in the simulated environment may also offer an additive benefit to the traditional didactic instruction, enhances performance, and possibly reduces errors. The cost-effectiveness of potentially expensive simulationbased medical education and training should be examined in terms of

Dr Ganni Sandeep

Managing Director GSL Healthcare institutions and GSL smart LAB (Simulation Modules for Advanced Research and Training Laboratory)

improvement of clinical competence and its impact on patient safety. It is a more ethical means of training in safe and controlled environments. GSL SMART LAB GSL Simulation Modules for Advanced Research and Training Laboratory is a world class medical and surgical training platform which is aimed at remodelling the approach towards patient safety and care. It has a cutting edge training system with new age fidelity simulators, a modern skills lab with basic and advanced skill trainer mannequins, premier faculty, a dedicated team and most importantly - a vision to make GSL Clinical Simulation Lab a seemly destination for world class Medical and Surgical Training and obliging the healthcare skill needs of the community.

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A


Technology Perspective

Tattvan E-Clinic: A Step Towards TechnologyEnabled Healthcare Facilities Dynamics of healthcare industry are rapidly changing in India. e-Clinics are formatted as the super speciality health centers with various healthcare services under one roof that includes doctor consultation, diagnostics services, emergency care services and pharmacy, says Ayush Mishra, Co-Founder, Director of Tattvan E-Clinic in an interview with Elets News Network (ENN).

Q Ayush Mishra

Co-Founder, Director of Tattvan E-Clinic

Q

How do you view present healthcare scenario in remote areas that are devoid of technology-enabled healthcare facilities? We divide healthcare into primary, secondary and tertiary healthcare. As we know rural areas are lacking in primary healthcare and for this, technology comes with a huge boost like telemedicine. At present, there are many private hospitals who run telemedicine van going to the rural area and offering primary healthcare. Telemedicine for primary healthcare is doing wonders however after primary health care patients need secondary and tertiary health care too. Apart from this, follow up is also important so who’s responsible for follow up? Not all doctors are ready with this now. Still, we need to work a lot to implement many things in healthcare sector through Telemedicine.

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May 2018

How did the idea to start Tattvan E-Clinic strike mind? Telemedicine is a revolution in the healthcare sector and doing wonders in many countries. I’ve been doing studies on the advancement of ICT in healthcare. In many of the countries the adoption rate of telemedicine is pretty high and hence it worked wonders for them. I realised that if there is any country in the world which needs it the most is our country – India. Because of the population and diversity there is still a huge gap in delivering healthcare. Most of the population still belongs to rural and small cities where access to proper healthcare is still not available. This mere thought urged an idea to start Tattvan E-Clinic.

Q

Tattvan e-Clinics aim to solve the problem of healthcare facilities in remote areas and small cities through connecting doctors from hospitals to patients in need. How does the whole process exactly work? When anybody talks about telemedicine in India only the primary healthcare comes into picture for the rural segment and our

government is doing a wonderful job in that. Our focus is more towards small cities where people have a good source of income and can spend well on health. However, they don’t have access to advanced healthcare. For every advanced healthcare, they need to rush to metro cities. It’s a hassle for citizens in small cities to travel and cost them an arm and a leg. Here, we come into the picture, at Tattvan E-Clinic patients have access to all advanced healthcare consultations. We arrange consultations through our O.P.D telemedicine console where patients have access to all hospitals of any metro city. We act as an information hub for patients where they come and get consultations from various doctors and hospitals and can decide which one meets best to their needs and budget. Apart from this, all the follow-ups can also be managed easily at our E-Clinic.

Q

Tell us something significant about your “On-Clinic services” A patient can book his appointment online and can visit our centre as well. Something significant about “On clinic services” - Where

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Technology Perspective

patient can visit our E-Clinic and meet our full-time well-trained doctors who make sure that their tele consultation with expert doctors happens well. We also have complete solution of telemedicine equipment to analyse blood pressure, blood sugar level etc..Everything is accessible remotely by the expert doctors through telemedicine equipment. These telemedicine equipment make the telemedicine consultation accurate and fast.

Q

How do you ensure costefficient yet best medical facilities to the rural population? We, at Tattvan, E-Clinic help patients with telemedicine consultation only, for rest of the secondary and tertiary healthcare needs they can choose from the variety of services offered by different hospitals in-lined with

Our focus is more towards small cities where people have a good source of income and can spend well on health however they don’t have access to advanced health care.

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us. They can select hospitals and doctors according to their budget. We help them in selecting the most appropriate hospital and doctor on the basis of previous case history and patient’s feedback.

Q

Tattvan E-Clinic is opening its first center in Bareilly, Uttar Pradesh. How will it fill the gap in healthcare delivery among the rural population? We have chosen Bareilly very strategically. It is our first E-Clinic in India, we also have our E-Clinic in Kabul, Afghanistan. Bareilly is an emerging healthcare hub which is one of the developed cities of UP and it is surrounded by many small cities and rural areas. We are sure that the strategic location of Bareilly would definitely help us to serve better in remote areas and the rural population.

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May 2018

23


Hospital Perspective

Robust Infrastructure Needed to Improve Healthcare Delivery Gathering structured digital data would be one of the best investments any Government can make to its rural population. Reliable, accurate and timely data can lead to a better preventive care and education, says Inder Davalur, CIO, KIMS Hospitals, in conversation with Elets News Network (ENN).

Q

KIMS believes in providing affordable comprehensive healthcare facilities in wide range of disciplines to people. How do you ensure cost-efficient yet best quality medical service to people? KIMS is no exception when it comes to organisations that find themselves faced with the challenge of lowering costs while maintaining patient care quality. One approach that KIMS has taken is to examine the alignment of process and technology. While most organisations use or introduce technology to improve quality or reduce costs, the study of how technology aligns with the business process yields a much better approach. A simple example is to consider the task of deploying wheelchair

and stretcher assistance to patients efficiently. At KIMS, this challenge was met with a detailed study of the frequency, location and type of requests and the distribution of manpower to meet the demands. The choice of technology instead of increasing manpower was the genius move. By combining an app and smart phones, we were able to rearrange the manpower distribution dynamically without increasing the numbers while reducing the patient waiting time too.

Q

In today’s times, technology is at forefront and playing a crucial role in transforming the healthcare ecosystem. How KIMS has harnessed technology to cater people?

Inder Davalur

CIO, KIMS Hospitals

At KIMS while the pace is not as quick as I would desire it to be, the effectiveness of its technology use is certainly noteworthy. Some of the areas where technology has already improved patient experience are the porter system, patient flow system (AI enabled), OT instruments flow (QR code enabled), and employee scorecard system (tied to patient flow system). While we are constantly looking for ways to improve the patient care with technology, we are also ensuring that the alignment of process with technology is not overlooked.

Q

Technologies like Artificial Intelligence, Machine Learning and Block chain have made things a lot easier and improved overall patient care in Metros. Do

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May 2018

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Hospital Perspective

you think benefit of technology is percolating down to lower strata of people in rural areas? India will continue to suffer from accessibility issues when it comes to healthcare delivery. Although smart phones users have increased in recent times, the use cases tend to be more in the realm of WhatsApp or Twitter than healthcare delivery. The application of AI (Artificial Intelligence) and ML (Machine Learning) must be leveraged to improve healthcare delivery in rural areas. While Blockchain would be a great fit for a universal EHR (Electronic Health Record), we would do well by implementing telemedicine in hard to reach rural areas, provide wearable health monitors for those with known heart diseases or other lifestyle conditions such as Diabetes. WiFi and the Internet are vastly under-utilised when it comes to providing healthcare to the rural population.

Q

What steps need to be taken to improve rural healthcare? A robust infrastructure providing electricity and Wi-Fi would be a great start. This would require PPP projects that are strictly timebound and include incentives for the private entity in the partnership.

Another area where technology can boost the access to the rural areas is the deployment and use of portable smart devices that can help health workers to collect data in the field digitally and then upload to a central server once they are back in the office. Gathering structured digital data would be one of the best investments any Government can make to its rural population. Reliable, accurate and timely data can lead to a better preventive care and education. The

India has a great deal of latent potential when it comes to healthcare delivery and the use of technology

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magic moment will be when we reverse the business model of making money from treatment to making money from providing health.

Q

How do you rate Indian healthcare system with the global standards in terms of technology, accessibility and affordability? India has a great deal of latent potential when it comes to healthcare delivery and the use of technology. While Indian healthcare costs are skyrocketing, it still continues to fare very favorably in comparison to our neighbors to the East or the West within the Asian continent. It is far better when compared to Europe and the USA. However, accessibility continues to plague our rural and semi-urban areas. The infrastructure – roads, electricity, water and the Internet – are all below par compared to our wealthier Asian neighbours. What India would do well is to make it attractive for our best minds in medicine, technology and hospitals to work together and create an ecosystem that is both progressive and sustainable. We have the money and mind but lack the will and right leadership to bring them together.

eHEALTH Magazine

May 2018

25


Leader’s speak

Fujifilm Improving Healthcare

Delivery With High-End Technology With advanced technologies including computed and digital radiography, full field digital mammography, advanced endoscopy systems, the Fujifilm is leaving no stone unturned to improve healthcare facilities inIndia’s every nook and corner, especially in villages and T-3 cities says Chander Shekhar Sibal, Senior Vice President, Fujifilm Medical, in conversation with Mukul Kumar Mishra of Elets News Network (ENN).

Q

Fujifilm is a pioneer in diagnostic imaging and information systems in healthcare domain, what distinguishes your solutions from competitors vis-a-vis quality and accessibility? Our products are best in terms of image quality. Major difference is quality and reliability of our products. We have CR (computed radiography), full field DR (digital radiography) and digital mammography and Synapse PACS (Picture Archiving and communication system). We have over 1,20,000 CR (computed radiography) systems installed worldwide. In India alone, we have 30,000 CR & Imagers installed. Image quality of our system is much better than our competitors. For example, CR system for mammography has got 50 micron image quality. We are the only company which provides such a high resolution. Our resolution is provided at very low dose. That is major advantage for our imaging system. Moreover our products are very reliable in nature and breakdown rates are far lesser than our competitors’.

Q

You recently launched endoscopy system. How is it beneficial and has edge over traditional methods of treatment? Early detection is the key to success in any kind of cancers. If it is detected early at first or second stage then patient can be treated cost-effectively.

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May 2018

Early detection increases life span of the patient. If cancer is detected at third or fourth stage then the cost of treatment goes very high and it becomes fatal at times. In India major problem is late detection of cancer. More than 50 per cent of the patients die within one year of detection of cancer in India. It is because of late detection. Here we have new technology for targeted biopsy and early alarm, then up to a certain level Treatment also possible if cancer invaded up to submucosa (second layer of gut wall). We recently launched a red dot awarded design Endoscopy system (ELUXEO – 7000 series), which is the first its own kind of system in area of flexible endoscopy loaded with 4 different color LED lights (Blu, Blue violet, green & red), to get white light all lights are channelized in single path (Technology called as multi light), Lights play vital role here, we takes short/narrow wave length light to get micro surface pattern, BLI & LCI are unmatchable feature allows clinician to detect the growth early, which helps to save the life. We are into the very highend systems with very high resolution scope with (Blue Light Imaging - BLI) and linked color imaging (LCI). These systems go inside the body and give high resolution images to detect cancers at very early stage. This is useful for all types of Gastro cancers including stomach cancer and colon

Chander Shekhar Sibal

Senior Vice President Fujifilm Medical

cancers. Then we have CR system. We have range of systems to detect cancers at early stage. Not only that, after screening, advance detection, staging comes, we have Endoscopic ultrasound system developed by FUJIFILM in-house with the best EUS scopes with shorter rigid portion reduce patient Trauma, allow doctor ease of working and maneuverability.

Q

Tell us something significant about your solutions like “special solutions” and Synapse Enterprise PACs. FUJIFILM Synapse is your onestop shop. With an integrated mammography, RIS and PACS solution, high end FDA approved 3D post processing applications cater to entire hospital departments right from Radiology, Cardiology, Surgery, Orthopaedics, Neurology, Urology, Dental and Maxillofacial , Podiatry, Forensic Science for Virtual autopsies. We have fully trained clinical and

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Q

In the digital era, technology is driving the healthcare industry. Apprise us about latest technology and innovations you recently adopted to improve patient care. We are very much committed to provide new technology and innovations which help to improve patients’ life. We are going for all digital campaign. We are making the X-ray rooms completely digital so that these images can be transferred through tele-radiology, through web and can be reported from anywhere. Doctors

Q

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you strategies to address this critical issue? For giving services to rural areas at primary healthcare centres, we are tying up with the Government hospitals through public private partnership. We have collaboration with KRSNA, a public private partnership firm. They provide services and we provide equipment to this company. We are also directly selling equipment to the Government. We have the distributor network covering all 712 districts in country. We have installed more than 30,000 equipments across country. We can provide same speed and quality for services in Tier 3 cities as we provide in metro cities.

Leader’s speak

dedicated IT professional’s support team. Fujifilm offers a comprehensive approach to PACS customers. Synapse product range have very unique feature which enables Multi Site hospitals and diagnostic centres to use the interconnected workflows and imaging needs. Tele radiology comes as a default component in our Synapse PACS RIS offering. Fujifilm provides obsolesce protection for software under CME which is one of the best attributes of our approach. We have recently installed 100 CR systems across Assam and we all have been reported through teleradiology. Radiologists are not available at primary healthcare centres in small cities. These images have been reported within hour by radiologists sitting at central place. We have our PAC system installed at MEDALL. There are 75 centres across India. There is a central reporting station where all radiologists sit and get reports from anywhere across the country. These systems are very useful for teleradiology which provides easy access to the patients where no doctors are available. These are transforming the healthcare in a big way.

can see those images and write the report. These are revolutionising the healthcare delivery to the patients in the smaller villages. In Assam, we have installed computed tomography at 100 places. Similarly 120, 100 systems have been installed in Karnataka and Kerala respectively. We are converting these X-ray images in digital images and sending them through web which makes healthcare delivery faster to patients. Immediately, patients can be treated and problems get detected on X-ray. Apart from that we are launching new products in CR and DR segment. Under our Make in India initiative we have launched EP CORSA DR system at IRIA 2018, this would provide much value to existing CR customers by increasing productivity, lowering X-Ray dose to patients and improving image quality, To promote our products further, Fujifilm is investing significantly into BTL activities like patient education program, road shows, recently we have organised symposium with the message “A Comprehensive Review of Breast Imaging Intervention in association with Vijaya Medical center, Vishakhapatnam. The event reached and impacted the minds of more than 200 Radiologists/ Oncologist across South region. We also invite Press media to spread awareness about the cause. We also launched the clinical case study book on digital mammography titled “Identifying Breast Cancer with 3D Tomosynthesis” written by Dr. Shilpa Lad from NM Medical Mumbai. All in all, the rapidly expanding sector presents immense growth opportunities. To leverage the growth potential both government and business groups need to collaborate to provide better medical care facilities to people.

Q

Indian device industry is growing as never before. How do you analyse the market scope of this sector? The Indian device industry is growing at fast pace. We don’t have much equipment infrastructure in our hospitals especially at the Government hospitals. Now, the Government is tying up with private companies through PPP to provide equipment, services to people. There are huge requirements due to range of factors. We have very less number of radiologists or doctors currently. Only 10,000 radiologists are catering to huge population of India. We require tele-radiology, digital solutions so that patients don’t need to travel to radiologists. Rather through images patients can be monitored and treated. The Government is coming up with new scheme National Health Protection Scheme (NHPS) under which Rs five lakh insurance will be given to underprivileged people (10 crore families) who are below poverty line. This will increase the paying power of the patient. With this new system in place, the poor people can avail tertiary care. ‘Modicare’ will improve healthcare delivery by empowering poor to get tertiary healthcare facilities.

eHEALTH Magazine

May 2018

27


Healthcare Perspective 28

EHR Much-Needed Tool to Improve Patient Care Electronic Health Records (EHR) are digital version of paper records having potential to transform clinical settings thereby improving quality of patient care, writes Dr N K Pandey, Chairman and Managing Director, Asian Institute of Medical Sciences, for Elets News Network (ENN).

E

lectronic Health Records/ Electronic Medical Records (EHR/EMR) are need of the hour as handwritten prescription remains illegible at times. In addition, the document cannot be electronically shared or stored. It is not structured data which can be computable and shareable with other computers and systems. Other shortcomings include expensive to copy, transport and store, easy to destroy, difficult to analyse and its negative impact on the environment. EHR represent a quantum leap in legibility and its ability to rapidly retrieve information. The objective of EMR / EHR is to make patient information available to anyone who needs it, when they need it and where they need it. With an EHR system, investigation results can be retrieved in a much faster, manner which saves time. EHRs are more efficient because they reduce redundant paperwork and have the capability of interfacing with a billing programme that submits claims electronically. Consider what it takes to simply get the results of a lab test back to a patient using the old system. This might involve a front office clerk, a nurse and a physician. The end

May 2018

result is frequently keeping the patient on hold. With an EHR system in place, the lab results can be forwarded via secure messaging or it gets available for viewing via a portal. Electronic health records can help with productivity if templates are used judiciously. Dr N K Pandey

Areas where EMR/EHR can be helpful:

Chairman and Managing Director Asian Institute of Medical Sciences

Quality of care and patient safety EHR improves patient care and safety through many mechanisms including improving legibility of clinical notes. In addition, it improves patient records access anytime and anywhere, reduces duplication, sends reminders about tests or preventive services. It does clinical decision supports that remind clinicians about patient allergies and correct dosage of drugs.

users can access via the internet from the office, hospital or home. Computer speed, memory and bandwidth have advanced to such level that digital imaging is also a reality now. Images can be part of an EHR system. Personal computers (PCs), laptops and tablets continue to add features and improve speed and memory while purchasing costs drop. Wireless and mobile technologies permit access to the hospital information system and the electronic health record.

Technological advances The internet and World Wide Web make the application service provider (ASP) concept for an electronic health record possible. An ASP option means that the EHR software and patient data reside on a remote web server that

Need for aggregated data In order to make evidence based decisions, clinicians need high quality data that should be derived from multiple sources: in-patient and out-patient care, acute and chronic

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Healthcare Perspective

care settings, urban and rural care and populations at risk. This can only be accomplished with electronic health records (EMR / EHR) and discrete structured data. Moreover, healthcare data needs to be combined or aggregated to achieve statistical significance. Although most primary care is delivered by small practices, it is difficult to study because of relatively small patient populations, making aggregation necessary. For large healthcare organisations, there will be an avalanche of data generated from widespread EHR adoption. New data analytic tools are needed to tackle huge amount of data generated from large healthcare aggregators. Need for integrated data Patients’ paper health records are standalone, lacking the ability to integrate with other paper forms or information. The ability to integrate health records with a variety of other services and information is critical to the future of healthcare reform. EHR / EMR can be integrated with multiple internal and

external applications: EHR is having ability to integrate and sharing patient health record with health information organisations, ability to integrate with analytical software for data mining to examine optimal treatments, etc. It also has the ability to integrate with genomic data as part of the electronic record. EMR/EHR is also having the ability to integrate with local, state and federal governments for quality reporting and public health issues. EMR can be integrated with algorithms and artificial intelligence.

EHR is having ability to integrate and sharing patient’s health record with health information organisations, ability to integrate with analytical software for data mining to examine optimal treatments.

EHRs offer physicians many opportunities to improve quality of care EHR prevents drug interactions and allergic reactions making it easier to take a holistic approach to health management. It also participates in research and clinical quality control. EMR encourages medical screenings for disease prevention and risk management. EMR transforms patient flow to enhance patient experiences and practice efficiency.

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May 2018

29


Hospital Perspective 30

DISHA A Right Step to Streamline Healthcare Delivery DISHA will improve accessibility and will make the patient real owners of his/ her own medical data. It will help in continuum of care and will drastically reduce exposure of patients to repeated diagnostics, writes Dr Sunil Sharma, Head, IT, Jindal Institute of Medical Sciences for Elets News Network (ENN).

D

igital Information Security in Healthcare Act (DISHA) is to provide a platform for establishing National and State eHealth Authorities and Health Information Exchanges, to standardise and regulate the processes related to collection, storing, transmission and use of digital health data. It will also ensure reliability, data privacy, confidentiality and security of digital health data. The Ministry of Health and Family Welfare (MoHFW) plans to set up a nodal body in the form of “National Digital Health Authority� through an Act of the Parliament as a statutory body for promotion/ adoption of e-Health standards, to enforce privacy and security measures for electronic health data, and to regulate storage and exchange of electronic health records. The purpose of the Act is to provide for electronic health data privacy, confidentiality, security and standardisation and provide for establishment of the National Digital Health Authority and health information exchanges and such other matters related with incidental thereto. This Act is currently at draft stage for public consultation and soon

May 2018

it will come into effect. For quite a long time, experts were saying that we were not ready for it. How are we going to do this when we don’t have infrastructure and standardisation in healthcare practice? The first step in this direction was formulation of electronic health standards in 2013 and subsequent revision in 2016. It was understood that with adoption of these standards properly, the data capture, storage, view, presentation, and transmission will be standardised to levels that will achieve interoperability of both meaning and data contained in the records. The focus was to provide a set of international and proven standards with intention towards achieving syntactic and semantic interoperability of health records. The idea that any person in India can go to any health service provider/ practitioner, any diagnostic center or any pharmacy and yet be able to access and have fully integrated and always available health records in an electronic format is not only empowering but also the vision for efficient 21st century healthcare delivery. DISHA is the step that has taken off late but it will have multifold impact. It will make access to

Dr Sunil Sharma

Head IT Jindal Institute of Medical sciences

healthcare records seamless for the individual who is the owner of the same. Once the health information exchanges are set up and are functioning, the biggest beneficiary will be the patients. Additionally, it will have immense impact on the current practices, where frauds in medical practices, overbilling for insurance patients and wrong treatment for a particular disease and hit and trial treatment will come in radar. The biggest concern for a patient currently is access to his medical data, its integrity and confidentiality. DISHA will improve accessibility and will make the patient real owners of his/ her own medical data. It will help in continuum of care and will drastically reduce exposure of patients to repeated diagnostics.

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Hospital Perspective

The second biggest beneficiary will be the insurance companies which have been facing the heat of losses in the wake of fraudulent claims. Proper information of the patient will reduce such cases and the genuine patients will benefit (The Act provides for consent of the patient in case the data has to be shared with the insurance companies for claim). Here also, the patient gets benefit as the discharge time will be reduced. Moreover, it will have positive impact on hospitals too which can have faster turnaround time. It will improve the coordination of care and information among hospitals, laboratories, medical professionals, and other entities through an effective infrastructure for the secure and authorised exchange of digital health data. Currently, the Government has been found to be on defensive while formulating and implementing health schemes, as the data is forged, exaggerated and does not depict the true ground picture. It is because of this reason that the healthcare policies have failed to bring in desired outcomes. DISHA will serve as the tool to carry out public health research,

review and analysis, and policy formulation and will improve the success rate of healthcare policies and programmes. In addition, it will also improve public health activities and facilitate the early identification and rapid response to public health threats and emergencies including bioterror events and infectious disease outbreaks. This will enhance health and clinical research and healthcare quality to promote early detection, prevention, and management of chronic diseases. Security of health information data is an important consideration in the light of the current findings and

DISHA will serve as a stepping stone in making the medical health record electronic.

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the Act should make stricter norms and regulations. The Government data and websites have continuously come under scanner as multiple instances of hacking and security breaches have been reported. In such a scenario to instill confidence in patient’s mind the Act should clear the air with strong focus on security measures. The Act also has provisions for penalties and compensations in case of breach of health data and also mentions punishment in case of data theft. Overall, the offensive sections of the Act are loosely drafted and need to be tightened substantially before becoming the law. DISHA will serve as a stepping stone in making the medical health record electronic. It will also make use of the interoperability standards and will also help to capture the required medical health information in standardised way. The dream of the patient to access his/ her medical record seamlessly on the go is not far from reality. Disclaimer: The views expressed are personal. Sources: Electronic Health Record (EHR) Standard for India 2016-Standard set recommendations v2.0 & Digital Information Security in Healthcare Act (Draft for Public Consultation) November, 2017

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eHEALTH Magazine

May 2018

31


special article

Ayushman

Bharat Scheme Cheers Private Players The launch of Ayushman Bharat by Prime Minister Narendra Modi, the Government of India’s ambitious healthcare plan for 100 million poor and vulnerable families, has underlined tremendous scope that public-private partnership in health sector holds in future, observes Priya Yadav of Elets News Network (ENN).

W

hile most state governments are pulling out all stops to provide health cover to the employees, it is the private health sector that is gearing up to spruce up its service delivery to reap benefits of the windfall. The Ayushman Bharat scheme has two-fold mission -- one, to create a network of health and wellness centres to deliver comprehensive primary healthcare close to the community, and two, to provide insurance cover to 40 percent of country’s population, that is most deprived, for secondary and tertiary care, including for instance, hospitalisation costs.

32

May 2018

It aims at covering 10 crore poor and vulnerable families and provide a cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. Survey done by NITI Aayog on the data thrown up by Rashtriya Swasthya Bima Yojna has shown that private hospitals are preferred by beneficiaries, both of RSBY and state level health insurance schemes. In Haryana, 67% of beneficiaries under RSBY went to private clinics and hospitals as against 87% in Uttar Pradesh and 73% in Gujarat. States like Rajasthan, Bihar and Madhya Pradesh saw 100% of claims coming

from private health sector. Aware of the gap between the demand for health services and the infrastructure available in the government sector, private health facilities are gearing up big time to move in and fill in the gap. This has spelt a win-win situation for all while people queuing up at hospitals are getting good treatment, private hospitals are getting a constant flow of customers and the government is effectively discharging duty by chipping in with the health insurance. In northern India, most of the State governments are acutely aware of the need of the hour and have taken steps. Over two years ago, the

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special article

In Haryana, 67% of beneficiaries under RSBY went to private clinics and hospitals as against 87% in Uttar Pradesh and 73% in Gujarat. States like Rajasthan, Bihar and Madhya Pradesh saw 100% of claims coming from private health sector.

Punjab Cabinet gave green signal to implement cashless health insurance scheme in place of reimbursement of medical expenses. The facility is provided to government employees and state pensioners and their dependants, over 6.5 lakh in number, in more than 250 empanelled public and private hospitals in Punjab, Chandigarh and NCR ( Delhi, Gurgaon and Noida). Expenses of the treatment taken outside the state would be reimbursed within 15 days by the insurance company. A patient admitted to the hospital for treatment will not have to pay any money as also 246 kinds of outdoor procedures and the treatment of chronic diseases in out patient department would be free of cost. Additionally, the prehospitalisation benefits up to 7 days and post hospitalisation benefits up to 30 days will be covered under the insurance scheme. Two years down the line, the government is mulling better options. A new universal health insurance scheme, covering all residents, is on

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the anvil. The State government is now working towards strengthening its own health infrastructure and empanel the government run hospitals for treating insurance covered patients. “ The need of the hour is to strengthen the government hospitals and improve service delivery. We want to provide quality health services to all that is also cost effective,� says Brahm Mohindra, Health Minister, Punjab. The State government is grappling with a situation where insurance companies have backed out following staggering bills slapped by private hospitals. In neighbouring Haryana, the State government is working towards implementing an insurance scheme wherein if a patient visits any private doctor, his fee would be reimbursed by the state government. As of now, the treatment is free of cost in government hospitals. There is a growing pressure on doctors in the government hospitals and the move is expected to ease it.

eHEALTH Magazine

May 2018

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Industry Perspective 36

World of healthcare: Challenges and Opportunities Healthcare is transforming with brisk pace, creating both new opportunities and threats for physicians. The population is becoming more health conscious and better informed about the benefits and value of primary and preventive as well as specialised care, writes Dr Rajesh Gulia, Chief Urologist and Director, Mayo Hospital, Mohali, for Elets News Network (ENN).

A

s the middle class expands, health becomes a higher priority due to which healthrelated spending has increased. Lifestyle-related diseases are also becoming more prevalent than traditional infectious diseases. There is a shortage of trained healthcare professionals. Physicians of urban areas are not well organised and they can’t be differentiated from the myriad of less qualified providers. Patients are becoming better informed and more sophisticated consumers of healthcare, but they do not know where to turn for high quality care. Over 3.6 million additional hospital beds will be required by 2034 just to attain a ratio of 3.5 beds per thousand people (Countries like China, Thailand, and Korea have a ratio of over 4 per 1,000). Corporate companies are also developing hospitals which compete with traditional physician owned nursing homes. The Clinical Establishments Bill will give further impetus to the institutionalisation of standards and clinical protocols. Emerging clinical management, patient billing and reporting requirements are driving the need for administrative infrastructure in the physician practice. Medical technology is an increasingly important part of

May 2018

the diagnostic process. Today the technology is moving out of the ‘hospital’ setting to stand alone and retail centers. Apollo has created over 60 franchised physician clinics offering facilities for specialist consultation, diagnostics (e.g. lab, imaging, radiology, and nuclear medicine), preventive health checks, telemedicine and 24-hour pharmacy, all under one roof. Health insurance dragnet and their growing Power Health insurance is important vertical of healthcare ecosystem. It has already covered 10 per cent of healthcare expenditures and is growing at more than 20 per cent per year. This is largely due to increasing awareness about the importance of healthcare insurance which provides a right vehicle to tackle financial needs. Corporations are also recognising the importance of healthcare for their employees and offering programmes for them. The Government strategy is shifting from providing care to offering insurance. State and local Governments are instituting a variety of schemes to improve access to healthcare for the lower income population. Rashtriya Swasthya Bima Yojana (RSBY) is expected to cover 60 million BPL families by 2020 and other jurisdictions are also copying this concept. Recently announced

Dr Rajesh Gulia

Chief Urologist and Director Mayo Hospital, Mohali

‘Ayushman Bharat’ – the National Health Protection Scheme is right step in this direction. Coming to terms with the inevitable We are beginning to see the inevitable next steps in the evolution of healthcare and insurance in India. With claims exceeding revenues, insurers are beginning to negotiate or dictate payment rates for services by hospitals and physicians, analyse healthcare costs, expand coverage to less expensive non-hospital settings, promote preventive care and early detection. Governments and independent third parties are collecting information on quality and cost. Large corporate hospitals are taking position to effectively balance the inevitable power of the insurance companies and meeting the growing administrative requirements. But the independent physicians are at high risk of losing access to patients and their ability to set prices.

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the status quo is doomed to decline. Effective change must not only address the changes in the market but it should also take into consideration the objectives and requirements of the physician. Requirements for success of an OPA include: Vision: An understanding of both how the market is changing and where you need to be positioned in the near future to be successful in that environment. Balance: Equilibrium between physician autonomy and organisational effectiveness. Leadership: Physicians who are willing to help shape the vision, passionate about achieving it, effective at communicating it to other physicians and able to motivate others to participate.

To strengthen the private medical practice, one strategy is to create an ‘Organised Physician Association’ (OPA) that balances the flexibility and independence of an independent practice with the leverage and efficiency of an organised group

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Market Sensitivity. Research-based definition of customer expectations and requirements and competitive conditions. Differentiation: Set apart from competitors in terms of clinical quality, service, convenience and efficiency. Strategy: A well-defined plan of action to achieve the vision based on an evaluation of options. Measurement: Clear and measurable objectives that are monitored and reported regularly to leadership. Continuous improvement: Regular adjustments to strategy and enhancement to differentiation. This process for creating the organisation would include the following steps: • Identify core group of physicians interested in the OPA concept. • Define the vision and purpose for the organisation. • Delineate potential features and characteristics of the business through a series of expert lead, information based brainstorming sessions. • Delineate the business model and value proposition. Invite additional primary and specialty physicians to join. • Devise a strategy and detailed business plan. Structure the organisation. Implement the plan. There are tremendous opportunities for physicians as healthcare in India continues to evolve, but there are also risks associated with it. Those physicians who capitalise on the lessons from other markets and adapt them to the unique environment in India will not only advance their own practice, but also improve the quality of care in their community. Organised physician groups enable physicians to maintain the autonomy of their own practice while capitalising on the advantages of a large group.

eHEALTH Magazine

May 2018

Industry Perspective

Proposed Strategy To strengthen the private medical practice, one strategy is to create an ‘Organised Physician Association’ (OPA) that balances the flexibility and independence of an independent practice with the leverage and efficiency of an organised group. This strategy has proven successful in the US as their insurance market evolved through similar phenomena. These organisations should be owned and governed by physicians and should have professional management to capitalise on opportunities, respond to market requirements and remove barriers to success. This enables independent physicians to build the critical mass necessary to compete effectively for patients and protect their income from erosion by larger and better organised hospitals and insurance companies without losing control of their individual practices. OPAs are owned and governed by physicians, have a sustainable business model and provide services and support to the owners and participating physicians to strengthen and expand their medical practices. They are likely to include a cross section of well trained and qualified primary and specialty care physicians in close geographic proximity interested in expanding and improving their practices. The power of the group would be used to gain the economies and efficiencies necessary to attract and treat more patients. It would also be used to improve the health of the patients and increasing the income of the physicians. Physicians that recognise and understand the coming changes in healthcare and insurance and position themselves to capitalise on these changes will not only survive in this new environment, but will thrive. Change is scary and difficult but

37


Healthcare Perspective 38

Universal Health Coverage:

Aiming for Quality, Affordable Healthcare Ayushman Bharat Programme has components to increase accessibility, availability and affordability of healthcare facilites. A fast track and successful implementation of this programme has potential to accelerate India’s progress towards Universal Health Coverage (UHC), writes Chandrakant Lahariya, National Professional Officer, Universal Health Coverage, World Health Organisation, India, for Elets News Network (ENN).

T

he constitution of the World Health Organisation (WHO) came into force on 7 April, 1948, the day which is now globally commemorated as the World Health Day. Every year, WHO selects a theme for the World Health Day (WHD). The theme of WHD2018 is ‘Universal Health Coverage: everyone, everywhere” and slogan is #HealthForAll. Throughout 2018, WHO aims to ‘inspire, motivate and guide’ stakeholders to make commitments towards universal health coverage (UHC). The UHC aims that ‘all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services’. In the recent times, UHC received global attention as an idea and aspiration with the WHO’s World Health Assembly 2005 resolution. This was further reinforced by the United Nations General Assembly (UNGA) resolution passed on UHC on 12 December 2012. The UNGA resolution was a landmark step as it broadened the scope of UHC agenda from the ambit of Health Ministers to

May 2018

the heads of the State and Ministers of Foreign Affairs, who are part of UNGA. To commemorate UNGA resolution on UHC, 12 December is now globally commemorated as UHC day. Understandably, the UHC has found a place in Sustainable Development Goals (SDGs) agenda as well as health goal 3 (or SDG-3). A specific target in SDG-3 on UHC is often considered overarching for all other targets in the health goal. Among experts and academicians, the UHC is largely well understood. However, to make substantial progress in this direction, it needs to be understood, equally well, by elected representatives and common men/women. Let’s understand what achieving UHC would mean to a poor and elderly widow living in a tribal village in India. To her, UHC would mean that she can have access to desired health services within acceptable distance and time frame. Her decision to seek healthcare services and the choice of selecting a health facility would not depend upon health problem, place of living, or income level. She would have enough choice of providers and when she would need specialist care,

Chandrakant Lahariya

National Professional Officer Universal Health Coverage, World Health Organisation, India

it would be facilitated by the first level of providers. When availing the health services from licensed providers, she would not have to worry about the quality and would have reasonable assurance that the Government would have mechanisms in place to ensure quality of services. Her decision to use health services would not be dependent upon her financial status and she would have sufficient confidence that access to services would be within her financial affordability and the use of health services would not make her poor. Programmatically, Universal Immunisation Programme (UIP) in India could be used as a good analogy to explain what it might mean with UHC. Under UIP in India, the Government offers a select number of vaccines to all children across the country. The additional

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A fast track and successful implementation of Ayushman Bharat program has potential to accelerate India’s progress towards UHC.

the population. UHC also ensures that people do not have to choose between buying basic needs of life such as food or accessing the needed health services. UHC is about increasing accessibility, availability of health services and providing appropriate care for the people. The countries should aim to achieve UHC in the time-bound manner. The Government of India has recently announced ‘Ayushman Bharat Program’, which has components to set up 1,50,000 health and wellness centres (HWCs) to provide a broad range of primary healthcare services. It has provision

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to provide financial coverage of up to Rs 5,00,000 for nearly 100 million families for the cost of secondary and tertiary level hospitalisation through National Health Protection Mission (NHPM). This program has components to increase accessibility, availability and affordability of all three types of health services (primary, secondary and tertiary) in India. Therefore, a fast track and successful implementation of Ayushman Bharat program has potential to accelerate India’s progress towards UHC. The WHD2018 provides another opportunity to make commitment towards universal health coverage in India. What the Governments at both national and state levels and other stakeholders (including government and citizen) will do collectively, now and in the time ahead, will determine the health status and healthseeking behaviour of that old tribal widow woman in a faraway remote village in India. The day, when she would not have to worry about health services, would be the day when the country (India) can boast to have achieved Universal Health Coverage.

Healthcare Perspective

vaccines are available in the private sector on payment basis. The vaccines in UIP are delivered through designated health facilities. The quality of these vaccines and services from all providers is regulated and assured by the Government. People make a free choice to get their children vaccinated at one of the facilities – either in public or the private sector. Majority of the parents prefer the Government facilities for vaccination. However, a few choose private sector. If they attend the Government facilities, the vaccines are free for them. However, they have to pay for these vaccines, and also for the vaccines which are not a part of the Government programme, if they choose to get their child vaccinated at a private facility. With this, nearly 85-90 per cent of vaccination services are delivered by the Government providers. There is no evidence or indication that any family has ever become poor due to access to vaccination services. However, UHC should not be confused with a single programme or scheme and it is not meant to achieve UHC for immunisation or UHC for tuberculosis. It is about agreed essential packages, which can cater majority of health needs of

Disclaimer: The views expressed are personal.

eHEALTH Magazine

May 2018

39


Hospital Perspective 40

Healthcare Insurance in North India

Health Insurance is a financial mechanism with which people are protected against catastrophic financial burden arising from unexpected illness or injury, writes Dr Vandana Bhardwaj, Head, IP Revenue Services, Sarvodaya Hospital & Research Centre, Faridabad, for Elets News Network (ENN).

T

he cost of healthcare is ever increasing. The cost will further go up in case of a serious accident or major illness. It is difficult, if not impossible, for a typical individual to find financial resources to meet such expenses, some of which may arise suddenly. For a country such as India, where the insurance penetration is as low as 3.3%, providing affordable and quality healthcare to its 1.2 billion population has been a continuous challenge with no definite solutions. According to a study published in

May 2018

2014, in the year 2012 14.2% of rural households reported out of pocket expenditure on in patient services and nearly 78.76% of households reported out of pocket expenditure on outpatient services. The high out-ofpocket expenses in India, stem from the fact that 76% of Indians do not have health insurance, according to data from the Insurance Regulatory and Development Authority. Opportunities in Indian Health Insurance Sector: The Government has taken an

Dr Vandana Bhardwaj

Head, IP Revenue Services, Sarvodaya Hospital & Research Centre, Faridabad

initiative to promote “HEALTHCARE for ALL� under National Health Mission with a vision to provide affordable health care services to all segments of society where they can include private hospitals on a partnership model with government healthcare schemes. This will ensure to provide health insurance cover to common man and also create job opportunities in health care sector and consequently will contribute to boost economic growth of the country. With information technology and consumerism transferring the health care system, there is vast potential for health insurance market waiting

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Hospital Perspective

to be tapped by private sector and nationalised health schemes. It will further improve the performance of health insurance sector in the country by lowered costs and increased level of consumer satisfaction. Challenges faced by Indian Health Insurance Sector: The present health insurance in India is characterised by the features like poor claims management, delayed claims settlement, inefficient services etc. Health insurance in India is challenged due to – high medical service costs and out of reach of many people, less number of hospitals ; high illiteracy rate, poor and inadequate health care infrastructure and poor budget allocation towards health care. • Overcharging of Insured patients: This is one common problem in hospitals where they have a tendency to overcharge (for few additional benefits) if the patient is covered under an insurance policy. This is one of the challenging practices health insurers face, and requires procedures which ensures that the billing is done on the basis of actual services obtained and not on factors like the insurance coverage of the patient. Tariff revision is done on yearly basis by

hospitals in lieu of rising health care costs and inflation. A different rack rate of the same consultant visiting different hospitals for the same services also creates difference in health care costs. • Lack of Standardisation or accreditation system for hospitals: The hospitals are not governed by any regulatory

With information technology and consumerism transferring the health care system, there is vast potential for health insurance market waiting to be tapped by private sector and nationalised health schemes.

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body for tariff and services and make the concern of pricing and billing serious. Though NABH and JCI accredited hospitals are regulated but the number is very less as compared to the extent of various private hospitals growing in size and numbers. All hospitals as per their category have their own tariffs and service charges according to their geographical location and presence. India meets the global average in number of physicians, but 74% of India’s doctors cater to a third of the urban population, or no more than 442 million people, according to KPMG report. Our country is 81% short of specialists at rural community health centres (CHCs), and the private sector accounts for 63% of hospital beds, according to Indian government health and family welfare statistics. It is the need of the hour to develop and create a Nationalised Health Insurance Scheme in India where there is Universal coverage, equal access to all and cost controlling measures with partnership model with health care providers. Appropriate regulatory changes can minimise the risks and turn potential benefits into concrete gains for each and every citizen of India.

eHEALTH Magazine

May 2018

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Industry Perspective 44

Pro-Active Approach Needed to Contain NCDs Preventive care is not limited to facilitating early diagnosis, creating awareness on diseases, it also includes reversing noncommunicable diseases by making lifestyle corrections - nutrition, exercise, stress and sleep management. This is what we have been strongly advocating with real life examples, writes Dr Priti Nanda Sibal, CEO, Medi-Skool and Medical Director, AB Hospitals, for Elets News Network (ENN).

T

here is no bigger motto than to save lives of people or help them in managing the chronic diseases in a better manner. These diseases are preventable even after having a strong genetic connect, provided prevention should be our focus. Recently in ‘Mann Ki Baat’ Prime Minister Narendra Modi urged the people to be more conscious about preventive healthcare because prevention doesn’t benefit only a person but his entire family and even whole society gets benefitted with the same. G Srinivasan, the Chairman of New India Assurance, said, “The wellness policies have done well in the group individual policies. We are now looking to extend this concept to individual covers as well as add-ons at an additional premium.” Medi-Skool was born with a vision to take this holistic preventive care to all Indians focusing on early diagnosis, lifestyle and psychological counselling. With population in billions and to provide a solution, Medi-skool introduces the ‘Preventive Healthcare’ under one roof with a team of doctors and psychologists who not only provide solutions / counselling / diet plans but do follow ups on the same too. It customises your lifestyle according to

May 2018

modern requirements. We help you to develop better food habits from the same kitchen you have been eating from so many years which in turn helps you to be proactive with your exercise schedule, sleep better and help in managing your response to stressful situations well. This results in better management of your chronic diseases. Today is the era of personalised healthcare. We need to look at everyone personally and offer personalised healthcare. At MediSkool we do detailed history and diagnostic tests to help you find the cause of your disease and then try to correct it. Using functional medicine approach, we help you to find the key to your good health. We have helped more than 1,000 people reverse their diseases such as diabetes, PCOD (Polycystic Ovarian Disease), hypertension, cardiac diseases,

Dr Priti Nanda Sibal

CEO, Medi-Skool and Medical Director AB Hospitals

migraine, relationship issues, thyroid problem, and menopausal symptoms by using functional medicine approach. We helped a 72-year-old lady who used to take 40 units of insulin for over a decade down to eight units within six months. Some PCOD girls have lost 35 kgs and more in a year. We have helped a woman to control her hypertension. Did uric acid medication and diabetic medicines in a span of nine months helping her to take control of her life again. Patients with ADHD (Attention Deficit Hyperactivity Disorder), migraine have learnt to manage their triggers better. This has been achieved not only by using the scientific knowledge but by monitoring and measuring the parameters well. Preventive care is not only about early diagnosis, creating awareness but it also includes reversing noncommunicable diseases by making lifestyle corrections. This is what Medi-

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Industry Perspective

Skool has made people believe in. India is infamous for being the world capital for cardiovascular diseases. The Global Burden of Disease reports that the heart diseases claimed the lives of 1.7 million Indians in 2016. More than 10 lakh Indians are diagnosed with cancer annually and the number is only rising. According to Lancet journal, about six to seven lakh people lost their lives fighting cancer in our country. With 100 per cent growth in diabetic patients in India in last 15 years and it ranks in top three countries with most diabetic population, we can’t afford to ignore it. One in three Indians has hypertension today and India is among top five in ‘Obesity Index’ in the world. Overall, more than 60 lakh people lost their lives to non-communicable diseases (NCDs) in 2016 in the country. The solution to this epidemic is changing our behavioural approach in health from reactive to pro-active and we must do it today than tomorrow. As an old adage says it is better to mend the roof before the monsoon arrives, in the same way it is better to

be on our toes before disease strike. Move from reactive to proactive approach in healthcare. The distinction between proactive and reactive approaches is a recognised principle of military strategy, often expressed in the phrase “seize, retain and exploit the initiative.”

Medi-Skool has a team of doctors, nutritionists, chef, trainer and psychologists that helps you become healthy, do it naturally. enjoy the life you were meant to live.

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Proactive strategies are superior because they allow the company using the strategy-the freedom to make its own decisions rather than responding out of necessity to a situation that already may be out of control. Companies that use proactive strategies have a better chance of seizing and retaining the initiative in the competition with other companies. With the growing focus on preventive healthcare, India is moving towards a stronger healthier nation. “There has been significant change in the workplace over the years, which has also changed the role of coaching. We can easily see lots of distraction and disruption faced by the individuals in their workplaces, like technology advancement forcing employees to work efficiently and faster, high competition in the business world, high customers demand, and rigorous changes. This is resulting in health issues that can be pre-emptied through “Preventive Healthcare”. Medi-skool helps people understand and assimilate the paradigm shift in this direction.

eHEALTH Magazine

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Technology Perspective

CORE Bringing Advanced Testing Diagnostic Techniques to India The modus operandi of CORE is to bring the most advanced testing diagnostic techniques and expertise to India and be the destination for all high-end diagnostic testing, says Zoya Brar, Founder & Managing Director of CORE Diagnostics in conversation with Elets News Network (ENN).

Zoya Brar

Founder & Managing Director CORE Diagnostics

Q

What are the hallmarks of CORE Diagnostics, a next-generation diagnostics service provider? As Picasso put it, “Every act of creation is first of all an act of destruction.” In 2013, when I set out to create CORE as a 23-year-old, I had a formidable task ahead of me – creating a start-up in a space that has traditionally been the forte of those much older, and much wiser, than me. For last five years, I have been painstakingly building the foundation – not only of a company, but also of an entire new industry within healthcare, and more importantly, of a revolution in workculture in India. This is taken a lot of creation, and a lot of destruction (of older ideas, as well as my own ideas). The modus operandi of CORE is to bring the most advanced testing

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diagnostic techniques and expertise to India, and be the destination for all high-end diagnostic testing. But that’s only one-half of CORE’s aspiration. We view our charter much more broadly: to re-shape the diagnostic industry – in a manner that it becomes the central pillar of healthcare delivery.

Q

CORE Diagnostics adopts advanced testing techniques for disease stratification and therapy selection. How have you evolved in terms of latest technology?

We have tie-ups with all major health care centers in the region and are constantly scouting for opportunities to stay up to date with leading technologies in India and abroad. We have evolved in this space by allowing: (a) A technology platform for collaboration amongst experts – at different locations but at the same time. The platform includes the capability of parallel sharing a massive number of images and live video-collaboration. (b) Digital Pathology system. CORE has been using digital

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Q

What distinguished services you provide that set you apart from other stakeholders of this field? The central hypothesis of CORE Diagnostics as a high–end diagnostics service provider is to cater to the “white space” in SelfPay Healthcare markets. Local, small labs (50,000 of them) can’t afford to offer high-end diagnostics. Larger national labs till date focus on volume. Today CORE has the broadest test menu with over 1000 tests in oncology, infectious disease and gynecology. We have the broadest coverage – with sales and service presence in 100 cities in India and 12 international markets – all served out of the 20,000 SqFt NABL accredited space in the NCR.

Q

Shed some light over molecular diagnostics, histopathology and Cytopathology. How these techniques have been helpful?

Molecular diagnosis is a branch of laboratory medicine or clinical pathology that utilises the techniques of molecular biology in medical practice. Polymerase Chain Reactions (PCR), Next Generation Sequencing and Genome Wide Association studies are some of the molecular techniques used to analyze biological markers in the genome (complete set of genes or genetic material present in a cell) and proteome (complete set of proteins that is or can be expressed by a cell, tissue or person). Fundamentals of molecular biology help us in understanding an individual’s genetic code and cell expression. This information is applied in medical testing. Histopathology studies the changes in tissues caused by a disease. This branch of diagnostics has been revolutionized by the incorporation of molecular methods like fluorescent in situ hybridisation (FISH) and PCR. Cytopathology studies and diagnosis diseases on a cellular level. Due to limited volumes of cell samples obtained from blood, lymph bone, the application of molecular diagnostics like PCR is an indispensable technique.

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Technology Perspective

pathology for remote reading routinely for the past 36 months (c) Global Expert Panel. CORE has built a panel of 100 experts globally, who provide second opinions, digitally – on diagnosis and treatment. These experts are the key authority figures in their fields.

Molecular diagnostics not only helps in diagnosing a disease but also helps in predicting the progress, selection of therapy and tracking the effectiveness of treatment of a disease. Thus, providing the entire gamut in patient care.

Molecular diagnostics not only helps in diagnosing a disease but also helps in predicting the progress, selection of therapy and tracking the effectiveness of treatment of a disease. Thus, providing the entire gamut in patient care.

Q

Medical device Industry is booming sector due to a range of factors including high demand of quality diagnostics service across country? How do you see this as an opportunity? Estimates of growth in the medical device market in India vary from 10% to 15% and in in-vitro diagnostics this is estimated to make up 24% of the combined market. We have also ventured into point of care devices for self-sampling that allow patients to collect samples in the comfort of their homes and mail in their samples to our central laboratory. We continue to explore this space as the opportunity presents itself.

eHEALTH Magazine

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Technology Perspective

Technology: A DoubleEdged Sword for Hospital Management Technology has improved every aspects of healthcare delivery including patient care, staff management and streamlining various processes. Despite many advantages, it has many shortcomings too. If used in clumsy manner or handled by inept staff, the technology may prove baneful to an organisation, writes Dr P N Kakar, Medical Director and Chairman-Quality, Park Group of Hospitals, for Elets News Network (ENN).

Dr P N Kakar

Medical Director and Chairman-Quality, Park Group of Hospitals

A

s a young man I always used to wonder why in India people talk about distance in miles and kilometers, whereas in the western countries one always measures distance in minutes. In the twenty first century as India is striving to enter into a developed world, one finds the same terms are now being used in India as well, though in the metropolitans only. The reason is that the technology has come in a big way in India and the infrastructure too is coming up very fast. These developments have brought changes which automatically drive you faster towards your goals and one becomes more and more productive. Healthcare has adopted technology in a big way and brought both opportunities and challenges within the system. In the Hospital management

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too, technology has made its mark and has started to play a big role. Embracing technology not only helps in diagnosing patients more correctly but in managing personnel, equipment, inventory, finances, quality, planning, staff performance and strategy as well. Today technology has brought us to a situation where just at the click of a button one can know what is happening in the Hospital. You can have all information related with patient care including admissions,

discharges, deaths, notifiable diseases, available beds, operation theatre lists, infection rates, revenues and all other details that one can ask for. However the challenge is always to keep a backup. It is important to understand that though the technology has moved by leaps and bounds and has brought India into the leading five nations into space industry, if not used properly or misused or handled by inept staff, it becomes a big headache. With the use of technology,

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Technology Perspective

hospital management as well as planning has become much easier. One can plan management of ICUs from one centre and advise treatment to few other ICUs by means of telemedicine. One can plan manpower accordingly. Pitfall is that if the connections go wrong then you may find yourself stranded. Clinical, financial and data for the administrative purpose all can help you in planning the strategy for further growth of the hospital. Appropriate data analysis becomes the guiding factor. However if the data is not correct it can mislead the planning and can prove to be a disaster especially if you are doing a business planning for a new project. Technology has made communication much easier and helps saving time and manpower. Today it is possible to do transatlantic robotic surgery, a huge advancement in medical science. Perfection in the same can be brought out by simulation, yet another aspect of advancement of technology which allows you to err and yet get away with it. Continuous training by simulation increases the

safety margin and reduces the errors. Simulation a great teaching tool and is the future of medical training. In the modern environment patients do not allow themselves to be used for teaching medical students and the technology has started to fill in the gaps. HIS system is a need based expandable system. One has to define the areas one wants to monitor and data collection and analysis can be done accordingly. Challenge is to change the mindset of the staff and make them tech-savvy. Technology has allowed us to expand our wings to a wider spectrum of the society and one such outcome is medical tourism. While it allows the world to use our expertise it also shrinks the world and bring people closer. Medical tourism also brings medical legal aspects in a big way to the forefront. Challenge is to keep abreast with latest technology that comes in the western world. So ultimately technology in hospital management provides both opportunities and challenges together. It is for us to chose and exploit as it suits us.

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With the use of technology, hospital management as well as planning has become much easier. One can plan management of ICUs from one centre and advise treatment to few other ICUs by means of telemedicine.

eHEALTH Magazine

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News Highlights

The Latest from Health World Delhi-based startup AffordPlan raises $ 10 million Delhi-based fintech startup AffordPlan which works for healthcare space has raised $ 10 million in series B funding round led by Lok Capital. Omidyar Network, Prime Venture Partners and Kalaari Capital, among others, participated in the funding round. AffordPlan offers financial assistance for non-emergency medical and expensive procedures related to pregnancy, eye care, plastic surgeries, bariatric, among others. Commenting on the development, Tejbir Singh, AffordPlan co-founder and CEO, said, “We will use the funds to strengthen our team, expand operations to 3-4 tier I cities and introduce newer products around saving, lending and insurance.” AffordPlan has partnered more than 300 hospitals in the country and helped about 1 lakh patients. “The current system of healthcare financing is mostly out-of-pocket payments. The penetration of health insurance is less and Indian households often rely on their savings

to finance healthcare expenses. We are working towards reducing the burden of out-of-pocket expenses for patients and are making healthcare more accessible and affordable,” he added. Singh stated that through its network of partnerships, AffordPlan helps bring down the overall treatment costs by as much as 15-20 per cent.

Healthcare startup PregBuddy secures seed funding from IAN Bangalore based startup PregBuddy which ensures high quality medical care through its continuum platform between doctors and expecting patients, has raised an undisclosed amount in a seed round of funding from Indian Angel Network. The round also saw participation from Rajan Anandan, an IAN Member & MD Google India, Madhusudhan Kannan, Chief Business Officer of Uber India & Emerging Markets, Jayant Kadambi, CoFounder & Chairman of YuMe and Puneet Gupt, COO(News Business) of Times Internet Limited among others. Renowned Angel investor and Founder of India’s 1st healthcare incubator-HealthStart, Pradeep K Jaisingh, is the lead IAN member joining the company board.

Commenting on the investment, lead IAN investor Pradeep K Jaisingh said “Technology is playing a defining role in today’s healthcare system both for enhancing quality and improving access to healthcare in India. PregBuddy has

emerged as an exciting new platform for both caregivers and patients alike, leading to great improvements in patient satisfaction, reduced costs and improved health outcomes. The company has had phenomenal success so far in this domain and we believe they will continue to excel in the industry to be a market leader.” PregBuddy, an innovative platform which was started in October 2016 by IIT graduates Sivareena and Subhadeep Mondal, offers personalised healthcare via peer support, organised information, expert access for nutrition, fitness and emotional advice, in addition to affordable access to essential products and services.

Vizag-Chandigarh innovation corridor launched In an effort to promote manufacturing of medical devices, Andhra Pradesh MedTech Zone (AMTZ) and the Chandigarh Region Innovation and Knowledge Cluster (CRIKC) have joined hands. With this motive, the Vizag-Chandigarh innovation corridor was launched on Monday at Visakhapatnam and Chandigarh. The virtual corridor was started in a gala event in the presence of many eminent dignitaries. The event was jointly organised by the Department of Science and Technology (DST)- Centre for Policy Research at the Panjab University, Royal Academy of Engineering, UK, NITI Aayog and AMTZ. This virtual corridor was launched by Professor Vinod K Paul, Member NITI Aayog, in the presence of Andrew Ayre, British Deputy High Commissioner, Chandigarh, Prof Sir William Wakeham, Royal Academy of Engineering, UK, Arun K Grover, Vice-Chancellor, Panjab University, Professor Rupinder Tewari, Punjab University, Mr. Anil Jauhri, CEO, QCI – NABCB, and Scientist from reputed organisations like SCTIMST, CMC Vellore, NIB New Delhi, CRIKC institutions and Medical Device manufactures. Speaking on this occasion, Dr Jitendar Sharma, a leading medical technology expert in the country, highlighted the need of collaboration between research institutions and manufacturing industry. This virtual corridor will benefit both industries and research institutions.

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Scientists have discovered that sedentary behavior may make people vulnerable to certain diseases. In a study published in journal PLOS One, researchers found that sitting for long hours may increases risk of dementia in middle-aged adults. The researchers at University of California, Los Angeles recruited some volunteers (aged between 45 and 75 years) and questioned them about their physical activity levels. The scientists also enquired about the average number of hours per day they spent sitting over the previous week. Scientists did high-resolution MRI scans on each volunteer to check the deviation in MTL area. Medial temporal lobe (MTL) is a brain region which controls memories. Thinning in this region precedes cognitive decline and dementia. The Study found that sedentary behaviour was a significant predictor of thinning of the MTL. Researchers also discovered that even physical activity at high levels was insufficient to offset the harmful effects of sitting for long hours. “MTL thinning can be a precursor to cognitive decline and dementia in middle-aged and

news highlights

Sitting for too long may damage brain: Study

older adults. Reducing sedentary behavior may be a possible target for interventions designed to improve brain health in people at risk for Alzheimer’s disease,” the scientists said.

Health Ministry to act tough against errant hospitals In an attempt to make healthcare more affordable and accessible, the Ministry of Health and Family Welfare has decided to fix accountability at various levels of its delivery process. The Ministry has taken a decision to name and shame the healthcare providers which would be found to be lacking on various parameters including sanitation, waste management and infection control under its Kayakalp initiative. The Ministry has also decided to act tough against errant hospitals which are getting negative feedback from patients through Mera Aspataal (My Hospital) App.

The Mera Aspataal initiative which was launched in August 2016, aims at empowering patients by seeking their views on quality of experience in a public healthcare facility. “From next year, we will not only name and award hospitals which perform very well under the Kayakalp initiative but will also name those health facilities which will not perform up to the mark on various parameters, including sanitation, waste management and infection control,” Union Health Minister J P Nadda said on Thursday. “Kayakalp has been instrumental in inculcating a sense of ownership amongst

all stake holders. This sense of ownership has translated into commitment for Swachhta,” Nadda further said. He was speaking at the national felicitation ceremony of Kayakalp awardees (2017-18) in New Delhi.

Fortis forms expert panel to evaluate binding offers With more healthcare companies throwing its hat in the ring to acquire stake in Fortis healthcare, its board has formed an expert committee to evaluate the bidding proposals. The committee which will be chaired by Deepak Kapoor, former chairman and CEO of PwC India, has decided to consider only binding offer. It will give its final recommendation by April 26. Till now four suitors including Manipal/ TPG consortium, promoters of Hero Group and Dabur India, Malaysias IHH Healthcare Berhad and Chinese firm Fosun Health Holdings Ltd are in the race to acquire stake in troubled healthcare chain. Out of these four, Manipal/TPG consortium, promoters of Hero Group and Dabur India have given binding offers while

remaining two, IHH Healthcare Berhad and Fosun Health have shown non-binding interests. “In exercise of its fiduciary duties, the board has decided to evaluate the binding offers and has appointed an advisory committee and also directed Standard Chartered Bank (SCB) to assist the committee,” a statement from Fortis read. On Thursday, Radiant Life Care, backed by KKR, submitted an offer of Rs 165 per share for Fortis Healthcare. Radiant expressed its interest to buy Fortis Memorial Research Institute, its flagship hospital in Gurgaon, as well as Fortis Shalimar Bagh. Last week, the Manipal/TPG led consortium had raised their offer for Fortis

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to Rs 155 per share by valuing the hospital business higher at Rs 6,061 crore from Rs 5,003 crore in its initial offer on March 27. Hero Enterprise Investment Office and Burman Family Office which had earlier made an offer to invest Rs 1,250 crore, has revised the same by offering to invest Rs 1,500 crore directly at a valuation of Rs 161.6 per share. Fortis Healthcare had also received an unsolicited non-binding expression of interest from Fosun Health Holdings Ltd which offered a price up to Rs 156 per share.

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article

Grecian Super Specialty Hospital – Offering Quality Healthcare in Punjab Founded in 2006 by Dr Shivpreet Singh Samra and Dr Shachi Joshi Samra, the Grecian Hospital was established with an objective to set up a cancer hospital in Punjab. Today, under the able leadership of Dr Shivpreet Singh Samra and Dr Shachi Joshi Samra, Grecian Hospital has earned a special respect among patients, bringing laurels to Mohali, writes Elets News Network (ENN).

T

oday, Grecian Hospital is equipped with ultra-modern facilities including the most advanced PET-CT Scan in North India. With a focus on Heart and Cancer treatment and 320-bedded facility, Grecian Super Speciality Hospital now offers over 15 specialities under one roof, and caters to a wide population while aiming to maintain its high rate of success in surgeries and treatment. “It is one of the first five NABH hospitals in North India since 2012. This assures guaranteed standard of care as per the Government of India norms. Grecian Hospital offers the best quality treatment with a friendly approach. We assure you of accountability and will take full responsibility for the best delivery of healthcare,” says Dr Shivpreet Singh Samra. The foundation of Grecian Super Speciality Hospital was laid on a belief that affordable and quality treatment is the right of every man and it must be accessible to all. The hospital worked towards the betterment of the masses for a decade and wishes to set new a milestone in the healthcare industry. Today, the Grecian Super Speciality Hospital is internationally recognised for its commitment

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to research, innovation, and toptier healthcare in all the medical specialties. Grecian has also turned out to be the preferred choice of foreign patients. Their commitment to quality healthcare is showcased by the prestigious NABH & NABL accreditations granted to hospital. In the coming years, Grecian Super Speciality Hospital aims to spread its facilities to other cities of Punjab making quality treatment more accessible to the people living in

The foundation of Grecian Super Speciality Hospital was laid on a belief that affordable and quality treatment is the right of every man and must be accessible to all.

Dr Shivpreet Singh Samra Managing Director Grecian Hospital

remote locations. Also, through new empanelments, health camps, polyclinics, new OPDs, Grecian Super Speciality Hospital wants to spread awareness on preventive health care for the well-being of the people. The hospital employs close to 600 professionals and support staff, impacting the lives of large sections of society. “At Grecian Super Specialty Hospital, Mohali we all work together to achieve optimal quality of life for the people we serve. We are all working on our mission to create a successful and dynamic Superspecialty Facility catering to one and all,” said Dr Samra. “All employees at Grecian Super Specialty Hospital have the vision to Provide Affordable Super-Specialty Medical Services with Courtesy, Empathy, Accountability, and Transparency. We strive to provide effective healthcare with efficiency and compassion,” Dr Samra adds.

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Surat Smart City Development Ltd.

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SMT ASMITA SHIROYA Mayor Surat Municipal Corporation


industry Perspective - Gujarat 54

Health Insurance Scenario in Gujarat – An Insight The percentage of India’s national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP), writes Neha Lal, Senior General Manager – Operations & HR, GCS Medical College, Hospital & Research Centre, Ahmedabad for Elets News Network (ENN).

C

urrently, efforts are being made to expand health insurance coverage as a means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarise the country’s history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. Drawing on preliminary fieldwork and recognising the need for a broad-based implementation science perspective (studying up, down and sideways), we have identified six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences healthcare utilisation; (3) differences in behaviour patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) mistrust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses. Considering these challenges of healthcare insurance, there are many schemes launched by Government of Gujarat / India, which are being operated

May 2018

through TPAs and Insurance companies to cater larger uninsured mass, needing healthcare services in Gujarat. Some of them are: Rashtriya Swasthya Bima Yojana (RSBY) It is India’s largest health insurance scheme. Launched in 2007 by the Central Government, it covers over 37 million people, mostly poor families, across the States. It represents a major departure from past approaches to government support for healthcare in India. Mukhyamantri Amrutum (MA) Yojana It was launched on 4th September, 2012 by the Government of Gujarat for the Below Poverty Line (BPL) and Lower Income Group (LIG) population, is especially vulnerable to the catastrophic health risks. The scheme aims to improve access of BPL families to quality medical and surgical care for identified diseases involving critical illness like Burns, Cardiology, Cardiothoracic Surgery, Cardiovascular Surgery, Renal, Neurosurgery, Paediatric Surgery, Polytrauma, Medical Oncology, Radiation Oncology, Surgical Oncology, Joint Replacement Packages and Transplantation Procedures. Rogi Kalyan Samiti (A Poor Patients Benefit Scheme) Under this innovative scheme the Department of Health, Government of Gujarat, has put Rs 4 crores as fixed deposit. The interest incurred is spent on the medical expenditure of poor patients

up to a limit of Rs 15,000/ per patient. Since the program became operational a total of 944 patients have been benefited and Rs 1,23,08,400 have been spent on relief till 14th July 2004. Benefit utilisation has increased in the last 2-3 years significantly. In 2001-2002, relief of 4.31 lakh was utilised which increased to Rs 12.80 lakhs in 2002-03 and Rs 80.54 lakhs in 2003-04. This scheme covers major cardiac illnesses, all types of cancer, neurological, nephrological and ophthalmological problems. Any other super specialty treatment identified by the Governing Body is also covered under this scheme. Bal Sakha Yojana Under this scheme, all babies born to BPL mothers in the State (approximately 3,00,000 births per annum) will be covered for neonatal care by partnering pediatricians, including care in their Neonatal Intensive Care Unit (level 2 ) at no cost to the beneficiary. After initialisation and stabilisation of the Scheme, the scheme may be extended to cover all infants up to one year age. Janani Suraksha Yojana (JSY) It’s a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Scheme has contributed immensely in increasing the Institutional deliveries among the BPL, ST and SC population.

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Special Feature

Indian Healthcare Insurance – The Scope, The Challenges Driven by the US government’s move to take healthcare to all citizens, India is steadily making strides despite it being a Herculean task. In these scheme of things, opportunities and challenges related to the Healthcare Insurance in India offers an interesting insight, explores Luv Saxena of Elets News Network (ENN).

W

hile the Healthcare Insurance in India comprises various complex challenges, it holds massive opportunities as well. Despite a plethora of medical innovations and interventions, addressing the pertinent question of access to affordable basic health and wellness care has remained a challenge, especially for people belonging to lowincome and lowest strata of life. Providing affordable and quality healthcare to over a billion people is nothing less than a Herculean exercise. So far, it has no definite solutions or

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quick-fix solutions, in a country where the insurance penetration is as low as 3.3 percent. Challenges faced by healthcare insurance: In India, the Healthcare insurance is provided in three forms; • Commercial insurance (health covers, maternity covers, accidental covers, etc.) • Government welfare schemes, completely taken care of by the government where the beneficiary does not have to pay to avail the scheme’s benefits

• Health schemes which are part insurance and part welfare where the beneficiary has to pay some nominal premium to avail the benefits (Rashtriya Swasthya Bima Yojana). Despite the endeavours towards expanding the horizon of healthcare in India, the out of pocket expenditure on healthcare is about 85.9 (according to 2013 World Bank data). Out of pocket expenditures of countries with comparable backgrounds and economic growth such as Indonesia and Malaysia stands at 75.1% and 79.9% respectively. As opposed to this, countries such as France and Canada have recorded significantly lower out of pocket expenditures at 32.9% and 50.1% respectively (World Bank). Low penetration of healthcare services and insurance leads to

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Opportunities available: Catering to individuals’ hospitalisation needs can’t suffice healthcare needs alone, enabling individuals to utilise primary and secondary healthcare in a similar manner is also essential for our Government and other institutions of the ecosystem. If early treatment of

Insurance sector to perform.

People of the country end up spending a major portion of healthcare needs from their pockets because in India only tertiary healthcare needs (hospitalisation) are covered under any kind of health insurance.

an ailment can prevent hospitalisation, not only does it save the patient emotional stress and pain but also benefits the ecosystem of healthcare socially and economically too. Thus, it becomes extremely important to address these needs and build a robust system, which enables coverage of primary and secondary care for all. Here, such scenarios offer great opportunities for Healthcare

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National Health Protection Scheme – ‘Modicare’ Recently, the Union Budget announced the National Health Protection Scheme (NHPS), the biggest such global plan to provide quality health coverage to a population larger than the combined citizenry of the US, France, Germany and the UK. Unofficially known as ‘Modicare’, the plan seeks to extend health insurance to 10 crore people from financially vulnerable households, meaning that about four in 10 Indians would have access to modern medicine, critical care, and quality tertiary care through private and state facilities — financed through Rs 5 lakh per family insurance cap. Thus, this plan presents huge opportunities for insurers in India. G Srinivasan, chairman and managing director of New India Assurance says “I look at it as a great opportunity for the insurance industry and there is a scope of expanding health insurance by 40% in one year.” In brief, one tends to understand as the Indian healthcare Industry is estimated to grow in leaps and bounds by 2020. With over 70% out-of-pocket expense burden on the consumers, the market is ripe for health insurance entities including global players. The healthcare industry is likely to witness major reforms. Whichever model evolves, it is clear that the healthcare financing and delivery system is poised for a major change. It looks the country’s healthcare transformation should focus on the three key goals of access, cost, and quality. Entities will encounter multiple challenges in catering to the needs of the 1.2 billion population, stratified on culture, economy, and means. Private entities need to complement public initiatives to develop a comprehensive healthcare delivery and financing system.

eHEALTH Magazine

May 2018

Special Feature

various difficulties such as reach and accessibility, literacy levels and information penetration, and mindset and cultural practices. Escalating costs of healthcare services and unavailability of competent medical professionals, equipment, infrastructure, and medicines are also huge challenges. On an average, people of the country end up spending a major portion of healthcare needs from their pockets because in India only tertiary healthcare needs (hospitalisation) are covered under any kind of health insurance. A visit to the physician or a sonography – primary and secondary outpatient healthcare services are not covered under most health insurance options and the patient has to pay from his or her own pocket. It may be mentioned that insurance schemes or policies can be utilised in India only when the patient spends 24 hours on a hospital bed.

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Visakhapatnam, 9 July 2018

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The ‘health medical and Family Welfare department, Government of andhra pradesh’ along with elets Technomedia, asia & middle east’s premier media and technology research organisation is organising ‘healthcare summit-andhra pradesh’ in Vishakhapatnam on 9 July 2018. The state government is committed to improve the health status and quality of life of its people, by focusing on health issues with the objective of reducing disease burden, creating an enabling environment, influencing direct and indirect health determinants such as nutrition, water, sanitation and other factors like education and employment in the state. To improve the accessibility and quality of health care services, specific efforts will be ensured to strengthen health infrastructure and promote public private partnership.

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Key THeMeS Government Initiatives in Health Health Insurance Medical Equipment Manufacturing Industry Technology & Innovation in Health Smart Health for Smart Cities Public-Private Partnerships for Healthcare Sector Building Effective Hospital Ecosystem Medical Tourism Opportunities for Pharma Sector

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