eHealth Magazine November Issue

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The Premier monthly magazine on the enterprise of healthcare in asia & the middle East volume 13 / issue 11 / November-december 2018 / ` 100 / US $10 / ISSN

Innovations

in Healthcare Laying Foundation of

New India

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November-december 2018 | Volume 13 | Issue 11

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COVER STORY

Innovations in Healthcare Laying Foundation of New India policymakers’ Perspective

rajasthan healthcare perspective 23 Kali Charan Saraf

Minister for Medical, Health & Family Welfare Government of Rajasthan

24 Banshidhar Khandela

25

14 Bhaskar Lakshakar

MD, Madhya Pradesh Public health Service Corporation Limited (MPPHSCL) & CEO, Ayushman Bharat, Government of Madhya Pradesh

Dr Kinny Singh

Mission Director, National Health Mission & Special Secretary, Department of Health Arunachal Pradesh

Minister of State for Medical, Health & Family Welfare Government of Rajasthan

Neurology perspective 26

Strokes Are No Longer Limited to Elderly People: Dr Padma Srivastava

punjab HEALTHCARE Perspective 16

Pardeep Mattu Joint Commissioner Food and Drugs Administration (FDA) Government of Punjab

Healthcare Innovation 18 Jaishankar Natarajan

Product Group Head

Godrej Medical Refrigerators

innovation in technology 20 Transforming Ideas into a Novel Cause Dr Ashok Seth Chairman Fortis Escorts Heart Institute

Professor - Neurology AIIMS, New Delhi

special feature 28

Madhya Pradesh’s Giant Leap in Healthcare Delivery

44 Case Study: EHRs in India: Challenges and Opportunities vis-a’-vis’ Ayushman Bharat 48 Healthcare Startup: INSPIRON Enabling Individuals to Cultivate Positivity

32

Ranking Top Hospitals 2018

Editorial Innovations catapulting healthcare industry in India Thanks to improved diagnostic and therapeutic options, healthcare has experienced an explosion of innovations in the past few decades, driving improved life expectancy and quality of life.

As healthcare organisations face unprecedented competition to improve quality, access, efficiency, and lower costs, innovative thinking is proving to be a major differentiator. It provides right impetus to drive healthcare industry, enabling people to avail affordable medical facilities.

Innovation has been, therefore, made the main theme of the latest issue of eHealth. Our cover story titled “Innovations in Healthcare Laying Foundation of New India� explores how innovations are augmenting the healthcare delivery. It highlights the role of Central Government as well as the States for taking a slew of innovative measures to strengthen the healthcare delivery process. The story underscores the need of techenabled innovative solutions in NCDs, cardiac care, telemedicine and other diagnostic issues.

The magazine carries the interview of Bhaskar Lakshakar, MD, MPPHSCL & CEO, Ayushman Bharat, Government of Madhya Pradesh, who talks about role of Ayushman Bharat to enhance patient care. He also sheds light on various healthcare schemes of Madhya Pradesh Government.

We have also interviewed Pardeep Mattu, Joint Commissioner, Food and Drugs Administration (FDA), Government of Punjab, who says Punjab has developed a web-based application on a pilot scale to benefit the public on drug information and monitoring system to check availability of medicines at chemist shops.

This issue carries interview of Dr Ashok Seth, Chairman of Fortis Escorts Heart Institute where he underscores the need of innovations in the context of Indian healthcare delivery system. He shares his passion for science and technology and how innovations can impact life of common man.

The magazine carries an insightful article by noted Neurologist Dr Padma Srivastava, who shares her perspective about stroke and other facets of NCDs. She says strokes are no longer limited to elderly people and people should go for health check up at least once in a year.

Our latest issue also carries the ranking of Top Private Hospitals of North India. Hospitals have been ranked on various parameters.

Elets Technomedia is organising Healthcare Innovation Summit to offer a platform to top policymakers, international experts, industry leaders to deliberate on how to develop an ideal healthcare delivery model for India. In the focused panel discussions, the healthcare luminaries will explore the ways to make people avail affordable and quality healthcare facilities.

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 Founder Publisher, CEO & Editor-in-Chief Elet Technomedia Pvt Ltd ravi.gupta@elets.in

cover story

Innovations in Healthcare Laying Foundation of New India Leveraging disruptive technologies like artificial intelligence, robotics, internet of things, healthcare aggregators are delivering top class affordable medical facilities to people in terms of diagnostic equipment, imaging, and telemedicine, writes Mukul Kumar Mishra of Elets News Network (ENN).

T

he world around us is changing at a fast pace— thanks to the latest technologies and innovations which have played a key role to bring a paradigm shift in every sector including healthcare. With growing awareness about health among people, there is a strong demand for quality health care facilities.

In the last decade, the Indian healthcare has witnessed a tremendous growth, partially due to innovative healthcare solutions which have not only enabled people

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in remote area to access quality care but have also increasingly reduced the cost of delivery along with increased efficiency.

The healthcare industry is one of the fastest growing sectors in India, providing plethora of opportunities to stakeholders of this field. According to a report by the industry body Assocham (Associated Chambers of Commerce of India) and research firm RNCOS, the Indian healthcare industry may see three-fold jump in value terms to $372 billion by 2022.

A spurt in the incidences of lifestyle

diseases and the rising demand for affordable healthcare delivery system due to increasing healthcare costs are driving the healthcare market in India.

Innovations to boost healthcare delivery Leveraging disruptive technologies like artificial intelligence, robotics, internet of things, healthcare aggregators are delivering top class affordable medical facilities to people in terms of diagnostic equipment, imaging, and telemedicine.

Innovations in the areas of new

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hospitals are developing mobility solutions using various technologies like artificial intelligence, Internet of Things, etc, to improve their patient care, streamline workflows and increase efficiency. The main objective of our mobility solutions is to empower stakeholders – clinicians, patients and management.”

These innovative practices hold huge significance in the wake of spurt in non-communicable diseases (NCDs) like cancer, stroke and heart related issue in recent years. According to WHO report, nearly 61 per cent deaths are attributed to NCDs. Unfortunately, we have a chronic shortage of specialists. There is a shortfall of 74.9% of surgeons, 65.1% of obstetricians and gynaecologists, and 79.8% of paediatricians. According to a 2012 WHO report, India has 0.7 doctor for every 1000 people.

In the backdrop of above mentioned facts, Indian healthcare system needs to harness full potential of technology and innovation to overcome infrastructural barriers enabling people top class medical facilities in their budget. Robotics, Artificial intelligence, Internet of Things (IoTs), teleradiology could be used to decrease the healthcare delivery time and cost. There is a new

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generation of pacemakers, stents, insulin pumps, drug injecting pumps to help patient get better medical facilities. mHealth is proving to be a game-changer. Diabetics, for example, have become adept at using compact electronic gadgets which accurately monitor blood sugar levels.

cover story

drugs, vaccines, diagnostic tests, telemedicine have also enhanced patient care and contributed towards enhanced quality of overall delivery of healthcare services. Healthcare providers and start-ups are coming up with innovative solutions to enhance patient care.

Vivek Tiwari, CEO, MedikaBazaar, says, “We are working towards providing hospitals with high-grade products for various treatments. For instance, in the fields of Radiology and Diagnostic, we are onboarding international vendors selling highquality products for enhanced breast tumour treatment.”

“Conventional diagnostic procedures like X-ray Mammography are painful and exposes patients to radiation while treatments such as Hyperthermia are quite complex. The exclusive radiology and diagnostic products, which will be sold on our platform will allow patients to get painless, safe, and relatively straightforward innovative painless AI driven diagnostics,” he further stated.

Shilpa Saxena, General Manager, IT& Digitalisation, Aakash Healthcare Super Speciality Hospital, adds, “Mobile access to patient histories helps clinicians to make immediate analyses of patient current condition and workout accordingly. Smart

Ayushman Bharat The Government is trying all possible measures to achieve the aim of Universal Healthcare Coverage. With series of innovative measures and initiatives like Ayushman Bharat, the Government has tried to strengthen healthcare delivery system to ensure healthcare gets unexpectedly closer to the needy.

AB-PMJAY is one of the largest Governments funded healthcare schemes of the world in which beneficiaries get Rs 5 lakh per family healthcare insurance coverage for secondary & tertiary care in any empanelled hospital across the country.

It is a digital and cashless scheme with least human intervention. The identified beneficiaries need only valid identification proof to avail the benefits. As per Ministry, total 7.41 lakh e-cards have been issued so far since the launch of the scheme. A total of 15,008 hospitals have been empanelled and more than 3.4 lakh beneficiaries have been treated under various hospitals across country.

As per the health official, 68 per cent of beneficiaries are getting treatment in empanelled private hospitals. Top specialties under which beneficiaries have received claim are oral & maxillofacial surgery, general surgery, ophthalmology and gynaecology.

Recently, the Union Cabinet also approved Allied and Healthcare Professions Bill which will help standardise allied healthcare. These professional will help to reduce cost of care and improve accessibility of healthcare service.

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november-december 2018

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cover story

State Governments’ Innovative practices The Narendra Modi-led government is encouraging the States to build a strong infrastructure and let people avail the best possible solutions. The State Governments are also trying their best to allign itself with the Centre’s aim to achieve healthy India.

Series of innovative practices have been adopted by States like Rajasthan, Andhra Pradesh and Madhya Pradesh to strengthen healthcare delivery system enabling people quality and cost-efficient medical facilities at their doorsteps. Taking cue from these innovative ideas, many others States are striding towards enhanced healthcare delivery model.

Rajasthan Rajasthan’s Bhamashah Swasthaya Bima Yojana (BSBY) is one of the most successful healthcare insurance programmes where insurer gets Rs 30,000 for general illness and Rs three lakh for critical illness.

The State is torchbearer in terms of technology and innovations that have been harnessed to benefit people. The Government recently launched innovative software named Nidaan for presumptive diagnosis and monitoring of seasonal and non-communicable diseases as well as the trends of ailments found in specific areas. The software is found to be helpful in formulation of specific action plans for control of diseases.

With the aim to screen newborns for hearing loss, a device called SOHAM was launched. This device would help doctors to detect and treat infants having hearing impairment.

Another mobile app based ECG device, ATOM, was also launched to screen patients at primary healthcare level.

Rajasthan is the first State in the country to introduce community mother milk banking project. The bank collects excess breast milk from lactating mothers and provides it to

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infants deprived of it. The bank is very helpful for those mothers who are unable to feed infants due to clinical reasons, or those who are orphaned or abandoned.

Andhra Pradesh The State healthcare delivery system system sets an exemple for others to emulate. From Arogya Raksha to Chandranna Sanchara Chikitsa, the Government has implemented many programmes to improve overall health of the State.

Chandranna Sanchara Chikitsa (CSC), a flagship programme of the Andhra Government, stands for primary medical care on wheels. It ensures availability and accessibility of medical services to the needy in remote villages. With the help of 289 Chandranna Sanchara Chikitsa(CSC) vehicles, people are catered with best medical facility.

Another State sponsored programme MukhyaMantri Aarogya Kendralu assures the state-of-the-art healthcare services free of cost to urban poor and slum dwellers.

Through teleconsultancy, the programme also ensures availability of full time medical officer, 30 diagnostic tests, supply of medicines and availability of specialist services.

Under NTR Vaidya Pariksha (Laboratory services) programme,

the State Government provides free diagnostic tests to the patients visiting Government hospitals. This enhances patient care and reduces the out-of-pocket expenditure for the beneficiaries. Currently, there are 105 labs in operation which includes seven mother labs and 98 processing labs spread across all the 13 districts.

Madhya Pradesh In Madhya Pradesh, technology and latest innovations are turning instrumental in making people more aware of their health concerns.

In this wake, the State Government is undertaking a number of initiatives to cater quality and cost efficient healthcare facility to every citizen.

The State Government has many schemes including Sardar Vallabh Bhai Patel Free Drug Distribution Yojna to Free Pathology Diagnostic Services, to provide holistic healthcare delivery. These schemes are benefitting all sections of the society especially the poor and vulnerable people.

The State Government has taken substantial measures on the front of accessibility and out-of pocket expenditures that are big issues plaguing healthcare delivery system of any State. Rural infrastructures which include facilities at sub-centers, primary healthcare centers (PHCs) and Community Healthcare centers

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Innovations in Cardiology MitraClip mitral valve repair without open heart surgery is one of the innovative scientific advancements of recent times. A few years ago, it was unbelievable to think that a valve which lies within the heart could be repaired by catheters, in an angioplasty like procedure without opening the heart and putting the patient on cardiopulmonary bypass.

Recently a team of doctors led

by Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute, performed the surgery at Fortis Escorts Heart Institute.

“The MitraClip is a novel catheter based non-surgical repair of the mitral valve inside the heart and is performed in the Cath Lab like angioplasty. Special catheters are inserted through the large vein in the groin and the catheter is passed from the right chamber of the heart to the left chamber of the heart by puncturing the partition called interatrial septum. Then under echocardiography and X-ray guidance a clip is put on the leaking mitral valve to decrease the leak which improves the condition of patient.

The patient is normally ready to be discharged in 24-48 hours’ time,” says Dr Seth.

A leaking mitral valve affects nearly 10 percent of the population who have coronary artery disease, heart attacks

The Government is trying all possible measures to achieve the aim of Universal Healthcare Coverage. With series of innovative measures and initiatives like Ayushman Bharat, the Government has tried to strengthen healthcare delivery system to ensure healthcare gets unexpectedly closer to the needy

or bypass surgery and continues to increase with age. The continuously leaking valves put pressure on the heart causing breathlessness. If left untreated, it leads to enlargement of the heart, heart failure and death.

Radiology and Imaging Radiology industry is witnessing an overhaul with respect to launching of cost-effective innovative imaging equipments in the secondary and tertiary healthcare segments.

Dr Rajeev Boudhankar, CEO, Bhatia Hospital, Mumbai, says that there are cutting-edge imaging techniques that may become popular in the near future. He lists out some of the innovations happening across world on the front of diagnostics imaging.

Pocket-sized hand-held ultrasound devices are predicted to replace

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the200-year-old stethoscopes in near future. They can diagnose heart, lung and other problems more accurately than traditional stethoscopes.

Similarly, Hyperspectral imaging may provide a non-invasive diagnostic method that allows determination of pathological tissue with high reliability. This technology is in use in the defence sector and is now finding applications in the healthcare imaging Industry, Boudhankar adds.

A modality called Electromagnetic Acoustic Imaging has been making use of electro-magnetic and acoustic waves for diagnosis. It helps to identify various types of solid Cancers at early stages of development.

Another technology Wafer Scale Mega Microchip enhances medical imaging techniques. It enables doctors to detect accurately the effects of radiation on cancerous tumours, thus helping early detection.

The University of California, Berkeley and the UniversidadAutonoma de Madrid of Spain have claimed to have made the use of 3D Meta material to augment ultrasound images by a factor of 50X. If this technology becomes successful commercially, it would help current ultrasound investigations to capture high-resolution images for medical imaging in both diagnosis and interventional procedures.

Dr M L Rokade, Consultant Radiologist, Jupiter Hospital, says, “Ultrasound has maximum usage in any hospital setting. Ultrasounds have become smaller to the size of palm top so that it is always available to the critical care consultant.

Today ultrasound has changed the way we see the fetus with its 3D/4D capability.”

Liver cirrhosis can be diagnosed early with shear wave elastography both on ultrasound and MRI. Contrastenhanced ultrasound is now being widely used for assessment of tumors and various lesions. Digital image radiography and PACS (Picture

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november-december 2018

cover story

(CHC) have been improved.

In addition, the Madhya Pradesh Government has paid special attention to women and child’s health. Schemes like Rastriya Baal Swasthya Karykarm, Mukhyamantri Baal Shravan Upchar Yojna and Pradhanmantri Surakshit Matritva Abhiyan (PMSA) are evidence of the Government’s intent to improve things on every level.

On digital health, the State Government has initiatives like MP Aushadhi, EMMS (Equipment Management & Maintenance System), and eHospital.

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cover story archival and communication system) is the standard of a modern day radiology department.

Diagnostic equipment Today, indigenous med-tech innovations assist diagnosis in resource-poor regions to provide last-mile care delivery. It also increases patient safety in referral and tertiary care centres. Locally developed low-cost technology such as portable electrocardiogram machines, IoT ophthalmic equipment, blood glucose monitors, vitals monitors, breastscreening equipment is assisting caregivers in remote locations.

3nethra is the portable, telemedicineenabled solution that can be used by minimally trained technicians to screen patients in remote locations.

Trained ophthalmologists can review patient’s scans remotely and only those patients that need specialized surgery can be advised treatment at tertiary care hospitals in the metros.

Telemedicine Telemedicine can be an effective tool in providing specialist access to patients in small towns and rural areas. With 3G and broadband access to every nook and corners of the country, telemedicine can be a gamechanger.

Using this IT-enabled solution, the

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images can be transmitted to another location and reported immediately on real-time basis so that the emergency medical care can be delivered on that very moment when it is actually required to patients. The process results in reduced visits, reduced costs, and faster diagnosis for the small town patients.

Cancer care In recent years, there has been many innovations which have enhanced cancer care. PET CT is one such techniques which helps initial diagnosis of cancerous cells. The technique helps in distinguishing benign (non-cancerous) from malignant (cancerous) disease and in determining it’s stage. The metabolic characteristics of the cancer help cancer physicians decide the best treatment options for treating the cancer.

“PET scan can often reveal much more about the cellular level dynamics of a disease than any other modalities like Ultrasound, CT or MRI. With combination of CT / MRI with PET in to a single machine, simultaneous localization of the disease becomes more accurate with better characterization of individual lesion(s),” says Dr Swagat Dash, Senior Consultant & HOD – Nuclear Medicine, Sarvodaya Hospital &

Research Centre.

Artificial intelligence-based health-tech company Niramai has developed non-touch, noninvasive and non-radiation based breast health screening technology.

Technology called Thermalytix, uses a high resolution thermal sensing device and a cloud hosted analytics solution for analyzing the thermal images. Their SaaS solution uses big data analytics, artificial intelligence and machine learning for reliable, early and accurate breast cancer screening.

Recently, iGenetic Diagnostics collaborated with with Lucence Diagnostics to launch Liquid biopsy tests in India. This test improves cancer diagnosis and treatment selection for patients with advanced cancer. The blood test analyses the cancer-driving mutations from the DNA shed by the tumor into the bloodstream to determine the best available treatment, which include targeted therapy and immunotherapy.

“Delivering advanced molecular diagnostics that can enable a quick and precise diagnosis will help to save lives. We are excited to collaborate with Lucence to deliver their proprietaryliquid biopsy tests for early cancer detection and better treatment selection to patients in India. Lucence’s technology will help doctors personalize treatment for their patients and improve patient outcomes,’’ says Arunima Patel, CEO and Managing Director, iGenetic Diagnostics.

Innovations are catapulting Indian healthcare providers to cater people with affordable, accessible and quality healthcare. A section of experts believes that innovation and technology work only if basic infrastructure is available across country. India needs to increase strengths of doctors, nurses and paramedics staff to leverage these technologies and innovations to benefit people at large.

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Policymaker’s perspective 14

‘Ayushman Bharat Reduces Transaction Cost for Beneficiaries’ There are around 1.2 crore families eligible for Ayushman, which means about six crore individuals. We are covering around 80 percent of population of Madhya Pradesh. That’s the outreach of Ayushman Bharat, says Bhaskar Lakshakar, MD, MPPHSCL & CEO, Ayushman Bharat, Government of Madhya Pradesh, in conversation with Elets News Network (ENN).

Q

How Ayushman Bharat is going to be a boon for beneficiaries?

Since Ayushman Bharat is an entitlement based scheme, the beneficiaries don’t need to go for separate registration and enrolment, that is, if I am eligible for it which is decided based on three parameters. One, if I am part of deprived category of SECC, 2011 then I am eligible. Second, if I am the unorganised labour, as per the MP Sambal Yojna, then I am eligible for the scheme. Third, if I am getting a food coupon under the National Food Security Act, I am eligible.

Any beneficiary, every household knows whether they are eligible under any of these three categories for the scheme.

Information is available with the families and they can identify easily whether they are part of the scheme or not.

If one has to avail the benefits of the scheme, they have to take simple steps. One has to walk into the hospital.

It can be two kinds of hospitals, i.e government-owned or private-owned.

If the private institutions are enlisted in the empanelled list of hospitals, they are duty-bound to cater Ayushman services to the beneficiaries. In case, one goes to government hospital, we identify the beneficiaries first with biometrics verification. Based on the same verification, the treatment is provided.

In Madhya Pradesh, entire medical expenditure is free in the government hospitals. Since the reimbursement against the packages is available, it further strengthens infrastructure of the hospitals because the Rogi Kalyan Samiti will have discretion to spend as

november-December 2018

per local requirement.

Q

If someone needs tertiary care treatment for diseases like cancer or cardiovascular diseases, what provision does the scheme entail?

If someone needs tertiary treatment then they need to visit some government medical college or empanelled private institution. This facility is available with both types of medical colleges, private and government. Both will be reimbursed by the Government for the kind of services they will be providing to patients. The best part is that patients don’t need to produce any kind of documents, any bills, evidence or certificate. Only thing we need is a valid photo ID to identify them whether they are beneficiaries or not.

Q

How far have we reached in empanelling hospitals, medical colleges? PSUs in the State have their own hospitals for employees. Is there any attachment with them as well?

There are two categories of hospitals, one is private hospital within the State. We decided to go with NABH accredited hospitals. There are around 100 plus accredited hospitals of which around 80 have been empanelled.

PSUs, BMHRC, AIIMS and others are with National Health Agency (NHA). An MoU is being signed between NHA and the State Government regarding the same.

Since there is portability system, even if NHA does the agreement, then

Bhaskar Lakshakar

MD, Madhya Pradesh Public health Service Corporation Limited (MPPHSCL) & CEO, Ayushman Bharat, Government of Madhya Pradesh

also it comes under the purview of the State Government.

Q

How do you rate the scheme in comparison to previous such universal healthcare schemes in the State?

In Madhya Pradesh, there was no Rashtriya Swasthya Bima Yojna (RSBY). There is one SIAF (State Illness AID Fund). But the limitation of the erstwhile scheme was that they were given once in a lifetime. It was only Rs two lakh rupees. Under Ayushman Bharat, Rs 5 lakh coverage is being given annually. And the documentation work was huge in earlier schemes.

In Ayushman everything is online and therefore I think the transaction cost for the beneficiaries has reduced substantially.

SIAF had its own limitations. It had limited coverage in comparison to

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Q

How is the State Government is planning to curb corrupt and fraud practices within the scheme.

Every scheme has some possibility of pilferage, so the only way to address these issues is to be vigilant and follow SOPs. We have focused on developing SOP/documentation and promote best practices in Ayushamn.

We will also conduct rigorous audits. There will be two layers of auditing system. One is by ISA (Implementation Support Agency).

SHA will have its own team which will further conduct a secondary audit. Then we will have hospital audit also separately. We will conduct audit of five percent hospitals (out of total empanelled). We will check the infrastructure, whether proper information is being given to beneficiaries or not by the hospitals.

It will be two-pronged strategies -- Hospital Audit and Claims Audit.

These two audits will be conducted twice. Then we will have third party audit also. These will check any kind of fraudulent activities. Overpricing, inflated treatment and co-payment are major concerns. A prudent audit is needed. We are developing fraud checking and curbing systems with the help of expert agencies.

Q

Health schemes like Ayushman Bharat require a lot of things including skilled manpower. What kind of preparations are being done to implement the scheme?

We have developed our own IEC and training material and SOP. The training can’t be conducted for heterogeneous groups. We have segregated different clientele. For doctors, we need to have different kind of training and so is for Ayushman Mitra, nurses, managers of private hospitals and all. We have developed training calendar as well.

It will be continuous and regular

process, not a one-time affair.

In the divisions, they will conduct district-level training, a TOT, while in districts; they will conduct block-level training. My entire staff is well-versed with the processes of Ayushman Bharat.

The main concern is to aware people about Ayushman Bharat -- how they get benefitted and about its processes.

Q

What is Ayushman Mitra? Kindly share about their profile.

Ayushman Mitra is an interface between the hospital and patients.

Ayushman Mitra have been employed

by ISA. They are having decent communication skills and basic computer proficiency. They are supposed to help the beneficiary to avail the benefits through their golden record generation. Once the record is generated and the patient is admitted in the IPD (In-Patient Department), the details are entered in PMS. This kind of data updation and data management is done by the Ayushman Mitra. They will also be doing IEC activities. At hospitals, they will address the query of beneficiaries.

We have designed uniform also for Ayushman Mitra so that they can be identified easily to assist beneficiaries.

A total of 176 hospitals have been empanelled till now in the State.

Private hospitals will employ their own Ayushman Mitra while we have provided Ayushman Mitra in Government hospitals through our ISA (Implementation Support Agency).

Every hospital will have at least four such Mitras at different time-interval.

In medical colleges, the number would be more. We will have around 560 Ayushman Mitra at the month-end.

Then we will have district coordinator also who will coordinate on the front of logistics or providing any other kind of assistance, if required.

Q

What is the role of MPPHSCL in making healthcare delivery efficient?

Ayushman can’t work in isolation. It

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has to have both supply and demand side. There is demand of services.

It is generated by communication IEC activities. It is matched through medicine, equipment and HR. We have scarcity of quality doctors.

To fill the gap, we have made provisions of tie-up with local doctors or labs. If a hospital doesn’t have required expert to do particular surgery, they can hire the doctor on the promise of paying certain amount to him per case basis. Similarly, if some hospitals don’t have facility of certain tests, one can tie up with some local private labs.

For medicine, we have Jan Aushaudhi portal. There are 472 procedures in Ayushman Bharat which have been identified as reserve one. To match the supply side, it is required that my medicine should be easily available in the hospitals.

If there will be clear information which hospitals lack which medicine, we can fill the gap easily. Same is for equipment also. There is portal, EMMS which we will use. On this portal, entire data is captured which hospitals lack equipment.

Policymaker’s perspective

Ayushman Bharat which has minimal human intervention.

Q

Tell us about other measures which have been taken to boost patient care under Ayushman Bharat.

In a bid to strengthen healthcare delivery system, we have taken following steps: 1. Extended the benefits to the beneficiaries of National Food Security Act (NFSA), unorganised labour (Sambal Scheme) and Socio Economic and Caste Census(SECC) 2. Developed own functional website/ SOP/ manuals/detailed trainings/ process flow and process documents 3. Only NABH compliant hospitals are eligible for empanellment 4. We have started working for direct incentive transfer to employees 5. Identified strategy and mechanism for fraud detection 6. Advancing for integration of e-hospital with the Ayushman portals

eHEALTH Magazine

november-december 2018

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Punjab Healthcare Perspective

‘Making Healthcare Accessible to All in Punjab’

The Department of Health, Punjab, has issued instructions to manufacturers and wholesellers to supply habit forming drugs to the retailers/ hospitals on the written order and their payments shall be accepted by way of approved sources only, such as by cheque or by money transfer, says Pardeep Mattu, Joint Commissioner, Food and Drugs Administration (FDA), Government of Punjab, in conversation with Elets News Network (ENN).

Q

How is the Department contributing to protect, promote and enhance health of people of the State?

The Department is ensuring safety and efficacy of drugs available in the market through random sampling adopting the risk-based approach.

The drugs samples are taken on the basis of seasonal trends which are at high risk of deterioration. The Department of Health, Government of Punjab, is committed to let people avail free of cost medicines and consumables. Quality of drugs and consumables are ensured at the pre-distribution stage. Punjab is the only State worldwide, providing free

of cost medicines and diagnostics facilities for diagnosis and treatment of Hepatitis ‘C’ patients.

Q

FDA has developed a web-based application of ‘Drug Information & Monitoring System’ to check availability of medicines as well as for monitoring of drug stores. Tell us more about the App. The FDA Punjab has developed a web-based application along with its Android mobile app on a pilot scale to benefit the public on drug information and monitoring system to check availability of medicines at chemist shops.

The pilot scale project has

Pardeep Mattu

Joint Commissioner Food and Drugs Administration (FDA) Government of Punjab

been successfully completed and launched by the Health Minister.

The department is in the process of up-scaling the project to roll out in the entire State. This application will benefit the society in terms of easy availability and access to medicines.

The regulatory authority will be in position to monitor the stock-in and stock-out of the drugs from the chemist shops. Further, this will be helpful in tracing and tracking of drugs also.

Q

Shed some light on the recent measures taken by the department to keep drug menace in check.

The department has imposed

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november-December 2018

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Punjab Healthcare Perspective

specific restriction on stocking and sale of indentified habit forming drugs such as Dextropropoxyphene, Diphenoxylate, Codeine, Buprenorphine, Pentazocine and Nitrazepam formulations by way of prohibiting the chemists by affixing stamp on the face of licences.

Q

What guidelines have been issued to pharma shops in this regard?

The department has issued

instructions to the manufacturers and wholesellers to supply habit forming drugs to the retailers/ hospitals on their written orders and their payments shall be accepted by way of approved sources only, such as payment by cheque by money transfer. Non compliance of the above said instruction will result in suspension / cancellation of licences.

Q

What steps have been undertaken to discourage food

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business operators (FBOs) who are found to be selling sub-standard quality of food products like flour, milk and ghee (clarified milk)?

The FBOs and manufacturers have been apprised with the consequences leading to manufacture and sale of sub-standard / adulterated / unsafe food products through counselling meetings. The sampling process has been geared-up and the innovative method of testing of Sub-Standard / Adulterated / Unsafe food products are under development process. The sellers / suppliers have been educated for ripening of fruits by using the incubators especially banana, papaya and mango etc. and has been asked to quit the use of intoxicating gases for fruit ripening. The adequate number of milk testing machines has been made available at the milk collection centres to access the adulteration and mobile testing vans has also been made available in the field. The State Food & Drug Testing Lab has been strengthened by installation of highend automatic equipment.

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healthcare Innovations

Unique ‘Boat Clinic’ Reaches 2,500 Remote Islands

Jaishankar Natarajan

Product Group Head Godrej Medical Refrigerators

I

ndia has made rapid economic progress over the last decade and this has placed an enormous demand on health care delivery and an efficient medical cold chain is indispensible for delivering quality healthcare in remote corners of the country. Besides ensuring expansion, the need of the hour is to embrace the latest technologies in the medical cold chain which has been evolving over the years.

Millions of temperature-sensitive medical supplies, such as vaccines and blood, are discarded due to improper storage or management practices.

Over 28 lakh units of blood have been discarded by hospitals and blood banks in India over the past five years.

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november-December 2018

Seven lakh units have been discarded over the past year alone.

The World Health Organisation has reported over 50 percent wastage of vaccines around the globe due to temperature excursions and improper storage within the supply chain.

These temperature-sensitive life saving supplies must be stored at a precise temperature throughout the cold chain to retain their potency, which is extremely challenging especially in a low-resource setting with unreliable electricity, poorly maintained equipment, and long distances between facilities.

Many of the medical supplies lose their effectiveness when exposed to extreme heat or freezing conditions.

This not only leads to expensive loss

and reduced healthcare delivery, but it also poses serious health risks to patients.

SELCO FOUNDATION is a social enterprise which works on projects creating inclusive development pathways that are socially and environmentally sustainable. It strives to inspire and support champions of sustainability across the world.

Godrej Appliances, an enabler for sustainable and efficient medical supply storage solutions to the last mile, is associated with SELCO for a novel cause.

The Boat Clinic The mighty Brahmaputra River, which flows through Assam, has around 2,500 islands inhabited by

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2.5 million people, who get affected by annual floods caused by the river during monsoon. This vulnerable population is prone to water-borne diseases. But acute soil erosion makes infrastructure development near to impossible on these islands, leaving thousands to fend for themselves due to inaccessibility of medicines and other healthcare facilites.

In 2004-05, the Center of North East Studies and Policy Research (C-NES), an NGO committed to create infrastructure in healthcare, education and other areas of governance in the North-Eastern states of India, launched and built AKHA. It is also described as ‘A Ship of Hope in a Valley of Flood’—a unique boat clinic to provide mobile health services to the poor and the marginalised on the islands in Dibrugarh district.

The focus: Immunisation of children, pregnant women and new mothers as well as treatment of vulnerable adult groups.

The concept won a World Bank Award for innovation aimed at bridging rural gaps. Since its

inception, the programme has been expanded to cover 13 districts of Assam with a total of 15 boats operating along the river. It is being supported by National Health Mission, Government of Assam, under Public Private Partnership (PPP) mode since 2008.

In 2017, the Jorhat boat clinic was installed with a Godrej medical refrigerator with support from SELCO Foundation, to provide a reliable solution for storage of vaccines/medicines required for an extended journey. The results were encouraging, enabling longer journeys and greater coverage per trip. In one ideal trip, the boat would leave Jorhat and travel for a minimum of seven days, setting up medical camps on the various islands before returning.

Post this success, in 2018 another boat, The Tinsukia Boat Clinic, was equipped with Godrej medical refrigerator.

The vaccines and other temperature-sensitive medical supplies are required to be stored precisely between 2 to 8 degrees

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Healthcare Innovations

It is also described as ‘A Ship of Hope in a Valley of Flood’—a unique boat clinic to provide mobile health services to the poor and the marginalised on the islands in Dibrugarh district

Celsius for them to be effective. Surge or drop in temperatures would render the costly vaccines unusable. Godrej Appliances got the opportunity to provide a solution to this challenge with their medical refrigerators that are powered by a UK patented Sure Chill technology. These refrigerators are solar powered and provide precise 4-degree cooling, the ideal temperature to store vaccines. But what makes these refrigerators most relevant to the boat clinic is that they maintain the right temperature inside the cooling chamber for up to 10 days – even without power.

Highlighting the thought process behind this association, Jaishankar Natarajan, Product Group Head of Godrej Medical Refrigerators, says, “Innovations are at the heart of every Godrej appliance and we constantly endeavour to provide our customers with thoughtfully made products that provide a relevant solution to their needs. Our medical refrigerators are able to keep temperature sensitive medical supplies, like vaccines and insulin, effective despite high ambient temperatures and inaccessibility to electricity and we are humbled to have had the opportunity to be a part of this noble lifesaving initiative.”

(Writer is Jaishankar Natarajan, Product Group Head - Godrej Medical Refrigerators)

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Innovations in Technology

Transforming Ideas into a Novel Cause One of the top intervention cardiologists of India, Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute, is behind many firsts when it comes to adopting new technologies for quality patient care delivery. He shares his passion for science and technology and how innovations can impact life of common man in an interview with Elets News Network (ENN).

Dr Ashok Seth

Chairman Fortis Escorts Heart Institute

Q

Fortis Escorts Heart Institute is one of the foremost hospitals in the country known for adopting innovations in patient care. Tell us about some of the recent innovations in intervention cardiology.

Medical science is innovating in a big way. In cardiology particularly, innovations revolve around how to make every aspect of treatment least invasive and safer. For years, heart attack and coronary artery blockages could only be treated by opening up the chest and doing the bypass surgery. Even today, to repair the valves inside heart, chest has to be opened to cut open the heart, cut out

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the defective valve and replace it with a new one.

Then came the angioplasty technique—a procedure to open blocked arteries without surgery— and gradually we moved forward to explore new ways to do those very techniques, which are only done by surgery now, through non-surgical methods.

One of the biggest non-surgical technological innovations has happened in the area of valve replacement. The first such nonsurgical catheter based replacement was done for the aortic valve, which is the main valve connecting the left ventricle to the rest of the body. This valve usually degenerates after the age of 65 and and occasionally at younger age as well. Once the valve becomes narrow, the only way to replace the valve had been to cut open up the chest wall and put the patient on cardiopulmonary bypass to replace the valve. But at the age of 75 or 80, this method is fraught with numerous risks and 30-35 percent of patients can’t have it. However, if they don’t have the valve replaced they may die within a couple of years.

So, the science and experts like us tried to look for safer & better options as to how can we replace the valve without operation. We came up with

was transcatheter cathcher arotic valve replacement. One of the first such cases in the world happened to take place in 2004 at Escorts Heart Institute.

After multiple trials, this technology has now become the mainstay of treatment for arotic valve disease. It allows us to treat patient of 85-90 years of age. We change the valve in cath lab through the nonsurgical procedure of TAVR. The patients go home in two-three days after their valve is replaced without any single opening in the chest. The next day people can’t even see the cut through where we passed the catheter and implanted the valve.

Now, around 150,000 people have undergone TAVI worldwide. Because of ease of the procedure and less than one percent risk, the procedure is now moving to patients above age 60-years.

Another technique that has made a considerable progress is related to non-surgical treatment of the leaking of mitral valve, which is between two chambers of heart, and affects 10% patients who have heart diseases, had a bypass or suffered a heart attack. Some people are even born with leaking valve. It affects people from the age group of 40 to 60-70 years and causes breathlessness and

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Impella heart pump A team of doctors led by Dr Ashok Seth, Chairman, Cardiovascular Sciences, performed India’s first “Protected Angioplasty and stenting procedure”on June 26 this year on a patient suffering from life threatening blockages with the support of Impella heart pump -- the ‘world’s smallest heart pump’, which can support a failing heart for upto 7-days and occasionally longer. The hospital became the first in India to offer this new life saving treatment to patients suffering from high risk blockages and failing heart.

This marked the beginning of the first “Heart Recovery Programme” in India, where the device can help the patient’s own diseased and weak heart to rest, recover and function on its own.

Mitra-Clip Mitra-Clip mitral valve repair without open heart surgery is one of the innovative scientific advancements of recent times. In another first in India, a team of doctors led by Dr Ashok Seth, supported by Professor Saibal Kar of Smidt Heart Institute, Cedars Sinai Medical Centre, Los Angeles, successfully performed the catheter based procedure of MitraClip to repair a leaking heart valve without surgery in a 69-years old gentleman who was suffering from repeated heart failure and in whom open heart surgery was not possible. The gentleman recovered within days and has since gone home feeling rejuvenated after getting a new lease of life.

Transcatheter aortic valve replacement (TAVR) Transcatheter aortic valve replacement (TAVR) is minimally invasive surgical procedure which repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place.

Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

A team of doctors led by Doctor Seth performed this surgery at Fortis Escorts for the first time in India

enlargement of heart.

Surgery in these patients sometimes becomes risky as the heart is weak, it is dilating, which makes repairing of the valves difficult.

This is where Mitra-Clip innovation becomes useful. It relates to non-surgical catheter based repair valves without opening up the heart in an angioplasty-based procedure in a cath lab. It has proven to be safe and effective in large trials. It also improves the survival of the patients and decreases the mortality nearly by 35 percent.

The first Mitra-Clip procedure in India was done by me at Fortis Escorts Heart Institute last week, though it was being done in United States and Europe for the last few years. People used to go outside the country to undergo this procedure.

There was a gentleman having a badly leaking valve. He had previously undergone a bypass surgery; he was breathless on minimal exertion; practically in bed; and his kidney function was gradually deteriorating. After our MitraClip procedure, he is well and was discharged 3-days later. One can’t detect any cuts on his body and he looks perfectly comfortable. The recovery was dramatic as the valve leakage was decreased immediately by 80-85 percent.

Science has progressed dramatically and we hope that techniques like this can help numerous patients in the country who would otherwise die or become candidate of heart transplantation.

And as we know hearts are not easily available.

Innovations in Technology

pioneering innovations in cardiac care

Q

How these technological innovations can be made costeffective?

There are global companies who have developed the transcatheter valves and those have been tested extensively and brought to us. But we have also helped create our own

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21

Innovations in Technology 22

TAVR valves in the country by supporting Indian company who want to create ‘Make in India’ valves.

They have actually created the valves with input from us. The Indian TAVR valve is as good as their Western counterparts. After permissions from the Drug Controller General of India and put the valves into trial.

After the successful trial and one year follow up, around a month ago it was approved by the Indian Government and DCGI to be used in the country for treatment of our patients.

The valve actually functions very well. Our valves are at par with the Western developed valves.

Good stents are also now being manufactured in India.

New generation of stents are being researched, developed and manufactured in India. They are being implanted in patients giving good results.

I was closely involved with the development of bio-absorbable stents, which have many advantages over metal stents. Bio-absorbable stents are need of the hour as conventional stents are metallic and may remain in the body for life time after getting inserted. It may not matter to patients of 65-70 years of age but for younger patients it does matter as they have to live for another 40 years taking blood thinning medicines, which act as anticoagulants.

So we explored the potential of bio-absorbable stents which dissolves after two-three years. We developed that technology. Initially these too had some disadvantages. But an Indian company made the thinnest bio-absorbable stent; we tested it and did the trials and presented it to the regulatory authority. Such device is today available to 10 countries, and we are among one of them.

At one point in time, the American stents were available for Rs 2 lakh in the market, while this device was available to Indians at Rs 50,000. This is the way technology

november-December 2018

starts affecting people.

Imagine, someone having stents in their arteries and it dissolved within two-three years and arteries regain their originality as if they never had anything inserted with. Technology can really help people.

A small pen-like motorised pump is another new innovation in cardiology that can support the heart attack patients to survive. This device can be inserted into heart the cavity to pump out blood from left ventricle to rest of the body and functions on a small motor. It supports patient with blocked arteries. This miniaturised submersible water pump like device is very fascinating. This is another technology and innovation which has been very useful to save lives. That is the spectrum of growth in technology.

Q

Do we have such skilled manpower in the country to perform the intricate procedures using these advanced techniques?

The foremost priority should be to make these science and technology innovations available to the common man. This can be made possible if it can be made in India, which is very much the case now. But when it comes to skills, these are very specialised kind of techniques which require training and we take it as our responsibility to pass on this know-how and expertise to more doctors. Since these are advanced techniques, these will always be available only at few centres across the country where people can come and get the procedure done. It can never be available at the grassroots level.

These are high-end technologies which are only safe & effective in experts’ hands, though there will be greater and greater no of doctors who would be able to perform this in coming years. But it will always be provided to limited number of people, thereby providing best outcomes.

The first NONSURGICAL CATHETER BASED TECHNIQUE FOR VALVE TREATMENT WAS transcatheter arotic valve replacement.

One of the first such cases in the world happened to take place in 2004 AT FORTIS ESCORTS HEART INSTITUTE. SINCE THEN THROUGH TECHNOLOGICAL DEVELOPMENT AND TRIALS TAVR HAS NOW BECOME THE MAINSTAY FOR TREATMENT OF AORTIC STENOSIS IN THE ELDERLY AND FORTIS ESCORTS HEART INSTITUTE AS THE LEADING CENTRE OF EXCELLENCE IN THIS AREA.

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delivery of healthcare services.

The State Health Minister on this occasion underlined the measures undertaken by the Rajasthan Government in recent years. “To strengthen healthcare delivery across the State about 20,000 paramedical staff and over 6,000 doctors have been appointed by the State Government.

In Rajasthan, we have more than 17,000 Government healthcare facilities including PHCs, CHCs and District Healthcare Centers.

Kali Charan Saraf

Minister for Medical, Health & Family Welfare, Government of Rajasthan

R

ajasthan launched Bhamashah Yojana in 2015. Today, around 25 lakh citizens are getting primary, secondary and tertiary care due to it. It has enabled people to claim up to Rs 30,000 for normal disease and Rs 3,00,000 for high-level treatment, according to Kali Charan Saraf, Minister for Medical, Health & Family Welfare, Rajasthan.

While participating in the 4th annual Healthcare Summit 2018 in Jaipur, the minister said there was a time when Rajasthan was considered as a Bimaru State. Today, it is among the developed States in terms of

To strengthen healthcare delivery across the State about 20,000 paramedical staff and over 6,000 doctors have been appointed by the State Government

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“We have opened health facilities in almost all the remote areas of the State so that people from villages don’t have to come to cities to avail initial treatment. Till now, somewhere about 900 PHCs have been upgraded with modern infrastructure,” he said.

Talking about Bhamashah Yojana, one of the best healthcare insurance schemes across the country, he said: “We started Bhamashah Yojana on 19 December, 2015. Today, around 25 lakh citizens are getting primary, secondary and tertiary care through it. In this scheme, one can claim up to Rs 30,000 for normal disease and Rs 3,00,000 for high-level treatment.”

Stating the significance of healthcare summits, the Rajasthan Minister said the presence of health experts and stakeholders from different States at the 4th annual Healthcare Summit 2018, was a blessing.

“The esteemed gathering will benefit us. We can take a cue from the best health practices of other states and implement them in ours. In terms of results, we have been implementing best-in-class health facilities to cater to every single citizen. Rajasthan has progressed from Bimaru State to most healthy State due to a series of measures undertaken by the Government,” he added.

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Rajasthan Healthcare Perspective

25 Lakh Citizens Getting Health Benefits Under Bhamashah Yojana: Kali Charan Saraf

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Rajasthan Healthcare Perspective 24

Rajasthan Turning into A Role Model in Healthcare: Banshidhar Khandela

Banshidhar Khandela

“We have also improved the sex ratio from 888 to 950 in four years and implemented 100 percent of the budget announcement. There was a time when gender discrimination was on its peak and considered as a widespread menace. With our painstaking efforts, the mindset has changed and people have started to acknowledge the importance of their girl child,” Khandela said.

Talking about how the State has made progress on this front, the Rajasthan minister said, “Our percentage of institutional delivery has also increased to 80 to 90

Minister of State for Medical, Health & Family Welfare, Government of Rajasthan

U

nder the visionary leadership of Chief Minister Vasundhara Raje and NHM Director Naveen Jain, Rajasthan has been fabulous in making healthcare accessible, affordable and cost-efficient, with the State taking a giant leap in women and child care, according to Banshidhar Khandela Minister of State for Medical, Health & Family Welfare, Government of Rajasthan.

The minister was speaking at the 4th Annual Healthcare Summit in Jaipur recently. It was organised by the National Health Mission, Department of Medical, Health and Family Welfare, Government of Rajasthan, jointly with Elets Technomedia.

november-December 2018

A total of 25 lakh citizens have been treated under Bhamashah scheme and claim of worth Rs 1,750 crore has already been paid

percent. The State has successfully implemented the Pre-Conception and Pre-Natal Diagnostic Techniques (PC-PNDT) Act, under which many culprits have been sent into jail. Today, in terms of providing healthcare to the last mile, Rajasthan has become a role model for other States.”

“Through the PPP (Public Private Partnership) framework, GVK EMRI is running an emergency service, through which an ambulance service reaches to the patients living in remote areas within 30 minutes. This service is proving to be a boon to cater expecting mothers. It is also helpful to drop them home safely after delivery,” the minister added.

Underlining the State Government’s achievement in healthcare sector, Khandela said, “We’ve almost doubled our health budget and the number of medicines to make every citizen a beneficiary of States health schemes. A total of 25 lakh citizens have been treated under Bhamashah scheme and claim of worth Rs 1,750 crore has already been paid.

“Our CM has been working painstakingly to make Rajasthan a disease-free State and only because of her efforts, a citizen below the poverty line can get treatment under the biggest hospital brands and can avail claim up to Rs 3 lakh for tertiary care,” the minister said.

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A

runachal Pradesh is gradually striding ahead in terms of providing efficient healthcare services to citizens of the State, said Dr Kinny Singh, Mission Director, National Health Mission & Special Secretary, Department of Health, Arunachal Pradesh, while speaking at the 4th annual healthcare summit Rajasthan held recently in Jaipur.

“We have recently launched a health insurance scheme, Chief Minister Arogya Arunachal Yojana, which will provide health insurance cover to all citizens of the State. To empower the district health societies, the State is providing a special flexi fund known as ‘Rogi Kalyan Kosh’,” Singh said while talking about steps taken by the State Government to strengthen healthcare delivery.

“We have started State’s first medical college recently. It will help us to reduce staff crunch in the State.

The model rural health research unit is also underway.”

Shedding light on innovative practices to enhance patient care, she said: “We are working on teleradiology solutions and free pathology services on PPP (Publicprivate partnership) mode. Our insurance scheme is not confined to low-income groups but we have covered every single citizen of our

State through it.”

“Arunachal Pradesh has also allocated a fund for renal care to help the end-stage kidney patients and started an IGNOU certified bridge course for ASHAs so that they can upgrade their skill to become ANMs.” “Our health department also started mobile medical units.

Unfortunately, it didn’t give desired results to us as vehicles were big in size and difficult to get into hill roads. So, we have brought into small mobile vans in place of units to cover every remote hilly area,” Singh said while speaking on the occasion.

Listing out the steps for women

We are working on teleradiology solutions and free pathology services on PPP (Public-private partnership) mode

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Policymaker’s perspective

Arunachal Making Tangible Progress in Healthcare Delivery: Dr Kinny Singh

Dr Kinny Singh

Mission Director, National Health Mission & Special Secretary, Department of Health, Arunachal Pradesh

and child care, she said: “Our health department has started to organise at least three medical camps for screening of every citizen for noncommunicable disease.”

“To reduce childhood mortality, the health department has started Measles-Rubella vaccinations campaign in February 2017. The second phase has been completed and we have achieved more than our target.”

Dr Singh said the State was also mulling to start health and wellness centres and a robust drug procurement system soon.

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Neurology perspective 26

Strokes Are No Longer Limited to Elderly People: Dr Padma Srivastava

A

s per the Indian Council of Medical Research, every 20 seconds somebody is having stroke. Every two-minute somebody is dying of stroke in India. Strokes are no longer limited to old people. It can affect anyone irrespective of the age. It is a timesensitive disease. Time is brain, said Dr Padma Srivastava, noted Professor of Neurology at AIIMS, New Delhi, recently.

Dr Srivastava, who has a primary area of interest in stroke, vascular dementia and multiple sclerosis besides actively participating in

november-December 2018

the Epilepsy Program at AIIMS, was speaking recently at the 4th Healthcare Summit in Jaipur.

Considering the challenges being faced in the country in terms of communicable and noncommunicable diseases, it is required that local physicians must be trained to tackle emergency cases, she said.

Many States have inline-block facility. Underscoring the need to train local physician to make them adept in tackling emergency situation, the neurology professor said, “It is not possible to tackle all brain attack patients by neurologists,

Dr Padma Srivastava

Professor - Neurology AIIMS, New Delhi

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Neurology perspective

as we have very few such experts; 2,000 neurologists for 1.2 billion population.”

“We need someone who can provide golden-hour treatment in emergency at the same place or nearby where a patient resides. We need to breach these gaps. We need to have standard operating protocols,” she said.

There has been a massive shift in diseases’ type i.e. most of the people used to suffer with Malaria, Diarrhoea and TB 20-30 years ago. But today that has been largely replaced by cancers, heart attacks, brain attacks, strokes, and kidney diseases, Dr Srivastava said.

Speaking about what needs to be done to strengthen existing healthcare delivery model, the neurology professor at AIIMS, Delhi, said, “Healthcare needs to be made optimal -- available, accessible and affordable. The Government has started Ayushman Bharat with the similar strategy. We need awareness, sponsored response system. For public healthcare point of view, we need ambulance facilities. Rajasthan has 108, through which one can call an ambulance in emergency situation.”

It is not possible to tackle all brain attack patients by neurologists, as we have very few such experts; 2,000 neurologists for 1.2 billion population

Sharing the details of latest initiative by the Himachal Government, Dr Srivastava said: “In Himachal Pradesh, 10 districts have functional CT scan facility. We have trained the district health personnel to tackle emergency cases. They stay on call always. They manage all diseases where quick response is needed. We got the Government of Himachal involved and started trainer training programmes being called telestroke.”

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“We have made telestroke facility available at all the district centres in the State. Brain stroke patient gets his CT scan done, WhatsApp all the images and we guide local physician to provide the medicine to dissolve the clot.

“It is very simple and effective way. We have treated many patients using the technology. We have training programmes in other States like Uttar Pradesh. Patients are being thromblysed in remote areas i.e Raibareli in UP and Una in Himachal,” she added.

Stressing on the need for people to pay extra attention on their health, she said, “Everybody after the age of 30 should get their BP, blood sugar checked on regular interval.

Everything is happening among young people now.”

Underlining the importance of technology, Dr Srivastava said, “One can have stroke risk map in his smart phones. It will help you to know risk factor and how to go about it.

Technology must be harnessed to get things facilitated. Local physicians, ASHAs, para-medical staff must be empowered to strengthen healthcare delivery system.”

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27

Special feature

Madhya Pradesh’s Giant Leap in Healthcare Delivery With people’s growing health awareness, there is a strong desire to avail better healthcare facilities.

The Narendra Modi-led Government is encouraging the States to build a strong infrastructure and avail the best possible solutions.

Madhya Pradesh is one such State focussing on boosting its health infrastructure, observe Mukul Kumar Mishra and Divakar Mukherjee of Elets News Network (ENN).

M

any of us today observe healthcare to be as necessary as food and water are to life.

Amidst steep rise in noncommunicable diseases including diabetes, cardio-vascular and heart related ailments, a lot of people are spending more on healthcare.

Rising income-level of the middle class has also enabled them to avail best medical facilities from private healthcare providers.

With an aim to take healthcare to the last mile, a comprehensive effort is being made in association with State Governments to embrace modern technologies. It is also being looked upon as one of the largest sectors in terms of revenue and employment generation.

In a State like Madhya Pradesh, technology and latest innovations are

28

november-December 2018

turning instrumental in making people more aware of their health.

In this wake, the State Government is undertaking a number of initiatives to cater quality and cost efficient healthcare facility to every citizen.

It is pertinent to mention that with initiatives like Ayushman Bharat programme, the Centre has tried to achieve the goal of universal healthcare coverage and aligned States to be a part of this health delivery bandwagon.

In an endeavour to enhance delivery of healthcare system, the Madhya Pradesh Government has reiterated its commitment towards making a tangible difference in healthcare. To provide accessible, quality and cost – efficient medical facilities to every strata of the society, the State Government has taken a slew of measures on every level i.e policy, schemes, and implementation.

“Madhya Pradesh has made a significant improvement in healthcare delivery through its careful planning and execution of healthcare programmes. We have constantly evolved over the past three years. We are one of the states having least-outof-pocket expenditure in healthcare sector,” says Dr Pallavi Jain Govil, Principal Secretary, Public health & Family Welfare Department, Government of Madhya Pradesh.

The State Government has not only announced many flagship programmes to improve patient care but also ensured that it should reach people in the remotest corner of the State.

The State Government has many schemes including Sardar Vallabh Bhai Patel Free Drug Distribution Yojna and Free Pathology Diagnostic Services to provide holistic healthcare delivery. These schemes are benefitting

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Mukhyamantri Baal Shravan Upchar Yojna and Pradhanmantri Surakshit Matritva Abhiyan (PMSA) are evidence of the Government’s intent to improve things on every level.

On digital health front, the State Government has initiatives like MP Aushadhi, EMMS (Equipment Maintenance and Monitoring System), and eHospital. “eAushadhi is a platform to ensure the management of procurement system. It ensures the timing of the order, consignment, and payments.

It also imposes the penalty, if finds something wrong or delay in the whole supply-chain management,” says Dhanaraju S, Director-Health Services, Mission Director, National Health Mission, and Managing Director-MPPHSCL, Government of Madhya Pradesh.

The Government has signed many MoUs to bolster the healthcare delivery system.

Telemedicine centers have been established across the State to provide patients best medical facilities in their nearby areas. The goal for establishing Telemedicine network is to provide accessibility of medical practitioners to the remotest regions through state of the art technologies with optimal economical outcomes.

The network consists of 15 remote centers and a central administrative

To provide accessible, quality and cost – efficient medical facilities to every strata of the society, the State Government has taken slew of measures on every level i.e policy, schemes, and implementation

Special feature

all sections of the society, especially the poor and vulnerable people.

To provide holistic healthcare facilities holistically, the Government has announced to develop all the Primary Health Centres and Urban Primary Health Centres/Civil Dispensaries as Health and Wellness Centres in 25 districts of the State.

These centres will be called Madhya Pradesh ‘Arogyam’ (Health and Wellness Centre).

The State Government has taken substantial measures on the front of accessibility and out-of pocket expenditures that are big issues plaguing the healthcare delivery system of any State. Rural infrastructure which includes facilities at sub-centers, primary healthcare centers (PHCs) and Community Healthcare centers (CHC) have been improved.

“Every healthcare facility in Madhya Pradesh has geospatial mapping which ensures that people can get health services in their proximity. We have positioned our sub-health centers, primary healthcare centers in this manner so that nobody has to travel a long distance to get treated,” Govil further stateds.

In addition, the Madhya Pradesh Government has paid special attention to women and child’s health. Schemes like Rastriya Baal Swasthya Karykarm,

hub (State Server) at M.P. Council of Science & Technology, Bhopal.

The facilities at the district hospital include VSAT connection, Telemedicine Hardware and Software, ECG machine and X-ray scanning facility. These 15 centers have been distributed in 10 District Civil Hospitals, 3 Government Medical Colleges and 2 Trust hospitals.

“We have an EMMS system in place to monitor the functionality of the biomedical equipment. Currently, we have 64,000 biomedical equipment at 1,600 health facilities. Out of these, 35,000 equipment have been given to a third party contract for maintenance,” Dhanaraju S adds.

Some of the healthcare interventions by the State Government to augment overall healthcare delivery enabling people to get better medical facilities in terms of quality, accessibility and affordability are: Madhya Pradesh State Illness Assistance Fund Scheme (SIAF) To provide treatment benefit of minimum amount of Rs 25,000 and maximum amount of Rs 2, 00,000 to family living below poverty line. The scheme was launched in 1997. Under the programme, people can avail benefits, 21 identified diseases from

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Special feature

empanelled hospitals under SIAF. Beneficiary simply avail the benefit by making an application on MPONLINE (SIAF) portal through CMHO office / empanelled hospital.

Sardar Vallabh Bhai Patel Free Drug Distribution Yojna Launched in November 2012, the scheme promises free availability of medicines in all the Government hospitals across the State. It was launched to strengthen existing supply chain and drug distribution system.

Under the scheme, all the medicines are made available to Out-Patient Department (OPD) and Indoor Patients (hospitalised patients) 24/7.

Doctors have been directed to write only predefined essential drugs to their patients. More than 250 types of medicines have been assured in drug warehouses under it.

Free Pathology Diagnostic Services Since February 2013, people of the State are benefitting from the scheme at all the Government hospitals. The Government has ensured free service at all sub-centers and district hospitals.

As per the State norms, 48 types of diagnostics are available at all District Hospitals, 32 types at all Civil Hospitals, 28 types at all Community Health Centers, 16 types at all Primary

Health Centers and five types of at all Sub Health Centers free of cost.

patients and at nominal charges of Rs 500 per session for APL patients.

Dialysis Scheme Chronic kidney disease is a big issue today amidst rising number of patients suffering with the disease globally. Madhya Pradesh has also seen an increase in the patient count in recent years.

Patients of chronic kidney disease require timely treatment and care to prevent further progression of the disease. These patients need at least two to three times dialysis per week which takes a toll on the budget of the family. Earlier, dialysis facilities were available in selected cities and it was a very costly affair. Treatment cost to patients was Rs 1,500-2,000 per session excluding the travel cost. If one includes travelling expenses and all, it used to come around Rs 20,00025,000 per month.

In the light of above issues, the State Government started the initiative to make the dialysis facility available at all district hospitals of the State. It was Madhya Pradesh which started dialysis centers at all district hospitals and later Government of India replicated the idea.

Currently, all district hospitals have the facility with a total of 160 dialysis machines operational. Dialysis services are available free of cost to all BPL

Cancer Chemotherapy Cancer Chemotherapy programme is being run in 50 districts across the State since 2014. Under the programme, the Government took series of measures i.e Cancer Chemotherapy units were established in all the districts, training was provided to one medical officer/ specialist and two staff nurses in each district and 19 types of anti-cancer drugs were made available through e-Aushadhi. In addition, beds were reserved in every district hospital for the cancer chemotherapy patients.

Telemedicine facility was adopted to help such patients at remote areas.

Child Health and Nutrition To provide holistic healthcare facility to newborns, 57 Special Newborn Care Unit (SNCU) with four pediatricians, 19 staff nurse and lab technician, were established in each district of the State.

The State has 315 Nutrition Rehabilitation Centres (NRCs) that ensure clinical management and therapeutic feeding of Severe Acute Malnutrition (SAM) children. NRCs of the State have been linked to the Medical College based Severe Acute Malnutrition Treatment Units (SMTUs) and Severe acute Malnutrition Advanced Referral and Treatment (SMART) unit of AIIMS Bhopal for critical care management of such children.

Rastriya Baal Swasthya Karykarm (RBSK) The Government has been running the programme which includes health checkup of all 0-18 years old at Anganwadi Kendra and government schools by mobile health team, across all 51 districts since 2013. The objective of the programme is to early detection and management of 4 D (Defect at birth, deficiency, childhood diseases, developmental delays and

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disabilities) identified children in order to decrease the death rate and also to decrease the pocket expenditure of the patient.

Under the programme, children of 4D are provided treatment in Community health center at block level, district hospital and higher centers. There are total 521 mobile health teams working in all 313 Blocks of Madhya Pradesh.

31 District Early Intervention Centers (DEIC) have also been established to provide quick better medical facilities to children. Those suffering with cleft lip and palate disease get free of cost treatment in smile train India, Madhya Pradesh based accredited hospitals. Clubfoot children are also getting free treatment through cure international.

Mukhyamantri Baal Hrudaya Upchar Yojna Under the programme, children (0-8 years) are provided treatment/surgery facility at accredited hospitals of country and State. The State has been running the scheme since 2015-16.

There are 42 procedures available for 14 diseases under RBSK. Mukhyamantri Baal Shravan Upchar Yojna The programme is designed to provide treatment/surgery facility to children (0-5 years) who are suffering

with congenital deafness. Children identified with congenital deafness undergo cochlear implant surgery in accredited hospitals. For cochlear implant surgery the Government has decided Rs 6.50 lakh package (Rs 5.20 lakh from RBSK and rest Rs 1.30 lakh through state fund).

Mahila Swasthya Shivir (MSS) To provide health check-ups and treatment to women (especially pregnant women, and school drop-out adolescent girls), the State Government has been organising Mahila Swasthya Shivir (camps) since the last three years. At these camps, qualified doctors provide services like quality ante-natal and essential diagnostic tests facility.

The aim of the programme is to provide specialist care and make women vigilant towards their health.

Pradhanmantri Surakshit Matritva Abhiyan(PMSMA) Under this programme, ante-natal check-ups of pregnant women of 2nd and 3rd trimester are conducted. The Health check-ups are done by qualified doctors at public health facilities on 9th of every month. There are a total of 633 registered private doctors who provide voluntary services under the scheme.

Nirogi Kaya Abhiyan Under the National Program for Prevention and Control of Cancer,

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Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), NCD Clinics have been set-up in all 51 district hospitals.

At NCD Clinics, passive screening is performed for Cancer, Diabetes, Cardiovascular Diseases and Stroke.

Cancer Chemotherapy units have been established in 51 district hospitals where cancer chemotherapy facility is provided to such patients. For active screening, Nirogi Kaya campaign has been planned.

Deendayal 108-Ambulance In a bid to provide quick medical facility in emergency situation, the Government is running Deendayal-108 service (108-emergency ambulance, Janani Express, Deenayal Chalit Aspatal and 104-Health helpline) through PPP mode. At present total 606 Deendayal 108-Ambulance, 735 Janani Express and 144 Deendayal Chalit Aspatal (Mobile Medical Unit) are being operated through the Centralized Integrated Call Center.

In addition, the Madhya Pradesh Government has decided to develop wellness centers across the State to provide hollistic healthcare facility. It has been decided that all 651 Primary Health Centers of 25 districts in the State, 30 Urban Primary Health centers and 19 Sub- Health Centers will be developed as Health and Wellness Centers in first phase (201819). Rest primary and sub centers would be developed as wellness centers in 2019-20.

Despite these steps, the Government faces flak on many fronts including IMR, NMR and healthcare infrastructure in rural areas. A section of people believes the State has not done tangible progress on these fronts.

The fact of the matter is the Government is trying its best to create a healthier State where everyone gets top medical facility in their budget. It is working big time to reduce out-ofpocket expenditure on healthcare and many of the schemes are big proof of this ongoing endeavour.

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Ranking : Top private Hospitals 2018 32

Ranking Top Hospitals 2018 Ranking of North India’s top Private Hospitals India is facing a double whammy of noncommunicable and communicable disease burden.

With the increasing burden of non-communicable diseases like stroke, cardiovascular and cancer, quality patient care is in huge demand. A large section of the Indian population, especially neo-middle class, wants to avail the best medical facilities from the best healthcare service providers.

In recent years, the Indian healthcare industry has witnessed tremendous growth. It is expected to reach US$ 280 billion by 2020 (Source: India Brand Equity Foundation).

The Government has also underscored the need to provide affordable healthcare facilities to the people. A slew of recent measures and initiatives like Ayushman Bharat speak volumes about the Government’s intent to create a healthier India.

Around 10 crore vulnerable families will be provided an annual health coverage of Rs 5 lakh under Ayushman Bharat, the National Health Protection Scheme. As many as 100,000 jobs are expected to be created from the scheme (As per IBEF data).

India has also emerged as a global destination for medical tourism. People across the world are flocking

to avail best medical facilities in their budget. As per the estimation, the hospital industry in India stood at Rs 4 trillion (US$ 61.79 billion) in FY17 and is expected to reach Rs 8.6 trillion (US$ 132.84 billion)

by FY22.

Many world class hospitals with best infrastructure have been set up by top corporates to offer world class medical facilities. These hospitals are equipped with best diagnostic tools, cutting-edge technologies, trained doctors, medical staff and infrastructure, enabling people to avail best possible treatment.

Against this back drop, many options have come up for patients. However, they find it difficult to decide which hospital to choose for which ailment.

All the aforesaid facts inspired us to take the initiative to rank “Top Hospitals in North India” in various specialities. The objective is to make people aware about the hospitals and their specialities so that they could make informed choices while availing treatment facilites. The ranking also serves as a motivating factor for various hospitals to further enhance the quality of their facilities and care, resulting into an augmented healthcare delivery system in India.

RANKING METHODLOGY In this exercise, we have tried to select and rate the top hospitals located in metros and tier-1 cities in North India Zone. The ranking has been conducted on the basis of data collected through primary, secondary, and perception based research.

This mammoth exercise was spread over 20 days where we covered public and private hospitals including multi-speciality, super speciality hospitals in North India.

We hope this exercise to help our readers to make informed decisions to choose best hospital as per the treatment required. It is hoped that eHealth’s ranking edition will be beneficial for hospitals as well in improving on various parameters concerning the delivery of health care.

In our perception based, leading hospitals of

november-December 2018

North India were ranked on various parameters.

The private hospitals have been ranked based on analysis of available data. We have provided list of top private hospitals of North India on various parameters. The grading provided to every hospitals is done as follows: Rating

Score Range

Description

AAAAA

95-99 percentile

Exceptional

AAAA+

90-94 percentile

Outstanding

AAAA

80-89 percentile

Very Good

AAA+

70-79 percentile

Good

AAA

60-69 percentile

Above Average

AA+

50-59 percentile

Fair

AA

40-49 percentile

Average

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Ranking Top Hospitals 2018

Infrastructure Infrastructure of a hospital is the basic premises upon which the delivery of quality health care is based. Infrastructure is directly tied to the treatment outcomes and plays a major role in providing top quality medical facilities to the patients visiting the hospital.

Infrastructure basically means a number of facilities for patients which directly or indirectly have a bearing on the overall treatment process. It includes bed count, OTs, OPDs, IPDs, consulting rooms, pharmacy, patient rooms, critical care units, hygiene practices, kitchen facility, canteen for visitors, etc.

Why eHealth considered “Infrastructure” as a parameter for Top Hospitals-North India Ranking?

As infrastructure is directly linked with quality of patient care, it is among the first criteria for people to consider while selecting a hospital to avail treatment facilities. eHealth considered following factors under infrastructure parameter for acquiring detailed information of a hospital before ranking it: Bed count Bed count is an important aspect which determines the capacity of the hospital to treat number of patients. Bed count gives an insight about how many patients the hospital can sustain at a given time.

Patient centric facilities It includes neat and clean rooms for patients with all the facilities including air conditioning, patient bed, wash room, attendant’s couch; availability of 24x7 pharmacy; timely visit of doctors and well-mannered nurses. These factors play a key role in offering best patient care.

Technology for advanced care Technology is the biggest enabler in improving the overall healthcare delivery. Continuous technological developments in healthcare have saved countless lives and improved the quality of life for even more.

Not only has the technology improved experience for patients and their families, but also made a huge impact on medical processes and the practices of healthcare professionals.

Why eHealth considered “technology for advanced care” as a parameter for ranking top hospitals in North India?

Considering the rising number of non-communicable diseases, the relevance of technology has gained utmost importance in healthcare sector. eHealth has considered this parameter to acknowledge the efforts of the hospitals in adopting high-end facilities like availability

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of cutting-edge diagnostics equipment, radiotherapy, etc, to provide advanced level of treatment in case a patient suffers from some serious diseases like cancer or cardio vascular disease. Having this parameter holds significance as people will have clear idea whether a particular hospital has the technology to provide them advanced level of care in case of an emergency.

Ranking : Top private Hospitals 2018

RANKING PARAMETERS

Online presence/Social media Internet has revolutionised the way people access information and today almost every service we avail, from buying groceries to ordering food from a restaurant, has migrated online to make possible their delivery on our doorsteps. But when it comes to availing healthcare facilities, people still bank on offline mode. Though telemedicine has emerged as a boon for patients residing in remote corners of India, most people still prefer to go to a doctor’s office for their health needs. Doctors, too, acquire new patients as a result of being a part of the health network or through referrals from other doctors, but reports suggest that it’s important for healthcare providers to have a strong online presence to keep the patients informed about the kind of medical services they can avail.

According to Google, 97 percent of consumers use the web to search for local businesses. There are about 79,000 hospitals in the public and private sector in the country and therefore having a good online presence is one of the most important differentiating factors for them.

Having a strong online presence is a crucial component of marketing strategy to make people know about the treatment options available, services and specialties a hospital or nursing home offers to the patients.

Social media is an important factor which improves the chance of generating additional revenue and establishing customer loyalty. It allows potential customers and other interested parties to engage easily via a channel that plays an important role in their everyday lives.

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Ranking : Top private Hospitals 2018

Why eHealth considered “Online presence/ Social media” as a parameter for Top Hospitals-North India Ranking?

An online presence is important because it reinforces your brand and what you offer to your target market.

Once you’ve communicated with your audience, you’ll need to have a web presence that helps portray why your product or service is so great – because that’s the next stop for the majority of your potential patients.

We chose this as one of the parameters because through this medium patients can get a better picture of what is it like to be admitted to any particular hospital or health centre through the feedback they get from other patients online. What kind of specialties the particular hospital or health centre offers? How was the experience for majority of the patients? Reviews on the various facilities a hospital offers—these are some of the answers a patient can easily access from the comfort of their home.

Imagine how easy it would be for the people to choose from a long list of healthcare providers in India, if they have proper credible info online about hospitals. Social media presence is also an important aspect, as how quickly a hospital responds to a patient’s query plays a crucial role in establishing a good rapport and credibility in the long run.

Patient Friendly Technologies It’s amazing to look back and see just how far the world has come technologically in a short span of time. What was in vogue 10-15 years ago has become obsolete in present times. As an enabler, disruptive technologies have given a fillip to every sector, including healthcare.

From improved operational efficiency to standards in patient care, the healthcare transformation has enhanced the entire experience for both patients and medical professionals. Digital tools such as iPads, mobile applications, online portals are gaining popularity in hospitals, as many seek to better engage patients, improve outcomes and reduce healthcare costs.

Why eHealth considered “Patient Friendly Technologies” as a parameter for Top Hospitals-North India Ranking?

Certification Standards The demand for quality healthcare services has risen considerably owing to various market forces such as medical tourism, insurance, corporate growth and competition. As a result the expectations of the consumer have also changed in terms of quality care.

This led to the emergence of several national and international accreditation bodies to put in place a quality assurance mechanism, thus enhancing patients’ access to better healthcare services.

Why eHealth considered “Certification Standards” as a parameter for Top Hospitals-North India Ranking?

Quality of care in health services has been identified as one of the key elements on the path to Universal Health Coverage (UHC), and is fundamental towards achieving the health related goals.

One of the pathways to improve QoC in any health system is via the accreditation route. Accreditation has been accepted globally as a regulatory intervention to set standards, and monitor quality of care. The idea behind an accreditation programme is to evaluate a health care organisation via self and external assessment, against predetermined optimal standards, to improve and set standards of care.

In the wake of India emerging as global hub of medical tourism, accreditation bodies like National Accreditation

34

Board for Hospitals (NABH), that emphasis on patient safety aspects and stringent quality assessment norms, is the need of the hour.

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Health Information Technology (Health IT) which includes health record systems, smart devices and apps, plays a crucial role to provide better care for patients. It supports recording of patient data to improve healthcare delivery and increases patient safety, decreases medical errors, and strengthens the interaction between patients and healthcare providers.

Technologies should be patient friendly so that they could be handy and easy to use. For an example if patient or their families don’t get proper information on hospital’s website, or their mobile app is not user friendly, then they won’t avail facilities from that particular hospital. Similarly, if the EHR system is complicated, that dissuades patients to avail facilities from them. Technologies only serve its purpose if they are not riddle like and general public easily understand every facet of it to get benefitted it to the maximum.

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Ranking Top Hospitals 2018 Ranking : Top private Hospitals 2018

Jammu & kashmir

himachal pradesh

punjab uttarakhand Haryana Delhi

uttar pradesh

north Northern Zone includes states like Haryana, Himachal Pradesh, Jammu & Kashmir, Punjab, Delhi, Uttar Pradesh and Uttarakhand. These states have made a tangible progress in healthcare delivery. This zone has several prominent private hospitals and diagnostics chains that have been catering cutting-edge technologies and innovations to patients.

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Ranking : Top private Hospitals 2018 36

Bariatric Hospital Name Apollo Obesity and Metabolic Surgery Centre Fortis Hospital Max Super Speciality Hospital BLK Super Speciality Hospital Sir Ganga Ram Hospital Fortis Memorial Research Institute Medanta The Medicity Fortis Flt Lt Rajan Dhall Hospital Primus Super Speciality Hospital Max Super Speciality Hospital, Patparganj Bhatia Global Hospital and Endosurgery Institute Max Hospital Asian Institute of Medical Sciences Artemis Health Institute Jaypee Hospital Fortis Hospital Max Balaji Hospital

november-December 2018

City/Area Sarita Vihar Mohali Saket New Delhi New Delhi Gurugram Gurugram New Delhi New Delhi New Delhi New Delhi Gurugram Faridabad Gurugram Noida Noida New Delhi

State/UT New Delhi Punjab New Delhi New Delhi New Delhi Haryana Harynana New Delhi New Delhi New Delhi New Delhi Haryana Haryana Haryana Uttar Pradesh Uttar Pradesh New Delhi

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Rank AAAAA AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA AAAA AAAA AAAA AAAA

Ranking Top Hospitals 2018

Hospital Name Indraprastha Apollo Hospitals Fortis Hospital BLK Super Speciality Hospital Medanta The Medicity Max Super Specially Hospitsl Fortis Memorial Reasearch Institute Sir Ganga Ram Hospital Fortis Hospital, Shalimar Bagh SIPS Superspeciality Hospital Alchemist Hospital Artemis Hospital Fortis Flt Lt Rajan Dhall Hospital Asian Institute of Medical Sciences Max Super Speciality Hospital IVY Hospital Shekhar Hospital

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City/Area New Delhi Mohali New Delhi Gurugram New Delhi Gurugram New Delhi New Delhi Lucknow Panchkula Gurugram New Delhi Faridabad Patparganj Mohali Lucknow

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State/UT New Delhi Punjab New Delhi Haryana New Delhi Haryana New Delhi New Delhi Uttar Pradesh Punjab Haryana New Delhi Haryana New Delhi Punjab Uttar Pradesh

eHEALTH Magazine

Rank AAAAA AAAAA AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA AAAA AAAA AAAA AAAA AAAA AAAA AAAA AAAA

november-december 2018

Ranking : Top private Hospitals 2018

Cosmetic & Plastic Surgery

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Ranking : Top private Hospitals 2018 38

Orthopedics Hospital Name Indraprastha Apollo Hospitals Medanta The Medicity BLK Super Speciality Hospital Indian Spinal Injuries Centre (ISIC) Sir Ganga Ram Hospital Max Super Speciality Hospital Fortis Memorial Research Institute Fortis Flt Lt Rajan Dhall Hospital Asian Institute of Medical Sciences Fortis Hospital, Shalimar Bagh Artemis Health Institute Shekhar Hospital Moolchand Hospital Paras Hospital Max Hospital Fortis Hospital

november-December 2018

City/Area New Delhi Gurugram New Delhi New Delhi New Delhi New Delhi Gurugram New Delhi Faridabad New Delhi Gurugram Lucknow New Delhi New Delhi Gurugram Noida

State/UT New Delhi Haryana New Delhi New Delhi New Delhi New Delhi Haryana New Delhi Haryana New Delhi Haryana Uttar Pradesh New Delhi New Delhi Haryana Uttar Pradesh

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Rank AAAAA AAAAA AAAAA AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA AAAA AAAA AAAA AAAA AAAA AAAA

Ranking Top Hospitals 2018 Ranking : Top private Hospitals 2018

Diabetology Hospital Name Indraprastha Apollo Hospital (Apollo Sugar) Max Super Speciality Hospital, Saket Medanta The Medicity BLK Super Speciality Hospital Sir Ganga Ram Hospital Fortis Memorial Research Institute Fortis Hospital, Shalimar Bagh Max Super Speciality Hospital, Patparganj Fortis C-Doc Hospital, Nehru Place Fortis Hospital Fortis Hospital

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City/Area New Delhi New Delhi Gurugram New Delhi New Delhi Gurugram New Delhi New Delhi New Delhi Mohali Noida

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State/UT New Delhi New Delhi Haryana New Delhi New Delhi Haryana New Delhi New Delhi New Delhi Punjab Uttar Pradesh

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Rank AAAAA AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA AAAA AAAA AAAA

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Ranking : Top private Hospitals 2018 40

Skin & Derma Hospital Name Indraprastha Apollo Hospitals BLK Super Speciality Hospital Max Super Speciality Hospital Fortis Memorial Research Institute Sir Ganga Ram Hospital Medanta The Medicity Fortis Hospital Alchemist Hospital Moolchand Hospital Max Super Speciality Hospital Paras Hospital Max Hospital Asian Institute of Medical Sciences SIPS Superspeciality Hospital Shekhar Hospital

november-December 2018

City/Area New Delhi New Delhi New Delhi Gurugram New Delhi Gurugram Mohali Punchkula New Delhi Patparganj Gurugram Gurugram Faridabad Lucknow Lucknow

State/UT New Delhi New Delhi New Delhi Haryana New Delhi Haryana Punjab Punjab New Delhi New Delhi Haryana Haryana Haryana Uttar Pradesh Uttar Pradesh

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Rank AAAAA AAAAA AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA AAAA AAAA AAAA AAAA AAAA AAAA

Ranking Top Hospitals 2018

Hospital Name Fortis Hospital Max Super Speciality Hospital BLK Super Speciality Hospital Apollo Indraplrastha Hospital Artemis Hospital Moolchand Hospital Medanta The Medicity Max Super Speciality Hospital Sir Ganga Ram Hospital Alchemist Hospital Columbia Asia Hospital Max Hospital

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State/UT Punjab New Delhi New Delhi New Delhi New Delhi New Delhi Haryana New Delhi New Delhi Punjab Haryana Haryana

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Ranking : Top private Hospitals 2018

Trichology

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Ranking : Top private Hospitals 2018 42

Opthomology Hospital Name Shroff Eye Center Indraprastha Apollo Hospitals Max Super Speciality Hospital BLK Super Speciality Hospital Center for Sight Fortis Memorial Research Institute Max Super Speciality Hospital Fortis Flt Lt Rajan Dhall Hospital Eye Q Super Speciality Eye Hospitals Fortis Hospital Bharti Eye Foundation

november-December 2018

City/Area New Delhi New Delhi Saket New Delhi Delhi Gurugram Patparganj New Delhi Gurugram Mohali New Delhi

State/UT New Delhi New Delhi New Delhi New Delhi Delhi Haryana New Delhi New Delhi Haryana Punjab New Delhi

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Rank AAAAA AAAAA AAAAA AAAAA AAAA+ AAAA+ AAAA+ AAAA AAAA AAAA AAAA

Ranking Top Hospitals 2018 Hospital Name Max Super Speciality Hospital Fortis Memorial Research Institute Kailash Hospital Research Primus Super Speciality Hospital Fortis Hospital Fortis Flt Lt Rajan Dhall Hospital Sir Ganga Ram Hospital BLK Super Speciality Hospital Medanta the Medicity Shekhar Hospital Max Super Speciality Hospital Moolchand Hospital

City/Area Saket Gurugram Noida New Delhi Mohali New Delhi New Delhi New Delhi Gurugram Lucknow Shalimar Bagh New Delhi

State/UT New Delhi Haryana Uttar Pradesh New Delhi Punjab New Delhi New Delhi New Delhi Haryana Uttar Pradesh New Delhi New Delhi

Rank AAAAA AAAAA AAAAA AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA+ AAAA AAAA AAAA

Ranking : Top private Hospitals 2018

Dentistry

emerging hospitals CK Birla Hospitals RBH Amrit Hospital Era Lucknow Medical College and Hospital QRG Health City Kalra Hospital Srcnc Pvt Ltd National Heart Institute Aakash Super Speciality Hospital SPS Hospitals Anand Hospitals

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Rajasthan Delhi Uttar Pradesh Haryana Delhi Delhi Delhi Punjab Rajasthan

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case study 44

EHRs in India: Challenges and Opportunities vis-a’-vis’ Ayushman Bharat

A

s India is embarking on a journey towards providing Universal Health Coverage through multipronged approaches of reducing catastrophic out of pocket expenditure and increasing access to essential health services , it is envisaged that Health Information Technologies (HIT) / Digital Health would create enabling environments for addressing some of the system level challenges in healthcare delivery.

Ayushman Bharat aims to provide health risk coverage through health insurance and improve access to primary healthcare through the health and wellness centres.

Healthcare delivery systems in India face challenges on multiple fronts, such as surging costs, inconsistent quality of care and opaque reporting of health outcomes.

Appropriate use of digital health tools, Electronic Health Records (EHR) in particular as a system level intervention, can improve efficiency and effectiveness of healthcare delivery in the context of health systems strengthening. With the operationalisation of Ayushman Bharat and its scale up, the healthcare establishments across the country are being empanelled for provision of healthcare services under this scheme.

november-December 2018

However, in the absence of mandated reporting of clinical outcomes by the healthcare establishments, increasing number of people availing services in the current health delivery capacity (which is significantly limited) can adversely impact quality of healthcare being delivered. Inconsistent quality of care poses an immense challenge towards achieving the overall objectives of Ayushman Bharat.

Understanding EHR An Electronic Health Record (EHR) is an unique longitudinal electronic record of a person’s health over the life course that comprise of patient demographics, progress notes, clinical problems, medications, past medical history, laboratory data etc. and can be accessed instantly and securely by authorized users.

Dr Oommen John

MD, MBA, The George Institute for Global Health, University of New South Wales, New Delhi

An unique identifier for each person, provider and clinical establishment delivering the care is essential for EHR, so as to enable the sharing of records across different healthcare providers The purpose of collecting medical records, as outlined by the Ministry of Health in the EHR Standards notified in 2016, is improved care that is evidence based, accurate and faster diagnosis that translates into better treatment at lower cost of care, avoidance of repeating unnecessary investigations, robust analytics including predictive analytics to support personalised and contextualised

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the findings from the survey and key stakeholders’ interviews.

A total of 50 key opinion leaders were contacted, 30 of them consented to participate. The informants comprised of CEOs of healthcare establishments, members of the working group of the 2016 EHR Standards for India, researchers in the area of digital health, industry representatives, experts from the Indian Association for Medical Informatics who have led and supervised EHR implementations in India and other countries. We also included a few medical students to gain the perspectives of the “digital native” generation who would be the key clinical decision makers in the near future.

The survey yielded following results: 1. How have Indian Healthcare establishments fared on the adoption of Electronic Health Records?

Figure 1: Distribution of the perspectives around EHR adoption in India

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2. What value do you see in the role of Electronic Health Records in the context of Ayushman Bharat?

83% of the key opinion leaders endorsed that Electronic Health Records would enhance the health systems ability to collate data and draw inferences on disease burden and treatment practices in India through the adoption of EHR in the Ayushman Bharat programme.

77% of the respondents highlighted that use of EHR for the implementation of Ayushman Bharat can augment the clinical workflow, seamless referral between primary, secondary and tertiary care settings and implement standard treatment practices at the point of care and thereby addressing the variability of care quality.

Transparent clinical documentation was recognized as third most important role of the EHR with 70% of them inferring that improving the transparency of clinical documentation would be a key factor for the success of the health insurance model of improving healthcare access.

Less than 30% felt that EHRs will only help for billing purposes and insurance claims processing, indicating that some of the concerns and perceived challenges by healthcare establishments around the scope of electronic health records are unwarranted and there is perhaps a need for sensitization and awareness building for healthcare establishments towards the capabilities of EHR in the Indian healthcare delivery settings.

case study

care, improved health policy decisions based on better understanding of the underlying challenges, all translating into improved personal and public health outcomes.

Despite broad consensus on the potential benefits of EHRs, the Indian healthcare establishments have been slow to adopt them. Research shows that EHR data provides valuable insights on the operational aspects of health insurance reimbursement models and informs policy directions on the payer - provider ecosystem. As Ayushman Bharat envisages to be implemented on a robust information technology backbone, it is an opportune time to explore and understand the status of implementation of EHRs in India.

We conducted a study to understand the perception among key stake holders on the current status of EHR in India. This was an online survey, followed by key informant interviews aimed at identifying frequently reported barriers for the adoption of EHR in India and potential solutions for overcoming the same through policy interventions.

3. What are the Challenges faced by Indian healthcare establishments in the implementation of EHR? As the key aspect for success of electronic health records relies on the clinicians using the EHR for clinical documentation and decision making, acceptance by the clinicians was perceived as an important challenge. Patient loads in outpatient settings was reported as a key barrier to the use by the clinicians. Lack of a common understanding between the clinicians and the software development teams on the essential functionalities of EHRs often leads to overlooking the clinical components that would help in efficient and effective care delivery. Hospitals tend to focus primarily on the billing and revenue cycle management, and deploy technology solutions that address only this aspect, which is a huge disincentive for the clinicians. Loss of face to face interaction due to technology disrupting the clinician patient communication was seen as a major drawback of EHRs. Not engaging with the end users (including understanding the patients’ preferences) results in poorly designed EHRs. Most EHRs do not consider the patient behaviours into the design process, unlike in the past, many patients are technology savvy and maintain their treatment related records in electronic formats and on their mobile phones, there are no mechanisms in most

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case study

EHRs to allow for patients to contribute these valuable clinical and treatment related information into the care delivery pathways.

Health care in India is provided in a multi-lingual context however most EHRs do not have multi lingual capabilities. As healthcare in most settings is delivered through fragmented multi-specialist approach, the inability of the health record to follow the patient from one centre to another in electronic format impacts the delivery of comprehensive multi-disciplinary care and also results in unwarranted repetition of investigations thereby increasing the financial burden on the patient and the healthcare systems specially in the case of a reimbursement model.

At the health system level, multiple parallel electronic formats of health data collection is undertaken across vertical programmes (TB, Vector borne diseases, NPCDCS etc) similar data being collected repetitively across these verticals. All these generate islands of valuable data that could inform decisions when consolidated into an common electronic data repository. There is a compelling need for better interoperability of these systems, and adhering to the EHR standards would be essential to make this happen. Finally Lack of any incentive for the clinicians for using EHR, the anticipated incentive being clinical value and improved care coordination.

Other specific challenges are as listed below: 1. Relative lack of computer literacy amongst healthcare professionals and EHRs lacking user centred design for ease of use.

2. Poor change management practices and communication silos within the healthcare delivery systems.

3. Lack of uniformity in EHR software despite the availability of EHR standards 2016 and an enabling environment created by the Government through the national EHR resource centre at CDAC, Pune.

4. Lack of synergy between healthcare providers resulting in non-interoperability. “Data hugging” by clinical establishments.

5. Lack of Operating System agnostic EHR and mobility extensions as apps.

6. Lack of awareness around privacy and health information security protocols.

7. No mandatory requirement to electronically monitor and report on clinical outcomes to a central nodal agency.

Overcoming Challenges and Leveraging the Opportunities for EHR in India: As the EHR standards for India are available since 2016 and adequate time has been provided for the healthcare establishments and EHR providers for compliance,

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Ayushman Bharat is an opportunity to mandate the implementation of standards compliant EHR for accreditation of clinical establishments under Registry of Hospitals in Network of Insurance (ROHINI).

This could be facilitated through the EHR certification process by National Resource Centre for EHR Standards in India, at C-DAC, Pune.

Further creating an enabling environment by incentivization through a higher reimbursement provision for those using certified EHR and submitting clinical summaries in electronic formats for the claims processing under Ayushman Bharat.

Creating awareness, with reference sets for clinical specialities, storage registries, data dictionaries and clinical terminologies, such as SNOMED CT (made available by the Government of India under a national license).

Ayushman Bharat is also an opportunity for rethinking health systems in Indian context and build consensus towards a digitally enabled future ready health delivery system. All of this being mindful that digital health technologies are only enablers and health systems strengthening involves a broader approach as outlined by WHO Framework on integrated people-centred health services.

A practical approach could be designing an integrated healthcare portal/software platform provided by the government for all stakeholders to “plug and play” where preventive health interventions, prescriptions, clinical procedures, lab reports etc. are updated at each encounter into an unique citizen health record. A model of an integrated platform was recently launched by the Ministry of Health and Family Welfare as Integrated Disease Surveillance Programme component incorporating the EHR standards (2016), this back bone could be leveraged to

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1. Sensitise healthcare workers on importance of EHR. 2. Introducing data science and health informatics as a part of curriculum in medical and allied health education.

3. Build synergy between healthcare professionals and software developers. A national repository of user centred EHR design elements and a national health data dictionary with common data models.

4. Utilize open source Operating Systems and tools for developing EHR. Open architecture for EHRs that allow API integration with point of care and IoT devices on a strong information security framework.

5. Use standard clinical workflow guidelines and including clinical workflow guidelines for developing EHR solutions.

6. EHRs to have functionality of directly porting data into clinical registries as well as outcome monitoring dashboards.

Relevance of emerging technologies for enhancement of EHR functionality The availability of large data sets in domains outside of healthcare combined with the rapid evolution of computational sciences offer promising opportunities for extracting new inferences and actionable insights that have the potential to radically improve health outcomes. However, health systems are yet to leverage these promising capabilities in data science, machine learning and artificial intelligence to discover novel approaches to healthcare delivery and improving outcomes.

EHRs are routinely not available in many LMIC settings including India, and non availability of data is often seen as the constraint for proactive policy interventions.

Valuable clinical information exists in compartments mostly outside the health systems and patient generated health data particularly from point of care diagnostics and IOT devices is growing at a tremendous pace. These are currently not used by the health delivery systems.

An example being mobile phone and internet based messaging platforms, where a wealth of clinical information is exchanged.

These unstructured datasets could be leveraged to build health data repositories while the EHRs are evolving and implemented in India.

The citizen digital locker could be another potential resource for a citizen held personal health record or portable EHR. As Patient generated data are not linked into the healthcare providers clinical information workflows the benefits of these data sets are not being utilised. Futuristic health systems and EHRs should permit self-monitoring and point of care testing data that facilitates health analytics with predictive and prescriptive output finally leading to

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individual specific precision medicine under the supervision of the treating clinician.

When functionality of the EHRs move into the hands of the end users, be it patients, their immediate care providers, the adoption and demand for the same would significantly increase. Improving the usability and user experience of EHRs such as incorporating voice based Inputs, hand writing inputs with Natural Language Processing and machine processing / learning techniques for clinical coding, contextually augmented Clinical Decision Support with automated patient notification to better manage care and follow up, with clear policy for patient data ownership would be a way forward to implement person centricity and prevent clinical establishments from continuing deliver opaque outcomes.

A national policy around health data as a public good and a framework for government led initiatives for developing AI models for improving the health of the citizens would be important as EHR adoption improves.

case study

develop the above mentioned “plug and play” platform services. This could also make provision for APIs for mobility extensions to allow patients to update their own data from their mobile phones and data by frontline healthcare workers and thereby allowing clinicians to review patient generated, field collected information and support the delivery of comprehensive care.

To improve usability, natural data input such as handwriting, voice could be considered in the EHR. An inter-exchange format for Indian standards and Indian language support could be built progressively. Sensitization of the workforce through training of doctors and nurses and making it incentive based and compulsory for career progression. The patients also should demand implementation of EHR and should be empowered with extension of a portable EHR (PHR) for their own use and portability.

This might be a step towards putting the person at the centre of health delivery systems.

THE WAY FORWARD Data is an emerging currency equivalent, India has the potential of becoming the global capital of this ecosystem, health data perhaps holds the key and Ayushman Bharat is a valuable opportunity for building a future ready person centred health system that the rest of the world could emulate. In this journey, a national standardized EHR might be the first step.

Dr Oommen John is an incurable optimist and works at The George Institute for Global Health India. He serves on the International Advisory Board of the Commonwealth Centre for Digital Health.

The views expressed are on behalf of the members of the “India EHR study group” who contributed to this report.

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healthcare startup

INSPIRON Enabling Individuals to Cultivate Positivity Nearly 85 percent of the population sufferig from mental health issues doesn’t seek medical help due to social stigma and lack of accessibility to mental health professionals. Being the country’s first psychological wellbeing café, we ensure people’s physical and mental health, say Nithish Meti and Priyanka MB, co-founders, INSPIRON, in conversation with Sudheer Gautham of Elets News Network (ENN).

Q

What prompted you and your partner to come up with the idea of a psychological wellbeing café? How is it different from regular psychology/ psychiatric treatment centres?

The industrial voids in the field of mental health sowed a seed for thought. Mental health has been largely ignored in our country’s health regulatory system. As per the latest statistics made available

by WHO, the burden of mental health problems is of the tune of 2,443 DALYs (expressed as the number of years lost due to illhealth, disability or early death.) per 100,000 population. The ageadjusted suicide rate per 100,000 population is 21.1.

In India, the economic loss due to mental health conditions during 2012-2030 is estimated to be $1.03 trillions. The most vulnerable and affected age group is 15 to 29 years.

Suicide is an emerging and a serious public health issue in India. Nearly 85 percent of the population doesn’t seek medical help due to social stigma and lack of accessibility to mental health professionals.

Credibility and lack of resources There lies a huge dearth of mental

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Nithish Meti and Priyanka MB Co-founders, INSPIRON

health workforce in India (per 100,000 population) which includes psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07). Recent research shows that there has been a substantial rise in unprofessional practices in the field of mental health.

Lack of information Poor availability of resourceful information on where and whom to seek help from with traditional practices continuing to decipher standardised scientific methods of treatment.

Q

How are we different?

Consultation over coffee Being the country’s first psychological wellbeing cafe, we have broken the stigma of seeking mental health services through our unique concept “Consultation over Coffee”.

Holistic approach We provide an atmosphere of warmth and care through writing, reading, art, music, dance, theater and animal assisted therapy. We started with scientific psychometric assessment, moved towards

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Accessibility The technological platform facilitates an easy access between clients and psychologists/ psychiatrists from the place of their convenience.

Credible mental health professionals We provide qualified psychologists & psychiatrists who are accredited to prescribe medicines and perform psychotherapy in the language comfortable to the client.

Q

Tell us more about the organisation, its contribution in mental healthcare space and the team.

INSPIRON was co-founded in 2011,

by Nithish Meti and Priyanka MB, social entrepreneurs, specialised in motivational speaking and Clinical Psychology respectively.

They had foresight about the global market of mental health.

Under the guidance of their mentor and Director Dr A Jagadish, the President of the Indian Psychiatric Society and owner of Abhaya Hospital, they ensured happier and healthier homes.

We have 60+ consultants and reputed professionals from the field of mental health, neurology and

adjunct based therapists to provide the best of services to our clients.

With collaboration with National Institute of Mental Health & Neuro Sciences (NIMHANS), the Health & family Welfare department of Karnataka and other reputed NGOs, we are waging war against the stigma associated with mental health. We are creating awareness, conducting research and providing an intervention platform for educational institutions, corporate enterprises and the general public.

healthcare startup

invidualised psychotherapy and tailor made workshops from early ages to the geriatric population.

Cafe

Q

Tell us a little about the source of funding to sustain the beautiful work your organisation does.

INSPIRON is being supported through Seed funding by individual investors. The prototype has been proven and it is ready to set its foot in the global market.

Q

Shed some light about the vision of INSPIRON. What are the future plans in terms of expansion and collaboration?

Decentralise to meet supply and demand We have facility of certified training and development for resource creation to meet the dearth of mental health professionals in the field.

We are creating a platform to seek help, thereby providing screening

Art of an Artist measures towards creating ‘Mental health first aid’ and ‘Mental health diagnostic centers’.

Technology to uplift the requirements of healthcare industry We are working on accessibility factor i.e. to make people avail mental health services across the globe. Artificial Intelligence and automation like modern technologies are used to address requirements of the field.

We are having low-cost emotional Wellness Cafe across the country, which provides complete mental health and emotional wellness solution.

Psychometric assessments for screening and intervention in different fields Scientific-based neurological interventions and standardised psychometric tool development to ease the process of evaluation in the healthcare, industrial, corporate and educational sectors for the Indian and global population, resulting in appropriate treatment measures.

Counselling Room

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