eHealth- Maximising Healthcare Access: November 2008 Issue

v o l u m e 3 | issue 11 | N OVEM B ER 2008

ISSN 0973-8959

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

Rs. 75

Cover Story: eHealth - Maximising Healthcare Access Dr. Jai Mohan, Prof. of Health Informatics & Paediatrics, International Medical University, Kuala Lumpur Page 8

In Focus: eHealth in Commonwealth Countries - Oppertunities and Challenges Dr. Arul Rhaj, MD President, Commonwealth Medical Association, UK Page 12

Spotlight: Unified Communication - Improving delivery of Healthcare Michel Gambier, GM Information Worker Group, Microsoft Asia Pacific Page 14

In Conversation: Scripting success -A fresh perspective on clinical reporting Ravi Mani, Director and Solution Architect, 21st Century Health Management Solutions Page 18

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Expert Corner: High Acuity Areas Monitoring Systems Market Insight, Healthcare Practice, Frost & Sullivan Page 43

Watch out for upcoming issues for exclusive regional surveys on IT usage and automation in Indian Hospitals.

December - East & North East India

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

CONTENTS w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 11 | November 2008

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COVER STORY

eHealth

- Maximising Healthcare Access Dr. Jai Mohan Prof. of Health Informatics & Paediatrics, International Medical University, Kuala Lumpur, Malaysia

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IN FOCUS

eHealth in Commonwealth Countries - Opportunities and challenges Dr. Arul Rhaj, MD President Commonwealth Medical Association, UK

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SPOTLIGHT

Unified Communications - improving delivery of healthcare

Michel Gambier General Manager, Information Worker Group Microsoft Asia Pacific

www.ehealthonline.org

w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 11 | November 2008

22

SURVEY

IT @ Hospital Survey 2008 Part 3 - South and Central India eHEALTH

PERSPECTIVE

ICT Facilitated NABH Accreditation

39

Dr. Vinoy Singh Head - Health Informatics Srishti Software

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EXPERT CORNER

High Acuity Areas Monitoring Systems Market Insight Healthcare Practice Frost & Sullivan

REGULAR SECTIONS india news BUSINESS NEWS

wORLD NEWS TECHNOLOGY TRENDS NUMBERS EVENTS DIARY

November 2008

26 30 36 41 46 48

Post Jobs Online for FREE @

www.ehealthonline.org Now a CAREER section specifically for professionals in eHealth, Health IT, Bio-medical Engineering, Medical Technologies, Medical Electronics, Telemedicine, Tele-health, Healthcare Operations and Administration.

Employers can now give specific details for the positions available & Job Seekers too can finally get a clearer picture of what jobs are on offer for them.

Get a clutter-free picture of the healthcare job market!!!

Get clicking on www.ehealthonline.org/careers to get started.

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

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

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

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

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

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

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

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

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

All contributions are subject to approval by the publisher.

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

www.ehealthonline.org

Volume 3 | Issue 11 | November 2008

president

Dr. M P Narayanan editor-in-chief

Ravi Gupta group directors

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

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

Susan Thomas Sarita Falcao Sales executiv e

Arpan Dasgupta mobile: +91-9911960753 email: arpan@ehealthonline.org Bharat Kumar Jaiswal mobile: +91-9971047550 email: bharat@ehealthonline.org Sr Graphic Designer

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Manoj Kumar (+91-9971404484) manoj@ehealthonline.org editorial correspondence

eHEALTH G-4 Sector 39, NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org is published in technical collaboration with Centre for Science, Development and Media Studies.

does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided.

Owner, Publisher, Printer, Ravi Gupta Printed at Vinayak Print Media E-53, Sector 7, Noida, U.P. and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP Editor: Ravi Gupta

November 2008

EDITORIAL Miles to go...

The rising costs of healthcare and sharp discrepancies in access to services are pushing more than 100 million people every year into poverty, says WHO’s latest annual report. It recommends a return to “primary health care,” a more holistic approach developed in the 1970s where general practitioners, family doctors or nurses perform tasks that these days are frequently carried out by specialists, to get health development back on track. Preventive care needs to be stepped up on a priority basis – and fast!

In many ways, eHealth has been sounding a similar idea about putting people in charge of their own health records. Good health is a public issue and all stakeholders must be involved in any step towards standardisation, evaluation and policy-making.

Higher uptake of technologies can in fact reduce costs significantly by reducing medication errors, better managing drug interactions, ensuring the authenticity of drugs delivered to market - and these are only some of the ideas that can be implemented. This aspect of eHealth should make service providers, especially hospitals, more open to its adoption. In India, there is still scope for advancing regional best practices in the health sector, given the wide variations in the levels of communication and IT infrastructure. eHealth facilitates collecting, transmitting and exchanging clinical data, monitoring quality of care, sharing data more securely and instantaneously, responding to adverse drug events, and reducing medical errors. Improved healthcare delivery at the patient-level is an outcome of several networks and decisions at multiple levels. Both hospitals and service providers are fast realising the benefits of integrated communications system. This issue looks at the solutions provided by one player, Microsoft.

Creating awareness about technological advances and innovations we can drive higher demand thus reducing the cost of products like the iShoe, covered in this issue and make the common man a true beneficiary of the Internet revolution.

Web 2.0 has changed the way medical science uses information technology – and it has the potential to change the way health science technology affects our daily lives.

We at eHEALTH strive to be a part of the electronic revolution by bridging the gap between service providers and end-users. eHEALTH Asia 2008 is one step in this direction, where players from the government, industry and civil society will meet for three days to share ideas and innovate. We look forward to having you participate and enrich the sharing experience.

Ravi Gupta Ravi.Gupta@ehealthonline.org

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COVER STORY

eHealth Maximising Healthcare Access Web 2.0 and other similar technologies are making the world a smaller more accessible space.

This bodes well for the healthcare environment. The content rich domain of medical science needs this open source, increased access and connectedness more so than any other.

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ntel has described eHealth as “a concerted effort undertaken by leaders in healthcare and high-tech industries to fully harness the benefits available through convergence of the internet and healthcare”. A more encompassing definition is provided by Gunther Eysenback, editor of the Journal of Medical Internet Research. He says, “E-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterises not only a technical development, but also a state of mind, a way of thinking, an attitude and a commitment to networked, global thinking, to improving healthcare locally, regionally and worldwide by using information and communication technology.” eHealth has demonstrated the ability to maximise health care access by extending the reach and quality of healthcare services to consumers as well as by improving the knowledge and skills of healthcare professionals irrespective of place of practice. Perhaps more importantly, it had contributed significantly to the ability of individuals to manage their own health and illness through access to knowledge, training and disease support groups.

Universal Access to Specialised Services Teleconsultation has provided a means of providing access to specialists (and specialised services) where such access is not easily available. A good example of this is in India where, despite a relatively late start, rapid deployment has occurred due to an enlightened business model, satellite services being provided free by the Indian Space Research Organisation.

In many countries which had some initial success, failure to address the high costs of broadband access have resulted in subsequent under-utilisation. An over-dependence on teleconsultation champions has been another problem, proving to be a roadblock to more extensive use of this technology. Some low-end teleconsultation services using email with multimedia attachments to support, store and forward telemedicine services continue to thrive and expand, and in more than a few instances supporting international collaboration in healthcare. Telepathology, teleradiology and teledermatology continue to grow and by their nature are suitable for second opinion referrals. Interestingly in some countries, the initial emphasis on using teleconsultation to support services like telepsychiatry, telenephrology and telepaediatrics has been replaced by the use of these systems to support educational activities and administrative meetings.

From Episodic to Continuous Healthcare Services Networked health systems and consumer access to the Internet now provide a means of moving from the model of episodic contact between consumers and healthcare providers to a model of continuous relationship more in keeping with the health requirements of consumers. Episodic care was appropriate when most morbidity and mortality arose from infectious diseases, but it is now no longer appropriate when diseases of lifestyle (such as ischaemic heart disease, strokes, diabetes, cancer, injuries and HIV) have become the major causes of illness and death.

Consumers are demanding more access to their healthcare providers, and surveys have demonstrated that modern www.ehealthonline.org

consumers would like e-mail access to healthcare providers and would be prepared to change their healthcare providers to achieve this link.

The Internet also permits expansion from the business of episodic illness care to well-being management, health risk factor management and chronic disease management, all of which are better served by providing more sustained support for the consumer than periodic office visits. Healthcare consumers are also benefiting from the electronic linkages between healthcare providers and health facilities with their drug and equipment suppliers, as well as with health maintenance organisations and health insurance companies, in ensuring better drug and equipment inventory control and facilitated payments. E-prescriptions have made it possible to ensure continuity of drug supplies for chronic diseases without necessarily having to revisit a distant specialist or health facility.

Linking Businesses and Consumers Many of the earlier developments in eHealth were driven by the needs of industry, especially those companies involved in the pharmaceutical and medical supply areas, as well as those working in health insurance and other payers.

However, other players are now coming on board these business-to-business (B2B) platforms including government agencies and health maintenance organisations.

Some of these agencies have recognised the benefits of developing business-to-consumer (B2C) links through home pages based on the Internet, e-mail and call centres in terms of improving services and developing customer loyalty. Consumers have also discovered for themselves that the Internet is a great medium for developing consumer-toconsumer (C2C) links through disease support pages and health discussion groups on the Internet maintained by support groups or individuals.

The manner in which Internet discussion groups have empowered individuals with rare diseases and parents of children with uncommon conditions is a striking example of the benefits of eHealth for consumers. More information is available from these sites than could possibly be conveyed during the short office visits with their doctors. Answers to specific queries are quickly available from other consumers, and while such information is not uniformly credible, discriminating consumers can find much to help them.

By visiting these pages, the health industry and healthcare providers who are not leveraging the benefits of eHealth could learn about the power of electronic networking to extend their reach and the repertoire of services provided.

Electronic Lifetime Health Records and Lifetime Health Plans (or Personalised Health Records) Many of these eHealth initiatives have been ad hoc and driven by industry or concerned consumers, but many countries recognised the need for coordinated eHealth initiatives. In 1997, Malaysia published its Telehealth Blueprint: Transforming Healthcare through Information Technology, the aim of which was to transform the healthcare system and realise the vision of a ‘nation of healthy individuals, November 2008

families and communities’ using information technology as a powerful enabler to build a system that is fundamentally consumer-centric.

An electronic lifetime health record for every citizen forms the core of this deliverable service. Such records will provide a means for the consumer to share their health records with those health providers they visit over the course of a lifetime in public and private health facilities. Health and illness will be managed in a proactive and forward-looking manner, with periodic health visits rather than episodic ‘one-off’ visits when illness strikes.

Each visit will result in updating the personalised health plan and ensuring ‘seamless, coordinated, continuing’ care.

This can be especially valuable in the management of health risk factors and chronic diseases. In these circumstances, shared medical summaries could ensure seamless continuity of care, avoid unnecessary duplication of investigations and reduce dangerous drug interactions. Technologies that can further enhance the value of eHealth centred-on electronic health records and plans are identified in Figure 1 below.

Figure 1: Enhanced eHealth Services Australia and the UK have subsequently published their national blueprints, both of which also centre on coordinating healthcare services through the use of nationally shared lifetime health records. Both countries have also launched national consumer health portals, with the UK’s portal being supported by a national telephone call centre manned by trained nurses. Similar consumer health portals launched by governments exist in Malaysia, Singapore and other countries.

In Asia, eHealth strategies of varying degrees have also been developed at national level in Hong Kong, Singapore, Japan and South Korea.

All players in the healthcare system should be linked to achieve optimal results including:  Consumers - via patient identifiers, smart cards, home monitoring systems and access to their own personal health records, into which they may enter observations.  Healthcare providers and facilities - through national health information networks, which may include total hospital information systems and total health information systems, teleconsultation hubs and continuing pro

COVER STORY

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fessional development portals.  The Government - through the information derived from aggregated patient data in electronic health records (which can be used to support health planning and financing) and early warning systems for acute illnesses and prevalence reports for chronic disease.  Health insurance and other payers - through e-commerce and group data services.  Pharmaceutical and medical equipment companies through electronic inventory control and just-in-time supplies.  Professional medical societies - through Internet-empowered continuing professional education support and credentialing activities.  Medical faculties - in providing distance education for the different categories of health professionals and support for acquiring post-basic, undergraduate or postgraduate qualifications.  Social welfare bodies - in providing support for disadvantaged patients.  Disease support groups - in extending their reach to their respective constituencies.

Geography and time need not be barriers to achieving high-quality care. A distant specialist, a rarely used drug, authorisation for payment or a clinical practice guideline need only be a click away. With the development of wireless networks and handheld computers, such services can reach the consumer or healthcare provider at all times. A summary of the health record has been incorporated into the national smart card in Malaysia, allowing consumers to carry relevant health information with them wherever they go. Life vests that monitor vital signs and sends them to a central health facility have been developed, as also a wrist watch that monitors vital signs. These, linked to geographical information systems, have been made available to army personnel working in difficult areas like Afghanistan and Iraq.

Ensuring Patient Safety and Better Health Outcomes The US Institute of Medicine has re-emphasised the morbidity and mortality that results from pharmaceutical drug use. In the USA alone, more than a million injuries and as many as 98,000 deaths each year can be attributed to medical errors. Decision support can be built into these lifetime health record systems to permit just-in-time information to ensure good clinical care.

With almost 10,000 different diseases and syndromes, 3000 medications and 1100 laboratory tests to select from, the average doctor requires some help in managing his patients. Keeping up to date is a herculean task, with 400,000 articles added to the medical literature every year. A continuing medical education portal for healthcare providers and a consumer health portal are needed to ensure consumer and provider access to accredited health information. This should be linked to electronic health record systems to ensure just-in-time decision support and enhance patient safety.

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From eHealth to Medicine 2.0 A very exciting and significant development for eHealth has been the adoption of web 2.0 technologies and approaches in what has been called Medicine 2.0 or Next Generation Medicine. Medicine 2.0 has been defined as Web-based services for healthcare consumers, caregivers, patients, health professionals and biomedical researchers that use Web 2.0 technologies and/or semantic web and virtual reality approaches to enable and facilitate social networking, participation, apomediation, openness and collaboration, within and between these user groups. This has coincided with the recent emergence of Personal Health Application Platforms and Personally Controlled Health Records such as Google Health, Microsoft HealthVault and Dossia.

Social networking (modelled on Facebook and similar applications) will allow health consumers to see and share what those with similar diseases are doing and reading on the Internet, foster viral dissemination of information and skills, and enable reputation and trust management and accountability and quality control. Social networking tools for health may get people interested in personal health records which they need to actively maintain (like their profile in Facebook), motivate them to take responsibility for their health and health information and, especially important, retain their interest over time. The philosophy of end-user participation and engagement is deeply engrained in Web 2.0 thinking, exemplified by tools like wikis. Patient access to and control over their own health data is probably an important pre-requisite to engaging him in the management of lifestyle risk management and chronic disease care. The emergence of social networking platforms and applications such as PatientsLikeMe, combined with Personal Health Records 2.0 create unique levels of participation and opportunities for engaging patients in their health, healthcare, and health research, and for connecting patients with their caregivers, formal and informal. Apomediation (use of informed or experienced agents to guide patients to high quality information or services), as opposed to disintermediation (cutting out the middleman), is supported by the Web 2.0 environment. Openness (as exemplified by transparency, interoperability, open source and open interfaces) and collaboration are important in eHealth development and are well supported by Web 2.0 applications.

In conclusion, not only is eHealth well and thriving but the best is yet to come in addressing the goals of better healthcare access and health outcomes.

Dr Jai Mohan Professor of Health Informatics & Paediatrics, International Medical University, Kuala Lumpur dr.jmohan@gmail.com

www.ehealthonline.org

arishmaTM The Solutions People

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IN FOCUS

eHealth in Commonwealth Countries Opportunities and challenges

Dr. Arul Rhaj, MD President, Commonwealth Medical Association, UK drarulrhaj.cma.uk@gmail.com

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HO defines eHealth as the use in the health sector, of digital data - transmitted, stored and retrieved electronically - in support of healthcare, both at the local site and at a distance (2003). In developed regions like Europe, Electronic Patient Records, Practice Management and Patient Management Systems are in place.

But in other regions, eHealth is interspersed and in its infancy. National Medical Associations of the Commonwealth Medical Association are being sensitised to take up the issue of eHealth actively in their countries.

Broad areas of application 1. Data base: Data base of all doctors, para medicals and public can be prepared and uploaded. This will provide ready information of details like the availability of manpower, relief requirements, and the types of services rendered.

Since we are moving towards re-certifications, this data base can provide details of certified manpower and the progressive training requirements. This data base can also be useful in planning and executing disaster relief. It will help to forecast budget and other health requirements, vaccination campaigns, management of epidemics, easier tracking of disease trends and patterns, and ultimately help in providing transparency.

Electronic patient record management system can be generated and centrally stored, at the Districts and State headquarters, and can be easily retrieved at a click of a mouse by using passwords. Diseases can be suitably classified according to the ICD system and confounding diagnosis can be eliminated to a large extent. It shall help in better monitoring and follow up care, as also proper and prompt extension of preventive care services. Likewise, multicentric research and trials can also be easily carried out and the system can also be helpful in assimilating research findings and in generating research focus.

2. Training: on use of the eHealth systems will have to be imparted and modalities for the same have to be worked out.

As a start, computer literacy can be imparted in medical college and training institutes, for doctors, administrators and paramedics. Younger generation is already becoming computer literate and could take a leading role in improving communication throughout the health system.

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3. Distant Learning: Learning is a continuous process and more so in the medical arena where the concepts and techniques are changing very fast and becoming difficult to keep pace with. Distance learning can be a useful method which can allow doctors and para medical staff to upgrade their skills. Duly certified distance learning programs can be prepared which are easy to comprehend and assimilate. These programs can be streamed live or can be made avaliable through the medical intranet, and can be accessed through specific passwords by the doctors and para medicals at their own convenience without interrupting the normal day to day functioning.

4. Conferences: Conferences are necessary for exchange of ideas and information, and their importance lies in their being interactive and it helps in fostering links. However, time is at a premium these days and travel is also somewhat cumbersome. Moreover, organising a conference is a tedious task, besides being a costly affair. If conferences were to be streamed live, it can become a two way affair and can be attended by multiple participants sitting across their computers with a web camera and video streaming facility. If there is an important discovery, invention or technique that has been developed, or a breakthrough research, an impromptu conference can also be organised to disseminate the findings immediately and gather feedback.

5. Patient consultation: Medical Intranet (MI) can help in patient consultation with the help of live video streaming.

Dedicated teams of medical experts can be created to man telemedicine centres round the clock, and these telemedicine centres can be created at a state or union territory level and all such centres throughout the country can remain linked with each other. A free or paid access into the Medical Intranet can be granted to the broadband service providers where any patient can walk in and get access to online telemedicine centre of his/her state. This will also help in decongesting the hospital OPDs. It can also be used to seek and confirm appointments.

6. Internet kiosks: There may be provision for downloadable information on various aspects of diseases, which even a layman can download and be able to comprehend. The www.ehealthonline.org

information can be prepared in local languages, with appropriate photographs and figures, omitting the medical jargon, so as to be able to provide needful information. These Internet kiosks can become a good health education medium and thereby help in raising the health standards of a community. Online support groups, discussion sites and interactive forums can also be formed and a patient can remain in contact with a doctor via email, if so desired. Easy to use softwares are readily available or can be created to suit the requirements by the vast trained and competent manpower available. These softwares can also be designed to be used in different regional languages and also by the illiterate.

7. Classroom teaching: Medical Intranet will have the capability to revolutionise classroom teaching. Our own experts can be tasked to vet, edit and update the available information, conforming to our culture, needs and available resources. Audio-visual teaching has been found to be more effective than just passing on the information from a dais. The updated literature can be downloaded and this shall contain all needed information presented in a easy to comprehend fashion, which shall be easier to memorise. By accepting Medical Intranet into classrooms, conformity of standards in medical and para medical education can be achieved, which shall be at par with any of the top overseas university. It will also help in curtailing expenditure in procurement of costly books and maintenance of library, as all latest medical journals and text books can also be made available on the MI, through central subscription.

8. Guiding surgery and other procedures: The MI can help in learning latest surgical procedures and techniques. These procedures can be streamed live and stored in the MI and can be accessed by the medical staff in their own free time also. Through this MI, a complicated case can be witnessed live by an expert sitting even a thousand miles away and in turn he/she can guide the surgery, if the patient can not be evacuated to another centre. Likewise other procedures can be guided from a far off place with convenience and precision, allowing even the complicated procedures to be taken up in small centres and in the remote areas. Although it will take some more time for the robotic surgery to come to our country, but robots have already stepped into the medical arena.

Within a medical setup or a hospital, all departments can be interconnected so that there is a better utilisation of available information and resources, correct and fast disposal, better follow up actions, automatic data and statistics generation and transmission, monitoring, etc, can all be achieved.

Enormous amount of benefits are to be harvested once this MI is in place [Table 1].

Issues for health professionals • Lack of access to appropriate hardware • Lack of education and training • Lack of interoperability of information systems across sectors • Lack of nursing input into the design of systems • Concern about confidentiality, security, legal issues November 2008

Table 1

• • •

and accountability Fear that computers will take nurses away from patient care Fear that computerised data may be inappropriately used for performance management Lack of an independent professional voice on eHealth issues

Barriers to overcome • Inability to accept and manage change • Changes in the professional-patient relationship which are perceived as a threat to professional authority • Concerns about confidentiality and security of information • Lack of or inappropriate, education and training Recommendations • Good health is a public issue • Access to health professionals to ICT devices and technical support • Involve the users - in designing, development and evaluation • Educate and train health professionals • Change management processes To conclude, eHealth will become the order of the day.

Every country in the Commonwealth can form a system to link the healthcare administrators, providers and beneficiaries. Best practices from developed countries are available; resources are available within each country.

What CMA intends to do is to promote eHealth system through member countries’ National Medical Associations.

In addition it will push the agenda through Commonwealth Secretariat, WHO, Commonwealth Heads of Government and Health Ministers.

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SPOTLIGHT

Unified Communications Improving delivery of healthcare Michel Gambier, General Manager, Information Worker Group, Microsoft Asia Pacific

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ommunicating accurate information quickly is a critical part of the Healthcare industry. Efficient communication tools have a profound effect on the quality and safety of patient care, and also have a huge bearing on patient satisfaction. Yet many caregivers are still limited to pen, paper, and pagers - with email and Web based knowledge resources slowly rolling out.

Today caregivers are overwhelmed with more and more information, but what they need is the right information, in the right context, at the right time - the point of care. This lag in technology adoption to improve communication poses significant risk for patients because it doesn’t provide real time access between clinicians, and makes it more challenging to coordinate care. In fact, there are many cases around the world where patients have died because they were not connected with the appropriate medical expertise in a timely manner.

At the same time, modern communication tools can increase efficiency in care helping care givers serve the growing number of patients they see each week. Modern communication technologies readily available from companies such as Microsoft can help meet these challenges and enable doctors to serve their patients with quality advice in a timely manner.

Seamless communications is what is needed in order to ensure high quality of evidence-based, time and cost-efficient patient care. Established tools can unite all the players in real time and across multiple communications channels, whether connected from their desktops or remote devices in patient care facilities.

Challenges facing healthcare professionals today Expertise is crucial in healthcare - providing the best care to patients today involves frequent sharing of knowledge and collaboration with other caregivers. However, today’s healthcare providers are constantly challenged to deliver more results while still delivering quality advice to patients. Physicians are faced with a barrage of daily challenges, including: Diversity of healthcare teams. Healthcare is an information science and the pace of discovery of new diagnostics and therapeutics is far outstripping the health system’s ability to distribute this new knowledge. The medical workforce is responding to this explosion in new medical evidence by ‘super-specialising,’ making clinicians more skilled than ever at diagnosing and treating diseases.

Yet the trend toward medical specialisation is leading to a fragmented model of communication that inhibits patient care. No longer does information flow directly between a single doctor and his or her patient, but treatment is delivered by a whole cadre of caregivers from the primary care physician, to a variety of specialists, nursing staff and laboratory technicians.

Given this diversity of patient-care teams, healthcare professionals are hindered by a lack of tools that can provide time-sensitive information to each other. For busy healthcare professionals moving from room to room, station to station, the ability to bridge those distances while collaborating is critical to the patient care process.

Proliferation of paper-based healthcare records. The growing amount of paper-based information and patient records in

Seamless communications is what is needed in order to ensure high quality of evidence-based, time and cost-efficient patient care.

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today’s healthcare organisations make it difficult to find and aggregate the patient information caregivers need - without having to quickly flip through multiple pages to find the crucial information required for an accurate diagnosis. Disconnected and proprietary information systems can increase error rates. Caregivers need a way to share critical patient information and knowledge in a timely and accurate manner, but quality healthcare is more than just data - it’s also experience. Clinicians need tools which will connect them with peers who have a deep understanding of the ailment and an additional perspective on the condition or patient’s history.

Constant innovation and training. The relative absence of real-time connectivity between clinicians means that healthcare has the opportunity to benefit from the “network effect” that other industries have utilised to share skills and knowledge, where much like the fax machine or Internet, the more people in the network, the more valuable it becomes. Clinicians may not be able to read every journal article that is published, and may only able to really share knowledge at annual conferences, which require time out of the office. Healthcare organisations can find it expensive to educate staff in remote locations. In a knowledge-driven industry like healthcare, efficient access to up-to-date information, insights and colleagues is critical to success. Therefore,

workforce development requires an effective communication and collaboration system.

Eliminating islands of communication between healthcare teams Envision a world where modalities for both real-time and asynchronous communication begin to merge on the desktop, PDA or Smartphone. Imagine doctors scheduling a virtual consultation with colleagues as easily as they can schedule an appointment in Outlook today.

As clinicians become even more mobile, Unified Communications enables employees to spread across the group’s network to connect with their colleagues in remote environments and access critical patient records, medical information and opinions from the devices and applications they know and use every day.

Unified Communications enables knowledge to be shared real-time across geographical distances. These tools create peer to peer networks which will facilitate more instantaneous knowledge-driven decisions, resulting in greater efficiencies in health systems and improved outcomes for patients. Healthcare is benefiting from the fact that Unified Communications tools have become commodities, which means price points are now well within budgets.

To understand how Unified Communications can be used

Real time communication

Live Conferencing

Care team

Office Communicator

November 2008

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By taking advantage of robust information technologies including Unified Communications... we can empower caregivers to collaborate and communicate with one another to provide more accurate, effective and accessible care to patients. by caregivers in day-to-day work, look to a hospital intern making daily rounds in the hospital, who suddenly needs an urgent specialist consultation for a patient.

Using Office Communicator on a Windows Mobile-device, the intern can get an immediate view of the doctors in the hospital directory and their areas of expertise. The intern can reach beyond the specialists they personally know and access a range of available people with appropriate skills.

With real time “presence” status updates, he can see immediately if someone can take a message or a phone call - and doctors can set up rules on how, when, where, and on which devices they want to be contacted.

Specialists will show up as unavailable when in the operating theatre or on rounds, as desired. But the intern now has a range of other specialists to seek counsel from that are available and can respond. He can then seek advice through an Instant Message (IM), telephone conversation, instant video conference (even from the mobile device) or simply by sending an email for less urgent questions.

Care teams can consult colleagues in other locations on patient care and treatment options by starting a Web conference in Instant Messenger. Their contacts could be in another part of the hospital, another city, or in a different country altogether.

What this means for caregivers today is that they are no longer restricted to the telephone for communicating with colleagues or patients around the world – they can choose what works best based on the need for a quick question, an in-depth inquiry, or a back and forth exchange. No more waiting on hold or playing phone tag. Furthermore, as communication technology converges to the computer and is increasingly facilitated by the Internet, a doctor’s choice of devices opens up. The office telephone, mobile Smartphone, Pocket PC, laptop, Tablet PC or desktop PC will all be able to do the same job for any need, be that instant message, e-mail, voice, or video communication. These Unified Communications solutions are robust, affordable and effective today.

Looking to the future, this technology will also have a 16

profound effect on the way hospitals conduct meetings and training in the future. The use of multimedia Web conferencing and interactive e-learning technologies will absolutely explode in healthcare as we increasingly communicate electronically in the office and at home for grand rounds presentations, staff training, patient education, and more. Finally, advances in speech recognition and the incorporation of speech recognition technology into Unified Communications will open up new vistas for securely accessing patient information and relaying clinical orders – and steps taken today to integrate this technology into patient care will continue to deliver enhanced capabilities in the future.

Success Exemplified How can healthcare providers aid their patients today?

Eastern Health in Victoria, Australia, is an example of a hospital that is leveraging Unified Communications to enable healthcare providers to go the extra mile for patients. The organisation provides public healthcare services to a population of 800,000 people across an area of 2,800 square kilometres.

With more than 7,000 staff working in five hospitals, Eastern Health relied on e-mail and voice mail to communicate with its practitioners. But the hospital needed an integrated messaging solution that could streamline collaboration and cut operating costs. To keep costs down while bringing more providers onto the system, Eastern Health wanted to expand the reach to their significantly mobile fleet, where workers often keep in contact using a range of handheld mobile devices and phones. Eastern Health was able to deploy a solution that could be integrated with other existing applications such as IM, and would allow the implementation of audio conferencing using voice over IP (VoIP) in the future.

With Unified Communications, Eastern Health successfully created an environment that enables Eastern Health staff - both in hospitals and on the road - to easily stay in constant contact, and use their time effectively to deliver improved patient care. By taking advantage of the integrated voice-mail capability in Microsoft Unified Communications solution, caregivers can now retrieve both voice mail and e-mail from a telephone, or retrieve voice mail from their computer. Finally, healthcare providers at Eastern Health are able to locate medical personnel much more effectively than with e-mail, thanks to presence management.

What the future holds Today’s progressive businesses use a wide variety of tools and technologies to facilitate communication, and we have an opportunity to extend this into a healthcare setting. By taking advantage of robust information technologies including Unified Communications, we have the opportunity to transform healthcare and improve patient care. We can empower caregivers to collaborate and communicate with one another to provide more accurate, effective and accessible care to patients. Medical science is a knowledge industry and patient care is about helping people. Unified Communications brings knowledge and people together to meet marketplace demands while improving patient health. www.ehealthonline.org

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IN P E RCSOP N E CVTE IRVSEA T I O N

Scripting success

- A fresh perspective on clinical reporting It is imperative that IT Administrators, CTOs, CIOs and Representatives from Clinical users make an informed choice while selecting a software product for EMR. However, amidst talk of difficulties in implementation, lack of standards, mindsets, challenges of change management etc. product design aspects of EMRs often take a back seat when it comes to informed decision making for a hospital automation committee. eHEALTH tried to explore the technology perspective of Clinical Reporting and Analysis systems with Director and Solution Architect of 21st Century Health Management Solutions, Ravi Mani.

Ravi Mani Director and Solution Architect 21st Century Health Management Solutions

Q. How do you compare IT systems for clinical areas with other relatively mature business areas?

A. To design and deliver a clinical reporting system that will cater to the needs of the healthcare market is a challenge.

Unlike business applications where the processes and entities are fairly standard across the world, software products for clinical reporting face different challenges. If one has accurate insight into real challenges, explores the existing approaches and applies technology that best suits the particular challenge one can always arrive at a solution.

Since we believe that technology is not a limiting factor. Of course implementing correct technology to convert a solution it into a widely adopted system by the users is also an equally important ingredient but my focus would be on the choice of technology.

Q. Correct me if I am wrong, but I think that any system can be automated if the logic is known. Why should medical science be an exception? It may be vast but I am sure it is well documented.

A. Yes the clinical flow is well documented, but it is not followed in practice the same way. It is as much an art as it is science. Doctors have to take split-second decisions when a patient is fighting death. Doctors do not have adequate infrastructure available all the time to meticulously follow documented process and they have more reasons to justify why the process cannot apply rigidly in care.

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Let’s dig it a bit deeper by focusing on the data clinicians need to capture. Various specialties of medical science require different information to be captured. There are no universal standards that are followed by all doctors, especially in countries like India. In fact, the problem is so severe that even within one specialty of a hospital, the doctors find it difficult to come to an agreement on the clinical data that needs to be captured.

The granularity of data depends on the extent of specialisation of the hospital. That is to say that the data requirements of a Cardiac Department in a multi-specialty hospital would be lesser than a Cardiac Speciality hospital.

This is because a Cardiac Specialty hospital would in all probability be involved in research and hence, the data requirements would be far greater.

Regional data requirements also vary depending on the disease profiles of the region.

Q. That’s true but software can always be tailored to any specific data requirement.

A. Specialists have designed and developed intricate systems for various medical disciplines. However, because of the above-mentioned challenges, such a system would inherently need extensive customisation and the system would fail to remain a product but will become a project leading to consume huge time and cost.

If you notice Enterprise Resource Planning (ERP) systems that have covered verticals such as banking, finance, www.ehealthonline.org

Figure 1.

manufacturing and many more, you’ll realize that this could be achieved because the extent of standardisation of the process is very high in these business areas. So the challenge of customisation seemed surmountable. So a single, allencompassing product developed with conventional design methods is fine. But this has not worked so far for clinical systems and will not work in future either.

If we forgo the product concept for clinical systems and try to develop a system as a development project from scratch we will only be jumping from the frying pan into fire! This approach also suffers from the fact that the users of the system have to depend on the vendor for any change that they might need from time to time or any analysis that they wish to perform on the data if it is not already available in the system.

Q. So what could be a solution that would allow vendors to create a product, while allowing the hospital to customize as required?

A. What is needed is to give the user community a system that they themselves can configure the way they want. The product should be a tool rather than a tailored solution, something that can be referred to as a ‘framework’. A framework can give standard templates, which the users can change. They may even create completely new templates for clinical data capture.

Q. We have a direction of the solution. Can you elaborate on the technical aspects of the framework?

A. The framework should allow IT Administrators and doctors to define the fields that they wish to capture. The fields could be simple like text, numbers, selection from November 2008

a list, dates etc. Such entries are typically required for OP consultation. The fields could also be complex like a table, the columns of which could again be either text, numbers, selection from a list, dates etc. Nursing charts that require periodic measurements can find this suitable.

They should be able to present hierarchical data structures by relating multiple tables that they have defined in the data capture form. Clinical data is typically hierarchical. Each visit is grouped under the patient’s name, and main aspect of data collection, such as patient history, family history, symptoms, signs, diagnostic findings and so forth are grouped under visit.

The data can be an object attached at any level in the hierarchy. It could be a scanned image, drawing by e-pen or also a pdf file downloaded from the Internet. All these inputs need to be accepted by the framework.

In other words, the users should be able to build a complete data capture form without having to code and compile programs, while at the same time be able to define simple rules like specifying mandatory fields, conditional data capture etc. And this is the principal differentiating factor from conventional systems that address all challenges imposed by clinical systems effectively.

Of course there are other critical technical aspects of the framework even after doing away with data capture issue.

These are:  To link to any conventionally developed system like Hospital Information System where the Patient Master Index would be residing because all the clinical data that is being captured has to be recorded against a patient.  It is not enough to only link all the data to the right patient but all points of Care need the data whenever and where ever needed by the service providers. These requirements will be specific and not all the data captured.

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Patient-desktop for OP, Nursing, ICCU, Treatment planning. Unless this is easy and effectively implemented, users can never be expected to capture data regularly.  Textual summary of the data captured is equally important as the users can have the ‘feel of’ case sheet in a single document for each encounter. It should be possible to print encounter summaries using the user-defined fields in the output document.  Lastly, the system should provide very flexible tools for analysis on any of the fields defined by the user for academic / research purposes, statutory reports etc.

Q. We agree that customisation needed by other systems such as ERP is not as extensive as clinical systems but every system needs some customisation.

Many of the ERPs provide extra fields in their databases that are preserved for future customisation. Is it not the same as what you mean by the framework?

Hence, we can send new product updates and upgrades to our customers without affecting their data definitions.

Once we decided the approach, we built an engine that allows the users to define complete new forms with simple and complex fields and having any number of hierarchies.

The engine provides all the necessary options to save a record, retrieve an existing record, navigate, define an output document (using Word template) as well as provide Excel based analysis of the data that is entered. The engine is tightly integrated with Microsoft Office as MS Office supports XML data. Also, because MS Office is extremely popular, users find it easy to change the outputs from the system without depending on us. The engine also provides a Patient File screen where all the encounters of consultation, investigations and procedures are chronologically listed and the details of which can be drilled through from the screen.

A. This is a typical response after the first look at framework. But the limitations with ‘predefined-extra-fields’ approach are that:  The number of fields is limited by the designer and clinical systems need much larger flexibility than this.  Incorporation of such fields may not require change in data base structure till one exhausts all extra fields, but it still needs compilation and re-deployment of the software.  Some vendors may allow users to define fields on the fly and create the fields in the database. But this approach fails since the vendor can never send a product upgrade as the original data structure that the vendor had made would remain the same.  Pre-allocation of fields until they are actually used is highly inefficient.  Hierarchies of data cannot be created by the user.  User defined lists are generally not possible with this approach.

Q. That really makes a big differentiation. But how can all this be achieved?

A. We at 21st Century have come up with a completely new approach using the XML technology. XML lends itself for unstructured data organisation while providing fast querying techniques. XML has been adopted by the major relational database vendors like Oracle and Microsoft and has become a universal standard.

The main advantage of using XML approach is that our database structure does not change even if users add new fields in the system. This is because such user-defined fields are not stored as separate fields in the table but as part of a single XML field in the table. This is where the challenge of customisation gets solved with innovative technology.

And the best part is that the data which appears unstructured and dynamic to the end user, is actually well organised, analysable and efficiently stored in the database with XML. 20

Figure 2.

Using this engine, our in-house panel of doctors create standard templates as part of the product for various specialties and this is distributed with our product. But, because of the features provided, users can use existing templates and change them as per their needs or create new templates of their own. Figure 1 and 2 are some examples of the forms developed by our customers using the engine.

The main philosophy behind the XML based engine is to empower end-users to get what they want without depending on the software or the solution provider. That will ensure a sustainable mechanism through a ‘product’ that addresses EMR for fast scalability.

For more information visit - www.21chms.com www.ehealthonline.org

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compelling reasons .. .

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Our Network

India : Mumbai • Delhi • Kolkata • Bangalore • Hyderabad Overseas : Kuwait • Dubai • Kenya • Singapore • Kuala Lumpur

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CU OR VV ER YR T S E YS T RO E PR O

PART 3 - South and Central India

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Madhya Pradesh, Karnataka, Kerala, Andhra Pradesh, Tamil Nadu

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outh India, where the major part of our survey took place, has some of the best indicators in terms of governance. The region as a whole has done much better than the rest of the country in the past as far as literacy, health, education and stability are concerned. The single biggest factor leading to the stagnation in the region is the lack of investment. Kerala especially, due to various inefficiencies and rigidity, may lose out on a great opportunity to tap the tourism and high-end healthcare market.

All is not lost, however. With a slew of private IT and medical institutions, there is the raw material available for building a robust health IT market. Poorer sections of the population are increasingly resorting to private suppliers for both hospitalised and non-hospitalised care. Public-private Patnerships (PPPs), which signal the

changing roles of the government and the private sector, are being popularised. PPP is defined more specifically as a financing modality that involves the deployment of private sector capital to build socio-economic infrastructures to improve public services, or the management of public sector assets.

Figure 1: Distribution of Hospitals by Type

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Kerala - God’s own country has traditionally been shown off as an example of how things should be done. The public health system here has a wide coverage and has been sustained by a literate and aware public. However, the government is deep in debt and this financial crisis is taking a toll on growth and investment. The fiscal deficit has doubled in the past 10 years and the public health system has not been able to keep up. Public expenditure on healthcare has fallen from 1.14% to 0.99%.

Most small and medium size hospitals were using local vendors due to price factor.

However the trend is changing since they are unable to get reliable support and are looking for better solutions to handle increasing demand from users.

Jose E. S, CEO - Coresys

partnerships which are poorly regulated. The budget for 2008 has a INR 20 crore health insurance package for the poor, but it is still to be seen if this will make any marked difference. The state government is actively trying to promote IT Parks in Kochi and Ernakulam.

Figure 2: Driving Forces of Automation

Foreign investors shy away from the state – a pity because Kerala has tremendous potential in the area of medical tourism. There are currently efforts on by the government to promote IT hubs in the state, but this will require dedicated resources and good planning. A comprehensive reform package is the need of the hour. From the Kerala experience, we learn that proper implementation and periodic review is mandatory before experimenting with private-public

Figure 3: Advantages of Using IT

November 2008

Andhra Pradesh - Andhra Pradesh aims to achieve INR 69,000 crores in software export turnover and seeks to create employment for 3 lakh employees directly. In December 2004, Gartner in its report “IT Outsourcing to India – Analysis of Cities” mentioned that Hyderabad would be IT Hotspot by 2010 and has rated it high on account of infrastructure and human resources. People in Andhra Pradesh have access to the emergency 108 line - a service active in only 3 states in the country.

Figure 4: Preferred Solution 23

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Indore Urban Health Programme Siddharth Agarwal (Environmental Health Project, USAID) , Sandeep Kumar (Urban Health Resource Centre) and Prabhat Jha (Urban Health Resource Centre)

The USAID supported Environmental Health Project initiated an Urban Health Programme (UHP) in 2002 for Indore which involved local stakeholders to identify a total of 539 slums beyond the official list of 438. Through a health vulnerability assessment exercise the most vulnerable areas of the city were identified to consciously focus more resources there.

Indore, the economic capital of Madhya Pradesh is also its most populous city. The decadal population growth (1991–2001) has been 47% with a burgeoning slum population (Census 2001).

The total slum population of Indore is estimated at over 600,000 inhabitants, approximately onethird of the total population of 1.8 million in 2001. Based on the urban health situation analysis of Indore, participatory planning with stakeholders in the city and the slum assessment exercise, two partnership programme approaches were implemented in Indore.

Ward Coordination Model This approach was also experimented with as a part of the Indore Urban Health Programme in Ward 5 with a slum population of over 50,000. This is a public sector driven approach, focusing at supply/service improvement targeted at immunisation outreach. As a part of this model the EHP (Environmental Health Project) has facilitated convergence of government and non-government bodies, private agencies, community groups and charitable organisations to conduct regular outreach in all vulnerable slums initially of Ward 5 of the city of Indore (which is divided in 69 administrative units or Wards). The Ward coordination committee meets once a month to review progress and develop strategies to utilise local resources in a complementary manner.

Since November 2003 through coordinated action, immunisation camps have organised each month with steady increase in coverage. Seven camps are held each month, 3 by the NGO and 4 by the Health Department covering 26 underserved slums (approximately 40,000 population) in the Ward. The Ward Committee is collaborating with technical experts from the Indian Academy of Pediatrics and the National Neonatology Forum for enhanced quality of services and community counselling. The main learning from this extensive programme is that all slums are not equally vulnerable. Many of the more susceptible ones are hidden from policy attention. These need to be identified and prioritised in the implementation of health and other welfare programmes.

Involvement of the universe of stakeholders is necessary to ensure optimal utilisation of resources and avoid duplication of services. Building linkages between the service providers and underserved slum communities through their representatives in the form of CBOs ensures increased willingness and demand for services at the slum level, matched with provision of quality services to meet this demand. Empowerment of slum communities is imperative for enhancing the quality of urban life.

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Source: http://3inetwork.org/reports/IIR2006/Social_Infra.pdf

NGO-CBO Partnership Model This model aims at demand generation for healthcare services by building social infrastructure and linking slum communities with public and private, maternal and child health (MCH) facilities. Five NGO–CBO consortia are taking this cause ahead in 75 slums covering 125,000 inhabitants. The NGO–CBO model has a 3-tier structure with the NGO building networks with service providers and offering supportive supervision, the LEAD CBO supporting capacity building and community linkage and the BASTI CBO representing the community and ensuring reach of services. Over two and a half years beginning April 2003 NGOs–CBOs have coordinated directly with Health Department and private/charitable institutions to organise at least 50 MCH outreach camps each month. There has been significant improvement in timely immunisation coverage, increased trained attendance in home deliveries and better infant feeding behaviours. Through NGO–IMC–Community linkage, renovation of toilet complexes has been completed in selected slums. The strengthened social infrastructure is evident from the health promotion and negotiation capacity of about 40 of the 88 Basti CBOs, most of which have been encouraged and strengthened during the programme period.

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With the availability of better security technologies and lower costs, smart cards have the potential for use in many applications, including in maintaining accurate health records. The state government has a stated policy of encouraging the use of Smart Cards and Biometrics.

Figure 5: Why medical records are in paper form despite implementation of automation software?

Tamil Nadu – Tamil Nadu has the best primary health indicators in the region. Of all the states surveyed, it has the highest number of maternity homes. Plans of making Puducherry an IT hub have not yet been realised. Still, the city has potential given the seven medical colleges and eight engineering colleges in the state. Tier-II cities, like Warangal, Visakhapatnam, Kakinada, Vijayawada, Guntur, Nellore and Tirupati have been identified for being promoted as IT hubs. For each IT hub in the State, Senior Officers of the Government have been appointed as Nodal Officers for handholding, to interact with the industry and provide requisite facilitations.

Madhya Pradesh – An infant mortality rate of 158/1000 (WHO, 2001), is indicative of the state of healthcare in Madhya Pradesh.

Figure 5: After implementation of software, are medical records still in paper form?

Karnataka - Medical colleges are mushrooming in Karnataka. However, with the shortage of good faculty, there are valid concerns about the decline in standards. There is especially a chronic shortage of human resources in the socalled backward areas or the northern districts. The post of Additional Director for communicable diseases needs to be strengthened. A good disease surveillance system at various levels including very strong district disease surveillance units is also needed.

Karnataka is implementing a user fee system in the health systems development hospitals. User fees are being charged for secondary and tertiary care. The positive side of the user fee is that if the BPL delineator can be guaranteed, the hospitals can have some discretionary funds available. This has brought about some miracles in the management of those hospitals. They have some money to buy whatever little they need - repairs, emergency medicines to be bought. Earlier even when a 15Amps plug had to be bought there was huge process. Now they get it purchase in one day.

Conclusion: Data on health infrastructure is sparse in general and more so in the case of urban health infrastructure. Despite continued investment in the urban areas infrastructure coverage in urban Asia is under pressure from rapid rural-urban migration. Even allowing for some wasteful expenditure in developed countries, we are certainly under investing in health.

Figure 6: Why the hospital changed its HIS

Watch out for Part IV of the IT@Hospitals survey in the December issue of eHEALTH, covering eastern India - West Bengal, Assam, Orissa For a complete list of surveys by eHEALTH visit: www.ehealthonline.org/survey

November 2008

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news review

INDIA

Sysmex, Transasia introduce products for Clinical Research sector Sysmex, the world leader in Haematology, in partnership with Transasia Bio-Medicals introduced recently the XT-1800i V & XT-2000i V (Veterinary mode), a fully automated Haematology analyser for High Quality Animal Blood testing. This instrument, it is said will be highly beneficial to India’s growth in the Contract Clinical Research sector and Pharmaceutical R&D. A lot of CROs and Pharmaceutical companies in India are working on development of new Drugs both independently and in collaboration with certain MNCs. There are very strict regulatory norms both in India and the US, which need to be followed. Animal testing is also mandatory to check the effectiveness of different compounds and their side effects. XT-1800i V and XT-2000i V Vet Analyser offers superior diagnostics for animal blood analysis thereby ensuring high quality standards to support clinical trials and drug discovery.

The unique feature of XT-1800i V and XT-2000i V Vet Analyser is its ability to analyse as many species as can be defined by the users themselves. The use of principle of Advanced Fluorescence flowcytometry ensures Efficient Quality Control. It also ensures the ability to trace and record all data without any possibility of overwriting the original data, which is in compliance with U.S. FDA. XT-1800i V and XT-2000i V Vet Analyser is a must for all veterinary universities, research labs, Veterinary Hospitals, Pharmaceutical Companies and Toxicological Labs involved in Clinical trials as it is Low maintenance and Robust analyser. Also most of the Companies involved in Clinical trials work in partnership with companies operational at the global level and have work going on simultaneously at different centers. They need to compile data in real time, which only Sysmex can offer by its online Quality Control of Sysmex Network Communication System (SNCS) - an Internet based online customer service, which allows maintainence of quality on Sysmex hematology analysers. Above all the direct benefit to all will be a better health and access to a subsidised Healthcare.

Escorts introduces 3D Trans Esophageal Echo in India Escorts Heart Institute and Research Centre Ltd. (EHIRCL), amongst the world’s largest standalone cardiac institutions, recently organised a symposium on ‘Emerging Techniques in Echocardiography’ at India Habitat Centre, New Delhi. Doctors from across Delhi and NCR came together for the session on the revolutionary 3D Trans Esophageal Echocardiography (3D TEE). Eminent cardiac specialist from EHIRCL like Dr. Ashok Seth, Dr. Savitri Shrivastava, Dr. Ashok, K Omar and Dr. Sameer Srivastava addressed the sessions sharing various case studies.

Dr. Navin C. Nanda, Director of Echocardiography and Heart Stations, University of Alabama, Birmingham (USA), spearheaded the session on clinical usefulness of the new 3D Trans Esophageal Echocardiography in the field of Heart treatment. Dr. Nanda was the first recipient of the Tufts University Award in Echocardiography and in 2006 received the Ellis Island Medal of Honour. 3 D TEE is the latest series of echocardiography imaging; this is a technique wherein ultrasound of the heart is done using the esophagus (food pipe) and stomach as a window vis-à-vis conventional trans thoracic echo, which is obtained by putting the probe across the surface of the chest. 3D TEE offers benefits like superior quality heart images, faster image acquisition for the heart treatment. Escorts Heart Institute and Research Centre Ltd. (EHIRCL), is one of the first to get this technology in India.

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Centre plans drug stores in all districts in India The government has decided to set up a retail network of drug stores across the country in public-private partnership that would sell 350 essential medicines at half the rate of its branded substitute. The project, being launched in 15 states in the first phase, would ultimately ensure at least one such store in every district of the country. The move aims at ending companychemist nexus, which tries to push costlier branded medicines to customers in the name of substitutes.

These stores would sell only good-quality generic medicines.

Generic formulations are identical to their branded counterpart in terms of dose, strength, efficacy and use.

It is learnt from official sources that the government has asked industry associations like Indian Drug Manufacturers Association, Organisation of Pharmaceutical Producers Of India, Indian Pharmaceutical Association, Confederation of Indian Pharmaceutical Industry and SPIC to join hands with it in its endeavour. Apart from private players, the government has also approached NGOs, chemist associations and state governments to participate in the project. While state governments are being sought to provide space for opening shops, chemist associations and NGOs are likely to play a major role in managing and promoting these shops in future.

There is a global shift towards use of generics as governments world-wide are making efforts to bring down escalating healthcare budgets. India has achieved a strong foothold in the global generics market. While in 2002 Indian companies accounted for less than 7% of all generic drugs approved for marketing by the US Food and Drug Administration, they accounted for over 20% in 2006.

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11 | 12 | 13 November 2008 Kuala Lumpur Convention Centre (KLCC) Kuala Lumpur, Malaysia As the Asian countries prepare themselves to tread the fast track developmental path, achieving excellence in healthcare systems and services and making them accessible for a majority of the population across the region, emerge as crucial pre-requisites.

Adding to that, the immense potential of this region to tap global healthcare markets through the healthcare travel industry, the need for modernisation of healthcare institutions, as well as making available advanced medical technologies becomes a pressing need.

Some of the contemporary advancements in communications, IT and enterprise automation technologies are bringing substantive advantage healthcare organisations.

Presenters & Organisers Initiated and presented by ‘eHEALTH’ magazine – a premier monthly publication on healthcare ICTs, technologies and applications, ‘eHEALTH Asia 2008’ is will bring together high level policy makers, healthcare managers, medical practitioners, institutional leaders and technology experts from across national health agencies, healthcare institutions, medical associations and technology vendors.

Strategic Partnerships & Collaborations ‘eHEALTH Asia 2008’ is forging strategic level multi-stakeholder partnership collaborations with national and international organisations having a mandate in healthcare and eHealth.

In this regard, the initiative has already been joined by partners such as the Commonwealth Secretariat, along with its healthcare and medical think-tank – the Commonwealth Medical Association.

The event further aspires to bring on-board government health departments, national medical associations, medical research institutions and healthcare service organisations in the Asian region.

• • • • • • • •

Focus Areas & Themes National eHealth Policy & Strategy Framework Country Case-Studies on eHealth Projects & Implementations Capacity Building & Training for eHealth Environment Emerging & Cutting-Edge Technologies in eHealth ICT-based Automation of Healthcare Operations & Management Data Standards & Interoperability for Health Information Exchange Online Applications for Consumer & Enterprise Healthcare Management eHealth Implications on Medical Tourism & Offshore Healthcare Special Panel

Commonwealth Ministerial Dialogue - Commonwealth Secretariat and Commonwealth Medical Association, with support of Ministry of Health, Malaysia will bring a top level delegation of Health Ministers from 8 Commonwealth countries in Asia, comprising - Bangladesh, Brunei, India, Malaysia, Maldives, Pakistan, Singapore and Sri Lanka.

The Ministerial dialogue will focus on exploring national eHealth strategies by sharing the vision of the top leadership and

Host Organisation

Gold Sponsor

Organisers

Presenting Publication

Supporting Partners

Contact Information Programme Enquiry: Dipanjan Banerjee (dipanjan@ehealthonline.org, M: +91-9968251626) Sponsorship and Exhibition Enquiry: Arpan Dasgupta (arpan@ehealthonline.org, M: + 60163457531) http://www.e-asia.org/2008/ehealth/index.asp

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CSIR launches collaborative research for anti-TB drugs

Govt puts clinical research approvals on fast lane

India recently launched a unique collaborative programme to discover drugs for infectious diseases common to the developing countries.

The ‘Open Source Drug Discovery’ (OSDD) programme, launched by the Council of Scientific and Industrial Research (CSIR), aims to build a consortium of global researchers and bypass the patent regime, which makes drugs expensive.

To begin with OSDD, a brainchild of CSIR Director General Samir K. Brahmachari, has taken up research on discovering new drugs for treatment of tuberculosis, a field in which no major advancement in treatment has emerged since 1960.

“The normal process of drug discovery, through the patent regime, has not worked very well for diseases in our part of the world,” Science and Technology Minister Kapil Sibal told reporters here.

Inspired by open source movements like Linux and the human genome sequencing project, OSDD seeks to expand resources for research manifold by allowing collaboration among voluntary researchers.

CSIR has set up a website - www.osdd.net - as a platform for collaborative research, data on pathogens, tools for data analysis, and discussion forum for members to share ideas and projects for students to participate in drug discovery.

Laboratory experiments during this process will be carried out at CSIR-sponsored centres. CSIR has earmarked INR 150 crore for the OSDD project under the 11th Plan and an equivalent amount of funding is expected to be raised from international agencies and philanthropists.

The government has begun speeding up approvals in the area of clinical research, which is set to boom in India, say top industry sources. The clinical research industry in India is currently USD 200 million, but is expected to reach USD 1.5 billion in just two years.

The government is also planning on introducing fingerprinting of clinical trial volunteers to ensure better data from the trials and also regularise insurance claims by these volunteers.

Currently, only Indian pharma companies are allowed to conduct clinical trials from phase zero. Foreign firms are only allowed to conduct phase 2 and 3 trials in the country. But the DCGI plans to allow foreign firms to conduct phase zero and 1 trials also. This could definitely provide a boost to the industry and help it reach the projected number of USD 1.5 billion soon.

Balco to build INR 300 cr cancer hospital in Chhattisgarh The Bharat Aluminium Company Ltd (Balco), which is a part of the Vedanta Group, will spend INR 300 crore in building a cancer hospital and research centre here, officials said.

“The state government has given a 41 acre plot of land free of cost to Balco at village Saddu in capital Raipur to build the cancer hospital,” an official said. The land has been handed given to the company on lease for a 30-year period.

Balco will develop the hospital, the first of its kind in the state, within 18 months of the beginning of construction in November this year.

India’s ninth largest state in terms of area, Chhattisgarh has an estimated population of 20.08 million but lacks medical and health care facilities. Balco has assured the government that it will treat poor people for free at its hospital.

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The removal of service tax for CROs and customs duty on all imported drugs used in clinical trials has helped give this industry a boost. It has been noted that the clinical research industry is growing faster than the pharmaceutical industry today and research firms are getting into long-term partnering deals.

A Merill Lynch report has stated that India is a more economically viable destination to conduct clinical trials. The overall cost of conducting trials in the US is 2.5 times the cost in India.

The increase in health and allied infrastructure and the implementation of good clinical practices (GCP) guidelines, is another reason why companies across the globe are looking at India as an attractive destination for clinical research. KPMG’s latest pharma report states that according to the US National Institutes of Health, about 272 trials are actively recruiting patients in India. Of this, 60% are phase 3 trails. In March 2008, about 80 hospitals (both government and private) were estimated to be involved in clinical trails apart from the 290 clinical research organisation in the country.

Indian companies have shifted from paper trials to electronic data capture (EDC) trials. But even this, industry sources say, needs to be improved to compete with countries like China, which is also an aggressive player in the clinical research space.

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BUSINESS

GE enters home healthcare monitoring market GE Healthcare, a business of General Electric Co., is entering a potential USD 5 billion international market providing health monitors for the elderly who live alone. GE Healthcare announced recently an agreement with privately held Living Independently Group Inc., a provider of a wireless monitoring system to distribute monitors to seniors and develop new applications. Financial terms were not disclosed.

Omar Ishrak, President and Chief Executive of GE Healthcare’s clinical systems business, said the market for home monitors is now valued at about USD 500 million, but could grow to as much as USD5 billion in 10 years. The monitors, which are attached to walls in homes and assisted living centres, track the movement of elderly people who live alone, providing alerts if seniors fall or have medical emergencies.

The industrial and commercial conglomerate also is banking on future applications that could advance the technology. GE’s Global Research Centre in Niskayuna, N.Y., will work to develop monitors that track a person’s weight and blood pressure, follow a senior’s slowing walk and collect other data used for disease management. “If you look into the future, more and more care is provided in the home, though this market is small now,” Ishrak said. “The opportunity for growth is there.”

Wockhardt to open 7 hi-tech hospitals

Trivitron Healthcare launches ‘Pride’ series

Wockhardt Hospitals Ltd. (WHL), part of the INR 3,000 crore Wockhardt Group, is planning to expand its operations across the country.

The company will open seven new super speciality hospitals at major locations across the country and increase the bed capacity of some of its existing super speciality hospitals with an investment of INR 700 crore by 2010.

Currently, the company has 17 super speciality hospitals with over 2,000 in-patient beds across the country, four in Bangalore, three in Mumbai, two each in Nagpur, Hyderabad and Kolkata, and one each in Rajkot, Surat, Bhavnagar and Nashik.

After the expansion, total number of in-patient beds of the hospital will rise to 3,700.

Anil V Kamath, managing director, Wockhardt Hospitals, said, “We are planning for a pan-India presence in the next two years with commencement of operations in tier II cities. We will open seven new super speciality hospitals in Bhopal, Central Mumbai, Goa, Kolkata, Jabalpur, Varanasi and Bhuj by 2010.”

Chennai-based Trivitron Healthcare has announced the launch of its Pride Series, an array of “innovative” products researched and designed for the Indian health industry.

Dr. GSK Velu, Managing Director, Trivitron Medical System, told reporters that the company has set up a 75,000 sq ft manufacturing facility near Chennai to facilitate the design, development and production of the Pride series of products, divided into Cardiac Care, Critical Care and Imaging categories.

“We are also considering the products from our other Global facilities as based on our requirement,” he said adding that the products would cost 30-50% less than other brands operating in this segment.

The company had invested INR 20 crore on Pride series, eyeing a return of INR 100 crore within a year, he added.

Due to lack of enough government sops for the industry, Velu said it was predominantly import-oriented, with only INR 2,000 crore worth equipment of the INR 12,000 crore sized industry being locally produced.

With a view to promoting indigenisation of the industry, the government should come out with Medical Technology Parks of India (MTPI), on the lines of Software Technology Parks of India (STPI) where extensive research and development of medical equipment could take place.

Siemens wins one of the biggest orders for medical systems The Catholic Medical Center in Seoul, Korea has ordered a total of seventy systems of medical equipment from Siemens Healthcare. Worth around 40 million USD (appr. 28 million), the order is one of the biggest of its kind in the medical industry worldwide. Siemens will equip the departments for radiology, nuclear medicine, oncology, cardiology and emergency medicine in the 8 hospitals that make up the Catholic Medical Centre.

Siemens has also signed a service contract with the Medical Centre for maintenance, upkeep and permanent monitoring of the equipment.

One of the 8 hospitals, Seoul St. Mary’s Hospital, is still under construction and will be Korea’s biggest hospital once it is opened in April 2009.

Catholic Medical Centre will then become a mammoth multi-medical science complex where a 2,000-bed facility, research and education will take place. “The Catholic Medical Centre has long commanded a leading role in Korea’s medical care. Now we want to join in the top league worldwide, including by providing the best possible medical service by using the most innovative high-tech machines available,” said Director Rev. Matthias YoungSik Choi. The systems Siemens will be supplying to the Catholic Medical Centre hospitals include magnetic resonance and computer tomography scanners, angiograph, X-ray, fluoroscopy and ultrasound machines, as well as equipment for nuclear medicine, mammography and radiation therapy.

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Apollo Hospitals, Merck arm to set up diabetes clinics Apollo Hospitals group along with MSD Pharmaceuticals, a subsidiary of US drug major Merck & Co, is setting up “Sugar Clinics” to tackle diabetes in India.

Under this joint initiative, Apollo will provide the clinical infrastructure while MSD would supply products and processes.

The two companies signed a memorandum of understanding to this effect recently.

Apollo group chairman Pratap C Reddy, has proposed to set up 200 sugar clinics across the country. With each clinic costing up to INR 25 lakh, the entire programme involves an investment of over INR 40 crore.

“We will set up 50 clinics in the next six months”, Reddy said adding that all Apollo hospitals in the country would start offering these facilities in a month’s span. At present, two such clinics are operational in Hyderabad on a pilot basis. There is also a proposal to launch stand alone sugar clinics where the incidence of diabetes is high.

Stating that “this is a war against diabetes, which has reached epidemic level in the country”, MSD Pharmaceuticals managing director, Naveen A Rao, said that MSD was only providing backoffice platform for the programme and “there is no financial part to it”.

Fortis plans hospital in Hyderbad Hospital chain Fortis is looking to expand its presence by setting up a hospital in Hyderabad.

This apart, the company would take the inorganic route for growth here, said Daljit Singh, President, strategic and organisational development, Fortis.

Speaking at a healthcare and pharma conclave recently, he said, “We want to have a strong presence in the central part of South India. Hyderabad is our consideration.”

The group is not making any representation to the state government for land, he said, adding that Fortis Hyderabad was part of the company’s bigger plan to set up about 40 hospitals across the country with an investment of INR 1,500-2,000 crore.

“We are exploring all modes of growth including greenfield, brownfield, joint venture, merger and acquisition,” Singh said.

Apart from internal sources, it would raise debt from financial institutions or take the PE route.

There would be at least 10 hospitals in tier II cities. These would typically have about 100-beds and cater to about 85 per cent of the health needs in these cities. If need be, the patients will be referred to its hub hospitals in the metros. Fortis is keen on having centres of excellence and super specialities in the metros, he said.

Nuance buys Philips Speech Recognition Systems Philips has sold its Philips Speech Recognition Systems (PSRS) to US-based Nuance Communications for USD 96.1 m. Nuance says the deal is strategic, about ensuring it has the technology, relationships and market strength to take the lead in a rapidly expanding European market.

As a result of the deal, Nuance will add SpeechMagic to its existing portfolio of products, gain a customer base of over 8,000 customers, 100 integration partners and become the leading provider of health speech recognition systems in Europe. Steenhaut said PSRS’s extensive range of dictionaries and terminologies in different European languages were of particular value.

Headquarted in Vienna, Austria, PSRS is a leader in speech recognition solutions, especially in the European healthcare market. With the addition of the PSRS business Nuance says its combined healthcare business in North America and Europe should reach a projected turnover in excess of USD 410 m. Nuance says the European market for automated documentation solutions may be worth up to USD 2 billion.

By buying PRSRS Nuance will get a much expanded language portfolio and speech recognition vocabularies. PSRS currently offers 25 continuous speech recognition languages and 150 speciality foreign language vocabularies. Nuance gains a strong customer base, with more than 8,000 SpeechMagic deployments. These include many UK NHS Trusts, several complete health regions throughout Spain, Norway, Denmark and Italy and hospitals in the Benelux, Germany, France, Sweden, Finland, Austria, the Middle East, Asia Pacific and Latin America.

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Carestream assists EU R-Bay project

TI delivers breakthrough power efficient AFEs

Carestream Health is acting as a major technical infrastructure provider to the EU-funded R-Bay validation project, which aims to address the uneven spread of radiologists across member states.

Carestream Radiology and Information Management Solutions are driving the initial test platform for the project by facilitating remote reporting of images from hospitals in Denmark, Finland and Czech Republic by clinical providers in Estonia, Lithuania and the Netherlands. The R-Bay project is paving the way for the creation of a unique internal eMarketplace for eHealth services in Europe that will act as a cross border commodity brokering and exchange place.

The eMarketplace will enable the sale and purchase of remote viewing, consulting and second opinion services across organisations, regions and nations, enabling pan-European distribution of radiologist resources across trusted and secure networks.

“Carestream Health has wide experience in system integration and the interoperability issues associated with implementing national and regional solutions, such as the Scotland National PACS project, Baltic e-Health project and Uppsala region of Sweden,” said Ulf Andersson, Marketing Director, Europe North, Carestream Health.

Texas Instruments Inc. (TI) recently introduced two new integrated analog front ends (AFEs) for handheld ultrasound systems. The industry-first 16-channel AFE5851 and the 8-channel AFE5801 bring breakthrough power efficiency and smaller footprint to support the new market for hand-held ultrasound systems that can fit in a doctor’s pocket.

The new AFE5851 features 39 mW/channel at 32.5 MSPS and integrates 16 variable gain amplifiers (VGAs) and eight 12-bit, 65-MSPS analog to digital converters (ADCs). The ADC is shared between two VGAs and each VGA differential output is sampled at alternate clock cycles to optimise power efficiency. The ADC has scalable power consumption to further lower power use with lower sampling rates. The AFE5851’s high channel count and low-power features allow for increased channel density in handheld ultrasound systems.

The second new device, the AFE5801, features 50 mW/ channel at 30 MSPS and 58 mW/channel at 50 MSPS and integrates eight VGAs and eight 12-bit, 65 MSPS high-speed ADCs with LVDS data outputs.

Both the AFE5851 and AFE5801 can be preceded by a transformer or an off-chip low-noise amplifier, which can be located on the probe. This new architecture results in at least 40% power savings when compared to other devices currently available on the market.

Sectra to provide radiology system throughout Northern Ireland “Our radiology solutions create a highly productive desktop and workflow environment and our IMS solutions go beyond conventional storage functions to provide efficient, intelligent management of patient data. As part of the R-Bay project, these solutions will ultimately help to better distribute radiologist resources to offer all patients in Europe the opportunity to access optimal medical care through panEuropean imaging services.”

To manage the project and meet the overall objectives, Carestream Heath will work closely with Finnish IT provider Mawell, who are responsible for providing the central eConsultation workflow portal. A portfolio of four services will be offered under the consultation portal - eInterpretation, eProcessing, eArchiving and eTraining. To facilitate these services, Carestream breakthrough thin-client architecture is being scaled to create a virtual cross border community, all within the same software framework, for efficient and secure sharing of patient clinical information.

R-Bay is utilising the latest version of Kodak Carestream PACS that offers optional integrated applications such as image fusion and orthopedic surgical templating in addition to native 3-D imaging and advanced cardiac features.

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The Department of Health, Social Services and Public Safety in Northern Ireland will implement an integrated solution for managing radiology information and images (RIS/PACS) provided by the Swedish IT and medical-technology company Sectra through a ten-year agreement.

The solution will be used throughout the entire public healthcare system in Northern Ireland. The contract is valued at £30 million and represents Sectra’s largest order to date.

Within radiology, the need for increased efficiency is expressed by hospitals’ demand to process more information, faster and at lower cost without compromising quality in patient care.

This creates a demand for efficient integrated RIS/PACS solutions that enable sharing of information and reading of images generated at several hospitals.

“This major project is unique in the way it links together so many hospitals for a totally seamless workflow of images and information throughout their entire public healthcare system,” said Jan Wolffram, Managing Director of Sectra in the UK and Ireland. Northern Ireland has about 1.8 million inhabitants and nearly one million radiology examinations are carried out every year. The installation is of significant size including some 25 hospitals, organised in five trusts.

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WORLD

Now, cancer diagnosis in 15 minutes

EU consults on ICT 2020 research strategy

Diagnosis of life-threatening diseases such as cancer may become a matter of minutes as scientists have developed a new bio-sensor technology, which they claim provides results within 15 minutes.

“The technology uses antibodies to detect biomarkers - molecules in the human body which are often a marker for disease - much faster than current testing methods,” said co-researcher Paul Millner from the Faculty of Biological Sciences at the University of Leeds. The researchers are hopeful that the technology could be developed into a small device similar to a mobile phone into which different sensor chips could be inserted, depending on the disease being tested for.

“We’ve designed a simple instrumentation,” Millner said, “which will make the bio-sensors easy to use and understand.

They’ll work in a format similar to the glucose bio-sensor testing kits that diabetics currently use.” Currently, blood and urine samples are tested for disease markers using a three-decade-old method called ELISA (Enzyme Linked Immunosorbant Assay).

The method, considered costly, takes more than two hours to complete and requires technical expertise.

“The new technology could be used in doctors’ surgeries for more accurate referral to consultants and in hospitals for rapid diagnosis,” he said. Tests have shown that the bio-sensors can detect a wide range of diseases, including prostate and ovarian cancer, stroke, multiple sclerosis, heart disease and fungal infections. It also holds prospects for testing tuberculosis and HIV, the researcher claimed. The technology was developed through a European collaboration of researchers and commercial partners in a project called ELISHA.

The European Commission has launched a public consultation into its ‘no-holds barred’ ICT research and innovation strategy over the next decade up to 2020.

The new ICT strategy promises to address key weaknesses in Europe’s ICT industry and markets, as identified in the recent Aho report.

Contributions from industry, ICT experts, policy-makers and the wider public are sought to inform the new strategy for the new EU ICT research and innovation, to be unveiled next year. The Commission has specifically identified health and ageing as areas that will require imaginative ICT solutions. Over the past 15-years the EU has invested almost 1 billion in eHealth research and development.

The aim of the 2020 ICT strategy will be to put European ICT industry, especially SMEs, to the fore of the race for global competitiveness.

The public consultation is open until 7 November 2008. “ICT is the primal force for innovation and development in the global economy, which is why Europe must attract investments in ICT research and development and the best minds and ideas,” said Viviane Reding, EU Commissioner for Information Society and Media. Reding added, “We also face challenges in energy, health and ageing that can only be tackled if we deploy ICT solutions.”

This consultation is part of the Commission’s response to the report by former Finnish Prime Minister Esko Aho (MEMO/08/430), which found key failings of current ICT research and innovation in Europe.

The Aho report found Europe is under-performing in both the level and intensity of its research and innovation investments. Internationally 33% of research and innovation in developed economies worldwide is in ICT, but in Europe it accounts for less than 25%, mainly because it is highly fragmented. Furthermore, the EU represents 32% of the global ICT market, but European firms only take up 22% of the global market.

Vodafone and Spanish Red Cross partner on 3G care The Vodafone Espana Foundation, the Spanish Red Cross and Qualcomm, have joined together to launch a project using 3G broadband technology to trial new ways of connecting elderly people in Spain to their family and friends. Called ‘3G Connecting Generations’ the project will use 3G mobile broadband technology to deliver services through voice and videoconferencing using media devices already familiar to them, such as mobile phones and television. Some 180 elderly people will participate in the pilot, of which the majority live alone and far from their families. The initiative also involves family members or day centers from more than 10 provinces in nine independent communities.

The trial will test how improved communications will allow them to remain independent for longer in their own homes. By using the videoconference system, participants in this project can establish personalised video communications with the Spanish Red Cross’s Contact Center, which answers their questions and support them with consistent social interaction. Through the Contact Centre the Red Cross can also conduct personalised follow-up video calls to check the health and well being of participants in the trial. In addition to communicating with the Red Cross and family members, the project enables participants to use their 3G video communication platform to meet and communicate with other people in order to expand their social circle. They can also use the 3G links to download multimedia content, including physical exercise videos and interactive games, designed to help them stay active. Qualcomm is supporting 3G Connecting Generations through its Wireless Reach initiative, designed to bring 3G technologies to underserved communities around the world.

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iSoft India gives shape to world’s largest health project Healthcare software provider iSoft has said that its Indian R&D team is developing a solution that it described as the world’s largest civilian IT healthcare project.

The Lorenzo software application, which will link nearly two-thirds of the hospitals in the United Kingdom, will also be launched in Europe, Australia and Germany in November. Hospitals will also be connected to general practitioners, allowing patients in the UK to get themselves treated at any clinic in the country without the need for re-entering data. The solution can be extended to any part of the world, said the company. The entire solution, for linking up all the hospitals as well operations with the hospitals is being developed and rolled out from the India development centre.

Some 900 people from its Indian R&D team are working on the Lorenzo project. In India, iSoft has tie-ups with Artemis Hospital of Apollo Tyres in Gurgaon and the Satya Sai hospitals in Bangalore and Puttaparthi. The company is also installing solutions for the Medicity group in Gurgaon and is targetting adding 100 hospitals to its list of clients next year. iSoft, which has 1,800 employees at its Bangalore and Chennai facilities, will hire 200 more by next year. It has grown by 50% in the last 12 months. Mr Govind said. The company closed its disaster recovery centre in Hyderabad early September and moved the operations to Bangalore and Chennai. About four-fifths of iSoft’s USD 500-million revenue in 2007-08 came from Europe, while Asia, Australia and New Zealand accounted for the rest.

GE announces healthcare initiatives GE Healthcare, the USD 17 billion healthcare business of General Electric Company, has announced healthcare initiatives targeted at early health care in the country, including a tie up with four partners.

Speaking at the Early Health Care Summit, V Raja, President and CEO, GE Healthcare India, said GE has tied-up with Manipal Heart Institute for mobile cardiac screening and entered into a similar tie-up with Vivus to deliver cardiac care to rural patients.

GE has also tied up with the NGO NICE Foundation for sustainable healthcare in maternal infant care, diabetes and IP care and has partnered with Grameen Health, a part of the micro financing unit, to help address needs of four billion people globally living on annual income less than INR one lakh.

GE and NICE would work towards creating new benchmarking healthcare models for creating sustainable healthcare delivery model in maternal-infant care. Infant mortality is 56.72 for every 1,000 babies born in India; some 12 lakh infants die during the first month of life, which is one fourth of the global number; every minute a mother dies in India, which is otherwise preventable. Twenty five per cent of the world’s childbirth happens in India yet it is one of the most neglected care areas, he said. These new healthcare models while delivering quality care will explore the possibility of innovative new technology, which are simple to use, portable, battery operated and economical.

Dell, Intel and Motion team up on health IT Global IT firms Dell, Intel and Motion Computing have launched a new service to assess, design and validate the quality and coverage of wireless networks soon to become the backbone of health care information flow.

The new Mobile Point of Care (MPOC) Wireless Assessment service enables health care customers to assess their wireless networks reliability and can provide 100% coverage and 24/7 access to patient information.

The service provides a comprehensive wired and wireless network analysis, design and validation to help ensure customers have a robust wireless network.

The ability to assess and treat patients using mobile technology is a growing trend across the healthcare industry. By 2010, 80% of hospitals are expected to have a wireless network, investing close to USD 10 billion in the next five years.

With that significant investment and patient care on the line, it is critical that hospitals have highly reliable wireless networks. Today’s hospitals are complex technology environments with many users on a variety of mobile devices that are continually moving from room to room. Making a service like this that helps ensure seamless connectivity that supports interoperability is key to caregivers’ ability to efficiently deliver high-quality care.

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PERSPECTIVE

ICT Facilitated

NABH Accreditation An NABH accreditation marks a milestone in any hospitals growth story. Typically a healthcare organisation is evaluated against 100 standards and 503 objective elements contained in 10 chapters. The following approach paper enumerates ICT functions that are taken into account for in the accreditation process.

Dr Vinoy Singh Head - Health Informatics Srishti Software

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ational Accreditation Board for Hospitals (NABH), a constituent board of Quality Council of India (QCI), have come up with standards for accrediting Hospitals with an aim to provide a framework for quality assurance and quality improvement. The intent of the standards is to provide information to patients about the level of healthcare an institution can or cannot provide.

NABH standard definition covers 10 criteria groups – first five are patient centric and the next five are organisation centric.

Relevant ICT technologies/functionalities facilitating compliance to these standards are mentioned below, grouped as per NABH criteria.

1. Access, Assessment and Continuity of Care (AAC) Criteria Group Standards for ‘Registration’, ‘Admission’, ‘Discharge’, ‘Transfer’ and ‘Referral’ processes are covered in this group and are taken care of by using the Patient Administration System (PAS) module of a Health Management Information System (HMIS). This functionality forms one of the basic blocks of a modern HMIS (refer figure 1).

Standard Clinical Assessment, including alerts for Allergy, ADR and Critical Problems are greatly assisted by use of ICT. Life critical information related to Allergy or ADR once captured is available across all the points of care in a hospital,

Figure 1: HMIS Functionality Stack

November 2008

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thereby improving standards of care to a great extent and also preventing life threatening mistakes.

Standardised Lab and Imaging services are covered through Laboratory Information System (LIS) and Radiology Information System (RIS). RIS systems either standalone or as a part of a modern HMIS, consist of a Picture Archival and Communication System (PACS) Server which is connected to different workstations (refer to figure 2).

closely along with a ‘Medication Interaction Alert’ module and an ‘Electronic Medication Administration Recording (eMAR) module.

(Figure 3 & 4) 5.Hospital Infection Figure 4: Drug Interaction Alert Modules control (HIC) Two important HMIS modules which cover the standards covered in this section are ‘Central Sterilisation and Store Department’ (CSSD) module and ‘Bio Medical Waste management’ Module.

Figure 2: PACS Server integrated with RIS

2. Patient Rights and Education (PRE) Standards related to ‘Consent Recording/Archiving’ are an important constituent of this group. Using ICT can not only help print and use situation specific consent forms (using templates saved in the application) but also scan the signed forms and save it in the application, making them available across time and space.

6. Continuous Quality Improvement (CQI) An intelligent HMIS, which is capable of reporting ‘Key Performance Indicators’ assists in achieving the standards mentioned in this section.

7. Responsibilities of Management (ROM) It is very difficult to achieve these functionalities without ICT. A modern HMIS is capable of creating a hierarchy of ‘Roles’ with robust ‘Role Based Security Rules’ thereby ensuring proper accountable Hospital Management.

8. Facilities Management and Safety (FMS) A ‘Materials Management System’, which includes Stores Management, takes care of all the processes related to Equipment and Devices life cycle.

9. Human Resource Management (HRM) A standard functionality mapping of an HRM module in an HMIS is necessary to meet these standards.

10. Information Management System (IMS) A modern HMIS takes care of the information needs of the care providers, management of the organisation as well as other agencies that require data and information from the organisation.

Figure 3: eMAR Module

3. Care of Patients (COP) By using speciality specific Clinical ‘Packs’, ICT ensures a standardised delivery of clinical care across all locations and departments of a hospital. Using Clinical Process Guidelines (CPG) modern EHR systems provide a ‘workflow template’, using which healthcare professionals traverse a pre-charted path and thereby ensure a standard model of care.

Figure 5: EHR in the centre of Healthcare universe

4. Management of Medication (MOM) Healthcare professionals need assistance while choosing a medication from a large list of medications available with respect to Drug Interaction and ‘Individual Sensitivity’. This is usually very difficult to achieve if the process is manual and the consultant is relying totally on his memory. Modern HMIS take care of this need through a ‘Pharmacy’ module working

Complete and accurate medical record is maintained for every patient, which also covers ‘Continuity of Care’. Confidentiality, integrity and security of information are maintained. Policies and procedures related to retention time of records, data and information can be enforced. Medical Audit can be performed. EHR functionality is shown above (Figure 5).

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TECHNOLOGY TRENDS

Fighting Pain

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he first recipient of the Eon Mini - the world’s smallest and longest-lasting, rechargeable neurostimulator to treat chronic pain of the trunk or limbs and pain from failed back surgery, was Adam Hammond. Hammond was skydiving in 2006 when his parachute did not deploy correctly. He hit the ground at a speed in excess of 45 miles an hour.

Even with its small size, the Eon Mini neurostimulator has the longest-lasting battery life of any rechargeable spinal cord stimulation (SCS) device in its class. It is the only small rechargeable neurostimulator to receive a 10-year battery life approval by the U.S. Food and Drug Administration (FDA).

For patients, this means the device should provide sustainable therapy and maintain a reasonable recharge interval for 10 years of use at high settings. The device’s battery longevity also means that patients require fewer battery replacement surgeries. The charging system is fully portable.

Pain management through neurostimulation systems work in two ways. One is surgically implanted and completely internal and the other has both internal and external components. In an internal neurostimulation system, the battery and lead(s) are surgically implanted – something like a pacemaker. In the external kind, a radio-frequency receiver and leads are implanted, and the power source is worn externally with an antenna over the receiver. The advantage of the external system is that it uses an ordinary 9 volt battery which can be replaced.

It should be noted that neurostimulators work to reduce and not to eliminate pain. Certain chronic pain patients have experienced at least 50% reduction in pain upon adopting this line of treatment. It has also been shown to increase activity levels and reduce the patients’ dependence on painkilling drugs. The use of neurostimulators to treat pain must be done very selectively. Proper patient selection and patient education is a must. According to Dr. Ken Follet, University of Iowa Hospitals and Clinics, Neurostimulation is also known as modulation of the nervous system. Rather than ‘cutting’ off specific nerves or blocking signals altogether, neurostimulation actually activates other nerve fibers, which are in fact, pain-inhibiting. Once activated, these paininhibiting fibers actually mask the strength of the pain signal reaching the brain, overall leading to less pain being felt.

The device consists of multiple electrodes on a wire that is inserted on the spinal cord and works with a battery. When this is turned on, the device electrically activates nerves in the body and somehow appears to block the transmission of pain signals to the brain. Patients will typically feel a tingling sensation that in a sense masks the pain and after 20 or 30 minutes, they begin to forget about the tingling sensation.

Where it is implanted is based on the location of the pain.

The intensity is strictly based upon what the patient feels is comfortable. The patient has his/her own remote control November 2008

Neurostimulation delivers low voltage electrical stimulation to the spinal cord or targeted peripheral nerve to block the sensation of pain. One theory, the Gate Control Theory of pain developed by researchers Ronald Melzack and Patrick Wall, proposes that neurostimulation activates the body’s pain inhibitory system. According to this theory, there is a gate in the spinal cord that controls the flow of noxious pain signals to the brain. The theory suggests that the body can inhibit these pain signals or “close the gate” by activating certain non-noxious nerve fibers in the dorsal horn of the spinal cord. The neurostimulation system, implanted in the epidural space, stimulates these paininhibiting nerve fibers, masking the sensation of pain with a tingling sensation (paresthesia).

Source:http://www.medtronic.com/neuro/paintherapies/ pain_treatment_ladder/neurostimulation/neuro_ neurostimulation.html

device and can adjust the strength of the stimulation. Another advantage is that it stimulates the secretion of endorphins, improves circulation-especially in the periphery.

Many patients who are being studied for the possibility of applying neurostimulators, have already had multiple surgeries. The most common one being back surgeries for treatment of herniated discs with sciatica. Sometimes patients have had enough. They don’t want to undergo more surgeries.

Implanting a neurostimulator does involve a surgical operation, but it is relatively safe and simple. Moreover, as percutaneous placement becomes more prevalent and multi polar electrodes allow for more targeted stimulation, all applications of neurostimulation are set to become more feasible and less invasive.

Pain is a serious and costly public health issue, and it remains largely under-treated and misunderstood. According to the National Institutes of Health, 90 million people in the U.S. suffer from chronic pain. The American Pain Foundation estimates that chronic pain costs approximately USD 100 billion per year in lost work time and healthcare expenses.

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Watch Out !

Don’t lose your balance Step into the iShoe - an MIT grad student’s invention could one day prevent falls the aged fear.

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our grandmother might have little in common with an astronaut, but both could benefit from a new device an MIT graduate student is designing to test balancing ability.

The iShoe insole could help doctors detect balance problems before a catastrophic fall occurs, says Erez Lieberman, a graduate student in the Harvard-MIT Division of Health Sciences and Technology who developed the technology as an intern at NASA. Falls among the elderly are common and can be deadly. In 2005, nearly 300,000 Americans suffered hip fractures after a fall, and an average of 24 percent of hip-fracture patients aged 50 and over die in the year following their fracture, according to the National Osteoporosis Foundation.

Lieberman is now testing the iShoe technology in a small group of patients. The current model is equipped to diagnose balance problems, but future versions could help correct such problems, by providing sensory stimulation to the feet when the wearer is off-kilter.

“By doing that we can replace the sense and thus improve people’s balance,” Lieberman says.

Lieberman and other iShoe team members have applied for a patent on the technology, to be jointly held by MIT, Harvard and NASA. In April, the company won a USD 50,000 grant from the Lunar Ventures Competition to help with start-up costs.

Lieberman originally developed the technology to help NASA monitor balance problems in astronauts returning from space.

Zero gravity environments wreak havoc on the vestibular system, one of three body systems that control balance. (The others are vision and sensory receptors called proprioceptors, which tell you where your body parts are in relation to other body parts and the outside world.)

“The change in gravity really screws with their sense of balance. They’re falling all over the place,” says Lieberman, who is a Hertz Fellow and also receives funding from the National Science Foundation and Department of Defense.

The effect usually lasts about 10 days, but NASA tests astronauts’ balance for 16 days after their return. Astronauts go into a phone-booth-like box, where they undergo a series of balance tests such as platform shifts and wall shifts.

While at NASA, Lieberman developed a new system for gathering data and an algorithm to analyse the data.

“We’ve developed the first algorithm that is really capable of not just looking at the pressure distribution of proprioceptors 42

Graduate student Erez Lieberman is working on an “iShoe” which uses technology developed by NASA to create an insole that could help elderly people keep their balance and prevent falls.

Photo / Donna Coveney

The iShoe insole would measure and analyse the pressure distribution of the patient’s foot and report back to their doctor.

Photo / Donna Coveney

on the feet but also analysing what that’s saying,” he says.

Lieberman soon realised that the technology could reach a wider audience than just astronauts. His own grandmother suffered a bad fall several years ago, and he theorised that a balance diagnostic could help doctors catch balance problems before such a fall occurs.

“You have a gradual progression of loss of balance, osteoporosis, and other factors that can lead to the fall,” Lieberman says.

The iShoe insole would measure and analyse the pressure distribution of the patient’s foot and report back to their doctor. The device could also be outfitted with an alarm that would alert family members when a fall has occurred.

Lieberman and his colleagues are now testing the device in about 60 people, hoping to generate data that will help them create a model to predict the risk of a fall.

Other members of the iShoe team are Katherine Forth, a former NASA postdoctoral associate; Ricardo Piedrahita, a graduate of University of California at San Diego; and Qian Yang, a Harvard undergraduate.

Source: http://web.mit.edu/newsoffice/2008/i-shoe-0716.html www.ehealthonline.org

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EXPERT CORNER

High Acuity Areas Monitoring Systems

T

he high-acuity cluster is the fastest-growing area of the hospital. Already representing up to 60 percent of US hospital’s costs and revenues, high-acuity care is expected to only grow further as the “baby boomers” become senior citizens. The following article helps navigate the trends of monitoring systems for patients with acute life threatening conditions. Understand who are the key market players and what are the latest trends in this technology.

Introduction High acuity areas are those where patients with various acute life threatening conditions are monitored and treated with utmost caution. The high-acuity cluster includes the emergency department (ED), the operating room (OR), and the intensive care units (ICU). Monitoring equipment in these areas is composed of electro–biomedical devices that conduct continuous or pulsed measurement of patients’ vital signs and other parameters as a diagnostic representation of patients’ well being. These monitoring systems are fitted with alarm functions, which are activated when the parameters for the patient are outside the “safe range” configured for that particular parameter setting.

Market Overview Patient monitoring systems, especially those in the high acuity areas are very well developed and have become an indispensable part of all hospitals in Europe. The awareness among medical professionals of these systems coupled with the increasing incidence of diseases has driven the market for these systems. Despite certain segments expecting high growth rates, the patient monitoring systems markets as such are in the mature phase characterised by high replacement rates of systems and low volumes of equipment sales. As a result of high replacement rates, more importance is being placed on maintenance and service of these systems.

November 2008

Market Segmentation

Fig 1. Market Segmentation

Apart from the segmentation schematically represented above, the High aquity areas monitoring systems can also be classified into • Vital sign monitors • The multi-parameter monitors The vital sign monitors are those that are usually termed as the lower end multi-parameter monitors which monitors the vital signs; temperature, blood pressure, oxygen saturation, respiratory rate and heart rate. These monitors can be typically found in the non-critical care centers like the high dependency wards and other special wards.

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Multi-parameter monitors are those that record and display these vital signs as well as other additional parameters such as invasive pressures, cardiac output, cerebrospinal fluid pressure, intra cranial pressure, ECG. Key Players The high acuity market is currently being led by GE Medical, Siemens Medical and Philips Medical Systems with a formidable combination of brand equity and longevity.

These three have a combined market share of about 65% with Mindray, Spacelabs Healthcare, Nihon Kohden, and Welch Allyn well represented as well. Different participants follow different sales policies. Bigger players like GE Medical, Siemens Medical and Philips Medical Systems have a well established direct sales force bringing the products directly into the market. Other players often market their products through their dealers and distributors.

Another important trend in this segment is connectivity of these monitors with the hospital information systems network to enable transfer of patient information. The latest systems used provide connection to the Web server and are HL7 compatible, thus enabling easy transfer of information.

As this is happening in several major countries across Europe and North America, there is an increasing use of information systems in the healthcare industry. Furthermore, easy connectivity of these monitors to the hospital network is a significant factor in the adoption of these systems.

The participants see their end-user groups to be Fig 2. Market share split among top participants

Technology Trends Technology is playing an increasingly important role in the improved delivery of healthcare. Hospitals have started making a concentrated effort to improve resource management, to streamline diagnostic and monitoring procedures and to optimise storage of information. Advancements in technology have enabled multiple parameters being displayed on the same monitor and a single monitor being able to display information simultaneously from several patients. Increasing adoption of wireless networks in hospitals has significantly reduced the clutter of wires in the ICU. These monitors provide alarm notifications under critical circumstances or emergency situations and also display important patient parameters.

• Hospitals • Physicians • Nurses • Other Technicians • ICU’s & • Other High Acuity areas.

High Acuity Areas Monitoring Systems, today and tomorrow The high acuity areas monitoring systems market as such is a saturated market mainly due to low replacement rate among certain segments. The market in the Eastern Europe is trying to catch up with that of the Western Europe in terms of its growth. Eastern European high acuity areas market is to a large extent affected by the entry of local participants and participants from the Asia Pacific, China and Korea.

This trend has been a driving force for this market and will continue to be so in future.

Thus the High Acuity areas monitoring systems market in the Eastern Europe has a combination of established, local vendors in the respective countries and vendors from the Asia Pacific and others regions. The market is growing and is expected to grow at a reasonably good rate creating stiff competition even among the giants.

Courtesy: Market Insight, Healthcare Practice, Frost & Sullivan for more expert comments visit www.ehealthonline.org/ expertcorner/

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NUMBERS

Primary Health Centre’s in India have an absenteeism rate of on an average.

43% 2

More than million people in the UK now buy their drugs online.

In the past decade, average expenditure of the Central Government of India on health and related areas has been around of GDP.

0.35%

8%

More than of India’s population is estimated to be suffering from cardiac diseases.

The Indian consumer spend on healthcare is set to increase to by 2028.

46

13%

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