eHealth November 2012

asia’s first monthly magazine on The Enterprise of Healthcare

volume 7 / issue 11 / november 2012 / ` 75 / US $10 / ISSN 0973-8959

Andhra Pradesh Scripting a new inside Ponnala Lakshmaiah Hon’ble Minister for Information Technology & Communications, Government of Andhra Pradesh

eHealth Magazine

healthcare story

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Manoj Kumar Dwivedi Secretary, Health & Medical Education Department, Government of Jammu & Kashmir p-14

Balaji Utla

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15 - 16 November 2012 Hyderabad International Convention Centre, Hyderabad, Andhra Pradesh, India

ehealth.eletsonline.com

Chief Executive Officer, Health Management and Research Institute, HMRI, Andhra Pradesh

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volume

07

issue

11

contents

ISSN 0973-8959

cover story Cascading Changes in Healthcare

By Sharmila Das, Elets News Network (ENN)

andhra pradesh

Ponnala Lakshmaiah

Hon’ble Minister for Information Technology & Communications, Government of Andhra Pradesh

17 policy “e-Governance Means Government at Your Service”

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Manoj Kumar Dwivedi, Secretary, Health & Medical Education Department, Government of Jammu & Kashmir

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tech trends A Bout of Technology

P Bala Kiran, Dy. Secretary, (Dept. of Information Technology), Director, Akshaya & Nodal Officer, Kerala

zoom in

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38 41

62 64

Healthcare Regulations Healthcare Regulations and Aftereffects

expert speak

Anjan Bose, Secretary General, Healthcare Federation of India

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Trajectory of Comprehensive Healthcare

Digitisation of Nursing Registration Prof Rafath Razia, Dy Director (Nursing), I/c Registrar, Andhra Pradesh Nursing and Medical Council, Andhra Pradesh

Special Feature

my journey Dr Om Manchanda, CEO, Dr Lal Path Labs

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10

52 54

Solutions for Efficient Healthcare Management

in focus A Satisfying Journey for HMRI

Balaji Utla, Chief Executive Officer, Health Management and Research Institute (HMRI), President, Corporate Sutainability, Piramal Health Care, Andhra Pradesh

Global Leader

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IT as a Catalyst and Enabler

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News

Janette Bennett, Clinical Director Asia Pacific, British Telecom Health

asia’s first monthly magazine on The Enterprise of Healthcare volume

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issue

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november 2012

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta

Editorial Team Group Editor: Anoop Verma Health Sr. Correspondent: Sharmila Das Research Assistant: Shally Makin

Web Development & Information Management Team Team Lead - Web Development: Ishvinder Singh Executive – Information Management: Khabirul Islam

governance Manager – Partnerships & Alliances: Manjushree Reddy Assistant Editor: Rachita Jha Research Assistant: Sunil Kumar

Information Technology Team

education Sr. Research Analyst: Sheena Joseph Senior Correspondent: Pragya Gupta Research Assistant: Mansi Bansal

General Manager – Finance: Ajit Kumar Legal Officer: Ramesh Prasad Verma Sr. Manager – Events: Vicky Kalra Associate Manager – HR: Sushma Juyal Associate Manager – Accounts: Anubhav Rana Executive Officer – Accounts: Subhash Chandra Dimri Admin Executive: Gurneet Kaur

Sales & Marketing Team Sr. Manager – Sales: Satish Shetti Manager – Marketing: Ragini Shrivastav Manager – Business Development: Abhijeet Ajoynil National Sales Manager – digitalLEARNING: Fahimul Haque Associate Manager - Business Development: Amit Kumar Pundhir Assistant Mamager: Vishukumar Hichkad Assistant Manager-Business Development: Shankar Adaviyar Sr. Executive Officer – Business Development: Gaurav Srivastava Sr. Executive – Business Development: Suman Pokhriyal

Executive-IT Infrastructure: Zuber Ahmed Finance & Operations Team

Subscription & Circulation Team Sr. Manager – Circulation: Jagwant Kumar, Mobile: +91-8130296484 Sr Executive - Subscription: Gunjan Singh, Mobile: +91-8860635832 Executive - Circulation: Ashok Kumar Design Team Team Lead - Graphic Design: Bishwajeet Kumar Singh Sr. Graphic Designer: Om Prakash Thakur Sr. Web Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th Floor, Annexe Tower, C-25 , Sector 62, Noida, Uttar Pradesh 201309, email: info@ehealthonline.org Phone: +91-120-4812600 Fax: +91-120-4812660 ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.

The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D-320, Sector-10, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

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editorial

The health agenda for India One of the side-effects of the growth and development that India has seen in the recent years is the rising costs of healthcare. The quality of healthcare has undoubtedly has improved, but many people from the poorer sections are unable to afford the facilities. In this context a system like the Rajiv Aarogyasri scheme in Andhra Pradesh is an exception.

Recently the Hon’ble Chief Minister of Andhra Pradesh, Shri N Kiran Kumar Reddy, said that the Rajiv Aarogyasri scheme would be expanded across the state. He said, “We are slowly expanding the scheme to cover all sections of society with a view to studying the lapses in its implementation. Our ultimate goal is to bring the state’s entire population under the Aarogyasri cover.”

Perhaps we can have such schemes for comprehensive coverage of all sections of society in all parts of the country. To a certain extent this is already being done. Different states have come up with their own health insurance schemes for their citizens. The Central Government has large number of insurance schemes.

The current issue of eHealth magazine is focussed mainly on the state of Andhra Pradesh. We have the coverage of large number of hospitals and we have also interacted with leading stakeholders in the health sector. As the 8th edition of the eINDIA, the eINDIA2012, is being held in Hyderabad on 15th and 16th November, there is an added depth to the kind of interactions that have been conducted in the magazine.

The eINDIA 2012 has been conceived on the clear vision of the entire nation being able to achieve the objectives of development and growth. The two-day confluence in Hyderabad will have a dedicated track on healthcare, which will serve as a platform for ideas, discussion and meetings on the subject of improving the field of healthcare through ICT deployments.

Health being a universal topic, on the whole you will find the November edition of eHealth is carrying a rather national and international flavour. There is an interview with Manoj Kumar Dwivedi, Secretary, Health & Medical Education Department, Government of Jammu & Kashmir. He talks about the remarkable healthcare initiatives that have been taken in the state. The implementation of ICT solutions in the subject of healthcare is leading to some interesting results.

Then the issue has special interviews of the Health Management and Research Institute (HMRI), Interviews of Rafath Razia Dy Director (Nursing) I/c Registrar, APNMC, interview from Rajeev Gandhi Medical Sciences of Andhra Pradesh, Janette Bennett from British Telecom Health and many more such interest reads.

We hope you will enjoy reading the issue and we hope to see you at the eINDIA 2012.

Dr. Ravi Gupta ravi.gupta@elets.in

november / 2012 ehealth.eletsonline.com

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volume

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issue 11

november 2012

asia’s first monthly magazine on The Enterprise of Healthcare

Social Circle

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Message

Andhra Pradesh has emerged as frontline State when it comes to the implementation of e-Governance projects in India. The State has been keenly focusing on growth and development of new and emerging technologies in the areas of healthcare and education. It has been active in using ICT (Information and Communication Technologies) to offer government services at the citizen’s doorstep.

Such e-Governance projects improve the outreach, make services more transparent, and reduce response time.

Mee Seva, a citizen centric facility, has been providing convenient access to citizens in an easier, faster and transparent manner. At present, 40 Government to Citizen (G2C) services are being availed and more than 100 services are planned to be delivered to the citizens across the state by December, 2012.

It gives me immense pleasure to share that the government of Andhra Pradesh is the Partner State for the eighth edition of eINDIA 2012, which is being organised at the prestigious Hyderabad International Convention Centre, Hyderabad, India, on 15th and 16th November, 2012. The Anniversary Celebrations of Mee Seva project will be held along with the eINDIA 2012.

I welcome all the thought leaders, think tanks and private players, who possess the necessary technological and social expertise to facilitate change and make society better. Let us all participate in eINDIA 2012, which is a celebration of e-Governance and be a part of the change revolution that the state of Andhra Pradesh has proudly entered into.

I warmly welcome all delegates and look forward to their participation in what promises to be an immensely enriching event.

policy

“e-Governance Means Government at Your Service” Ponnala Lakshmaiaha is a veteran politician hailing from TELANGANA with strong technical and academic background. He is currently a Cabinet rank minister in the southern state of Andhra Pradesh.

He held key portfolios in the Andhra Pradesh cabinet including Information Technology & Communications, Endowments, Major & Medium Irrigation, Aqua Culture and Fisheries. He has been in politics since late 70’s and has contributed his share as a Cabinet member to the growth of AP state.

He has helped pave way for irrigating hundreds of thousands of acres of under-cultivated lands into today’s bountiful crop-yielding arable lands as minister for Major Irrigation. He has contributed in the areas of policy formulation for hardware, animal husbandry, dairy development, poultry, and allied industries in the state of Andhra Pradesh.

Ponnala Lakshmaiah’s political career that spans over three decades is focused on service to the socially and economically challenged sections in the state of Andhra Pradesh There is no doubt that a great progress has been made in the e-Governance space in the State of Andhra Pradesh.

Please share with us your vision for further improving the governance structure through ICT in Andhra Pradesh?

As far as government is concerned, we are committed to good governance. This good governance has two components, one is human element and the second is the infrastructure or the technological element. To reach out to maximum number of people we need the help of technology, but this technology must be handled by sensitive and competent people, only then it will lead to best possible results. The e-Governance systems are a result of both, the human element and the technology. It always results in better systems of governance. We are going all out to create more efficient e-Governance systems, as we are motivated by the desire of serving people in better ways. That is our vision; whatever we do should bring maximum possible advantage to the people. The research and the technological implementation that is happening in name of e-Governance should benefit the common man and raise his standards of living.

The IT industry in the state has been growing at a healthy rate. What kind of contributions, in terms of enacting new policies, has the government in the state made for the development of the IT industry?

The ICT industry has always been the main driver behind the jobs creation and fostering of regional development in the country. The Government of Andhra Pradesh is committed to the development

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of a more competitive industrial environment. There are large numbers of initiatives that we have taken to develop the IT industry. In order to promote sustained growth of ICT sector, not only to enhance the balanced regional socio-economic development but also to spread the usage of IT to the last mile of the State, for the benefit of common man, Government has announced the ICT Policy 2010-2015. If I may say so, the IT Policy in the state is far more effective as compared to that in any other state in the country. As a matter of fact, it is well known that in the world one out of every three IT professionals is from India, and one out of every three Indian IT professionals is from Andhra Pradesh. This by itself is a proof of the fact that the state is blessed with abundant talent in the field of IT. There are more than 700 institutions in the state that are engaged in churning out highly competent IT professionals. These talented professionals coming out of our institutions serve the manpower needs of not just the Andhra based IT industry, but the entire world. It is a result of work done by the government on the policy and infrastructure front that we have so many institutes capable of providing world class training in IT related subjects.

A decision to set up Information Technology Investment Region (ITIR) around the city of Hyderabad has also been taken. Will this also lead to improvement in the size and scope of IT industry?

I was about to come to ITIR. The Centre has finally gave “in principle” approval to the Andhra Pradesh government’s proposal

policy

Ponnala Lakshmaiah Hon’ble Minister for Information Technology & Communications, Government of Andhra Pradesh november / 2012 ehealth.eletsonline.com

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policy

for setting up an Information Technology Investment Region (ITIR) around the city. This will give a much-needed boost to the state’s efforts to attract fresh investments into the industry. The ITIR will be developed in an area of 202 sq km (50,000 acres) in two phases over a period of 25 years. The ITIR is aimed at attracting an investment of Rs 2.19 lakh crore in the ITITES sectors and create direct employment for 15 lakh youths.

ITIR is a combination of production units, public utilities, logistic, environment protection mechanism, residential areas and administrative services. ITIRs will include Special Economic Zones, Industrial Parks, Free Trade Zones, Warehousing zones, Export-Oriented Units, growth centres, existing settlements and estates.

The most important e-Governance programme in Andhra Pradesh is the Mee Seva. Tell us about Mee Seva.

What are the ways by which Mee Seva is benefitting the people in the state?

Government of Andhra Pradesh has always been at the forefront of leveraging IT for development and governance.

The Mee Seva means “At Your Service.�

It is an all-inclusive programme, and has vastly benefitted all sections of the society, and especially the poor section, who rely heavily on welfare schemes for their well-being. Mee Seva leveraged creation of Centralised Land Records database, its purification, digital signing and a web-based application that allows functionaries to take up necessary updation etc. The unique feature of this application and database is that it is in Telugu. Through this system lakhs of citizens in the state are able to access crucial documents and certificates through common kiosks. Crucial documents get issued to the citizens across the counter.

When we talk about G2C services in the e-Governance space, we are basically talking about putting governance in the online pace. But this kind of processes also lead to a lot of crucial information pertaining to the citizen being put in online

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mediums. So what kind of security measures are we taking to protect the privacy of the individual?

The intention behind our e-Governance initiatives is very clear; we want to reach out to the people. The manual systems do not reach to the people in the ways in which we would want to. So we are using technology to improve the system of interaction between the government and the people. As far as the security systems are concerned, they are in place. There is latest technology being used to provide most convenient and secure gateways for conducting transactions. We also have laws to give strict punishments to people who target government websites.

It is an accepted belief that IT industry is concentrated mainly in the urban areas, so what steps you are taking to develop IT industry in smaller towns?

The Government is taking many new initiatives to ensure that IT industry can also move into our tier II towns. Many new institutions have been allowed to come up in the towns. In fact five years ago, hardly any IT industry was located in the town of Vizag, but now the same place generates revenues of more than `1,000 crore. Similarly things are going to pick up at other towns also.

You have been associated with many rural development projects. In your opinion what kind of impact ICT can have on rural industries and in agriculture?

Modern technology has a role to play in every sector, including agriculture. For instance, in agriculture you need to know the nature of the soil, you need to know what kind of fertilizers will be most suitable. You will need information on transplantation of the produce post harvesting. The thing is that such information can be more easily accessed through the use of technology. Nowadays we have computer systems that can be accessed in Telgu language. This has brought computing and Internet close to many farmers. In fact, I would like to tell you that we are one of the first Unicode

members along with IBM, Honeywell and Microsoft. Only 9 entities are the permanent members, Andhra Pradesh is 10th member. We are taking active measures to ensure that Telgu becomes one of the premier languages for conducting business on the web.

Mee Seva initiative has become very popular among the people and many other states in the country are planning to launch their own versions of Mee Seva. At a ground level, what kind of impact is the Mee Seva initiative having on the people?

In the past, for issue of Caste, Residence, Income certificates of students, the applications were physically submitted at Tahsildar Office. This was followed by field verification by concerned VRA/VRO and after receiving the report, Tahsildar used to issue physically ink signed certificates. During the high demand months of June-August / admission closing dates, Tahsildar office used to receive more than 1,000 applications in a day, which resulted in inordinate delays or issue of certificates without verification. Mee Seva has really made service delivery very convenient for the citizen. Prior to the launch of Mee Seva project, applicants used to visit the respective departments to avail services, many a times applicants were forced to visit these offices to get their certificates.

Under the revised process, Mee Seva is able to issue certificates across the counter within 15 minutes in 90 percent of the cases.

Given the fact that the technology keeps evolving at a very rapid pace, where do you see the governance in the next 10 years?

I see paperless, cashless, transparent, hassle free, instantaneous governance becoming a reality. One thing I believe certainly, with the talent we have in Andhra Pradesh, a major revolution in governance is bound to happen. The state has been on the forefront when it comes to the implementation of Aadhaar. In times to come the Aadhaar system will start playing a central role in the management of government benefits and subsidies.

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Policy

Bridging the Health Divide in Jammu & Kashmir “During the last 12 months, the state of J&K has shown more improvement in the field of healthcare as compared to any other state in the country,� says Manoj Kumar Dwivedi, Secretary, Health & Medical Education Department, Government of Jammu & Kashmir

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policy

Kindly tell us about the initiatives that your department is taking to bring improvement in the healthcare facilities that are available to the people in the state?

The State Health Department is dedicated to achieve universal basic healthcare for all the citizens of the state. We are making great efforts to ensure that the quality of healthcare becomes better in all our secondary and tertiary hospitals. I would say that the primary mandate of the State Health Department is to ensure that primary healthcare system gets further boost and every person is able to access quality healthcare in this geographically difficult state. There should be a primary healthcare centre within one kilometre distance of every citizen in rural and urban areas. This will bring about a dramatic improvement in the health status of the citizens, especially those who are living in the rural areas. The idea is to provide access to equitable, affordable and quality healthcare to all. We are focussed on reducing Infant Mortality Rate and Maternal Mortality Rate, stabilising the population and ensuring that the gender and demographic balance is maintained.

So this is what we are trying to achieve at the primary level, and we also realise that at the secondary and tertiary level, we have to upgrade the quality of healthcare. All the parameters of healthcare that are the indicators of the quality of healthcare, i.e., IMRI the overall fatality rate, birth rate, are being taken into account, to enable us to develop better methodologies for healthcare delivery.

being undertaken to further upgrade the mobile based monitoring systems. We also have a wide network of ambulances; more than 800 ambulances are attached to various healthcare stations for transportation of patients to healthcare centres. The ambulances will soon be outfitted with GPS tracking systems so that their movements can be monitored through a Central Monitoring System. The Hospital Management System is already being implemented in different hospitals. We are starting with two hospitals, one in Jammu region and the other in Kashmir. In both these hospitals we are planning to have end to end computerisation of the entire hospital system.

How is e-Governance in healthcare leading to the improvement in the kind of care that the common man receives?

Lot of new e-Governance initiatives in healthcare have been taken, and it is pleasure to inform that according to new data, during the last 12 months, the state of J&K has shown more improvement in the field of healthcare as compared to any other state in the country. The use of new technology in the field of healthcare has definitely had a role to play in the development of healthcare in the state. We have a system in place to closely monitor the health of mother and children. There is an efficient mother and child tracking system in place to update the state government on their health parameters and nutrition factors.

We are developing a system through which data can be collected at block level through the computer and fed into the overall health database of the state. We are also having a system where health workers in villages can use mobile phones with preloaded software to collect and transmit information.

According to you what are the main healthcare projects of the states that had been immensely successful and have the potential to be replicated?

The application that has given the best result is actually the implementation of ‘Janani-Shishu Suraksha Karyakram (JSSK).’ This is a key sponsored scheme under the National Rural Health Mission. In J&K the MMR rate is better than the national average, but we are endeavouring to reduce it further. So we are having in place lot of facilities like free medical checkups, free medicine, free compulsory medical checkups for mothers. We are also setting up lot of community healthcare centres, which are proving to be very effective in providing healthcare to our citizens.

What kind of mobile software will this be?

It will basically be a Java based application, with a very easy to use interface. The healthcare workers will be able to feed the parameters of the data related to pregnant ladies in an area, children born in that area. The data will get automatically transmitted to the block level and uploaded on our servers. It is necessary for the state of J&K to use mobile based systems because unlike other states we don’t have a State Wide Network; however, the penetration of mobile telephony is at 90 percent. Steps are

The bigg est chal lenge th we face at has to d o wit shortage of docto h the rs and staff nu rses

What steps should be taken to ensure that the government owned health care centres, especially those in rural areas, are fully manned?

The biggest challenge that we face has to do with the shortage of doctors and staff nurses. To overcome this challenge, we have introduced the scheme of incentives. We have divided the difficult areas into three categories difficult areas, very difficult areas, and inaccessible areas. Difficult areas are those areas that are very far from cities, but are accessible through roads. The very difficult areas are those which are not completely accessible via roads, they require little walking distance.

Inaccessible areas are those which are cut off with snow in winters, we are talking about places like, Ladhakh, Kargil. In the incentive scheme for doctors that we have started the docnovember / 2012 ehealth.eletsonline.com

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Policy

Similarly there is lack of trained nursing staff. We train about 400 nurses every year, whereas we need 1000 nurses for various districts in our state.

What is your opinion of the medical training that is available in the state? Is it at par with the training that is available in other parts of the country?

There is no doubt that we are lagging in the aspect of medical education. We are lagging in that and it is also a problem that no one is likely to come from other states for serving in this difficult state. For improving medical education, we have taken steps to introduce fast track learning courses at our teaching facilities. We are also making it possible for the professors at our institutions to get promoted quickly. As there was shortage of faculty, we have made changes in our recruitment rules to make it possible for more people to apply for the jobs.

Intensiv e being m efforts are ad healthca e to upgrade r every co e facilities in n Nationa stituency under lR Mission ural Health

tors employed in the National Rural Health Mission Scheme get incentive of 20000, 15000, and 10000 depending on the nature of the area where they are serving. This has started giving results and now doctors are willing to serve these areas. Earlier we had about 200 posts vacant in these areas and now only 10 – 15 post are lying vacant.

What are other challenges that you face in developing healthcare in the state? What are the solutions for overcoming these challenges?

The other big challenge is that of infrastructure, there are large numbers of primary and sub-primary healthcare centres which are being run in rented buildings. Obviously this is a big challenge because doctors are not ready to serve where there is no facility for providing medical care. So we are trying to upgrade the infrastructure in every part of the state. The third challenge that we face is that of lack of nursing training schools, and lack of medical colleges. We presently produce 300 doctors every year from the state, but we actually need more than 1000 doctors. The seats in the medical colleges have to be increased.

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In your opinion what kind of experiences and sensibilities as an administrator, must a health secretary bring to his job? How do you tackle the challenges and the pressures that are part of your Job? The healthcare sector is very different compared to other sectors. Even if there are lot of private sector participation in healthcare, and we have hospitals like Apollo, Max and others, we still need government involvement in healthcare to ensure that the poorer section of the population is taken care of adequately. As an administrator my focus is on developing policies that are for the poor. Healthcare sector is also difficult because the human resource in this sector is difficult to manage. So the job of the administrator is to develop policies that can attract more talent. We have to provide adequate incentives for the doctors and other healthcare staff to join the mission of proving better healthcare to all. We have to have an open mind so that we can have the cooperation of all the Panchayats and people from diverse areas of the state.

Before becoming a Health Secretary, you had been an IT Secretary. Which job you find more satisfying and more challenging?

Being an IAS officer, I have to move from one department to the other. There are some departments like Finance and IT where the activities happen on a broader scale. I say this in the sense that these two departments develop policies and systems that can have an impact on every other department. As IT secretary I had the chance of being involved in the development of IT solutions that were being used in the healthcare segment. So when I came to the Healthcare sector, I was already conversant with the IT systems with which the healthcare sector can be revitalised. Immediately after joining the healthcare segment, I have started the initiative of updating our websites. We are now making active usage of social media to dish out health related information to the public. Lot of new initiatives have been taken for computerising the healthcare delivery systems.

cover story

After interviewing a range of top ranked hospitals in Andhra Pradesh, we have come to the conclusion that the growth of Indian hospitals is a halfway through chase.

The crests and troughs of the growth story is presented here. A closer look!

Andhra Pradesh

Cascading

Changes in Healthcare

By Sharmila Das, Elets News Network (ENN)

H

ospital operation in India has gone a paradigm shift. Lot of work related sophistication has come in the form of health IT and medical equipment. To make the transition process faster and even more efficient, today Indian hospitals largely rely on technologies.

Technology has brought the required turnaround in dealing with any disease and patient per se. Dr Parvez Ahmed, Director of Rainbow Children’s Hospital says, “The latest improvisation in techniques related to health is very cost-effective. Technology has made procedures simpler and less painful, less cumbersome and less time consuming”.

Technology Handholding While healthcare is shallow breathing in Indian villages, in urban India the picture is different. Urban and semi urban hospitals are adopting technologies in a greater way to make healthcare reachable to all.

For instance, at Rainbow Children’s Hospital the health centers are interconnected through Wipro Health Management Information System (HMIS). Dr Ahmed shares, “We can access our other centers through main branch. HMIS is implemented in overall system like in operation theaters, pharmacy, billing, HR, accounts etc. Also we have facilities to offer web based appointment services to patients. After ap-

pointments, appointment confirmation is given through an SMS. Audio / visual conference systems are in place so that interconnectivity is maintained. It is pivotal in smooth functioning of healthcare sector and ensures less manpower, less negligence, less human error, less experience.

Hence productivity is manifold”.

Similarly Kasi Raju, COO, Care Hospital says, “We realised that ICT is no longer a simple tool for billing and accounting. Hence we have taken IT as one of the key elements in all our strategic decisions. Considerable investments have been made in terms of building a robust and state of the art november / 2012 ehealth.eletsonline.com

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cover story

infrastructure (including LAN/WAN and data centre), implementation of Oracle ERP etc. Plans are on to move towards paperless and filmless operations, by revamping our current IT applications and implementation of Electronic Medical Records (EMR) across all our facilities. A comprehensive Patient Relationship Management platform is being deployed to enhance patient experience. With ever increasing demand for on-time information for patient care and business decisions, it is clear that ICT based analytical tools like Business Intelligence (BI), Credit Default Systems (CDSs) will be the enablers”.

R Govind Hari, Chairman & Managing Director, Pushpagiri Eye Institue & Pushpagiri Healthcare Hospitals Pvt Ltd says, “Investment in ICT is around two percent of our capital and revenue, but we intend to move it to 4.5 percent in next three years. With NABH focus, we are slowly moving towards analytics and data mining for both our clinical process and administrative process. e-Learning is being slowly integrated in our teaching at both under graduate level and post graduate level”.

Present Scenario According to the Investment Commission of India, the market size of hospitals and nursing homes will grow at 20 percent every year and projected to stand at `54,000 crore. Medical equipment on the other hand will be somewhere close

Kasi Raju

COO, Care Hospital

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While healthcare is shallow breathing in Indian villages, in urban India the picture is different.

Urban and semi urban hospitals are adopting technologies in a greater way to make healthcare reachable to all to `9,000 crore with 15 per cent growth; clinical lab diagnostics with `4,500 crore - a clear 30 per cent increase. In addition to this, imaging diagnostics will be another money-spinning business standing at `4, 500 crore (30 per cent growth).

Other services including training and education, aesthetics and weight loss, and retail pharmacy will stand at `9,000 crore.

Yet, affordable healthcare is a farfetched concept in Indian villages. According to reports, several hospitals in India have ventilators that do not function, and most cannot even afford a ventilator. This has led to higher mortality rate. While healthcare facilities in larger towns and cities have improved drastically, in towns and villages most

“We realised that ICT is no longer a simple tool for billing and accounting.

Hence we have taken IT as one of the key elements in all our strategic decisions”

residents are still dependent on small private clinics and government facilities that are highly stretched.

Remote villages in the country are still lacking chemist shops, let alone a clinic. For the wider masses, healthcare services remain prohibitively expensive.

Although as per a recent study, the Government has set up over 22,000 primary healthcare centers in villages across India, these often remain just structures as doctors, radiographers, pathologists, etc, are hard to find.

On this R Govind Hari says, “Affordable Healthcare is meted out to a patient on the basis of need but not on his or her ability to pay. We need to build a cross subsidy model where the affordable pays for the one who cannot afford in the healthcare business without compromising quality. Reaching out to tier II and tier III towns, providing the stateof-the-art quality, using and training local talents, which are less expensive, increase the volume through sensitising and educating the population”.

Kasi Raju says, “By affordable healthcare we mean, immediate action to preserve and expand coverage, essential health benefit requirements, community health insurance options, affordable coverage choices. Affordable healthcare is essential healthcare which is scientifically and practically sound bases social acceptable methods and technology. The healthcare provided by the various institutions to be universally accessible to each and every person in the world”.

According to Rekha Ranganathan, Senior Director and Head of Strategy at Philips Healthcare, affordability means different things to different consumers.

“It has one meaning for the premium consumer, and another for rural customers. So we have to constantly evaluate the price point which our consumers are able to pay,” she said.

At the end, it can be said that India with its enormous potential of delivering healthcare across all verticals only will be conductive if a required amount of handholding comes from the Government and from the private healthcare organisations and other private players.

Care Hospital | cover story

A Careful Service Kasi Raju, COO, Care Hospital, believes although there are a lot of issues prevailing in Indian healthcare, it has the potential to climb new highs What is your take on the Indian healthcare sector?

The Indian healthcare sector is undergoing phenomenal expansion. Private hospitals and continued investment in the public health programmes are driving the boom. Together this, health infrastructure serves a population of 1 billion, growing at about two percent annually.

India’s over 300 million strong middle class is driving unprecedented demand for quality health care. The combination of high quality services and low cost facilities is attracting regular stream of international patients. Costs of advanced surgeries in India are 10-15 times lower than anywhere in the world. The time is right for us to scale our operations and capitalise on the emerging opportunities in India’s healthcare segment.

How do you think the upcoming technologies can help in providing healthcare to all?

We have always considered technology as one of the key enablers for enhanced patient care. CARE was one of pioneers in implementation of telemedicine and telehealth, to deliver affordable healthcare to all sections of the society ( Urban to rural population). Technology adaption should go beyond bar-coding, analyser interfaces, imaging solutions etc and ensure cost effective healthcare delivery for all. Today technology per se has become more reliable and affordable. However the key to effective healthcare delivery would be to carefully evaluate and adapt suitable technologies keeping patient care and patient wellness as the prime focus. Upcoming technologies like Radio Frequency Identification (RFID), mobile devices, speech recognition, handwriting recognition etc. sound very promising and would be ideal for the healthcare delivery.

mortality audits and post procedure complications along with facility audits to improve patient and staff safety Implementation of quality standards for labs (NABL), Hospital (NABH) and blood banks (NABB)

What are the IT investments your hospital has made over the years?

We realised that ICT is no longer a simple tool for billing and accounting. Hence we have taken IT as one of the key elements in all our strategic decisions. Considerable investments have been made in terms of building a robust and state of the art infrastructure (including LAN/WAN and data centre), implementation of Oracle ERP etc. Plans are on to move towards paperless and filmless operations, by revamping our current IT applications and implementation of Electronic Medical Record (EMR) across all our facilities. A comprehensive Patient Relationship Management (PRM) platform is being deployed to enhance patient experience. With ever increasing demand for on-time information for patient care and business decisions, it is clear that ICT based analytical tools like Business Intelliegence (BI), Credit Default Swaps (CDSs) will be the enablers.

How do you ensure quality and patient safety in your hospital?

For that we do patient satisfaction surveys to understand patient’s experience and to learn about opportunities to improve care.

Also we perorm outcome audits such as

What are the top five challenges you face in the hospital operation and execution and how do you sail through them?

The five challenges we face in hospital operationa and execution are: fixed costs in the hospital, counseling of patients, availability of full time star consultants, full time availability of trained supportive staffs, lack of trained nursing staffs To sail throught the challenges we have done cost cutting on electricity and fuel expenses, lean staffing management in hospital, cutting down innovative costs.

We did proper video counseling, proper documentation of reports, one to one interaction between the consultant and the patient attenders. For retention strategy we have undertaken regular training sessions, continous training programmes, team bonding programmes and motivation programmes What is your take on the term affordable healthcare?

By affordable healthcare we mean, immediate action to preserve and expand coverage, essential health benefit requirements, community health insurance options, affordable coverage choices. Affordable healthcare is essential healthcare which is scientifically and practically sound bases social acceptable methods and technology. The healthcare provided by the various institutions to be universally accessible to each and every person in the world. The most important factor would be to facilitate the healthcare by different means for the underprivileged. november / 2012 ehealth.eletsonline.com

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cover story | SAnt Parmanand Hospital

Serving a Million Dollar Industry Dr Shekhar Agarwal, Executive Director, Sant Parmanand Hospital, sees the healthcare sector has grown tremendously because of some positive changes

What is your take on the Indian healthcare sector?

The Indian healthcare sector shows overall speedy signs of growth mainly because of increase in life expectancy, higher income levels, greater reach of health insurance, and growing lifestylerelated diseases.

The Indian healthcare sector is already a million-dollar industry that is currently undergoing a rapid expansion phase. Government initiatives and public-private partnerships will help create better opportunities for nurses, paramedics, emergency medical technicians and specialised doctors across the country.

Indian healthcare can rate as one of the best in the world when it comes to providing healthcare to all. At present the health facilities are available practically at the door steps and variable cost of treatment is available depending upon the financial status of the individual.

What are the IT investments your hospital has made over the years?

The hospital upgrades the IT department on yearly basis depending upon the demand and the needs of the various departments. Approximately about five lacs are invested in the department every year.

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What are the top five challenges you face in the hospital operation and execution and how do you sail through them?

There are three major challenges: (a) Delay in receiving and recovering of payments from the Third Party Administrator companies. (b) Reluctance of the patients to pay completely for their medical bills when their treatment has been completed. (c) Rapid out-flux of the staff nurses going for jobs abroad.

We deal with individual cases depending upon the merit of each case.

What strategy you think can come handy in making affordable healthcare true to Indian population?

Affordable health care is the healthcare which is easily accessible to one and all without compromising on the quality and also not being taxable to the pocket of the patient. In other words the facilities should be easily and readily available at a reasonable and affordable cost to the general population.

In order to make the term true to Indian population one has to adopt a holistic approach. Not only the Government sector, the private sector but also the general population has to play an

equally important role if the goal has to be achieved. The government must ensure that the grant sanctioned for healthcare reaches the people in the true sense and not just only on paper.

The general public should be made aware of their health rights and the facilities being provided to them by the government. Government has to further launch new social health schemes and provide more facilities and infrastructure at their PHC and dispensaries.

What are your views on the regulatory issues of healthcare?

Especially, lack of distinctive regulations between drugs/devices creates a lot of confusion in the minds of the manufacturers who are eyeing to set their footprints in India for business. Currently, medical devices are regulated as drugs under Drugs & Cosmetics Act by DCGI of Central Drugs Standard Control Organisation (CDSCO), the central governing body of the country. Lack of a dedicated center in the country to oversee certification, approval or monitoring of medical devices etc would lead to communication gap between the agency and the manufacturers. Due to this, the foreign manufacturers need to have patience in their approach, as registration of their medical devices may take time in India.

fortis Hospital | cover story

Taking Healthcare to Masses Aditya Vij, CEO, Fortis Hospital, says hospital management is related to the usage technology by skilled medical staff

What is your take on the Indian healthcare sector?

The size of Indian healthcare sector was USD 66 Billion in 2011, with healthcare providers accounting for about USD 33 billion and private healthcare providers making up USD 24 billion. This space is dominated by a large number of small and medium sized players - It is estimated that 85 percent of hospitals have 30 beds or less, while 10 percent have between 30 and 100 beds. Only five percent of hospitals have more than 100 beds with only 1 percent having more than 200 beds.

How do you think the upcoming technologies can help in providing healthcare to all?

There have been rapid technological advancements in healthcare and it is believed that this will only accelerate in the coming decade. These technologies help in improving treatments, awareness, affordability and access of healthcare. For example, Interventional cardiology has transformed cardiac care over the past decade.

In future, healthcare system will cater to an increasing number of health problems, both chronic diseases and preventive care. Improvements in communication technologies will offer better collaboration for various aspects of healthcare to deliver the required care.

This would mean that hospitals would have a more active role in supervising technical care outside of the hospital, and in making specialised knowledge accessible to all parts of healthcare system.

What are the IT investments your hospital has made over the years?

How do you think ICT is a game changer in the overall hospital operation?

Keeping pace with our rapid growth in establishing a strong healthcare delivery network across country, we have continuously upgraded our super specialty units to applications that allow for Electronic Health Records (EHR), implementation of protocols, and practice of outcome based medicine. Currently, we are running projects to upgrade our back-office systems to an Enterprise Resource Planning (ERP) system. An integrated Health Information Services (HIS) and financial system is being implemented to re-engineer processes, e-institutionalise improved processes across various Fortis Hospitals in India and automate standardised processes.

For improved patient care we use a RFID base real time location system. Recently we also have introduced ‘CritiNext’, a Tele-ICU, to provide distinctive care to patient population in Tier II and Tier III cities. This initiative aims to bridge demandsupply gap of trained manpower in ICUs in remote area hospitals . Patients would be monitored and managed by clinical experts from Fortis Escorts Central Command Centre. We have already gone live with project at Raipur and Dehardun and will expand this gradually.

How do you ensure quality and patient safety for a super-speciality hospital like Fortis?

Clinical excellence and patient-centricity are guiding principles of service delivery at Fortis. This is reflected in every functional area of the company, beginning from hospital architecture, clinical and support service processes, bed-to-floor space ratio, nurse-to-patient ratio, and so on.

What is your take on the term affordable healthcare? What strategy you think can come handy in making the term true for Indian population?

To address the need of underserved patient systems, Fortis launched a secondary care format brand ‘Fortis General’.

Fortis General provides quality, reliable, accessible, and affordable healthcare to the growing middle class and sections below. It will primarily (may not be exclusively) focus on cities outside metros and tier-I cities, substantially increasing the geographic and demographic reach of Fortis healthcare delivery network. It will open up a new segment as more than 46 percent of patients in tier II and tier III cities travel over 100 kms from small towns and rural areas to seek medical care. Low land cost and availability will also facilitate expansion.

What are your views on the regulatory issues of healthcare?

The complex set of regulations for starting a new hospital varies from state to state.

For example, in context of fire protection and safety regulations for hospital buildings, each state follows different set of rules and has different criteria for ‘building height’ restrictions.

In the context of construction of new hospitals, Floor Space Index (SPI) norms for hospitals and commercial buildings are same in most of the states. Few state governments e.g.

Maharashtra allows additional FSI for trust hospitals but this benefit is not extended to private hospitals.

We are also facing issue of collecting payments from Government agencies such as Ex-servicemen Contributory Health Scheme and Central Government Health Scheme for treatments provided. november / 2012 ehealth.eletsonline.com

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cover story | kohinoor Hospital

Dream a Better Healthcare Dr Rajeev Boudhankar, Vice President, Kohinoor Hospital, is optimistic about taking bold steps in his hospital operation What is your take on the Indian healthcare sector?

How do you rate Indian healthcare when it comes to providing healthcare to all?

According to the Department of Industrial Policy and Promotion, during April 2000-March 2012, the hospitals and diagnostic centres in India have attracted FDI worth USD 1.34 billion, while the drugs and pharmaceuticals and the medical and surgical appliances industries have attracted FDI worth USD 9.19 billion and USD 521.45 million respectively. The hospital services market represents one of the most lucrative segments of the Indian healthcare industry. On the back of steady rising demand, the hospital services industry is expected to grow to USD 81.2 billion by 2015.

Hospitals are attractive business models for long term investors with the project Internal Rate of Return (IRR) being approximately 10-15 percent for tier I and metro cities, 2025 percent for tier II cities and 25-30 percent for tier III cities.

During the period of financial year 2011-12 to financial year 2013-14, the Indian Pharma market is expected to grow at a CAGR of 15.3 percent. Indian hospitals are fast becoming the preferred choice for an increasing number of foreigners.

What are the IT investments your hospital has made over the years? How do you think ICT is a game changer in the overall hospital operation?

Our hospital has invested in hardware as well as software in a big way. We have online Hospital Information System (HIS) with all HIS modules in place. We have specialised software in the CT scan and Cath lab for enhancing the quality of images, PACS in the imaging department, RFID technology for transmitting pathology lab samples through automatic system, bar coding for medicines and consumables in the pharmacy and stores. We have a specialised HR related software for all HR issues including attendance, leaves, Rota duties, payroll management, performance appraisals, etc. ICT is a game changer for hospital operations because it helps cut down errors of human nature like wrong drugs, wrong patient samples for surgery, wrong patient for investigations in any diagnostic departments including interventions.

What are the top five challenges you face in the hospital operation and execution and how do you sail through them?

Attrition of well trained employees is one challenge: Some of the strategies include doctor engagement programmes, employee engagement programs, better ‘hygiene factors’ along with competitive salaries, crèche for working female employees, T&D, research facilities for senior doctors, etc

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What is your take on the term affordable healthcare?

What strategy do you think can come handy in making the term true for Indian population?

‘Affordable’ is a subjective term. ‘Affordability’ for middle classes is different from that Below Poverty Line population.

Hence, different strategies need to be thought for different segments by different agencies like Government supported hospitals v/s private hospitals. ‘Universal right to healthcare’ though sounds utopian, can be a step in this direction. It needs to be incorporated in the Constitution of India as a fundamental right.

What are your views on the regulatory issues of healthcare?

The regulations and laws needed to start a hospital and then make it operational are so many in number that it seems that the government is more interested in controlling the healthcare industry than making it accessible and open to investors and entrepreneurs who want to enter this sector. Health is one of the pillars of world peace and therefore needs better treatment at the hands of the regulatory authorities.

M V Hospital | cover story

Enabler of

Good Health Dr Vijay Viswanathan, Head & Chief Diabetetologist, M V Hospital for Diabetes, speaks about the factors that are hindering operational efficiency and enhanced patient experience

What is your take on the Indian healthcare sector? How do you rate Indian healthcare when it comes to providing healthcare to all?

When it comes to medicine and healthcare, India is not ahead of other nations. For a country with a population of 1.2 billion, we are not generating enough doctors, nurses and technicians. With this rate, it is very difficult to achieve India Vision 2020 and offer medical care to ensure health for all.

What are the top five challenges you face in the hospital operation and execution and how do you sail through them? a) Hospital management demands smart minds and smart technologies to keep the healthcare system running smoothly. b) To manage the right staff levels. c) Patient safety and satisfaction d) Rising expenditures e) Tough market competitions.

becoming more and more engaged in making informed decisions about their health and are well aware of the costs associated with those decisions.

In order to remain competitive, healthcare providers now not only need to look at improving operational efficiency but also at the ways of enhancing patient experience.

On the other hand, in spite of all these developments, a vast majority of population is still deprived of basic healthcare facilities. With the increasing population and changing epidemiology of diseases, it has become a mandatory to improve the standards of healthcare on a whole right from primary healthcare centers to district hospitals to multi specialty tertiary care hospitals. There is a need to develop healthcare system based on quality practices. Quality is the only answer for the issues like affordability, healthcare for all and also to establish India as a healthcare destination. India has got a huge potential but at the same time lack of basic facilities is hindering its growth to be able to reach its peak.

What is your take on the term affordable healthcare? What strategy you think can come handy in making the term true for Indian population?

Indian hospitals are establishing themselves globally as world class facilities through national and international accreditation. Consumers are also

What are your views on the regulatory issues of healthcare?

Healthcare is a regulated industry. A competitive healthcare sector is critical to effective health care policies.

Antitrust enforcement in the healthcare sector is a major focus for the government and industry participants alike. Employers, consumers, and

What are the IT investments your hospital has made over the years?

Indeed, we have invested money in developing a Health Management Information System over the years in terms of patient information, patient appointments, billing etc.

the government are all purchasers of healthcare services and want to have access to affordable, high-quality health care.

Healthcare providers must comply with a multitude of central and state laws in every state where they do business. They operate in a complex regulatory environment in which central healthcare laws intersect, and often overlap a variety of state-specific legislation, including state health regulations, insurance laws, antitrust laws, consumer protections laws, and other statutes. This multi-layered environment requires considerable attention in planning and implementing a healthcare deal, which may require regulatory review by numerous state and central agencies. november / 2012 ehealth.eletsonline.com

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cover story | Pushpagiri Healthcare Hospitals Pvt Ltd

Providing Effcient Healthcare R Govind Hari, Chairman & Managing Director, Pushpagiri Eye Institute & Pushpagiri Healthcare Hospitals Pvt Ltd, sees innumerable ways in making healthcare facilities more efficient through deployment of contemporary technologies What is your take on the Indian healthcare sector?

The Indian healthcare scenario is undergoing tremendous change and challenge. Costs are rising, the focus on primary healthcare is not enough, preventive care is not a good word, everybody wants a specialist to treat him, and manpower shortage is killing. In spite of all this we are seeing positive traction in terms of focus on National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM). We are seeing the Government trying its best to build capacity. But much more has to be done. From 1.5 percent of GDP spending on healthcare we must go up to 4 percent of GDP in the next ten years.

How do you think the upcoming technologies can help in providing healthcare to all?

Technology is helpful in many ways. From telemedicine to improved diagnostic system, to better software systems, to technology focused on improving quality of procedures, to reduction in cost and time in terms of efficiency, technology is playing a critical role. One area which is neglected thoroughly is technology in elearning given the tremendous shortage of teachers.

What are the IT investments your hospital has made over the years?

We have focused on four areas: (a) HIS system to improve the process. Coupled with NABH focus, we are slowly moving towards analytics and data mining for both our clinical process and administrative process (b) Tele ophthalmology is one more area. (c) e-Learning is being slowly integrat-

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ed in our teaching at both under graduate level and post graduate level. (d) Developing our content / clinical repository, accessing those available in public domain. (e) Investment in ICT is around 2 percent of our capital and revenue, but we intend to move it to 4.5 percent in next three years.

How do you ensure quality and patient safety?

Firm determination is needed at any cost to maintain quality. Quality is an ongoing, never ending, constant monitoring, upgrading and innovating objective which is to be kept in mind regardless of the cost implication, by default, for a super speciality hospital. By this tool alone one can achieve patient safety. Patient safety depends on quality and both are like “ two eyes making one in sight” What are the top five challenges you face in the hospital operation and execution and how do you sail through them?

1. Capacity building – Lack of manpower, reluctance to improve skills. 2. From

e-learning and regular presentation by every doctor and nurse to sponsoring candidates for workshops we are working slowly in this area. 3. Learning from our mistakes and processes. 4. Using technology and peer review, peer evaluation and regular formal interactive sessions, we have slowly been able to build emphasis on doing less mistakes and learning from our mistakes. 5. Unrealistic expectations from the patient, who are unwilling to listen. This has become anyway a national obsession. So the focus in counseling and educating the patient, sensitising the population has become a very critical area for us.

What is your take on the term affordable healthcare?

Indian healthcare business needs to work closely with Government and NGOs and focus on primary healthcare through accessibility and acceptability and build a strong community healthcare system.

“Aarogysri” is one of the best initiatives, initiated and successfully run by the Government of Andhra Pradesh over several years which has bridged the gap between super speciality and affordability. A similar initiative nationally could be adopted.

What strategy do you think can come handy in making the term true for Indian population?

Para-medical and medical education to be made affordable and available together in terms of quality and quantity. Encourage nationally not-for-profit organisations/societies/trusts to play equal role along with corporate and make them focus on health education and primary healthcare services. Encourage and sensitise the population to alternate medicines.

Rainbow Children’s Hospital | cover story

SAG in the window period of those infectious in blood. Hence inducing blood transfusion almost an infection-free, safer procedure.

Cataract surgery done by laser method is used in Ophthalmology camp. A number of patients can be treated in a single day due to such advanced laser surgery.

Believer in Quality Healthcare Dr Parvez Ahmad, Medical Director, Rainbow Children’s Hospital, feels good healthcare is largely dependent on skilled medical staff What is your take on the Indian healthcare sector?

The Indian healthcare sector is fast developing field which is perpetually improving on knowledge, skills and techniques.

Unfortunately healthcare in India is unequally distributed. Urban areas are exposed to all latest acquisitions but sadly majority of Indians who reside in rural areas are still trying to fetch proper healthcare. Indian healthcare will be good and thriving only when there is equality in distribution of its services.

How do you think the upcoming technologies can help in providing healthcare to all?

The latest improvisation in techniques related to health is very cost-effective. Technology has made procedures simpler and less painful, less cumbersome and less time- consuming. For example, Laparoscopy assisted surgeries have reduced patients’ pain, morbidity and hospital stay. More number of patients are treated with latest technologies in a day without taxing the doctors and the medical staff.

Nucleic Acid Amplification Testing (ID. NAT) - this recent technique has been designed to detect the presences of HIV or HB-

What are the IT investments your hospital has made over the years? How do you think ICT is a game changer in the overall hospital operation?

All centres are interconnected through Wipro Health Management Information System (HMIS). We can access our other centres through main branch. HMIS is implemented in over all systems like in operation theatre, pharmacy, billing, HR, accounts etc. We have web based appointment services for patients. After appointments, appointment confirmation is given through an SMS. Audio visual conference system has been adopted so that interconnectivity is maintained. It is pivotal in smooth functioning of healthcare sector ensuring less manpower, less negligence, less human error, less experience.

Hence productivity is manifold.

How do you ensure quality and patient safety in your hospital?

Safety regulations should be ensured from the stage of planning itself. Fulfilling the statutory requirements like fire safety, Accrediation of Atomic Energy Regulatory Board (AERB) approval. Printed Circuit Board (PCB) approval, etc is essential.

Recruiting qualified staff can also help. Verifying their credentials from the competent authority like university or medical/ nursing councils should be done. Allowing them to do patient care only according to their qualification, experience and skills. Regular staff training about patient safety protocol/ policies and developing the patient safety quality indicator and implementation/monitoring of the same is required.

What is your take on the term affordable healthcare?

When patient recovers completely from an illness with minimal investment including a series of medicines, investigations, hospital stay, it is called affordable healthcare. Maximum health output with minimal investment marks healthcare affordable for patients.

What strategy do you think can come handy in making the term true for Indian population?

Healthcare should be reinforced properly at the primary healthcare, sub centres and community health centres. If healthcare services are increased at primary and secondary level effectively, affordability will proportionately increase.

What are your views on the regulatory issues of healthcare?

One of the foremost issues regarding the regulation in the healthcare industry is the compliance with medicare standards. All the healthcare organisations have to comply with the regulatory requirement as well as with it’s emphasises on patients, employees and environment safety. november / 2012 ehealth.eletsonline.com

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cover story | Rockland Hospital

On a Rock Solid Mission Rajiv Tewari, Director, Health & Wellness, Rockland Hospital, thinks healthcare in India is going through a positive transition technology like most other hospitals in the form of HIS or Hospital Information System to help the patients to get better services. ICT will help in facilitating communication between various stakeholders in large geographical boundaries by connecting the patients, doctors and others engaged in the process of healthcare delivery. ICT like all other technologies will however at best play a support role. The game changers would still be the doctors and managers of the healthcare processes.

What is your take on the Indian healthcare sector? How do you rate Indian Healthcare when it comes to providing healthcare to all?

The Indian healthcare sector faces shortages of doctors, nurses, technicians and paramedics at all levels. India has less than one doctor per 1,000 patients, compared with a global average of 1.4. India needs at least 8,00,000 additional doctors and 18 lakh more nurses. Huge rush of even the primary and secondary care patients in tertiary care hospitals located in metros clearly indicates the status of healthcare in smaller towns. The private players are moving in to fill the gap but they too are metro focused due to the concentration of specialist doctors in those areas and due to huge investment requirement to justify the returns on investment in small towns. Quality healthcare is virtually nonexistent beyond the metros and select large towns.

What are the IT investments your hospital has made over the years?

The Rockland Group has been using

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What are the top five challenges you face in the hospital operation and execution and how do you sail through them?

Patients need access to quality healthcare at reasonable costs. The challenge is in balancing the quality with the costs for a very diverse range of patients up to village level.

Pricing is case of tertiary care is decided by the payers accounting for almost 80 percent of a hospital’s billing.

Government employees are covered by health schemes where the rates are controlled by the Government. The insurance agencies as well as a large number of corporate negotiate and fix low cost packages too. The biggest challenge therefore is in managing the costs in a way that quality of treatment is not affected negatively.

Rockland is working on a five layered model of health delivery to convert the challenges into an opportunity through a Rockland Health Network that will connect the primary, secondary and tertiary care services into an integrated model of health care. This network will be connected with the patients through a chain of health volunteers, quality certified doctors, nursing homes and small hospitals finally connected with the Rockland Medical Corridor in Delhi NCR. The Rockland Medical Corridor comprises three Multi

Speciality Hospitals for tertiary care. The Medical Corridor has assisted living Centres, budget hotels and well trained teams for organising the travel and stay of the patients and their attendants.

What strategy do you think can come handy in making affordable healthcare true for the Indian population?

The people of our country need a robust healthcare model that can guarantee access to quality healthcare to the village level. A glance at the cost involved in creating a health network up to village level will indicate that neither the Government nor the private sector will be able to organise such large levels of investments alone: • Tertiary Care: `100 to 150 Lakhs per bed • Secondary Care: `30 to 50 Lakhs per bed • Primary Care: `10 to 25 Lakhs per clinic A minimum of 200 beds are required for a tertiary care hospital to be able to break even and generate surpluses on a long- term basis. Investment in a single tertiary care hospital would cost approximately `300 crores and then additional resources will be required to manage the operational costs.

Government has vast resources at its command which can be leveraged to create a healthcare model that can effectively cover even those who are below the poverty line by simply leveraging the already existing budgets to ensure the poor and by providing land and infrastructure back up. Private sector has the entrepreneurial and managerial capability to leverage these resources in an economically and socially sustainable way so the management of services should be left to those who have the capability to manage the operations in an economically sustainable manner.

Hiranandani Hospital | cover story

A Sunrise Industry Dr Sujit Chatterjee, CEO, Dr L H Hiranandani Hospital, shares his thoughts on how India can reach the goal of universal healthcare What is your take on the Indian healthcare sector?

How do you rate Indian healthcare when it comes to providing healthcare to all?

The Indian healthcare sector is considered a sunrise industry.

There are various projections which are given by various institutions of how large healthcare sector is in economic terms from hundreds of billion to thousands of billion USD. My take is that it is developing at a rapid pace but the large bandwidth of secondary level of care needs to be focused upon as this is an area of weakness in the Indian healthcare sector. We are unable to provide healthcare for all as there is a huge discrepancy between the doctor patient ration as compared to some of the other developed countries in the world and also in the regional areas. The Government of India needs to be aware that investment in healthcare has to be manifold of we are to provide healthcare for all.

What are the IT investments your hospital has made over the years? How do you think ICT is a game changer in the overall hospital operation?

Over the years the hospital has completely revamped the hardware keeping in line with the newer models of computers that keep on coming in. We have invested in large number of servers to enhance the capacity to absorb data, archive data, and retrieve data. Through IT, I think we have been able to

achieve large amount of standardisation through picture archival through use of local area network we have been able to transpose results in quick time especially in emergency situation, admission, discharge, procedures are far smoother and inventory at every given level is extremely accurate.

Five challenges faced in the hospital operations 1. Standardisation in healthcare 2. Documentation 3. Electronic Medical Records 4. To fight medical equipment obsolescence 5. Cost control How did you manage to sail through those challenges?

It is impossible to sail through the challenges. But it is essential to address each challenge. It would require a manual to address all these in detail but it should suffice to say that it requires enormous contribution from the doctors and nurses.

Once the results of evidence based practices are available to all they are more amenable to change for the better. Medical professionals of one generation are averse to computerisation and data capture in the electronic format (this is possible due to not having expertise in using the computers or navigating through electronic medical record in quick time) but if they are trained and assisted this problem can be overcome.

What is your take on the term affordable healthcare?

What strategy you think can come handy in making the term true for the Indian population?

Healthcare can be made affordable in this country. Government can float schemes which are realistic. There are centres which are able to perform tertiary care operations at low cost and that is because they have sheet volume. I must digress to my favourite topic and that is Insurance. It is the young who should be charged high premium for healthcare and the benefit translated to those who have no income, have retired and dependent on pension. This will help the insurance create enormous corpus, give no claim bonuses and come up with ready scheme which can be promoted across the length and breadth of the country. It is an easy answer but it requires the Pandits sitting in high places to evaluate.

What are your views on the regulatory issues of healthcare?

My views on the regulatory issues of healthcare are not standardised. There are for eg. archaic laws which we are still focused is the Drugs & Cosmetics Act 1940. Recent version on this has still not seen the light of the day. I think this a case in point would give a fair idea of my views of regulatory issues of healthcare. november / 2012 ehealth.eletsonline.com

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cover story | vikram group of hospitals

When Health is not Wealthy Enough!

What is your take on the Indian healthcare sector? How do you rate Indian healthcare when it comes to providing healthcare to all?

Healthcare needs huge investment both in capital and in sustained operations.

Over the decades, private hospitals have sprouted in large numbers as the Government failed to scale up resulting in even the Government depending on private institutions to carry out the various different benevolent schemes. Trouble is that on the one side people see the cost of healthcare as prohibitive and on the other hand many hospitals are financially sick themselves! In this environment, to provide high quality care is not at all easy. So, people who can afford healthcare do have various very good options at par with the world’s best. But for the masses that’s not the case. The good news is that Indian doctors are amongst the most skilled one can find in the world.

What are the IT investments your hospital has made over the years? How do you think IT is a game changer in the overall hospital operation?

IT investment runs into crores of rupees over the last decade. This is basic essential without which we cannot run a hospital anymore. IT is not limited to finance and accounts. It’s a part of every facet of patient care both in the front as well as the back end. Patient safety processes are hugely IT dependent too. Accreditation

by NABH or even ISO for that matter, is impossible without an active IT department What are the top five challenges you face in the hospital operation and execution and how do you sail through them?

1.High cost of finance 2. Attrition among skilled staff (nursing, technicians) 3.

Training of unskilled staff (housekeeping, security, etc) 4. Shortage of specialists (for tier III cities) 5. Recurrent investment towards infrastructure and equipment to fight obsolescence. Each of them has to be tacked as best possible within the limitations of the system and it’s an everyday problem. A bit of foresight and planning helps mitigate.

Dr S B Vikram, Managing Director (CEO),Vikram Group of Hospitals, goes candid and says that healthcare in India needs good capital infusion

What is your take on the term affordable healthcare? What strategy do you think can come handy in making the term true for Indian population?

I believe that healthcare is very cheap in India as it were. Cutting corners is going to jeopardise patient safety. The need of the hour is for the government to come out with a slew of reforms: a) Subsidised electricity and water (commercial rates is what is charged while industries get a lower tariff). Reduced municipal taxes, the huge fee levied for no apparent reason for Pollution Control. Reduced VAT and remove customs on equipments and pharma. All these will bring down the cost of setting up hospitals as well as cost of providing care. Being a free market, they will all get passed on to the end consumer. It’s time the government stops taxing the misery people are already going through!

What are your views on the regulatory issues of healthcare?

Accreditation is the way forward. I’m not for regulating the prices of services, the market forces will take of that one.

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Dr Balabhai Nanavati Hospital | cover story

Technology Paves the Way Dr Pavan Kumar- Head of Department of Cardiovascular Surgery, Head of Telemedicine Centre, Dr Balabhai Nanavati Hospital, has taken the hospital to a new peak of success by introducing super efficient tele-medicine services How do you think the upcoming technologies can help in providing healthcare to all?

Technologies have always played a major role in healthcare sector. Be it any surgery or treatments, the use of advanced technologies have always been a boon. Technology for healthcare includes machinery/equipments/devices or methods for diagnostics as well as for therapeutics that may be used in relation to provision of healthcare services. This helps to save the lives of people in the earlier stage of their disease avoiding future complications.

Kindly tell us about the telemedicine services have been launched in Nanavati?

Tele medicine centre was established in 2006 under CSR by Nanavati Hospital to provide healthcare to unreachable India, with the help of information technology tools of videoconferencing and connectivity. This state-ofart centre houses all essential gadgets and connectivity by Integrated Services Digital Network (ISDN), broadband, satellite and fiber optic cable network, the centre is presently connected via broadband connectivity to 57 district and sub district hospitals of state of Maharashtra, through ISDN connectivity to 15 district hospitals in Madhya Pradesh, through ISDN connectivity to five private nursing homes and via Pan African e-network of Ministry of External Affairs (GOI) is connected to 35 African countries. This makes the center the largest telemedicine service provider in western India.

What is your take on the Indian healthcare sector?

Use of advanced technologies in the medical sector has completely redefined its services. Today India has become a popular destination for medical tourism. This shows the rapid growth rate of healthcare sector in India.

What benefits it has offered? What was the investment involved?

These are the following benefits: Tele – consultations: Through this centre, 150 top medical specialists have provided over 6000 tele-consultation till date. Out of which 3548 tele-consultations have resulted in diagnosing and treatment of far living patients in 37 medical colleges.

Tele – CME lecture programs: Total 252 such lectures via telemedicine have been delivered in this period benefitting 6452 doctors and paramedics, nurses in African countries, Maharashtra and Union territory hospital.

Tele radiology program: Recently introduced in 2010, it provides CT scan and MRI image reading by radiologist for peripheral centres where no such facility is available.

385 patients have benefitted through this program till date Tele ICU management program: Telemedicine centre through its connectivity provides management of ICU patients to two different hospitals currently.

Tele ECG program: An in-house research project and a “country’ first”, tele-ECG machine developed, tested and commercially produced for benefit of ECG recording at home and transfer over phone to centre and diagnosis by specialist. It has served to over 1000 heart patients in Mumbai in last two years and was helpful in getting the correct and timely treatment to them.

ECG on mobile program: An offshoot of tele-ECG project, successfully launched countrywide in partnership with Blackberry smartphone MNC and Vodafone carriers in 2010, this center has special partnership status with blackberry for development of mobile health applications.

Support to orphanage for healthcare needs: Takwe village near Pune houses and orphanage run by a Fazlani Group of philanthropic organisation for 200 children.

The center has established telemedicine unit for healthcare needs of these children and for nearby villages as well.

Supporting national school health program: This tele medicine centre supports National school health program run

by NRHM especially in cities of Silvassa and Dadra Nagar haveli of UT where over 80,000 children have been screened for delayed milestones, deficiency diseases, infections and congenital diseases. november / 2012 ehealth.eletsonline.com

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cover story | Kokilaben Dhirubhai Ambani Hospital

Point-of-Care Tablets are the Future Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital and Research Centre, elaborates on the future of healthcare in the technology era, in conversation with Nikita Apraj, ENN and general surgery applications. This technology initially was preferred for cardiac surgery but is now proven to be beneficial in Urology and Gynecology.

Tell us how has technology helped hospitals for better care?

If one tracks the progress of medicine over the last decade, the transformation brought about by technology has been across the spectrum of clinical and administrative fields within a hospital. The technology can be in diagnostics that can help you pick up ailments faster, or treatment modalities that make delivery of care superior. Thus, both diagnostics and therapeutic technologies are moving in parallel–taking healthcare to the next dimension.

Please share with us some key technology trends in healthcare?

Previously a doctor was dependent on medications and surgery was about manual expertise. During surgery there was significant damage to normal tissues. Today it is possible to get deep seated problems without harming normal tissues on the way for example radiotherapy, radio-surgery and robotics for greater precision and maneuverability. Technology today is helping doctors perform what was impossible earlier with more precision and lesser damage to tissues. Some of the latest technologies include high end 3Tesla MRI, 256 Slice CT Scanners, Intraoperative MRI, DaVinci Robot and so on.

There are also organ or disease specific technologies which are helping to offer better diagnosis, treatment and outcomes.

The future belongs to robotic surgery, wherein the robots are providing assistance to the doctor in improving precision, dexterity and maneuverability in small spaces especially for cancer treatment. This can also be used for thyroid surgery, ENT

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What IT solutions have you adopted in your hospital?

The basic infrastructure involves the Hospital Information System (HIS) or Hospital Information Management System (HIMS). This includes an administrative module which relates to overall hospital administration that includes registration, admission, discharge and billing. The clinical module helps you to track all the clinical parameters that you want. Our adoption of HIS is evolving, and after successfully implementing the administrative module we are now focusing on the clinical module. HIMS ideally implies a paperless filmless hospital. This is the gold standard that everyone wants to achieve.

To enable this, for the patients in the wards we have ‘pointof-care tablets’ which are Wi-Fi enabled and connected to a central server where all patient data is stored that can be accessed anytime. Each patient is given a unique identification number which when keyed in gives you the entire clinical history without touching a sheet of paper. The tablet also can access images from the picture archival systems or Picture Archiving and Communication System (PACS). You can now browse through the patients entire set of investigations including laboratory data and images of X-Rays, CT Scans, MRI and Sonography.

Thus we are moving towards the gold standard of electronic medical records or EMR. Doctors can also avail of the trend analysis tools which are based on high end computing, helping them make better assessments, take better decisions and change the treatment modalities of the patients instantly.

Tell us your views of healthcare scenario in Andhra Pradesh?

A huge opportunity lies in the tier II cities across the country, as there are so many cities that do not have a multi-specialty hospital with facilities for quality tertiary care. Andhra Pradesh has a large population of patients coming to Hyderabad for treatment and the city has become the capital of healthcare in the state. The new hospitals across new cities in the state will help support the demand for quality healthcare services in the state providing relief and benefit to the patients without having to travel long distances.

PD Hinduja National Hospital | cover story

Leading the Way in Indian Healthcare on Internet with features as customer feedback, patient education, rights and duties, average waiting time, access to customer care /other important phone numbers/email addresses; and authentication based access to Electronic Medical Records (EMR) (including investigation reports / clinical notes) empower the patient with a vital source of healthcare information.

A management dashboard with various utilisation and quality parameters displayed and updated real time will help the respective supervisors / managers keep a check on all the parameters against their respective benchmarks. This will establish the necessary monitoring and control mechanism in place- which would ensure efficient and effective patient healthcare delivery.

Established in 1950s, PD Hinduja National Hospital and Medical Research Centre, is a pioneer in bringing various state-of-art technologies and equipments to India.

Mahesh Shinde, Director, IT, P D Hinduja National Hospital, talks to Nikita Apraj, ENN How does technology help hospitals in providing better-quality services?

Technology helps hospitals in many ways.

SMS based alerts help indicate status of payment, whether it is due or captured.

It also helps patients to know about their appointments. They know when their appointment is due or updates if it is rescheduled. They get information about scheduled operations and surgeries. Such points of contact with patient help facilitate alleviation of patient anxiety.

Providing a patient dashboard accessible from a kiosk in hospital premises and

What IT solutions you have implemented in your hospital?

P. D. Hinduja Hospital has recently deployed Picture Archiving and Communication System (PACS) to support the various modalities of our imaging department. Reporting for the images is being done with a speech to text software. Images are hosted on a private cloud- such that the radiologists have access to view the images from any location in or outside the hospital.

We are coming up with an upgraded version of hospital information system that will have a lot of extended features for an enhanced patient experienceassisted by support technologies like SMS, smart card, mobile computing and GPS. Various other technology initiatives have been planned- that would be rolled out in the near future.

What role can mobiles play in connecting hospitals to patients?

Mobile apps can act as an extension of Hospital services. We launched our tel-

emedicine programme in June 2007 to extend our healthcare delivery to the inaccessible, non-affording and underprivileged social classes. The set up comprises of an interactive video front with the voice output and polycom camera attached to a terminal for data transfer and net meetings, supported by Integrated Services Digital Network (ISDN) and IP lines.

We conduct online continuous medical education for doctors of different medical specialties and teach and train students to use telemedicine in effective ways. We offer expert advice in almost all medical specialties through video conferencing. Complete report analysis can be done by online transfer of reports. We also conduct tele-health campaigns at remote sites for different specialities as a part of our corporate social responsibility.

Which state-of-the-art technologies and equipments are used in your hospital?

We were the first in Indian healthcare industry in acquiring various new technologies to provide quality service to our patients. P. D. Hinduja was the first hospital in India to introduce Twin Speed MRI, a revolutionary technology in neurovascular and cardiology imaging. We also were the first to install Gamma Camera / PET scan that redefined treatment in cancer management, orthopaedics, neurology and cardiology.

P. D Hinduja Hospital had the first Gamma Knife installed, a gold standard in radio surgery and a non invasive surgical tool - first such unit in South Asia. The hospital has always believed in quality healthcare for all and thus has been instrumental in acquiring the latest medical technologies and providing healthcare at an affordable cost to the needy. november / 2012 ehealth.eletsonline.com

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cover story | Devi eye hospital

Eyeing

Healthcare for All

Dr Balakrishna Shetty, Chairman and Medical Director, Devi Eye Hospital, gives a clearer picture of hospital operation by saying huge electricity bill is a challenge for an emerging hospital to survive execute non projects and expand existing projects and make them efficient and cost effective. ICT can make hospital administration transparent and accountable. Can help to maintain constant quality healthcare all the time. With the click of a button one can quickly analyse the trouble spot and quickly fix them.

What are the top five challenges you face in the hospital operation and execute and how do you sail through them ?

Due to high electrical power costs hospitals spend a lot on power generations. We face difficulty in employing and retaining qualified doctors and paramedical staff because they leave us for high remunerative jobs. Another problem we face is that high costs of imported hospital equipment and maintenance. High costs of consumables and disposables also are a problematic area.

What is your take on the term affordable healthcare?

What strategy do you think can come handy in making the term true for Indian population?

Healthcare to all can be best achieved by empowering the individual to seek healthcare and avail quality healthcare either through Government or through private healthcare organisations using group insurance schemes which should be practical and transparent.

What is your take on the Indian Healthcare sector?

Indian healthcare must be divided as urban and rural. Urban healthcare is covered 70 percent by private sector and about 30 percent by Government. In rural healthcare private participation is almost nil. Government budgetary spending in healthcare sector though sizeable, but it does not reach to the individual due to rampant corruption, which can be checked effectively by e-tendering e-governance etc.

How do you think ICT is a game changer in the overall Hospital operation?

ICT can be a game changer. Can gauge and assure the target groups requirements, quality and level of care. Can plan and

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What are your views on the regulatory issues of healthcare?

Regulations are welcome as long as they are needed and practical. Healthcare policies and regulations should be reviewed and revised on annual basis. Transparency is the key word. Unnecessary regulations should be removed and before starting new regulations all the involved parties should be taken into confidence. Individual must be compelled to set aside part of his income towards health insurance. Organisation (Public/Private) must be made responsible for health cover through group health insurance. Quality health cover to all is possible only through active participation of private sector health providers.

Premier Hospital | cover story

Standing Tall on his Founder’s Fame is a MoU between the State Government and the hospitals.

The Government takes care of the bills of such patients. The second one is the private healthcare sector. In Hyderabad there are plenty of private hospitals and many more are coming up. There are exclusive hospitals for international patients, (continental). Now the private sector-people are entering tier-II cities of Andhra Pradesh like Vishakhapattanam and Vijaywada. Moreover, the Government is also doing its job to provide better healthcare services. Public awareness is being spread through the media including All India Radio and Television channels. And even there is a Public Private Partnership (PPP) in healthcare promotion. In this sense, the Government monitors all these hospitals. These hospitals are under close surveillance of the Directorate of Medical and Health Offices.

They keep visiting the private hospitals to check whether they are conforming to the regulatory framework. They also visit the hospitals at the time of outbreak of the dreaded diseases and take weekly feedback.

Dr K Kamlakar, CEO, Premier Hospital, Hyderabad, one of the leading super specialty hospitals in Andhra Pradesh, speaks about the hospital’s super fast service that has earned a good reputation

What is the background of the hospital?

Premier Hospital is a 100-bed secondary care and multi-specialty hospital. Though this hospital was established 20 years ago, the present structure is only one year old and it is on the corporate line now. Dr Mahesh Marda is the Managing Director a well known physician and during his long career, he has earned name, fame and credential. That is why in health sector Dr Marda and Premier Hospital stand synonyms to each other.

What is your take on the healthcare sector of Andhra Pradesh?

The State Government has a plan for BPL families. The Government has empanelled several hospitals which have been providing quality health services. The BPL family members can visit these hospitals for treatment. After the treatment they are entitled to come out without giving a penny for the same. There

How do you see the role of technology in revolutionising healthcare sector?

Technology has imparted a big role in revolutionising the healthcare system. Telemedicine has come in a big way. If a hospital doesn’t have radiologist, this telemedicine system are used. The hospital sends the image to the radiologist sitting far away through fax or other mode and takes the report back.

For external quality assurance, the hospital sends the report to third party for second opinion. Thus we take care of the quality assurance of the report. The modern technology has reduced time and cost in delivering the diagnostic reports and also has accuracy. Our laboratory gives the test report within five to 10 minutes. With state-of-the art technology the blood samples collected at collection centre goes automatically to the laboratory and after the test is completed by automatic machines, the report is delivered within five to 10 minutes. In our hospital this type of speedier test is also done.

What type of challenges do you see in healthcare sector?

Communicating with patient is the biggest challenge before us. Of late, due to technological advancement and Internetlike mode of communication the patient himself or herself does have half-knowledge about treatment and healthcare.

In that case they argue with the physicians with their limited knowledge gathered from various offline and online sources and we have to satisfy such patients. november / 2012 ehealth.eletsonline.com

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cover story | Asian Heart Institute

Integrating Patient Services through IT How does technology help hospitals in providing betterquality services?

Technology helps hospitals in various ways. With the new technology, newer equipments are getting introduced for surgery. A classic example of technology is the use of robot for performing surgeries. Robotic surgery has numerous advantages the most important amongst them being faster recovery and lesser pain. Thus technology helps improve patient outcome.

Use of technology is also increasing in diagnostics- Lots of better diagnostic techniques are available today to figure out a medical condition. Use of better diagnostics has reduced the need to make long incisions. Today, diagnostic tests can be done without any invasion as well.

Technology has also eased the documentation work in hospitals. All patient records and reports are now easily accessible. Now patients need not carry a big file of reports and films with them. All information can be easily accessed through internet and softwares, even on a mobile.

Technology is also helping hospitals to improve quality, reduce the costs in terms of inventory and operational efficiency.

One of India’s leading cardiac surgeon Dr Ramakanta Panda, VC and MD, Asian Heart Institute talks to Nikita Apraj, ENN about cutting edge services provided in the hospital

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What IT solutions you have implemented in your hospital?

Our hospital is one of the few hospitals in the country which has almost gone paperless. 80 percent of our transaction is carried out on IT-enabled system. We are now moving towards a new system that looks after all the three aspects of the hospital – Hospital Information System (HIS), Electronic Medical Records (EMR) and Enterprise Resource Planning (ERP).

What role can mobile devices play in the field of healthcare?

Mobile devices help monitor patient in real time. I can get patient data in operation theatre which then can easily be transferred on my iPad. It helps us to get all the required information related to the patient for better diagnosis. Besides, mobiles can also be used in HIS, EMR and ERP. We plan to integrate all the services so as to make them accessible through mobile devices.

Which state-of-the-art technologies and equipments are used in your hospital?

We have commissioned da Vinci Si Robotic Surgical System with simulator at Asian Heart Institute. It is the latest technology in robotic surgery that offers the most advanced cutting edge treatment option. It is the only one of its kind in the country. Asian Heart Institute is the first to offer robotic surgery in Mumbai. We have performed more than 100 successful robotic surgeries.

Asian Heart Institute is almost a wireless hospital. We perform most of our daily activities through Wi-Fi. We are also working on integrating all inroom services like internet, TV, billing. We look forward to provide an integrated service model where the patient can perform all transactions simply using his/her smartphone.

Share with us your views on Andhra Pradesh as a healthcare investment destination.

Hyderabad is marching towards becoming metro cities like Mumbai and Delhi. It is one of the most important commercial, industrial and financial hubs in the country. It is also one of the most important cities in IT industry. The city certainly deserves the healthcare infrastructure of highest possible quality.

The healthcare industry in Hyderabad should be ready to provide services which the city will need in next 10-15 years. At present, people in Hyderabad come to Mumbai for better healthcare services. In next few years they should not need to travel to other metro cities. They should get the same quality care and services in the city itself.

Jaslok Hospital | cover story

Technology is Ultimate “No healthcare specialty is left untouched by technology,” says Dr R R Pulgaonkar, CEO, Jaslok Hospital.

He talks to Nikita Apraj, ENN about the exclusive technologies being used at the hospital and all other department of the hospital are linked together. Simply entering the patient ID can provide us with all the information about the patient.

What role can mobile devices play in the field of healthcare? Does Jaslok Hospital use telemedicine?

Mobile devices are an in-thing these days.

We provide SMS alerts to our patients regarding their diagnostic reports. At present, it is not automated but soon it will be.

Handheld devices can be used by doctors and nursing staff while taking round. They can enter the prescription and instructions on these devices which then will transfer to pharmacy, billing sections and other related departments.

It makes the information available to another point the moment it is entered. We do not yet use telemedicine. However, we are planning to go for it soon.

How does technology help hospitals in providing better quality services?

Healthcare is bit slow in accepting IT as compared to other sectors. That’s the reason healthcare sector is not as developed as other sectors like banking and railway are.

CT Scan is a beautiful example of how technology helps in healthcare. There are other technologies like MRI, Digital Subtraction Angiography (DSA) nuclear medicine, gamma camera. Technology has changed the ways treatment and management works.

What IT solutions you have implemented in Jaslok Hospital?

Our aim is to be a paperless hospital.

We want all hospital data to be in elec-

tronic form and we are already marching towards it. Every patient in Jaslok Hospital is given a smart card at the entry point and has registration and other details of the patient. The patient simply needs to swipe the card whether he goes to OPD, X-ray, lab or to any department in the hospital. We use a comprehensive Hospital Information Service (HIS) from Napier Software, Singapore. It covers hospital management and basic patient data in which case-sheets can be incorporated later.

We also have Laboratory Information Service (LIS), automated solutions in our laboratories, Picture Archiving Communication System (PACS), Radiology Information Service (RIS). All these services and inventory management, pharmacy

Which state-of-the-art equipments and technologies are used in Jaslok Hospital?

We have the latest 3 Tesla MRI. We perform MR guided Focused Ultrasound surgeries which is the only of its kind in the country. The technology is used to dissolve tumours in any part of the body without any surgery. It is a revolutionary technology. We already have treated more than 250 surgeries with this technology which is the highest number in the world.

Besides, we also use PET scan, DSA, Cardiac cathlab. We have got various RF updated systems to deal with motion studies and motion-defect surgeries like those related to tremors. For radiotherapy, we have commissioned two LINACs (Linear Accelerators), of which one is the latest version. november / 2012 ehealth.eletsonline.com

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cover story | Hyderabad Eye Centre

Offering a Clearer View!

What is the role of IT in Ophthalmology?

Just as any branch of medicine, IT plays crucial role in ophthalmology too. If you want to take advantage of IT you can do it. But I’m a little bit traditional in implementing IT, as it smells some sort of advertising, when you roll it out. As a doctor we are not allowed to advertise. However, most people do it in their centers. I don’t think it is bad as long you are grounded with the facts and not inflating them. It is good to have a website. With a website you can showcase what you are doing.

Nowadays everyone checks the website before visiting a doctor visit. Few years back nobody used to look at the net and do some research before finalising a doctor. Website helps in getting consultation and to get the contacts of the clinics.

since then, in 20 years I have been doing this sort of surgery but there are more developments now. New lenses are coming now. All those lenses were not earlier. The newer material lenses, newer technical superior lenses or we called advanced optic lenses, multi focused lenses etc. However, surgical part has not changed much I would say from 1999; it’s the technology in the lenses that have changed so much. Development in the surgical segment is a two way developments. One: the cuts are becoming smaller and smaller that ensures healing is faster. The second thing which has come very late even that technology is not available in one or two centers of Hyderabad which is called Phacoemulsification surgery or Phaco surgery which is basically what we are doing.

What are the leading technologies in eye care?

In Ophthalmology 90 percent work is related to cataract surgery, although there is a new trend of correction of Myopia.

Three years back cataract surgery was the concept that unlike in the older days when we learnt in 1989 of making of good stitches and all, all these things have gone. I learnt it in England and put it in practice there and came back in 1999. Ever

Is there any kind of technology that has given us finer lenses?

It is the western concept of not wearing glasses, that’s why the newer developments have come in lenses so that with the help of these lenses one does not need to wear glasses. But if the patient is ready to wear glasses, then there’s no need of any lens. If the patient says I’m 70 years old and have worn glasses for 30 odd years and I have no issues in wearing glasses then we will be happy to prescribe glasses.

Is the technology put them in any kind of risk?

Glasses just help them to see well. Glasses have some advantages and disadvantages. The disadvantages are like with a spectacle side vision become less, blur, then sometime people forget to carry glasses and they become handicapped therefore everybody wants to be free from glasses. Young generation more likely to go with a Lasik surgery and even some older people too.

How to deal with the myths associated with Lasik surgery?

Lasik surgery is an established treatment now; I don’t see there is any challenge associated with it. Yes, there are few complications but then every surgery has complications. I think Lasik is worth doing, its quick and gives excellent vision. However, if you follow the guidelines after Lasik surgery chances of any complications will decrease.

Milind Bhide, Consultant Ophthalmologist at Hyderabad Eye Centre candidly says ‘some medical guidelines are grey’! In conversation with Pragya Gupta, ENN

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But people are slow in following guidelines?

Yes, everything is becoming so commercial. You have to accept that, people are so tempting about money. Therefore some guidelines or prescribed medicines are grey. Yet, few practitioners stick to the rules and some do not. I’m happy to see ourselves in the latter category.

My Journey

Positivity with Perseverance Hailing from a humble background, he was pushed towards excellience and growth by his hunger to innovate and look out for something new. Dr Om Manchanda, a man with a mission, talks about his early days of struggle and his success mantra with Shally Makin, ENN

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My Journey

The Beginning Dr Om Manchanda was born in a small village, called ‘Nagina’ in Mewat district of Haryana. This village had a population of less than 5000. His parents settled down in this village post the India-Pak partition in 1947. He did his schooling till 10th standard from the same village.

As happened with most people, his parents too went through extremely difficult time during partition. They lost everything they had. His father was about 28 years at the time of partition. He had to rebuild the entire thing! Om heard many partition linked stories from his parents, and their experiences have had a significant influence in his early years of growing up.He did his schooling till 10th standard from the same village. Early days at school comprised of sitting on floor and learning, since the local school in his village

Dr Om Manchanda, CEO, Dr Lal Path Labs is popularly known as Om. He did his MBA from IIM-Ahmedabad, and made his debut with Hindustan Unilever (HUL) in1990. From Hindustan Unilever, he moved to Monsanto India as the Head of Marketing and later as the Head of Sales in 1999. Om’s next career move was with Ranbaxy Global Consumer Healthcare in 2003 and he started there as Head of Marketing. Later, he led the International and Innovation group of the company’s Consumer Healthcare Division.

He moved on from Ranbaxy after two-and-a-half years in 2005 to Dr Lal Path Labs Pvt Ltd (LPL).

had no chairs. From there he moved on to Hisar for graduation in veterinary sciences from Haryana Agricultural University. After graduation, he started preparing for an MBA. He was then selected at the coveted IIM – Ahemdabad, and since then, there was no looking back. From his first job at Hindustan Unilever (HUL) to Monsanto to Ranbaxy to Dr Lal Path Labs, he has grown leaps and bounds – all thanks to his never-say-die attitude.

The Hardships He believes that the key internal trigger was a restlessness to do something ‘out of the box’ and a desire to create or build a lasting institution/brand. Given his experience of consumer sales, marketing and brand building, he was uniquely placed to take on such a challenge. In 2005, LPL received an external funding from a private equity and was looking for a professional to scale up the organisation. His journey has an interesting and quite a few diverse links. Prior to his doing MBA, he graduated in veterinary sciences. Not only that, he completed first year of his masters in Veterinary Medicine in 1988 before going to IIM - Ahmedabad. For the next 17 years, till 2005, he was involved in diverse areas. LPL opportunity provided him to come around an almost full circle wherein he could relate to medical

field, and at the same time use all the management skills acquired thus far.

This proved to be a unique combination which was new to the industry.

Silver lining Since he joined LPL, the company has grown more than tenfold in topline and nearly 20 times in market cap. The infrastructure has grown from 10 labs to about 125 labs. They serve nearly 10 million patients in a year. Amongst many achievements, he rates Unilever Global Innovation Award in the year 1999 as the most significant achievement of his career. This was awarded to him for the successful development and launch of an innovation called, ‘Tea Based Beverage’ in HUL, from an idea stage to launch phase.

Learnings There are two important realisations those have guided his journey. First, life consists not in holding good cards, but in playing those you hold well. Second, as you walk on this path, one should stay flexible and open to grab fresh opportunities. The trick lies in getting out of your comfort zone and grabbing a new one. Life, he believes, keeps throwing opportunities at us. One simply needs to be alert and a little adventurous to seize

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My Journey

the initiative and make the most of it. Om is not an expert at it, but he has seen this phenomenon repeating itself time and again in his own life. It is important that a person should have the courage to live a life true to oneself, not the life others expect of him or her.

Cherished moments

Up, close & personal birth August 30, 1965

Awards and Achievements Unilever Innovation Award - 1999

ANNIVERSARY April 7, 1992

Learnings Learn to deal with success. Any success is a team work, learn to share it Self awareness is extremely critical for self development.

Any perceived weakness can be a great strength in another situation Deserve before desire and at the same time learn to embrace hunger. One may not get everything one desires in life

Biggest achievement Leading an innovative project Tea Based Beverage from idea to launch stage in the year 1998 while at Hindustan Unilever Ltd SUCCESS MANTRA Ability to take on new challenges and walk into unchartered territories

Strengths Perseverance

Purpose In Life Stay happy and have the courage to live a life true to yourself (immediate family included) and not the life that others expect from me

Weakness Find myself difficult to deal with routine and monotonous work

Things you like Nature; keen to visit and see as many natural landscapes and wild life as possible

Inspiration My parents, and a couple of bosses during Hindustan Unilever assignment

Book Management books by authors like Jack Welch , Peter Senge, Steven Covey , John Phillip Jones, etc

What do you value most about yourself as an organisational leader Caring for people, and promotion of meritocracy

Music Very fond of Indian Music. Kishore Kumar and Jagjit Singh are his favourites

What would you like to change about the organisational set up today Bring further clarity in systems, structure and processes

Food Italian and coastal cuisine are my favorites Holiday destination Kerala, Goa, Himalayan Trekking. International: New Zealand and Alaska Past Time Gardening

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Dreams dreams a) Engage in a work where I can make use of small town / rural India’s huge talent so that they get the opportunity for growth b) Devise new business models in healthcare which can make healthcare accessible and affordable to rural India

While his career has seen several twists and turns like the proverbial Bollywood flick, looking back, he feels that his decision to change career of a vet and securing admission at IIMA was the single most significant moment. Second most significant defining moment was his selection for a job at HLL at IIMA campus.

In his personal life he is married man with two daughters. They are all very fond of traveling and holidaying. Om and his family prefer one long vacation in a year. They all are nature lovers and their favourite destinations in India are Kashmir, Kerala, Andaman and Goa. International ones are Alaska and New Zealand.

For the last few years, he has also been going for annual trekking holiday in the Himalayas. He loves reading management books and likes Kishore Kumar melodies.

Insight He considers himself immensely lucky that life, time and again, has presented him with such innumerable opportunities where he has been able to prove himself.

He also strongly feels that life hasn’t really singled him out for such special favours.

However, some of us – unmindful of our potential – ignorantly pass on such prospects, while others seize those with both hands. He feels one needs to be essentially flexible and a little imaginative with one’s thinking while reviewing life’s opportunities. With this thought in mind, he can’t resist sharing a little management gyan. He quotes: ‘When life gives you lemons, make lemonade’. This basically means making the best of a bad situation and taking an optimistic approach. A lemon in this instance means something sour, something which is not working. Om says, “I personally prefer the take When life gives you lemons, get some tequila and salt and make margaritas, cheers”!.

tech trends

A Bout of Technology A couple of decades back, technology in Indian healthcare was a rare phenomenon. Thanks to the advancement happened in this space over a period, health technology is now the game changer!

D

ifferent health technologies have made inroads to Indian healthcare because of two major reasons: to optimise cost and ensure better healthcare. Better healthcare can be seen in the form of less manpower, more productivity, with more accessibility. Seeing the medical technology advancement even Hollywood filmmakers could think of enacting a scene of using video conferencing.

A few recent examples The telemedicine centre of Nanavati Hospital, the telemedicine service provider in Western India, is a good example of how medical technology can be used.

Communication technology based on Integrated Services Digital Network (ISDN) broadband/satellite-based connectivity has been launched at the hospital. Using this technology, the hospital provides teleconsultation and tele-education in India through its network of 34 peripheral rural centers in India and in 45 African countries through its international network.

Dr Pavan Kumar, Head- Department of Telemedicine, Nanavati Hospital shares, “Since the inception in 2006,

our center has provided over 4,000 teleconsultations and over 100 Continuing Medical Education (CME) programmes to doctors and paramedics in rural India and Africa. With over 4,000 teleconsultations and 500 treatments, the hospital has till date saved approximately over ` 1 crore in travel and consultation fees, stay and treatment of patients�.

Max Healthcare has moved to an Electronic Health Records (EHR) system from their existing Hospital Information System (HIS). The system included Computerised Patient Record System for documenting, ordering, reporting and viewing of clinical information. Apart from this, Bar Code Medication Administration (BCMA) was implemented along with unit dose dispensing policy to track and reduce waste, returns and medication errors. An m-health system for accessing laboratory reports and radiology images was also implemented for improving turnaround times of starting care plans.

Today, Max Healthcare facilities catering to 1,000 beds have gone live using the system and all the patients admitted

Interviews Gautam Khanna, Executive Director, 3M India Mohammed Younus Farooqui, Managing Director, Cedara Healthcare Pvt Ltd Deepam Mishra, CEO, i2india Dr Bhuvaneshwar, Trivitron Healthcare Pvt Ltd

have their records on the system. Till date, the system has approximately processed data of 104,130 patient-days across the facilities that are live with 3,123,900 pharmacy orders, 2,603,250 laboratory orders, 520,650 radiology orders and 312,390 bedside procedures.

End note To offer something extra and to stand apart, every healthcare organisation thrives to give the best possible patient care. Driving with this objective, Indian healthcare now is seeing the emergence and growth of sophisticated telemedicine centers, mobile health services, EHRs and medical apps. november / 2012 ehealth.eletsonline.com

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tech trends

Apt Solution for Remote Healthcare Gautam Khanna, Executive Director, Healthcare Division, 3M India, spills the beans on effective healthcare in remote areas How do you think technology has been making contribution in healthcare?

The use of technology has certainly enhanced the delivery of patient care both from a clinical and administrative perspective. It has provided care givers the ability to access patient information in a timely manner regardless of location. This access to patient information helps facilitate clinical decision making, especially at the point of care. This clinical and demographic information can then be used by hospital administration to evaluate the quality and cost of healthcare delivery.

What kind of health IT/medical equipment solutions you are offering to Indian healthcare market?

3M Health Information Systems (3M HIS) specialises in the analysis and development of health policy as it relates to casemix based funding and measurements of outcomes of care through the use of advanced techniques such as simulation modeling. 3M HIS is the world leader in the design and implementation of case-mix based resource allocation systems and case-mix software such as Diagnosis Related Group (DRG) groupers; abstracting, data collection and analysis software; and simulation modeling software, which is designed to facilitate the development, and implementation of DRG based resourcing and management systems.

While the above is a 3M core competency, we work to continually improve integrated systems, drive better clinical outcomes, and grow both revenues and the bottom line. From document creation, to imaging, through chart management and on to revenue cycle management, 3M delivers exceptional value to our customers through our expert software and consulting services.

In this respect, what is the market share of your target market be it Health IT or Medical equipment market?

What is the growth potential of this segment?

In the case of Health IT, 3M can vouch for a majority share when it comes to our core competency in Clinical Coding, Grouping and CaseMix methodology. We are also looking to penetrate the Indian market with our Electronic Document Management Solution (EDMS).

What changes or rather say advancement has happened over the years in your targeted health technology segment? What are the reasons for such change?

The dawn of the electronic and portability age has certainly had a positive impact on how healthcare is delivered all over the world. The perfect synergy between these two industries has

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complimented efforts in developing countries as they continue to find ways to deliver effective patient care in remote areas.

This medium of delivery will also prove to be paramount as we face the challenges of population growth, an increased in chronic diseases and an aging population. At a micro level, the emerging Asian economy over the last 10 years has also had an impact on the evolution of healthcare technology. The emerging middle class and higher levels of disposable income have brought about increased expectations when it comes to the quality of delivery of healthcare. The other compelling argument is the notion of medical tourism. This exploding market and the need to stay competitive has forced healthcare organisations to improve on how they deliver care which is another reason why we are seeing an increased emphasis on Electronic Health Record (HER) in the region.

How the doctor-patient fraternity has been adopting the changes that health technologies have brought to modern healthcare?

We certainly have seen two generations of thought when it comes to how these two groups have adopted to the changes in health technology. There is certainly one generation that still believes in the novelty of the paper patient record, to view it in its physical form and the delivery of patient care in person. What is important here is that the Health IT industry needs to take the necessary steps to accommodate this evolving school of thought and not to single them out. The second group is one where both care givers and patients expect to have access to healthcare information at all

tech trends

times at the tap of an app on their smartphones. In such situations, necessary security, patient confidentiality concerns and health information portability regulations need to be given serious considerations and adopted accordingly. Aspects of which that are very much part and parcel of the present Health IT solution offerings.

In making the transition smooth, what steps you think a hospital or healthcare institute should take? Do you have a role to play in this?

The two aspects that 3M takes very seriously, as we experience this shift in healthcare delivery, is the concept of education and executive sponsorship. While it is important to have the necessary tools and solutions, it is just as important that empirical evidence of best practice is shared with healthcare organisations on success stories in the industry. This will then help facilitate a dialog between peers which in itself will serve as an education tool. Secondly, to further compliment an organisation’s efforts during this transition, it is paramount that such projects are championed and

sponsored at the executive level. The latter has proved to be a key success factor in all 3M projects both the private and public healthcare sectors.

What is your view on Andhra Pradesh healthcare? What are the developments you have seen here in this space and what are the major issues of Andhra Pradesh healthcare?

Andhra Pradesh has recognised the burning need for a more organised healthcare system in the state. The Government is committed to providing affordable and equitable quality health care to all citizens of the state and reduces infant and maternal mortality and morbidity and the burden of communicable and non-communicable diseases. For many years now, through numerous initiatives, they have been making healthcare more affordable and thus more reachable through schemes like the Aarogyasri Health Care Trust.

Other initiatives include measures to strengthen the health system from primary health service delivery system,

mobile health vans with a medical officer, public health nurse and community health officer to strengthening the secondary hospitals with the necessary equipment, specialist doctors and trained nurses. Such commitment on reforms is the first big step towards improving healthcare for citizens, and that part seems to be in place with the government’s plans.

As far as the issues are concerned, healthcare is still an emerging sector, and it is important to get some of the basic elements correct right at the beginning to ensure effective scalability for the future.

One such element is that of the Health Information Systems. There needs to be more effective data collection as the first step by the healthcare providers which can in turn be used for better patient outcomes. Even in cases today where the data is being collected effectively, the system of collection involves heavy utilisation of resources. Through technology, a lot of resources can be saved, and any resource saving in an already resource constrained industry can spiral into even more effective healthcare.

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tech trends

An Optimum Solution Mohammed Younus Farooqui, Managing Director, Cedara Healthcare Pvt Ltd, speaks at length about the health technology that his company offers

What kind of health IT/medical equipment solutions you are offering to Indian healthcare market?

We offer design and management consultancy for hospitals of which ICT is a part. We optimise work flow processes and assist hospitals in implementing technologies like barcode etc.

How do you think technology has been making contribution in healthcare?

Technology can really impact cost of providing services promptly in healthcare delivery. Its deployment will also render the processes transparent. Indian hospitals have been slow in adopting technology but for billing and administration processes. Huge benefits can be realised with technology deployment within the hospital supply chain, emergency response, discharge processes etc.

Many hospitals have adopted and benefitted from technology deployment especially Health Information Services systems Picture Archiving Communication System systems etc. Another area that is yet untapped is the potential benefits that will result from networking small hospitals.

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In this respect, what is the market share of your target market be it Health IT or Medical equipment? What is the growth potential of this segment?

We see a growth of 20-20 percent in this segment. Presently our services are availed more in the Gulf Corporation Council (GCC) countries where technology adoption is more than Indian Hospitals.

What changes or rather say advancement has happened over the years in your targeted health technology segment?

Several changes like cloud computing, faster networks, more medical equipment are coming on HL7 platform that makes it possible to integrate medical equipment into hospital systems like integrating alarms, automatic dose settings depending of on condition of the patients etc.

How the doctor-patient fraternity has been adopting the changes that health technologies have brought to modern healthcare?

Doctors and patients have adapted to technology well in terms of enhancing communication and non-clinical part of the services. However, in areas like Credit Default Swap System (CDSS), Electronic Medical Record (EMR), automated prescription and order filling systems etc. the adoption is slow and yet to take off.

In making the transition smooth, what steps you think a hospital or healthcare institute should take? Do you have a role to play in this?

The critical issue is the buy-in by the top management and clinical team. Without this even if the systems are implemented it will not be properly used. The second factor is training and hand holding that is required during the transition phase. It is extremely important to adequately estimate the time required and budget for the same.

What is your view on Andhra Pradesh healthcare?

Andhra Pradesh has been on the fore front of healthcare developments in India. Be in the private hospital sector, medical education or public health initiatives like Arogyashree. Hospitals have adopted technology early on and have access to the latest in the market. AP being the hub of IT has benefited the hospitals in this regard. The move now is towards EMR and also towards standards accreditations like Joint Clinical Intervention (JCI) and National Accreditation Board for Hospitals (NABH).

tech trends

Making Patient Monitoring Easy Deepam Mishra, CEO, i2india shares the benefits that medical technology has offered to the entire health fraternity

What changes or rather say advancement has happened over the years in your targeted health technology segment? What are the reasons for such change?

There has been great change in the perception of the patient towards technologies. Patients are becoming more educated and demanding. They are willing to accept new technologies for better health. Patients want to reduce their drug usage and adapt to drug free solutions. Lung flute has been a good fit to overcome this problem of patients and helped reduce medication dosage with its continuous usage.

How do you think technology has been making contribution in healthcare?

In today’s high paced era, technologies are focusing on reducing the time and effort required for all forms of medical services –from diagnosis to treatment. Technology will continue to play an increasing role, both at the local as well as at the hospital location.

With cost and portability improving, medical technologies can be brought to the patients, instead of making the patient always travel to them. Technology is also contributing to faster recovery of the patients. Hence patients don’t have to invest for prolonged hospital stays. Technologies have helped in tapping the tier II and tier III cities by providing remote diagnostic and mobile monitoring facilities to patients in those cities. Recently, many non-invasive technologies are being introduced in the Indian market making patient more compliant and adhered to the treatment.

What kind of health IT or medical equipment solutions you are offering to Indian healthcare market?

I2india offers simple, non invasive drug free yet low cost solutions which can either be administered by the local healthcare providers or the patients themselves. We seek solutions for remote diagnosis, low-cost patient screening and mobile monitoring.For example, we have introduced a non invasive, drug free and cost effective device named Lung flute used for inducing sputum and alleviating lung congestion. This simple device can be used either at home or at the primary healthcare clinic, hence making the patient free from going through complex and expensive hospital treatments. The product has been well established in the Indian market and has become an integral part of pulmonary rehabilitation.

How the doctor-patient fraternity has been adopting the changes that health technologies have brought to modern healthcare?

The adoption level in both the groups is steadily increasing, due to increase in awareness. Doctors are increasingly relying on technology to pursue easy and less time consuming technologies.

Patients too are increasingly developing more faith in doctor’s suggestions for adoption of new technologies.Such adoption is faster in bigger cities due to relative ease of patient education and for the awareness of the doctors about new technologies.

In making the transition smooth, what steps you think a hospital or healthcare institute should take? Do you have a role to play in this?

Despite improvements, hospitals and healthcare institutes are still slow to adopt new ideas – perhaps stymied by the fear of losing patients for increased cost of treatment as well as for lack of clarity on regulatory approvals. Often hospitals and doctors tend to focus too much on up-front and immediate costs and not on ongoing long-term impact and costs. For this, doctor and patient awareness programs can be held. Companies like us can help doctors conduct such program at local level. Other than this media can play big role to spread awareness.

What is your view on Andhra Pradesh healthcare?

We do not claim any specific expertise in AP, but our products have had a good reception and overall we have had a good experience in AP. Andhra Pradesh seems to have developed a lot in healthcare. Many big chain hospitals and innovative healthcare providers are now operating in the major cities. november / 2012 ehealth.eletsonline.com

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tech trends

On a Growth Mission The ‘Valve Man’, Dr Bhuvaneshwar joins Trivitron Healthcare Pvt Ltd, with an objective to lead the company’s new initiatives in innovation and education. Dr Bhuvaneshwar also aims to strengthen the company’s manufacturing base thereby helping them to become India’s leading medical device company. He shares his insight on the latest offering from the company gies. As a first step, Trivitron has already tied up with IIT Madras by setting up a Trivitron Innovation Centre in the Department of Engineering Design at IITM. Linking with other leading R&D groups in the country like the Biomedical Technology Wing of the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum is an important part of the future plans. The other critical part of the innovation strategy is to set up R&D groups within each of its business units with strong collaborations within and outside the company.

As a new entrant in Trivitron, what do you wish to achieve in the coming years? What is your vision?

The current market areas of investment and focus at Trivitron are Imaging sciences, Lab Diagnostics, Cardiology and Critical Care and Life Support Solutions.

As a part of its new innovation strategy, Trivitron will focus for innovation in these areas and introduce innovative and cost effective products in the coming years.

As a part of its strategy, Trivitron will collaborate with leading research centers and Institutes in the country, where advanced research is already in progress. The company will work towards developing these laboratory level prototypes into manufacturable technolo-

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Indian healthcare has redefined its definition with time. Now it’s more about healthcare that is cost effective and prompt. In this changing scenario, how do you think technology has been making contribution?

Medical devices and equipment market has grown consistently at over 10 to 15 percent per annum over the last two decades in the country – probably at a much higher rate in the last five years as a result of the growth of the country’s economy and the demand from an expanding middle class. Healthcare is a major focus area of the Government of India in the 12th five year plan with the aim of making it affordable to all.

So, all put together, there is no doubt that the medical devices industry in the country is poised for a substantial growth in the coming decade.

What changes or rather say advancement has happened over the years in your targeted health technology segment? What are the reasons for such change?

The availability of low cost microprocessors, high reliability electronics and wireless communication at ever increasing complexity and lowered prices and their application to the healthcare products has been the most exciting advance in the last 10 years.

In making the transition smooth, what steps you think a hospital or healthcare institute should take? Do you have a role to play in this?

Accreditation of medical services for improving and maintaining the standards of healthcare in the country is definitely a necessity. This is the only way hospitals, clinics and test laboratories will provide a minimum quality of service to everyone in the country. At present, one has to pay higher prices for getting better quality service and there is no method of guaranteeing that one will get it just because you are paying more.

tech trend

Telemedicine

Making Geography History!

Making distance a meaningless factor, ATNF has ensured quality medical care through telemedicine with over 125 peripheral centres including 10 overseas, says Kishore Reddy

Kishore Reddy General Manager, Business Development, Apollo Telemedicine Networking Foundation (ATNF), Hyderabad

How has been your Journey through the ATNF so far?

I have a passion for e-Health services and the ATNF, which is a non-profit organisation of the Apollo Hospitals group, has given me a lot of opportunities to fan it out in accordance with the vision of our Chairman. My prime intention is to develop different healthcare technology- based models from Apollo hospital and sharing this expertise with video centres in the urban and rural locations. It has really been a very satisfying journey so far.

How do you see the healthcare sector in India and particularly in Andhra Pradesh?

Healthcare in the private sector is much better in South India compared to the north India and services are quite accessible too in this part of the country.

But these services are limited only to the

physician level. Specialist’ services are available only in big cities. It is really a picture in contrast that around 90 percent of the tertiary care services or the specialists’ services are available in big cities while 70 per cent of Indian population lives in rural or semi-urban areas. So there is a huge gap between the two.

What is the solution to bridge this gap?

The solution lies in the use of technology for delivering services to the people at their doorsteps. There are a number of new technological solutions now available, which can be deployed to effectively bridge this gap and provide primary, secondary and tertiary level health services to the suffering masses in remote areas. Telemedicine is one of them.

How do you see telemedicine services reaching out to people in rural areas?

Taking into account India’s strides in the field of ICT, telemedicine could help to bring specialised healthcare to the remotest corners of the country. It is still at its inception stage in India. But it has the potential to deliver the end results to the rural masses of the country. At present, India uses tele-consultation and tele-expertise shared services. Moving forward one can see the tele-surgeries happening with robots in place operating the patient by listening to the expert.

However currently rural people in India has access to expert advice to reduce their health risks. But to make the telemedicine more effective there needs to expand the communication network and bandwidth. Due to lack of it people in many parts of the country are not getting benefits of the system. november / 2012 ehealth.eletsonline.com

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tech trends

tech trends

“IVF Has Huge Global Market” 2010, the estimated market size of Hospital Information Systems (HIS) in India was close to INR 4.6 billion and is expected to reach INR 9.8 billion in 2015. The top three states with highest number of hospitals with HIS installed are Maharashtra, Delhi and Andhra Pradesh. Eastern states are the most under penetrated in terms of usage Healthcare IT systems.

Dinesh Samudra, Managing Director and CTO, PALASH Healthcare Systems (PHS), reflects on the market trends and future plans of the company with eHealth Magazine Please share with us your views on the current Healthcare IT trends in India and which segments of Health IT are poised for growth in the coming years?

The Indian healthcare sector is likely to see investments totaling close to USD 78 billion in 2012 compared to investments of USD 34 billion in 2006 and 80 percent of all these investments comes from the private sector. The huge market in India that remains to be tapped is reflected in the hospital to bed density per 10,000 population, which was in India at 12 beds compared to 31 and 39 in the USA and UK respectively. Even developing countries such as Brazil and Chine have 24 and 30 beds per 10,000 population. When it comes to doctors India has an average 0.6 doctors per 1000 population against the global average of 1.23 doctors. We are optimist as measures are being taken by the government. The government has decided to increase health expenditure to 2.5 per cent of the gross domestic product by the end of the twelfth five year plan, from the current 1.4 per cent. Now we have 100 per cent Foreign Direct Investment (FDI) is permitted for health and medical services under the automatic route, also allocation for National Rural Health Mission (NHRM) is proposed to be increased from `18,115 crore in 2011-12 to `20,822 crore in 2012-13.

How has the healthcare market in India especially hospitals grown in terms of maturity in investment and adoption of IT? India is considered to be the fastest growing healthcare IT market in Asia with a growth rate of approximately 22 percent. In

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As new devices make entry into the healthcare segments, what role mobile based applications have in the future?

I can say that mobile based applications have good future in healthcare market. To name a few – patients EMR is available 24x7 to both patients and doctors, It will also help to establish Patient Cantered Medical Services , provide various alerts to patients like – medication, education and alerts to care provider related to patients diagnosis and out of range diagnosis results. In the future looking at our growing population providing quick medical assistance to patients is going to be the need of an hour and there mobile devices can play major role.

Tell us more on the partnership with Zensar and expected outcomes from it?

Palash Healthcare Systems has proven track record in India and Middle East in implementing enterprise IT solutions for healthcare industry through its existing team. This partnership with Zensar is targeted towards developing new markets and propositions in key geographies. Zensar’s focus on emerging markets will help us in breaking in to these markets in India and Middle East.

Tell us more on the new focus areas and target groups for Palash in the coming years for profits and business expansion?

We are entering a new phase in product development, with the introduction of our next generation products in the Healthcare IT solutions space. With total of 160 installations (30 out of India and rest in India), in future we are planning to grow outside India with focus on Web based product of PALASH. We are also focusing on our flagship product In-Vitro Fertilisation (IVF) which has huge market not only in India but also outside India.

The product features data maintenance, treatment processing, analysis and result management for IVF clinics. IVF procedures require data maintenance at various stages right from diagnosis to treatment and the further follow-ups. There is a need for comparison of patient data between and among various treatment groups. There is also a need for continual updating and revision when new data of the patients become available as also at the end of each cycle.

NEWS

Hyderabad Government Hospital Doctors Falling Prey to TB The packed corridors of government hospitals are turning out to be the biggest occupational hazard for doctors on duty with many falling prey to infectious diseases. As many as 22 cases of tuberculosis have been diagnosed among junior doctors in the last two years at Osmania and other state-run hospitals including NIMS. Senior physicians point out that the incidence of tuberculosis among young doctors is becoming disturbingly prevalent over the last few years unlike earlier when hardly any doctor was diagnosed with the dreaded disease.

While no study has been conducted to gauge the magnitude of the problem faced by the healthcare professionals so far, TB prevalence among the medical fraternity is being pegged at anywhere between 10 percent to as high as 30 percent presently. While senior doctors are also affected, a chunk of the sufferers are junior doctors and nurses who are the first point of contact with patients in public sector hospitals. Doctors say not only are they precariously close to patients but the government has also failed in providing them with even face masks.

Brain Stroke Cases Register Alarming Rise Amongst Youth

There is a 30 percent increase in brain stroke cases being reported across the city, especially in younger patients in the past few years which has got doctors in Hyderabad alarmed about the rising occurrence of the disease. On World Stroke Day, observed every year on October 29, specialists from city hospitals are advising denizens to make certain lifestyle changes in order to decrease the risk of brain stroke which is gradually climbing to one of the top spots for leading causes of disability and deaths in the Indian cities.

Dr Jaideep Ray Chowdhry, senior neuro- physician at Yashoda Hospital said, “Around four years ago, we got 284 cases of brain stroke in a year alone, but last year, the figure went up to 414 cases. The most alarming trend is the increase in occurrence of stroke among those below 40 years of age.” He stated that while around five years ago, only 11 percent of the total cases would be from this age group, today the figure easily comes up to 16 percent. He attributed the rise to unhealthy lifestyle choices made by most urban youth.

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Fortis Opens Next Generation Quaternary Care Hospital Fortis Healthcare Limited, India’s largest healthcare provider with an expanding global footprint, today articulated its vision for its next generation hospital, the ‘Fortis Memorial Research Institute (Fortis Memorial), expected to open shortly in Gurgaon, India.

Commenting on the new concept, Malvinder Singh, Executive Chairman, Fortis Healthcare Limited, said, “This is yet another defining step in our endeavour to bring the ultimate healthcare delivery system to the people of India, a thought originally espoused and evangelised by the late Dr Parvinder Singh, our Founder Chairman and father. A comprehensive institute, it is aimed at delivering cutting edge medicine in line with the best in the West. No effort has been spared and every conceivable detail looked into, in the setting up of this next generation hospital, positioned as the healthcare destination facility, in Asia.”

The Fortis Memorial is a one stop, multi-super specialty quaternary care hospital providing medical excellence.

A first of its kind in Asia, it redefines Healthcare delivery, elevating it to a position of individualised, total care for complex medical problems, requiring specialised medical attention. Adopting a patient centric approach, the Fortis Memorial builds on its four strong pillars of exceptional clinical talent, world-class infrastructure, cutting edge technology, and personalised service delivered with compassion, in a friendly environment.

NEWS

Fidelity Ind Plans to Acquire Stakes in Trivitron Fidelity India Capital is planning to acquire 35-40 percent stake in Trivitron Healthcare for ` 400 crore. Fidelity will buy the stake from HSBC and ePlanet along with some fresh equity issuance by the company. The company plans to use the funds from Fidelity to scale up its medical technology business. Kotak Mahindra Capital Co is the advisor to the deal.

Trivitron was planning to raise USD 100 million in January this

year for expansion of its Medical Technology Park and offer partial exits to its PE investors, HSBC Private Equity (now Headland Capital Partners) and ePlanet Ventures, from which it had raised `50 crore in 2007. It was also looking at two to three acquisitions in European and US markets.

Founded by GSK Velu, Trivitron Healthcare is a global medical technology company focusing on manufacturing and distribution. Its key segments include cardiology and implantable devices, imaging sciences, diagnostics, critical life support solutions and ophthalmology and also have a range of offerings in the value and premium segments. It is setting up a medical technology park in Chennai.

Care World TV Launches Series For New Mothers

Motherhood marks a new phase in the life of a mother. The experience of being mother is full of changes, challenges, transformations and sometimes complications too. Focusing on this side of motherhood, Care World TV has launched a show named ‘Maa: A New Phase of Life’. The show consists of 20 episodes featuring different stages of pre and post pregnancy.

‘Maa: A New Phase of Life’ revolves around the topics such as regaining shape, lactation, mood swings and takes on serious problems such as thyroid, hemorrhoids, stretch marks and many more. It focuses on all the complications with a very sensitive approach and deals with the psychological and physiological changes that a mother has to face during pregnancy and post delivery. The show provides guidelines to cope with psychological issues related to motherhood. It intends to increase understanding between couples, provides directions to deal with feelings of stress, lack of confidence, depression, being new parents, etc. It is a host to an array of world renowned gynecologists, pediatricians, dieticians, physiotherapists

and many more specialists.

Talking about its newly launched show Mr. Ajit Gupta, Managing Director, Care World TV said “Our audience knows a lot about the link between a pregnant woman’s health and her baby’s development once it is born. But there is limited understanding about prenatal and postnatal behaviour of a woman, her mood swings and strong emotional reactions. The hard-to-explain bouts of sadness and the ‘feeling down’ phases are noticed in almost 70 to 80 percent of expectant and new mothers. Through this show, we are trying to help today’s young mothers.

Earlier, when there were joint families, mothers were attended to with great care, help and support of elders, but now it has become really difficult, especially for working mothers.”

The show is created to educate & impart awareness amongst women who have just entered this different phase of life or will enter it in the future. Each episode is targeted towards certain complications and the experts’ suggestions on the causes, symptoms and treatment of the same.

Care World TV is the Asia’s only satellite healthcare TV Channel. It is successfully on air for the last two years disseminating health related information to the masses, thus bridging the gap between the functionary and the beneficiary.

Superbugs Simply Float across Hospital Wards Infections caused by hospital superbugs are difficult to cure. Superbugs such as MRSAs, NDMs and C-difficile are fast developing resistance to all known antibiotics, sending the global medical fraternity scrambling for newer formulations.Now, a new research underlines why these bugs mainly found in hospital ICUs are deadly: they simply float on air currents and contaminate surfaces far from the beds of infected patients.

In other words, cleaning hospitals beds and surfaces is not enough of a guarantee against superbug infections, said the study done by the University of Leeds.Actions such as coughing, sneezing or simply shaking the bedclothes can send these superbugs into flight, and proliferate on freshly cleaned surfaces.

In a controlled experiment, the Leeds researchers used a special technique to disperse the superbugs and found that they had grown on various surfaces across the stimulated set-up. The university’s officials said in a press release, The level of contamination immediately around the patient’s bed was high but you would expect that. Hospitals keep beds clean and disinfect the tables and surfaces next to beds.”But the team captured significant quantities of bacteria right across the room, up to 3.5 metres away and along the route of the airflows in the room.

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healthcare regulatinos

Healthcare Regulations and H Aftereffects

The Indian healthcare regulations have gathered different reactions from the industry peers. The following article is an attempt to bring those reactions in a cohesive way

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ealth is wealth for many. At least if we look at the mushrooming number of private hospitals and clinics in India, one would easily agree on the fact that healthcare in India is dominated by private players. Yet bed to patient ratio in India stands at one bed for a thousand patients whereas globally the ratio is three beds for a thousand patients which implies that healthcare facilities in India is not sufficient. A recently launched World Bank report reveals in India private sector dominates the healthcare sector. The report says inadequate legislation and lack of tendency to enforce regulations actually causing poor quality of medical services in the country. The report further adds, in India eighty percent spending on health comes from personal funds.

However, the prevalent laws do not ensure that those private medical services are qualified by any minimum healthcare standard.

The report says, “Powerful medical lobbies have opposed government efforts to regulate the private sector�, adding that India’s medical councils are not enforcing laws relating to registration and licensing of medical practitioners. The report has taken into account of the challenges the consumer health organisations have grumbled about. For example, doctors over-prescribing drugs, recommending unnecessary investigations and treatment, and failing to provide appropriate information for patients. Yet, people choose private sector over Government hospitals because of better accessibility and relatively shorter waiting time for treatment and diagnosis.

healthcare regulatinos

Leaders Speak Dr Shekhar Agarwal, Executive Director, Sant Parmanand Hospital One of the foremost issues regarding regulation in the health care industry is the compliance with Medicare standards.

The Medicare standards, in turn, are themselves made up of a wide range of individual issues that include, but by no means are limited to: the clarification of the necessity for advanced beneficiary notices, streamlining the process for writing orders for diabetic glucose monitoring supplies, as well as many others. At present, the methods of addressing these concerns cut a broad swath, ranging from mere word processing work in which clarification is made through rewriting the language of policy to full scale changes in those policies or regulations. In some cases, however, it has actually been necessary to introduce regulations through legislation.

Kasi Raju, COO, Care Hospitals Health governance is scattered over ministries. There is poor efficiency of government expenditures. Accepting large number of unavoidable “illegal” medical practitioners and co-opt them with training is a real challenge. Patient laws must guarantee quality, affordability and availability of medicines.

Rajiv Tewari, Director, Health & Wellness, Rockland Hospital There are already enough regulatory mechanisms in use by organisations like Central Government Health Scheme (CGHS), Delhi Government Employee Health Scheme (DGEHS) for the Government Employees. The insurance companies have their own mechanisms for ensuring their interests and the patient’s interests. All that is needed is a minor modification to the Government systems to ensure a quick response system to avoid delays in decisions and payment cycles. This will help in the alignment of the private health care providers with the government ultimately benefitting the patients”.

Dr Parvez Ahmed, Medical Director, Rainbow Children Hospital One of the foremost issues regarding the regulation in the health care industry in the compliance with Medicare standards. All the healthcare organizations have to comply with the regulatory requirement. It’s emphasises on patients, employees and environment safety. Some of the healthcare organisations are lacking in the compliance of the regulatory requirement like compliance with the fire safety, Atomic Energy Regulatory Board (AERB) approval and disposal of hospital hazardous liquid waste/effluents as per the statutory norm.

Aditya Vij, CEO, Fortis Hospital The complex set of regulations for starting a new hospital varies from state to state. For example, in context of fire protection and safety regulations for hospital buildings, each state follows different set of rules and has different criteria for ‘building height’ restrictions. In the context of construction of new hospitals, Floor Space Index (FSI) norms for hospitals and commercial buildings are same in most of the states. Few state governments e.g. Maharashtra allows additional FSI for trust hospitals but this benefit is not extended to private hospitals. We are also facing issue of collecting payments from government agencies such as Ex-servicemen Contributory Health Scheme (ECHS) and Central Government Health Scheme (CGHS) for treatments provided.

Dr Sujit Chatterjee, CEO, Dr L H Hiranandani Hospital There are for example archaic laws which we are still focused and point in case is the Drugs & Cosmetics Act 1940. Recent version on this has still not seen the light of the day. Looking at the scenario it is imperative that Indian Government should think about formulating a comprehensive plan of regulations Indian healthcare.

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expert speak

Indian Healthcare

Work in Progress Indian Healthcare: A Fascinating Story

The healthcare sector has got its due recognition over a period of time feels Anjan Bose, Secretary General, Healthcare Federation of India, still a lot needs to be done. He shares his views on Indian healthcare system About Healthcare Federation of India For quite some time, the feeling was growing among some of the key stakeholders that the healthcare sector is growing very fast, but all the challenges associated with the sector were also growing. We came together to build a NASSCOM-like institution in Healthcare, Today you cannot think about IT sector in India without NASSCOM, which was built in the 1980’s. I joined the Healthcare Federation of India as Secretary General as I felt it is a wonderful opportunity to do something good in healthcare of the Country. A few months back the Federation was registered. We are now in the process of getting our logo registered. The vision of this institution would include bringing the various healthcare stakeholders together like the Indian healthcare providers (hospitals), technology providers’ medical equipment and devices, diagnostic service providers, as well as the healthcare insurance providers. Now we are all set for an official launch within a few months.

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The story of Indian healthcare is very fascinating. In the last three decades the sector has gone through a very rich transition. The sector has witnessed tremendous growth in all the segments. Some of the private, corporate players and also leading Government Institutions have now become some of the best names worldwide. The Government has done a splendid job in focusing on healthcare in the last few years. A lot of attention has been coming on the different necessary elements of healthcare; the global technology providers have been focusing on the Indian market now. Technology leaders GE, Philips, Siemens, J&J etc have got their innovation and manufacturing centres in India. In a nutshell, the visibility of the sector, the recognition of the sector as one of the major contributors of growth in the country’s development is much more now, compared to a decade back! I have been associated with Healthcare around the world for three decades now and I’m very delighted with the kind of focus Healthcare is getting from all its stakeholders. I am very happy that it has been recognised that health is wealth.

Health and education are two important factors for any country’s development. There are many areas of excellence today in Indian healthcare; in delivery, clinical areas, technology and diagnostic support are just a few of these. One major area of concern is the overall gap in skill set; doctors, nurses, in paramedical and biomedical areas. We are truly sitting on a dormant volcano today.

Indian healthcare is in serious need of trained manpower and all efforts to bridge this gap should be welcome. The other areas which are work in progress are Quality/Regulatory and Infrastructure. We need to speed up our overall efforts as one team in the country in these areas. Government, private, everyone that will result in more appropriate, more accessible healthcare for our Nation as well as attract many more medical tourists.

About Health for All by 2020 I would like to see quality healthcare reachable to all. There are a lot of drives coming from Government’s initiatives; the private players are also responding to Government calls. I think overall affordability is important and it is going in the right direction.

Still work in progress. With scope of continued collaborative partnerships amongst private players and with the Government bringing in the right technology supported by disruptive innovation and frugal innovation should help here.

expert speak

Accessibility will much be dependent on technology and how it evolves. Tele-medicine has been catching up, mobile van healthcare reaching greater sections of society yet there is a lot of gap still to be bridged.

High Level Expert Group Report on Universal Health Coverage for India This report, instituted by the Planning Commission of India,” is dedicated to the people of India whose health is our most precious asset and whose care is our most sacred duty..” It’s terms of reference cover very important points like developing a blue print for human resources in health for India, developing systems which will ensure access to essential drugs, Vaccines and medical technology by enhancing their availability and reducing cost to the Indian consumer; develop a framework for health financing and financial protection that offers universal access to health services. Most importantly, it also addresses the social determinants of health. This well-thought-

of report should be a very good guideline in further improving the healthcare of our great nation across all segments.

To Conclude For Healthcare Federation of India the vision would include further enhancing the overall image and quality of healthcare considering there is trust deficit among the stakeholders. Our duty will be to help in bringing back the trust/confidence among the stakeholders by being honest to the needs of the Nation, by being honest to ourselves thereby enhancing the image of the medical community as a whole. Also we will need to intensify the domestic innovation and manufacturing aspect so that the import ratio of medical equipment and devices go down to a reasonable level. Over the years, the Government has done very good job of rationalising the import duty and other tariffs but that is not all. To further rationalise the percentage of medical technology import, domestic innovation and manufacturing should have to be increased.

Arunachal Pradesh

Not in Pink of Health!

Kindly shed some light on the healthcare scenario of Arunachal Pradesh ?

We are in Arunachal Pradesh; the population density here is very less. Because of which our healthcare delivery cost is very high. We do not have any medical college, dental college, nursing college till now. So first and foremost we want to have these established in the state. We are lacking super specialties, we do not have any neuro-surgeon, cardiologist, cardio surgeon and we are still very far behind the Indian healthcare scenario. However, we are planning and trying to cope up with the healthcare scenario of the rest of India. As Arunachal Pradesh is internationally bordering China, Burma and Bhutan, our main problem is that our population density is not very high and local area network area is very weak, it is 84, 000 thousand square kilometer but population is say 12 lakh only. So the cost delivery of healthcare is very high. To deliver to the beneficiary and grass root level we have to spend a lot of money. For that we don’t get substantial fund assistance from the central Government because the Government funding scheme is based on population and density and not based on distance and difficult area based. Therefore we suffer and face great difficulties. This is not happening only in Arunachal Pradesh but it is happening in all India level. We are not able to make understand the Government of India about our situation.

Dr K Nishing, Additional Director at Directorate of Health Services, Arunachal Pradesh, took a quick time out to speak on the healthcare scenario of his state. He goes candid in saying the state’s healthcare stands much behind from the rest of India

What are the healthcare projects have been launched in the state?

We don’t have any separate healthcare projects running in the state. Whatever is there with the Government of India healthcare initiative plans, we are trying to implement those here. Indian healthcare is good, the IAS system is good but the main thing is that the beneficiary should get the benefits. With the less number of populations we are handicapped to offer prompt and efficient healthcare. Sometimes we need to send a helicopter or need three to four days to reach a single patient. november / 2012 ehealth.eletsonline.com

55

in conversation

P Bala Kiran, Dy. Secretary, (Dept. of Information Technology), Director, Akshaya & Nodal Officer (Endosulfan Victims’ Rehabilitation), Kerala, reveals the healthcare initiatives his state has taken to ensure technology enabled healthcare reaches to most. Interviewed by Aruna Tiwari, ENN

Trajectory of Comprehensive Healthcare What is your take on the Indian healthcare sector? What are the major developments that the country has made and what are the challenging areas the sector is facing?

In the recent times, the Indian healthcare sector is increasingly getting primary importance with union health budget allocation of `21,000 crore, which was much better than `8000 crore in 2004-05. In terms of life expectancy, child survival and maternal mortality, India’s performance has improved steadily. As per SRS-2010, life expectancy is now 63.5 years, infant mortality rate is now 47 per 1000 live births, maternal mortality ratio is down to 212 per lakh live births and total fertility rate has declined to 2.6. However, there are wide divergences in the achievements across states.

For example, in Kerala, the progressive social movements had a vital role in enhancing the social accessibility by means of effective political participation, increased literary and awareness programmes. The kind of social development which occurred in the State (high physical quality of life at lower rates of economic growth) has been described as the “Kerala model”. In healthcare delivery as well, the state has offered something new to the

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world by way of good health at low cost, partly as an offspring of the broader development path of the state. In recent times other states, example Tamil Nadu and Himachal Pradesh, have been able to make substantial progress in provision and acceptance of services. Many other states are in the process of adopting practices that have proved successful and the results should be obvious before long.

The most important factor of production in health is manpower.

At present their availability is skewed with some states not able to generate enough skilled manpower. Lack of systems for monitoring, ensuring supplies on time and capacity building are also major constraints. These will become even more obvious as India scales up the availability of resources to health sector.

Tell us about the successful healthcare projects which have been launched in the state of Kerala.

Achievements of Kerala in healthcare are considered exemplary in terms of common healthcare indices employed to measure the ranking of states. In fact it is not only far above the national average but even comparable to the developed

in conversation

countries in the world. The Department of Health and Family Welfare is the primary Government entity responsible for healthcare management in the state. The department has been implementing various central and state programmes intended for improvement of healthcare of its citizens very efficiently and this is reflected in various social and health indicators which are comparable to the western standards. Now the department has also taken care to take IT implementation to the grassroot level by providing one PC each down to the Primary Healthcare (PHC) level. The field staff is already trained to handle computers. The department is now all set to take the IT implementation to the next level.

Also, Kerala implements all of the national healthcare programmes and most of the successful outcomes have been the result of efficient implementation of these programmes. e.g: Family Planning, Malaria control, TB control and Prevention and control of HIV/AIDS. Some of the unique programmes we have started are: • Population based control of non communicable diseases • Pain and Palliative care for the terminally ill • Programme for supporting the victims of gender violence What are the challenges to the health sector in the state and what strategies have you implemented to overcome them?

The state is now believed to be in the stage III of the epidemiologic transition signified by the high incidence of lifestyle diseases. The observations of the Cardiology Soci-

st e h hig est e th low s a h ncy, a l a te a r t a e r c K xpe ty l i l e a life t mort aterna ) n R m infa ) and e (MM t R a r M I ( ity l a t mor

District wise details of healthcare institution and beds (as per the 1991 census) District No of healthcare institutions Number of beds Alappuzha 343 8,835 15,819 Ernakulam 546 Idukki 194 4,096 Kannur 392 5,149 Kasaragod 209 2,107 Kollam 704 7,530 9,323 Kottayam 440 Kozhikode 342 9,034 5,030 Malappuram 327 Palakkad 316 4,925 Pathanamthitta 310 5,096 73,410 Thiruvananthapuram 1011 Thrissur 434 12,991 Wayanad 127 2,307 Total

5,095

105,152

ety of India, Kerala Chapter reproduced below summarises it all – “Kerala has the highest life expectancy, the lowest infant mortality rate (IMR) and maternal mortality rate (MMR). This social transition also has unfortunately led to the highest prevalence of Coronary Artery Diseases among all Indian states with a rural prevalence of 7.5 percent and urban prevalence of 12 percent. Cardiovascular death is 50 percent of the total death and by 2020 it is predicted to go up to 2/3 of the total death.”

Kerala has already emerged as the diabetes capital of India. Kerala is facing new health challenges like return of infectious diseases, increase in accidents and injuries, increasing geriatric population and their problems, high level of suicides, diseases due to environmental degradation, diseases like dengue, JE, chikungunya and HIV/AIDS. Coming to the strategies, the awareness levels of the people is the most valuable asset of Kerala. Using this, Kerala organises an annual programme for control of communicable diseases. Kerala has a programme for screening of the entire population for diabetes and hypertension. Soon cancers of the oral cavity, breast and cervix will be added. In order to strengthen decentralised leadership, Kerala has set up an administrative cadre as a speciality for doctors and soon a course will be started to give them a post graduate degree in Health Administration.

Tell us about your vision for the state’s health department.

The Health Department vision for 2020 is to create a ‘society that can afford healthcare cost’; that is healthy, active and vibrant to fight against lifestyle and modern diseases; a state actively involving, interfering and regulating the unethical practices and providing a pollution free environment, taking care of the old and weak, thereby establishing a proper healthcare system for the people of the state” november / 2012 ehealth.eletsonline.com

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in conversation

How do you propose to bring down the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR)?

The MMR (50 per 1 lakh) and IMR (10 per 1000) rates of Kerala are the lowest in the country and comparable to the best of developed countries. Both rates have been controlled to a great extent due to excellent Institutional deliveries in Kerala (about 99.8 percent). It is the aim of the present government to have 100 percent institutional delivery and decrease the IMR and MMR further. To reduce the Maternal Mortality Rate even further, regular medical audits of maternal mortality have been conducted. Most of the conditions are being addressed by revamping hospital procedures to address Post Partum Haemorrhage and sepsis and ante natal care for pre-eclampsia.

Tell us about the eHealth initiatives that are being taken?

Presently, the Department envisages an effective IT enabled integrated framework to ensure efficient service delivery to the common citizen and provide a centralised database of healthcare information allowing close monitoring and control measures.

This will be a robust and sustainable IT solution supporting nearly 30,000 healthcare service personnel consisting of doctors, paramedical and other non-clinical staff at the primary, secondary and tertiary care centres maintained by the state Government. It is also scalable to include private healthcare providers who agree to partner with government in the provision of RSBY or Universal Health Care.

The ultimate vision is about building an Integrated Healthcare Cloud which will also be shared by the private healthcare institutions as well and thus will hold the complete healthcare data about all the citizens in the state. All these would be integrated into a single project – eHealth Kerala.

What steps should be taken to ensure that the government owned healthcare centres, especially in rural areas, are fully manned?

Government had implemented a compulsory rural service obligation for medical graduates studying in government colleges.

However, this had failed to ensure continuous availability of doctors. Instead the recruitment process has been modified to ensure that doctors get to choose their location of posting. The expectation being that doctors lower in the merit list would have to choose rural postings if they desired to be in government service and they would get posted out in two years. The current problem is that the recruitment process of the PSC is not agile enough to respond to the attrition rate. Some of the shortfall is being made good by contract doctors recruited under NRHM.

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n a p t u re as e s s ad rs a c h e ala trativ docto r e K inis ill or f w y m t e ad ciali ours em e c h a sp soon a give t ree g to and arted ate de tion t u ra be s st grad minist d a po alth A e H n i What is your opinion on quality of medical education in the state? What are the steps the state has taken to ensure best quality medical education in the state?

With five medical colleges in government sector, two in cooperative sector and 16 in private sector the reach of medical education in the state is very good. However private medical colleges offer varying levels of quality. Efforts are being through the Kerala University of Health Sciences to conduct periodic inspections to ensure quality. Since the main problem of these hospitals is the lack of adequate patient load, an effort is on to link them up with government hospitals.

expert speak

Filling the Lacunae in Medical Education Dr M Sasidhar, M D (Micro) I/c Director, Vice Principal, Professor & HOD Dept. of Microbiology, Rajiv Gandhi Institute of Medical Sciences, (Semi-autonomous institution) Government of Andhra Pradesh (AP), speaks about his organisation’s perspective of medical education What is your opinion on the status of medical education in India and in Andhra Pradesh? What are the developments the state has witnessed in this specific area?

Medical college is a tertiary care for promoting, enhancing public health in multifaceted and multidisciplinary way as well as educating future doctors of the Indian society. Medical education is the back bone for the healthy and productive and wealthy India. India has evidenced a drastic uplift in this sector in recent past by liberalising the stringent restrictions and amending the rules of Indian Medical Act 1951 further paying the ways for the apex institutions like AlMS across the country and new medical colleges in both Government and private sectors particularly in rural areas for improvising the medical care of society.

AP caters 12.5 percent (40 medical colleges) of medical graduation in contrary to the previous five percent in 1980’s.

AP state government is keen in the aspect by increasing medical seats in Government colleges and by establishing new medical college in each district and promoting the private sector in the medical education but not compromising the desired standards of Medical Council of India (MCI).

What is your opinion on the quality of medical education?

What steps should an institute like your need to adopt?

Quality is the parameter that depends on curriculum administration, trained and dedicated faculty, further regular updation of medical knowledge by Continuing Medical Education’s (CME) and promoting research. Every institution has to adopt stringent measures like regular and periodic curriculum make

up as per the desired standards and encouraging the initiative from students.

What are the steps you/your institute have taken to safeguard the quality parameter?

Strict implementation of curriculum , implementation of all available methodology in teaching and encouraging student participation evidenced by up to 100 percent results in university examinations.

To solve the problem of getting NOC for setting up medical college in the country, what steps should the Medical Council of India (MCI) need to take?

Getting NOC depends on several factors as a whole, but liberalisation in certain aspects depending on the geographical and community level feedbacks from the states can be considered depending on descriptive powers of council but not compromising on the standards, as everything is not possible in a given situation.

How active is MCI in offering solution to scarcity of medical colleges, doctors and para- medical staffs in India and in AP? No doubt MCI is putting its effort but still the lacunae exists like some of the states are not even having a medical college. As the need of the hour, we need further liberalisation depending on the existing criteria of different states and places.

AP state under Directorate of Medical Education is promoting various paramedical and nursing courses from long under paramedical board. november / 2012 ehealth.eletsonline.com

59

zoom in

Digitisation of Nursing Registration

Prof Rafath Razia, Dy Director (Nursing), I/c Registrar, Andhra Pradesh Nursing and Medical Council, talks about the challenges and opportunities that the nursing examinees experience. In conversation with Rozelle Laha, ENN

Tell us about the medical education scenario in Andhra Pradesh.

The healthcare sector in Andhra Pradesh was made a III-Tier structure -primary, secondary and tertiary¬- by the then Chief Minister NT Rama Rao in ‘80s.

So the whole Healthcare Department falls under two ministers, one for Medical Education and another under Minister for primary and tertiary care services. Each primary healthcare centre ideally serves 30,000 members of the community. But at most of the places, the situation is different. These centres are supposed to address all healthcare issues concerning maternity and child health. Besides they have to also attend cases that come under the government’s National Rural Health Mission like Malaria, HIV and leprosy, and provide day care facilities.

In Andhra Pradesh, Dr NTR University of Health Sciences at Vijay-

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wada, affiliates health courses. Currently, there are seven colleges of Nursing in Andhra Pradesh and nine schools of nursing under government and teaching hospitals.

On the other hand, there are nearly 400 private schools of nursing which provide General Nursing & Midwifery (GNM) diploma. I have proposed one college of nursing for each medical college. There can be one school of nursing for each district hospitals. Likewise, one multi-purpose health training centres can be set up in each area hospital. Such an initiative can improve balance in the nursing education sector.

Is there any difference in the courses offered by private and government institutions?

Andhra Pradesh follows the same courses that are given by Indian Nursing Council. So program is uniform but the man-

zoom in

agement is different. For student, if they get in Government institution, they get stipend and the education and the hos-

tel fee is free and definitely the standard of education or quality of education is better. On the other hand, private institutions need to streamline the education process in line with government to provide quality. The Government College of Nursing provides stipends to students.

In the first year they get `1,500 and

second year they get `1,700 and third year they get ` 1,900 and fourth year they get `2,000, all through four years.

The fee is very nominal and affordable at `1,1500 whereas in private it’s about one lakh.

What are your views on improving the quality of nursing education?

The Auxiliary Nurse Midwife (ANM) training is being looked after by another Directorate. This degree program is under University and administratively it is under Director of Medical Education. We will be better coordinated if there is a nursing directorate and all nursing educational activities and nursing services are encouraged. I hope to see a lot of improvement to include quality improvement whether it is a certificate, diploma and degree and all admissions. The registration process has been digitised from 2005 and we have computerised data of the nurses graduated and registered. In 2005, Catholic Health Association of India has taken up project of CDCP (Centre for Disease Control and

Prevention), sponsored by US based international organisation to digitise the whole process.

What is the approximate number of seats in Nursing in Andhra Pradesh?

In National Public Health Week (NPHW), in the ANM programme there are 300 seats. There will be an increase in the number of seats in the future which will encourage the nursing sector.

What kind of investments has been done by the Government for the nursing sectors in education?

The Government of India proposed to start with seven nursing schools in 85 percent Government of India projects and 15 percent Government of Andhra Pradesh projects. The project includes three ANM Schools and four GNM Schools. For few years, the recruitment has not taken place, even though the vacancies are there. There is a regular recruitment through Nurses Recruitments Exams by regional director in Andhra Pradesh in each zone.

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special feature

Solutions for Efficient Healthcare Management The information and communication technology (ICT) revolution is having dramatic effects on the delivery of health services to common citizens

I

t has become common for healthcare professionals to keep a remote eye on elderly patients at home by making use of health monitoring systems, sensor networks and alert services. The medical data from patients can be stored in the cloud so that it is available to healthcare professionals in an easy manner.

ICT is also being deployed to piece together the fragments of our medical history that are scattered between our local doctor, hospitals and other medical centres.

ICT enabled systems are making it possible for authorities to keep track of the health status of citizens living in different parts of the country. Even people living in rural, remote and inaccessible areas can be provided quality healthcare services in a seamless manner through the use of telemedicine and other systems. When it comes to healthcare, prevention is always better than cure. The process has now started to use ICT for data collection, analysis and modelling. A host of new technologies have an important role to play in preventative medicine.

NICSI, a section 25 company under NIC, has been engaged in developing many cutting edge solutions that can bring vast improvements in the efficiency of healthcare organisations operating in the country. Some of the solutions that are having a major impact in the Indian healthcare sector are the following:

e-Hospital@NIC NIC, under the Department of Information Technology of the Government of India, is a premier Science and Technology organisation, at the forefront of the active promotion and implementation of Information and Communication Technology (ICT) solutions in the government. NIC has spearheaded the e-Governance drive in the country for the last three decades building a strong foundation for better and more transparent governance and assisting the governments endeavor to reach the unreached.

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This is basically a Hospital Management System. It is a workflow based ICT solution for Hospitals. It is specifically meant for the hospitals in Government Sector. It covers major functional areas like patient care, laboratory services, work flow based document/information exchange, human resource and medical records management of a Hospital. It is a patient-centric system rather than a series of add-ons to a financial system.

Developed by NIC by making use of Free Open Source Software (FOSS) tools, the e-Hospital@NIC Suite conforms to HL7

special feature

Standards. It has been developed keeping in mind the requirements of healthcare service delivery in public hospitals in India.

The solution has already been deployed in many hospitals in the country.

Key Features of e-Hospital@NIC 1. ISO / IEC 9126 Certified 2. Based on HDF(HL7 Development Framework) 3. Unicode(UTF-8) based Indian Multilingual Support 4. Vocabulary- ICD-9, LOINC etc.

5. Comprehensive Reporting on various customizable parameters 6. Comprehensive Role based Access control and Security 7. Embedded User Manual 8. Data Security and Privacy 9. Audit logging of transactions 10. Powerful Search facility and tracking of patient history 11. Enables data sharing across various department 12. Touch Screen Kiosk interface 13. Available on Linux as well as Windows platform

eHospital@NIC Blood Bank A web based comprehensive blood bank management Solution, the eHospital@NIC Blood Bank is geared to cover all the activities of a standard blood bank. This workflow based blood bank management system facilitates exhaustive donor registration.

The screening of blood is faster and more structured.

The Key Features of eHospital@NIC Blood Bank Maintain and update Unique Donor Identification.

1.

2.

Track and maintain all Donor Types-Voluntary, Family and Replacement.

3.

Blood Group Identification with forward grouping and Reverse Grouping.

4.

Screening of Blood Bag with Tests like HIV (method, Result), HCV, HBsAG etc.

5.

Component separation tracking of whole blood.

6.

Requisition for manual as well as computer registered Patients.

Transfusion Reaction Detail 7.

8.

Complete Key Consumables Inventory Management.

9.

Tracking Camp Detail with camp location, organizer and employee involved.

10. Stock Transfer 11. Comprehensive Reporting on various customizable parameters.

12. Comprehensive Role based Access control and Security.

13. High Level of Data Security and Privacy 14. Audit trail logging of transactions.

15. Powerful Search facility and tracking of donor history.

Telemedicine centre at Kidwai, Karnataka

eHospital@NIC Telemedicine With telemedicine healthcare professionals can provide medical aid from a distance. It is an effective solution for providing specialty healthcare in the form of improved access and reduced cost to the rural patients. It also leads to reduced professional isolation of the rural doctors. eHospital@NIC Telemedicine is a web based comprehensive telemedicine application. eHospital@NIC Telemedicine aims to extend the reach of specialised healthcare services to masses residing in remote rural areas.

Key features of eHospital@NIC Telemedicine 1. Comprehensive Electronic Health Recorder (EHR) with unique patient ID 2. Integrated VC and Web conference tool for studio and Desktop PC based consultation.

3. Email/ SMS alert for physicians and patients.

4. Structured investigation using clinical reports.

5. Digitised medical images from X-Ray, Ultrasound scanner, CT Scan, MRI etc.

6. Secured environment through encryption and hashing algorithms.

7. Based on HL7 Development Framework 8. Medical Vocabulary- ICD-9, LOINC etc.

9. Embedded User Manual 10. Comprehensive Reporting on various customizable parameters 11. Comprehensive Role based Access control and Security 12. High Level of Data Security and Privacy 13. Audit trail logging of transactions 14. Powerful Search facility and tracking of patient history Telemedicine Module by NIC is web based telemedicine software that has been developed by making use of free open source software (FOSS) tools. The system conforms to Healthcare Standards, for managing telemedicine services for masses in remote places. It is available as ‘Software As A Service’ (SaaS) under NIC’s Service Delivery Platform over NICNET. The vibrant video-conferencing system, developed for telemedicine, facilitates interactions between Doctor to Doctor and Doctor to patient.

As the reach of NIC, NICNET and Technical Support Services has started extending up to district levels, there exists a massive scope for expanding the reach of healthcare services. november / 2012 ehealth.eletsonline.com

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in focus

A

Satisfying

Journey for HMRI Balaji Utla, Chief Executive Officer, Health Management and Research Institute (HMRI), President, Corporate Sutainability, Piramal Health Care, says that with the innovative healthcare plans embedded with technology and a committed workforce, HMRI, has been making healthcare services affordable for the marginalised people. In conversation with Pragya Gupta, ENN Please shed some light on your engagement with the HMRI. I used to work for an IT firm Satyam Computer Services as head of Corporate Strategy. I was for almost 18 years with the IT firm. Prior to joining HMRI and Piramal Healthcare Ltd, I was CEO of Satyam Foundation, a Corporate Social Responsibility (CSR) arm of the Satyam Computer Services (now Mahindra Satyam). I also studied in a business school in Hyderabad for about nine years before joining Satyam Computers in 1993.

Since 2010 I have been working with the Piramal Enterprises looking after HMRI as part of the CSR. What is the objective of HMRI? Founded as a non-profit organisation and supported by Piramal Foundation, the HMRI works towards making healthcare accessible, affordable and available to all segments of the population.

In order to achieve this goal, HMRI leverages cutting edge information and communication technologies to cut costs without compromising quality as well as public-private partnerships to scale its solutions to the last mile.

Once we build solutions, which are IT leveraged, we work with the state governments, as Health is a state subject, to supplement government efforts. We primarily focus on delivery model and try to physically reach the target for all types of diagnostic tests, delivering medicine etc.

HMRI envisions a future in which all vulnerable groups have the necessary information to make informed decisions regarding their health and affordable, available and accessible high quality health infrastructure to support the realisation of those decisions.

What are the key problems or challenges in the healthcare sector in the country?

The most significant challenges in providing equitable healthcare are availability, accessibility and affordability.

Shortage of skilled health workers including doctors and paramedics to provide medicare to a majority of people, around 72 per

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cent of the population, who live in rural areas, is the biggest challenge. While many states have quite a good number of medical colleges, particularly in south Indian states, the scene is different in other parts of the country. The result being that some states have very limited doctors passing out every year, others have more doctors on roll with every passing year. But still the overall situation is not encouraging. The patient - doctor ratio is abysmally low in the country. Similarly there is a big shortage of paramedical personnel in the country.

Services of even these small numbers of doctors and paramedics are not being utilised fully owing to large distances and poor road connectivity between rural habitations and health centres. According to a survey a rural Indian has to travel an average six kilometer to reach the nearest health facility in the country.

The third most intriguing challenge, of course, is affordability of an Indian to avail the health facilities. The Government of India contributes only 26 per cent of country’s total health expenditure per Indian forcing the needy to cough up two third of the expenses out of pocket. The problem is further compounded when despite being able to meet the expenses, the patient is not sure of getting the medicine or expert advice in time at his place.

Further our healthcare system is not designed in the right economic model. There is nothing wrong in private enterprises. Their design by nature is faulty. They want to make money and want more sick persons to pep up their business. They offer undesired services and it results in escalating the healthcare charges.

How these challenges can be addressed?

Fortunately, there are quite a few people who are recommending Universal Health Plan, without exception. The society should cover the need for healthcare for everybody. This is what the Dr K srinath Reddy report to the Planning Commission has also recommended. Whether it is practical or non-practical, is an argumentative issue.

in focus

Balaji Utla Chief Executive Officer, HMRI, President, Corporate Sutainability, Piramal Health Care

november / 2012 ehealth.eletsonline.com

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in focus

Ensuring equitable access for all Indian citizens to affordable, accountable, appropriate health services of assured quality as well as public health services addressing the wider determinants of health delivered to individuals with the government being the guarantor and enabler, although not necessarily the only provider of health and related services, the Reddy panel has recommended.

The panel has also suggested that these services should be delivered at an affordable cost so that people do not suffer financial hardship in the persuit of good health.

Besides, the High Level Expert Group (HLEG) on Health in its report to the Planning Commission has recommended strengthening of the primary healthcare system to address the challenges.

And I think it is the core area where the government needs to focus as most of the population who live in remote, rural areas visit the primary health centres first for their ailments in primary stages.

People suffering from diseases like cough, diarrohoea can be treated easily in a cost-effective way.

But this is not an attractive proposition for private sector players as the cost of treatment for such minor diseases would be nominal and profit-oriented private health sector has no interest in them.

In fact, preventive health care needs to be focused. Preventive health care means taking measures to check emergence of the disease. I will elaborate it with an example. Suppose a person has put his legs in mud and then comes for cleaning it get the mud removed. But such a solution will not be needed at all, if one tried to escape the mud while walking. This is preventive measure.

The shortage of resources like doctors and paramedics can be minimized only by opening more medical colleges and launching short-term courses for the paramedic streams. In India, some states have quite a good number of medical colleges like in the states of Kerala, Mahrashtra, Andhra and Karnataka but majority of states do not have sufficient number of colleges to produce doctors and allied medical staff to meet the growing challenge of healthcare.

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For example, Uttar Pradesh has a population almost double of Andhra Pradesh but it has medical colleges just one third of what Andhra has. So, the government should make efforts to open more medical colleges to plug this disparity.

Moreover, we should also make arrangement to leverage more time of the doctors much more efficiently .And, here comes the role of technology. Telemedicine delivers services to a patient in a remote area with a specialist’s prescription; thanks to the Internet, broadband and bandwidth.

But there is also a problem in extending telemedicine services effectively in the areas where it is needed the most because bandwidth is least available in remote hilly areas. So increasing the bandwidth in such areas is needed to extend this facility. By setting up a robust bandwidth infrastructure, telemedicine services can effectively extended to the needy and can also meet the shortage of doctors in remote areas.

With mobile telephone penetration growing in the country, the services of experts can also be availed even during odd hours. Suppose a patient in a remote hilly develops some complication in the night and no doctor is available around, then mobile phone comes handy for him to consult a doctor and get prescription.

But it is possible only when there is a good bandwidth infrastructure there.

You have just completed five years, what have been the key milestones in the journey so far?

Our key milestones during the period

has been one in the health information service wherein, we got around 50 million calls from different parts of the country during last five years. The health information helpline is a solution to the health information and access problems in the country. A caller gets medically validated advice and counseling from the helpline.

We also demonstrated the feasibility of telemedicine during the period. Our telemedicine project is being implemented in the tribal belts of Araku valley and Khammam district of Andhra Pradesh. It has reduced maternal morbidity among Araku valley tribals. And the results show that all high-risk cases had safe deliveries ever since the project was launched in 2007. It also ensured that over 95 percent home deliveries were attended by trained health workers.We have been able to increase institutional deliveries in tribal areas significantly.

Our telemedicine solution has ensured that people residing in remote locations get the advice of specialist physician through videoconferencing.

And that is really very satisfying for me.

Further our mobile health services -104 and Sanjeevani have also delivered remarkable results during the period. Our 104 Mobile services identified and provided medicine to around three million people with chronic diseases during the course of operation. The mobile service addresses geographic access problems with a focus on maternal and child health and chronic diseases services to people living around Primary Health Centres. We have been able to provide diagnostic, medication services to around four million people through this service in Andhra Pradesh and Rajasthan.

Sanjeevani Mobile health services has been launched exclusively for the state of Assam where 78 mobile vans are operational 24 days a month across the state focusing mainly non-communicable diseases.

We have deputed psychological counsellors in Assam who have really worked to save atleast 200 people from doing suicide with their advices. And that is a big achievement for us.

Global Leader

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Janette Bennett, Clinical Director Asia Pacific, British Telecom Health, speaks to Shally Makin about the new project initiative the company planning for Indian healthcare market

Global Leader

Brief us about BT’s plans for the Indian market?

The healthcare system during 60s in UK witnessed various collaborative works with other countries as well. We understood the market, looked at the hospital agenda along with other aspects the funding models are different in India. Gradually, the community is changing but every country had their own challenges in healthcare at every moment. Everybody has something to learn from somebody else. There is not a perfect system devised to carry procedures in the healthcare system, so the countries exchange their technological advancements and our motive is taking ICT to every hospital. Within the hospital we can work towards achieving desired architectural facilities right through the implementation and delivery, there are number of case studies where we can share the healthcare operation head. Now the vast vocalisation is back and interest in India has shown net impact for patient availability. The more efficient the vocalisation is, the more use of ICT will be invested. We have also done a lot of work in the hospitals which are much more self -managed and are much cheaper at the cost point.

There are a lot of tele-health services through communication and geographical areas in India. Now if we look about two dimensions digital hospitals and tele- health, it is actually about building the infrastructure with expertise and skills in building educational aspect.

How do you think India is the preferred destination for technological innovations?

We work closely with hospitals which are very keen to work with us. Indian technology is growing very rapidly as far reaching to more international standards and quality wise is very high.

So actually we are taking up a mobile project and the market of mobile project market changes very rapidly especially when we are taking up the medical technology and the cost point as well. Markets in India are very interesting and there are a number of strong players and are looking to globalise technology.

What are the current projects that you are working on?

British Telecom (BT) has won a major networked IT contract in Australia’s health sector where it has been selected by Serco, the international service company, to be its IT partner at the Fiona Stanley Hospital in Perth, Western Australia. BT will install and manage the hospital’s communications infrastructure and run a range of IT services aimed at helping the hospital become one of the most technologically advanced and environmentally friendly hospitals in the country. This includes deploying a secure local area network and providing systems integration services, unified communications, mobility, and conferencing technologies.

Comprising a specialist medical centre, a private tertiary hospital, and a luxury hotel with state-of-the-art conference and wellness facilities, the Connexion complex is currently under construction and is expected to be completed in 2013. It will design, build, and support the entire facility’s technology and applications architecture, bringing together multiple business applications such as the finance and human resources systems,

customer relationship management, queue management, security solutions, and the hospitality management and healthcare information systems. Users will benefit from single-signon, which permits them to enter one name and password to access multiple applications from a variety of devices. This will allow staff access to information on-the-go, helping to provide quality care to patients.

What makes BT’s technological and clinical infrastructure different from the industry to emerge as one of the best?

BT has a unified communication in telemedicine and has a global reach. We are in 119 countries and we work with top 60-70 percent in the worlds banking industry. We also work in Ministry of Defence in the UK. We deal with consultations of hospital managers so there are primary selling points and in the firm opposition there are very less people who have work of experience in this particular area. At UK we operate with the international standards, health informatics components by messaging instructions with the transcript systems integrated there. We developed the technology required for end to end transcript service. Now BT is looking at the secondary usage service in UK as well which is a very viable data as UK government declared a certain level of security.

So we have lot of projects in UK since deployment is underway. There are various countries like in some we have green fields hospitals, architectural designs, IT requirements, the implementation and unifying management, optimising the heating and the lighting. In other places we are doing system integration and applications with a large number of RFID that helps an organisation to streamline and maximise its resources with usage of equipments. We do have an impact on tele-health services running in number of places. In depth we are also looking into the business analytics side i.e the organisation, research and education agenda. We are integrating solutions. The end product in the hospital information system sells the patient graphics.

What are your future plans to keep pace with the advancements?

The first tele-health stand was built by the BT Staff working in UK. We are working with a number of agencies now about evolving medical devices. We have a fair knowledge about the systems whereby we take old technology through intelligence in order to make sure they are well integrated. We know that the information could be transferred in some way by the technology and Internet. She thinks the biggest issue is the human factor. So tele-health is really a core centre into our system.

We know what to look for the country, for the clients so that they are ready for next type of change because there is a human factor or organisational factor. We are looking into the type of expansion in the healthcare sector even in India and other country. We are looking to bring together and increase the things which are in other countries. november / 2012 ehealth.eletsonline.com

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