Asian Healthcare IT Market- Riding high on India: October 2007 Issue

V O L U M E 2 | I SSUE 10 | OCTOBER 2007

ISSN 0973-8959

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

Rs. 75

COVER STORY

Asian Healthcare IT Market - Riding High on India APPLICATIONS

Spatial Health Management Information System (SHMIS) DEVELOPMENT DIMENSION

Patient Empowerment Through e-Health IN CONVERSATION

Amit Kumar Chief Information Officer, Max Healthcare POWER HOSPITAL

Max Devki Devi Heart and Vascular Institute, New Delhi PERSPECTIVE

Hospitals - ‘Know IT Right’ ZOOM IN

HL7: Standards in Interoperability EVENT REPORT

Frost & Sullivan HealthIT Executive Summit, Goa

w w w .e h e a l th o n l i n e . o r g

Asian Healthcare IT Market - Riding high on India

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w w w . e h e a l t h o n l i n e . o r g | volume 2 | issue 10 | october 2007

COVER STORY

Exclusive Interview

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Asian Healthcare IT market Riding High on India

Amit Kumar Chief Information Officer, Max Healthcare

Dipanjan Banerjee, eHealth

APPLICATIONS EVENT REPORT

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Spatial Health Management Information System (SHMIS)

Pramod K Singh, Institute of Rural Management, Anand

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Frost & Sullivan HealthIT Executive Summit, Goa

August 31 - 2 September, 2007, The Leela, Goa

DEVELOPMENT DIMENSION

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Patient Empowerment through e-Health

Milon Gupta, Eurescom

IN CONVERSATION

20

Our focus will be on EHR and conforming to international healthcare standard

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Amit Kumar, Chief Information Officer, Max Healthcare

POWER HOSPITAL

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Max Devki Devi Heart and Vascular Institute, New Delhi

PERSPECTIVE

30

Hospitals - ‘Know IT Right’ Vishal Ranjan, Asclepius Consulting

ZOOM IN

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HL7: Standards in Interoperability

Susan Thomas, eHealth

NEW S R EV I EW

INDIA NEWS 16

22 October 2007

WORLD NEWS 24

BUSINESS NEWS 26

PRODUCT PROFILE

28

EVENTS DIARY

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

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IN LIGHTER VEIN

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Volume 2 | Issue 10 | October 2007

EDITORIAL

PRESIDENT

Dr. M P Narayanan EDITOR-IN-CHIEF

Asian Healthcare IT - on a high !

Ravi Gupta MANAGER - eHEALTH

Dipanjan Banerjee mob: +91-9968251626 email: dipanjan@elets.in RESEARCH ASSOCIATES

Susan Thomas Dolly Ahuja SALES EXECUTIVE

Arpan Dasgupta mob: +91-9911960753 email: arpan@elets.in DESIGNED BY

Bishwajeet Kumar Singh Om Prakash Thakur WEB

Zia Salahuddin Santosh Singh CIRCULATION

Manoj Kumar (+91-9210816901) manoj@elets.in EDITORIAL CORRESPONDENCE

eHealth G-4 Sector 39 NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org

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Emerging trends show that developed Asian markets like Singapore, Taiwan, Korea and Hong Kong, are providing higher quality of public healthcare, despite spending lesser on healthcare IT than their counterparts. Also evident is the fact that India is the fastest growing healthcare market, with growth forecast of 22% (CAGR), ahead of China and Vietnam.

According to Springboard Research (a global IT market research firm), the total market for health IT in Asia is expected to reach $4.83 billion by 2010.

In case of India, healthcare accessibility is quite lower due to many barriers - geographic, economic and social. Not to mention the inherent weaknesses of the public healthcare system. In our ‘Applications’ section, the article on Spatial Health Management Information System explores the public health scenario in India, hindrance to its progress, and proposes a GIS-based IT system for better governance of public health.

The HealthIT Executive Summit organised by Frost & Sullivan in Goa witnessed encouraging participation from senior executives of Tier I public and private healthcare institutions, government departments and the IT industry. Do read the exclusive report.

It is a pleasure to announce that starting from this issue we have expanded the scope of our ‘Product Profile’ section to include software solutions.

If you are in healthcare business and planning your IT strategies, the ‘Perspective’ section is your must read. Asclepius Consulting – a healthcare management consulting firm from Bangalore writes on finer points of health IT strategies and pitfalls to avoid.

It is predicted that by the year 2030 the ageing population of the European Union will rise by 52% and the number of people between the age of 15-65 will decrease by 7%. Hence, patient empowerment will be driven by this demographic change. Healthcare expenditure in Europe has already reached 8.5% of GDP. In order to prevent it from growing further than economic growth, public heath institutions and insurers are promoting e-health. When patients are more responsible and empowered,the cost of healthcare can be better contained; and an acceptable level of healthcare can be guaranteed for all. Get a low down on this in ‘Development Dimension’.

expressed in this publication. All views expressed in the magazine are those of the contributors.

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is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. is published by Elets Technomedia Pvt. Ltd. In technical collaboration with: Centre for Science, Development and Media Studies

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October 2007

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COVER STORY

Asian Healthcare IT market Riding High on India Asian healthcare IT market is sizzling. Big investments are pouring in and much more is yet to come. Time for vendors and solution providers to go ‘ga-ga’. But how exactly does the market look like? How should you go about it? What are the dynamics and crtiticalities that lie ahead? Read on...

T

he phenomenal growth witnessed over last few years in the healthcare sector across Asia have received a lot of attention from both local and global markets. To meet the surging demand for quality healthcare, coupled with an increasing need to conform to global standards in delivery and management, healthcare service providers across most developed and developing economies of the region are fast gearing up their IT investments.

Latest findings of Springboard Research – a leading global IT market research firm estimates the total Healthcare IT market in Asia (excluding Japan) to be US$ 2.95 billion (INR 11,800 crore) in 2006 and expects it to accelerate with a compounded annual growth rate (CAGR) of 13.1% to reach US$ 4.83 billion (INR 19,320 crore) by 2010.

MARKET GEOGRAPHY

While these figures are exciting enough for vendors and solution providers to raise toast, it is interesting to note that current geographical spread of this market is largely skewed towards China and Australia. Considering proportions of actual spending in healthcare IT, China emerges as the most lucrative destination with 46% of overall spending coming from across the ‘The Great Wall’, while ‘Down Under’ seems

to be the next best market, with 25% spending coming from this island country.

ADVANTAGE INDIA

While China glitters and Australia shines, there are opportunities are galore in the emerging Indian healthcare sector. The market potential in healthcare is getting so high in the land of Taj, that businesses in Big Apple are already celebrating - amply evident from the summary of recently held Bear Stearns 20th Annual Healthcare Conference in New York, with top notch industry leaders unanimously chanting India as the next Asian healthcare hub.

Going by the research result, India emerges as the leading Asian market on ground of percentage growth of investment in healthcare IT. The expected growth rate of Indian market has been pegged at 22%, closely followed by China, Vietnam and Australia.

In value terms, the overall healthcare market in India is estimated to reach a staggering US $3 billion (INR 12,000 crore) by 2010. The major factors in this growth are attributed to higher demand for quality services, increased spending capacity of consumers, better healthcare awareness,

Healthcare IT market in Asia (excluding Japan) was recorded at US$ 2.95 billion (INR 11,800 crore) in 2006, and expected to accelerate with a compounded annual growth rate (CAGR) of 13.1% to reach US$ 4.83 billion (INR 19,320 crore) by 2010.

Source: Springboard Research

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closer linkage of healthcare with quality of life, availability of advanced medical treatments and diagnostic methods and greater availbility and access to healthcare insurance for consumers.

With nearly 60% of the current Indian population in the age group 15-59 years, expected to grow to 64% by 2025, coupled with a steadily increasing trend in per capita income, there is an immense potential for the healthcare sector and in turn, the IT and peripheral industry to benefit from it.

SPEND TREND

While healthcare IT spending in most emerging Asian economies have

have been found to be most typical in the region, resulting in sustained growth of the market, at a pace that is even higher than many of the currently emerging economies.

VENDOR BENDERS

A major challenge for IT vendors, as identified in the research is attributed to the highly fragmented and disparate levels of development within industry players and relatively slower rate of market maturity. While this charecteristic is common in many other industry sectors in Asia, healthcare seems to be having the deepest of furrows. Moreover, even within groups

India emerges as the leading Asian market on ground of percentage growth of investment in healthcare IT. The expected growth rate of Indian market has been pegged at 22%, closely followed by China, Vietnam and Australia registered appreciable increase, it is quite intriguing to find that some of the advanced counterparts, namely - Singapore, Korea, Hong Kong and Taiwan have registered much lower investments, and yet they posses much better capacities for delivering high end health services. One reason behind this apparently peculiar trend might be attributed to existance of a sufficiently strong IT infrastructure, leading to lesser need for current investments.

However, it may also result out of a relatively stable health system with adequately high doctor-patient ratio, backed up by sufficient infrastructure facilities and lower population pressure - thus allowing service providers to deliver even with basic or existing IT facilities.

Judging by percentage of healthcare IT spending as part of overall national IT spending, Australia tops the chart, followed by China, Malaysia, New Zealand, Philippines and Vitenam. The trend and spending pattern of Australia October 2007

of developed and developing nations, there are apparently uneven, and often, contradictory trends and spending patterns, adding to market volatility.

Much of this is comprehensible on the premise of local conditions prevailing in each country, in terms of economic, regulatory and even political environment – causing markets to surge, slump or flatten within particular political boundaries.

It has been observed, that developed nations which have gone up in healthcare value chain are now showing higher spending in technologies for care management and patient records.

While on the other hand, and quite predictably so, emerging markets are putting larger share of their budgets in IT infrastructure, clinical applications and diagnostic equipments.

“While most industries in Asia are very fragmented as far as development, maturity and growth, we see this even more accentuated in the Healthcare industry�

Jonathan Silber Research Manager Springboard Research Singapore

INVESTMENT INSIGHTS

Major factors driving IT investments 7

COVER STORY

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ASIAN HEALTHCARE IT MARKET - RIDING HIGH ON INDIA

IT & SOFTWARE VENDORS

MEDICAL EQUIPMENTS & DEVICES

Global Vendors: Microsoft, IBM, HP, Intel, InterSystems, ibahealth, Oracle, SAP, Accenture and EDS

Global Vendors: Cardinal Health, McKesson, Emdeon, GE Healthcare, Siemens Medical Systems, L&T, CareStream (Kodak), Agfa Healthcare, Drager

Indian Vendors: Wipro HealthCare IT, Sobha Renaissance, TCS, HCL, BirlaSoft, Karishma Software, SN Informatics

on value-added applications in developed markets are attributed to changing regulatory environment and privacy restrictions in some countries - leading to the need for introducing higher service quality standards, patient records management and even information sharing among service providers. Yet another trigger can be identified as the need of service providers to match up with global standards for higher business prospects, leveraging better returns and attracting the international clientele. Quite in contrast, emerging markets grappling with inefficient public healthcare systems and often dismal rural service delivery are investing heavily in community care, telemedicine and health information networks.

COMPETITION CAULDRON

While market opportunites continue to soar, the vendor space too is getting crowded and competitions are sure to get fierce, sooner than later. While multinational IT and medical technology firms are making a beeline for the Asian healthcare pie, domestic and local ISVs and SIs are also pulling up socks to make a mark.

IT & Software Solutions

The MNC league of IT companies that are offering solutions specific to the healthcare industry includes - Microsoft, IBM, HP, Intel, InterSystems, ibahealth, Oracle, SAP, Accenture and EDS to name a few. However, domestic players with global footprints are fast emerging as strong competitors with quality offerings and often, with a differential local competetive edge over foreign counterparts. Some of the domestic IT players in India include – Wipro HealthCare IT, Sobha Renaissance, TCS, HCL, BirlaSoft, Karishma Software, SN Informatics and others.

However, considering the fast changing market landscape, and increasing dependence of business success on both technical expertise and local intelligence - global and domestic players are increasingly finding it beneficial to forge partnerships and leverage each other’s strength for a faster market capitalisation.

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Indian Vendors: Trivitron, Eastern Medikit, Advanced Micronic Devices, Elacons, Godrej, Lifeline, Narang Enterprises

Medical Equipments & Devices

In the medical equipments and devices space, the dominance of multinational vendors continues with a strong hold, with nearly 90% of the demand being met through imports. Some of the prominent global vendors includes – Cardinal Health, McKesson, Emdeon, GE Healthcare, Siemens Medical Systems, L&T, CareStream (Kodak), Agfa Healthcare, Drager Medical, Sanrad and others. However, there is a slow but steady progress of many domestic companies who have forayed into this segment and are offering quality products at much economical rates. Similar to the trend in IT industry, the medical technology segment is also witnessing JVs, mergers and acquisitions between and amongst global and local players. In India, Trivitron Group (one of the top 10 domestic medical equipment companies) have recently announced a joint venture with Aloka, Japan (leader in ultrasound technology) for manufacturing of high technology, low cost ultrasound equipments for the emerging markets. With this JV, Trivitron is targeting to capture a sizebale portion of the INR 500 crore (US$ 125 million) ultrasound equipment market in India, growing at an impressive CAGR of 20%.

About the article This article is brought to you by eHealth, in technical collaboration with Springboard Research – a leading IT market research firm working across the globe. While most of the data and information used in this article have been extracted from the latest report of Springboard Research on ‘IT and Technology in the Healthcare Industry in Asia’ (excluding Japan), certain portions of the text are carrying information, insights and opinions drawn upon through independent research of eHealth Team, and may or may not subscribe to the views of Springboard Research.

Dipanjan Banerjee Manager - eHealth Group dipanjan@ehealthonline.org

www.ehealthonline.org

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APPLICATIONS

Spatial Health Management Information System (SHMIS) Redefining public health governance in India The article briefly describes the status of health and health infrastructure in India and also tries to discuss governance issues involved in delivery of public health care. Further, it examines the governance structure for public health in India and finally proposes a Spatial Health Management Information System (SHMIS) and its effective operationalisation.

Pramod K Singh INTRODUCTION

Public health management needs information on various aspects like spatial pattern of the prevalence of diseases and health infrastructure available in order to take decisions on either creating additional infrastructure or for taking immediate action to control epidemics or other diseases.

Unfortunately, at present, public health sector in India has very poor knowledge management practice.

STATUS OF HEALTH IN INDIA

High infant mortality, low birth weight, under-nourishment, very high level of anemia in women (about 50%) reflects the sorry state of health status in Indian population. While providing home to 17% of the global population, India bears a disproportionate burden of 23% child deaths, 27% of maternal mortality, 20% maternal deaths, 30% TB cases, and 68% leprosy cases of the world.

Performance of the health care delivery system in India is reflected in the country’s ranking in Human Development Index (HDI) and in the disease burden, including - waterborne diseases (10 million), malaria cases (75 million), filariasis cases (14 million), tuberculosis patients (14 million), blind people (9 million), disabled people (16.15 million), leprosy (1 million), STDs (50 million), and HIV/AIDS (4 million).

Scenario of health standards is unevenly distributed across the country. There is a great degree of variability of health standards across Indian states. As per indices computed based on National Family Health Surveys (NFHS) estimates of 1998-99, a severe under nutrition (weight-for-age) persists among children less than three years of age in the states of Bihar, Jharkhand, Madhya Pradesh, Chhatisgarh, Orissa, Uttar Pradesh, Uttarakhand and Rajasthan (ref: Figure 1).

Vector-borne Disease Severity Index (VDSI) is computed based on spatial distribution of four diseases (malaria, kala10

FIGURE 1 [SOURCE: WWW.INDIASTAT.COM]

FIGURE 2 [SOURCE: WWW.INDIASTAT.COM]

azar, filaria and dengue). State-wise data of 1992 was used for preparing the VDSI. Figure 2 shows that Bihar, Uttar Pradesh, Maharashtra and Karnataka are very high in composite vectorborne disease severity index.

Severe iron deficiency anemia in women persists in the state of Tamilnadu, although its per capita income level is relatively higher. Moderate iron deficiency anemia persists in women in the north-eastern states like Assam, Meghalaya and Sikkim. However mild iron deficiency anemia in women persists in the eastern states and some of the north-eastern states.

STATUS OF HEALTH INFRASTRUCTURE IN INDIA

One of the major and persistent causes of malfunctioning of public healthcare infrastructure in the rural areas is a critical shortage of key health manpower, particularly of doctors, nurses, and laboratory technicians in public facilities (Ref: Table 1). This is partly due to management failures such as inadequate incentives, poor working conditions, and lack of www.ehealthonline.org

transparency in posting of doctors in rural areas.

As per the estimation of the Ministry of Health and Family Welfare (as on 31.03.2001), shortfall of Community Health Centers (CHCs), Primary Health Centers (PHCs) and Subcenters (SCs) in rural and tribal areas is shown in Table 2 Like the health scenario, the health infrastructure is also not distributed evenly across Indian states (Ref: Figure 3).

Total health infrastructure (dispensary plus medical staff) is fairly good in states and Union Territories like Andaman and Nicobar Islands, Kerala, Pondicherry, Karnataka, Jammu and Kashmir, Himachal Pradesh, Punjab. Situation of the same is miserable in states like Bihar, Jharkhand, Haryana, Uttar Pradesh, Tripura, and Nagaland.

Table 1: Shortfall of health care manpower Category

Number

Number sanctioned

Shortfall % in Position

Doctors at PHCs

29,689

25,724

13.35

ANM

160,246

134,086

17.40

Pharmacists

25,910

21,077

26.98

Lab Technicians

25,910

12,709

51.10

Nurse Midwives

43,520

17,673

47.27

[Source: www.indiastat.com]

Public health infrastructure has a very strong urban bias. It is unfortunate that while the incidence of all diseases is twice higher in rural than urban areas, the rural people are denied to have access to proper health care, as systems and structures were built up mainly to serve the fairly well-off urban elites.

While health care of the urban population is provided by a variety of hospitals and dispensaries run by corporate, private, voluntary and public sector organizations, the rural health Table 2: Shortfall of Hospital and dispensary Shortfall of PHCs in Rural Areas Shortfall of SCs in Rural Areas

4,488 22,842

Shortfall in CHCs in Tribal Areas

282

Shortfall in PHCs in Tribal Areas

459

Shortfall in SCs in Tribal Areas [Source: www.indiastat.com]

4,814

care services, mainly immunization and family planning, are organized by ill-equipped rural hospitals, primary health centers (PHCs), and sub-centers.

Table 4 shows that the quantum of public health expenditure is insignificant considering the scale required to meet even the modest health needs. India’s outlay on public health expenditure is much lower than the average public health expenditure of 2.8% of GDP for low and middleincome countries and the global average of 5.5% of GDP. FIGURE 3 [SOURCE: WWW.INDIASTAT.COM]

GOVERNANCE ISSUES RELATED TO HEALTH SECTOR IN INDIA

The main governance issues related to health sector in India are mobilization of physical infrastructure; access, accountability and transparency; issues related to human resource motivation and gender concerns. Access to healthcare is hindered not only by geographic, social and cost barriers, but also by inherent systemic and structural weaknesses of the public healthcare system, some of them are as follows: Compartmentalized structures and inadequate definition of roles at all levels of care; • Inadequate planning, management and monitoring of services/facilities; • Inefficient distribution, use and management of human resources so that people have to contend with lack of key personnel, unmotivated staff, absenteeism, long waiting times, inconvenient clinic hours/outreach, service times, unauthorized patient charging.

• Displaying insensitivity to local/community needs; ineffective or non-existent referral systems, resulting in under-utilization of PHCs, over-utilization of hospital services, duplication of services and cost-ineffective provision of services; • Inadequate systems to enforce accountability and assure quality.

• Inadequate attention to health education and public disclosure.

• Inadequate attention to attention to vulnerable groups

Table 4: Public health expenditure and basic health indicators in India Country

Total health expenditure as % of GDP

Public health expenditure as % of total

Infant mortality Rate/1000

Under 5 Mortality Rate/1000

Life Expectancy

India China Sri Lanka Malaysia Korea UK USA

0.9 2.7 3.0 2.4 6.7 5.8 13.7

17.3 24.9 45.4 57.6 37.8 96.9 44.1

70 31 16 8 5 5 7

95 43 19 8 5 7 8

64 70 72 73 75 78 77

[Source: www.indiastat.com]

October 2007

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APPLICATIONS

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SPATIAL HEALTH MANAGEMENT INFORMATION SYSTEM (SHMIS)

Under the circumstances, our search is for a model that makes for a just health care system as an ideal for rural India. The main criteria for this could be: • Universal access, and access to an adequate level, and access without excessive burden; • Fair distribution of financial costs for access and that of burden in rationing care and capacity; and a constant search for improvement to a more just system; • Training providers for competence, empathy and accountability, pursuit of careful and costeffective use of the results of relevant research; and • Special attention to vulnerable groups such as children, women, disabled and the aged.

SPATIAL HEALTH MANAGEMENT INFORMATION SYSTEM FIGURE 4: AN IDEAL SHMIS FOR INDIA

IT based information and knowledge sharing holds the key to good governance. The current state of information resource and knowledge management is inadequate. Hence there is an urgent need to initiate development of a Spatial Health Management Information System (SHMIS). The SHMIS would be ideally located at the Ministry of Health and Family Welfare, Government of India and there would be a server at this location which would accumulate the meta-data and also have accessibility to other servers. This server would be linked to National Spatial Data Infrastructure (NSDI) server. Apart from the central location there would be servers located at state and district level with state Health Departments. The hospital information network would be connected to the server at district level for ensuring online real time updating. The Research institutes and medical colleges will have servers which would be linked to either state level or directly to the central server depending on the operational area of the institute. Other players like pharmaceutical sector, civil society organisations can also have their information network linked to any one level (national, state or district).

The district level server should also be updating taluka-wise and village-wise epidemiology and health infrastructure in the district. In order to ensure accountability, monitoring may be performed at District, Block and Village at CHCs, PHCs and SCs respectively. Civil Society Organisation (CSOs), citizens and other interest groups may also take part in the monitoring process. While the proposed SHMIS would provide a proper information flow, the decision system would be much more effective with the enriched analytical ability of GIS. The model SHMIS is shown in figure 4.

The lone model of information system aided by GIS can help in better and faster delivery of health services in following ways: • No need for every agency to provide all types of data to the next level. It will have the discretion to filter the information by classifying shared and unshared data. e.g. every admission record at hospital need not be communicated to the next level, rather only the aggregate data may be shared.

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It will decrease the cost of storing and analyzing the information at the actual source, thus avoiding duplication and increasing accessibility through Internet.

• User can access the data of any level by logging into the central server without having the hassle of visiting every website - thus acting as a single-window service station.

• At each level, data would be viewed geo-spatially, which would help to take rational decisions and hence better health care planning.

Last, but not the least MIS depends on its effective operationalisation. Better operationalisation of SHMIS would require following preconditions, such as distributed architecture; commitment to open source software; agreements on data interchange standards; web enablement; commitment to holistic capacity building and change management; the Ministry of Health and Family Welfare (MHFW) should be acting as integrator institution •

CONCLUSIONS

Indian public health infrastructure and services are presently much below the acceptable standards of quantity, quality and accountability. Poor governance system and poor knowledge management is the major cause of concern. Once SHMIS is in place, the governance of health services and infrastructure in India can be expected to become much more easier and efficient.

For the complete version of the article with references log on to www.ehealthonline.org Pramod K Singh Assistant Professor, Institute of Rural Management (IRMA), Anand, India E-mail: pramod@irma.ac.in

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> >

DEVELOPMENT DIMENSION

Patient Empowerment through e-Health The vision of the empowered patient is still lagging behind reality, but now e-health offers the opportunity for patient empowerment. Potential benefits include better health outcomes and higher cost-effectiveness.

However, looking at the European situation, one realizes that a number of obstacles have to be overcome, before these benefits can be reaped.

Milon Gupta

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he concept of patient empowerment emerged in the 1970s in the United States and Europe in the context of the civil rights movement. Patients and their organisations demanded a right to self-determination over decisions affecting their health.

In addition to political pressure for giving consumers and patients more rights, there were also factors in the healthcare sector itself, which supported this trend. Alternative medicine and the growing number of alternative treatments, especially for chronic diseases, increased the choice available to the patients. A growing sensitivity to environmental factors influencing health further fuelled the push towards patient empowerment.

PATIENT EMPOWERMENT IN EUROPE

Most European countries have included patient empowerment in their healthcare policies via patient rights legislation and patient charters. However, considerable differences still persist across Europe: the approaches and the level of implementation vary significantly.

Surveys of patients at the National Health Service (NHS) in the UK conducted in 2004 show that 47% of inpatients, 30% of outpatients, 36% of emergency patients, 32% of primary care patients, 39% of coronary heart disease patients, and 59% of mental health patients would have liked more information and choice in decisions about their care.

While in Denmark the extended choice of hospitals was introduced in the early 1990s, similarly, in Norway free choice of hospital was implemented in January 2001.

In other EU countries, like France and Germany, social insurance systems seek to limit patient choice, aiming to encourage the use of so-called “preferred providers” and to avoid multiple treatment by different doctors in order to lower costs. At the same time, both Germany and France have improved the patient rights for information access and strengthened their responsibility for their health. In 2002, the French Parliament adopted a “Patients Rights and Quality of the Health Care System” law, under which, patients are responsible for decisions regarding their health status.

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PATIENT-EMPOWERING E-HEALTH APPLICATIONS

The European Commission has defined e-health as “the application of information and communications technologies across the whole range of functions that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security administrators and - of course - the patients.”

The focus of the first phase of e-health development was on systems and applications, which facilitated the work of medical professionals and healthcare institutions. Although this contributed to the higher effectiveness of the healthcare system in general; e-health technologies like hospital information systems were designed to empower healthcare professionals and not the patients. In Europe, the focus has shifted in recent years towards more patient-centric e-health applications.

Web-based health portals

Health portals on the Web are the most common e-health application for patient empowerment. According to a survey

by EU project eHealth ERA, health portals have a share of 31% among all e-health applications classified as patientempowering.

Nearly all EU countries have at least one national health portal - for example the UK e-health portal NHS Direct Online , which had 13.5 million users in 2006. In addition, some countries have specialised portals for specific groups of citizens or for specific health issues. These portals offer a varying degree of interactivity, ranging from information repositories with low interactivity to websites with high interactivity offering contacts to medical experts, consultation via videoconferencing, and training programmes.

Physician-patient communication

Communication between physicians and patients in Europe is in most cases still limited to face-to-face consultations and telephone. Some studies in fact convey the impression that the majority of physicians and patients are not ready to use e-mail for health care purposes; many physicians have reservations about time demands, medicolegal risks, and doubts about the www.ehealthonline.org

appropriate in some cases, but their complexity and the resultant low transparency can also reduce the level of acceptance. Examples of this automated approach are projects on smart sensors and electronic decision-making systems that autonomously decide on alerts or even therapeutic measures, e.g. insulin injections.

DRIVERS AND BARRIERS FOR PATIENT EMPOWERMENT THROUGH E-HEALTH

SOME PATIENT-EMPOWERING E-HEALTH APPLICATIONS

ability of patients to use e-mail appropriately. According to a recent survey in ten EU countries, 28.4% of the respondents answered that they had a telephone consultation with a doctor, but only 1.4% had a consultation by e-mail.

Electronic Personal Health Records

A report to the Nuffield Trust highlights that “ePHRs have the potential to improve communication between providers and patients by sharing information, to enhance the quality of records by highlighting inaccuracies, and to reduce the burden of care by engaging patients in managing their own health and illness.”

One of the most prominent examples of ePHR implementations in Europe is HealthSpace in the UK. It provides patients with secure access to a personal online health organiser, including a calendar for appointments and reminders as well as a means to keep record of their blood pressure, weight, and their progress in self-care programmes on, for example, stopping smoking or managing diabetes.

However, apart from the limited number of ePHR offerings, the citizens’ knowledge about them and their trust in such systems seem to be rather limited. This is understandable, as the public discussion in Europe so far has mainly been focused on Electronic Health Records (EHR) as a tool for health organisations to become more effective, rather than patient empowerment. e-chronic care and self care

New processes based on ICT tools driving chronic care, emphasise prevention of complications, utilising evidencebased practice guidelines and patient empowerment strategies.

Chronic care is primarily targeted at patients with chronic conditions like diabetes, asthma, HIV/AIDS, cancer, and other such disease. ICT-enabled monitoring of such patients’ health condition facilitates necessary adaptations of therapy plans and in medication, allowing the healthcare professional to intervene on time to avoid acute care intervention.

However, a number of ICT systems for chronic care aim to create smart environments that eliminate the need for the patient to do anything himself. These systems may be October 2007

On the demand side, patient empowerment through e-health is, in Europe, mainly driven by the ageing population and the growing health consciousness and individual health demands by large parts of the population. From 2005 to 2030 the number of people in the age group 65+ will rise in the EU by 52 % or 40 million, while the age group of 15-64 will decrease by about 7 % or 20.8 million.

This demographic change puts enormous cost pressure on European healthcare systems. In Europe, healthcare expenditure has already reached an average share of 8.5% of the GDP and is rising faster than the overall economic growth.

Thus, on the supply side, public health institutions and health insurers promote e-health and more patient responsibility as a way to contain the cost of healthcare, while guaranteeing an acceptable level of healthcare for everyone. In addition, the fast development of ICT, for example in the area of sensors for health monitoring, adds another push.

On the other hand, many citizens in Europe still lack the necessary health literacy, computer literacy, and Internet access. In 2006, 46% of households in the EU27 had no computer and 58 % no Internet access at home. The situation is even worse for elderly people: 90% of the age group 60+ in the EU27 had no Internet access.

In addition, patients have privacy concerns and a lack of trust when it comes to sending personal health data via the Internet. Patients also have concerns regarding the dehumanisation of their medical treatment, if they have to rely increasingly on interacting through computer interfaces and are dependent on automated processes they cannot control.

On the supply side, many physicians are not yet ready for the organisational change, being still attached to the model of the doctor dominating the decision-making process. Others also have legal concerns in regard to their liability in case something goes wrong, other issues are the lack of nationwide and Europe-wide interoperability between e-health tools and the lack of integration and legacy systems.

The type of disease also limits the advisable extent of patient empowerment. Patients with acute diseases who need urgent medical help still have to rely more on decisions by physicians than patients with chronic conditions.

For the complete version of the article with references log on to www.ehealthonline.org Milon Gupta Manager, Marketing and PR Eurescom, Germany gupta@eurescom.eu

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NEWS REVIEW

INDIA

TRIVITRON AND ALOKA SIGN JV Trivitron group of companies, the largest Indian medical technology company and Aloka, the innovators in Ultrasound technology from Japan recently announced their joint venture agreement to manufacture cost effective, High Technology Ultrasound equipment in India to suit the needs of the developing countries. The Joint Venture will embark on an Initial investment of about 50 crores by both the companies followed by further investments in due course.

The investment pooled in by the two companies will be used for acquiring necessary Capital, Equipment and Infrastructure for setting up the manufacturing unit. Trivitron will additionally extend its current distribution network in India for Sales Application and Engineering support for the new products. Apart from meeting the needs of the Indian Market, the products manufactured by the JV will be exported to several developing/developed countries across the world.

As the part of the deal Aloka will also bring in their patented Technology for manufacturing Ultrasound Systems, Ultrasound Probes and related Ultrasound Accessories. The Training requirements for the manufacturing unit will be met through special training sessions provided in Japan and day to day supervision by Senior Japanese Engineers, based in India. Aloka is also planning to use Premier Institutions in India as Clinical Research and Product Development Sites for bringing the new innovative Ultrasound Systems in the years to come.

India currently meets over 90% of its medical equipments requirements through imports; But with the recent growth areas such as Electronics Manufacturing, Biotechnology Manufacturing, Mechanical Components Manufacturing, Pharma Manufacturing India can soon be the hub for indigenous medical technology. The Current market for Ultrasound equipments in India is around 500 Crores and is growing at an average CAGR of 20% per annum.

TRIVITRON MD RECEIVES RAJIV GANDHI SHIROMANI AWARD, 2007

FORTIS VENTURES INTO SOUTH INDIA

In recognition for his outstanding contribution in the field of Diagnostic and Health care industry in India Dr. GSK Velu, Managing Director, Trivitron group of companies has been conferred with the ‘Rajiv Gandhi Shiromani Award,2007’.

The award was presented on the occasion of 63rd birth anniversary of the former Prime Minister late Rajiv Gandhi, to select individuals of the country in recognition of their outstanding contributions and achievements in the fields of industry, business and public life, administrative, social, educational and cultural services.

Dr.Velu, a Bio Medical Engineering Scholar from ‘BITS’, Pilani, acquired MBA from top Management school ‘Loyola Institute of Business Administration’, Chennai, and a Doctorate in Pharmacology, from IBAM, Kolkata.

He is also the recipient of the “Entrepreneur of the Year Award” given by Frost & Sullivan, Modern Medicare and GE Health Care for his remarkable achievements in the successful functioning of the Organization.

The Fortis group recently announced their decision to buy 48% stake in Chennai-based Malar Hospital for around Rs 42 crore. This move will mark the group’s first entry in South India.

At present, Fortis has a network of 12 hospitals primarily in the north, and 16 satellite and heart command centres.

The acquisition will be through International Hospital Ltd, a whollyowned subsidiary of Fortis, and group company Oscar Investments Ltd (OIL). In the first phase, International Hospital Ltd will buy the promoters holding of 28% at Rs 30 per share. The total equity of the company is Rs 1.39 crore.

Additionally, International Hospital along with Oscar Investments will inject Rs 14 crore as loan, which will be converted into 25% equity, subject to approval by Malar shareholders. OIL will acquire approximately 7% (of the expanded equity capital), while International Hospital will have 18%. Post conversion, International Hospital will hold 23% and an additional 18% equity, and another 7% held by Oil, taking up the total equity to nearly 48%. The acquisition will be funded through internal accruals and debt.

IHL and OIL would make an open offer to the shareholders of Malar Hospitals, as per the Securities and Excahnge Board of India guidelines.

Malar Hospital with 180 beds is a multi-speciality hospital focusing on comprehensive medical care, says a company statement.

Fortis plans to increase its capacity to 40 hospitals and 6,000 beds by 2010, from the existing 12 hospitals and 2200 beds.

INDIAN GOVT PLANNING WORKPLACE HEALTH POLICY FOR IT PROFESSIONALS A growing number of young IT professionals in India are seen to be suffering from lifestyle diseases. Keeping this in view the government is planning a workplace health policy for those working in this sector.

Discussing this issue, Union Minister of Health and Family Welfare, Anbumani Ramadoss recently said he would soon be meeting with IT Minister, A. Raja on this matter. They intend to soon organise a conference to be attended by members of the IT industry, where they will form an IT-related workplace health policy.

The conference would be either held in Chennai or Bangalore. Expressing concern over people suffering from cardiac problems, strokes and mental disorders, as early as 25 and 26, he said such people face a lot of work-related stress and peer pressure.

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SWEDISH BUSINESS BULLISH ON INVESTMENT, JV OPPORTUNITIES IN INDIA

RIL PLANS RS 25K CR HEALTHCARE INITIATIVE OVER 7-8 YRS

A Swedish industry delegation led by the country’s trade commissioner Fredrik Fexe, and representing some 20 top companies in various sectors including healthcare recently visited India scouting for partners.

The trade commissioner has been quoted as saying that more than 100 companies from Sweden are now interested to invest in India in the next three to four years. Anticipating the current round of talks to result in an investment of 150 million (Rs840 crore),including new manufacturing plants by companies such as Atlas Copco India Ltd, SKF India Ltd, and Huntleigh Healthcare India Pvt. Ltd, already present in India; India is the world’s second fastest growing major economy after China.

Sweden’s ambassador to India Lars-Olof Lindgren said last week that the trade between his country and India was at an all-time high now at some $1.8 billion: exports to India worth $1.4 billion and the rest in imports from here.

The Swedish industry is dominated by firms in information technology and telecom services, construction, chemical industry and automotive industry.

According to sources, Reliance Industries (RIL) plans a Rs 25,000 crore healthcare initiative over 7-8 years.

The healthcare initiative will integrate with Reliance Retail foray.

This is one of the biggest plans that RIL has formulated on the lines of its retail foray, as it plans to set up 1,500 healthcare units in B, C towns.

A pilot project, is already under implementation at Jalandhar and will be replicated at all the existing primary healthcare centres of the government, which probably don’t give the right kind of service that is needed to service the healthcare needs of the rural population.

Over the next 7-8 years, the plan is to invest up to Rs 25,000 crore in rural healthcare population. McKinsey had earlier predicted that by 2015 the Indian healthcare market itself will become USD 20 billion, probably Reliance will play a massive role in getting to that figure.

COUNTRY TO HAVE FIRST MOBILE MAMMOGRAPHY UNIT SOON The Indian Space Research Organisation (ISRO) and Sir Ganga Ram Hospital, will connect the hospital’s cancer specialists to patients in rural areas, by providing the country its first mobile mammography service (to be launched soon) in a bid to provide medical aid to breast cancer patients in far-flung rural areas.

Built at a cost of Rs 17 lakh and mounted on a truck, the mobile unit comprises a di-com compatible mammography system that will convert film into digital format before transmitting it to a base unit at the hospital. ISRO has agreed to provide a free satellite link for the mobile unit.

According to the National Cancer Registry Programme 2004, breast cancer is the predominant type of cancer in women in India, and lately an increasing number of women in rural areas are reporting this type of cancer.

NEW DELHI’S FIRST FULL-FLEDGED NURSING COLLEGE The Union Minister of Health and Family Welfare Dr Anbumani Ramadoss recently inaugurated New Delhi’s first ever college of nursing at the Lady Hardinge Medical College. Affiliated to Delhi University, the college is recognised by the Indian Nursing college.

A training school for nurses was started at LHMC back in 1916, and the services have been upgraded since then, to a college to improve the quality of nursing services as also to train more graduate nurses. Fifty students have already enrolled in the first batch. To overcome the shortage of nurses in the country, government has earmarked Rs

319 crores for the upgradation and development of nursing services in the 11th Five Year Plan. The country needs another million nurses to cater to its population.

The minister said two more nursing colleges, are in the offing for the Capital, nursing schools at Ram Manohar Lohia (RML) and Safdarjung hospitals are soon to be revamped and upgraded into colleges. And more will come up in Mumbai, Chennai and Kolkata.

Union Health Secretary, Naresh Dayal, also present at the inauguration said the role of nurses has become highly specialised and upgrading their services is on top of the ministries agenda.

INTEL WORLD AHEAD PROGRAM Marking a new phase of Intel’s World Ahead Program, an alliance of 16 companies has formed to expand Intel’s efforts to provide people in developing countries with the benefits of technology.

At a recent press conference, Intel chairman Craig Barrett announced the formation of the World Ahead Alliance in India. The alliance pledges to apply techonolgy to advance health, education and rural empowerment.

The World Ahead Alliance brings together 16 Indian organisations that have been influential in the results achieved during the early phases of the Intel World Ahead Program, including non-profits, education companies, hospitals and service and technology providers.

The members consist of Apollo, Comat Technologies, Fortis Healthcare, Karishma Software Limited, Manipal University, Narayana hrudalaya, NIIT Limited, Sankara Nethralaya, SN Informatics Private Limited among others.

With the Ministry for Health and Family Welfare of the government of India, Intel helped inaugurate two rural health projects in India this week, including a pilot program for remote diagnostics and screening at Tindivanam Taluk Hospital in Tamil Nadu.

Intel had earlier deployed its first remote health programs in a digital village pilot in Baramati, a small town about 120 kilometers from Pune.

The pilot in Baramati attracted the attention of government and industry leaders, inspiring e-health projects that will be deployed across Tamil Nadu and the country. The projects include a tele-health program for community hospitals and a school health-monitoring system.

Mr. Barrett was also slated to visit China, Africa, the Middle East and Latin America to explore how digital inclusion programs are taking root and creating life changing opportunities.

October 2007

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EVENT REPORT

Frost & Sullivan HealthIT Executive Summit, Goa August 31 - 2 September, 2007, The Leela, Goa

T

he surf-n-sand is surely a holiday goer’s delight, and for that matter, reason enough to indulge and set free from hectic work schedules and deadline blues. But there are times when life seems fair enough; work and leisure get your rare equal share and you do ‘business-on-thebeach’!

That is exactly how it turned out at the recently held ‘2nd Annual Health IT Executive Summit’ organised by Frost & Sullivan, held between August 31- September 2, 2007 at the luxurious The Leela, Goa. This two day exclusive event focused on the theme – ‘IT Advancements in Healthcare Delivery’, witnessed an encouraging participation from senior executives of Tier I public and private healthcare institutions; Government heath departments and the IT industry.

Opening this event, Ms. Jayanthi Kulkarni, Director, Healthcare Practice (South Asia and Middle East), Frost & Sullivan, delivered an emphatic overview of the current status and growth potential of the healthcare IT market in India, underlining the promising market forecast (of 18% CAGR between ‘2006-’10) and the differential advantage it delivers in terms of efficiencies in clinical and operational processes of hospitals; lowering service costs; and delivering patient satisfaction and customer delight.

The ‘Guests of Honour’ of the event comprised three eminent persons from the government sector- Dr. S K Bhattacharya, Additional Director General, ICMR, Govt. of India; Mr. V C Sharma, Chairman & MD HSCC India Ltd. Govt. of India; and Dr. Ashok Kumar, Deputy Director General Director, Central Bureau of Health Intelligence, Govt. of India. It was

A panel discussion in progress. (From left to right) - T. Gopinath (HP), Ranjan Dwivedi (UNAIDS), V C Sharma (HSCC India), Rohit Kumar (Microsoft), Kerry Stratton (InterSystems) and Manish Gupta (Fortis).

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encouraging to find in their speeches, an almost unanimous reiteration about the keen intent of government towards fostering faster IT adoption in public healthcare domain.

In addition, their presentations also highlighted some of the major initiatives undertaken within their own agencies, towards implementation of MIS and IT based work flow and administration.

The two days of deliberations witnessed an impressive line up of high powered presentations and crackling panel discussions, involving senior executives from healthcare and IT industry. Speakers and panelists included senior hospital administrators, medical practitioners, IT Managers and technolgy developers.

Some of the most prominent issues that resonated thorughout these interactions concerned the need of healthcare service providers for IT solutions with robust, multi-functional, interoperable and scalable features, and most importantly - ‘patient centricity’ at the core of solution architectures.

While speakers like Daljit Singh (President, Fortis Healthcare) and Vijayrajan (CIO & CTO, Manipal Health Systems) delivered a vivid picture of existing IT systems, HIS and MIS in their facilities, they also shared a fair glimpse of their future plans and their need for appropriate next generation solutions.

Bringing a flavour of best practices from Singapore, Dr Samuel Yeak, Chief Medical Informatics Officer, Tan Tock Seng Hospital, showcased the IT practices and infrastructure at his hospital along with the macro level public health information strategy adopted by National Healthcare Group (NHG) of Singapore government. While sharing the Singaporean experience in developing a national public health information network and discussing the implementation details of the initiative, he appreciated the magnanimous scale of such replication in India, in view of the population and geographical spread of the country.

A fair share of IT industry perspectives and latest technological offerings for the healthcare sector came through captivating presentations from senior corporate leaders and business heads of leading IT vendors inlcuding - Microsoft, HP, InterSystems, Sobha Renaissance and Agfa Healthcare.

Some of the futuristic ideas shared by the industry were highly captivating and provided a vision for the next generation of tech-driven healthcare. A number of interesting concepts and applications emerged, such as - converged IT integration through ‘Future Health’ vision of Microsoft; integrated healthcare management and patient centric HIS of Sobha Renaissance; state wide public healthcare information network and applications of HP; national health information exchange and database solutions from InterSystems and high end medical imaging and RIS data solutions from Agfa Healthcare.

Healthcare just got healthier !

Glimpses from the dais...

Vijayrajan, CIO & CTO, Manipal Health Systems

Kerry Stratton, MD- Healthcare, InterSystems

Event coverage and reporting by: Dipanjan Banerjee Manager-eHealth Group dipanjan@ehealthonline.org Manish Sharma, Principal Consultant, Shobha Renaissance Information Technology

October 2007

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IN CONVERSATION

Our focus will be on EHR and conforming to international healthcare standard Amit Kumar - an alumni of IIT Kanpur and a Masters in Computer Science from University of Kentucky, USA, is currently the CIO of Max New York Life Insurance & Max Healthcare. Previous to this he has worked with TCS and Citibank.

Get a glimpse of the IT strategy of Max Healthcare in the following interview with eHealth.

Max Healthcare is considered as one of the best and fastest growing private healthcare companies of the country.

What is the vision of Max in terms of making its facilities as best-in-class in terms of IT capacity and availability of advanced medical technologies?

Amit Kumar Chief Information Officer, Max Healthcare 20

We have been working quite hard to develop an overall IT strategy for Max Healthcare. Presently, we have a ‘Business Plan’ in place and by implementing the same, we expect our hospitals to reach the international level of automation. We have options to either go for the new international ERP software from our in-house development team or to strengthen the existing one to meet the functional and operational requirements.

Our focus will be on Electronic Health Record (EHR) and conforming to international healthcare standard.

In spite of a stupendous growth of healthcare industry in India (with a CAGR of nearly 16% over last few years), the average IT adoption www.ehealthonline.org

rate stands at a dismal 5%. What according to you puts-off big-scale IT investment decisions of most healthcare players?

Financial constraints seem to be the primary reason behind this. It is always a challenge to get budgets for IT spend, over medical equipments. Nevertheless, the extent of Data that is stored proves to be so important that IT infrastructure has started becoming the back bone of healthcare institutions. Also, the industry will gradually appreciate benefits of IT in areas such as - clinical process improvement, operational efficiency and care management. However, establishing Health Data Centre and BCP is still a capital intensive component in IT infrastructure development.

What is the practice at Max with respect to EMR & PACS? What IT backbone, platforms and standards are being employed for this purpose?

We are yet to implement our EMR project. The PACS solution has been identified, but the procurement is yet to happen. Our core software is on SQL and the WAN connectivity runs on leased lines. With regard to standards, Max is following its own internal standards.

Since no single standard exists today, it becomes very challenging to get doctors’ acceptance on any particular software for recording medical data.

What crucial advantages has Max Healthcare experienced in terms of operational, procedural and business excellence through use of EMR & PACS? PACS helps to deliver processed images that get visible in EMR. The 3D images gives 100% clarification to surgeons before they walk into the OT. Certainly, this gives a lot of leverage for surgical procedures.

Max Healthcare facilities are already certified under ISO 9001:2000 and from September ‘06 Max has adopted

Six Sigma standards for higher efficiency and service quality. How have you integrated your enterprisewide IT strategy to leverage such quality control practices in operations and services?

Incorporation of quality and performance control standards definitely helps in boosting efficiency and consistency. Certain processes have been optimized, for instance - auto indent in materials department saves time to utilise for other activities. Bar Code in inventory control and pathology sample collection has also made life easy.

Max Healthcare Institute has initiated the Max TeleMedTM programme for spreading out its services outside urban centers. What is the level of success in this initiative? What are the service offerings and business model of this initiative?

While this was working fine by connecting to remote locations, we are not doing much in this at present, as Max is yet to make a business plan to promote the facility in a bigger way.

Currently, one of the biggest challenges of the healthcare industry is to develop a consensus among service providers for equitable sharing of medical data among each other. While there are a few concerns regarding privacy issues, the real apprehension seem to be more on bottom-line effects for individual players. What is your view on this and how does Max foresee such an initiative within the healthcare industry?

A standard on this is yet to be seen where technology can help one hospital to share their patient info with others.

Introduction of smart cards will automate this process and help decision makers to put data sharing process in place.

“

Since no single standard exists today, it becomes very challenging to get doctors’ acceptance on any particular software for recording medical data.

”

Read more expert interviews at www.ehealthonline.org/interview/index.asp October 2007

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POWER HOSPITAL

Max Devki Devi Heart and Vascular Institute, Saket

This section features Hospitals & Healthcare Institutions providing top class healthcare services and infrastructure in their endeavour to provide International Standards in comprehensive patient care. To have your facilities featured, write to dolly@elets.in

M

ax Heart and Vascular Institute is a 200 bed stateof-the-art cardiovascular facility located in Saket, in South Delhi.

It is a tertiary care center designed to provide the highest levels of professional expertise and patient care in India and its neighbouring countries. The hospital is equipped with cutting edge technology- digital flat panel cath labs, state of the art OTs, apex tertiary level coronary services, provided by on-site medical consultants to handle acute MI, preventive care services, advanced diagnostic services including a 64 slice ‘Phillips Brilliance’ CT scanner and comprehensive nuclear medicine facilities.

All services at Max Heart and Vascular Institute are patient centric. The hospital has large, comfortable rooms (Suites, Deluxe, Standard and Economy) and services are delivered through specially trained nursing staff, F & B services, and housekeeping services ensuring global standards of hygiene and infection control. A world class Hospital Information System connects all the parts of the hospital, delivering a seamless and unique experience.

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SERVICE PROFILE

Max Healthcare offers a comprehensive and advanced Cardiac Care Programme encompassing all areas of Cardiology, Vascular Medicine and support services.

• Preventive Cardiology • Non Invasive Cardiology and Diagnostics • Clinical Cardiology • Invasive and Interventional Cardiology (including peripheral vascular interventions) • Electrophysiology, Pacemaker and Arrhythmia Services • Cardiothoracic including minimally invasive surgery • Vascular Surgery • Acute MI services with Control Command Center • Emergency services • Nuclear Diagnostic Services • Advanced CT Scan Imaging • Support Services Procedures & Surgeries performed in the hospital include Cardiovascular Interventions, Cardiac Pacing and Electrophysiology, Cardiac and Vascular Surgeries. www.ehealthonline.org

TEAM OF EXPERTS AT MAX HEART & VASCULAR INSTITUTE

Leading cardiologist Dr. Ashok Seth is the Chairman and Chief Cardiologist of Max Heart & Vascular Institute.

Dr. Ashok Seth is an internationally renowned cardiologist who has contributed extensively to the growth, development and training in the field of Interventional Cardiology (angiographies & angioplasties) in the Asia Pacific Region.

For his outstanding contributions and achievements Dr. Seth was awarded the PADMA SHRI by the President of India in 2003.

He has performed more than 40,000 angiograms and 15,000 angioplasties in his career, for which he has received recognition in the “Limca Book of Records”.

Dr. Seth graduated from J N Medical College, Aligarh Muslim University, in 1979. Soon after, he left for the U.K. for pursuing post graduation degree and further training. After 10 years in the U.K., he left his career as Cardiologist at the Birmingham University, Queen Elizabeth Hospital, to return to India to start the Invasive Cardiology programme of the Escorts Heart Institute, New Delhi as its Chief of Invasive & Interventional Cardiology in 1988.

He has pioneered numerous new techniques of angioplasty in Asia Pacific. He was the first cardiologist in India to use Directional Coronary Atherectomy and Stents and more recently the ‘Drug Eluting Stents’ in treating heart blockages, a step that has revolutionized the treatment of coronary artery disease. He was also the first person in Asia to perform ANGIOSCOPY and Angiojet Thrombectomies and of the few cardiologists in the World to perform Percutaneous Myocardial Laser Revascularization.

Some of the other key doctors are Dr. Anil Bhan, Director - Cardiovascular Surgery & Chief Coordinator, Dr. Bishnu Panigrahi, Director – Cardiac Anaesthesiology, Dr (Col) C.P. Roy, VSM, Director - Non Invasive Cardiology, Dr. Praveen Chandra, Director - Cath Lab & MI, Dr. (Col) Kumud Rai, Director - Vascular Surgery and Dr. Sandeep Singh, Senior Consultants – CTVS and In charge Mechanical Heart Support

MAXimisers Accreditation Max Healthcare hospitals become the first in North India to receive prestigious National Accreditation - NABH, awarded for the delivery of highest quality of patient care.

Honorable President of India Dr. APJ Abdul Kalam conferred the honour upon Max Devki Devi Heart & Vascular Institute and Max Super Specialty Hospital, Saket at the 2nd National Quality Conclave on 9th Feb 2007.

ISO 9001 Focus

Six Sigma Highlights

INTERNATIONAL PATIENT SERVICES

The institute has a comprehensive international services programme managed by professionals with vast experience in services industry. Salient features of this programme are as follows: • Initial screening to diagnose and assess the nature and severity of the ailment.

• Telemedicine evaluation and recommendation • Travel arrangements made for transfer to Delhi on a turnkey basis includes visa, ticketing, pick up - at airport, money transfer and exchange, ATM withdrawals.

• Where existing, international insurance cover is respected.

• Diagnosis and treatment at the hospital.

• Arrangements for the return journey.

October 2007

COMPREHENSIVE PATIENT CARE

Max hospitals and medical centres offer comprehensive medical care around the clock, ranging from consultation to diagnosis and from surgery to pharmacy.

Max believes in ‘Total Patient Care’, which involves empathetic listening, offering choices and respecting patients’ medical and non-medical needs and concerns. At Max, patients are guided through periods of great stress, which is invariably brought on by illness. Above all, Max respects the patients‘ choices and confidentiality.

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WORLD

AMERICAN ELDERLY ACCESSING INTERNET FOR HEALTHCARE

Researchers Mary Schmeida, PhD and Ramona McNeal, PhD reported their findings in the Journal of Healthcare for the Poor and Underserved. This study, published in the month of August, shows how the scenario has changed since their last report. The elderly and poor people in America are becoming more Internet-savvy by the day.

The same journal had published in August last year, a study on state hosted web sites, by Edward Miller and his colleagues from Brown University. This study showed how the elderly were having problems in getting information from such web sites. Some people were

facing special problems because of their disability to see properly. The too small font sizes were the major reason.

It was also noted in the latest study by Schmeida and McNeal, that the information that was searched on Medical Care and Medical Aid was accessed by an indiscriminate array of people. That is to say, people of all ages, from all income groups, ethnic origin, and regardless of their being born as male or female, sought to satisfy their queries from such online searches.

Information from a survey on around 3000 people, that was carried out for the Pew Internet & American Life Project, was also included in the study.

Even though broadband is less accessible in the villages, the rural American population is also actively using the Web today. This just goes to show the ‘Underserved’ want to receive good service and are willing to seek it.

EMR EXTENDED BY ARDEN CANCER CENTRE, UK

Electronic Medical Records for all patients will be accessible to Cancer care staff at the University Hospitals Coventry and Warwickshire NHS Trust, by Christmas. The Oncology Department was the first one to get the system in the Arden Cancer Centre. That was in January. Since then it has gradually spread to other sections.

Impac’s Electronic Medical Record (EMR) software, has been delivered by Elekta, to create and maintain detailed electronic records of each one of their cancer patients.

Now all 400 dedicated users can share a Master Patient Index, and have one common set accessible to the whole trust.

Through the Impac EMR, hospital staff can access patient information from remote locations. The system captures diagnostic as well as treatment information, along with scheduling and billing details.

COMMUNICATION SIMPLIFIED AT HOSPITALS IN DENMARK Wireless Technology has replaced magnetic boards, pagers and hand-written notes at the Horsens Hospital. All the key personnel of the Surgical ward are electronically tracked with RFID.

The University of Aarhus has developed iHospital which consists of AwareMedia. These are flat screens that post schedules and lists of personnel present in the different rooms, like the Operating, Recovery and Post-operative ward. They also post live feeds showing the current status of the Surgical theatres, drag and drop touch screen and chat feature.

For in-house communication, they have developed ‘AwarePhone’.

Each handset has the standard capabilities of IM, SMS and voice, together with showing the location, schedule and status of each person.

Aarhus University is also trying to get private parties to invest.

ESSEN UNIVERSITY HOSPITAL IN GERMANY GOES WIRELESS Fujitsu-Siemens has designed Tablet PCs especially targeting hospital environments. It uses wireless LAN, initially for five wards. With this wireless system, the Medico-module, ‘Nursing Process Management’ can be accessed by the nurses. Soon to be introduced is also the Electronic Medical Chart.

An ambitious project will be taken up by the Essen University Hospital’s Nursing Service that will make it one of the first German Hospitals to be fully wireless.

The device does not have a fan for ventilation. It is easy to disinfect.

It comes with a carrier handle.

When a physician uses the Tablet PC for keying in prescription, a special software called RP-Doc will check it for errors. RP-Doc was developed by the University of Saarbrucken.

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A lot of time gets saved for the nurses as, with an electronic documentation workload management can now be done automatically. There is no need for any extra documentation work for the Nurses at the end of the day. Essen is using LEP, the workload management tool that about 200 hospitals in Europe are using. It was developed in Switzerland and is available in German, Italian and French. The English version will be released soon.

The eHealth plan for Essen University Hospital, still requires ‘smartcard’ for identification of nurses. It will first of all, require a Central Professional Association in Germany to represent nurses.

This will enable the cards to have digital signatures that need to be registered centrally.

www.ehealthonline.org

MOBILE TECHNOLOGY FOR TELEHEALTH SERVICES IN US The California Association for Health Services at Home (CAHSAH) as part of its Group Purchasing Organization (GPO) program, has selected WebVMC to participate as a provider of remote patient monitoring services.

WebVMC has developed the RemoteAccess and Remote Nurse mobile technology system. This system connects patients, with their families, health care professionals, and providers through a webbased software solution.

The Remote patient monitoring may change the way the home care industry operates. The system has been designed to address some of the issues faced by home care providers all over the world. Issues like staff shortage and patient wellness can be dealt with in an easy and affordable solution.

MOBILE PHONE BASED WIRELESS TELECARDIOLOGY SYSTEM IN UK Telecardiology system is the result of the joint co-operation between eHIT Ltd and AnalyzeYou Inc. The System collects and analyses ECG recordings. It also makes use of a novel algorithm developed by AnalyzeYou Inc, in order to help the cardiologist to identify early signs of heart problems and even prevent sudden death.

Heart activity is continuously measured by a wearable ECG miniature sensor, which transfers the data wirelessly, to the patient’s mobile phone. This information is automatically transferred to the health care provider through a mobile connection such as GSM, GPRS, 3G or CDMA. The mobile electrocardiograph offers a simple yet efficient way to get in touch with health care professionals anytime and almost anywhere.

ELECTRONIC HEALTH CARDS: PILOT BEGINS IN BULGARIA

REPORTS LINK RFID IMPLANTS TO CANCER, CRITICS ARE SKEPTICAL

The Pilot for issuing electronic health cards in Bulgaria has been started by the Bulgarian Ministry of Health.

They are joined by National Health Insurance Fund, ICW, Kontrax and Cisco.

A microprocessor chip is installed in the card. It stores details of the patient, issuer, card number and a security certificate. A reliable and secure private network connects the cards to NHIF and all physicians and pharmacies in Slivnitza. The software solutions have been modeled after those in use in Austria and Germany.

On successful completion of the pilot, the cards will be distributed to all the regions by 2009.

A recent report published in the Associated Press links RFID implants in laboratory animals, to cancer.

This report has met with a lot of skepticism.

Professor Kevin Warwick, Cybernetics, University of Reading, England who has himself had RFID chips implanted in his own body, questioned the ethics of the research team of Dow Chemical, for not making the report public, since 1996. He cited that several animals have had RFID implants for many years, and have not shown any problems.

VeriChip, the maker of RFID devices for monitoring human health, made two studies, after the report in AP. Their studies concluded that there was no link between the microchip implants and malignant tumors in mice.

MICARDO GETS EAL 4+ CERTIFICATION

PENNSYLVANIA HOSPITALS LEAD IN IT ADOPTION

Version 3 of Sagem Orga’s operating system MICARDO, has been certified Evaluation Assurance Level (EAL) 4+ by the BSI, the German Office for Security in Information Technology.

When BSI gives the Common Criteria certificate, it signifies that the architecture of MICARDO’s OS meets the most stringent security criteria. Sagem Orga has received certification for all its card versions used in eHealth infrastructure of Germany.

The MICARDO OS supports the new German patient health card- eGK, as well as the country’s SMC and HBA cards for physicians and pharmacists.

October 2007

A recent report announced that Pennsylvania hospitals were leading nationally, as far as adopting health Information Technology is concerned. The American Hospital Association conducted a survey on Pennsylvania Hospitals’ Use of Information Technology in late 2006.

The results of the survey showed that Pennsylvania Hospitals use more health IT functions at a moderate or high level, when compared to the other hospitals. They use computerized order entry at a higher level. They use electronic results review at a higher level. They have more partially or fully implemented electronic health records. They spend more per bed -capital spending and operating costs - on IT. They are much ahead in use of bar coding, electronic decision-support, RFID technology, and sharing of clinical data.

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BUSINESS

NEWS REVIEW

FIRST ‘PHARMACOVIGILANCE’ CENTER LAUNCHED IN INDIA Accenture and Bristol-Myers Squibb Company have together launched the pharmaceutical industry’s first ‘pharmacovigilance’ center, in Chennai, India, to monitor safety of data collected on medicines.

Pharmacovigilance entails the capture, assessment and reporting of potential side effects on medicines. The new center will undertake the processing and coding of adverse event data and the generation of regulatory periodic and aggregate reports on safety as well as physician medical

review of adverse events.

The opening of the center, marks the first time a collaboration for ‘end-to-end’ safety case processing has been established. The center promises seamless handling of data and reports between Accenture and Bristol-Myers Squibb while not compromising patient safety.

The pharmacovigilance center, to be operated by more than 140 Accenture employees, is part of Accenture’s Life Sciences Centers of Excellence in Bangalore and Chennai that Bristol-Myers Squibb already utilizes.

BATTLE BETWEEN GOOGLE AND MICROSOFT COULD TRIGGER REVOLUTION IN HEALTHCARE Wireless Healthcare, an independent UK based analysts specialising in the ap-

SRIT FORMS A JOINT VENTURE HEALTHCARE ICT COMPANY IN CHINA Sobha Renaissance Information Technology (SRIT), a Bangalore based global software products and solutions provider, recently announced the setting up of a joint venture (JV) company in China called Sunpa Sobha Software (China) Ltd with ‘Yunnan Sunpa Image Tel Tech Co. Ltd (Sunpa)’ as its JV partner. Headquartered in Kunming, Sunpa Sobha Software (China) Ltd. will have operating branches in Beijing, Shanghai, Guangzhou, and Shenzhen.

This is SRIT’s first JV foray into the Chinese Market and possibly the first JV between the two countries in the realm of Healthcare ICT (Information & Communications Technology).

Sunpa is a world-class telemedicine ‘Products, Solutions and Services’ company that develops, integrates and produces a series of patented equipments & peripherals for Telemedicine, PACS and Tele-education.

They execute key projects under the Chinese Government’s National Hi-tech Development Program, and are recipients of their Central Government’s second best award among the top-100 state-level prize-winning hi-tech projects.

Dr. Madhu Nambiar, Founder, MD & CEO SRIT has reportedly said that although the initial capitalization of the joint-venture is US$ 1 million, the joint-venture estimates increase of capitalization to US$20million in the next couple of years. .

NORWEST WILL VENTURE BEYOND IT TO HEALTHCARE AND RETAIL IN INDIA Kurt L Betcher, administrative partner and chief financial officer of Norwest Venture Partners (NVP), and his colleague and general partner Robert B Abbott were recently in India.

Betcher’s focus was on the logistics of setting up and running an office in India, while Abbott, was looking for investment opportunities in the country, beyond the realm of technology that NVP had so far restricted itself to.

Though the Palo Alto-based company’s presence

has been felt in India since late 2003, with frequent visits and the occasional investment made by managing partner Promod Haque and general partner Vab Goel, the latest visit is significant. It indicates the continued commitment of VC firms like NVP to India and the opportunities they see in the country.

After pursuing only technology and technologyrelated companies till now (NVP has invested in five Indian companies and in 22 companies that have an India linkage), the venture capital firm now feels that healthcare and retail are ripe to explore..

plication of mobile and wireless technology in the healthcare sector, says that Google and Microsoft, knowing that a large number of Internet searches are health related, are actively attempting to build a presence in the healthcare sector.

According to them, informed patients who have ‘googled’ their symptoms could gain access to their genetic profile and manage their health using an online patient record.

Wireless Healthcare believes that Google’s recent investment in the genetic profiling company 23andMe and Microsoft’s purchase of the intelligent medical search company Medstory could lead to the emergence of services that are highly disruptive within the healthcare market.

They see it as the emergence of a new ehealth model that challenges some of the assumptions made by existing online healthcare providers and medical device manufacturers.

TELEHEALTH MARKET TO WITNESS SURGE New research by Datamonitor says, drive to cut costs while improving medical care is set to drive the worth of the telehealth market to $8 billion (£4 billion) by 2012, with an annual growth rate of 56 per cent, compared to 9.9 per cent for the whole clinical market.

Telehealth systems deliver medical services via digital networks, allowing patients to be advised or treated at home or elsewhere. Current procedures include the domestic monitoring of blood sugar levels among diabetics and remote consultations conducted via video conferencing.

Such telehealth technologies are especially useful in rural areas, but can also help urban clinics keep tabs on patients and encourage them to come in for checkups more frequently.

Advantages of remote health monitoring will outweigh financial hurdles. The global market for remote access health systems will be worth more than $8bn (£3.97bn) by 2012, according to analyst Datamonitor.

Datamonitor predicts a five-year compound annual growth rate of 56 per cent compared with 9.9 per cent in the clinical market. The ageing population and a shortage of healthcare services will boost demand for telehealth networks.

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www.ehealthonline.org

NHS (UK) ICT SPEND TO HIT £2.9BN

INFINEON, SOLE SECURITY CHIP SUPPLIER FOR LARGEST PATIENT HEALTHCARE CARD PROJECT IN US

The total spend on Information and Communications Technology in the NHS is set to hit £2.9bn in 2007/8 according to figures in a new report on NHS investment for the King’s Fund.

Actual ICT spending in England is estimated to have increased from £1bn in 2002/3 to £2.3bn in 2005/6. In 2006/7, the planned increase in ICT spending is set to rise by 25 per cent to just under £2.9bn.

The King’s Fund report, says that actual spending on ICT in the NHS was slower to pick up than originally envisaged, but has since exceeded the recommendations made five years ago.

The NHS National Programme for IT (NPfIT) is identified as a major recipient of this additional investment, but the report notes that up to the end of March 2006, actual expenditure on the contracts let in 2003 and 2004 was lower than planned.

Siemens, and two New York hospitals, Mount Sinai Medical Center and Elmhurst Hospital Center have formed a health smart card alliance to deploy up to 1.2 million Patient Health Smart Cards to link as many as 45 affiliated and related medical facilities in the New York metro area.

The patient health smart card trial began in late 2006 and is scheduled to end in 2007. In 2008, the health smart card alliance expects to issue approximately 500,000 smart cards which integrate a highly secure Infineon microcontroller.

The patient health smart cards are issued by the affiliated and related medical facilities with the patient’s printed photo. To use the card, the patient inserts the card into a card reader and enters a private PIN number to unlock the data on the card’s security crypto-controller.

Today, Infineon provides its secure microcontroller chips to the world’s largest national patient cards, health insurance cards and social security cards, including Italy, Taiwan, Slovenia, Spain, India, Poland, Great Britain, and Germany.

HRSA GRANT TO FUND NURSING IT PROGRAMS IN US

The National League for Nursing and three institutions of higher education recently received a $1.5 million grant to fund a five-year Health Information Technologies Scholars Project to integrate technology into academic and clinical practice.

The Department of Health and Human Services, Health Resources and Services Administration’s Division of Nursing awarded the grant, to the School of Nursing at the University of Kansas.

The ultimate goal of this project is to improve the future workforce by providing them with the knowledge, skills, competencies and attitude to offer safe, quality, and efficient healthcare through the use of technologies.

Other participating schools are the University of Colorado at Denver and the Health Sciences Center at Indiana University in Bloomington.

NLN will also create a private e-Community to be used as a central database for documents related to the project, and to facilitate communication among the participating faculty and administrations at the three schools of nursing.

October 2007

EKAHAU AND VERICHIP COLLABORATE ON RFID SECURITY Hospitals across the world using Ekahau’s Wi-Fi enabled real time tracking solutions (RLTS) will benefit from tighter system security after the Finland-based company partnered with VeriChip.

As part of the agreement, Ekahau will work alongside Xmark, a VeriChip subsidiary which specialises in RFID-based healthcare security systems. Specifically, the companies will collaborate on providing solutions around asset tracking,infant protection, patient safety and theft prevention in the healthcare industry.

Solutions such as wander prevention, perimeter security and campus to bed-level tracking of assets are initial areas of focus for the collaboration.

The two companies are also co-operating on an integrated solution that combines RFID and Wi-Fi technologies to suit the particular needs of individual hospitals. One of the first hospitals to benefit from the partnership will be the Herentals Hospital in Belgium which uses Ekahau’s RTLS to track patients through its operating room complex.

Precision tracking of patients through the operating theatre will enable more efficient throughput and better use of existing resources, which is essential to the running of any modern hospital.

TENDERS TO OPEN IN OCT FOR RS1,500 CR AIIMS-LIKE HOSPITALS IN SIX CITIES A Rs1,500 crore project, the first major government investment for healthcare will kick off in the first week of October with the opening of architecture and design tenders for six hospital projects. It is to be led by the Union ministry of health and family welfare, to set up over a dozen multi-speciality hospitals and medical education institutions across the country, under the National Rural Health Mission (NRHM).

The medical institutions - being modelled on New Delhi-based All India Institute of Medical Sciences (AIIMS) - at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh costing Rs1,500 crore are expected to be completed in 2009.

The proposed institutes will be equipped to handle multiple diseases and disorders with 800 hospital beds along with intensive care units and trauma care centres. They will have medical colleges with annual intake

of 100 students and will also offer doctoral courses.

The following phases of the National Rural Health Mission, which include upgradation of seven medical institutions in six other states, and setting up of super-speciality medical institutions and research centres in another five states through the public-private partnership model, are also being finalised.

The emphasis on health care infrastructure under the five-year, Rs40,000 crore NRHM of the government comes in the wake of strong criticism from non-governmental organizations and national healthcare action groups. As also with private players such as Fortis Healthcare Ltd, Max Helathcare Ltd, Hinduja Group, Apollo Hospitals Ltd, and Wockhardt Hospitals Ltd, among others, have earmarked between Rs10,000 crore and Rs15,000 crore for new hospitals and expansion of existing ones.

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PRODUCT PROFILE: MEDICAL & HEALTHCARE DEVICES This section gives you an overview of latest medical and healthcare equipments in the global market. eHealth brings you this service absolutely FREE. To have your new products featured, send us the details at dolly@elets.in

HAMILTON G5: WORLD’S FIRST 3D VENTILATOR BY TRIVITRON

Trivitron, the largest Indian Medical Technology Company in association with Hamilton Medical AG; a Swiss manufacturer of “Intelligent ventilators” has recently launched Hamilton G5world’s first 3D ICU Ventilator, in India. The new HAMILTON-G5 ICU ventilator is focused on improved user interface and high patient’s safety.

Hamilton G5 with a unique Ventilation CockpitTM is designed for simplified operations and monitoring.

Hamilton G5 comes with the following features: • User-friendly and simple operations.

• Innovative ventilation cockpit with dynamic lung displays on real time Tidal volume, Lung compliance, reSPIRODOC: ALL-IN-ONE TELESPIROMETER AND OXIMETER

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Now also records SpO2 and HR for comprehensive monitoring Capable of recording all of the key spirometric parameters (i.e. FVC, FEV1, FEV1%, PEF, FEF-25-75, FET and flow/volume curve) as well as date and time of test, symptoms and other valuable information. the small Spirotel can be used for screening purposes and homemonitoring applications.

Recorded data can be accessed on the spot for instant information.

Alternatively, the values can be recorded over a longer period of time and stored (e.g. overnight recording with 1 reading stored every 10 seconds).

Recorded data can be transmitted via a fixed or mobile telephone line to an Internet server.

The spirometric device requires no calibration and the integrated software can conveniently be upgraded via the Internet.

For Details Contact: MIR - Medical International Research Via del Maggiolino, 125 Roma I-00155 Roma, Italy Tel: 39-06-22754777 Fax: 39-06-22754785 mir@spirometry.com http://www.spirometry.com/

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For Details Contact: Trivitron Group of Companies 15, IVth Street, Abhiramapuram, Chennai - 600 018, India Ph : +91 - 44 - 2498 5050 Fax : +91 - 44 - 2498 5757 / 2467 2782 corporate@trivitron.com

INTELLIVUE MP90

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sistance and patient activity in synchrony with actual breaths irrespective of Lung Mechanics.

Suitable for infants, pediatrics and adult patients.

Works on a new concept of Adaptive Support Ventilation (ASV) - reportedly used for 98% of the ventilatory time of critically ill patients– which is more responsive than conventional modes in adapting to the patient’s breathing activity.

ASV is also popular as it requires fewer user interactions and gives fewer alarms.

Also has an automated P/V Tool that helps in finding the best PEEP, based on respiratory mechanics.

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Portal technology: Compatible Waveforms: 6, 8, or 12 per independent display (13 for ECG) Monitor screen display: Up to three independent configurable displays; Up to three slave displays; User’s choice of XGA/SXGA Screen navigation: Touchscreen Mouse; PS2-compatible; user’s choice; Remote SpeedPoint Multi-Measurement Server and extensions: Compatible Flexible Module Server (8 measurement slots): Two supported Flexible Module Servers Networking capability: Standard

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For Details Contact: Philips Medical Systems PO Box 1286 5602 BG Eindhoven, The Netherlands Fax: +31 40 27 64 887 E-mail:medical@philips.com http://www.medical.philips.com/main/products/

• TERASON 2000 ULTRASOUND SYSTEM

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First ultrasound system to utilize a Windows laptop computer back end. System includes a standard laptop PC, Terason’s Microsoft

Windows-based ultrasound software, and a SmartProbe™.

Custom chip design results in efficiency, flexibility, high-speed computation, low power consumption, and sophisticated image processing.

Imaging Modes: 2-D / B-Mode with user controlled multi-frequency; Variable scan angles on all phased, microconvex, and curved linear arrays; Trapezoidal imaging option on linear arrays; M-Mode; Power; Directional Power; Pulsed Wave Spectral; and Color Doppler; Simultaneous display of 2-D and M-Mode or Spectral Doppler; Optional real-time Triplex mode User programmable and preset protocols: Real Time Image Zoom; Full-Screen Imaging; Auto Image Optimization; Dynamic Clip Storage and Playback; Measurements; OB calculations; Body markers; Optional Features; Real-time Triplex mode; OB reporting package; 3D rendering; Voice activation Operates via battery or AC power

For Details Contact: Terason Ultrasound, Division of Teratech Corporation 77 Terrace Hall Ave. Burlington, MA 01803 Toll-Free phone (within USA only): (866) 837-2766 Local/International Telephone: (781) 270-4143 Fax: (781) 270-4145 http://www.terason.com

www.ehealthonline.org

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PRODUCT PROFILE: SOFTWARE SOLUTIONS

PrimeSuite 2007 - Integrated EHR, Practice Management & Interoperability OVERVIEW

SALIENT FEATURES

PrimeSuite®, is one of the leading fully-integrated Electronic Health Record (EHR), practice management and interoperability solutions for the healthcare industryGreenway Medical Technologies’ flagship solution. Greenway was the fastest growing EHR company in 2006 according to INC 500 magazine.

PrimeSuite was the first ambulatory EHR to receive CCHIT 2007 Ambulatory EHR Certification. PrimeSuite is workflow oriented to maximize Return on Investment (ROI). The average ROI for PrimeSuite is US$22,000-US$81,000 per physician, per year.

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Client: Server: Database(s): Code base / tools:

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Top-ranked year after year by the KLAS customer satisfaction organization Greenway’s entire customer base of 16,000 users are referenceable PrimeSuite is based on the Microsoft.NET Architecture to ensure a highly secured environment The clinical content library consists of over 2,600 EHR templates that customers can use from day one EHR Clinical templates can be shared among Greenway users and customized to best fit any workflow EHR is used at the point of care to increase care quality and save lives, time and money

Tech Specs Windows & Internet Explorer Windows Server SQL Server Microsoft.NET

Modules Electronic Medical Records

Medical Billing

Patient enrollment; Chief complaints (CC); History of present illness (HPI)

ICDM-9 coding; CPT/Dx coding; Householding

Constitutional exam; Past, family, and social history (PFSH); Review of symptoms (ROS)

Data validation; Patient messaging; Maximum visits/coverage

Automatic coding; CPT/Dx codes; ICDM-9 codes

Eligibility inquiry; Claim scrubbing; Narrative reports

Current medications; Previous encounters; Procedure workflows

CMS-1500 form; EDI support; Clearinghouse submission

Graphics & drawing; Image / x-ray store; SOAP notes

Direct-to-carrier submission; ERA support; Claim status

Order entry (CPOE); Pharmacy interface; Drug database

Re-bills / tracers; Batch posting; ERA posting

Interaction check; Lab orders & results; Health protocol alerts

Code-level posting; Credit card processing; Claims reporting

Duplicate therapy check; Drug / disease check; Treatment options

Superbill; 3rd party printing; Custom billing plans

Patient instructions; Narrative reports; Referral letters

Billing dashboard; Finance charges; Dunning letters

Letters & excuses; Patient education; Patient portal

Ad hoc reporting; Carrier database; HIPAA compliance

Custom templates; Ad hoc reporting; Voice recognition Touch screen / stylus; Wireless support; HIPAA compliant CCHIT certified; HL7 support; SSL security October 2007

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PERSPECTIVE

Hospitals - ‘Know IT Right’ Fragmented IT solution cannot deliver seamless patient care Given the nascent stage of the industry, Indian hospitals are taking a cut-paste approach to IT... however, such an approach fails to deliver its potential and creates pockets of excellence. Healthcare IT solution should emerge as an output of an overall endeavor to improve processes than as a stand alone tool for quick fix solutions.

Vishal Ranjan, Aravind Hiremath, Satyajeet Prasad and Sachin Prasad

HEALTHCARE IT IN INDIA

The healthcare sector in India is witnessing increasingly higher service requirements from the population it serves.

However, delivery mechanisms are currently plagued with several process inefficiencies and disconnected work flows, leading to poor patient care and management failure in hospitals.

The acute shortage of doctors resulting in poor doctorpatient ratio limits the quality time and attention for each patient. At times, absence of medical records and poor diagnostic facilities leave significant gap in the clinical analysis. Further, there are informal levels of information and clinical data exchange – both within the hospital as well between different healthcare centers – leading to significant information loss, errors and poor quality of patient care.

Significant benefits can be achieved by streamlining activities, redesigning work flows and institutionalising processes across hospitals. Globally, IT adoption and implementation of hospital-wide IT systems is an accepted solution to roll out efficient and standardised processes.

However, given the nascent stage of the industry, Indian hospitals are taking a cut-paste approach to IT. Owing to the poor supply market of Healthcare IT products, Indian hospitals have lesser choices and end up adopting a solution which is either over-designed and hence costly, or under-designed and hence useless. Bigger hospitals end up automating select operations using ‘Best in Breed software’ while smaller hospitals employ the ‘next door software developer’ to quickly fix the billing and appointment processes. Unfortunately, both end of the spectrum remain wrongly served and continue to struggle with the same inefficiencies which they started with.

Given the resource crunch, such errors are costly and amount to overall skepticism against IT by doctors.

WHAT COMES FIRST?

The most common challenge for IT implementation is an ambiguity on the problem definition. Typically, hospitals 30

choose an IT solution to automate specific work flows or adopt the latest software which gives brilliant results. However, such an approach fails to deliver its potential and creates pockets of excellence, rendered redundant by the slow and inefficient processes around them.

One of the highly reputed hospitals adopted IT to schedule their patients for the doctors to avoid waiting time at the reception. However, the problem did not go away as the scheduling in radiology department (X-rays, CT, MRI etc...) was not digital.

A good IT solution emerges as an output of an end-to-end process design exercise - clearly identifying existing gaps, bottlenecks and repetitive inefficient activities. In fact, several IT solutions would need a certain level of maturity of the non-IT processes to truly deliver the real potential of IT.

WHERE DOES IT CREATE THE MOST VALUE?

Most IT enablement is driven by an opportunist approach of minimising cost and maximising automation of nonskilled manual activities. IT is more important for certain things, which are datacritical. For instance, EMR (Electronic Medical Record) is infinitely more important than the list of appointments. IT can also be useful to cut down repetitive activity of doctors. An IT solution should relieve doctors from routine work and allow them to attend complicated cases and carry out quality conversation with patients.

Industry experiences suggest that IT can be best leveraged in reducing cost of errors in clinical work flows than in administrative activities. Exhibit 1 (in the following page) depicts the relative cost per patient in each step of a patients journey from admission to discharge, overlaid with corresponding levels in ‘chance of error’ at each step.

Healthcare IT provides significant value in activities where hospital representatives (doctors, nurses, laboratory etc.) interact with patients. In healthcare workflow, the high cost and high probability of error drive an inordinate cost of inefficiencies in patient-facing processes and should be addressed first-hand to achieve seamless patient care. www.ehealthonline.org

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HOSPITALS - ‘KNOW IT RIGHT’

PERSPECTIVE

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are defined and measured, the Return on Investment for IT solutions disappear readily in ‘intangible benefits’.

Training and change management

HOW TO IMPLEMENT IT?

Having decided what processes need IT enablement it is important to undertake a scientific approach for IT sourcing, as explained in Exhibit 2;

If there is one thing that derails IT implementation time and again - it is the ubiquitous skepticism against IT. Training and change management, especially for the doctors, is critical for the success of IT implementation. However, unlike manufacturing ERP, where change can be driven from the top; it may work totally reverse as doctors are more independent and do not necessarily fall under strict hierarchy. Here the role of training, hand holding and befriending the doctor is much more critical than in any other industry.

Continuous improvement

It is estimated that more than 60% of the value of software is realized 12 months after its installation. Quick wins typically emerge from plugging process inefficiencies or by reducing the number of errors. However, as users get familiar with a product, they deploy the same tool in innovative situations and create much more value than what was envisaged as a sourcing objective. A configurable product from a long term vendor, committed to upgrades, is advisible for continuous value from investments.

WHAT IS MY CORRECT SOLUTION?

Document the scope

A documented scope of IT implementation is very important to control the implementation. Ideally, this scope of functional requirements should be prepared with the user group (doctors, nurses, clinicians etc.) and it should emanate from a process mapping exercise. Nevertheless, a stand alone scope document should be prepared in terms of process elements, rather than functionalities required.

Preparation of sourcing strategy and sourcing the IT solution

As a best practice, clear metrics, deliverables and the sourcing plan should be in place even before a vendor is approached.

The sourcing objective should be articulated and should drive all aspects of the procurement cycle. The sourcing strategy should drive specific efforts in finding the correct vendor, negotiating and designing the contract.

Installing and testing the solution

Unlike manufacturing ERP solutions where the solution is ‘released’ on a final ‘Go-live’ day, healthcare solutions need a significant pilot phase to test the solution under live conditions, as human work flows are less predictable than manufacturing processes. Overall, the pilot on a group of patient reflects the ability of the software to respond to varied operating scenario. During this period, the solution should be tested against the benefit metrics. Unless benefits 32

There is no correct answer to this question – for in Healthcare IT, even the best solution may not be the correct solution.

Overall, the correct solution is the one which can meet your process requirements and support your vision of seamless patient care. The technology and delivery capabilities of the vendor should be the most important constituent of evaluation criteria. Product flexibility, modularity and configurability should be evaluated. The product should be an assimilation of IT as well as clinical knowledge.

CONCLUSIONS

Given the infancy of healthcare IT industry, adoption of IT in a hospital can be a strong sustainable competitive advantage for an ‘otherwise’ commoditised healthcare market. However procuring healthcare IT is an involved process and should get strong senior leadership attention. Healthcare IT solution should emerge as an output of an overall endeavor to improve processes than as a stand alone tool for quick fix solutions.

The challenges for IT implementation emanate from external as well as internal factors and a robust sourcing strategy is critical to address these challenges. The vision of ‘Seamless Patient Care’ cannot be achieved on the back of broken processes and stand alone pockets of excellence; but by an integrated and efficient workflow sitting on the back of smart and simple IT solutions.

Vishal Ranjan Partner - Asclepius Consulting vishal.ranjan@asclepiusconsulting.com

www.ehealthonline.org

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HL7: Standards in Interoperability Susan Thomas

H

ospitals typically have many different computer systems used for everything from billing records to patient tracking. In most cases there is little or no communication among them. However, ideally, all of these systems should communicate (or “interface”) with each other when they receive new information.

The HL7 protocol was developed to address this need for data sharing among medical applications. It is a computer communication “language” that allows clinical applications to communicate essential information about patients demographics, medical history, financial information, diagnosis and procedures at different facilities.

Simply put - HL7 provides standards for exchange, management and integration of data that supports clinical processes and patient care, along with management, delivery, and evaluation of healthcare services.

FEATURES

HL7 refers to the highest level of the International Standards Organization’s (ISO) communications model for Open Systems Interconnection (OSI). The application level addresses definition of the data to be exchanged, the timing of the interchange, and the communication of certain errors to the application. It also supports functions such as security checks, participant identification, availability checks, exchange mechanism negotiations and, most importantly, data exchange structuring.

The HL7 protocol is an ANSI-accredited standard. Although recent advances in technology (such as the use of XML as alternative syntax for HL7) promise to dramatically simplify the implementation of HL7 interfaces, those advances are yet to be realised. When they are done, the hope of “plug and play” interfaces may become a reality. In the meantime, interfaces between ‘HL7 compliant’ vendors are tedious, if not nearly impossible to configure.

VERSIONS OF HL7 STANDARD

Standards are developed by Health Level 7 (HL7), and are used as messaging specifications for exchanging data between health information systems. The various versions of the HL7 standard are as given below: • HL7 Version 2.x 34

HL7 2.x Backward Compatibility HL7 Version 3.0 HL7 Version 3.0 Resources HL7 Version 3 is a HL7 messaging standard. Version 3 uses a Reference Information Model (RIM) as a common source for the information content of specifications. As part of Version 3, the HL7 Vocabulary Technical Committee developed methods that allow HL7 specifications to draw upon codes and vocabularies from a variety of sources. The V3 vocabulary work assures that the systems implementing HL7 specifications have an unambiguous understanding of the code sources and code value domains they are using.

The HL7 Version 3 development methodology is a continuously evolving process that seeks to develop specifications that facilitate interoperability between healthcare systems. The HL7 RIM, vocabulary specifications, and model-driven process of analysis and design combine to make HL7 Version 3 as the methodology for development of consensus-based standards for healthcare information system interoperability.

The HL 7 Development Framework (HDF) is the most current rendition of the HL7 V3 development methodology. The HDF documents the processes, tools, actors, rules, and artifacts relevant to development of all HL7 standard specifications, not just messaging. The HDF is expected to encompass all of the HL7 standard specifications, including any new standards resulting from analysis of electronic health record architectures and requirements.

• • •

HOW IT WORKS

When HL7 organizes data from one application or system in order to transfer to another, it does so by placing the information into an Hierarchical Message Description (HMD) and an Implementation Technology Specification (ITS), which forms the actual “coded message” that is transferred.

The mechanism for transmitting a message to another system or application is not determined by HL7. Transmission occurs across the Internet via TCP/IP, for instance. (Remember that HL7 is designed to operate in the top Application Level of any network architecture.) An HL7 compliant application or system receiving a “coded message” interprets the data because it understands the various models incorporated in the message structure. www.ehealthonline.org

HL7: STANDARDS IN INTEROPERABILITY

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FIGURE I: MODELS USED TO BUILD THE HIERARCHICAL MESSAGE DESCRIPTION (HMD) (SOURCE: HTTP://HEALTHINFO.MED.DAL.CA/HL7INTRO/963/1027/1027.HTML#FOOTNOTE)

Figure I illustrates the various models and specifications that are used to build the Hierarchical Message Description (HMD). The collection of HMD is how HL7 packages the appropriate data transferred to another HL7 compliant system or application when combined with an Implementation Technology Specification (ITS), such as XML. Basically, HL7 V3 translates everything into “building block” models which are then transformed into a Hierarchical Message Description (HMD). Once a message is transmitted to another HL7 V3compliant system, the recipient system is able to interpret the message because it uses the same model specifications.

FIGURE II: HL7 INTERFACE MODEL SOURCE: WWW.INTERFACEWARE.COM/MANUAL/CH-2-2-1.HTML

ADVANTAGES OF USING HL7 Open Systems vs. Closed Systems

Following a standard protocol proves to be an advantage in connecting to any system that supports this particular part of the standard, both now and in the future. For example, Internet Explorer or Netscape can connect to any existing and future web server using HTTP and HTML standard protocols.

Adhering to a standard protocol is called “open system architecture”. Anybody can interface with an open system using appropriate protocols, independent of its 36

FIGURE III: PROPRIETARY INTERFACE MODEL SOURCE: WWW.INTERFACEWARE.COM/MANUAL/CH-2-2-1.HTML

vendor.

When using HL7, the interface allows for numerous systems to be added to a single HL7 feed. New systems can be added without having to modify the original source system as demonstrated in figure II and III. “Closed” and “Proprietary” are used interchangeably to mean that characteristics of the system are hidden by the vendor from public domain. Although the closed-system model is easier to design and initially costs less to implement, closed systems have greater reliability on single vendors and more reliance on specific applications and technologies.

Although the worldwide trend is to follow an open-system architecture, there are still tradeoffs in following a standard protocol when developing interfaces. For instance, a greater initial investment is required.

Time and money must be spent to understand the standard and create the infrastructure required to support the standard, such as a parsing framework and networking code.

However, the benefits are abundant. For example, it will be easier to answer user requirements because HL7 is considered the standard for exchanging data between healthcare systems. In addition, because HL7 is the standard, it will be easier to create a system that can interface with an open system now and in the future.

Susan Thomas Research Associate, eHealth susan@elets.in

www.ehealthonline.org

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