SURVING IT Challenges in Healthcare Industry : October 2008 Issue

v o l u m e 3 | issue 10 | O CTO BER 2008

ISSN 0973-8959

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

Rs. 75

Cover Story: Surviving IT Challenges in Healthcare Industry eHEALTH Page 10

Spotlght: Spearheading Innovation Dr. Biswadip (Bobby) Mitra, Managing Director Texas Instruments, India Page 16

In Conversation: Practising Technology Integration Dr. Rajesh Gupta Controller Medical Informatics, Artemis Health Institute Page 23

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Expert Corner The Other Side of Health IT Solutions Devesh Rajadhyax Director & Solution Architect 21st Century Health Management Solutions Page 51

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In Focus: Surviving Sepsis Dr. Mitchell M Levy World renowned expert in Sepsis Page 44

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

November - South & Central India || December - East & North East India

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

CONTENTS w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 10 | October 2008

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COVER STORY

Surviving IT Challenges in Healthcare Industry eHEALTH

SPOTLIGHT

19

Spearheading Innovation

16

Dr. Biswadip (Bobby) Mitra Managing Director Texas Instruments (India)

PERSPECTIVE

Requirements of Quality in Hospital Information System Harpreet Singh Chief Executive Officer Oxyent Technologies & Oxyent Medical Pvt. Ltd. India

23

IN CONVERSATION

Practising Technology Integration Dr. Rajesh Gupta Controller Medical Informatics, Artemis Health Institute, Gurgaon

www.ehealthonline.org

w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 10 | October 2008

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POWER HOSPITAL

Artemis Health Institute Gurgaon eHEALTH

44

IN FOCUS

Surviving Sepsis

Dr. Mitchell M Levy World renowned expert in Sepsis

EVENT REPORT

46

ZOOM IN

Moving On...

49

2nd GE Healthcare Early Health Media Summit,

The United States of America adopts ICD-10 codes

25-27 Sept 2008, Bangalore eHEALTH

eHEALTH

51

October 2008

The Other Side of Health IT Solutions Devesh Rajadhyax Director and Solution Architect 21st Century Health Management Solutions

REGULAR SECTIONS india news BUSINESS NEWS

wORLD NEWS NUMBERS EVENTS DIARY

EXPERT CORNER

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Volume 3 | Issue 10 | October 2008

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Dr. M P Narayanan editor-in-chief

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EDITORIAL In sickness and in health!

The healthcare industry is proving to be a treasure-trove of opportunities for the IT industry in a time of general market sickness. In the face of the recent US credit crisis, which has impacted IT spending in key verticals such as banking, financial services and insurance, retail and manufacturing, where customers have delayed or postponed their investments on deploying new technology applications, the healthcare industry seems to show strong commitment towards adopting IT. A recent survey by market analyst Datamonitor revealed that healthcare industry would significantly increase IT spending in 2009 as growing demand for healthcare services from the aging ‘baby boom’ generation in the Western Europe, the US and Japan, leads to rising costs for national and private health systems in these countries.

Similar increase in adoption of technology in hospitals in India is a sure sign of the changing times for the healthcare industry. When a large corporate hospital such as Apollo Hospitals announces that they are quite ready to roll out their Universal Hospital Identification Number (UHIN) project, this is ample signal for other hospital chains to follow suit – or so we hope!

Albeit, the announcement also brings to light another factor key to such necessary change - greater collaboration between software vendors and hospitals.

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Bishwajeet Kumar Singh Graphic D esigners

Ajay Negi Chandrakesh Bihari Lal (James) Om Prakash Thakur

However, this smooth growth is often impeded by more practical issues such as lack of trained human resources, IT staff that can understand the need for a more comprehensive planning and growth of IT in healthcare; and if ever a hospital manages to find the right personnel to man its IT operations, then the lack of visionary management itself proves to be the biggest hurdle.

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Manoj Kumar (+91-9210816901) manoj@ehealthonline.org

This is the focus of our cover story in this issue – based on impressions we have gathered from our interactions with the healthcare and health IT industry. We hope you would find it interesting and let us know your opinion on it, whether you agree or not. We believe knowledge sharing is a two-way street!

editorial correspondence

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Jobseekers may log on to http://ehealthonline.org/careers/Jobseeker.asp

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

October 2008

Ravi Gupta Ravi.Gupta@ehealthonline.org

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COVER STORY

Surviving IT Challenges

in Healthcare Industry

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s the healthcare industry in India goes through an quite smartly been adopted by some of the big players in the expansion spree and gears up to become the best-inindustry, to a large extent, it remains an ornamental posiclass, IT is increasingly being embraced and adopted tion in the corporate structure, with limited authority and by healthcare organisations. While for some organisations at times with just a shadow power. This issue emerges time the motivation for IT implementation and again during interactions with is propelled by intention to automate such people. and modernise their functioning, Notwithstanding the criticality many others are doing it simply to of the role of a CIO in a service or“While the coveted designation follow the fad. ganisation, or for that matter, pracWhatever the reason, ‘e’ has slowtices in other industry sectors (such of CIO has quite smartly been ly started getting the better share of as - banking, pharma, manufacturadopted by some of the larger healthcare (although long awaited). ing, retail or airlines), most healthplayers in the industry, to a large However, the trend is quite new and care organisations in India are still very nascent, as compared to other merely paying lip-service with their extent, it remains an ornamental countries. There is a clear crunch of CIOs and/or IT Heads. position in the corporate structure, adequately qualified and relevantly In reality, the corporate power experienced IT manpower in this centre remains with CEOs/COOs/ with limited authority and at times domain and so far it has not been CFOs, particularly when it comes with just a shadow power.” smooth sailing for most organisato actual decision-making like IT tions. budgeting, IT investments and in Among all this, people who are some extreme cases, even IT profacing most of the brunt are those curement and implementation. who are managing IT in healthcare organisations. While the Often, IT plans proposed by CIOs are derailed by their betcoveted designation of Chief Information Officer (CIO) has ter ‘Cs’ (if not by high-powered doctors with a strong clout 10

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and fan following within the organisation). Reasons would be anything starting from lack of funds, weak business case, internal resistance or many a time, just ignorance.

Quite evidently, there is a real need to rationalise the power play inside corporate boardrooms!

Interestingly, it is not just the CIO who faces flak. Vendors and suppliers are equally at a loss when they get pushed into such a corporate cauldron. Often, they find themselves stuck in the midst of a myriad of decision makers, with their ever-widening differences in opinion, requirements, specifications, and ‘ego’ of course. Very often, vendors complain about this peculiar problem with healthcare organisations, wherein, there is never a single point of decision when it comes to IT projects. It is only after countless rounds of meetings, endless number of repeat presentations and well-oiled ego massaging right from down below to the top, which gets them somewhere near to project finalisation.

However, the saga just doesn’t end there... it’s a different story altogether at the implementation and testing stage.

Until recently, most hospitals would not have in-house IT experts or consultants, and they would have hardly invested adequate time or resource in preparing a concrete IT roadmap for themselves. Thus, in most cases, they would not have much homework done before they call in vendors. It is often assumed by the management that IT implementation is a stand alone, hands-off activity and vendors should be able to provide solutions to any and every problem that they are facing at the moment.

Surprisingly, IT is perceived not with a systematic and participatory approach but just as if an off-the-shelf, readyto-use, one-stop solution. Moreover, almost every doctor, nursing staff and administrative executive would have their own opinions about the kind of functionality they need or the type of user interface they require... and not always do they add value to the software intelligence. Customisation requests can be as ‘insightful’ as placing a particular tab/button from right to left or top to bottom... a serious challenge indeed!

IT Prospects in Healthcare Industry - Boom and Bottlenecks Healthcare is possibly among the most data-critical, information intensive and knowledge driven service sectors. Yet, for long, the industry (particularly in the Indian context) has been one of the slowest adopters of IT. Currently, the IT penetration in Indian healthcare industry is way too small compared to global standards and according to industry analysts, it will be a while before the health IT market blossoms. However, there is a silver lining to this – leading market research firms and IT industry experts have projected India among the fastest growing healthcare IT markets in Asia, following China.

Interestingly, the reason for such slow market growth for health IT and hospital automation solutions and services, is not solely due to lack of funds of healthcare providers. Major October 2008

Pain-points for IT in Healthcare • Inadequate directives from top management and lack of commitment from middle management.

• Lack of technology orientation among doctors, clinicians and hospital staff.

• Gaining confidence and sustained interest of staff members to use IT systems and adapt to necessary workflow structures.

• Dependency on top management for implementation process and in pressing the end users to keep using the system.

• Limited in-house support during implementation and testing.

• Very long post-implementation support time, before being able to provide desired results and improved outcome.

• Need for regular reminders to staff members about reducing dependence on paperwork and increased reliability on IT systems.

• Greenfield & Brownfield projects have their own set of problems.

While Greenfields don’t have data to start with, Brownfields have too much of it to handle and put into a single system.

• Hiring and retaining experienced IT professionals in a hospital.

Remuneration of mainstream IT companies is difficult to match up with.

• CIOs/IT Heads are often not the final decision-makers, CEOs/CFOs are.

• Once systems and solutions get into place, IT managers feel the lack of newer and more challenging assignments for them. Lack of growth prospects gets them running out of hospitals to elsewhere.

• Justifying the IT ROI is a big challenge in this industry where core investments are huge and has a substantially long turn-around time.

• Financing required for post-implementation training for users and software up gradation is often not provided in the primary IT budget.

investment is already happening for healthcare infrastructure development/expansion and medical equipment, but not comparably so for health IT. While the overall healthcare market in India is expected to reach nearly USD 70 billion by 2012, the potential for medical equipment market over the same time period is pegged at USD 18 billion, while that of health IT market at USD 3 billion.

Let’s look into what is really holding back the healthcare sector from making IT investment a priority – Legacy Lock Traditionally, healthcare service organisations have always kept a distance from trends and developments in the mainstream IT industry and remained in silos. Medical services are often thought of as stand-alone interaction between patients and doctors, and the procedures carried thereof, with simple paper based information and filing system, along with a general acceptance for the service to be timeconsuming and cumbersome. Doctors in their traditional role would not bother to spend any time on recording, storing or managing patient data and would only do diagnosis and prescribing. Lack of competitive environment also kept 11

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away the need for having professional business approach of healthcare institutions, and thereby, any requirement for integrated information management systems for clinical or business intelligence.

S(Low) Return-on-Investment It is often difficult for healthcare organisations to comprehend the benefit (in financial terms) of IT investments in their organisation.

With traditional business rational for investments (‘quick returns’) it stands for a marginal chance with decision-makers to approve anything that cannot show how the input cost is going to be recovered quickly. This again relates to the fact that, traditionally, there has been no emphasis on concepts of ‘service excellence’, ‘customer care’ or ‘business intelligence’ in healthcare sector. However, with the arrival of private sector participation in this industry, these are fast becoming a norm, rather than exception. It’ll be a while before top-notch of hospitals starts appreciating the fact that automation and intelligent IT systems (moving beyond just patient registration, billing, accounting) will help them in saving substantial cost in the long run by gaining operational excellence, improving service turn-over time, lowering inventory, and also improve future business potential by gaining goodwill through customer satisfaction and delight.

Technophobia Even if the top management of a hospital is willing to go for IT implementation, often the biggest hurdles are found among the primary beneficiaries – essentially, nursing staff, administrative personnel and doctors, resulting out of their fear of technology and computers. However, it has nothing to do with incapability of personnel themselves, but simply due to their non-acquaintance with IT products and systems during their early career. Typically, a systematic training and capacity building plan can help in getting over with any technology aversion among staff members. Also, it often helps in winning over the confidence of older staff members through formal or informal orientation by young, IT-friendly people within the team. This can be achieved by identifying ‘champions’ or ‘advocates’ of technology from among existing people and mobilising them to get a quicker buy-in from the rest. This approach is equally applicable for both doctors and non-medical staff, and it has been found (in many cases) to be a very effective way of breaking the initial barriers in introducing computer-based working environment.

Human Capacity Crunch Many hospital automation projects get stalled or delayed, simply because of lack of able personnel who can understand IT and technology from a hospital’s viewpoint, and can identify the solutions that will fit best. Even those who can, face the problem of them not being equally adept in clinical, 12

operational and administrative domains, adding to the existing woes. This problem can be solved by developing adequate IT capacity in people from a medical background. Due to absence of professional programs that can develop IT capacity among medical doctors, such persons are always few in number and hard to find. However, of late, some of the reputed healthcare institutions in the country have realised this need and introduced specialised courses to develop appropriate human capacity for this purpose.

Regulatory & Legal Environment Currently, there is neither a direct incentive nor compulsion for the healthcare industry to either automate their operations or transit to electronic form of medical record keeping/reporting. Often, existing legal environment will be put on a backburner for the entire purpose of total electronic environment in hospitals. Weak cyber laws and IT laws do not always acknowledge e-records as sufficient and tangible evidence of proof.

IT Adoption and Planning Issues in Healthcare Organisations By: Abhishek P. Singh, Principal Consultant & Dr. Amit Kumar Talele, Senior Consultant, Technopak Advisors - Healthcare Practices

Rapid development and innovations in information technology have played a significant role in increasing efficiencies across various industries. However the healthcare sector, especially hospitals have been lagging in adoption of information systems due to a combination of factors mainly including costs and implementation issues.

Most hospitals in India, barring the few A class facilities (existing and upcoming), still rely on paper records which are not only difficult to maintain but also time consuming in terms of retrieving data or developing effective decision support tools. In multi-specialty tertiary care hospitals, caregivers depend heavily on continuous monitoring and smart decision support tools, which in turn depend on availability of adequate information technology.

Role of information systems in hospitals can be broadly divided in terms of decision support in finance and medical services. However we are focusing on information systems mainly with respect to medical services.

1. Factors influencing investment decisions in hospital information systems • Availability and Inter-operability: Multiple modules are available for different operational processes. E.g. billing module, pharmacy module, Physician module, www.ehealthonline.org

“IT investments never go for waste ” Q. What are the biggest challenges faced by IT Managers of healthcare organisations?

A. Probably, the biggest challenge for IT managers in healthcare industry is to convince their COOs/CFOs that intangible benefits gained through IT actually adds-up to long term revenue gain for the organisation. The IT roadmap set up by CIOs is often difficult to get accepted at the top management level. Although, the time has come when we are seeing substantial increase in IT budgets as compared to earlier years, it still remains as a heavy responsibility for CIOs to keep THEM updated on every benefit, at all steps, and convince that IT investments have not gone for waste.

Q. What is the best way of tackling the general IT apathy among doctors, nurses and administrative staff and its effect on the success of IT implementation?

A. No doubt the best way is to show them the direct benefits that come from automation. While doctors will be happy to see the clinical analytics from the data entered by them, nursPradeep Saha, Head - IT, Max Healthcare es need to be shown that only automation can bring quality and save time to make them more efficient. For instance, the huge stock spread across hospital wards can have an easy control by a good materials management system in place. Also, IT systems help in easy distribution of work load - like doctors enter the order, nurses administer the drug and pharmacy makes the issue. If this would have been a manual process, it would become a completely nurse centric activity.

Q. How important is the vision and intention of top management in implementing IT in a healthcare enterprise?

A. While management thinks that IT is the backbone of the company, it is the responsibility of CIOs to present a clear road map in front of them. A very important step in this direction is to have a ‘IT Governance Body’ formed by the management, which can take the responsibility of prioritising the IT road map. This approach always makes the management expect an outcome, which forces them to keep others on their heels to deliver faster results.

Q. In what ways can you estimate the qualitative and quantitative returns of IT investment for a hospital?

A. Any electronic transaction ends up in ‘quality’. More transactions we make, the richer our data becomes and this in turn, helps in making Business Intelligence (BI) work on it. With the help of this BI we can easily analyse and diagnose the organisation status, which translates into higher quality and commitment. Advanced automation and a rich MIS results in better time management and lesser manpower, and hence lower cost of operation. ROI cannot be justified better, if we can lessen manpower need. In addition, automation can also help us in delivering care right at the patient’s door-step, ensuring patient retention and hence better revenue performance.

OT module, IP module, PACS, etc. Hospitals have to evaluate the availability considering their specific requirements.

In the absence of a single vendor agreement, irrespective of a new or existing facility, the hospital IT team has to ensure inter-operability of the modules.

The entire information systems network has to function October 2008

seamlessly and be able to consolidate data at appropriate levels. e.g. data from admission module has to flow seamlessly into the IP module as well as the billing module.

Clinical pathways have been demonstrated to significantly improve clinical outcomes. Integration of clinical pathways into hospital information systems needs 13

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alignment with the operations processes and customisation, which in turn affects the overall costs.

The HIS is also expected to be integrated with backend support systems i.e. Accounts & HR module.

Multi-facility Integration: Rapid expansion of hospital groups across the country and prevalence of the hub and spoke model has created a need for sharing data across locations. This has a technical impact on the nature of systems and hence influences IT investment decisions.

Besides, there is further challenge for technology as different hospitals under the same umbrella often have different operational processes.

Future Readiness: Major healthcare providers realise the importance of technology for business continuity and enhancement. More business is coming in through health insurance players than ever before. Medical tourism from western countries is also accelerating the pace in a more organised manner with international healthcare insurance players tying up directly with Indian healthcare providers. Both scenarios will have increasing demand on the Indian providers to be transparent and technology compliant as per the requirements of insurance companies.

Budget: Hospitals are capital intensive and have a long gestation period. This coupled with intense pressure on margins and the high cost associated with adoption of hospital information systems poses a significant hindrance to wide-spread implementation of information systems. (Complete information system solutions for multi-specialty tertiary care hospitals can cost anywhere in the range of 3-5% of the total capital expenditure.)

Enhancement of Positive Outcomes: According to a 1999 report by the Institute of Medicine in Washington DC, there are 44,000 to 98,000 annual deaths in the US caused due to medical errors, costing the system around 35+billion USD of which half is accounted to preventable medical errors. Indian healthcare sector does not offer visibility into such statistics. But, these figures can be significantly reduced with decision support systems like computerised physician order entry (CPOE) with intelligent alert systems. This offers a clear potential for hospital information systems to align with the top management’s commitment to the issue.

2. Difference between Green Field and Brown Field hospitals in IT planning, budgeting and implementation • Change in process and user acceptance: Information systems help to streamline and increase efficiency of operations. Hence, processes in a heavy IT environment can be significantly different than those compared to conventional paper based hospitals. This results in greater flexibility advantage for Green Field hospitals that have to primarily develop processes in alignment with the information systems. However the situation is challenging for Brown Field hospitals that have to analyse existing processes and re-engineer them for alignment with information systems. While this on its own sounds innocuous, the challenge lies in the ability of the 14

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implementation team to balance issues related to acceptance of the process change by users.

Staff Training: Existing hospitals have a full manpower compliment that needs to be trained to use new systems.

This results in comparatively higher implementation costs for Brown Field hospitals.

Integration with existing information systems: Another challenge in Brown Field IT implementation can be attributed to the technical issues related to integration of existing and new information system modules. It is not unlikely to see different vendors having different operating platforms, which leads to higher costs for integration.

3. Effect of human factor in the success/failure of IT implementation in healthcare service organisations • Change Management: One of the most significant factors affecting the success of information systems implementation is effective change management. This is especially more pronounced in Brown Field hospitals.

As discussed above information systems result in significant change of operational processes. Adding to this the intensive training requirements of the staff lead to a general resistance to change.

• The ability of the project manager to be able to achieve system acceptance and active participation of the users is crucial to the success of the overall implementation.

• General IT skills of healthcare work force: A general trend seen across multiple countries is that inadequate levels of IT training and abilities leads to apprehension and reluctance to accept IT systems. However, as observed currently, a significant focus on health information systems in educational institutions should gradually help to achieve greater acceptance.

4. Understanding of the long term benefits of Information Systems among healthcare decision makers • Absence of structured studies: Most of the healthcare decision makers are well aware of the potential benefits of information systems. However in the absence of structured case studies indicating the economic benefits of information systems in India, there is hesitation to invest adequately.

Indian Healthcare has seen few large hospitals adopting information systems to various levels which can be good sources of case studies to showcase the real financial and quality related benefits of information systems. However, most IT marketing strategies and communication focus on product features rather than the overall long term quality and economic benefits to hospitals.

There is an opportunity for IT vendors/companies, as a community, to take up these hospitals as case studies which will help the growth of the health information systems market in India.

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SPOTLIGHT

Dr. Biswadip (Bobby) Mitra has been with Texas Instruments for over 20 years and is the Managing Director of Texas Instruments (India). In this role, he leads all of TI’s R&D, Sales and Marketing activities in India.

Rated the most innovative company in India, with over 570 patents filed in the USA so far from the India R&D Center to its credit - the highest amongst all technology companies in the country - Texas Instruments India is driving Analog and Digital Signal Processing innovations for applications such as Industrial Electronics, Video Appliances, Medical Electronic Devices, Automotive Electronics, Energy, Security & Surveillance, Wireless, etc.

Spearheading Innovation Q. How do you gauge the potential of the medical market for Texas Instruments, and what are your plans for India?

A. I would like to draw some parallels before I proceed to discuss the scope of the medical electronics market itself.

Semiconductor chip technology has really revolutionised the world of communications over the last decade. We have seen what semiconductor chips have done towards making cell phones more powerful, application rich and affordable. If we contrast this with the role of semiconductors in the medical field, we realise that we have not even scratched the surface.

We at Texas instruments (TI) see this as a great opportunity.

We think that the critical role that semiconductors played earlier in the field of communications can be replicated in the medical field in the next 10 years.

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The semiconductor market for medical electronics devices for 2007 was USD 2.7 billion globally. Estimates for 201314 are USD 4.5 - 5 billion according to Databeans. Since the market is very fragmented and diverse, there are opportunities that will be larger and faster growing than others, e.g. blood glucose monitors are growing at a 15% CAGR. Within the ultrasound market, portable equipment is forecast to grow from 17% market share today to 27% market share by 2012. In the future, we will also see implantable devices developing as an area of high growth.

TI is helping shape electronics to revolutionise healthcare.

TI’s expertise across analog and digital technologies, and ability to address the imaging, data conversion, power management and connectivity requirements, helps our customers www.ehealthonline.org

put innovative medical electronics systems into the hands of more people. Collaborating with our customers, and universities, TI is building a community for investing in new ideas to advance electronics that serve the growing healthcare needs. Medical electronics manufacturers are applying TI’s semiconductor technologies in a great variety of areas that will enhance the accessibility and quality of healthcare.

TI has a large team of 1400 people in India engaged in R&D as well as Sales and Marketing activities. TI was adjudged one of the most innovative companies in India last year by NASSCOM. Engineers from TI India have till date filed over 570 patents in the US; so our focus on innovation has been very strong. We have been present in India for over 20 years, but what is new is the focus in the last 2-3 years on the India semiconductor market, in which the medical electronics sector is high in our focus.

“We have been present in India for over 20 years, but what is new is the focus in the last 2-3 years on the India semiconductor market, in which the medical electronics sector is high in our focus.”

Q. What would you say are Texas Instrument’s key focus areas in the medical market in India?

A. TI will focus on four key areas in the medical market in India. Consumer Medical- Included in this segment are portable devices such as digital thermometers, blood glucose monitors, blood pressure monitors, insulin pumps, heart rate monitors, digital hearing aids, etc. This area also includes the growing trend for health and wellness related medical equipment like electronic exercise monitoring.

Medical Imaging- The medical imaging market is a key growth area within the medical market with application areas such as ultrasound, which are highly benefiting from semiconductor capabilities to bring higher performance, lower power and smaller size. Further application areas are CT, MRI, X-Ray, etc.

Diagnostic, Patient Monitoring and Therapy - This market segment includes applications such as ECG, EEG, blood oxygen (pulse oximeter), defibrillators and implantable devices.

Medical Instruments - This segment includes laboratory equipment, dialysis machines, analytical instruments, surgical instruments, dental instruments, etc., as well as bionics.

We will also focus on microcontrollers, critical for lowering power consumption in portable equipment, and also wireless technology, particularly for patient monitoring in remote areas through telemedicine. We are looking at how we can combine the microcontroller and wireless technology to develop devices that can be worn by recuperating patients in their homes to monitor their health and transfer the data through wireless means to their doctor in the hospital.

Q. Kindly throw some light on the R&D strategy and key innovations in India.

A. There are two parts in our innovation strategy; one, which I am personally very excited about, is innovating with our October 2008

customers. So we are working closely with a number of product manufacturers and helping them in their innovation. We also get useful insights on products of the future from healthcare providers.

The second part is innovating with universities. Today, we are associated with over 700 leading engineering colleges around the country.

The School of Medical Science & Technology (SMST) at IIT Kharagpur, with whom TI is associated to conduct research in the field of medical electronics, is a very good example, as the researchers out there are mostly medical doctors. This is a big advantage in view of the challenges we face in India to take healthcare to the remote areas. These doctors are able to understand both technology and medicine at the same time.

Q. How do you foresee the future of TI in the medical market?

A. TI has been selling products to the medical electronics market for many years, but last year, the company started giving more focus by putting dedicated resources in place.

We see an important growth opportunity in this market in the coming years and are committed to increasing innovation of medical electronics and helping shape technology to improve the quality and accessibility of healthcare.

To address the growing challenges of the medical device market with rising healthcare costs and increased demand in emerging economies, our strategy is three-fold.

Analog and digital catalog portfolio: We are providing coordinated solutions for Medical applications out of TI’s existing product portfolio – the full range of semiconduc17

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tors from building blocks to complete solutions - based on innovative DSP and Analog technologies, deep applications knowledge for targeted medical end equipment, and a worldwide and local support infrastructure. Our portfolio includes data converters, amplifiers, power management, interface, mixed-signal and logic products, as well as products from our DSP processor (high-performance and low-power), microcontroller, Digital Light Processing and Wireless portfolios.

Application-specific products: We are working with customers to design application-specific products that are finely tuned to their signal processing, low power and wireless connectivity requirements. Focus areas for application-specific products are signal chain products, wireless connectivity and implantable devices. Furthermore, TI provides global manufacturing strength, which are important attributes to the medical device industry.

Investment in the future: To ensure that we are offering leading-edge devices targeted directly at the current and future needs of our customers, we are investing in innovation, partnering with venture companies and working closely with universities around the globe. In the universities sector, TI committed USD15 million to medical electronics research worldwide last year. We are helping to drive standards through close involvement with the respective standards’ bodies. One thing that is unique from a technology point of view in medical equipment is that it is a cross-disciplinary area. One needs analog chips as well as digital chips, software and embedded systems, and also digital signal processing. TI formed a worldwide medical business unit last year to address this industry. This has helped in focusing on areas that offer opportunities for research and innovation in the medical electronics field.

Q. How has your engagement with the medical technology companies in India been? What are the challenges and opportunities you see in collaborating with them?

A. An interesting, but little known fact is that there is a large number of innovative, home-grown medical electronics companies in India, designing and manufacturing medical equipment in Tier II and III cities. These companies require application support, and TI with its large portfolio of products – nearly 40,000 in number - plays a very effective role as their partner in innovation. For example, when a medical electronics company designs an ultrasound system, TI application engineers work closely with that company’s design engineers on the semiconductor solutions.

We worked with some medical electronics companies in India to develop our analog front end chip AFE5805 that integrates several parts such as the amplifier, Analog-to-Digital and Digital-to-Analog data converters, etc into one chip. This technology actually helped in reducing the cost of the ultrasound machine. By being able to offer the industry’s lowest power, smallest size and lowest noise features, the AFE5805 18

brings superior image quality to portable ultrasound systems, a market where we are seeing a lot of potential.

Future devices in the AFE58xx family will address specific requirements in all segments of the ultrasound market.

Within telemedicine too, there is a requirement of high definition video for which we have chip solutions. The next challenge is to enable the systems in the telemedicine centre to “talk” to each other. Some of them would connect wirelessly and some through wires. So this requires working with a number of OEMs to develop a complete telemedicine solution.

Q. What do you think are the key technological revolutions required in the field of medicine? And how does TI propose to be a part of it?

A. Technology-wise, low-power solutions will make the single biggest impact. In fact, at TI, we are focused on moving from low power to ‘no power’ technology. Over the last few years, a number of features have been added to portable electronic devices without increasing the size of the battery. This has been made possible by making all the systems inside the portable applications consume less power to do more through active power management. TI plays an important role in both line powered and portable power applications that efficiently convert power at the point of use. Medical electronics manufacturers are applying TI semiconductor technologies in a great variety of areas that will enhance the accessibility and quality of healthcare.

Patient monitoring and telemedicine will enable healthcare services to be cost-effectively administered to remote populations and will even allow medical services to be more pervasive in urban settings. Increasingly, we see devices becoming portable, wearable or implantable with these markets being important growth areas. Implantable devices, for example, will move from being predominantly therapeutic to also providing preventive solutions.

With the increased personalisation and portability of healthcare, we see interest in personal medical applications, such as heart rate monitors with wireless networking capabilities. There is significant innovation taking place in the Medical Imaging market with equipment developing in two key areas – highest performance in high-end devices; and smaller form factors for more portable mid-range and lowend devices for remote use.

Overall we think we are just at the beginning of a development in the medical electronics market that could go through a similar evolution as the PC market in the 1980s and the communications market in the 1990s – both developments were driven by semiconductor technology making devices smaller while consuming lower power and providing higher performance. We feel well positioned to be a key driver of this evolution and are looking forward to seeing the medical market develop over the coming years. www.ehealthonline.org

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PERSPECTIVE

Requirements of Quality in Hospital Information System Harpreet Singh Chief Executive Officer Oxyent Technologies & Oxyent Medical Pvt. Ltd., India.

Introduction The proliferation of information technology (IT) and other high technologies into medical imaging and diagnostic equipment in the last decade has resulted in the evolution of powerful new devices in the field of medical diagnostics. This has created business opportunity for companies involved in integrating this digital hub of devices and providing logical data sets to Users.

paper charts to electronic format, access from any location, availability of training & support, customisation capabilities; ease of installation, ease of use and the history of vendor are very important.

The development environment ensures that the HIS has the portability and connectivity to run on virtually all stan-

These new developments have helped in the early detection and treatment of diseases and significantly improved patient care. A typical Network is illustrated in figure 1.

A hospital information system (HIS), also called clinical information system (CIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. This encompasses paper-based information processing as well as data processing machines.

When looking at an electronic medical record and practice management system, features such as ability to convert September 2008

Figure 1: Medical Network 19

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dard hardware platforms, with stringent data security and easy recovery in case of a system failure.

HIS provides the benefits of streamlined operations, enhanced administration and control, improved response to patient care, cost control, and improved profitability.

The main features of HIS include:  Modular Structure  Integrated Design  Single Sign On Capability (Ecosystem patterns)  Multi Level Security  Easily Customizable Workflow (Business process execution language)  Web based Graphical User Interface (GUI) Based and User Friendliness.

Analysis There are plenty of HIS product offerings presently in the Indian medical sector. But most of them have a common set of problems, such as, hours to days of downtime during time-critical care delivery, frequent interruptions in healthcare workflow due to non-support delays from IT providers, and even within the time to deploy updates each additional Operating System Version increases system configuration cost, and every additional PC configuration increases IT support cost, and inconsistent hardware configuration causes slower update and higher cost of ownership. Also old architecture and frameworks, which increases ownership cost and increases the effort on adopting faster communication mediums like Internet and handheld devices.

Value Dials Patient Safety Quality of Care Patient Satisfaction Staff Productivity Staff Satisfaction Revenue Enhancement Cost Optimisation

Tangible & intangible units measuring impact of technology

Figure 2: Measurable Quality Variables for a HIS System

Figure 2 highlights issues that have created business opportunity for new vendors to come up with better hospital management systems, these attributes are important factors for any HIS system targeting the market.

Approach to New Technology All systems today seek to provide patient-centric care.

Built on an integration platform, Oxyent Medical (OM)’s Hospital Information Center (HIC) brings benefits from inception, leveraging a wide range of systems and data sources, both within and outside medical institution, whether internally developed applications or products from other vendors.

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Oxyent Medical follows ISO standards in C2M (Concept to Market) methodology and work internationally to produce medical grade software.

By embracing data and processes from such a wide range of sources, OM’s HIC helps organisations leverage their current investments and offers freedom of choice, as well as future-proofing against changes in systems and standards.

Salient Features  One Integrated View to Patients for Billing, Collection, Discharge Detail, Patient Medical History etc.  Package Supports Adaptability & Scalability of Software making it more robust.  General and Standardized Health Packages for the OPD & IPD Patients.  Authentication & Verification of entries through Audit Logging.  Web 2.0 based Easy Query Handling for instant decision of Bed Allocation for Patients, and request for the Bed Transfers.  Effective integration with existing or new PACS (Picture Archival and Communication Systems).  Data Mining and Business Reporting provisions for Graphical Presentation of the Data for Top Management’s Analysis.  Comprehensive Performance Reports.  Customisable Work Flow Management (compliant to Business Process Execution Language (BPEL)) for all Functional areas.  Medical Archiving Support with EMC’s, Jukeboxes etc.  Interface facility with the Smart Card Technology.  Interface with the Bar Code.  Interface with various Laboratory Equipments for Data Capturing.  Integration of multiple units of Hospital across country.  Web-based Architecture that lowers the cost of scaling up quite drastically, by installing low-end computers with browser capabilities.  Efficiently move information between the client and the server. www.ehealthonline.org

arishmaTM The Solutions People

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A web-based model allows you to have distributed users; but reduces the maintenance task to a group of web servers. Hence, the downtime is dramatically reduced and the task is more manageable.

Another advantage is that a web-based model allows you to have distributed users; but reduces the maintenance task to a group of web servers. Hence, the downtime is dramatically reduced and the task is more manageable.

The diagram depicts the flow of Staff and Patient objects across different modules of HIS system. The diagram shows HIS modules as engines of these two data objects operating to perform analysis based on customisable workflow.

applications on devices with a very small form-factor. Moreover, web-based systems allow easy integration with data heavy PACS systems, which medical professionals want to use remotely.

 HIC describes an architecture that uses loosely coupled component to support the requirements of business processes and users.  HIC architecture is a collection of components. These components communicate with each other. The communication can involve either simple data passing or it could involve two or more services coordinating some activity.  HIC infrastructure can be shared by components with different backgrounds  All the components are connected to HIC over Web.  A component is function that is well defined, self-contained and does not depend on the context of any other function.

The solution is modular and gives healthcare organisations the convenience of a flexible rollout strategy. Hospitals can choose to prioritise the deployment of those modules considered critical from the organisations patient care delivery goals.

Conclusion With the difference between phones and computers disappearing with each new generation of cell-phones, and the convergence of technologies, web-based applications also open up opportunities in terms of delivering very powerful

Implementation of OM’s HIS consistently delivers the following benefits to healthcare providers.  Increase in revenues through online charge capturing and tracking of all billable services  Reduced operational costs through reduction in staff required for back office tasks  Better inventory management through accurate estimation of demand, timely procurement and distribution of medical and non-medical items  Increased productivity and elimination of human error through seamless integration with medical equipment  Improved patient satisfaction through reduced turnaround time at points of care  International, standards based clinical data repository (HL7v3 & CDA)  Web based (Web 2.0) solution supporting AJAX and advanced imaging needs.  SaaS based business model allowing cost reduction.  Easy customization due to Integrated Development Environment, which combines framework with solution.  Portal based solution especially useful for medical enterprise, which have huge patient base and varied applications.  Service Oriented Architecture allowing modular and scalable system design

Figure3. Logical view of OM’s HIS Solution.

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IN CONVERSATION

Practising Technology Integration As one who came to this Greenfield project as part of the systems implementer team, Dr. Rajesh Gupta, one of the few medical doctors in the Health IT field, was faced with a number of challenges he met head on and solved with the help of his team. He shares with eHEALTH the highs and lows of his experience as Controller of Medical informatics, Artemis Health Institute, Gurgaon.

Dr. Rajesh Gupta Controller Medical Informatics, Artemis Health Institute, Gurgaon

Q. Do you consider lack of interoperability of Electronic Medical Records (EMR) as one of the bottlenecks for the growth of the health IT industry?

A. Even if we go in for EMR in the corporate hospitals, a very small percentage of the population will be covered. This is something that needs to be considered, since the greater part of the data is with the government hospitals. Unless the government has some policies to implement EMR in government hospitals and share the data among all hospitals, even if the private hospitals go forward with such a project, it will not benefit the society at large. Having said that, it would be a great beginning, if corporate hospitals take the initiative and share the patient records.

Q. Does that mean that unless we have a national level archiving and interoperability policy, it is not feasible? What about hospital chains having multiple locations?

A. If Artemis opens another hospital, we will definitely adopt this practice. Our current HIS is capable of doing it. If a patient has had a CT scan here, s/he doesn’t need to do a CT scan again in another Artemis facility. It is not only convenient and faster for the patient that s/he already has the results of some tests - it also benefits her/him financially.

However, sometimes there are genuine concerns, such as when the test is too old - you cannot hold a CT scan from a year back valid/informative. At the same time, if a patient has done a CT scan last week in Gurgaon and is now in Mumbai, then that report can be very useful. The patient doesn’t have to go through unnecessary radiation hazard as well.

Q. When you were setting up the entire HIS, what was your experience in handling the modalities? Were there interface problems?

A. There were problems. We had a team of 8 people from iSOFT who were here for 4 months – including technical persons developing the interface, a team of Philips, who were

October 2008

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our primary suppliers for modalities, a team of biomedical engineers, and obviously various departmental users. While interfacing we had some problems, not major ones. We could go through radiology equipment easily.

However, we are facing difficulties with the Echocardiography. Echocardiogram (ECHO) is considered to be an ultrasound modality in DICOM standard. But Ultrasound belongs to radiology department, while ECHO belongs to Cardiology department, so we were finding it difficult to get that sorted out. Ultrasound is already integrated, and we are now trying to integrate ECHO as a different entity altogether.

But this is a limitation of the DICOM standard, which has no separate modality as ECHO, because it is an Ultrasound based equipment. So we are still working on it with the help of iSOFT who are helping us to figure out how we can program it so that we can get it online within existing DICOM standards.

“A big challenge is the HIS training to the end users.

Today I can say that 95% of doctors are happily using the HIS with complete EMR available online at the click of a button.”

Q. What has been your experience in dealing with people during the implementation?

A. The biggest challenge to any HIS system is resistance from the user. We were fortunate that Artemis Management was very clear with its vision that we are going to use EMR. Its message was very clear to all the doctors, the nurses, the technicians, front office, inventory and store employees.

Dealing with doctors and nurses was a challenge. We had nurses who had never touched a computer in their life and we had to plan their training accordingly.

Initially when we started the implementation, we did not have data, being a greenfield project. Each department was asked to collect and feed their own data into the system. This was done in a specific format provided by iSOFT. After the data was collected, it needed to be validated, checked and then entered. Laboratory and radiology departments entered all the data, so it worked beautifully. Other modules’ data was entered by data entry operators, which took quite some time to correct.

Another big challenge is the HIS training to the end users.

We had various kinds of feedback from all our users. Today I can say that 95% of doctors are happily using the HIS with complete EMR available online at the click of a button. Artemis has also installed the pneumatic chute which is used to dispatch lab samples, medicines etc.

Q. Do you have a practice of keeping any paper records at all?

A. We do. You cannot go totally paperless due to some legal constrains. Digital signatures are not yet legalised in India.

So if we are taking consent from the patient for any procedure, it has to be on hard copy and it has to be stored alongside the medical record. All other patient records are available online.

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Q. When choosing a health IT vendor, what are the top criteria you would base your choice on?

A. The first criterion is scope. What is the expectation from the solution? Whether you are looking at maintaining online EMR or you just want patient administration, stock, inventory modules. The second criterion is definitely cost. If your budget is limited, then even if you like some of the best solutions, you simply cannot afford it. The third criterion has to be post implementation support and vendor’s reputation, which is critical in order to achieve success.

The best solution should capture each and every detail of a hospital transaction, be it any department. According to me it would be complete EMR, complete patient administration, finance, billing, stock, purchase, business intelligence, PACS and MIS. We at Artemis do not yet have the purchase and finance modules, for that we are going to implement SAP and integrate it with HIS to complete.

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POWER HOSPITAL

Artemis Health Institute Gurgaon A truly world-class, fully integrated healthcare facility, where each user can experience the easy and transparent workflow, whether staff, in-patient or outpatient.

T

he Apollo Tyres Group forayed into the healthcare sector recently with a 500-bed hospital, Artemis Health Institute (AHI) in Gurgaon. The healthcare arm of Apollo Tyres is a wholly owned subsidiary of PTL Enterprises Ltd - a part company of the Onkar S Kanwar group - and will, in the long term, have diverse interests in medical education, research and manufacturing of medical accessories.

institute for medical training and education for nurses and paramedics. Over time, AHS is looking to set up an all-India network of such facilities in cities, which have the highest gap between felt demand and supply of quality healthcare services. A few months ago, Philips announced a technology partnership with Artemis Health Institute to collaborate in its worldwide research and development efforts.

The Gurgaon hospital, is a multi-super speciality facility with specialisations in Cardiology, Cancer, Orthopedics, Cosmetic Surgery, Obstetrics & Gynaecology, Neurosciences, Minimal Invasive Surgery and Ophthamology. Apart from the super-specialities, AHI also offers specialised programmes and clinics for the special needs of its customers such as Artemis Breast Clinic, Asthma Care Clinic, Well Woman Programme, and Executive Health Check-up.

The hospital won the eHEALTH Award for the ‘Best ICT Enabled Hospital of the Year’ recently. This award was given to Artemis Health Institute for being equipped with the latest technology in predictive, diagnostic and therapeutic imaging, along with the highest levels of in-patient monitoring, and a paperless and film-less Hospital Information System. Artemis is the first installation in India to offer film-less and paperless environment, thanks to the HIS, which has eliminated the need for storage of large amounts of medical records in paper form as everything is filed and maintained online. The HIS provides concise and easy to read summaries to the doctors and patients. Incidentally the project was implemented in a very short time of six months.

Artemis Health Sciences (AHS) Pvt. Ltd. plans to increase it presence in a phased manner. Phase 1 was the setting up of the hospital project (under which 206 of the 500- beds are ready and functional). The next is to encompass the establishment of a world-class clinical research facility. Phase 3 would entail the manufacture of high technology hospital consumables, and the final phase would be the creation of an 26

The facility situated in Gurgaon is an example of a wellplanned infrastructure supported by a Hospital Information www.ehealthonline.org

AHI’s unique patient indentification card HIS in use helps track OPD wait time

System (HIS) provided by IBA Health a leading health IT company with an impressive international footprint. The HIS, suitably customised by the Artemis IT team with support from the vendor takes into account each detail and makes the use of it by the hospital staff and doctors as easy as possible.

The hospital management has since the beginning shown a commitment towards making the hospital environment as paperless as possible and continuously urges the staff and doctors on the panel to use the HIS for all functions. This commitment and vision is backed by an excellent support system with a dedicated team available 24/7 at a dedicated number in the hospital to solve any technical problem.

Artemis has many firsts to its credit, being the first installation in India to offer: Intelligent critical patient monitoring system with clinical decision support application backed by portal imaging technology Film-less and paperless environment (seamless integration with the Hospital Information System) An endovascular suite inside an operating room, which will allow endovascular surgery and catheterbased procedures along with hybrid surgery in the composite unit Functional MRI Scanning using Non-Contrast Imaging for Cancers (DWIBS) MRI-PET fusion technology 3D dynamic road mapping for reconstructive imaging

Radiology Image Interpretation Room

a patient visits the hospital they receive a unique lifetime registration number free of cost with a card. This unique identification number provides the complete details of the patient’s medical history as recorded at AHI during subsequent visits. Some excellent IT inputs/facilities here comprise of the twin display facility at the main registration desk, where when the patient details are being fed into the system, the patient/relative can see it and correct the attendant if necessary. After this they are escorted to the designated nurse station / relevant diagnostic area, and then the nurse co-ordinates their meeting with the doctor.

The vitals of patients waiting in the OPD is checked beforehand in a chamber close to the consultation room and logged into the HIS, so that precious time is not wasted, and the doctor can immediately diagnose the patient and move on to the next patient. Attendants, nurses and doctors, also help the HIS monitor each movement of the patient, by continuously feeding in the required details as well as logging the time of admittance, consultation and the whole gamut

When we visited the facility there were a few things which struck us as unique, such as a general reception area, where the attendants ushered the visitors to the hospital into the relevant part of the hospital - the inpatients were guided towards one direction the out-patients towards the other, leaving no room for confusion.

OPD visitors are directed towards the OPD section, where the OPD staff helps them fill up a registration form, first time October 2008

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Pneumatic chutes - the cutting edge in hospital infrastructure technology

Artemis Healthcare Institute’s range of diagnostic services includes, amongst others, Imaging services (64 slice CT, 3T MRI, Mammography, Fluroscopy 4D ECHO / Ultrasound); the laboratory services include diagnostic services for neurological disorders (EEG, EMG, NCV), non-invasive cardiology (ECG, TMT, Holter), nuclear medicine (PET - CT Fusion, Gamma camera). which helps provide Business Intelligence on factors such as average wait time, consultation time and so on.

At hospitals patients have to often run around the facility to access different diagnostic areas such as pathology labs and imaging facilities. Keeping this in mind, AHI has created a comprehensive suite of diagnostic services backed by leading-edge medical technology all at one place. The diagnostics department is located near the outpatient area so as to make getting any tests required an easy task. The same convenience is made available for the Wellness centre for women and the executive health check up centre.

The billing is kept apart from medical/clinical processes.

The patients when they need to do tests, pay at the registration counter and their details are fed into the HIS; when they reach the diagnostics area, their name will automatically show up if they have paid for the tests and their tests will be done against that account, if they have not paid, their names will not show up at all.

The technological infrastructure at AHI also includes: • Cath Labs with Stent Boost (software visualisation tools) • 64 Channel CT Machine with step-and-shoot technology, which reducesX-Ray radiation by 83 percent • Intelligent Ultrasound/Echo Technology • 3 Tesla MRI Machine 28

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Whole Body Imaging with contrast and high-end spectroscopy The HIS is equipped to allow doctors access from their login ID to results of all tests, images from radiology and so on of their patients. The head surgeon may also view a real time video of a surgical procedure being performed by his team from his personal chamber. The HIS server uses 760 MB per day and the PACS server about 4 GB daily. The facility also has 3 terabytes of Storage Area Network.

The IT budget for the hospital project was INR 6.5 crores, which was very well used in equipping the hospital with TFT monitors and small desktop machines, thus there is no bulky equipment anywhere. Each bed in the ICU is provided with a bedside laptop, from where, the nurses and doctors can access and update patient vitals and details on the HIS. In the 32 bed ICU section the patient to nurse ratio is maintained at 1:1.

Another very interesting use of cutting edge technology is the introduction of pneumatic chutes in the hospital connecting the wards to the laboratory and pharmacy. The test samples are collected and bar coded from the patient bedside and sent via the chute to the lab where the tests are done.

The pharmacy too sends medication required for patients to the wards via the pneumatic chute, thus reducing the need for movement and saving on time. All this technology truly helps the hospital to achieve the highest level of quality patient monitoring and care.

Specialised Clinics at Artemis Health Institute are another example of AHI’s commitment towards developing patient-centric care environment. These clinics are dedicated towards the treatment of a specific disease group and are a one-stop destination for the entire gamut of consultation, diagnostic and therapeutic services pertaining to a particular disease group. The primary benefits that a specialised clinic offers to the patients are decreased waiting time between referral, diagnosis and treatment, enhanced peace of mind, more privacy, a hassle free experience throughout diagnosis and treatment. www.ehealthonline.org

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news review

INDIA

No Cure Without Care 2008 successfully concluded No Cure Without Care 2008 - Facing Challenge in Today’s Hospitals, second in it series, was successfully concluded on the 19th of July in Bangalore.

The conference saw a participation of about 175 delegates and highlighted issues like Measuring, Analysing and Improving Patient Satisfaction, Communicating Effectively in Hospitals, Indian Medical Care, Work Motivation in Hospitals, Handling Insurance and Corporate patients in Hospitals, Impression Management in Hospitals, Effective Documentation Techniques in Hospitals and Challenges for Brand Building in Healthcare Delivery.

AMEN, a Healthcare Management Consultancy providing Recruitments, Event Management and Process-Reengineering solutions conducted this conference as a part of their ‘Events’ Initiative. “We are greatly motivated at the success of this conference and plan to have this in various other cities of the country once every 4 months. Our next NCWC conference is most likely to happen in Chennai in the month of November,” said Mr. Paniel, Chief Consultant and Head – Operations, AMEN. The Indian healthcare industry is undergoing rapid expansion, and in order to survive the competition in the healthcare market and grow, hospitals today are training and continuously updating themselves on current issues, challenges and effective methods of Hospital Administration.

However, most conferences and workshops conducted in the healthcare industry today focus on only medical issues and hospital administration. The people expected to attend programs on healthcare management include heads of healthcare organisations and others from the managerial level.

However, “It is equally important to make such programs available for different cadres of hospital personnel” said Mr. Paniel, a conference series, started with the intention of bringing to light various management issues not only for staff from the middle and top management of the hospitals, but also for various other hospital personnel from the lower levels of management.

Health camp reaches out to thousands of poor Nearly 6500 people made it for OPD check up, besides 1000 people availing free specialised surgery facilities, as part of the 10-day long Annual Mega Health Camp organised by Smile Foundation in Shahpura, which started on September 7, 2008.

A team of 40 specialist doctors along with 120 paramedical staff are treating people free of cost. Initial two days of Mega Health Camp served the underserved population with surgeries in Hernia and Stones, eye treatments, Orthopaedic treatments, ENT treatments, Gynae checkups, Oral treatment, Sonography tests, ECG and X-rays besides other routine check ups. Approximately 9000 people benefited from the much-awaited Health Camp in ten days this year. Patients are served food, medicines, and lodging, daily usage items, all free of cost.

Healthcare programmes of Smile Foundation include three strategies at the national level, namely ‘Smile on Wheels’ [mobile hospital programme in outreach], Multi-disciplinary Mega Health Camps, Integrated Education & Health Care Projects.

The Multi-disciplinary Health Camp strategy focuses on providing integrated multi-disciplinary health care services (preventive, curative and referral) including investigative and surgical interventions in a make-shift hospital environs in rural settings. Noteworthy among them is the Annual Multi-disciplinary Mega Health Camp being conducted in Bhilwara in Rajasthan since year 2002.

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

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

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

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

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

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

In order to bring high level decision-makers and visionaries of healthcare sector, the event further aspires to bring on-board government health departments, national medical associations, medical research institutions and healthcare service organisations in the Asian region.

Host Organisation

Organisers

Supporting Partners

Presenting Publication

Focus Areas & Themes

• • • • • • • •

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

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

The Ministerial dialogue will focus on exploring national eHealth strategies by sharing the vision of the top leadership and creating an opportunity for learning from each other’s experiences.

Asian Healthcare CIO Conclave – While technology and IT promises to transform healthcare through improved service quality, better patient safety, higher cost efficiency and enhanced quality, the IT managers and CIOs of modern healthcare organisations face a myriad of challenges, be it in terms of implementing and operationalising ICTs, gaining organisation-wide acceptability for systems and processes or even achieving seamless work flow and interoperability.

In order to address all these issues and beyond, through creation of an open forum for constructive debate, brainstorming and experience sharing, the event will bring together some eminent CIOs and IT Heads from reputed healthcare organisations across the region and put together a panel (titled – ‘Asian Healthcare CIO Conclave’) that will seek to explore viable solutions to challenging questions facing the industry at the moment.

Contact Information

Programme Enquiry: Dipanjan Banerjee (dipanjan@ehealthonline.org M : +91-9968251626) Sponsorship and Exhibition Enquiry: Arpan Dasgupta (arpan@ehealthonline.org, M- 91-9911960753)

General Information Conference Venue The conference will be held at ‘Sunway Resort Hotel & Spa’, located within an 800-acre integrated “Resort within-a-City” landmark, comprising a collection of hotels, spa, conference and convention centres, theme park, mega shopping and entertainment mall, medical and educational facilities and a multitude of business and leisure facilities. It is just 35 minutes from Kuala Lumpur International Airport (KLIA) and 25 minutes from the city centre.

Currency The monetary unit in Malaysia is Ringgit Malaysia (RM) and it is currently pegged at RM 3.60 to US$1.00. Major credit cards as well as Travelers Cheques in the principal currencies are accepted

Weather and Clothing Malaysia has an equatorial climate with uniform temperatures throughout the year. Temperatures range from 32°C during the day to 22°C during the night.

Official Language Bahasa is the official language of Malaysia, while English is widely spoken and understood by local population.

Official language of the conference is English. (Language translation facilities will not be available for conference attendees.)

http://www.e-asia.org/2008/ehealth/index.asp

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Hyundai Motor launches rural mobile health clinic India’s second largest car manufacturer Hyundai Motor India Ltd has initiated a satellite-linked mobile health clinic with telemedicine facility covering 20 villages near its Irrugattukottai plant near Chennai, a company statement said recently.

The company has also entered into an agreement with Sri Ramachandra University to operate the mobile clinic manned by a team consisting of a medical officer, pharmacist, nurse and an attendant.

Hyundai Motor has availed the services of the university, which in turn engaged Indian Space Research Organisation (ISRO) to have the telemedicine connectivity via antenna, fixed on the mobile van, to enable interactive treatment involving both doctor and patient with the main centre at Sri Ramachandra Medical College.

The project cost, estimated to be around INR 1 million, is borne by Hyundai Motor as part of its corporate social responsibility (CSR) activity, the statement said.

Indu Projects, CARE, Hopkins to jointly set up health city A consortium of real estate developer Indu Projects, USbased healthcare major John Hopkins and Hyderabad-based CARE Hospital is setting up a 2,000-bed health city in Nagpur.

The consortium will invest around INR 750 crore in the project through a combination of debt and equity.

The Maharashtra government is developing an International Cargo and Passenger Hub Airport at Nagpur, an aviation hub. The project includes a special economic zone (SEZ). The Maharashtra Airport Development Authority, which is developing the SEZ, will lease the 74-acre land to the consortium for 66 years.

The consortium, expects to get the regulatory nod in the next few months and the civil work will start by the end of the year or early next year. The health city envisions building 10 superspecialty hospitals and will primarily target overseas patients. In the first phase, the health city will have 750 beds and it will be operational in the next 36 months.

Indu projects will be responsible for the development and management of the project, while CARE Hospitals will operate the hospital. John Hopkins will be the knowledge partner but will also hold equity in the consortium. Indu Projects will fund majority of the investment and is expected to hold majority stake in the consortium, although details of the holding structure are being worked out.

The health city plans to have medical, para medical and other medical education centres. The consortium is also in talks with a Thailand-based group to set up a health and wellness village in the health city.

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Karnataka partners EMRI for medical emergency project The Karnataka government has signed a MoU with the Hyderabadbased Emergency Management and Research Institute (EMRI) to roll out ‘Arogya Kavacha’, a scheme that provides free emergency services in the public private partnership (PPP) model in rural and urban areas.

EMRI is a non-profit organisation founded and funded by B Ramalinga Raju, chairman, Satyam Computers and his family. The institute, by partnering the state governments offer professional emergency service through a call centre or response centre.

The Karnataka state government has announced in this year’s Budget, the ‘Arogya Kavacha’ scheme - releasing INR 10 crore to operationalise the scheme. The public health and family welfare department is expected to provide 10 acres to EMRI for establishing a call centre, training facilities for drivers, train doctors, nurses and house a few offices associated with it.

The department is expected to bear the expenditure on the necessary equipment and material (software), equipped ambulances, running cost of the centre, human resources and for administrative expenditure.

Speaking to reporters after signing the MoU, Venkat Changavalli, chief executive officer, EMRI, said, “The institute is planning to cover the state in two phases. In phase I, they will set up a 24x7 call centre with 75 seats and 150 ambulances to cover a few districts. In phase II, all the 29 districts will be operationalised with 517 ambulances.” The response services (ERS) will be launched after integrating medical, police and fire services in the state from November 1. Chief Minister B S Yeddyurappa, speaking at the MoU signing ceremony said, “This scheme is devised keeping in mind the 10,000 deaths every year in the state from accidents. ‘Arogya Kavacha’ programme aims to offer timely transport facility to shift the victims of accidents to the nearest hospital.”

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GE Healthcare, Varian to collaborate on MRI system GE Healthcare and Varian, Inc. will be collaborating to develop a new pre-clinical 7T magnetic resonance (MR) imaging system. Under the agreement, initial development and integration will be a joint effort between the two companies. Once development is complete, Varian will offer customers a fully integrated 7T System combining GE Healthcare’s state of the art electronics, user interface, pulse-sequences and applications with the magnet, gradients, positioning devices and RF coils provided by Varian.

Pre-clinical magnetic resonance imaging is a versatile and non-invasive method to investigate anatomy, metabolism, and physiology in research models. It has a broad range of applications in soft tissues, including brain and organ imaging, tumor assessment, disease progression, and functional imaging. In research, other potential applications include investigation of new contrast mechanisms and agents, monitoring gene expression, analysis of protein interactions, and determination of pharmacokinetics. Magnetic resonance spectroscopy imaging is a closely related technique, used to measure the concentrations of specific molecules in the body, enabling direct measurement of neurotransmitters in the brain or metabolites in muscle.

“We feel this system is an ideal addition to our existing pre-clinical MRI product line,” said Martin O’Donoghue, Vice President, Scientific Instruments, Varian, Inc. “It will appeal to the burgeoning group of researchers who have experience with GE MRI systems. We feel this will give them the pre-clinical MR imaging tool they have been looking for.”

“This promises to be an important advance in pre-clinical MR,” said Jim Mitchell, general manager of Molecular Imaging technologies for GE Healthcare, and the leader for pre-clinical technologies. “We have made an enormous effort to ensure GE Healthcare is the place researchers look first for the most advanced imaging technology for pre-clinical applications. Together with Varian we anticipate being able to expand our preclinical imaging offering which currently includes PET, SPECT, CT scanners as well as dual and tri-modality imaging systems.”

CSC selects InterSystems for trust integration Computer Sciences Corporation (CSC) is to use InterSystems Ensemble for the integration of all new applications it provides to existing trust systems. CSC, the local service provider for the North East and Midlands regions in England’s NHS National Programme for IT, has selected Ensemble as the standard trust integration engine (TIE). The Ensemble TIE will include pre-built and pre-tested interfaces for key trust-based applications.

As a result of the deal, the Ensemble integration platform will be used for integrating new solutions, such as Lorenzo, with existing applications provided by CSC. The TIE will be available to all trusts in NME under the CSC deal. Trusts have the option to expand their use of Ensemble beyond the TIE to address other trust integration requirements. “Proven, comprehensive and extensible integration is vital to the success of the NPfIT programme,” said Mike Dyer, CSC’s NHS chief technology officer. “Our new TIE initiative directly addresses the need to achieve a single view of a patient record and keep disparate systems synchronised.”

NHS Yorkshire and the Humber is one of the first strategic health authorities to use Ensemble under the contract.

InterSystems Ensemble had been successfully implemented at a number of NHS sites including Barts and The London NHS Trust, Moorfields Eye Hospital NHS Foundation Trust, Plymouth ICT Shared Services, Peterborough Hospitals NHS Trust, Mid Essex Hospital Services NHS Trust, Bolton Hospitals NHS Trust, and East & North Herts NHS Trust. InterSystems says it has provided over 400 implementations of Ensemble in healthcare organisation globally. These connected healthcare initiatives have made it possible to create and integrate electronic health records, delivering improved care while costs are significantly reduced.

In February 2008, InterSystems Ensemble was ranked as Number One interface engine in the survey of healthcare providers conducted annually by KLAS, a leader in healthcare technology research.

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Healthcare to attract USD 500 m PE funding in 3 yrs According to industry estimates, over the next three years the healthcare services segment in India will attract PE funding worth about USD 500 million.

PE investments in healthcare are focused on three key segments hospitals, pharmaceutical companies and more recently the emerging healthcare services segment. The healthcare services include diagnostic chains, medical device manufactures, disease management services and allied healthcare services, which are increasingly attracting investments from a variety of venture capitalists. Though in recent times PE funding preferred retail, infrastructure, financial services, now most fund managers believe that the returns on investment earned in the past would not be possible going forward. At the same time, healthcare sector has a recession- averse trait. This status would ensure that healthcare sector remains robust and continues to attract increasing attention from PEs. Indian healthcare sector, which is at a nascent stage, is finally shedding the image of a stagnant, perfunctory sector and the enormous unmet demand within the industry has ensured a business opportunity for everyone. PE fund infusion would bring fiscal discipline in the healthcare sector. Besides, it would also lead to the consolidation of the un-organised healthcare market.

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2 nd International Conference & Exhibition

“ Telemedicine: Myths and Reality” 23-24 October 2008, Lviv Topical issues of telemedicine and eHealth in Ukraine and worldwide

Dear collegues!

Conference discussion topics:

On behalf of Association for Ukrainian Telemedicine and eHealth Development (National Member of Іnternatіonal Socіety for Telemedіcіne and eHealth) let me invite you to participate in the 2nd International Conference "Telemedicine: Myths and Reality”, that will be held in Lviv on 23-24 October, 2008.

1st Conference "Telemedicine: Myths and Reality”, organized at the fall of 2007 by Western Ukrainian Telemedicine Center “Meditech” and Association for Ukrainian Telemedicine and eHealth Development (AfUTeHD), became really a success story of the project, that put together more than 200 participants from 10 countries worldwide.

High growth of interest in telemedicine and ehealth from different environments: physicians, managers and decisionmakers, medical and technical university officials, private sector and students, - has been ascertained.

It demonstrates the necessity of regular realization of scientific and practical forums on issues of telemedicine, informatization and computerization in Health Care as well as unified electronic medical space formation.

Also, it is very necessary to create scientific approaches and evidence base for development of Ukrainian ehealth.

Due to organisation of such conferences and seminars it become possible to exchange ideas and achievments, to discuss and to create working groups. Gained experience and knowledge will ensure the future work on standardization of medical information systems, for an effective decision making, for understanding the routine ehealth and telemedicine usefulness.

I am glad to welcome you to attend 2nd International Conference "Telemedicine: Myths and Reality”. I believe this year we will also present you high-grade scientific program, helpful practical recommendations. New ideas and the way of their realization will be our gift for you.

Best wishes, Anton Vladzymyrskyy, M.D., Ph.D., Head of Executive Board of Association for Ukrainian Telemedicine and eHealth Development Organizers

Supported by

• Clinical telemedicine (teleradiology, teletraumatology, telepediatrics, teledermatology, telepsychiatry, emergency telemedicine etc.)

• eHealth • Home and mobile telemedicine, telemonitoring • Hospital information systems and telemedicine networks • Medical electronic records, medical information safety • Technical and program solutions for telemedicine and eHealth • Informatization of Public Health • IT-managemant in Public Health and pharmacy • Telemedicine as certified education • Distance education • Transboundary telemedical projects • Deontology in telemedicine • Legal regulations of telemedicine functioning in Ukraine and abroad • Telemedical services payment About the Conference: Conference materials will be published in «Ukrainian Journal of Telemedicine and Medical Telematics» An exhibition of technical equipment and software for telemedicine and eHealth will be held during the conference.

Please visit conference website: www.telemed.net.ua to find information on terms of registration and participation in conference.

Deadline for abstracs submission - 1 September 2008 Conference venue: Large conference hall, Hotel “Dnister” Address: 6, Mateyka str, Lviv Ukraine

Our Partners

WESTERN UKRAINIAN TELEMEDICINE CENTER

To participate in conference, exhibition or sponsorship, please contact Conference Board: E-mail: conference2008@telemed.net.ua Tel./fax: + 380 32 2430055 www.telemed.net.ua

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Idhasoft launches hospital management system

PwC backs PPP in healthcare

The USD 100 million company, Idhasoft, an IT services company in the healthcare space, has implemented software in several corporate hospitals in Hyderabad and Chennai. It has now launched a hospitals information system called Idhasoft Hospital Management System (iHMiS) product in Pune. iHMiS is an end to end web-based solution, catering to various departments like patient care system, OPD, pharmacy, OT, laboratory information management, bio-medical, blood bank, radiology PACS, MRI , CSSD, EMR, RFID management soon.

Ramesh Subramaniam, MD Idhasoft said, “iHMiS is the only product, which combines rich healthcare functional features and integration to some of the best medical equipment. The product has been developed using Microsoft Dot Net and J2EE Platform and therefore has been built with current and future demands of all customers - local/ International as the product conforms to global norms and process like HIPPA/JCI/ WHO etc.”

The application follows a modular approach and is customised to suit the requirements of a 50 to 5000 bedded hospital. The product is also well integrated with popular ERP products like oracle and SAP. Idhasoft plans to further invest several million dollars to further bring in newer products ranging from clinical research to RFID etc. He further added, “In Pune, it has already won its first customer from a large infrastructure based company, which is building a chain of hospital across Pune and other cities.” Headquartered in India, Idhasoft currently has operations in Atlanta, Georgia, California (Redwood). It provides end-to-end solutions for organisations across retail, banking, financial services, manufacturing, healthcare and insurance domains.

Idhasoft is one of the fastest growing private companies in India.

Idhasoft’s goal is to generate USD 200-250 million revenue in this fiscal year and be amongst the top 50 IT companies by December 2010. In India, Idhasoft markets its product jointly with IBM, where customer a well integrated and tailored to the IBM series of server range of products.

The huge investments required to bridge the gap between the demand for healthcare and the existing supply can only be met through public private partnership, points out a recent study by PricewaterhouseCoopers (PWC).

Health is a state subject and governments are actively courting private industry in healthcare.

The PPP experience in India and other developing countries in Asia suggest five common models, based on social marketing, social franchising, contracting in, contracting out and equity arrangements. However, the Asian experience revealed challenges in the healthcare sector, like the need to have an appropriate policy framework backed by an appropriate institutional mechanism.

Another problem in PPP was use of generic contracts without any reference to specific indicators like number of free treatments to be offered by the government and cost of serving the below poverty line (BPL) policies.

Also, analysis of PPP arrangements in the Indian health sector and elsewhere showed that recourse mechanism available in case of default by either partner was rather weak, the study points out.

There was perceived imbalance of power in the PPP partnership, with the government emerging as the dominant partner. Further, the absence of established accreditation standards for ensuring quality of healthcare services impacted government’s ability to ensure consistent service from the private partner.

High interest rates and turbulence in the equity markets created the need for newer norms for risk capital investments in hospitals.

Recently, Apax Partners picked up 1.7 per cent stake in Apollo Hospitals, taking its total stake at 15 per cent.

Fortis Healthcare adopted the PE route too. Similarly, smaller firms like R G Stone Clinic and Dr Lal Path Labs and Metropolis also received PE funding.

EZ-CAP, InterComponentWare form strategic partnership MZI HealthCare, LLC (MZIHC), and InterComponentWare, Inc. have announced a strategic partnership to deliver eHealth solutions to Independent Practice Associations (IPAs) and health plans nationwide. MZIHC is a leading vendor of health plan software and offers the widely used EZ-CAP(R) product for claims adjudication. ICW is a global leader in eHealth technology solutions that provide secure access to aggregated patient data and interoperability across disparate systems.

The companies have complementary solutions that provide IPAs and health plans with clinical and administrative patient data in a dashboard view, accessed via a secure web browser. Having an electronic patient record available at the point of care improves the quality of care delivery and lowers costs by providing actionable and comprehensive information to providers in a single view.

A key feature of the solution is the ability to leverage an organisation’s existing infrastructure.

A defining characteristic of ICW’s solution is its flexibility in aggregating data from EZ-CAP along with other data sources such as pharmacies, laboratories, hospitals, and physicians offices, and providing core information in the form of an electronic patient record.

Jeremy Coote, CEO of ICW Inc., notes, “Connectivity and the ability to deliver true interoperability are critical factors in the success of this partnership. By combining the EZ-CAP platform and ICW solutions, we can deliver relevant data to all stakeholders in the care continuum, when and where it is needed. Moreover, our customers will have an extendable platform, ready for the integration of valueadded applications.” ICW has recently implemented its interoperable solution at an existing EZ- CAP customer in southern California.

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Barco upgrades 3D imaging software Belgium medical imaging specialist Barco has released an updated version of its Voxar 3D advanced visualisation software suite, integrated into Agfa’s IMPAX picture archiving and communication system.

Version 6.3 of Voxar is said to provide streamlined imaging workflow, enabling physicians to read and report their studies faster and more efficiently. Using the new software, a PACS workstation user can now move from 2D images to creating MIP, MPR, 3D or 4D reconstructions.

Barco says the new Voxar 3D suite is available with a full set of integrated clinical applications. These include VesselMetrix for quantitative 3D vessel analysis; CardiaMetrix for CT cardiac analysis; ColonMetrix for CT colonography; and PET-CT Fusion for the interpretation of whole body oncology studies. Barco’s Voxar 3D version 6.3 enhances IMPAX with advanced visualisation. It combines speed, easy access and advanced functionality in a package that is efficient, reliable and cost-effective. Voxar 3D is said to be designed to optimise the ease-of-use and productivity of the daily imaging workflow. The software enables advanced visualisation accessible on any IMPAX workstation over a standard 100 Mbps hospital network.

Voxar 3D also delivers fast loading. With the client-server ‘Enterprise’ version, loading an entire 1000-slice series in full diagnostic quality is said to take around 10 seconds, while a 2000-slice series takes about 13 seconds. With the introduction of version 6.3, Barco has also put more emphasis on cost-efficiency. It makes use of powerful, off-theshelf server technology and graphics cards, allowing users to benefit from the latest IT advances at a lower cost. Barco designs and develops visualisation products for a variety of selected professional markets.

The company had sales of 747m in 2007.

Seattle fund bankrolls Asian private hospital chain Columbia Pacific, a Seattle investment firm, said it has raised USD 135 million to go after the Indian market. Its Asian venture, Columbia Asia, has 13 facilities in Malaysia, India, Indonesia and Vietnam - and expects to have 39 by the end of the decade, more than half in India.

The latest investment is expected to bring the total equity raised by Columbia Asia to USD 325 million.

Columbia Asia’s operations began in 1994, when Chairman Rick Evans, previously with Columbia Pacific, opened an extendedcare facility in Malaysia, then one of Southeast Asia’s blossoming “Tiger Economies.” The idea was to adapt business methods honed in U.S. health-care management to private hospitals serving the region’s budding middle class.

Now India, with its booming economy and giant population, is looking more like the land of opportunity. “It took me one day of driving around Bangalore, India, to see the opportunity was unbelievable,” Evans said. The southeastern city is India’s Silicon Valley, housing Microsoft’s research campus, among others.

Middle-income households there were “underserved,” he said.

India’s economy grew at a pace of 9 percent last year, but it still lags behind in healthcare services. It has 1.5 beds per 1,000 people, half the rate of Brazil and China.

The company’s growth is in part driven by the expansion of private health insurance in Asia. About 70 percent of the company’s revenues come from insurer payments, Evans said.

Columbia Asia already has five facilities open in India, but expansion there presents its own set of challenges. For one, trained nurses are hard to keep, as many are lured away by jobs in the U.S. and other countries, where their skills are in high demand.

Global Hospitals to launch a 500-bed facility soon Multi-speciality healthcare provider Global Hospitals Group will soon launch a hospital with 500 beds in Chennai. The hospital, which already has its presence in Hyderabad and Bangalore, would also be setting up a hospital each in Mumbai and Kolkata. It is claimed they are the first to have the Positron Emission Tomography (PET) Computer Tomography (CT) facility, which has been set up at a cost of INR 16 crore.

This machine has been imported from the United States and it would provide information regarding the stage of the disease in a patient. “The structure and function of a body can be identified using PET CT facility,” Nuclear Medicine Physician Sumathi said.

So far, we have diagnosed around four cases using this facility and on a day about six to eight cases can be done, she added. “Earlier, for doing this scan, patients were airlifted to Mumbai for treatment” she said, adding, with this facility being set up here in Chennai, patients can be treated here itself.

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Medical data breach insurance offered in US Members of a US healthcare purchasing alliance are now able to take out insurance to cover the financial costs of data breaches. The move comes in the wake of a growing number of US hospitals facing hefty bills after they experienced data breaches, either through external attack or internal failures.

With the cost of litigation, fixing breaches and taking corrective action it is estimated that each data breach in the US healthcare system costs on average nearly USD 200 per record and USD 6.3 million per incident. The figures come from a recent study by Kroll Fraud Solutions published by Healthcare Information and Management Systems Society (HIMSS).

Faced with these kinds of risks and potential costs, one alliance of healthcare purchasers in San Diego has started offering organisations the chance to sign up to insurance to protect them against the expenses related to data breaches.

Premier Insurance Management Services, a unit of the San Diegobased Premier Inc. is now offering members of the alliance the chance to sign up for “data privacy and network risk liability” insurance in partnership with Media/Professional Insurance, Kansas City. The insurance is said to cover such expenses as crisis management, public relations and customer notification. According to Health Data Management the insurance also covers expenses, fines and penalties arising from government and regulatory agency investigations into the handling of personal data. A recent study on the security of US healthcare organisations found that only 56% of breached organisations surveyed notified the patients involved.

Royal Philips Electronics announces the euHeart Project Royal Philips Electronics will lead a new European Union (EU) funded research project called euHeart, which is aimed at improving the diagnosis, therapy planning and treatment of cardiovascular disease - one of the biggest causes of mortality in the western world.

The euHeart project complements the recently announced HeartCycle project, also led by Philips, which focuses on the long term management of chronic heart disease patients.

The euHeart consortium aims to develop advanced computer models of the human heart that can be personalised to patientspecific conditions using clinical data from various sources, such as CT and MRI scans, measurements of blood flow and blood pressure in the coronary arteries and ECGs. These computer models will integrate the behaviour of the heart and the aorta at molecular, cellular, tissue and organlevel. They will also incorporate clinical knowledge about how cardiovascular disease disturbs the correct functioning of the heart at these levels. As a result, it may be possible to develop simulation tools that doctors can use to predict the outcome of different types of therapy, and because the models will be personalised to individual patients, the therapy could be equally personalised.

New software cuts waiting at hospitals A new software package, developed by researchers, helps hospital or emergency staff anticipate the rush of patients hour by hour for the day or the next week, even on holidays with varying dates, such as Easter.

The Patient Admission Prediction Tool (PAPT), designed by Australian e-Health Research Centre (AeHRC), can predict accurately how many patients will be present at emergency departments, their expected requirements and the number of admissions.

This could assist many areas of health management from basic bed management and staff resourcing to scheduling elective surgery - not to mention reducing stress for staff and improving patient outcomes. The software was developed by clinicians from Gold Coast and Toowoomba Hospitals and Griffith University and Queensland University of Technology, collaborating with AeHRCe. Emergency departments already know there’s a pattern to presentations and admissions, but existing models are very simplistic.

PAPT uses historical data to provide an accurate prediction of the expected load on any day. The prototype PAPT package has a simple interface designed in consultation with those who will ultimately use it every day. Over the next year the team plans to assess and quantify the impact of using the forecasts.

The aim is to turn the prototype package into a product for hospital use. This work was presented at the 2008 Health Informatics Conference held in Melbourne recently.

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The euHeart consortium comprises public and private partners from 16 research, academic, industrial and medical organisations from six different European countries. It will run for four years and has a budget of approximately EUR 19 million, of which approximately EUR 14 million will be provided by the European Union as part of the EU 7th Framework Program.

The project forms part of the Virtual Physiological Human (VPH) initiative - a collaborative effort that aims to produce a computer model of the entire human body so that it can be investigated as a single complex system.

Within the multidisciplinary euHeart consortium, the University of Oxford is the scientific coordinator of the project, while King’s College London leads the clinical program.

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Portable machine to detect bird flu outbreak in ‘two hours’ Scientists are on track to create a mobile machine that would identify strain of bird flu within hours, a development that would make it possible to set up exclusion zones before the deadly virus could spread. Currently it takes up to a week to identify different types of bird flu, including the potentially fatal H5N1 strain. A rapid test for flu viruses could save thousands of lives in the event of a pandemic by cutting the time taken to identify cases to just “two hours”.

Scientists at Britain’s Nottingham Trent University are now developing a portable machine, the size of a briefcase, which can be used at the spot of a suspected outbreak or taken to a patient to detect the flu in two hours. The device is designed to pick up all types of flu - including the deadly H5N1 strain of avian influenza. At the moment, the H5N1 strain, while highly infectious among poultry, is not easily passed to humans, and cannot be passed from human to human.

However, scientists fear that a strain of bird flu, possibly H5N1, could eventually mutate and cross the “species barrier.” It could then gain the ability to pass easily from person to person and perhaps lead to a dangerous global pandemic, they fear. The device would allow fast, on the spot screening, and especially important is the fact that it will be fully automated so there will be no requirement for a skilled person. The researchers are helping to develop two machines - a briefcase-sized version for use out in the field, and one about the size of a desktop computer for international border points, hospitals and GPs’ surgeries. The device will work by scanning swabs containing saliva or a tissue sample from birds or animals, and screening them for viral traces of influenza, the report said.

Health bodies to get details of citizens internet use The British government office has published a consultation paper, which considers making logs of all telephone calls and Internet usage, including e-mails mandatory for at least 12 months. The paper is in response to a European Parliament directive, issued in March 2006, on the “retention of data generated or processed in connection with the provision of publicly available electronic communications services/ networks.” In the UK, access to personal Internet and text data will be made available to all public bodies licensed under the 2000 Regulation of Investigatory Powers Act (RIPA), including health authorities, if the paper is approved.

These will only be accessed for investigations into crime or other threats to public safety. In health this includes checking for previous complaints relating to cruelty, abuse or self-harm. The Home Office said the measure will mean companies have to store “a billion incidents of data exchange a day”, and that as it derives from an EU directive, the data will be made available to public investigators across Europe.

Details of personal Internet and text traffic, but not the content, will have to be made available by telecommunications companies to public sector officials investigating crime, or to “protect the public.” It will also cover voice over Internet protocol calls, such as those made on Skype. The European Parliament has issued the directive as guidance and it is up to individual member states how they adopt these. The aim is to have regulations in place across the region by next year at the latest.

Version 3 of HL7 released Developer of global healthcare standards, Health Level Seven, has announced the release of Version 3 Normative Edition 2008, a globally defined suite of specifications based on HL7’s Reference Information Model. The suite provides a single source that allows implementers of Version 3 specifications to work with the set of messages, data types, and terminologies needed to build an implementation.

It assembles all of the HL7 Version 3 (V3) content approved as normative standards through the end of 2007, and includes standards for communications to document and manage the care and treatment of patients in a wide variety of healthcare settings.

Version 3 is currently being adopted to support large-scale integration, public health, decision support and research. Several countries have chosen the standard for their initiatives to create national electronic healthcare record and data exchange standard, as it provides a level of interoperability unavailable with previous versions.

Within the US, jurisdictional agencies needing support for large-scale integration, such as the centre for disease control and prevention have adopted V3. Significant V3 national implementations also exist in Canada, the United Kingdom, the Netherlands, Mexico, Germany and Croatia. HL7 say the suite allows implementers an opportunity to test specifications in real-life settings and then provide their feedback to be incorporated into the final published standard. The release also includes standards that address messaging and transport specifications, implementation technology specifications, administrative management and health and clinical management.

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Surviving Sepsis Septicemia (Sepsis) is the second leading cause of death in non-cardiac ICU with more than 750,000 patients developing Sepsis in North America and equal numbers in Europe. More than 162 patients die every day in Germany due to septicemia. In ICU, the death rate is around 50% inspite of active treatment.

S

epsis is usually treated in the intensive care unit with intravenous fluids and antibiotics. If fluid replacement is insufficient to maintain blood pressure, specific vasopressor drugs can be used. Thus, in order to ensure apt diagnosis, a patient suffering from Sepsis is to be constantly monitored. Patient monitors have to adhere to the Sepsis treatment guidelines in order to successfully monitor the patient.

Philips is the only company in the world, which has the Sepsis treatment guidelines at its bedside monitors. Philips also follows the Surviving Sepsis Campaign (SSC) guidelines.

Dr. Mitchell Levy, a world renown expert in Sepsis is also an authority in Surviving Sepsis Campaign. The Surviving Sepsis Campaign (SSC), an initiative of the European Society of Intensive Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine, has been developed to improve the management, diagnosis, and treatment of sepsis. The Campaign continues to expand efforts with guidance and support from these three bodies through ongoing collaboration of selected members of each society. The Institute for Healthcare Improvement has worked with campaign leadership to lend expertise in reinforcing the campaign as a quality improvement initiative. Dr. Levy, an active member of the Society of Critical Care, spoke at a conference organised by Philips in New Delhi, on “Reducing Mortality in Sepsis” to spread awareness about the protocols for treating 44

sepsis. During a discussion with eHEALTH, he highlighted the need for proper monitoring.

The SSC aims to reduce mortality from sepsis via a multipoint strategy, primarily: • Building awareness of sepsis • Improving diagnosis • Increasing the use of appropriate treatment • Educating healthcare professionals • Improving post-ICU care • Developing guidelines of care • Facilitating data collection for the purposes of audit and feedback Interview with Dr. Mitchell Levy Q. Kindly share whith us the vision behind the Surviving Sepsis Campaign?

A. I think the reason we are here and the reason what Philips is doing is so important is that the issue of sepsis cuts across all national boundaries. It is one of the most serious illnesses and killers in critical care. In the US alone there are 750,000 new cases of sepsis every year. In the US, more people die from sepsis in the ICU every year than from breast cancer, lung cancer and colon cancer combined. Part of what we’ve tried to do over the past 5 years is just simply raise awareness of sepsis. If you asked patients, ‘Do you know what breast cancer is”, they’d be offended. But if you say, “do you know www.ehealthonline.org

what sepsis is?”, even if it’s a family member, as likely as not, they would have no idea. And so it shows we just haven’t done a very good job in critical care, of making people aware of the problems we face with sepsis. I think the reason for that is, if you say “pneumonia, abdominal infection, burst appendix, gall bladder disease”, people understand that.

But ultimately what that is, is the bodies response to infection – and that’s what sepsis is. The body’s response when it gets infected. We just haven’t done a very good job in making the public aware of sepsis, yet it is so common. I think, that is in part because until 5-8 years ago, there really hasn’t been much we could do about it, other than antibiotics. But over the past 5 or 8 years, we have begun to see different interventions published in the literature that have been lifesaving. In addition to that, there is more evidence now that it’s not just antibiotics but how quickly you get them. We recently published some data which showed that for every hour of delay in getting appropriate antibiotics, there is an 8% higher chance of dying. It’s not just a matter of going to your physician, getting an antibiotic and then you get better, it’s about your physician being able to diagnose sepsis very quickly and acting on it very quickly. That, I think, is the key to why we’re having this meeting tonight and why we have this ‘Surviving Sepsis Campaign’ running.

It is a global effort, which has involved North America, Europe, Latin America, India and China, over the past 4-5 years. It’s goal has been to increase awareness of sepsis and encourage early diagnosis and treatment of this critical illness.

Q. What initiatives are being taken to create awareness about sepsis?

A. Over the last 5 years, we have done a number of educational programmes globally on defining sepsis. We had a consensus conference in 2001 to address what the definitions of sepsis are. We published that study in 2002. We have done a number of educational initiatives with books and pamphlets on diagnosing sepsis so that clinicians can understand what the definition is and how important it is to diagnose this early. And finally, we have started going directly to the public – to try and increase public awareness of sepsis so that people are maybe, a little more cautious than they used to be when they get a cough. In many cultures, India included, people don’t want to go to the doctor. Elders in the family often prescribe home remedies. That’s OK, but at certain times when the fever gets very high and when the patient starts having shaking chills, they actually have to go see a medical doctor. We have a number of initiatives to train physicians how to diagnose the illness early and act on it. Now we have some studies based on the approach I just mentioned, that have been published, that have demonstrated that when you take these educational materials and bring them to hospitals, you save lives.

About 4 months ago we published in the Journal of the American Medical Association the results of the study that we did in Spain, of some 40 hospitals. We were able to show that through just educational materials and heightened awareness, we decreased the mortality by 14% (a relative risk reduction).

October 2008

Dr. Mitchell M Levy speaks with eHEALTH on surviving Sepsis.

He is a world renowned expert in Sepsis and an authority on the Surviving Sepsis Campaign. He is also an active member of the Society of Critical Care Medicine.

Q. Was this because treatment was started earlier or was it because it was the right kind of treatment?

A. I think it is a combination of both. I don’t think you can separate those two. The right kind of treatment is an earlier kind of treatment. The whole point of the Surviving Sepsis Campaign is that there are two bundles or groupings of therapies that are done together. The first bundle is one that’s done immediately after you walk in the door of the hospital and is finished at the end of 6 hours. And the second bundle is finished at the end of 72 hours. So it gives you an idea that it is not just about doing the right thing, it’s about doing the right thing in time. There’s no question, and we have data published that shows that the longer you wait, the less likely you are to help people survive. So the key is 2 things – doing it right and doing it quickly.

And that’s honestly where the monitoring comes in. It’s not hard to understand that if the goal of the Surviving Sepsis Campaign is to improve survival, and to take things that you know work, diagnose people quickly, and do them in a timely way, then the challenge is “How do we know?”

There are a number of tools where you can imagine that if people are attached to these kind of monitors anyway in the emergency department, that if those monitors that are just monitoring your heart rate, your blood pressure, how fast you breathe, what your temperature is - if they could just become smart monitors and say “hey, your patient has a fever, your patients heart rate is pretty fast, and they’re breathing very quickly, why don’t you think about sepsis?” That is the next step in monitoring. It is to remind clinicians of possible risks. As busy clinicians, sometimes you can’t think of everything all the time and prompts, especially computerised prompts, can really be helpful. We thought that if we could get clinicians to apply the right therapies at the bedside more quickly, we would save lives. That was 4-5 years ago. The gratifying thing for us is that having put forward that hypothesis, we now have data being published in high-level peer reviewed literature that says “yes, it’s true. If you follow these protocols, more people survive.”

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ZOOM IN

Moving On..

The worlds largest spender on healthcare has decided to adopt ICD-10 codes. What does this mean for the healthcare community?

“The nicest thing about standards is that there are so many of them to choose from.” Ken Olsen, founder of Digital Equipment Corp., 1977

I

n August, the US government Department of Health and Human Services (HHS) announced that the currently used International Statistical Classification of Diseases and Related Health Problems 9th Revision-Clinical Modification (ICD 9-CM) will be replaced by the ICD-10-CM and ICD-10-PCS (Procedure coding System) codes. The proposal was welcomed by stakeholders in healthcare worldwide. The ICD-10 code sets are scheduled to take effect in the US in October, 2011. According to Mike Leavitt, Secretary of HHS, “The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay-for-performance, bio-surveillance, and other critical activities. Conversion to ICD-10 is essential to development of a nationwide electronic health information environment, and the updated X12 transaction standards are a critical step in the implementation of these new codes.”

The US has lagged behind in the adoption of ICD-10 as it was only in 1988 that the country adopted ICD-9 standards.

The Center for Medicare and Medicaid Services also proposed a rule to migrate to Version 5010 of the Health Insurance Portability and Accountability Act (HIPAA) transaction sets, and Version D.0 of the National Council for Prescription Drug Programs’ standards. The switch to ICD-10 codes is required since the updated versions of the 1996 HIPAA, which lays down standards for electronic transaction in the medical field, use them. ICD-10 impacts HIPAA in the areas of claims, remittance advice, eligibility inquiries, referral authorisation, and other widely used transactions.

The rationale of the US HHS behind the upgradation is: • ICD-9 is outdated, with only a limited ability to accommodate new procedures and diagnoses.

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• • • •

ICD-9 lacks the precision needed for a number of emerging uses (for example, pay-for-performance and biosurveillance).

ICD-9 limits the precision of diagnosis-related groups (DRGs) as a result of very different procedures being grouped together in one code.

ICD-9 lacks specificity and detail, uses terminology inconsistently, cannot capture new technology, and lacks codes for preventive services.

ICD-9 will eventually run out of space, particularly for procedure codes.

Adoption of the ICD-10 code sets are expected to: • Support value-based purchasing by accurately defining services and providing specific diagnosis and treatment information, such as identifying cases of MRSA and other specific conditions, and would further Medicare’s ability to detect and prevent program abuse.

• Support comprehensive reporting of quality data.

• Ensure more accurate payments for new procedures, fewer rejected claims, improved disease management, and harmonisation of disease monitoring and reporting worldwide.

• Allow the United States to compare its data with international data to track the incidence and spread of disease and treatment outcomes because the United States is one of the few developed countries not using ICD-10.

This said, ICD-10 has not been without criticism from some quarters. For example it does not highlight the mechanism of injury. The failure to produce mutually exclusive codes presents problems for determining the incidence of drowning events. It also differentiates between Asperger www.ehealthonline.org

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Syndrome and Autism almost solely on the basis of onset criteria.

The Blue Cross and Blue Shield Association (BCBSA) has issues with the timeline for moving to ICD-10 and Version 5010 standards. It believes that the notice period is too short and will lead to a ‘major meltdown’ among providers. They allege that the impact will include delayed provider and consumer payments, less ability to detect fraud and abuse, and higher IT costs due to the short deadline. BCBSA’s stand is backed by the National Committee for Vital and Health Statistics (NCVHS), which officially advises HHS on HIPAA matters. The American Medical Association and America’s Health Insurance Plans (AHIP) have also disapproved of the two-year switchover period.

The move from ICD-9 to ICD-10 will be expensive for the US. 95% of medical practitioners will have to purchase new Practise Management Systems or upgrade their existing ones. About two-thirds of practitioners will also need to buy code selection software in addition. ICD-9 has 17,000 codes whereas ICD-10 has over 155,000. HHS admits that the switch - like the NPI cutover - could initially cause significant cash flow problems for providers because of the increased risk of payment hold-ups due to coding and systems problems. HHS is predicting that claims-error rates will rise between 6 and 10% of all claims at the ICD-10 implementation date, up from a normal 3% rate typically seen for annual updates of ICD-9.

ICD is a precursor to the widespread use of electronic health records. There may be a need to expand the level of detail of classification entities by linking them to standard description of signs, symptoms and other descriptors of illness.

These are being formally developed over the world as standard terminologies. The revision process should proactively define the linkage between terminologies (e.g. SNOMED-CT and other terminologies) and the ICD-11. The WHO believes that following the approval of the International Classification of Functioning Disability and Health (ICF) by the World Health Assembly as a WHO’s international framework to describe and report health and disability, there is a need to align ICD codes and their definitions with the ICF, and review their joint use as WHO reference classifications for public health purposes. According to a WHO collaborative study, the most common ICD-9 categories of diagnoses were depressive disorders, anxiety disorders, alcohol use disorders, and somatoform disorders.

What is ICD-10?

ICD-10 is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organisation (WHO). This latest standard was ready in 1992 after nine years of work.

A downloadable version of ICD-10, second edition and a CD-ROM version, is available from the WHO e-commerce web site at http://bookorders.who.int/ bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&c odcol=15&codcch=4592# .

Is ICD-10 uniform across the world?

No. Several countries have their own versions of the ICD10 standard. Australia, Canada and Germany have all made modifications to the WHO standard. Modifications require the permission of the WHO. What is Version 5010?

The updated version of the health care transactions standard would replace Version 4010/4010A1. The new version, Version 5010, includes structural, front matter, technical, and data content improvements. Since the updated versions are more specific in requiring the data that is needed, collected, and transmitted in a transaction, their adoption would reduce ambiguities. Version 5010 would also address a variety of currently unmet business needs, including, for example, providing on institutional demand an indicator of conditions that were “present on admission.” Version 5010 would also accommodate the use of the International Classification of Diseases, Tenth Revision (ICD-10) code sets, which are not supported by Version 4010/4010A1.

What’s next?

To keep the scientific currency and public health utility of the classifications, ICD is scheduled for 10 yearly periodic revisions and annual updates in line with the recommendations of the governing bodies of the WHO. Certain areas such as oncology, mental and addictive disorders, internal medicine, and external causes of injury have been identified by the WHO-FIC Network as main foci of the update and revision process. Work on ICD-11 has already begun. The first draft is expected to be ready in 2010 and is scheduled to be published about four years later.

Who influences the framing of ICD codes?

An update and revision process has been prepared by the WHO involving all stakeholders. The ICD-11draft is envisaged as a Joint-Authoring Tool much like the online encyclopeadia www.wikipedia.org.

Disease Virus 48

Anyone can participate in the process. Just register at http://extranet.who. int/icdrevision/nr/login.aspx?ReturnUrl=/icdrevision/Default.aspx and follow the guidelines to post proposals or comments. ICD-9 and ICD-10 regulations may be viewed at: www.cms.hhs.gov/TransactionCodeSetsStands/02_ TransactionsandCodeSetsRegulations.asp#TopOfPage. www.ehealthonline.org

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EVENT REPORT

2nd GE Healthcare

Early Health Media Summit

25-26 September 2008, Bangalore

T

he age old wisdom about healthcare says – ‘prevention is better than cure’. While this notion is universally true, complexity in nature of diseases and dynamic unpredictability in their occurrence pattern are on a steady rise across the world. In such a situation, (while simultaneously factoring the rising cost for availing and provisioning healthcare services) early disease diagnosis and preventive healthcare practices are proving to be far more economical and socially responsive.

With this view, GE Healthcare (the USD 17 billion healthcare business of General Electric Company) has been working diligently for over the last few decades to bring technological innovations that can leverage early diagnosis of life threatening diseases and also develop low-cost, high quality medical devices that can substantially bring down healthcare costs around the world.

In order to showcase the latest healthcare innovations happening at GE and create a platform for knowledge exchange and experience sharing among senior leadership of the company and people from different media houses, GE Healthcare recently hosted its second annual ‘Early Health Media Summit’ between 25-26 September 2008 at the silicon valley of India.. Bangalore.

The event began with a pre-conference half day visit to the John F. Welch Technology Centre (JFWTC) and X-Ray manufacturing unit of GE, located in the Whitefield area in outskirts of Bangalore. This USD 120 million technology centre of GE is truly a place of distinction… notably the biggest R&D facility of the company outside the US, employing nearly 3500 scientists and engineers, working on a wide range of technologies covering healthcare, bio-medical engineering, aviation, electronics, molecular modeling, materials research, engineering analysis, MEMS to name a few.

The facility tour guided by Mr. Ashish Shah, General Manager, Global Technology Organisation-India, JFWTC was one of awe and all inspiring. Emphasizing the tremendous contribution of the centre in leveraging GE’s global businesses, Mr. Shah said, “innovation is at the heart of GE and this centre, and that is what makes this place unique in its own way”. Talking about low cost healthcare innovations that have come out of the centre, Mr. Shah showcased the MAC 300 & 400 portable ECG machines, which are entirely designed, manufactured and distributed from India…having features like high quality algorithm, embedSeptember 2008

ded display screen (for MAC 400), extended battery life (100 ECGs on full charge), in-built micro printer, USB and telephonic interface ports… all of this at one-third of standard ECG machines! Another notable instance, in the field of high technology work at this centre is the development and manufacturing of the highly sophisticated full suite Cath Lab machine. Developed, designed and manufactured completely at the Bangalore facility, this is known to be among the most advanced Cath Labs in the world, with an amazingly powerful and high precision table positioner having an adjustable limit of up to 120 microns – a true demonstration of the technological prowess of this centre. The subsequent visit to X-ray manufacturing unit (located adjacent to JFWTC) proved to be another testimonial for the ingenuity and excellence achieved by GE in indigenous production of medical grade X-ray equipments. The level of technological sophistication, operational efficiency, advanced production techniques and global sourcing strategies implemented at the facility becomes evident as one takes a guided tour of the plant. Clockwork precision while maintaining highest quality standards are the fundamental work ethics followed at each and every department of the production unit – to put into perspective, the recent release of the ‘Tejas XR 6000’ fully digital compatible X-ray machine of GE (under it’s ‘in India, for India’ initiative) is a product of this facility.

The second day of the event was earmarked for a full day conferencing, dotted with power packed presentations by senior GE executives and insightful panel discussions comprising eminent people from the government, private healthcare providers and non-profit community health organisations who are working in partnership with GE on various health programs.

The opening address by V. Raja, President & CEO, GE Healthcare, South Asia was an extremely insightful deliberation, providing a comprehensive vision of GE for continuously investing and innovating cutting-edge technologies in early health diagnosis. Sharing a couple of his own personal experiences regarding fatal implications of the lack of early disease diagnosis technologies, Mr. Raja mournfully mentioned the loss of his beloved cousin sister and elder brother whom he lost way back in his childhood. Highlighting the dire need for making healthcare affordable for masses, he emphasized the fact that India still has more than 700 million people living at less than US$ 2 per day of earning. Adding to this, he underlined the fact public health expenditure in India is currently dismally low… “India is currently spending 49

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more on fossil fuels and external credit interest than that on healthcare” said Mr. Raja. Urging the government to channelise bigger allocation to healthcare he added, “healthcare spending should be seen as investment and not as expenditure, since health of the nation is one of the biggest asset for any country”. In this context, Mr. Raja highlighted the efforts of GE Healthcare in bringing indigenously produced, low cost, high quality diagnostic devices through its ‘in India, for India’ initiative. Some of the notable achievements in this direction are the launch of portable ECG machines, portable ultrasound devices, digital X-rays and Cath Lab equipments in the Indian market.

While combating communicable diseases occupy a high priority in public health expenditure, non-communicable diseases (NCDs) do not generally get an appropriate attention. Speaking on this topic Dr. Ali Mehdi, Research Associate, Indian Council for Research on International Economic Research (ICRIER) commented on the widespread prevalence of NCDs, while bringing out the revelation (contrary to conventional belief) about its increasing occurrence pattern in rural areas as well. In this context, he reiterated the over-riding need for low cost diagnostic devices like those brought out by GE and its potential to make early healthcare affordable and accessible.

Presenting on the role of clinical imaging in paediatric cardiology, Dr. Sunitha Maheshwari from Narayana Hrudalaya, Bangalore, emphatically spoke about the revolutionary advancement in cardiology imaging technologies and the tremendous benefit rendered therein upon doctors. Reflecting on the increasing cost for healthcare services, she praised companies like GE for investing heavily on imaging and diagnostic technologies that is sure to reduce the financial burden on consumers by avoiding wasteful treatments and medical procedures. Moreover, she remarked, that imaging technologies are definitely going to bring a high degree of efficiency in healthcare services. Similar perspectives were also brought out by Dr. Raghuram Ushalakshmi of KIMS Hospital, Hyderabad who spoke eloquently about his work at the Centre for Breast Diseases at KIMS and how diagnostic imaging is making early cancer detection and cure a possibility in the present day.

Probably, the most advanced form of imaging technology application is ‘molecular imaging’. In his highly insightful presentation, Dr. Jean Luc Vanderheyden, Molecular Imaging Leader in GE Healthcare showcased the fine art and intriguing science of this cutting edge realm of technology, which is taking healthcare into the next level. The potential with MI to study and understand real time activity of cellular and sub-cellular components is revolutionising traditional medicine. Custom made bio-molecules for targeted treatment of specific ailment in the human body and tailored drugs for individual patients depending on their biological or genetic make-up are a possibility with MI. Dr. Jean asserts his high hopes that GE will soon emerge as the global leader in MI technologies.

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Bringing focus on public private partnership (PPP) models and scrutinizing opportunities and challenges thereof to make it a viable mechanism to spread healthcare benefits to the masses, the panel discussion titled - ‘Driving Healthcare Access to all through PPP’ was apt and appropriate, particularly with an impressive line-up of panelists comprising – Chandra Iyengar, Addl. Chief Secretary, Public Health & Family Welfare, Govt. of Maharashtra; Madan Mohan Upadhyay, Principal Secretary, Govt. of Madhya Pradesh; Dr. H Sudarshan, Hon. Secretary, Karuna Trust & Chairman, Task Force on PPP, NRHM, Govt. of India; Dr. Sunitha Maheshwari, Paediatric Cardiologist & HOD, Narayana Hrudalaya; Ashok Kakkar, VP-Government Relations, GE Healthcare.

The hour long discussion of panel members and an active participation from the floor fructified into a list of recommendations for the PPP initiatives in healthcare. Some of these are – better participatory partnership models with accountability and evaluation mechanisms, enhanced focus on scalability and replicability of projects across governments and geographies, unambiguity in communicating benefits to stakeholders and beneficiaries, respecting and recognizing the contribution of private players.

Talking about technology in healthcare is almost incomplete without mention of IT and communication technologies. Thus, the presentation of Clarence Wu, VP & GM, IT Solutions, GE Healthcare (Asia-Pacific) was an appropriate placement to give the proceedings a right mix. Highlighting the topic of Digital Imaging and Integration of Health Information, Clarence spoke at length about the ‘Centricity’ suite of solution from GE that can provide healthcare organisations with a robust, scalable and interoperable IT environment for seamless care and efficient workflow. Bringing a user perspective into this realm of Health IT, Dr. H K V Narayan, Medical Superintendent, Tata Memorial Hospital shared his experience in implementing a highly successful IT-based work environment at his facility, and reassured about the range of benefits accrued through increased efficiency gains, quality controls and cost savings in the long run.

A series of insightful presentations followed from some of the prominent partners of GE Healthcare with contributions from Dr. Kishore Kumar, Director, Cradle; R Basil, MD & CEO, Manipal Health Systems; Dr. S S Ramesh, Cardiologist, Vivus Group of Hospitals and Dr. Padmanabha Reddy, NICE Foundation. Each one of them are trying in their own ways to maximise the reach of healthcare to the rural masses and help them to get access to diagnostic and curative medical service. While, Cradle is working for maternal infant care, Manipal Health is spreading health services through their rural extension centres. While Vivus is offering low cost cardiac care in rural Karnataka through their mobile heart unit, NICE Foundation is offering a helping hand for rural poor through their village health programs.

Overall, one must admit, that the summit proved to be a fantastic display of the hope for a healthy India!

www.ehealthonline.org

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EXPERT CORNER

The Other Side of

Health IT Solutions An insightful look into the real challenges IT Admins face after implementing IT systems in healthcare institutions.

Devesh Rajadhyax Director and Solution Architect 21st Century Health Management Solutions

What is the other side?

We live in exciting times. Every hospital worth its salt is either implementing a new IT system or thinking of it for the next year. Each moment somewhere, one or the other software is being evaluated. The side of software that we all see is of course the functionality.

Debates arise over small points in functionality of software. But the side that is seldom seen, and one which hides the key to how successful the system will be are the implicit qualities of the software (and hardware) that you are going to acquire, such as performance, manageability, interoperability and so on. I will in this article discuss this, with very little or no technical details.

This article is for If you are the CIO/CTO of a hospiSeptember 2008

tal, this article is for you. You must be familiar with the ideas discussed here, but there are some interesting points related to ‘Healthcare’ IT. You are not the CIO, but your hospital is planning to implement new IT systems or to change existing IT systems, and you are the informed decision maker, who likes to know things yourself, then this article is for you.

You have been (miraculously) identified as the person who is supposed to advise on the new IT systems of your hospital, and you want to know where to begin, you would like to read this stuff.

And lastly, if you are planning to make a new Healthcare IT system (my best wishes), you would like to consider the issues highlighted in this article.

Background I am going to discuss many problems and issues, which are specific to the healthcare industry. Speaking about India (and other such countries), we work with several limitations. It is often difficult to put together a good IT team. Many IT professionals do not consider a hospital as their long-term destination. The team changes very often. Many hospitals have to do with IT staff who are upgraded from the rank, rather than certified professionals.

Some of the points that I write about have to be seen with this in mind.

India is going through a phase where earlier basic systems are being replaced by new generation systems.

But the IT infrastructure, especially the desktops and network is not always revamped. This also poses certain challenges that are discussed here.

Another effect of this transient phase is that a hospital has some systems that are sophisticated and some older systems that continue because they are not easily replaceable. Issues of interoperability usually revolve around this situation.

With this background in mind, let me turn to the other side of IT systems.

Performance Just like the Black Holes, Near Death Experiences and Team Spirit, Performance is always talked about but rarely experienced. Every system that you have bought was supposed to be high performance, but users have always complained that the system is SLOW. Performance, almost as a rule, is measured as Time. It may be the time to make one patient bill, the time to show one x-ray image or it may be the time to start the reporting system.

There is no benchmark for the right performance. It depends entirely on the use of the system. On the registration desk, where patients are waiting, you will need a quick response from the system; whereas while preparing the monthly bill of your corporate client, a more unhurried response can be tolerated.

Of course, you would like to have 51

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The response depends upon the infrastructure that you have.

Some software are designed to work with lower system configurations, whereas some assume availability of high end infrastructure.

a nanosecond response everywhere, but as you would have guessed, there is compromise involved here. Generally, if you are looking for more facilities for the user, it will have a lower performance, than the systems which are bang on target and do very specific things. This is the reason why your old B & W Nokia phones may be much faster than the new PDAs. Also, better response sadly means more investment in state-of-the-art hardware.

The next important thing is, the response depends upon the infrastructure that you have. Some software are designed to work with lower system configurations, whereas some assume availability of high end infrastructure.

Both approaches have pros and cons, but you have to decide which is the right system for you. If you have a legacy 1990’s network which is difficult to change, you should make sure that the new Imaging Systems / PACS you are buying takes this into consideration.

Now, what is regularly ignored about performance is that performance goes down with time. As the system takes in more and more data, it slows down. Many of you must have seen that the billing system, which was once blazing fast, is no longer winning the 100 m sprint now. It is especially the custom-made systems that suffer from this syndrome, as they are made, put in place and accepted because their performance seems very good. Older, established software products normally go through this in their first few implementations and so are more reliable.

Manageability Remember what I mentioned in the Background? It is often difficult to find competent Hospital IT Administrator.

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Most IT Administrators who have seen the system from childhood-that is, from implementation-are familiar with the whims and fancies of the system. In fact, many veteran Admins know more about the system than the techies in the company that made the system! But, when the IT administration changes hands, it is hell all over again.

The systems that are manageable, behave like an old and docile dog.

Configuring such a system means something as routine and unchallenging as this:  read the administrators manual  open the system and find the SAME screen as in manual  change the setting  sit back and see that the change is effective Some systems do not allow others to master them so easily. To change something, the admin may have to:  Speak to someone old and senior in the system provider organisation  Open database  Change, delete, create files  Restart various computers  And so on…

Such systems are not manageable.

Manageable systems are well documented. The documentation corresponds to the software deployed, and when software is updated, the documentation is updated too!

Manageable systems are possible to manage mostly from one place, and sometimes even from a remote place.

The systems that require you to ‘come down and see for yourself’ do not fall in the ‘Ten Most Liked Systems’ of the sys admins.

Traceability IT systems are like families. They remain in good shape in the same way, but each one breaks down in its own fashion (to modify slightly what Leo Tolstoy said in Anna Karenina). The trouble is that, it becomes impossible to say whether something has gone wrong or it has not happened. For example, take your mail system. If you do not get a mail, there may not be

any mail, or there is some trouble with your mailbox. Traceable systems alert the admins quickly when some part of the system is not working properly.

Take another example, the OPD clerk prepares a pharmacy request, but for some reasons it does not get stored.

Now the pharmacy cannot see the request, but the pharmacist is not going to suspect anything, since s/he does not KNOW that there is a request! The system should detect such events and notify the admin that the system is behaving badly.

Traceability also means that it should be possible to find out where things are going wrong. Traceable systems allow the admin to put the system in troubleshooting mode, so that various logs are generated, which help in tracking down the problem.

Interoperability A health institution goes on acquiring IT systems as it grows. Usually the billing and account systems are the first, then come the administrative systems such as HIS and RIS; later the clinical systems like PACS and EMR are installed. To make some sense out of this maze, the systems need to talk to each other. Healthcare has been blessed with many standards such as HL7 and DICOM, and it is the job of experts to understand and apply these standards. But what really matters is whether careful consideration has been given to exchanging data with other systems when the system is designed.

Interestingly, when two or more systems are interfaced, the importance of Traceability increases many times.

Something may go wrong in one system, while the other system carries on as if nothing were wrong. With sound traceable systems, such disasters can be detected in time and corrected.

In closing I hope that this article gives you a new angle to look at the IT systems being planned for your hospital. A little attention paid to these details during planning can go a long way towards ensuring many years of smooth functioning of the systems. www.ehealthonline.org

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NUMBERS

Poor environmental quality is directly responsible for around of all preventable ill health in the world today.

25% 1.5%

A mid-sized hospital in India spends less than of its turnover on IT.

15.12

million medical tourists visited Thailand in 2006.

Health insurance was introduced in India in

By 2025, 65% of American will be above

54

65

1986

years of age.

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spot the BIG opportunity... watch out for special articles, interviews, news round-up and industry updates in the ANNUAL SPECIAL ISSUE - January 2009.

For advertising enquiries contact Arpan Dasgupta (arpan@ehealthonline.org, +91- 9911960753)

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EVENTS DIARY

11-13 November 2008 eHEALTH Asia 2008 13 - 14 October, 2008 3rd Annual Global Healthcare Expansion Congress Dubai, UAE http://www.healthcareexpansion.com

14 - 16 October, 2008 Medical Tourism Congress India India http://www.informedia-india.com/

23 - 24 October, 2008 2nd Intl Conf-Telemedicine: Myths and Reality Lviv, Ukraine http://www.telemed.net.ua/

24 - 28 October 2008 12th Asian Oceanian Congress of Radiology Seoul, Korea http://www.aocr2008.org/

29 - 31 October 2008 Healthcare Operations

KLCC, Kula Lumpur Malaysia

17 - 19 December 2008 International Meet on Integrated Health Social and Economic Impacts of Extreme Events New Delhi, India

http://www.e-asia.org/2008/ehealth/

http://events.du.ac.in/

14 - 17 November 2008 4th National Conference of Telemedicine

9 - 11 January 2009 Medical Technology India 2009

PGIMER, Chandigarh, India

http://www.medicaltechnologyexpo.com/site/in-

meenusingh4@rediffmail.com

dex.html

16 - 18 November 2008 Healthcare IT Summit

7 – 11 January 2009 62nd Annual Conference of Indian Radiological & Imaging Association ‘09

San Diego CA United States of America

New Delhi, India

Patna, Bihar www.iria2009.com

http://www.healthcareitsummit.com/us/

18 - 20 November 2008 Net Health Asia 2008

12 – 13 February 2008 Map World Forum

Shanghai, China

Hyderabad India

www.nethealthasia.com

www.mapworldforum.org/2009/conference/gsi. htm

19 - 21 November 2008 International Medical Travel Conference 2008

21 - 23 February 2009 Meditec Clinika 09

Seoul, Korea

Hyderabad, India

Singapore

http://www.medicaltravelconference.com/index.

http://www.meditec-clinika.com

https://www.ibc-asia.com/healthcare

php

1 - 4 November 2008 Seminar on PACS Administration

21 - 22 November 2008 2008 BPC World

Dubai, United Arab Emirates

Mumbai, India

www.otechimg.com

http://www.bp-council.org/

4 - 6 November 2008 World of Health IT

27 - 28 November 2008 Strategic Healthcare Management

Copenhagen, Denmark

Mumbai, India

Kuala Lumpur Malaysia

http://worldofhealthit.org/

http://www.marcusevans.com/

http://himssasiapac.org/

10 - 14 November 2008 3rd Annual International Medical Travel Conference (IMTC)

5 - 7 December 2008 Medifest ‘08

27 – 29 March, 2009 Medical Fair India

Seoul, Korea

Pragati Maidan New Delhi, India

New Delhi India

http://www.medicaltravelconference.com/

http://www.vantagemedifest.com/

http://www.mdna.com/shows/medfairindia.html

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23 – 26 February 2009 Global Healthcare 09 Singapore http://www.magenta-global.com.sg/healthcare/

24 - 27 February 2009 HIMSS AsiaPac 2009

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