LABORATORY INFORMATION SYSTEMS -OPPORTUNITIES IN APAC: September 2007 Issue

V O L U M E 2 | I SSUE 9 | SE PTE MBER 2007

ISSN 0973-8959

A MONTHLY MAGAZINE ON ICT AND HEALTH

COVER STORY

LABORATORY INFORMATION SYSTEMS - OPPORTUNITIES IN APAC TECHNOLOGY TRENDS

POCKET ELECTRONIC HEALTH DIARY DEVELOPMENT DIMENSION

Rs. 75

LABORATORY INFORMATION SYSTEMS OPPORTUNITIES IN APAC

e-CHOUPAL - DELIVERING RURAL HEALTHCARE SERVICES SPOTLIGHT

AN INITIATIVE TOWARDS AFFORDABLE SURVEILLANCE PERSPECTIVE

e-HEALTH 2.0 : OPPORTUNITIES FOR PUBLIC HEALTH INFORMATION NEWS REVIEW

WORLD NEWS BUSINESS NEWS INDIA NEWS

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w w w . e h e a l t h o n l i n e . o r g | volume 2 | issue 9 | september 2007

COVER STORY

Laboratory Information Systems - Opportunities in APAC

A Frost and Sullivan Market Insight

TECHNOLOGY TRENDS

Pocket Electronic Health Diary

Dr Shabbir Syed Abdul

DEVELOPMENT DIMENSION

e-Choupal - Delivering Rural Healthcare Services

Dr Pankaj Trivedi and Mukti Bapna

SPOTLIGHT

An Initiative Towards Affordable Surveillance

Adele Waugaman

PERSPECTIVE

e-Health 2.0 : Opportunities for Public Health Informatics

Susheel Oommen John

EVENT REPORT

eHealth India 2007 31 July - 2 August 2007, Hotel Taj Palace, New Delhi

NEWS REVIEW

INDIA UPDATE

BUSINESS NEWS

WORLD NEWS

PRODUCT PROFILE

EVENTS DIARY

30 September 2007

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

Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to eHealth projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians. We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: ARTICLES/ CASE STUDIES should not exceed 2500 words. For book reviews and event reports, the word limit is 800. AN ABSTRACT of the article/case study not exceeding 200 words should be submitted along with the article/case study. ALL ARTICLES/ CASE STUDIES should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far. BOOK REVIEWS should include details of the book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the

book in JPEG/TIFF (resolution 300 dpi). Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable. In the case of website, provide the URL. THE MANUSCRIPTS should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post. RELEVANT FIGURES of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format. A BRIEF BIO-DATA and passport size photograph(s) of the author(s) must be enclosed.

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

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Volume 2 | Issue 9 | September 2007

PRESIDENT

EDITORIAL Health needs the right dose of IT

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ffective deployment of technology requires efficient as well as intelligent use of it, especially in the domain of healthcare, where the level of complexity is a good few degrees higher many other disciplines. ‘Information’ is the cornerstone of the healthcare industry, and the most vital component for ‘decision-support-systems’ of practitioners and service providers. While specialty healthcare centres are concentrated in urban centres, there is a gaping need and untapped potential along rusty roads as well – thankfully, telecommunications is there to travel that last mile for us. These and many more were the key issues that came up over the two days of conferencing at ‘eHealth India 2007’, (held within eINDIA 2007 ICT conference and exhibition) from July 31-August 3, 2007 at the Taj Palace Hotel, New Delhi. We present you with a detailed event report inside this issue - update yourself if you missed it ..and even if you were there, have a look again, you might find your candid moment in our photo gallery. Laboratories constitute the core operational component of any specialty hospital set up. Often, they are the most humongous generators of data and information, providing the most crucial input for doctors to decide on the course of patient treatment. With increased adoption of process automation in hospitals, the demand and market potential for laboratory information systems (LIS) is growing over the years. The cover story of this issue presents a Frost & Sullivan Insight article on market opportunities for LIS in the Asia Pacific and discusses critical factors for its implementation success. In addition, we also bring you some interesting articles from both domestic and international front focusing on a range of topics. Under ‘Technology Trends’ we cover an article on personal hand-held devices (PeHD) and intelligent use of web 2.0 for healthcare (health 2.0); while in ‘Development Dimensions’ we feature one of the most successful corporate initiatives in rural India – that of rural healthcare delivery through ITC’s e-choupal network. Collection of data is an essential first step to revolutionizing healthcare as seen in this month’s Spotlight Section, where we profile a joint project of United Nations Foundation and Vodafone in African countries of Kenya and Zambia. Before signing off, it is my pleasure to inform you that starting September issue we are introducing two new sections to our magazine - ‘Product Profile’ and ‘Events Diary’. While the former will feature latest medico-healthcare equipments, gadgets and devices, the latter will be a ready reckoner for healthcare events and expositions in India and around the world.

is published by Elets Technomedia Pvt. Ltd. In technical collaboration with: Centre for Science, Development and Media Studies (CSDMS, www.csdms.in) © Elets Technomedia Pvt. Ltd. www.elets.in

Ravi Gupta Ravi.Gupta@elets.in

September 2007

COVER STORY

Laboratory Information Systems - Opportunities in APAC Laboratory Information Systems (LIS) is a suite of software applications that help manage the daily operations of a laboratory, ensuring better control and management of resources. This article looks at the LIS market in Asia Paciﬁc as well as the factors of successful LIS implementations.

LABORATORY INFORMATION SYSTEM

Laboratory Information System or LIS is a suite of software applications that helps to manage the daily operations/ workflow of a laboratory. Accounted for as one of the largest capital expenditure in any diagnostic laboratory, a successful LIS implementation not only ensures effective control and management of resources but also offers the following benefits: • Increase in productivity - Faster turnaround time for results • Process large quantities of specimens safely and efficiently • Greater data accuracy - Faster data validation • Reduces instances of lost or misplaced specimens • Reporting and Statistics - Ensures billing accuracy • Ability to track and audit data on any course of events • Provides workload and statistical reports The typical components of a LIS may be depicted as below:

CONNECTION TO THE HIS AND EMR

While the LIS plays an important role in ensuring accurate laboratory results, it does not work alone; patients’ test results/reports are usually interfaced to the Electronic Medical Records (EMR) to ensure that clinicians can get access to updated/ complete test results. Together with patients’ results gathered from other departments (e.g. Radiology), the EMR enables the clinician to obtain a comprehensive overview of patients’ medical histories. This greatly enhances the clinical decision-making process and ultimately helps to deliver better patient care. In addition to vendors that specialize 6

only in LIS solutions, there is also rising competition in the market from; Total Hospital Information System (THIS) vendors Touted as a ‘one-stop service provider’, THIS is a convenient solution for full hospital overhaul. However, LIS modules from such total solutions sometimes lack in features and Flexibility. In Vitro Diagnostics (IVD) vendors Some IVD vendors offer their own LIS solutions which are bundled with their instruments. Although limited in features, such LIS can be economically attractive at the onset (IVD vendors offer price advantage through re- agent bundlinkg.)

THE SECRET TO SUCCESS - THE IMPLEMENTATION PROCESS

While most solution providers have kept pace with technology (e.g. offering Web-based platforms) the core functionality required by diagnostics laboratories have remained much the same over time.

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This has resulted in most commercial LIS providing solutions with very similar functionalities. Facing intense competition, LIS vendors have realized that the only way to stand out from the crowd is to be focused in the implementation phase of a LIS and ensure that their customers reap the maximum financial and clinical benefits while enjoying a high level of end-user satisfaction.

ENTER THE LIS ADMINISTRATOR

The LIS Administrator is often a laboratory technician who plays the role of the “implementation lead” or commonly known as the “process champion”. This is an important role in the rollout of a LIS implementation as the LIS Administrator has to ensure that process flow (workflow) of the laboratory is mapped correctly. No two laboratories share the exact same workflow; while similarities may exist, each laboratory has its unique requirements and its way of doing things which are influenced by work culture and management style. Hence the LIS administrator plays an important role in ensuring that the vendor has implemented the correct business logic / workflow that for the facility. The LIS administrator also plays the role of an educator, creating awareness amongst the end-users about the benefits of the LIS as part of the change management process.

THE IMPLEMENTATION JOURNEY -PITFALLS TO AVOID

Depending on the scope of the project, implementation can take anywhere from a month to a few years; therefore it is vital that the vendor is chosen correctly as the choice of

September 2007

partnership can make or break the success of the LIS implementation. One of the most important factors includes having the LIS vendor understand the local culture and work processes. Having said that, while a strong network of local support is important, some facilities fall into a situation where they engage small local startup (consisting perhaps of 1-2 developers) to develop a customized LIS. While the final solution might fit like a glove, it may not be the right ‘way’ to do things as the developer might not know the compliance regulations or international standards required. A worst-case scenario that frequently occurs is when the local startup/vendor folds up after a few years, leaving the hospital with a non-supported/non-evolving LIS. In addition to having good local support and infrastructure, it is also important for bigger or international LIS vendors to have a R&D arm that constantly ensures that their solutions consistently evolve to follow the need/growth of the medical facility even after implementation. This is particularly important in ensuring that the investment in their LIS is maximized. While there is no magical formula to ensure that the potential vendor has the capability to fulfill all of the above, it may be wise to ask for reference sites and speak with existing users to share their experiences. • Does the potential LIS vendor ‘listen’ to their customers and anticipate to changes? • Has the implemented LIS met the needs of the facility? • Has the potential vendor proven their after sales support capabilities?

ADOPTION IN ASIA PACIFIC

While demand for LIS is relatively low in countries which are advanced adopters of healthcare IT (e.g. South Korea, Japan and Singapore) the potential is huge in the large and upper

“80% of the functions found in commercial LIS are similar, the key differences lies on how it is implemented.” Mr. Lee Kok Keong, Founder,

LABORATORY INFORMATION SYSTEMS - OPPORTUNITIES IN APAC

COVER STORY

COMPANY FOCUS Wipro HIRePS - Laboratory Information System Wipro HIRePS - Laboratory Information System is a stand-alone application that provides an integrated and comprehensive solution for performing and reporting tests. This application facilitates the workflow management including displaying and printing various test requisitions received from wards (ICUs, OT, Emergency, etc.), out patients and other hospitals. It enables online display of the status of the samples, test results, report generation, etc. The application provides (Uni/Bi) directional interfaces to laboratory equipment. This results in eliminating chances of human error, as opposed to a system employing manual keying of test results.

Misys Laboratory Information System Misys Laboratory information system is a high-performance software system that manages specimen data from requisition entry through specimen tracking to final cumulative report production. For more than 25 years, laboratories have been relying on this highly flexible, customizable solution that allows clients to create a custom laboratory system to meet all user-specific business and workflow needs. Key Benefits of Misys LIS:

•

Key Benefits of Wipro LIS:

• • • • • •

Improved operational efficiency through tracking of samples Increased productivity and elimination of human error through seamless integration with medical equipment Improved patient satisfaction through reduced turnaround time of lab reports Improved quality control through reliable & accurate test results Improved decision making through online availability of information Helps meet regulatory compliances

• •

• • • •

Improves patient care by integrating across clinical disciplines to enable the creation of a longitudinal lab record. Promotes operational efficiency to build your business. Offers comprehensive business intelligence tools, including reports for patient data analysis, and client problem tracking to provide personalized service to your physicians and primary caregivers. Provides interfacing to major instruments and hospital information system (HIS)/enterprise vendors Works with enterprise and departmental solutions Enables robust patient report documentation Offers a wide range of features that assist in regulatory compliance

SOURCE: HTTP://WWW.MISYSHEALTHCARE.COM/PRODUCTS/ SOURCE: HTTP://WWW.HEALTHCAREIT.WIPRO.COM/LABORATORY.HTM

medium hospitals in Malaysia, Indonesia, Vietnam, Thailand, Philippines, India and China. Although deemed as a relatively mature market, the LIS market is still viable due to: • An increasing need for new LIS implementation as more facilities seek to cut down on test result reporting errors, increase profitability, improving patient care, and minimizing risk; • Replacement of outdated LIS since the maintenance costs of continuing outdated systems can be high, and many legacy LIS systems will not support the needs of modern laboratories; • Ageing population in Asia coupled with the lack of qualified technicians has pushed governments to establish Total Laboratory Automation systems to perform laboratory testing in a timely and cost-effective manner; the results are not only increased productivity, accuracy and patient safety but also the need to manage information effectively. Another boost for the adoption of LIS is the blooming 8

PRODUCT+PORTFOLIO/MISYS+LABORATORY/DEFAULT.HTM

medical tourism industry in the region. The quest for foreign patients is fueling the need among medical institutes to establish standards, comply with international regulations and invest in both medical technology and Clinical Information Systems such as LIS to raise the quality of patient care. With such strong growth factors, the LIS solution looks to be in continued demand in Asia Pacific. A Frost & Sullivan Market Insight Frost & Sullivan is a global growth consulting company, has been partnering with clients to support the development of innovative strategies for more than 40 years. The company’s industry expertise integrates growth consulting, growth partnership services, and corporate management training to identify and develop opportunities. Frost & Sullivan serves an extensive clientele that includes Global 1000 companies, emerging companies, and the investment community by providing comprehensive industry coverage that reflects a unique global perspective and combines ongoing analysis of markets, technologies, econometrics, and demographics. For more information, visit www.frost.com. For further details on the study, please contact: Remi Chaterjee Corporate Communications Frost & Sullivan (South Asia). Email: remi.chaterjee@frost.com

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TECHNOLOGY TRENDS

Pocket Electronic Health Diary (PeHD) Technology for Developing Countries PeHD is a pocket electronic health diary system created on patients’ own interest and managed by hospitals who offer it. The main aim of a PeHD for developing countries is to introduce an electronic health record where there is no centralized health care system and governments cannot maintain database of citizen’s health records. This will be an initial step not only towards paperless health care systems, but also to empower patients through access to their medical information.

Dr.Shabbir Syed Abdul

n this era of ICT (Information and Communication Technology) when no sector has been left untouched, recent advancements in ICT have changed health care systems. The use of ICT through Telemedicine and e-Health tools has created bridges between space and time, this has been reflected on a “better access to health care and access to better health care, cost effectiveness, equity and efficiency of health care” [11]. These qualities of Telemedicine and e-Health services are attracting policy makers on health care from developing countries where there is a boom of health crises and lack of infrastructures, human resources, and of course funding [2]. PeHD is a decentralized, patient centric, health record which provides an organised summary of personal medical information for presentation to health care providers [3]. It is multifunctional and multipurpose, includes text, images, sounds, and other multimedia content. It not only supports doctors to have access to the patients’ medical records, but also for Hospital treatment purposes, Government bodies for statistical purposes, and research purposes. The Health information is not only stored in a server but also stored in a USB drive for quick accessing of essential medical information where internet is 10

not available [4]. And patients have to carry this USB drive along with him/her as an ATM card or credit card. As PeHD is used by different users (stakeholders), different interfaces are made so that only information required for that user can be accessed from patient’s health information data. PeHD’s main goal is to help patients to become active participants in their own care, empowering them to acquire awareness of their own,or their family members’, health status. The available literature does not yet seem to adequately describe the potential capabilities and utility of these systems in developing countries - “Unfortunately few systems have been described in the literature and fewer evaluated” [10] and “In addition, the lack of a proven business case for widespread deployment hinders Personal Health Records adoption” [3]. Most consumers and patients receive care from many health care providers, and consequently their health data are dispersed over much paper record of many hospitals. A fragmented system of storing and retrieving essential patients’ data impedes optimal care.

PRESENT SCENARIO

It is common to have patients visiting the hospital or GP without any previous

medical reports, incomplete, or very old and half torn reports. Sometimes reports are in good shape but we aren’t able to read due to the doctor’s illegible handwriting [5]. Patients often arrive in casualty with serious illnesses, but don’t know anything about their previous treatment, even what operation they had undergoneor what medication they might be on, the only thing they would recall is that they are on anti hypertensive medicine or anti diabetes and the colour of the tablets (red or white). It is common for patients not to carry medical records. Thus one can imagine in this situation how difficult it will be to manage the case. In t an emergency, there’s no room for errors. However if anything goes wrong, Doctors are blamed. It is now time to provide our doctors a little help with a system which gives them complete access to their patient’s medical history. We have found that PeHD is what we need to achieve our aim.

THE PROPOSED SOLUTION

The proposed solution is called PeHD – Pocket electronic Health Diary – and its internal structure is shown in fig1. PeHD is a decentralized, patient centric, health record supported by a www.ehealthonline.org

simple device such as a pen drive (common designation for a solid state memory device with a USB interface) [6]. It is able to store not only the person’s own health information (a database), but also the technical means to read it (a computer application), and the necessary security mechanisms to protect it (encryption tools); making it a fully autonomous system. In fact this is now possible with the given capabilities of such devices which are able to store over 1 GB of data. This could only be achieved, some years ago, with a non portable sized hard disk. The information inside the pen drive is organized according to 2 security levels: public and protected (private). An application is stored inside the pen drive, allowing the interaction with a PC without any additional software. While the public data is accessible by everyone, the protected (private) data is only accessible by the authorized. Public data includes, for instance, blood type and allergies. The protected data is accessible by a login/password combination, and includes past medical history, medication, exams, vaccination, etc. Any telemedicine application, to be successful, must be economically feasible. Excellent ideas have never left the pages of scientific journals or conference proceedings due to this problem. The low cost of this solution allows for an easy dissemination through both a public healthcare system and private companies. This work is currently under development. Requirements have been completely identified, the system specification has been produced and its implementation is under way, with the aim of using Open Source technology and platforms. A prototype of a working product is expected in September 2007 (current year).

BENEFITS TO USERS Patients:

1. They can access their own medical record for rechecking medication schedules (Usually patients get confused when they have more then 4 medicines with different times to take them); for confirming review date, investigation date and vaccination date [7]. 2. If they are elderly or unable to use the computer they can permit someone taking care of them by giving the token (flash memory \ pen drive ) to them.

Figure 1. Pen drive internal structure

3. They can be reassured about medication schedule in case of confusion by sending email (if and when available) to their doctor, communication barriers are responsible for many adverse effects of drugs in out patient setting. [8] [9] September 2007

4. They can send and receive email from their family doctor. 5. They don’t need to go to diagnostic centres just for collecting results, they will receive them directly on their PeHD via internet. In addition, doctors can also check these results from their own office, and contact patients for further treatment or instruction if needed. Health Care Professionals (Doctors / Nurses / Lab Technecians):

1. Doctors can access the PeHD to get complete medical history, investigation reports, present medications, allergies to drugs etc. There by tsaving lots of time and getting the correct information about the patient. Moreover, this will be of great help for diagnosing present illness. 2. Previous Investigation record prevents repeating of same investigation, saves time for diagnosis, patient’s money, and lab technicians’ workload. 3. Doctors can contact their supervisors / professors and colleagues for case discussion or for second opinion. 4. Nurses can access the PeHD if the patient is admitted in the hospital and can order lab tests, check lab results, check medication schedules; this can help in starting medicine which was effective in previous treatments. Hospitals which can offer PeHD

1. These Hospitals can rope in new clients: once people obtain a PeHD from a hospital they will continue to revisit it for future treatment (though it may not be obligatory,) 2. Clients may also be assigned to a Medical Officer from the same hospital who could help the patient maintain his/ her PeHD, thus adding to the clinician’s list. 3. These hospitals can approach new patient markets. i.e. they can collaborate with nursing homes in other towns and villages, they can facilitate telemedicine consultation if needed, and subsequently get patients from those hospitals (Nursing homes) if future treatment is required. 4. They can use this PeHD integrated with the hospital’s EPR (patient record) whenever this patient is admitted to the hospital. 5. Hospital can make a deal with a Health Insurance company and can offer free treatment for patients with PeHD by taking premium amount which was mutually agreed between the Hospital and the Insurance Company. 6. The PeHD can help maintaining up to date statistic databases with births, deaths, diseases, diagnosis, treatments, etc. Government bodies:

Can maintain accurate and up to date records of diseases in the given region. Especially of infectious diseases which are diseases that require adequate steps for their prophylactics 11

TECHNOLOGY TRENDS

POCKET ELECTRONIC HEALTH DIARY

and prevention, and in this way epidemics can be predicted at the earliest possible time.

OWNERSHIP AND FLOW OF THE INFORMATION

When this USB is plugged in only strictly necessary information will appear on the screen. Like chronic diseases, allergies and blood type. The rest is password protected. Different information will be available for different parts of the health service. For instance the pharmacy can access only information about the medication. They do not need to know name or what health problem the patients are suffering from. The same applies for a laboratory. This technology makes the patient the owner of the information, and gives him or her more control over the record. Patients cannot change what the doctor has written, but they own the information. The information is encrypted, and one will not have access without knowing the password to the detailed medical data. If the patient is not able to communicate the password, you could call the hospital and provide a number given on the memory-stick in addition to a description of the patient. Among other things one could use special features like scars and other skin lesions.

CONCLUSIONS

This paper proposesa solution for the introduction of personal health diaries in developing countries, namely in regions where there is no centralized system for EPR (Electronic Patient Records) and internet access is limited . In these scenarios patients do not have a single point-of-care and are

Sketch of the information flow from PeHD.

approaching different health care providers. With PeHD the patient is given both, access to his/her own health information and the responsibility for it and in this way empowers the patient and encourages him/her to actively participate in maintaining his/her own health. For doctors this technology facilitates the access to their patients’ health record. Most of the information is immediately obtained, and the larger files, like MRI images or echocardiogram, is stored in the hospital server. In the PeHD links to the hospital’s EPR can be stored. The PeHD also includes URLs of publicly accessible health information on the internet.

ACKNOWLEDGMENT

We acknowledge the support from NST “Norwegian Centre for Telemedicine” and the University of Tromsø.

REFERENCES

[1] M. Savard. “The Savard Health Record: A Six-Step System for Managing Your Healthcare”, Alexandria, Va.:Time – Life, 2000 [2] M.A.Ryan.”Maintain your medical records. Today’s Chemist at Work”. Vol. 8(8) pp. 49-50,52-53. 1999 [3] E. Spragins. “Get it writing”, Newsweek Aug 24, pp. 62, 1998 [4] Tang et al. “PHRs: Definitions to Adoption Strategies”, JAMA Vol 13 Number 2 Mar/April 2006 [5] P. C. Tang, E. H. Shortliffe.”Traditional hospital records as a source of clinical data in the outpatient settings”, proceedings of the symposium on computer application in medical care, Philadelphia:Hanley & Belfus, pp. 575-579, 1994 [6] Paul et al. “Personal health records: Definitions, Benefits, and Strategies for Overcoming Barriers for Adoption”, JAMA Vol 13 Number 2, Mar/April, 2006 [7] D. L. Hunt, R. B. Haynes, S. Hanna and K. Smith. “Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review”, JAMA, num. 280, pp. 1339-1346, 1998 [8] T. Delbanco, D. Z. Sands. “Electrons in flight – e-mail between doctors and patients”, N Engl J Med, num. 350, pp. 1705-1707, 2004 [9] T. K. Gandhi, S. N. Weingart, J. Borus, et al. ”Adverse drug events in ambulatory care” N Engl J Med, num. 348, pp. 155615, 2003 [10] H. S. F. Fraser et al “Implementing electronic medial record systems in developing countries”, Informatics in primary care, num. 13, pp. 85-95, 2005 [11] A.C. Norris. “Essentials of Telemedicine and Telecare”, pp. 30-32, 2001

Dr.Shabbir Syed Abdul is currently pursuing his Masters Degree in “Telemedicine and eHealth” from University of Tromsø, Norway. He is interested in the implementation and information management issues of electronic health records especially in developing countries. He is also a member of the International society of Telemedicine and eHealth.

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DEVELOPMENT DIMENSION

e-Choupal - Delivering Rural Healthcare Services Lack of health services is one of the main impediments for improving the quality of life in rural India and the same has been reiterated by the e-choupal initiative of ITC. e-Choupal is a starting point for reﬂecting on key challenges in achieving “ Health-For-All” and developing effective response system. It tries to provide primary, secondary and tertiary health care as well as consultancy services. The paper focuses on providing health services in rural areas and also about its innovative policy. It also shows an innovative model used in healthcare services. Dr. Pankaj Trivedi and Mukti Bapna

et’s begin with some fundamental questions on the state of public health situation in India Why there is a child mortality rate of 1 death every 30 seconds in India? Why does a mother die each passing minute? Why do thousands of people fall prey to malaria and bird flu every year in the country? Even a minimal understanding of current public health scenario in the country will be enough to precisely point out the reasons, which are are none other than lack of proper medical facility and adequate healthcare infrastructure outside urban centers. All along, rural areas have been miserably neglected when it comes to providing public healthcare. Furthermore, when we discuss this problem in a little detail, some other crucial questions crop up, and these are • How to break our cultural taboos and change behaviours? • How to provide literacy about health among people? • How to provide high-quality care in low resource settings? • How to give access to health professionals such as to ensure right treatment for patients? • How do we design and implement affordable public healthcare system? • How to guarantee a ‘fair-for-all’ system of health?

How to educate people to plan ahead for potential health problems? In order to make an attempt to address such questions and offer a solution for them, a rural health service model has been designed, based on ITC’s e-Choupal network. (‘Choupal’ is a Hindi word, meaning an informal assembly or forum where villagers meet to share local news and information. The e-Choupal initiative has been pioneered by Mr. S. Sivakumar, CEO, ITC Agro-Business Division, started in 2005) •

OPERATIONAL MODEL

In general, the e-choupal project constitutes a network of rural kiosks, providing a number of information and communication related services for rural population. In terms of health services, e-Choupal provides preventive, primary, secondary and tertiary healthcare services. Primary care practices provide health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of healthcare settings, for instance office, inpatient, critical care, long-term care, home care, day care, etc. Secondary and tertiary healthcare services are provided by reputed

doctors and specialists, made available to the populace through telemedicine services arranged at proximal distance. In addition, e-choupal also provides consultancy services, diagnostics and pharmacy services. In providing these products and services, e-choupal used a three tier model as given below : Tier 1: Choupal level health (paramedic) centers Tier 2: Hub/Mall level ‘choupal sagar’ health centers, pathology centers and pharmacy Tier 3: Specialist doctors, diagnostic centers & specialty centers of partner hospitals Tier 1 includes dissemination of health advice and information at the choupal premises and arranging the necessary infrastructure for free health camps in villages. Activities at Tier 2 include providing the necessary infrastructure to the physician and provision of requisite space for lab and pharmacy, thus facilitating organized and quick service to patients. Tier 3 includes telemedicine services which help rural citizens to gain access to reputed specialists from top hospitals. The model is a combination of technology (facilitated through echoupal infrastructure) and community, www.ehealthonline.org

interfaced through a ‘sanchalak’ (operator), who interacts with the local community and hence binds all members of the rural populace. e-Choupal has partnership with reputed organisations in the healthcare segment, who bring their core expertise in medical care at both ends of the spectrum – starting from rural initiatives to super-specialty hospitals. State government agencies help in the improvement of local regions by participating in pulse polio drives, Sakshartha (Literacy) Mission, tuberculosis prevention mission, HIV/AIDS awareness camp, family planning mission etc. The partnership is very strategic since core aspects of healthcare are managed and provided by the partner, who also take care of the last mile connectivity and delivery factors. • FINANCIAL MODEL

• Patient fees and subscriptions/donations from partners and government primarily provide the required inflow of cash to run the program. Fees charged to patients availing the services are only Rs. 25 ($ 0.6) for consultancy, with a validity of one week, irrespective of number of times a patient avails the service in that week. A cost benefit analysis of the business model indicates that the project is financially viable & sustainable. e-choupal initiative results in marginal additional fixed cost, which can be recovered easily by scaling up operations. Following figures may be useful to understand the commercial viability of the program: The average population covered by a choupal is approximately 6500 (constituting approximately 1200 household). The yearly average expenditure per rural household on healthcare is nearly Rs. 4400 (approx. $ 105). Hence, potential revenue from each choupal through healthcare service alone is Rs. 5.3 million (approx. $ 126,000). The number of choupal in a typical state like Madhya Pradesh is 1700. Thus, the total market potential in a state is approximately Rs 9200 million ($ 220 million). The total potential for all 8 states to which the project has been extended comes to around Rs 75,000 million (approx. $ 1786 million). In addition to this, the concept has been extended to other states like Uttar Pradesh, Maharastra, Rajasthan, Andhra Pradesh and Karnataka, and is working well as per costbenefit analysis

SUSTAINABILITY STRATEGIES

For long term sustainability the following strategies are implemented: September 2007

• • • • •

Leveraging technology to reduce the cost of telemedicine. Building volumes to increase profitability – (a) spread word of mouth publicity (b) organise awareness camps through kiosk operators (c) conduct health camps in villages. Obtaining regular feedback and carrying out research to figure the medical needs. Adopting market-based models as a scaling up strategy so as to reach large number of people in need. Designing inclusive system in which healthcare facilities can be provided in low resource environment. Creating trust among local communities, as well as introducing public incentives for encouraging better usage of new facilities at local level. Encouraging readers to visit original website to learn multiple dimension of the concept.

FACILITIES

Choupals also provide some additional and value-added community services for ensuring capacity building and awareness generation • Choupal radio broadcasts preventive health measures and remedies for localized ailments. • Doctors compose and deliver engaging talks on radio. • e-choupal website makes available 24 hours query sessions. • Telemedicine services allow villagers to interact directly with specialist through video conference mode and also at an economical rate. • Health camps are co-operated by kiosk operators to facilitate activities like free eye-checkup, free tuberculosis camp, free cataract cure camp etc. Out of the total number of patients who avail the healthcare service of e-choupals, more than 75% qualify as “low income 15

DEVELOPMENT DIMENSION

E-CHOUPAL- DELIVERING HEALTHCARE SERVICES

or marginalized”. This in itself is indicative of the fact that the rural health service model of e-choupal is ensuring that the weaker sections of the society gain access to quality and affordable healthcare.

RECOMMENDATIONS

In order to improve service delivery mechanism through e-Choupal network and maximise benefits for rural community, the following recommendations may be considered: • More courses for capacity building of existing paramedics in the village. • More programs on training and certification for healthcare service in rural areas. • Changes and modifications in the pharmacy regulation. • Certified training for rural citizens for enabling them to sell basic drugs in villages. • Create standards for health data exchange. • Proper regulation and protocol for leveraging modern technology like telemedicine etc. • Provide incentives on tax for capital equipment. • Provide concessions to players contributing in the rural healthcare segments. • Co-operating with the local paramedic through kiosk operators and focusing on their training and accreditation.

CONCLUSION

e-choupal provides the “last mile” complementary solution for rural communities by introducing high-tech and high quality services in low income settings. This has helped to push geographical barriers and overcome cost constraints. Experiments have consistently demonstrated the importance of creating trust in local communities, as well as introducing incentives to start using these new facilities at the local level. e-choupals are acting as change makers, and are well set to achieve the mission of “Health-For-All” within its macro agenda for transforming rural economy through innovative solutions and services.

REFERENCE

• • • •

www.echoupal.com Case study on “ How to improve health for all” by Stephanie Schmidt. Case study on “ Delivering healthcare services through the e-Choupal “ by S.Sivakumar. Other related Websites. Mukti Bapna is currently working as Assistant Professor in Christ college, Pune. She has submitted her PhD Thesis on eGovernance under guidence of Prof. (Dr.) Pankaj Trivedi.

About e- Choupal ITC’s International Business Division, one of India’s largest exporters of agricultural commodities, conceived e-Choupal as a more efficient supply chain aimed at delivering value to its customers around the world on a sustainable basis. The e-Choupal model has been specifically designed to tackle the challenges posed by the unique features of Indian agriculture, characterised by fragmented farms, weak infrastructure and the involvement of numerous intermediaries, among others. ‘e-Choupal’ also unshackles the potential of Indian farmers who have been trapped in a vicious cycle of low risk taking ability - low investment - low productivity - weak market orientation - low value addition - low margin - low risk taking ability. This makes them and the Indian agribusiness sector globally uncompetitive, despite rich & abundant natural resources.

information in their local language on the weather & market prices, disseminate knowledge on scientific farm practices and risk management, facilitate the sale of farm inputs and purchase farm produce from the farmers’ doorsteps (decision making is now information-based). Real-time information and customised knowledge provided by ‘e-Choupal’ enhance the ability of farmers to take decisions and align their farm output with market demand and secure quality and productivity. The aggregation of the demand for farm inputs from individual farmers gives them access to high quality inputs from established and reputed manufacturers at fair prices. As a direct marketing channel, virtually linked to the ‘mandi’ system for price discovery, ‘e-Choupal’ eliminates wasteful intermediation and multiple handling. Thereby it significantly reduces transaction costs.

The Model in Action

The Status of Execution

Appreciating the imperative of intermediaries in the Indian context, ‘e-Choupal’ leverages Information Technology to virtually cluster all the value chain participants, delivering the same benefits as vertical integration does in mature agricultural economies like the USA. With a judicious blend of click & mortar capabilities, village internet kiosks managed by farmers – called sanchalaks – themselves, enable the agricultural community to access ready

Launched in June 2000, ‘e-Choupal’, has already become the largest initiative among all Internet-based interventions in rural India. ‘e-Choupal’ services today reach out to more than 3.5 million farmers growing a range of crops - soyabean, coffee, wheat, rice, pulses, shrimp - in over 31,000 villages through 5200 kiosks across six states (Madhya Pradesh, Karnataka, Andhra Pradesh, Uttar Pradesh, Maharashtra and Source: www.echoupal.com Rajasthan)

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NEWS REVIEW

INDIA

MICROSOFT INDIA & IDRC EXTEND FUNDING SUPPORT FOR TELECONSULTATION INITIATIVE OF ARAVIND EYE HOSPITAL

icrosoft India and International Develop-ment Research Centre (IDRC), Canada under their ‘Rural Innovation Fund’, have selected ﬁve organisations who will receive ﬁnancial assistance to support and escalate their work on rural innovation. One of the recipient institutions of this funding support - Aravind Eye Hospital in Theni, Tamil Nadu has proposed a low cost telemedicine solution that reaches out to the rural population. The hospital has showcased an innovative use of IT in facilitating online consultation for patient with ophthalmologists. This approach helps patients acquire the right advice directly from ophthalmologists, saving a lot of time and money. The objective now is to develop an appropriate model to increase the uptake of eye care

US VARSITY LINKS UP WITH IIIT-HYDERABAD FOR TELEHEALTH SERVICES

he former President of India, A.P.J. Abdul Kalam inaugu-rated the webbased telemedicine link at the IIIT campus of Hyderabad, Andhra Pradesh, with cooperation of University of Arkansas for Medical Sciences, USA on 15 August 2007. The Centre for Distance Health (CDH) at the UAMS explained to the former President that web based telemedicine link will eliminate healthcare disparities in the country. The telelink with IIIT in India will help India’s healthcare providers to improve healthcare services in India. The CDH is already providing distance health implementation of educational, clinical, research and outreach opportunities to the rural popula-tion of Arkansas, including dia-betes self-management, high risk obstetrical management and cardiology consultation.

September 2007

services at the vision centres opened by the hospital. Commenting on the initiative, Neelam Dhawan, Managing Director, Microsoft India, said, “The Rural Innovation Fund

was established to help communities with limited access to technology to realize their potential. The response in the ﬁrst year of its existence has been tremendous - every one of the 700 applications submitted tells a story of achievement.”

WOCKHARDT OPENS DOORS OF ITS NEW SUPER SPECIALITY FACILITY IN RAJKOT

on’ble Chief Minister Narendra Modi recently inaugurated the N M Virani Wockhardt Hospital, Rajkot the latest addition to the Wockhardt Hospitals group. This facility will help those in Saurashtra to escape the inconvenience and overhead expense of travelling to other cities for quality treatment. This super speciality hospital has a total of 200 beds, including 42 critical care beds equipped with life saving equipments like IABP, Ventilators, multichannel monitors, infusion systems, along with 24 ICCU’s, 5 advanced Operation theatres, latest digital ﬂat panel cath lab for angiography, angioplasty and other cardiac procedures, computerised diagnostic laboratory. The hospital is fully computerised driven by HIS system and more than 75 doctors on the panel. It also has top-of-the line 2D Echocardiography machine, high-end ortho & neuro surgical sets. The tertiary care includes critical surgeries such as heart surgery, knee or hip Joint replacement, brain and spine surgery, Minimal Access Surgery [MAS], kidney and other life saving surgical facilities.

FORTIS HEALTHWORLD FORAYS INTO RURAL INDIA

ortis HealthWorld - the one stop healthcare retail chain initiated its plans to reach rural India by signing their ﬁrst health store in Mandi Ahmedgarh. This store is the ﬁrst of many such stores that FHWL will open in rural India through its tie up with ‘Hariyali Kisaan Bazaar’, a unit of DCM Shriram Consolidated Ltd. By setting up these stores Fortis HealthWorld seeks to empower rural India, mainly the farming community by providing all encompassing health needs under one roof such as OPD facility , telemedicine, routine pathology test collection centres, prescriptions, OTC, alternate medicines (ayurveda & homeopathy) and also

veterinary medicines and fast moving personal health products. Mr. Ashish Kirpal Pandit, CEO, Fortis HealthWorld said “This alliance with DSCL Hariyali Kisaan Bazaar is an integral part of our commitment of providing world class pharmacy and allied services to rural India. Quality services and a well stocked pharmacy with genuine medicines, pathology tests, telemedicine will now all be available under one roof and within easy access to the rural population.” Fortis HealthWorld will ride on the existing 70 outlets of the Hariyali Kisaan Bazaars across India. Another 200 outlets will be added in next 15 months.

APOLLO HEALTH CITY LAUNCHED IN HYDERABAD

pollo Hospitals Group have recently launched the ‘Apollo Health City’ in Hyderabad - a first of its kind in the Asian region. With Chief Minister of Andhra Pradesh, Dr YS Rajashekar Reddy doing the official launch, the initiative got the desired fillip to jump start its operations. Built on a sprawling 33 acres landscaped property, the health city will have 300-beds with over 50 specialties and super-specialties, along with 10 centres of excellence, covering - heart diseases, cancer, neuro-sciences, orthopedic, opthalmic, emergency, renal diseases, minimally invasive surgery, cosmetic surgery and trauma. Apart from this the Apollo Health City will host educational and research facilities for post-graduate specialisation courses for doctors, nursing , physiotherapy, hospital management, medical informatics, emergency medicine and paramedics.

INDIA NEWS

AIIMS TO GO ‘NEAR-PAPERLESS’ The All-India Institute of Medical Sciences (AIIMS) of India is moving one step forward by becoming paperless institute. In the ﬁrst phase of the initiative, AIIMS is making patient’s medical history online. The program aims to provide information and records of patients anywhere and anytime. The project will also help doctors to take their decisions fast. The hospital has automated one of its centres by starting registration of new cases online. The facility will also provide immediate access to a patient’s complete health records including lists of prescriptions and allergies, which will reduce medical errors, improve patient safety and avoid duplicate tests and other procedures. The system can deliver alerts that warn physicians about drug-drug interactions or suggest best practices for a patient with a speciﬁc condition.

CWS - BITS PILANI USING TELECOM TECHNOLOGY TO PROVIDE HEALTHCARE SERVICES UGC Centre for Women Studies (CWS) at BITS, Pilani has joined hands with Sewa Bharti, Pilani to open new vistas for the people by inaugurating a Telemedicine Centre, ﬁrst of its kind in Shekhawati Region of Rajasthan. The centre aims at delivery of health care services across distances using telecom technology. Inaugurated on the occasion of 60th Independence day, by Dr. L.K. Maheshwari, Vice Chancellor, BITS-Pilani, the Telemedicine Center would be beneﬁcial towards improvisation of health care accessibility, immunization drives, educating young mothers and children about hygiene and general cleanliness. Using the software ‘Remedy Kit’ and internet technology, vital information regarding pulse rate, heart beat, blood pressure, ECG can be transferred over the broadband link from Seva Bharti to Medical Center, BITS-Pilani. The health care personnel at Medical Center will analyze and diagnose the health condition and prescribe the medicines which will be available at Seva Bharti Complex. The entire procedure will take merely 3-5 minutes.

SPACE HOSPITALS TO EXTEND SERVICES IN 15 ANDHRA PRADESH DISTRICTS A mobile telemedicine facility involving corporate hospitals in Andhra Pradesh and Tamil Nadu will be launched in 15 districts of Andhra Pradesh. Chennai-based Space Telemedicine Hospitals Ltd announced that ambulances ﬁtted with Very-Small Aperture Terminal (V-Sat) and videoconferencing facilities would be rolled out to

help the rural poor in Andhra Pradesh to get the modern diagnosis and treatment as part of the new venture of Space Hospitals. Space Hospitals with 70 centres in the network across the country, would also facilitate the referral services of famous hospitals and specialists, he added.

PUNJAB RECEIVES INR 2000 CRORE FROM NATIONAL RURAL HEALTH MISSION

TELEDIAGNOSYS SET TO OPEN MORE TELERADIOLOGY REPORTING CENTRES

National Rural Health Mission (NRHM) has sanctioned INR 2000 million to improve health services in Punjab. The State has received INR 150 million from the state government. The state government will promote Ayurvedic medicines and soon organise “Health Melas” in the villages. In this respect, a qualiﬁed Ayurvedic Doctor would soon be appointed along with a director. The Health Minister Prof Lakshmi Kanta Chawla stated that health department will initiate a state-level compaign against the use and illegal sale of the drugs. Three trauma centres would soon be set up at Amritsar, Jalandhar and Pathankot.

TeleDiagnosys Services Pvt Ltd, a premier provider of Teleradiology reporting services to hospitals and radiology groups in US and several other countries announced recently that their company will be opening 2 state-of-the-art Teleradiology reporting centers, one each in Pune and Mumbai under the leadership of well known radiologist Dr Deepak Patkar, widely known in the radiology circles for his expertise and pioneering work in radiology. The existing center in Mumbai will be expanded to take in more work whereas the Pune center will be a new facility allowing TeleDiagnosis to take on more customers and service the existing ones more effectively. TeleDiagnosys plans to add upto 100 radiologists and support staff in each center to provide radiology reporting services to fulﬁll the increasing demand for its quality services from across the world. These centers would also be backed by high quality secure telecommunication network and latest workstations for reading radiology images transmitted to India for interpretation. The company’s exceptional growth in the Teleradiology market is driven by its ability to offer high quality services at low costs, including 24 x 7 x 365 coverage on preliminary and ﬁnal interpretations.

TELEMEDICINE CENTRES OPEN IN HARYANA, RAJASTHAN In a recent development the Sir Ganga Ram Hospital New Delhi, entered into a PPP project with the government to open medical kiosks and telemedicine centres at three rural locations, Gohana (in Haryana), Kaithun (in Rajasthan), and at Dasmal (Himachal Pradesh.) The government is investing Rs.1 million on each of the centres, and intends to open 15 more such centres within the next two years. B.K. Rao, chairman of the board of management SRGH, said the hospital is going to start tele-ophthalmology vans and mammography vans which will be connected through satellite courtesy the Indian Space Research Organisation (ISRO) and will be stationed in different states and go to villages on a daily basis and examine the villagers.

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EVENT REPORT

eHealth India 2007 July 31 – August 02 2007, The Taj Palace Hotel, New Delhi BACKGROUND

Quality of public health and availability of proper healthcare amenities are one of the prime yardsticks for estimating the level of development and well being of any country or society. Advent of powerful medical electronics coupled with latest tools of IT and communication technologies are bringing opportunities for advanced healthcare services including – faster and more accurate clinical diagnosis, efficient emergency response, complex health analytics, wide area disease surveillance, remote patient assistance, rural health solutions, along with quality enhancement in services through online and integrated health insurance solutions, healthcare financing, extended care management and awareness. Spanning from primary healthcare to medical image archiving; complex forecasting of health hazards or even performing critical surgical procedures - technology is leveraging healthcare at all fronts. However, ground realities and challenges still looms large - burgeoning population pressure, inadequate number of qualified doctors and paramedical staff, concentration of healthcare facilities in urban centres, lack of standardisation in service delivery and paucity of public funding are prime challenges in improving health status in India vis-à-vis the developing world.

INTRODUCTION

eHealth India 2007 was marked with power packed conferencing and networking sessions, which addressed some of the most pertinent issues of the healthcare sector, by way of engaging top notch policy makers, public health September 2007

specialists, academicians, technology developers, health industry experts, development agencies and civil society practitioners. The two days of the event witnessed an arduous effort to explore opportunities of technology leveraged public health systems and find ways of efficiency gains and value additions for multiple stakeholders in the healthcare ecosystem. Presence of eminent experts from countries like Canada, Singapore and Norway and their process of engagement through presentations and discussions on policy interventions, research agenda and technology solutions helped in analysing situations in India with reference to developed nations. Furthermore, it also provided opportunity for solution vendors to gage future needs of health sector, showcase latest innovations and technology applications on offer, investigate market potential and deliberate on issues pertaining to stakeholders at large. # Session I (Opening Session): ‘ICTs in Healthcare - Prospecting Public Health Transformation’ Delivering the ‘keynote address’ in the opening session of the conference Smt. Aradhana Johri, Jt. Secretary, Ministry of Health and Family Welfare, Government of India outlined the healthcare policy of the country, while emphasising government’s commitment towards adopting ICTs for improving public health services in rural and urban areas, disease surveillance projects and data surveys. While being candid in expressing the government’s vision to improve overall public health system in India by means of suitable technology applications, Ms. Johri highlighted her concerns about ground realities that often plagues such initiatives. Taking Bihar as a case in point, she described

the near impossibility of using highend technology in a low literacy and politically unstable environment. However, she expressed hope in achieving success in such environments with simple ICT tool such as telephone or mobile phones. The first ‘special address’ of the conference delivered by Michael Clarke, Director - ICT4D, IDRC, Canada was an eye opener to the crucial issue of ‘information as a cornerstone of public health’. His deep insight in this matter, punctuated by startling revelations through research data, established the critical factors of accurateness, access and management of medical records for ensuring error-free healthcare service. Dr. Ranjan Dwivedi, National Professional Officer (eHealth), WHO – while delivering the second ‘special address’, gave a comprehensive presentation about various e-health initiatives of the WHO. While emphasising the healthy economic position of India brought through the attainment of excellence in IT, he mulled over the fact that India is still way behind the developed world in terms of public health standards and it still has one of the highest disease instances in the world. As recommendations for improvement of such prevalent conditions in India, he underlined the need for suitable technology solutions, higher adoption of local language computing and need for more nursing colleges and paramedical training facilities in the country. Trevor Hodge, Sr. VP (Investment Strategy & Alliances), Canada Health Infoway – while delivering the ‘guest address’, appropriately brought in a developed world perspective on public healthcare system and presented the conceptual framework of Canada Health Infoway (an SPV of Canadian government) for efficient 19

EVENT REPORT

investment of public funds in health system modernisation. In his highly informative presentation, Mr. Hodge traced the evolution in public healthcare management in Canada and expenditure patterns on IT in the health sector. In terms of new developments in this sector, he finds enormous potential in delivery of clinical services using ehealth technologies. # Session II: ‘Improving Public Health Through Technology Interventions Development Sector Perspective’ Role of development sector and international agencies in Indian healthcare sector, particularly with regard to rural interventions and public

health research, deserves a special mention in any forum on healthcare. With an attempt to involve them in the process and infuse a wider perspective on technology interventions in public health, this special session focused on the development sector. Chaired by Michael Clarke, Director - ICT4D, IDRC, Canada this session had three eminent speakers – Dr. J.P. Misra, Principal Specialist (Health Sector Support), GTZ HSS India; Dr. Susheel Oommen John, Consultant, The Leprosy Mission Trust India and Dr. Shabbir Syed Abdul, Dept. of Telemedicine & eHealth, University of Tromso, Norway. The session delivered an overview of institutional efforts in using low-cost technologies and 20

affordable telemedicine solutions in areas of rural healthcare, health surveys, awareness programs and immunization campaigns. Almost all three speakers underlined the need to analyse local conditions and suitability factors while selecting technology applications for rural healthcare. # Session III: ‘Hospital Information Management System (HIMS) Leveraging IT for Seamless Patient Care’ Healthcare is known to be one of the most information intensive and data critical discipline. Accuracy, completeness and timeliness of data and information, and ease of accessibility

are at the core of service development strategy of any healthcare institution. Involvement of multiple departments and practice groups in patient diagnosis and treatment, and often, the need of post-treatment monitoring for extended medication period renders a typical complexity to IT architecture of hospitals. Chaired by Dr. Ashok Kumar, Dy. Director General, Central Bureau of Health Intelligence, Ministry of Health & Family Welfare, Govt. of India the HIMS session brought together 5 eminent speakers from among top tier healthcare service providers and solution vendors. Presentations by Manish Gupta, CIO, Fortis Healthcare; Pradeep Vaidya,

Head-IT, Wockhardt Hospitals and Amit Kumar, CIO, MAX Healthcare highlighted IT architectures of some these big hospitals and underlined a compelling need of service providers to develop patient centric IT strategy, which at the same time, equally aligns with overall hospital work flow and its clinical processes. It was encouraging to find the level of IT sophistication adopted at these facilities with almost all of them having full scale EMR and PACS implementations. Claire Medd, Regional Healthcare Manager (Asia Pacific), Intel Corporation and Seema Gupta, Consultant, Wipro Health Care IT talked about latest innovations in healthcare solutions of their respective companies. While Intel corporation is more upbeat about bringing personal mobile healthcare devices for the domestic market, Wipro Healthcare reaffirms the resounding success of their HIS solutions and their newly launched mini-HIS offering for the SME segment service providers. # Session IV: A Special Session on ‘Health Hiway’ – an Apollo Hospitals & IBM Initiative The concluding session of the second day had a special presentation on ‘Health Hiway’ initiative – a collaborative effort of Apollo Hospitals and IBM, towards building a ‘National Health Data Network’ for providing a full range of service offerings for the healthcare community. Conceptualised and developed at Apollo, this unique and first-of-its-kind initiative in India will ride on IBM’s IT infrastructure to roll out best-in-class applications for improving clinical and financial performance of hospitals. This special session was conducted and delivered by the senior executives of the Health Hiway team comprising – Ashvani Srivastava, PresidentStrategic Initiatives, Apollo Hospitals Group, Mohammed Hussain Naseem, VP – Healthcare, IBM and Srivathsan Aparajithan, Head – Healthcare Business Solutions, IBM. # Session V: ‘Community & Public Healthcare- Solutions, Best Practices,Challenges’ The third day of the event began with a session that attempted to explore www.eHealthonline.org

eHealth India 2007 Photo Gallery

September 2007

EVENT REPORT

Medical College, New Delhi; S K Meher, Sr. Programmer, AIIMS, New Delhi and Manish Chawla, Polycom.

innovative solutions, case studies and best practices of technology usage in community healthcare in India. Probably the most pertinent discussion topic for any healthcare conference in India, this session brought together a highly eminent panel consisting of Dr. K. K. Ghosh, Head- Medical Electronics & Telemedicine Division, Dept. of IT, Govt. of India; Dr. S B Gogia, President, IAMI; Dr. K. Ganapathy, Head- Apollo Telemedicine Networking Foundation; Dr. Rakesh Biswas, Associate Professor, Dept. of Medicine, Melaka Manipal Medical College, Malaysia and Nalini Gupta, Marketing Advisor- Chairman’s Office, Reliance Communications. A number of initiatives from across government, academic and corporate sectors were brought forth and discussed with in-depth detail and dexterity, which generated a high octane brainstorming with speakers and audience alike. # Session VI: ‘Insurance, Banking & Healthcare Outsourcing Imperatives of eHealth Adoption’ While IT and electronics are sweeping the healthcare industry, opportunities are galore for insurance firms, banking institutions and healthcare outsourcing companies to offer valued-added services and capitalise in this widening business ecosystem. Chaired by Trevor Hodge, Sr. VP (Investment Strategy & Alliances), Canada Health Infoway, the session had captivating presentations by Kamalnaini Sharma, Regional Maanager 22

- Rural & Agri Business, ICICI Lombard and Anand Rangachary, Managing Director(South Asia & ME), Frost & Sullivan. While Kamal showcased the online health insurance application and processing systems of ICICI Lombard and their value-added services for individuals and hospitals, Anand presented the market potential for financing and healthcare outsourcing industry covering healthcare sector investments, clinical research outsourcing, offshore diagnostics and medical transcription. # Session VII: ‘ICTs for MedicoHealthcare Education - Capacities@ Classroom’ To ensure that technology and IT investments in healthcare finds adept hands to make them work at highest levels of efficiency, capacity building of doctors, paramedics, nurses and health administrators is of prime importance. Introduction and usage of ICT tools in classrooms and training programs forms the basis for fulfilling such requirements. Chaired by Dr. Ved Prakash Mishra, Chairman, Post-Graduate Medical Education Committee, Medical Council of India & VC, Datta Meghe Instt. Of Medical Sciences, Nagpur this session highlighted some of these initiatives at medical colleges and corporate enterprises. The speakers were Dr. P.S. Reddy, VP(Operations) & Chief Content Officer, Medvarsity Online Ltd; Dr. Dr. Achal Gulati, Professor, Maulana Azad

# Session VIII: ‘Future of Integrated Healthcare: policy implicationsstandardisations – delivery modelsbest practices’ The conference concluded with a lively panel discussion which delved deep into issues and insights of two days of deliberation with an attempt to envisage the emergence of an integrated healthcare environment. Moderated by Dipanjan Banerjee, Product Lead, eHealth Magazine - the panelists included Trevor Hodge, Sr. VP (Investment Strategy & Alliances), Canada Health Infoway; Werner van Huffle, Health & Human Services Industry Strategist, Public Sector Group, Microsoft Asia Pacific; Sandeep Sinha, Program Manager-Healthcare Delivery & Health IT (South Asia & Middle East), Frost and Sullivan; Dr. BS Bedi, Convener of National Task Force on Telemedicine, Ministry of health & Family Welfare, GoI & ExDirector Telemedicine DIT, GoI; Rajeev Sood, Industry Head- Public Services, SAP and Nabaroon Goswami, Dy. General Manager, e-Meditek Solutions. The conclusion that emerged from the discussion reaffirmed a broad consensus among the panelists on the idea that standards of public healthcare are at different and often varied levels of maturity in different geographies. Each model must suit the socio-economic and demographic situation it serves and must reflect out-of-the box thinking for tackling local challenges. Technology is unanimously accepted as an enabler for healthcare management and need for more public-private partnership has been called for. In the same tune, it is also required to have an integrated healthcare model, allowing sharing of the basic clinical data. Public health policies too need to have a dedicated focus on IT and service standardisation norms. Wishing you a e-Healthy year ahead!

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NEWS REVIEW

WORLD

IRELAND TO INVEST EURO 500MILLION IN E-HEALTH

UNIVERSITY OF QUEENSLAND DEVELOPS TELEHEALTH ROBOT

s part of the National Development Plan (NDP) 2007-2013 the Irish Government plans to invest nearly 500million Euro in deploying ICT facilities and capacity building in public health systems over the next seven years, at the rate of 70million Euro per year. The six-year investment plan is intended to provide the funding to deliver Ireland’s National Health Information Strategy. ICT developments in the health service will be targeted at improving patient-centric systems in our hospitals and community settings. This initiative will be directed at implementing systems that improve operational processes in public health services by supporting healthcare professionals, while capturing information, which is necessary to ensure proper planning for future. Some of the areas which will be given support includes chronic disease management

(for example diabetic care), emergency departments, medication management and health surveillance. The Irish Department of Health and Children said that they would be looking at investing in national ICT infrastructure to support health professionals working in a variety of settings. The Department also recognises ICT infrastructure as the foun-

RHAPSODY INTEGRATION ENGINE EXPANDS NHS TRUST CONNECTIVITY

rion Health Limited, a leading provider of integration and clinical workﬂow technology to the health sector, has recently announced that Rhapsody™ Integration Engine continues to be adopted at a rapid rate by NHS Trusts in England, answering the need to link together internal hos-

pital systems as well as interface to systems deployed under NHS Connecting for Health. In the past three months, Rhapsody has been deployed by three acute NHS Trusts representing altogether 7 hospital sites, 11,300 staff and more than one million patients. East Lancashire Hospitals NHS Trust and the Robert Jones and

September 2007

Agnes Hunt Orthopaedic and District Hospital NHS Trust have both adopted Rhapsody as a Trust Integration Engine. In addition, Northampton General Hospital NHS Trust has recently completed deployment of Rhapsody to manage integration to their LSP supplied systems. Northampton General Hospital NHS Trust has implemented Rhapsody to provide inter-system messaging across critical clinical systems. Rhapsody is currently processing 6,500 PAS messages daily in Northampton. Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust (RJAH) is using Rhapsody to transfer radiology reports from their newly implemented Radiology Information System (RIS) to local GPs and into the Trust’s Graphnet Electronic Patient Record.

dation for provision of modern information systems within the health service that will help to enhance patient care. In addition to this, ICT funds will also be used for development and improvement of support systems which are required to provide information for planning and management purposes in health services.

niversity of Queensland’s Centre for Online Health - a world leader in telemedicine research is helping Queensland doctors conquer the tyranny of distance and improve delivery of specialist medical care. The university has developed a wireless robot- Ekka, which can be wheeled to the bedside of sick children for video-link consultations with Brisbane specialists, reducing the need for families to travel to the city for specialist care. The Ekka robot is one of four robots that will be commissioned over the next three years, thanks to a $335,000 grant provided by mining company Xstrata (Community Partnership Program), through the Royal Children’s Hospital Foundation. The project is an extension of the telepaediatric research led by the Centre for Online Health, in collaboration with the Royal Children’s Hospital in Brisbane.

MEDISYS HELPS IDENTIFY PUBLIC HEALTH THREATS THROUGH INTELLIGENT WEB SEARCH SYSTEM

he European Commission has developed a medical intelligence system - ‘MediSys’, that constantly collects and sorts information from more than 1000 news and 120 public health websites for detecting early signs of epidemics, disease outbreak or industrial hazards. Complementing traditional approaches, MediSys will provide health authorities with real-time knowledge for helping to identify such incidents at the earliest possible instance and react in a timely manner. It can also provide invaluable information to authorities tackling incidents such as bio-terrorism attack. Using pre-deﬁned keywords and combinations, MediSys crawls through the web and sorts information into three primary categories: “Diseases”,

“Bio-terrorism”, and “Other Threats”. Articles or “hits” are then classified in more precise categories such as “AIDS-HIV”, “Respiratory infections”, “Avian flu”, “Legionella”, “Anthrax” or “Nuclear safety”. Statistics are stored on the filtered categories and “breaking news” is detected in a given category. Based on the level of new articles retrieved and the detected keywords, an automatic alert can then be sent by e-mail and SMS to decisionmakers who are on permanent standby. The system proved to be very fruitful during the outbreak of foot and mouth disease in UK. MediSys detected a sudden jump in news reports and automatically sent email and SMS alerts to Public Health officials across Europe for emergency preparations and action.

WORLD NEWS

NEPAL WIRELESS NETWORKING PROJECT WINS ‘ASIAN NOBEL PRIZE’ - TELEMEDICINE ALONG WITH OTHER RURAL SERVICES GETS A FILLIP Mahabir PunImelda Abano - a Nepali teacher has been honoured with the prestigious Ramon Magsaysay Award, regarded as the Asian Nobel Prize, in recognition of his innovative application of wireless computer technology in Nepal. He received the 2007 Award for Community Leadership and a US$50,000 prize along with six other awardees in Manila, Philippines. The project meets the communication needs of a remote hilly area in Nepal, which is seven hours climb to the nearest road and deprived of any telephone connection. Under this project, a few villagers and a team of international volunteers initially powered several computers with small hydro-generators in a nearby stream, and thereafter linking them wirelessly to the Internet with a series of television dish antennas and mountaintop relay stations, using the nearest telephone connection in the town of Pokhara - a two-day trip away. The project has so far provided 14 rural villages with access to services like telemedicine, distance learning, e-marketing of local products and telephone services.

UAE GOVERNMENT ANNOUNCES NEW FEDERAL HEALTH STRATEGY AND MODERNISATION PROGRAM The Ministry of Health, UAE has announced 35 initiatives in public healthcare to be implemented in the next three years. The ministry is seeking to become the regulator of healthcare services under the new health strategy for 2008 to 2010, which includes unifying healthcare policies and offering more medical specialties. The plan aims to ensure medical services to all UAE nationals and residents, promote best international practices, enhance preventive medicine to combat the spread of epidemics and infectious diseases, increase the community’s awareness of services and how to beneﬁt from them. The initiatives include building an electronic network connecting hospitals and healthcare centres in the UAE, building a medical archiving system and national health database in association with the UAE e-Government, and developing a comprehensive training programme for health staff. The ministry’s ultimate objective is to lay the foundation for sustainable development within the healthcare sector, which follows international best practices. Public hospitals are expected to become self-managing by 2010 with operational and ﬁnancial independence. Source: http://archive.gulfnews.com/articles/07/08/13/10146145.html

NEW YORK GOVERNOR LAUNCHES COMPREHENSIVE HEALTH INFORMATION TECHNOLOGY PROGRAM In order to advance patient-centered care and enable improvements in health care quality, affordability and outcomes for each person, family and business in New York, Governor Eliot Spitzer’s recently announced the launch a comprehensive health information technology program. An initial $106 million will be invested in the health care community during 2007-2008 to support the implementation of health IT tools to allow portability of patients’ medical records and new tools to assess and target improvements in health care quality. The Ofﬁce of Health Information Technology Transformation has been charged with coordinating health IT programs and policies across the public and private health care sectors. These programs and policies will establish the health IT infrastructure and capacity to support clinicians in quality-based reimbursement programs and new models of care delivery.

ADOPTION OF HEALTH TECHNOLOGIES IN INDIA - IMPLICATIONS FOR THE AIDS VACCINE INDRANI GUPTA, Institute of Economic Growth, Delhi MAYUR TRIVEDI, Institute of Economic Growth, Delhi SUBODH KANDAMUTHAN, Institute of Health Systems, Hyderabad About the Book The effectiveness of a new health technology is judged by both its accessibility and also the extent to which it has been adopted in a particular country. With the possibility of an AIDS vaccine in the near future, the International AIDS Vaccine Initiative (IAVI) has emphasised the need for countries to prepare well in advance for its smooth access and adoption. Reiterating IAVI`s appeal, this book ably captures the course India needs to take for the successful adoption and implementation of the AIDS vaccine in India.

The ﬁrst of its kind, this book examines the adoption of four health technologies in India—Hepatitis B, No Scalpel Vasectomy, Voluntary Counselling and Testing and Antiretroviral Treatment. Using a set of parameters, the authors not only bring to light the various dimensions, strengths and weaknesses of adoption of health technologies in India, but also how and where more attention needs to be paid with regard to the adoption of the AIDS vaccine. Publisher: SAGE Publications Pages: 236 pages Price: Rs 295 ISSN No.: (978-0-7619-3590-2) .

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NEWS REVIEW

BUSINESS

LIFESIZE BAGS BIRMINGHAM CANCER NETWORK CONTRACT IN UK, EXPANDING BUSINESS IN INDIA FOR THE FAST GROWING AUDIO-VIDEO MARKET LifeSize - the high deﬁnition video communications company, recently announced their success in wining a deal from Pan Birmingham Cancer Network in UK, for providing high deﬁnition video communications for their new telemedicine program. By aiding a network responsible for the care of 1.6 million people, the LifeSize systems are playing a vital role in the diagnosis, treatment and care of cancer patients. Network clinicians, are already using the technology to regularly review cases and adopt or change courses of treatment.

Apart from saving consultants’ time, the system also enables hospitals to provide more timely patient care. In addition, it allows for more inputs from specialists at other sites who otherwise might not have been able to attend. LifeSize Communications, also announced its plans of expansion in the Indian market by signing distribution agreements with leading resellers like - Actis Technologies, Enkay Technologies and SEC Communications, in addition to its existing channel partner, PLUS Business Machines.

With a large number of systems already installed in India, LifeSize and its partners aim to reach out to customers in key verticals such as government, large enterprises, BFSI, telemedicine, the education sector and the technology and service industries. [According to industry estimates, the audio-video conferencing industry in India stood at Rs. 100 core at the end of 2006-07, up from Rs. 65 core in the preceding ﬁnancial year and is likely to grow at a CAGR of 24.9% through 2011 --- to be included as a special window item just after this news]

LIPIDLABS ACQUIRES AND ADOPTS ‘TELEMEDICUS (TMI)’ CORPORATE NAME AND TECHNOLOGY LipidLabs, Inc. announced its board resolution that adopts the Telemedicus (TMI) corporate moniker as they move forward into the telemedicine marketplace. LipidLabs has recently purchased the assets of Telemedicus, Inc., including the “Disaster Relief and Emergency Medical Services (Dreams) Technology” and related communication equipment and technology developed by Texas A&M University. The ‘Dreams Technology’ was developed through a $20 million funding from Department of Defense for cutting-edge emergency medical response projects. Through high-quality video, doctors in hospital emergency rooms can see and direct the ﬁrst responders’ treatment of the patient. This technology improves trauma victims’ probability of survival, especially in remote areas, offshore drilling and battleﬁelds beyond the physical reach of medical specialists in well-equipped trauma centers. The Telemedicus technology has been in operation since 2003 in Houston and in Liberty County, Texas. It can be used to treat trauma casualties anywhere conventional advanced emergency medical treatment is unavailable - in military operations, offshore drilling operations and in rural areas.

LIFE-SAVING TECHNOLOGY GETS AN UPGRADE IN NORTHERN CANADA Life saving diagnosis of a patient who survived stroke in North Bay, Canada with remote assistance from a neurologist 300 Km away in Toronto via telecommunications technology and digital brain images captured and transmitted by using computers, cameras and software have recently been held up as a testament to the technology upgrade initiative of Northland Transportation Commission. The commission’s telecommunications branch

September 2007

will invest about $4 million to improve and expand bandwidth and security for healthcare services. The work will allow all 117 hospitals in North Canada to link up to a high capacity healthcare network. This $12 million project to be implemented over the next ﬁve years will be done in collaboration with Smart Systems for Health Agency a telemedicine services ﬁrm, along with telecom partners - Hydro One Telecom and Ontera.

HEALTHCARE ONTHE-FLY : MEDLINK TO PROVIDE MEDICAL SUPPORT TO SPIRIT AIRLINES PASSENGERS MedAire Inc., a global provider of remote medical education, expertise and equipment, recently announced that US based Spirit Airlines will add MedAire’s 24/7 MedLink Global Response Services to its entire fleet. (Spirit Airlines Inc. is the largest Ultra Low-Cost Carrier in the US, Latin America and the Caribbean). MedLink will provide flight attendants and pilots with a onecall solution for in-flight medical situations, through board-certified physicians working at a level-one trauma center in Phoenix, Arizona. As part of the three-year agreement, crew members on-board Spirit’s fleet of 36 aircraft will have 24-hour access to MedLink from anywhere around the world, using the aircraft’s existing communications system. MedLink physicians, who have extensive experience in the field of aviation-specific medicine, manage thousands of medical emergencies every year.

AFFILIATED COMPUTER SERVICES, INC. TO IMPLEMENT MALTA GOVERNMENT’S INTEGRATED HEALTHCARE IT SYSTEMS PROJECT Afﬁliated Computer Services Inc. has signed a Euro 15 million contract with the Government of Malta for delivering an integrated healthcare IT system to improve patient care. Named as ‘Integrated Health Information System’ (IHIS), the project will result in the installation of state-of-the-art digital medical equipment at Mater Dei Hospital the nation’s largest care facility. ACS Healthcare Solutions’ picture archiving and communication systems, radiology information systems and library information systems will be installed at

Mater Dei in an effort to vastly improve clinical care records and documentation. By initiating this project, the Ministry of Health in Malta started its effort to provide high quality medical and healthcare services for citizens and also build provisions for planned future expansion of Malta’s healthcare network 25

BUSINESS NEWS

ANOTO GROUP’S ‘FORMS SOLUTION’ FOR HEALTHCARE SECTOR PROMISES TO GREATLY INCREASE OPERATIONAL EFFICIENCY OF HOSPITALS Anoto Group, the pioneer in Digital Pen & Paper (DPP) technology, has launched the Anoto Forms Solution, a ready-made hardware and software package that will enable the healthcare market to roll out DPP applications more quickly and easily. The bundle is designed to electronically capture and transmit data that has been entered into paper based forms by healthcare workers, dramatically reducing administration time for all staff. The Anoto

Forms Solution includes the ﬁrst ever Anoto branded digital pen, which will be available exclusively as part of the new package. Anoto Digital Pen and Paper technology automatically stores what a user writes or draws. The pen

FROST & SULLIVAN CONFERS RAYTEL CARDIAC WITH THE ‘2007 NORTH AMERICAN MARKET LEADERSHIP AWARD’ FOR THE CARDIAC MONITORING AND DIAGNOSTIC SERVICES SEGMENT Frost & Sullivan has selected Raytel Cardiac Services as the recipient of the 2007 North American Award for Market Leadership in the cardiac monitoring and diagnostic services market, by commending the company for its dominant presence in pacemaker services and its signiﬁcance in other ambulatory monitoring segments. Pacemaker monitoring is an established service market segment in ambulatory monitoring. These services stem from the need to routinely get checkups on implanted pacemakers. As some checkups can be accomplished simply over the phone, it has created a lucrative market for health service providers. According to Frost sources, Raytel Cardiac is also offering various value-added components to its services, for example, the large variety of options in payment and service. Beginning with basic data acquisition from the device, Raytel’s services include the interpretation of the report by a consulting physician, if requested. Moreover, the company has gained recognition for maintaining the highest level of quality of technicians and reporting services. It also provides everyday notiﬁcation to physicians to meet the prescribed criteria for their services.

records what is being written on to a form printed with Anoto special dot pattern. This data is transmitted back to a PC or server via a docking station or a mobile phone, without the need to type up notes. It has a successful track record in the healthcare sector for improving staff productivity and reducing costs by making form-based processes more effective, without changing existing working routines or re-training staff.

IBM/MAINSOFT PORTAL SOLUTION TO SERVE MEDICAL COMMUNITY IBM and Mainsoft Corporation, recently announced that the Belgian University Hospital Ghent (UZ Gent) has chosen IBM WebSphere Portal Version 6.0 to develop a self-service virtual information center for its 5,000 staff members, students, healthcare professionals, plus more than 380,000 patients and their families that visit the hospital each year. Using the .NET-Java interoperability software from Mainsoft, UZ Gent’s .NET development team will use the Visual Studio 2005 development environment to integrate its existing .NET application framework, 15 strategic .NET applications, more than ﬁve terabytes of data stored in an Oracle database, and an LDAP (Lightweight Directory Access Protocol) repository. According to Dr. Bart Sijnave, CIO, UZ Gent the choice of IBM’s open architecture and Mainsoft, because of the platform-independent nature of the solution, which will help to respond quickly to emerging needs and changing technological circumstances. Expected beneﬁts include, enhanced communications with patients and their families, who will use the portal to locate doctors, request their medical records, make appointments and pay bills online, as also, streamlined collaboration with health professionals who will be able to make referrals, request consultations, transfer patients and access continuing education programs, and unique entrance for researchers and students to exchange knowledge and best practices in healthcare. And also reduced operational expenses associated with managing patient records, information exchanges and billing.

FORTIS PLANS TO ESTABLISH MEDICITY IN GURGAON

IBA HEALTH REPORTS 50% INCREASE IN PROFIT

Fortis Healthcare recently revealed plans to set up a medicity in Gurgaon, and another 28 hospitals all over India by 2010. The group will invest Rs 1,800 crore (approx. USD 438 million ) on the project. In the next three years, they plan to become a national player and are eyeing the western and southern parts of India market. Post-expansion, the company is aiming to have 7,000 beds, treat 1.75 million patients and carry out two lakh operations and surgeries yearly. For this purpose, they intend to have 40 hospitals under the Fortis group across 14 states by 2010. The group will invest Rs 800 crore on the medicity project at Gurgaon, while the remaining funds will be intended for establishing or developing 28 hospitals. The total expenditure for the growth at Fortis that comprises management deals and acquirements, greenﬁeld plants could be to the tune of half a billion dollars. Out of which, the company’s involvement would be about Rs 1,000 crore (approx. USD 243 million).

IBA Health Limited (ASX-IBA), the largest health information technology company listed on the Australian Securities Exchange, recently announced a profit after tax (after minorities) of $22.9 million for the year till 30 June 2007, up by 50 per cent from FY2006. Revenue increased by 26% per cent to $74.7 million. IBA Health provides information and communication solutions to connect providers, payers, patients and communities, it now has a presence in five Asian countries as well as in the Middle East, Africa, Australia and New Zealand. With their world class solutions, low cost infrastructure, centre of excellence in Bangalore and a network of offices throughout the region they are well positioned to capitalise on major opportunities as these countries upgrade their health infrastructure. The results reflect the continuing success of their acquisition strategy and their ability to unlock the value of these acquisitions to generate organic growth.

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Anurag Dubey, Shwetha Thomas, OR visit: www.frost.com/HealthITsummit

* By Invitation Only

PRODUCT PROFILE

ICR1000

• •

• • • •

• •

T r u e Flat Scan Path™ Ultra precise scan and protective cassettes 300,000+ high resolution images per plate Touch-free active area of phosphor plate for artifact free image Positive traction drive system for transport of imaging plate across scan head For use in general radiology, orthopedics, dental and pediatric applications as well as to complement existing centralized CR installations Maximum capacity of 70 plates per hour throughput Small footprint and optional wallmount for small spaces or installation inside X-Ray room

For details contact: iCRco, Inc. 2580 West 237th Street Torrance, CA 90505 Phone: (310) 921-9559 Fax: (310) 921-2559 Email: info@icrcompany.com

NIVOMON SERIES

Nicomon : NonInvasive Continuous Cardiac Output (NICO) Vasomon : Peripheral flow (IPG & OIP) Nivomon : NonInvasive Continuous Cardiac Output (NICO) with Peripheral flow (IPG & OIP) Features: • High resolution 10.4” colour TFT display • Non-Invasive Technique to measure Cardiac Output (CO) • Impedance plethysmography principle • User-friendly medical signal display with Patient information 28

• Real time signal processing • Calibration that guarantees the performance of whole system • Data storage and analysis facility for multiple patients • USB printer compatibility • Light weight • Patient safety as per IEC standards • Displays Heart rate, ECG and cascade waveform along with on-screen indicators For details contact: Larsen & Toubro Limited Medical Equipment & Systems Powai Campus, Gate No.7 Annexe Building, 2nd floor, Saki-Vihar Road, P.O Box 8901 Mumbai - 400 072, India Tel: +91 (22) 67051223 Fax : +91 (22) 67051276 E-mail: ebg-med@lntebg.com

MICROMON N-XT

Features: • High-resolution 5.2” (diagonally) CRT display (640x480 pixels) • Optional single channel recorder • Cautery and defibrillator protection • Programmable Arrhythmia package for Tachycardia, Bradycardia , Asystole, Skipped beat and Irregular • Four gain setting for ECG waveform • Colour coded and graded alarms, red for patient related and yellow for machine related • Cautery and defibrillator protection • Mains and optional battery operation [in-built battery] for 2hr • External battery jack (12V) for car battery • Can be interfaced to L&Ts central station – Skyline For details contact: Larsen & Toubro Limited Medical Equipment & Systems Powai Campus, Gate No.7 Annexe Building, 2nd floor, Saki-Vihar Road, P.O Box 8901 Mumbai - 400 072, India Tel: +91 (22) 67051223 Fax : +91 (22) 67051276 E-mail: ebg-med@lntebg.com

BPL CLEO (BPL HEALTHCARE)

Features: • 14.4 cm (5.7”) STN Blue LCD with backlit display • Trend of SpO2 and Pulse Rate for last 24 hours (Optional display) • Compact & Portable • Plethysmograph • Signal Strength • Numeric Value of SpO2 and Pulse Rate • Pitch Tone Variation for different SpO2 Values • Built-in rechargeable battery For details contact: BPL Limited Healthcare Business Group BPL Towers, 13, Kasturba Road Bangalore - 560 001, India Ph: 91 80 22270134 Fax: 91 80 222 75641

DF 2509 R DEFIBRILLATOR (BPL HEALTHCARE)

Features:

Less than 5 seconds to charge to 360J with battery 100 Charge/ discharge of 360J with fully charged new battery Event Recording Thermal Printing LCD for sharp & bright non fade display (Without Recorder Model DF 2509 also available) For details contact: BPL Limited Healthcare Business Group BPL Towers, 13, Kasturba Road Bangalore - 560 001, India Ph: 91 80 22270134 Fax: 91 80 222 75641

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SPOTLIGHT

An Initiative Towards Affordable Surveillance Recognising that good information is essential to every aspect of public health planning - from outbreak response, to identiﬁcation of priorities, and evaluation of programs - the United Nations Foundation and The Vodafone Group Foundation launched a health data surveillance programme in 2006 Adele Waugaman

p-to-date, accurate data is a necessity for public health, and providing that data requires affordable information technology. That’s the premise behind a joint project of the United Nations Foundation and The Vodafone Group Foundation to support digital health data systems in developing countries. Through a partnership with the UN World Health Organization and DataDyne. org, a non-governmental organization, the foundations have launched a programme that empowers developing country public health professionals to use sustainable technologies to save lives. The programme strives to make quality health data as accessible as the mobile phone by putting effective health data-gathering tools in the hands (literally) of health workers on the ground. Most information about public health in developing countries is collected on paper, usually by means of houseto-house surveys. The process of collecting and then entering this information into computers, so that it can be aggregated and analyzed can take months or even years. The same dataentry process can also introduce errors. Recognising that good information is essential to every aspect of public health planning – from outbreak response, to identification of priorities, and evaluation of programs – the United Nations Foundation and The Vodafone Group Foundation launched a health data surveillance programme in 2006. Powered by the free, easy to use, open source, EpiSurveyor mobile software tool, the programme enables health experts to get critical health information more quickly and accurately, even in resource poor environments. With the Episurveyor, governments and international organisations can now access more timely and accurate data on which to base crucial public health decisions.

FROM MEASLES TO MOBILES

The partnership between the United Nations Foundation and The Vodafone Group Foundation began in 2003 when Vodafone became the largest corporate sponsor of the Measles Initiative—a coalition of NGOs, governments, and international organizations including the World 30

Health Organization, U.S. Centers for Disease Control and Prevention, the American Red Cross, and UNICEF. The Measles Initiative supported the vaccination of millions of children against measles, the number one vaccinepreventable killer of children in Africa. Together with the WHO and UNICEF, the measles Initiative pursued the goal to reduce measles mortality by 50% in just five years, between 2000 and 2005. Hard work by country governments, with support from the Measles Initiative partners, enabled countries to surpass this goal and reduce global measles deaths by 60 percent—an impressive 2.3 million lives saved. Having exceeded the 50% reduction target, WHO, UNICEF, and country governments, with support from Measles Initiative partners, are redoubling their efforts to reduce mortality from measles. In 2006, WHO and UNICEF announced a new goal: reduce global measles deaths by 90% by the year 2010.

REACHING THE MEASLES INITIATIVE GOAL

To meet the new 90-10 goal, Measles Initiative partners requires a high standard of information. Programme leaders must have access to accurate and timely data to determine the initial rate of measles deaths, number of children vaccinated, and subsequent decreases in mortality rates. Experience has shown that handheld digital data collection is far superior to paper-based systems. Prior to the use of EpiSurveyor, the available commercial software required expensive consultant programmers every time a new form was needed, or an old form needed to be modified. To help fill this gap, the United Nations Foundation and The Vodafone Group Foundation have built on their support for the Measles Initiative by funding the development of the pioneering EpiSurveyor mobile health technology—a software tool with the power to overcome one of the greatest challenges facing international public health: the collection of timely, accurate, reliable data www.ehealthonline.org

AN INITIATIVE TOWARDS AFFORDABLE SURVEILANCE

SPOTLIGHT

THE OPEN SOURCE EPISURVEYOR MOBILE SOFTWARE TOOL ENABLES HEALTH EXPERTS TO GET CRITICAL HEALTH DATA MORE QUICKLY AND ACCURATELY, EVEN IN RESOURCE POOR ENVIRONMENTS

to support analysis and decision-making. In several countries improved technology is being introduced to gather more efficient, reliable, and accurate data.

DATADYNE’S EPISURVEYOR

Joel Selanikio, a technologist, a physician, and an epidemiologist, had just the right combination of experience to come up with the powerful idea behind this mobile health solution. Through the course of his work as a Wall Street computer consultant, a pediatrician, and a medical officer at the U.S. Centers for Disease Control and Prevention, Dr. Selanikio developed an interest in applying computer science to the public health domain. In 2003 he and technologist Rose Donna, formerly of the American Red Cross, created DataDyne to improve the quantity and quality of public health data. With support from the UN Foundation and The Vodafone Group Foundation, Selanikio created EpiSurveyor, DataDyne’s premier software solution, shortly thereafter. EpiSurveyor allows anyone with average computer skills – the ability to use a word processor or email, for example – to create and share mobile data collection systems in minutes, and without the need for consultant programmers. In keeping with its mission to break down the barriers that block access to health data in developing countries, EpiSurveyor is free— anyone with internet access can download the programme. EpiSurveyor is also open source, enabling those with higherlevel programming skills to manipulate the programme to 32

respond to health needs as they arise. Finally, EpiSurveyor is built to run on mobile devices, enabling maximum mobility and ease-of-use for health workers who spend most of their time in the field. EpiSurveyor operates using a Java-based engine and a Windows-based Designer application that allows fast and easy creation of forms and data systems. In addition to pioneering DataDyne’s open source solutions for international public health, Dr. Selanikio also works hand-in-hand with public health officials – including those with the health ministries and the WHO – to develop “train the trainer” sessions that enable in-country officials to use the EpiSurveyor software. EpiSuveyor’s adaptable and scalable software makes it ideal for tracking integrated health campaigns, such as those organized by the Measles Initiative that frequently distribute Vitamin A and anti-malaria bed nets during measles vaccination campaigns. Once trained in its use, health professionals can use EpiSurveyor for a range of activities: from household surveys to clinic surveillance, from outbreak investigation to medical recordkeeping. Local capacity is greatly enhanced, while dependence on consultants is correspondingly eliminated.

KENYA AND ZAMBIA PILOTS

With funding from the UN Foundation and The Vodafone Group Foundation, and in partnership with the World Health Organization (WHO), DataDyne launched pilot programmes to build digital health systems in Kenya and Zambia. The goal www.ehealthonline.org

of these pilots was to replace paper-based health surveillance systems used to collect measles data in Africa with more efficient and effective digital systems that use PDA-based systems. In both countries, programmes began by training health supervisors in every province on the use of the EpiSurveyor software running on low-cost Palm Zires. Selanikio conducted the training along with WHO officials, and worked closely with local Ministries of Health to support the programme’s local integration. Trainees have since trained scores of other local health staff, advancing sustainability and reducing future costs. Initial data received from the field in these countries confirmed that the programme was gathering increasing amount of information related to a variety of issues: measles, HIV, maternal/child health, clinic management, and others. In some cases, the programme provided data faster than before; in others, it provided data that had never been collected at all. The result has been to provide health workers in the participating countries with a flexible tool for the collection and rapid analysis of a whole variety of health data. This in turn has enabled them to understand better the strengths and shortcomings of current health systems, to investigate outbreaks faster, and in general to better understand complex but critical public health issues in their countries.

IN JULY 2007, FOLLOWING A NATIONWIDE MEASLES INITIATIVE IMMUNIZATION CAMPAIGN, ZAMBIAN HEALTH WORKERS USED EPISURVEYOR TO DETERMINE VACCINATION COVERAGE RATES

MEETING OTHER CHALLENGES

In addition to providing information for monitoring and fighting communicable diseases, EpiSurveyor’s flexible epidemiological surveillance software enables health workers to implement an early warning system for epidemics. This was demonstrated recently in Kenya, where EpiSurveyor was used to help contain an outbreak of polio—a disease nearing total eradication in Kenya. The last native case of polio in Kenya was seen as far back as the 1980s, but in early 2007 political unrest and fighting in neighboring Somalia brought unvaccinated refugees, and a new wave of the poliovirus, back within Kenya’s borders. Titus Kolongei, a health officer with the KEPI (Kenya Expanded Programme on Immunizations) and member of the first group of EpiSurveyor trainees, adapted the software to September 2007

track infected children and those with whom they had come into contact, thereby tracing the path of the virus as it moved through Kenya. Kolongei also used EpiSurveyor to evaluate the success of an accompanying effort to immunize almost two million children in areas surrounding the outbreak. Previously, the use of such “advanced” handheld tools would have required the enlistment of expensive consultants from overseas, but empowered with EpiSurveyor, KEPI officials like Kolongei were able to contain a potentially catastrophic disease outbreak without outside assistance. In Zambia, health workers have likewise modified EpiSurveyor to meet needs as they arise. After an initial training, health officials there developed new digital health data forms for a range of monitored illnesses, from yellow fever to diarrhoea. Health officials in Zambia also modified EpiSurveyor to digitize their daily administrative report, facilitating important communications between provincial field offices and headquarters.

CONCLUSION

The success of this sustainable, mobile health data surveillance system in empowering the measles control effort, and in developing fast, creative solutions to containing other lifethreatening diseases, has led the WHO to adopt EpiSurveyor as a standard for data collection in sub-Saharan Africa. The WHO will soon expand the use of EpiSurveyor throughout the continent to equip health workers with sustainable tools to save lives by fighting a range of diseases, and supporting related data collection and analysis. EpiSurveyor allows anyone to very easily create a handheld data entry form, collect data, and then transfer the data back to a desktop or laptop for analysis. By cutting down on data collection time, it helps to rapidly identify stock-outs and other supply shortages. By eliminating the need to transfer data from paper to computer, it avoids unnecessary errors. And because it can be customized for unique applications by health officials, it empowers developing country health officials to develop and maintain their own surveillance programmes without using expensive consultants. For their part, the United Nations Foundation and The Vodafone Group Foundation plan to continue their support of developing countries’ transition to digital public health data systems, using low cost, open source software—technology that leverages the burgeoning mobile computing network to put tools for efficient public health management squarely within the hands of developing country health practitioners. As the success of the Measles Initiative shows, this unique public-private alliance of NGOs, individuals, governments, and intergovernmental organizations can open the door to the to stunning advances with the potential to revolutionize international public health. Adele Waugaman is Senior Officer, Communications and Strategy at the United Nations Foundation, where she supports the Technology Partnership program. The program, run in conjunction with The Vodafone Group Foundation, supports technological solutions to some of the world’s most pressing humanitarian problems. Ms. Waugaman holds an MA in International Affairs from The George Washington University.

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PERSPECTIVE

e-Health 2.0 : Opportunities for Public Health Informatics Diseases pose an immense challenge to those affected by them as well as for the care providers. Regular visits to the clinics and frequent investigations are required to monitor and prevent complications. This paper describes ideas for development of intuitive web based monitoring tools that could be of immense value in public health. Susheel Oommen John

ublic health informatics deals with the use of Information and communication technologies for addressing the health issues of the population rather than of individuals. In India, Public health informatics is still in its infancy. Most of IT deployment in health care is in the area of hospital management systems and telemedicine; one rarely comes across IT deployment for public health. There are some efforts by the Government of India to set up disease surveillance systems. The key difference in deploying IT for public health as compared to a healthcare IT deployment is in that the former focuses on preventive and promotive health. It aims to alter the risk of the populations for disease and disability through intelligent use of “information” through leveraging Technology.

BACKGROUND

It is generally believed that deploying Information technology solutions would drastically transform existing operational challenges. It is because of this popular notion that most of health care IT deployment has been limited to the niche areas of hospital management and telemedicine. It is rather unfortunate that intelligent use of information is not the focus, instead the hype about technology eclipses the entire arena. As a result the present generation of IT solutions deployed in India are rudimentary in terms of its real potential. Public health informatics depends heavily on the “information” rather than the technology. It is the intelligent capture, analysis and interpretation of “information” that has the potential to decrease the risk of disease and disability. Since India is still in its infancy with regard to deploying IT in the health sector, we could redesign our health systems based on available information and deploy a large country wide public health network that could radically transform the health of the populations. This calls for two radical changes in mindset- first being that “information” will remain at the core of all deployment of technology. The technology must match upto the requirements that information collection, collation and processing demands. This would necessarily mean that users 34

will be the ones driving and defining the need in contrast to the present trend of vendors pushing technology down people’s throats. It is expected that the Industry will see rampant growth when the users start defining the needs and technology is improvised to meet the growing demand. The second change in mindset requires that the concept of return on Investment be redefined; returns in terms of health risk reduction of the populations will take years to demonstrate. Technology must help us redesign the health systems rather than attempting to automate the existing workflows / practices.

WHAT IS HEALTH 2.0 ?

Health 2.0 derives its definition from the definition of web 2.0, where the technologies used allowed intelligent interaction between the users and the deployed solutions. Currently available technologies allow users to actively participate and contribute to the information that is front ended using web interfaces. Empowering the end user to add to the information pool would hold the key to a public health informatics network. Given the limitations of the present day health care and public health system in the country, current technologies offer avenues for re engineering processes by which end users contribute as well as benefit from the system. Since information is the key focus, technology should not be a bottleneck to the use of information, instead the systems must evolve such that standards are open (such as W3C), protocols are shared and everyone is able to use the systems irrespective of the technologies or tools they would like to use. The Industry must mature to a level where growth and penetration is seen beyond their quarter end metrics.

DISEASE SURVEILLANCE

One potential application of Health 2.0 concepts is in the area of disease surveillance. This could be used both during epidemics as well as non epidemic situations. www.ehealthonline.org

PERSPECTIVE

E-HEALTH 2.0 :

OPPORTUNITIES FOR PUBLIC HEALTH INFORMATICS

Assume a particular geographic location is under threat for an emerging epidemic such as avian influenza. The population can be sensitized about the symptoms when “bird flu” is to be suspected; they could then be asked to upload the demographic details of the person at risk through a cell phone or a toll free number. The disease surveillance team then records the details into a database. The epidemiologist could use data mining tools to locate the geographical areas with maximum disease intensity and target the interventions based on the intelligent information available, that would actually be contributed by the affected people. In this way the burden on the public health system could be drastically reduced so that they could meaningfully engage themselves in implementing interventions.

USING HEALTH 2.0 CONCEPTS FOR DENGUE OUTBREAKS:

Dengue outbreaks are a matter of great concern as they take several hundred lives year after year. Deploying a dengue information and management system could drastically improve the situation. Well before the dengue season, a dengue monitoring unit could be set up. This would have a web interface where users (affected people, health care workers, volunteers) could register themselves and log in to use the information (about prevention and precautions). They could add information about a particular locality where many cases are having the suggestive symptoms and signs. This could be done using an SMS gateway, web interface or a toll free call centre facility. The information that is added through these different channels could then be integrated into a database that is interfaced to a Geographic Information System for complex analysis, outbreak prediction and geographic spread. Besides the information about the cases, the portal could also provide information about the health facilities that are providing the primary services (screening), the lab support services, testing for platelet counts, and special services such as dengue serology and platelet transfusions. The intelligent capture and use of information could avoid unnecessary delay and anarchy that one witnesses during every dengue season. The system should be capable of integrating with other existing information systems such as the meteorological data, municipal corporations’ data on high risk areas for vector breeding and vector control data. The information available from this system could be made available to the electronic and online media, particularly for round-the-clock news channels, who would be able to disseminate intelligent information to their viewers and could potentially save lives rather than ruminate over some sore dengue related incidents or government’s inability in avoiding such outbreaks. The explosive growth of Internet penetration and information technology could translate into better health for the citizens of India.

ANTIBIOTIC RESISTANCE: POTENTIAL AREA FOR PUBLIC HEALTH INFORMATICS

During episodes of infections, the human body is invaded by certain organisms that are viral, bacterial or fungal. The rapid multiplication of these organisms within the body leads to symptoms specific to the areas where they invade. It is common belief that any infection should be treated using antibiotics, therefore both medical professionals as well as the affected person use antibiotics indiscriminately. Antibiotics are chemical substances that have a specific action against a specific group of organisms. If they are used indiscriminately then the organisms that they are meant to attack, develop resistance. As a result the antibiotics turn ineffective. From the public health perspective this poses a huge challenge. This could be effectively addressed through leveraging ICT initiatives. Currently the information about organisms responsible for a particular type of presentation is only known to specific institutions that attempt to culture and identify the causative organism. Once the causative organism is identified, antibiotic sensitivity pattern is carried out. This helps in identifying the most effective antibiotic. Despite several institutions doing this exercise, the information remains isolated as islands of knowledge. Effective deployment of technology could be leverage to connect these islands of information and form bridges between them and the users ( Medical Practitioners ). Currently due to the paucity of this information, large number of medical practitioners rely on skewed information provided to them by representatives of the pharmaceutical industry, who are not known to act in the best interest of patients or science in general. Imagine a system where antibiotic sensitivity pattern for common organisms are made available through a web portal to all practitioners in the country; assume they are able to query the system for specific diseases, seasonal patterns, multiple organisms with cross sensitivities. The practice of medicine could be radically transformed; there would be a significant transition towards evidence based practice of medicine rather than empirical prescription. This would save thousands of crores of rupees for the nation that is lost in unnecessary expenditure on drugs, something the pharma industry surely doesn’t want to hear. But in a growing economy could one afford to have leaking taps? Public health informatics is more about common sense than computer science, its about using information intelligently. India as a nation has seen its 60th year of freedom. It is time now that its citizens be made free to use the information and benefit from the information that is available.

Susheel Oommen John Research Resource Centre The Leprosy Mission Trust India susheel.john@gmail.com

www.ehealthonline.org

EVENTS DIARY

18 - 19 September, 2007

18 - 21 October, 2007

The Pan African Health Congress Johannesburg, South Africa

MEDIST 2007 Istanbul, Turkey.

www.panafricanhealth.com

www.cnr-medist.com

18 - 20 September , 2007

23 - 24 October, 2007

DIHE 2007 Dushanbe, Tajikistan.

World of Health IT ‘07 Vienna, Austria

www.caspianworld.com

http://www.worldofhealthit.org/

20 - 21 September, 2007

23 - 26 October, 2007

HIT 2007 Singapore

CMEF 2007 Autumn Chengdu, China.

http://www.availcorp.com/english/events_list. php?eventsid=114&backurl=index.php

http://en.cmef.com.cn/

www.frost.com/HealthITsummit

5 - 6 September

25 - 28 September, 2007

Global Healthcare Expansion Congress Hyatt Regency, Dubai

Vietnam Pharmed & Healthcare 2007 HoChiMinh City, Vietnam.

www.healthcareexpansion.com

http://www.vietfair.com.vn/Web/ProductDetail. aspx?proid=30&lang=en-US

31 October - 4 November , 2007

2 - 5 October, 2007

Sudan Health 2007 Khartoum, Sudan.

31 August - 2 September, 2007 Frost & Sullivan Health IT Summit Goa, India

26 - 28 October , 2007

5 - 7 September, 2007 West African Health 2007 Lagos, Nigeria. www.westafricanhealth.com

www.expomedical.com.ar

http://www.sudanhealth.com/?__LNG=2

http://www.minskexpo.de/

2 - 3 November 2007

9 - 11 October, 2007

Telemedcon 07 Chennai, India

Bio Technica 2007 Hannover, Germany.

http://www.tsi.org.in/default1.asp?name=Home

www.biotechnica.de

19 - 23 November 2007

10 - 12 October, 2007

IMTC International Medical Travel Conference Manila, Philippines

6 - 8 September, 2007 MEDEX Australia 2007 Melbourn, Victoria, Australia. www.expotrade.net.au

http://www.globallinkph.com/event_2007_ healthWorldExpo.htm

Medicine 2007 Minsk, Republic of Belarus.

6 - 8 September, 2007 ExpoMedical 2007 Buenos Aires, Argentina.

Health World Expo ‘07 Metro Manila, Philippines.

HOSPITAL 2007 St. Petersburgh, Russia www.primexpo.ru/hospital

www.availcorp.com/english/events_list.php?event sid=113&backurl=upcomingevents_list.php

10 - 12 September, 2007 10 - 12 October, 2007

23 - 25 November, 2007

BIM China 2007 Beijing China.

Chesilab Expo 2007 Tamilnadu, India.

www.bimchina.com.cn

http://www.scientificdealers.com/chesilab-expo/

12 - 14 September, 2007

12 - 14 October, 2007

30 November – 1 December 2007

HospiMedica 2007 Bangkok, Thailand

Medifest 2007 Pragati Maidan, New Delhi, India.

hospimedica-thai@mda.com.sg

www.vantagemedifest.com

Workshop on Medical Informatics & Biomedical Comm. MGIMS, Sevagram,Wardha, India

13 - 14 September, 2007

16 - 19 October, 2007

EU-Asia Medical Devices Business Meetings Bangkok, Thailand.

HospiMedica Brno 2007 Brno Exhibition Center, Czech Republic.

13 - 15 December 2007

www.asiainvest-thailand.com and/or www.euindiachambers.com

www.comnetexhibitions.com

www.hospital-india.com

MEDX 2007 Muscat, Oman. http://www.ebsoman.com and/ or http://www.medxoman.com

www.jbtdrc.org/July%202007/future_event.htm

Hospital India 07 Bangalore, India

www.ehealthonline.org

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