v o l u m e 3 | issue 9 | SEPT EMB ER 2008
ISSN 0973-8959
A Monthly Magazine on Healthcare ICTs, Technologies & Applications
Rs. 75
Cover Story: eHEALTH India -2008 Event Report Page 8
Development Dimension Revitalising Primary Healthcare in the information Age Joan Dzenowagis, Diana Zandi, Misha Kay eHealth Unit, WHO Page 18
Power Hospital: Parkway Hospital Singapore eHEALTH Page 32
Zoom In: Connecting People, systems and services eHEALTH
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|2 6 Ku Sun | 2 al w 7 N a ay o Pa Lum Re vem ge p so b No ur, rt H er . 3 Ma ot 200 0- la el 8 31 ys ia
Event Report: Making the eHealth Connection eHEALTH Page 48
Watch out for upcoming issues for exclusive regional surveys on IT usage and automation in Indian Hospitals.
November - South & Central India || December - East & North East India
For advertising opportunity in these issues, get in touch with - Arpan (arpan@ehealthonline.org, 9911960753)
w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 9 | September 2008
Cover story
CONTENTS
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eHEALTH INDIA 2008 Event Report 29-31 July 2008, Pragati Maidan, New Delhi
DEVELOPMENT DIMENSION
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Revitalising Primary Healthcare in the Information Age
Joan Dzenowagis, Diana Zandi, Misha Kay eHealth Unit, World Health Organisation
SURVEY REPORT
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IT @ HOSPITAL Survey 2008 Part - II, West India eHEALTH.
POWER HOSPITAL
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Parkway Hospital - Singapore eHEALTH
September 2008
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ZOOM IN
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Connecting People, systems and services eHEALTH
EVENT REPORT
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Making the eHealth Connection eHEALTH
EXPERT CORNER
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The Evolution of Surgical Systems - robotics applied to medicine Healthcare Practice Frost & Sullivan
RE G U L AR SE C T IO NS india news BUSINESS NEWS
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wORLD NEWS 40
NUMBERS
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EVENTS DIARY
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www.ehealthonline.org
IN-BOX I think you are providing a good platform to Healthcare IT in India. I started my career with healthcare IT but left India in 2004 due to lack of options and rigid attitude of market in mixing Healthcare Informatics with cabling and Networking and without any relevance to business intelligence and information management. Country like India can benefit greatly from the fundamentals of Information exchange. Dharmendra Ghai (Project+,CDIA+) Pacs INF. Specialist(Clinical IT Systems) HIS Department Hamad Medical Corporation Doha, Qatar ------------------------------------------------------------------------I have been going through your website and find the articles, newsletters quite interesting. I would like to subscribe to your weekly newsletter ehealth. Thanks & Warm Regards, Dr Fahad Mustafa Khan Business Analyst Healthcare and Lifesciences Consulting Infosys Technologies Ltd
I happened to see your valuable publication “eHEALTH� in the Ministry of Health, Government of India, New Delhi, in a recent meeting. I was impressed with it. I would like to have its copies on regular basis. I would also like to recommend this publication for subscription in the Central Library of our institution for the benefit of our faculty and the students. Dr Babu L Verma (PhD, MAMS,FSMS) Professor of Bio-statistics, SEA Regional Councillor of the International Epidemiological Association(IEA) and Global IEA - INCLEN Liaison Officer Division of Biostatistics Department of Social & Preventive & Medicine M L B Medical College & Hospital Jhansi, Uttar Pradesh, India --------------------------------------------------------------------I am very happy to receive copies of eHEALTH magazine. I am sure the magazine would be useful for the students and faculty. A K Mahapatra Director, Sanjay Gandhi postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Editorial Guidelines eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. - an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and wellresearched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and international case studies, research outcomes, policy developments, industry trends, expert interviews, news, views and market
intelligence on all aspects of IT applications in the healthcare sector. Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to eHealth projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians. We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: Articles/ case studies should not exceed 2500 words. For book reviews and event reports, the word limit is 800. An abstract of the article/case study not exceeding 200 words should be submitted along with the article/case study. All articles/ case studies should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.
Book reviews should include details of the book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi). Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable. In the case of website, provide the URL. The manuscripts should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post. Relevant figures of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format. A brief bio-data and passport size photograph(s) of the author(s) must be enclosed. All contributions are subject to approval by the publisher.
Please send in your papers/articles/comments to: The Editor, eHealth, G-4, Sector 39, NOIDA (UP) 201 301, India. tel: +91 120 2502180-85, fax: +91 120 2500060, email: info@ehealthonline.org, www.ehealthonline.org
www.ehealthonline.org
Volume 3 | Issue 9 | September 2008
EDITORIAL The time is ripe
president
Dr. M P Narayanan editor-in-chief
Ravi Gupta group directors
Maneesh Prasad Sanjay Kumar Sr. manager - PRODUCT DEV EL OPMENT
Dipanjan Banerjee mobile: +91-9968251626 email: dipanjan@ehealthonline.org
Pilot projects such as, ‘Gramjyoti’ (Light of the Village) in India, and ‘Alokito Bangladesh’ (Enlightened Bangladesh) led by Ericsson, have remained pilots for long. For the uninitiated, these projects aimed to showcase the benefits of mobile broadband for the underserved regions using wireless 3G/HSPA (3rd generation/ High Speed Packet Access) technology. The technology enables people to communicate wirelessly with high-speed data transfer and enjoy services like Video Call, Mobile TV, and High Speed Mobile Broadband. Ericsson acquired permission from the Bangladesh and India to deploy demo 3G/HSPA network in Dhaka and across 18 villages and 15 towns in Tamil Nadu respectively in 2007. This technology has proven a new ray of light for people in these regions.
research A ssociates
Susan Thomas Sarita Falcao Sales executiv e
Arpan Dasgupta mobile: +91-9911960753 email: arpan@ehealthonline.org Sr Graphic Designer
Bishwajeet Kumar Singh Graphic D esigners
Ajay Negi Chandrakesh Bihari Lal (James) Om Prakash Thakur web
Zia Salahuddin Santosh Singh
Among other facilities, such as distance learning and faster communication this technology provides the people of this region with medical assistance where there was none before. The project uses 3G/HSPA technology, which allows officials in an ambulance visiting a neighbourhood to collect medical details, such as ECG and other data along with medical history of those who come for a check-up, and send it wirelessly to a medical specialist in a distant hospital. After checking the details and seeing the patient live through video conferencing, the doctor sitting in a distant location prescribes the patient as needed. This eHealth application is conducted with assistance from Apollo Hospital, India and Bangladesh. In India recently, the much-awaited announcement of the release of spectrum for 3G technology sent a loud cheer through the ICT community. It has renewed hope for growth of connectivity in India. The 3G policy is expected to make mobile broadband a reality in no time and help in providing last mile solutions in our rural areas, much like it has in the pilot project.
subscriptions & circul ation
Manoj Kumar (+91-9210816901) manoj@ehealthonline.org editorial correspondence
eHealth G-4 Sector 39, NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org is published in technical collaboration with Centre for Science, Development and Media Studies.
does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. Owner, Publisher, Printer, Ravi Gupta Printed at Vinayak Print Media E-53, Sector 7, Noida, U.P. and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP Editor: Ravi Gupta
The broadband policy announced by the government in 2004, estimated 9 million broadband subscriptions by the end of 2007. However, statistics reveal that the figure stood at approximately 3.6 million by the end of 2007. With the release in spectrum now, the target seems to be readily achievable. Wireless broadband with its benefits of cost, reliability, and accessibility is expected to rapidly grow as compared to wire line broadband. The WiMax and the 3G policies in this regard will compliment this rapid spread of wireless broadband in the far-flung areas. It is hoped that the target of 20 million broadband subscriptions will be an achievable dream by 2010. The Government should quickly embrace the opportunity that this technology makes available, to provide value added services in terms of better information dissemination, telemedicine, eHealth and also ‘mHealth’ (healthcare through mobile devices) in areas that are still under-served.
Ravi Gupta Ravi.Gupta@ehealthonline.org
September 2008
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COVER STORY
eHEALTH India 2008
Event Report 29-31 July 2008, Pragati Maidan, New Delhi
And so it finally happened! eINDIA 2008, India’s largest ICT event was held from 29th to 31st July 2008 at Pragati Maidan, New Delhi. As part of the seven tracks, ‘eHEALTH India 2008’ - presented by eHEALTH magazine provided a unique opportunity for healthcare industry players, policy makers, academicians, researchers, technology vendors and other stakeholders to come together on a common platform and share experiences, discuss pertinent issues and showcase innovations over three days of active conferencing and an exciting exhibition.
The eHEALTH track kicked off with an opening address by Dr. Rachel Jose, Additional Director General (Health Services), Directorate General of Health Services, Ministry of Health and Family Affairs. Dr. Jose highlighted the poor state of healthcare delivery in India. She went on to state how telemedicine is a possible solution to the healthcare crisis as by 2025, 65% of the Indians are likely to be literate. Emphasising the pioneering work done by the Indian Space Research Organisation on this front, she said that though e-health in the country is mostly restricted to medical transcription, there are more than 150 live telemedicine projects. The majority of these are funded by ISRO. Speaking of the urgent need for automation, she said that ‘there is a need for automation of data because of the presence of health insurance’. Dr. Jose pointed out the main challenges to automation, including, shortage of reliable connections, the need for greater bandwidth, legal/ethical issues, complicated licensing procedure and data security issues. Today we have several stand alone Electronic Medical Record (EMR) systems without interoperability. Dr. Bidhan Das, a member of the National Accreditation Board for Hospitals (NABH) introduced the pertinent issue of EMR. As of today, EMRs are an expensive option. Currently, no national standards exist and there is also minimal exchange of information between service providers. Dr. Das painted a picture of an ideal situation which healthcare service providers can aim for. This includes standardisation, integration, and seamless information exchange. He stressed the need for a well drawn out roadmap for health IT, which takes into account Integration, Automation and Accessibility. An important point raised at this time was the need for a standard tariff structure and increased insurance coverage. Automation can help to reduce the cost of administration as price falls. For this to happen, i.e. to push for wider use of automated systems, Dr. Das suggested that stringent action should be taken against defaulters. www.ehealthonline.org
eHEALTH India 2008 at a Glance
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1) D. Purandeswari, Minister of State for Higher Education, 2) Dr. Rachel Jose, MoHFW, GoI 3) Dr. Bidhan Das, NABH 4) Kerry Stratton, MD, InterSystems 5) Dr. Hemant Kumar, Microsoft 6) Joseph Amuzu, Commonwealth Secretariat 7) Dr. R. S. Tyagi, AIIMS 8) Satish Kini, 21st Century Healthcare Solutions 9) Anjan Bose, Philips Electronics 10) Dr. Karanvir Singh, Sir Ganga Ram Hospital
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People Speak
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“It Was wonderful to be part of the mega event” - Dr. Sridhar Arunachalam, Manipal University. “Please accept my congratulations for eHEALTH India 2008 conference. Unfortunately I could not attend the event because of my pre occupation with project related work. The conference was attended by my Principal Consultant from Infosys, who appreciated a lot about the sessions and speakers” - Dr Fahad Mustafa Khan,Business Analyst, Healthcare & Lifesciences Consulting, Infosys Technologies Ltd.
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“Thanks for your great support” - Nikita Chavan, Business Development Manager, idhasoft “The event was fantastic in terms of content and industry insight. Excellent platform to network with other healthcare players and exchange thoughts. Kudos to eHEALTH team for organiSing such a wonderfull conference. Wish you more and more success in future.” A. Baskaran, Head-Strategic Business & Relations, Karishma Software “It was a worthwhile event to attend. The coverage on eHEALTH is excellent and selection of topics and speakers was well thought out. I certainly enjoyed meeting and networking in this event and look forward to attending the one in Malaysia.” - Raghu Iyer, Founder & Chairman-Business Intelligence Technologies “Great show. Truly phenomenal, the work that you guys have done. Well thought-out sessions, most informative. Overall, excellently managed. Cannot wait for 2009 and do keep up the good work!” - Dr. S. B. Bhattacharyya, VP (Clinical Services), Karishma Software lTD. Secretary, IAMI “It was a good conference overall. However,the level of participation from the providers (doctors, hospitals) was not that high’” - Nagesh Srinivasan, Director, Marketing&Sales-Yos Technologies Private Limited. 10
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11) S K Meher, AIIMS 12) Aniruddh Nene, 21st Century Healthcare Solutions 13) A Vijay Simha, BPL Healthcare 14) Dr. Ashok Kumar, CBHI, GoI 15) Medical Technology Forum www.ehealthonline.org
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People Speak “eHEALTH India 2008 was a great success. Wish you all the best for future events.” - S.K.Meher, Medical Informatics Specialist, Department of Computer Facility, AIIMS, New Delhi. “It was good to be a part of eHEALTH India 2008. I wanted to congratulate you on a event well organised” - Alam Singh, Asst Managing Director, Milliman. “Thanks for the opportunity to participate in eHEALTH India 2008. Though I was there only for a short period, I could feel the enthusiasm among participants” - A. Vijayrajan, CIO & CTO, Manipal Hospital, Bangalore. “I would like to congratulate you for the great success of ‘eHEALTH India 2008’. The enthusiasm shown by the team members was great. It was indeed a good platform for sharing the innovative ideas. and it also motivated us to come out of our shell. The topics chosen for technical sessions were very relevant to the present scenario” - Sakhi John, Head - Medical Informatics, Majeedia Hospital, Hamdard University. “Congratulations for a great show” Dr Hemant Kumar, Director - Health Solutions Group, Microsoft India. “Good show indeed and wonderfully organised. Congrats for showcasing it so well.” - Tapas Kar, CEO, Value Based Consulting. “Congrats for excellent arrangement. The conference was very educative and informative.” - HNN Murthy, Head - IT & Healthcare, RGCIRC, New Delhi. “All things considered, we had a great time at the event” - Anantharaman S Iyer, Regional Director (India), InterSystems. “I must congratulate all of you for the wonderful job done in eHEALTH India 2008” - Indrajit Bhattacharya, Professor, IIHMR, New Delhi. September 2008
There was a special address by Kerry Stratton of InterSystems and Dr. Hemant Kumar of the Microsoft Health Solutions Group. Kerry Stratton gave the audience a comparative overview of the national e-health policies of various countries (including India, China, UK, Sweden and Brasil). “Technology is not the issue today”, said Stratton. “ The problem is with fragmented systems.” Dr. Kumar provided an insight into the future of medicine. Dr. Kumar pointed out how Bumrungrad Hospital at Bangkok, Thailand increased its efficiency and output levels several fold by implementing a Microsoft system of automaton. “Privacy of the patient has to be maintained, but not to the detriment of electronic health records”, said Stratton. He also brought out an interesting point – that it is not the lack of technological solutions that is the cause of poor healthcare delivery, but rather fragmented systems. This is evident by the fact that the rate of implementation of EHRs even in US hospitals is less than 8%. The theme of the first session was ‘Public Health Transformation – Challenges, Success stories & Solutions’. The session saw a lively discussion and presentations by Dr. Ashok Kumar, Director, Central Bureau of Health Intelligence, Dr. Vijay Rai, CMO (NFSG) & Nodal officer (IT), Department of Health and Family Welfare, NCT, Dr. C. Raghavendra of the Indian Institute of Management, Bangalore, Joseph Amuzu of the Commonwealth Secretariat, UK and Dr. Tarek Badr, Project Manager of the Family Card Project, Government of Egypt. Dr. Rai gave the audience an insight into the history of automation in the public health system in Delhi. He also discussed future plans for further improvement. Dr. Raghavendra, who conducted a study of government health surveillance in Chittoor district of Nalgonda, Andhra Pradesh, shared with the audience her experience and analysis, pointing out that ‘Many IT projects remain pilots forever” and cautioned against the manipulation of health data. The situation across the Commonwealth of Nations with respect to IT and health varies widely, as was pointed out by Amuzu. He stressed the need for universal standards - for example, with respect to electronic signatures. Automation within the public health system is a challenge throughout the world. The conference saw foreign participation through the participation of Tarek Saad Badr, who spoke about the Family Card Project of the Government of Egypt which uses smart cards. The project has been a success, even though Egypt faces problems like multiple legacy systems and reluctance to use technology on the part of users. An important point that Dr. Badr brought out was the need for citizen relations management, especially in transitional societies which lack IT-trained healthcare professionals. During the discussion which ensued, some participants brought up the question of whether the common man is ready for automation and digitisation.
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People Speak The event was great and went well. I enjoyed it so much. But was disappointed with the chairing of the sessions. Speakers were allowed too much time to present. This dragged most of the sessions beyond the stipulated time, making participants to lose interest. I suggest all speakers are limited to 10 or 15 minutes and possibly presentations are vetted in advance and slides limited to 15 or less.” - Joseph Amuzu, Advisor, Social Transformation Programmes Division Health Section, Commonwealth Secretariat “I would like to congratulate your team for a successful completion of eHEALTH 2008. It was well conducted and the sessions were interesting. My only grouse was that the sessions were not keeping time. In fact we should have used an auto cut off device for those speakers who were continuing beyond their allotted time.I do not find any session taking things to a greater height, in fact no session went behind the present day realities except Mr. Bhaskaran, from Phillips. It was an enlightening experience with his talk about the future.” - Dr. Satish Amarnath, Medical Director, Manipal Cure and Care Pvt Ltd. “First of all I thanks eHEALTH for inviting me in the event. This was indeed a great event. We got lot of inputs from this event and came to know about what is the latest in health delivery where we stand and what all improvements we can do in our systems. Also I came to know about different clinical cutting-edge technologies, which can be embedded in our system. This I think builds a very healthy forum where we can all address our problems and probably come up with a solution.” - A. P. Singh, Deputy Manager IT, Fortis Hospital
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What is a good HIS supposed to deliver? How does a hospital choose a good vendor? What do you do when faced with resistance to automation? These were some of the practical issues addressed by hospitals MDs who took time out of their busy schedule to participate in eHEALTH India 2008. These included Dr. Karanvir Singh of Sir Ganga Ram Hospital, Dr. Nagpal of Batra Hospital and Dr. Suryanath of Care Hospital. Dr. Karanvir gave an insightful, first-hand account of how to go about the automation process in a facility. He cautioned CIOs against rolling out a Hospital Information System in a hurry and stressed the need for proper assessment of vendors and the needs to be met. “The implementer knows best”, he said, “not committees.” Dr. Karanvir also advised hospital administrators on how to manage resistance to automation, through a very well received address. The session on ‘Improving Clinical Outcomes, Leveraging Business Performance’ had presenters like Mr. Anantpadmanabhan, President of the Kovai Medical Centre Hospital, Mr. Ashok Chandavarkar of Intel, Avinash Pandey of Crane Global Solutions and Satya Adhri of Idhasoft. Mr. Adhari gave an overview of electronic health infrastructure using the internet. According to Mr. Chandavarkar, there is an urgent need to use Mobile Point of Care (MPOC) as doctors and nurses can then be more efficient by spending less time on administrative tasks. Currently, a nurse spends most of his/her time on administrative work rather than with the patient. Another viable idea was that of hospitals sharing a central pharmacy. The importance of integration in healthcare systems and within hospitals, was the main topic of discussion at the session on ‘EMR Best Practices and Information Sharing for Integrated Healthcare’. The session was chaired by Dr. S.B. Gogia, President of the Indian Association for Medical Informatics and Pradeep Saha of Max Healthcare, Ananthraman Iyer from InterSystems, Satish Kini of 21st Century, Alam Singh from Milliman and S.B. Bhattacharya from Karishma Software engaged the audience in a lively discussion afterward. Satish Kini, like most other speakers, sympathised with the doctor community when he spoke of implementing systems. “It is wrong to force our doctors in India who are overstretched.” he said, whilst stressing the need to reduce the workload of medical practitioners. One of the main highlights of the event was the ‘Hospital CIO Conclave’. This saw 59 hospital CIO’s elucidate the challenges they had to face in each of their facilities and how they overcame them. On the stage were Vijayrajan A. from Manipal Hospital, Manish Gupta of Fortis Healthcare, Pradeep Saha, Max Healthcare U.K. Ananthpadmanabhan from KMCH, Dr. R.S. Tyagi of the All India Institute of Medical Sciences, Dr. Suryanath of Care Hospital, Col. S. Patole from the Army Hospital Research and Referral Centre, Y. Srihari of Narayana Medical College & Hospitals and Dr. Rajesh K. Gupta from the Artemis Health Institute. Despite the space crunch at the dais, the discussion was fruitful in bringing out the complexities involved in data recording, sensitivity of patient in-
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COVER STORY
eHealth India 2008 Awards Best Government Initiative of the Year - National Population Stabilisation Fund: In an effort to provide information to the public, the National Population Stabilisation Fund of India also called Jansankhya Sthirata Kosh (JSK), prepared State Level Health Facility maps for 19 states excluding one northern state (Himachal Pradesh) and North Eastern States from the datacollection - Survey of the India. Shailaja Chandra received the award on behalf of JSK. Three innovative strategic programmes have been initiated under this fund Prerna, Santushi and a call centre. The Jansankhya Sthirata Kosh has a mandate to catalyse a movement in favour of population stabilisation and turn it into a people’s programme.
Best NGO Initiative of the Year - Emergency Management and Research Institute (EMRI): EMRI is a non-profit organisation founded and funded by B Ramalinga Raju, chairman, Satyam Computers and his family. The institute, by partnering the state governments, offer professional emergency service through a call centre or response centre. EMRI, Secunderabad, received the eHEALTH India 2008 Award for Best NGO Initiative of the Year. It offers free emergency response service for medical, police and fire emergencies. The Karnataka government has recently signed a Memorandum of Understanding (MoU) with the organisation to roll out ‘Arogya Kavacha’, a scheme which provides free emergency services in the public private partnership
Best ICT Enabled Hospital of the Year: Artemis Health Institute, Gurgaon The hospital is equipped with the latest technology in predictive, diagnostic and therapeutic imaging, along with the highest levels of in-patient monitoring, and a paperless and film-less Hospital Information System. Artemis is the first installation in India to offer: Film-less and paperless environment (seamless integration with the Hospital Information System) where complete hospital workflow is done online. The HIS project has eliminated the need for large medical record charts as everything has been posted online. The project provides concise and easy to read summaries to the patients. Incidentally the project was implemented in a very short time of six months.
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People Speak “Thanks a lot for inviting us to participate in the eHEALTH conference... congratulations to the entire eHEALTH team for an excellent organisation and really insightful sessions. The conference was able to get participation from the entire who-is-who of the Indian healthcare industry. Such sessions prepare the industry for the future technology paradigm and are excellent learning while rolling them out to the mass market. I am sure, going forward, we shall see increased participation from ‘not-thewho-is-who’s of the healthcare industry the CIOs/ owners of <200 bed hospitals - who would tremendously benefit from keeping abreast with the healthcare ICT developments.” Do keep up the good work !! - Vishal Ranjan, Director, Asclepius Consulting & Technologies Pvt Ltd.
formation, motivation of staff to use new systems/software and working within limited budgets. Capturing patient data at source and in one go, it was agreed, is necessary. Day 2 concluded with Dr. Ajit Nagpal, Chairman of Batra Hospital, chairing a lively discussion on ‘Connected Healthcare – network infrastructure, information access & remote service delivery’. Vijaya Verma, founder of Yos Technologies, stressed the need for consumer centric healthcare and and patient access to medical information. “How do you get a central repository in a multi-organisation set-up is a major question facing healthcare in the country”, said Dr. Nagpal. According to the young entrepreneur Vishal Ranjan of Asclepius Consulting, it is a matter of grave concern that there are ‘minimal ICT solutions for more prevalent diseases.’ Treatment through ehealth requires strong protocolbased treatment and the support of multiple stakeholders, including the government. Manish Gupta shared his ideas on m-health, which he said has great potential through the
September 2008
use of mobile phones, smart cards and developments in mobile imaging. These are no longer front line technology, but are the most viable options for mass projects due to their common interface. On Day 3, Dr. R.K. Mathur, Chief Radiologist, Max Healthcare, S.K. Meher of AIIMS, A. Nene from 21st Century Healthcare and Suresh Ranganathan of Agfa Healthcare gave an overview of the current use of medical imaging, Radiology Information Systems (RIS) and Picture Archiving and Communications Systems (PACS). “Filmlessness”, said Dr. Mathur, “will largely be driven by insurance in the coming years.” The post tea-break session on the morning of the third day saw one of the most interesting presentations by Dr. Ajoy Kumar Ray, Head – School of Medical Science & Technology of IIT, Kharagpur. Dr. Ray explained to the audience that image retrieval was as important as storing and transfer. Molecular imaging is the future of medical imaging, good quality of which is essential for pre-cancer detection. The conference ended with the ‘Medical Technology Forum’ where a panel of Poornima from Texas Instruments, Kalyana Raman of Trivitron, Sumati Randeo of Abbott healthcare and A. Vijay Simha from BPL was chaired by Anjan Bose of Philips Electronics. The discussions centred around a wide range of topics. From trying to find a solution to the eternal dilemma between placating multiple power centres and acting decisively on how important it is for a doctor to make eye-contact with a patient. During the networking breakfast, delegates and participants from all seven tracks got a chance to intermingle and share fresh ideas and learnings in a single space which proved to be an immensely enriching experience. We at eHEALTH magazine hope that the lessons learnt and the knowledge shared will be taken back to workplaces, businesses, hospitals and classrooms and boardrooms. As societies develop and economies transform, we should be looking more at preventive rather than curative health. Better disease surveillance, data storage, data transfer, and generally improved access to technology is the future of health IT. In the years to come, we look forward to user-centric technology, greater mobility and very importantly, low-cost IT solutions. We at eHEALTH hope to showcase the developments in these arena’s on a bigger scale at the eHEALTH Asia 2008 at Kuala Lumpur from 25-27 November and we hope to have you with us. Like one of the speakers put it – ‘It has been a fascinating technological journey.’
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Revitalising Primary Healthcare in the Information Age The Internet and World Wide Web have evolved from an information highway, to an enormous virtual library, to a platform for global enterprise and well beyond. ICT has changed the way we communicate, seek information, conduct business and commerce, share data and build knowledge. Joan Dzenowagis, Diana Zandi, Misha Kay eHealth Unit, World Health Organisation, Geneva
Technology is changing the rules At the time of Alma Ata when the World Health Organisation called for a global commitment to Health for All, the world was on the brink of the information revolution. In the 30 years since then the rapid growth and broad diffusion of information and communication technologies (ICT) have had a profound impact on society and the lives of people in all countries. The world has come to rely on connectivity and increasingly sophisticated software to support its financial networks, just-in-time food supply chains, news and information services, and connected global transport systems. The Internet and World Wide Web have evolved from an information highway, to an enormous virtual library, to a platform for global enterprise and well beyond. ICT has changed the way we communicate, seek information, conduct business and commerce, share data and build knowledge. By changing the means and ease of sharing knowledge and information these technologies have transformed the world in ways never imagined in 1978. The impetus for the rapid diffusion and uptake of ICT around the world is clear. Catalysed by government incentives and businesses opportunities, investment in ICT reflects a belief in the potential of markets to drive development. Technology is becoming more readily available, access to information is possible and affordable, and consumers are embracing mobile phones, online social networks, and similar tools of the information society. Their expectations and behaviour, such as online purchasing, information seeking and sharing are changing the rules and the relationships between consumers, professionals, industry and government. This is happening in all sectors, including healthcare. However, there are many left behind, as the “digital divide” remains a reality within and between countries. What impact can these 18
technologies have on health, and on primary healthcare in particular? And given the reality of the digital divide, what can be done to ensure that everyone benefits? The primary healthcare approach Revitalising primary healthcare calls first and foremost for a renewal of the principles and values, which underpin it. At its core, primary healthcare is a commitment to equitable and affordable care for all people, ensuring citizen-centred services needed to live a healthy and productive life. The World Health Organisation considers primary healthcare as “an approach to organising health systems.” And in the information age, ICT must be central to this. Highlights of the primary healthcare approach: Reaching all people, enabling care for everyone, where ever they live. Reform of health services towards citizen-centred care, involving people in their health. Engaging all sectors, recognising the role of others in supporting health. Leadership and effective, responsive government. Care for everyone Reaching all people is a fundamental element of primary healthcare. Yet some countries, chronically burdened across the spectrum of government obligations, have a diminished ability to provide even basic health services. In particular, countries in conflict and transition or those affected by natural or man-made disasters require external aid and technical assistance. Strategic use of ICT can help governments coordinate aid, reach out to citizens and put in place measures to support displaced persons by anticipating needs and fawww.ehealthonline.org
cilitating planning for personnel, equipment and supplies. The extensive use of ICT in coordinating the global response to the Asian tsunami in 2004, and the China earthquake in 2008 provide important lessons in this respect. For example, ICT was used to relay updates on health conditions, facilitate delivery of water, food, supplies and medicines, and to connect to experts for remote consultation. Whether for immediate assistance or follow-up care, ICT provided critical support for reaching those in need with the basics of care. Improving healthcare delivery Telemedicine and related terms refer to a spectrum of ICT applications with the potential to improve access to care by linking patients and professionals where distances may be great and local expertise limited. Many of the early technological problems of telemedicine have been resolved and the bandwidth and infrastructure situation continue to improve. Today the main obstacles to realising the potential of telemedicine have more to do with the policies, training and business models that will facilitate its integration into existing primary care services and its responsible, sustainable use. Challenges in ensuring this include financing initial equipment purchase and ongoing operating costs, establishing policies to protect patient privacy and confidentiality, and resolving questions of data ownership, liability for care delivered, and payment-for-service models. The European Union has transformed the concept of “access to care” to include the right of its citizens to receive care in any country in Europe. A landmark Directive, issued in July 2008 stipulates, “provision of cross-border healthcare does not necessarily require either the patient or the professional to physically change countries, but may be provided through information and communication technologies”. In establishing the legal and policy basis for doing so, they have opened the door to using ICT to improve access to care in Europe. The world will be watching how this unfolds and will be taking careful note of its impact on healthcare, including the effect on cost, safety and patient satisfaction. Towards citizen-centred care Early uses of ICT in health facilities focused primarily on the efficiencies to be gained in areas such as administration, finance and supply chain management. To be sure, these applications are fundamental to containing costs, ensuring adequate supplies and managing the day-to-day facility operations. But the use of ICT in primary care extends well beyond these fundamentals. Every health centre and health professional needs information to act and to communicate effectively, in order to do their job well. This also applies to individuals, who need to be informed and active in their own healthcare. As technology based health services continue to be introduced, user expectation grows accordingly. There are a myriad of ways in which ICT can be used in primary care. Whether sending text messages to patients to remind them to take their medications, allowing online scheduling of appointments, monitoring chronic diseases at home, or sending test results to specialists for interpretation, technology can make September 2008
Relationships between professionals and patients are changing as patients become more informed, and begin to experiment with using ICT to manage and monitor their chronic conditions. No longer considered the sole authoritative source of information, health professionals increasingly act as “infomediaries” in interpreting information and guiding patients to online resources.
Public Health Centre, Parol, Maharashtra, India
health services more efficient, personalised and reliable. Health professionals are adapting to new roles shaped by ICT. Relationships between professionals and patients are changing as patients become more informed, and begin to experiment with using ICT to manage and monitor their chronic conditions. No longer considered the sole authoritative source of information, health professionals increasingly act as “infomediaries” in interpreting information and guiding patients to online resources. They are using technology to monitor patients at home, consult via eMail, and receive automatic alerts when laboratory results are out of the expected range. In this age of social networking, professionals are sometimes bypassed completely as patients connect with online communities and resources for self-diagnosis and self-prescribing of medications. A revitalised approach to primary care recognises the greater role that patients play, and will use ICT to enhance this role by providing information and guidance, thereby treating the patient as a full partner in their own care. ICT is also changing primary care through its impact on professional and research communities. The adoption of 19
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Examples of ICT in health ICT in public health practice
ICT in healthcare and laboratory practice
Identify disease and risk factor trends
Track and provide patient information
Model diseases in populations
Enable communication between patients and professionals; deliver training
Analyse demographic and social data
Deliver services despite distance and time barriers via telemedicine
Access research, publications and databases
Standardise ordering and delivery of drugs and supplies
Monitor and communicate potential threats to health
Monitor care, quality and safety in all settings, including the home
Adapted from: Dzenowagis J (2005). Connecting for Health: Global Vision, Local Insight. Report for the World Summit on the Information Society; WHO, Geneva.
facility-based tools such as electronic medical records and e-prescribing enables more responsive, integrated and safer care. Professional tools such as decision support systems, resources such as journals and databases, and the possibility to be connected to a network of professionals further support the delivery of care. And in the same vein, large-scale computing initiatives such as “grid” are bringing the power of supercomputing to solve long-standing challenges in health, towards improving diagnostics and better targeting therapies and drugs. This ultimately leads to more personalised care and more effective patient management in primary care services. Engaging all sectors The interdependence of the sectors and thus the need to engage others in supporting health has never been more evident – or more realisable. The uses of ICT are common to all sectors: gathering, analysing, managing and exchanging information; expanding knowledge, linking systems, enabling research, improving capabilities, communicating and coordinating. As the World Summit for the Information Society began in 2003, the then-United Nations Secretary General Kofi Annan said this about the transformative potential of information and communication technologies: “From trade to telemedicine, from education to environmental protection, we have in our hands, on our desktops and in the skies above, the ability to improve standards of living for millions upon millions of people…” To realise this potential requires that the health sector engage fully with the technology sectors – telecommunications and information technology – to bring the power of communications to every single health centre, healthcare provider, and citizen. Leadership and effective, responsive government As eGovernment initiatives around the world have shown, ICT supports transformation and revitalisation. Where the strategic objective is that governments are well managed, accountable, and resources are allocated to achieve results, different functions are aligned towards ensuring that government acts as one. Information “interoperates” rather 20
than resting in silos. Practices, approaches and tools are shared. There is clear accountability, efficiency and relevance to meeting people’s needs. In the same way, citizens interacting with their modern health services should be able to receive consistent, reliable information and services. In using technology to achieve this goal many stakeholders benefit: citizens have ease of access, transparency and seamless service; management is effective, efficient and focused; employees have pride and job satisfaction; officials can better use tax money, improving public trust; successful government initiatives depend on social consensus on major actions, which means that citizens need to be included in the debate on values, goals and approaches. ICT enables citizens to be informed, to participate, and to speak from a common knowledge base. Ensuring solutions equal to the challenges The WHO eHealth Strategy, approved by 192 Member States at the World Health Assembly in 2005, has citizencentred care at its core. It represents a recognition of the growing contribution of ICT and a willingness on the part of governments to facilitate the adoption of these technologies in health services and systems. Countries all around the world are faced with prioritising investments, providing safe, cost-effective care and ensuring the education, deployment and management of personnel. As they strive to take advantage of ICT in health they face a number of issues, which parallel those faced years ago with the incorporation of ICT into systems such as banking. Chief among them, for example, is to ensure that regulatory and legislative systems support consumer protection, privacy and confidentiality, while enabling information sharing where needed. This requires foresight and action. In addition, the global nature of ICT means that there are shared challenges worldwide. Agreeing on mechanisms to improve health Internet quality and cooperating on protection measures against Internet fraud are but a few. Left unresolved, these and related issues will not only hinder effective implementation of primary healthcare. They will also limit the true potential of primary healthcare to take advantage of the opportunities offered by the information age. www.ehealthonline.org
SURVEY REPORT
PART 2 - WEST
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Rajasthan, Gujarat, Maharashtra
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he per capita income in Western India is the highest in the country at USD 850 (PPP). It would be appropriate then to assume that this would have an impact on the level of automation of medical care in the region. Things are however more problematic than that when the regional inequalities are taken into account. The three states have their own peculiar issues which impact healthcare and the number and quality of hospitals in the respective region. Gujarat and Maharashtra have hospital facilities which far exceed neighbouring Rajasthan in terms of both quality and quantity. Maharashtra and Gujarat also have a number of civil society movements which promote sanitation and efficient water use – precursors to well being.
August 2008
Let us look at each of these states individually. Rajasthan has a population of approximately 60 million and the health indicators in this region are often below the national average. The literacy rate is about 4% below the national average (at 61%) and female literacy is an abysmal 44.3%. The state has a poor sex ratio (909 in the 0-6 age group), an infant mortality rate of nearly 80 immunization levels of less than 37%, and 33.4% ‘safe’ deliveries. Clearly the entire health system needs an overhaul. In such a situation, it becomes important that paperwork is minimised for patients and their relatives and they spend the least amount of time and money at a hospital. Implementing electronic health in Rajasthan is a challenge when less than 55% of households have electricity supply and just 23% of the population is urbanised. The condition of primary health centres – which form the bulk of healthcare facilities – is appalling. Less than 4% of these have provisions for training of any kind. There are approximately 12,250 registered medical facilities with about 38,000 beds between them. Jaisalmer, Bi21
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kaner, Barmer, Jaipur, Jodhpur, Dausa, Dhaulpur, Alwar and Sirohi have decadal growth rates of over 30%, though only the district of Kota has an urbanisation level of more than 50%. One thing we notice is that there is no clear overlap between health indicators and the growth rate in district. The state urgently requires better infrastructure, more hospitals and better IT and support services.
level of automation in hospitals across these three states. Over half the hospitals surveyed [55%] belong to the Mission/Trust NGO category. Nearly 40% are privately owned. Also, a majority of them [55%] have less than 150 beds and only 17% are large, i.e. over 300 beds each. The hospitals surveyed said that the most important rea-
On a more positive note, the capital Jaipur and other cities like Udaipur, Ajmer and Jodhpur are witnessing an increase in the number of large, speciality hospitals. The Jaipur Development Authority has plans to make the city a Medicity and hub of medical tourism. Six large investors, including the Reliance Medi Care Ltd., Fortis Healthcare, Bombay Hospital, Trinity Group and SPA Enterprise are scheduled to invest over USD 46.69 million in the project. Gujarat – Gujarat is one state where The Wockhardt group has plans for extensive expansion in the state’s tier-II cities. Over 65% of the population here is below 35 years of age and the state also has good infrastructure on the whole. The InfoCity at Gandhinagar has been set up to give a fillip to the IT sector. Rajkot, Surat, Bhavnagar and Jamnagar have planned Software Technology Parks. Vadodara has also been identified as a future IT destination by the state. Maharashtra – Pune is one of the fastest growing cities in the country and an IT hub. Due to this, private hospital chains are keen to set up shop in the city. Apollo, Sahayadri, Wockhardt and Ruby Hall are some of the companies with expansion plans here. The second part of the IT@Hospital Survey looks at the
Figure 2: Break-up of hospitals by size.
Driving forces of automation:
Figure 1: Break-up of hospitals by type.
Figure 3: What drives automation.
Less than 50% of large hospitals spend more than INR 50 lac on IT systems annually. 22
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arishmaTM The Solutions People
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son for automation is the need for better service quality. About 61% agreed that corporatisation of healthcare delivery has an important role to play. None of the hospitals surveyed however, admitted to health insurance being a driver of automation. Advantages of IT As consumers, payers, and regulatory agencies require evidence regarding health care quality, the demand for process of care measures will grow.
Figure 4: Percentage of Hospitals who state the advantages of IT.
What are the main reasons for hospitals switching to another HIS? Many hospitals have solutions created 10-12 years back, which are mostly obsolete in their capabilities. The users have also got trained to handle more complex solutions. So there is always demand to upgrade and move up the value chain for better products. Jose E. S Coresys CEO
Figure 6: Kind of software preferred
Changing for the better a significant majority [83.3%] of hospitals changed their HIS due to technical faults with it.
Kind of software in use:
Figure 5: Percentage of Hospitals using software
Figure 7:Reasons for changing HIS
More than 94% of hospitals have an annual IT budget of less than INR 50 lacs. 24
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Paperless - still a way off
How is a vendor selected? Various criteria to select a vendor for automation
Cost/pricing
Average Rank
1.00
Maintenance and Support
1.75
Level of R&D Investment
2.67
Inbuilt tools to measure outcomes
3.14
Implementation assistance
3.54
User Training
4.29
Vendor/Support Organisation Reputation
6.17
Flexibility/Scalability
5.75
Provision of Managed/Hosted Services
8.80
Measuring the success of implementation
Figure 8: Do you have EDMS
Figure 10: Criteria for measuring success of implementation.
PEOPLE SPEAK What is the reason for the low use of Electronic Document Management Systems? The hospitals or Doctors do not perceive any financial benefit in using EMR Systems. On the other hand it may by virtue of its efficiency reduce the patient stay, support better rationalization of Investigations and medication and therefore may actually cause revenue loss to the Hospital or doctors. So the Medical Community is not keen on using EMR systems. Doctors also are not comfortable with the concept of entering data into systems themselves. Many are more open to the EMR if someone else enters the data for them. Dr. Sumanth C. Raman Advisor-Life Sciences and Healthcare Tata Consultancy Services Ltd. Figure 9: Why hospitals use paper despite having EDMS.
Some kind of Electronic Document management Software is installed in 11% of hospitals. August 2008
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Money matters
When we talk of Hospital IT, it is not just installing computers in different departments of Hospital like OPD Regn & Billing , Labs & Radiology reporting, Pharmacy , Stores & Accounts and using them glorified typewriters . It should be a truly integrated HIS system with all the functions of the Hospitals connected to each other like links of a chain and helping various users to facilitate proper patients management which is patent senstitive, accurate , accountable , transparent and affordable. Satish Kini Chief Mentor 21st Century Health Management Solutions Pvt. Ltd.
Figure 11: Annual IT spending.
Conclusion: Indiaâ&#x20AC;&#x2122;s software service exports form the fastest growing industry today, with the western and southern regions taking the lead. The Ministry of Health of the Central Government has recently started consultations to examine the feasibility of creating a national consortium for the purchase of digital information products at favourable prices for the country.
Figure 12: Average size of IT team.
The Indian government has been taking steps to build an enabling environment for the use of ICT in the health sector. The key enactment of the Information Technology Act 2000, providing a legal basis for all digitally related information actions and privacy issues; comprehensive guidelines and recommendations for IT infrastructure in health (2003); and the creation of a task force on the topic of telemedicine (2005). The most significant challenges to date have been the coordination of inter-ministerial and departmental activities, and resource constraints. Within the private sector too, the IT players are beginning to consolidate. Recently, the Ahmedabad Computer Merchant Association (ACMA) organised a meet which brought 16 IT-associated bodies together. The future scenario in Maharashtra looks bright as industrial lobby groups and hospitals are keen on exploiting the potential the region has for medical tourism. Mumbai, the financial capital of India is also a major research hub. It remains to be seen how the IT industry and hospitals work together to make automation in the health sector more effective.
Figure 13: Would you prefer a software that interoperates with your existing IT solutions or those in affiliatied hospitals?
Watch out for Part III of the IT@Hospitals survey in the November issue of eHEALTH, covering southern and central India â&#x20AC;&#x201C; Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Madhya Pradesh
Most hospitals changed their HIS because of technical problems with the software. 26
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news review
INDIA
Escorts receives the coveted NABH accreditation Escorts Heart Institute and Research Centre (EHIRC), one of the top cardiac super-specialty hospital in Delhi, recently became the third hospital under the Fortis Healthcare umbrella to receive the NABH accreditation, the highest national recognition for quality patient care and safety. Mr. Shivinder Mohan Singh, Managing Director, Escorts Heart Institute and Research Centre & Fortis Healthcare Ltd received the coveted certificate from Mr B K Rana, Deputy Director, NABH. The other hospitals under the Fortis Healthcare umbrella to have received the NABH accreditation include Fortis Hospital Noida and Mohali. NABH (National Accreditation Board for Hospitals and Healthcare organisations) is a constituent autonomous board of the Quality Council of India (QCI), set up to establish and operate accreditation programme for healthcare delivery organisations. The accreditation is in recognition of Escorts Heart Institute’s impressive track record and future resolution in providing quality patient care and patient safety. Escorts Heart Institute has always been the hallmark of medical quality and expertise in cardiac care and NABH accreditation is a testimony to this fact. NABH standards greatly emphasize patient rights, benefits, safety, control and prevention of infections in hospitals, practicing good patient care, protocols and better clinical outcome. Speaking on the occasion, Mr. Shivinder Mohan Singh, Managing Director, Escorts He art Institute and Research Centre said, “As a leading healthcare service provider in India, it is our responsibility to continuously raise the bar for quality standards. The NABH accreditation marks a milestone in our endeavor to take Escorts Heart Institute from excellence to pre-eminence and reaffirms our ability to deliver world-class integrated healthcare services to our patients.” He further added, “Greater adoption of quality accreditation like NABH by the healthcare service providers in India will accelerate India’s emergence as a medical capital of the world. We wish to lead that change.” Escort Heart Institute underwent several months of rigorous screening process to receive the coveted accreditation.
ESI Corp to set up 28 medical colleges The Employees’ State Insurance (ESI) Corporation that provides healthcare facilities to industrial workers has decided to step into the field of medical education. In an innovative move, it will set up 28 medical colleges and start post graduation courses by the next academic session in 2009. “We are aware that there is a shortage of doctors and it’s no different for ESI hospitals across the country. By the next academic year, we are planning to start 500 seats at the post graduation level,” Chaturvedi said in an interview. He said the ESI Corp, which is under the Ministry of Labour and Employment, aims to set up a medical college in every state and become self-reliant. “The adding of 500 medical seats will help aspiring students every year, and in return we will get qualified doctors to serve in our own hospitals. “A while ago we had put our proposal before the health ministry and have already got the go ahead. We have the capital and manpower, and now have the ministry’s support too,” he said. The ESI Corp is associated with over 331,000 factories and establishments across the country and provides benefits to about 10 million workers and their families. The corporation currently has 144 full-fledged hospitals, 42 hospital annexes, 1,388 dispensaries, 1,942 panel clinics and 300 diagnostic centres across the country. Chaturvedi said the existing network of ESI hospitals would help the corporation in implementing the plan. “We have the basic infrastructure and what we need to do is to upgrade it, add laboratories, other necessary equipments.” Chaturvedi said “a new medical college will cost them INR 2.5 billion” and the ESI has adequate funds. The Planning Commission has said this year that India faces a shortage of about 600,000 doctors.
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Kilo Scale Synthesis Lab at Chembiotek, Kolkata TCG Lifesciences Ltd has commissioned its cGMP kilo scale synthesis laboratory in Kolkata at ‘Chembiotek,’ its discovery research services business unit. This represents a significant new step in establishing its fully integrated drug discovery and development research services offerings to the global pharmaceutical and biotechnology industries. With the aim to support its clients’ developmental needs by supplying material required for ‘First-in-human’ clinical studies, this facility has been designed with reactor capacity ranging up to 200L and reaction capabilities ranging from -80 to +200 degree Celsius. High-end equipment, such as Differential Scanning Calorimeter and Reaction Calorimeter, have been installed with matching equipment like centrifuges, jet mills, vacuum tray dryers, sifters, etc. Following ‘safety through quality’ principle, the whole facility is integrated with a full scale Effluent Treatment Plant and due care has been taken to comply with stringent Health, Safety and Environmental (HSE) norms. A strong quality control team has been put in place to monitor achievement of the cGMP norms for the release of the material synthesized. Chembiotek provides high-end chemistry and allied discovery research solutions to its customers. The addition of this cGMP compliant kilo lab will allow them to offer developmental chemistry services which would enable them to speedily and seamlessly transfer technology from their current chemistry labs to the kilo lab for scale-up, process development and optimisation. This kilo lab will also serve as a robust platform for technology transfer to pilot plant scale. The kilo lab would operate on a 24x7 basis with particular emphasis on efficiency, time optimisation, innovative analytical techniques and highest quality control standards. Keeping in mind the spectrum of reaction handling capabilities, the lab will serve the varying needs of the existing and prospective customers. It will support all Investigative New Drugs (“IND”) enabling activities and the manufacture of clinical trial materials under GMP conditions. Other capabilities would include analytical method development, synthesis of impurities, metabolites and degradation products and stability studies, as per the international guidelines.
KLE Society bags Kolhapur health city project
For Indian doctors, PG now a long and rustic journey
Belgaum-based Karnataka Legal Education (KLE) Society has bagged the INR 500 crore ‘Medical Health City’ project, proposed by the Kolhapur municipal corporation (KMC), after winning the bid against the likes of Reliance Group, Hyderabad-based IVRL Group, Chennai-based Apollo Hospital, Delhi-based Value Group, Mumbai-based Hinduja National Hospital and Chennai-based Narayan Rudra Hospital. Apparently, the society had submitted an offer of INR 31.42 crore for the space in the project. KMC will provide around 10.56lakh sq ft of land and other infrastructural facilities for the project, which will be the first of its kind in Western Maharashtra. The KLE society is expected to build a well-equipped hospital having 2,000 beds and other modern medical facilities. Besides, it will offer a well-built hospital in the area of 50,000 sq ft to KMC, replacing the present hospital, which needs renovation and other amenities. While KMC’s new hospital will provide medical facilities for the epidemic-diseases, the KLE society’s private hospital will provide ultra-modern facilities to those who afford the fees and other costs of the medical services and facilities. Speaking about the project, Dr. Sudhir Deshmukh, health officer at KMC pointed out that KLE society’s offer is to be discussed in details in due course of time and will be finalised for the submission for final approval during KMC’s general body meeting.
At present, PG in medicine is a three-year course, which most doctors pursue to specialise in niche areas, and now it is learnt that health minister A Ramadoss has already cleared a proposal to make mandatory one-year rural internship services for PG. The Medical Council of India (MCI) is preparing the guidelines and the government is planning to implement the new rules from the next academic session. Doctors will have to have a rural stint for a year before getting their masters degree in medicine. “After being cleared by the health minister, the proposal has been sent to the state medical councils. Once the guidelines are issued by the MCI, the states would have to mandatorily follow them,” a senior health ministry official said. When contacted, an MCI official said that the guidelines would be issued in some time. The new policy of extension of medical PG by an additional year would require an amendment to the regulations guiding the PG courses. Last year, the government had planned one-year mandatory rural internship in MBBS. However, following strong protests from medical fraternity the government decided to roll back the proposal. The medical fraternity was of the view that mandatory rural service in PG course is fine, provided the final degree given is also accordingly modified. Hence, the government has gone ahead with the idea of including an extra year in the PG programme. The government feels that the move will help to partly fill the huge shortage of medical services in rural areas.
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25 | 26 | 27 November 2008 Sunway Resort Hotel Kuala Lumpur, Malaysia As the Asian countries prepare themselves to tread the fast track developmental path, achieving excellence in healthcare systems and services, and making them accessible for majority of population across the region emerge as crucial prerequisites. Adding to that, the immense potential of this region to tap global healthcare markets through medical tourism and healthcare travel industry, the need for modernisation of healthcare institutions, as well as making available advanced medical technologies becomes a pressing need. Some of the contemporary advancements in communications, IT and enterprise automation technologies are bringing substantive advantage for healthcare organisations.
Presenters & Organisers Initiated and presented by ‘eHEALTH’ magazine – a premier monthly publication on healthcare ICTs, technologies and applications, ‘eHEALTH Asia 2008’ is will bring together high level policy makers, healthcare managers, medical practitioners, institutional leaders and technology experts from across national health agencies, healthcare institutions, medical associations and technology vendors. Strategic Partnerships & Collaborations ‘eHEALTH Asia 2008’ is forging strategic level multi-stakeholder partnership collaborations with national and international organisations having mandate in healthcare and eHealth. In this regard, the initiative has already been joined by partners such as - ‘Commonwealth Secretariat’, along with its healthcare and medical think-tank – the ‘Commonwealth Medical Association’. In order to bring high level decision-makers and visionaries of healthcare sector, the event further aspires to bring on-board government health departments, national medical associations, medical research institutions and healthcare service organisations in the Asian region.
Host Organisation
Organisers
Supporting Partners
Presenting Publication
Focus Areas & Themes
• • • • • • • •
National eHealth Policy & Strategy Framework Country Case-Studies on eHealth Projects & Implementations Capacity Building & Training for eHealth Environment Emerging & Cutting-Edge Technologies in eHealth ICT-based Automation of Healthcare Operations & Management Data Standards & Interoperability for Health Information Exchange Online Applications for Consumer & Enterprise Healthcare Management eHealth Implications on Medical Tourism & Offshore Healthcare
Key Sessions & Panels Commonwealth Ministerial Dialogue – Commonwealth Secretariat and Commonwealth Medical Association, with support of Ministry of Health, Malaysia will bring a top level delegation of Health Ministers from 8 Commonwealth countries in Asia, comprising - Bangladesh, Brunei, India, Malaysia, Maldives, Pakistan, Singapore and Sri Lanka. The Ministerial dialogue will focus on exploring national eHealth strategies by sharing the vision of the top leadership and creating an opportunity for learning from each other’s experiences. Asian Healthcare CIO Conclave – While technology and IT promises to transform healthcare through improved service quality, better patient safety, higher cost efficiency and enhanced quality, the IT managers and CIOs of modern healthcare organisations face a myriad of challenges, be it in terms of implementing and operationalising ICTs, gaining organisation-wide acceptability for systems and processes or even achieving seamless work flow and interoperability. In order to address all these issues and beyond, through creation of an open forum for constructive debate, brainstorming and experience sharing, the event will bring together some eminent CIOs and IT Heads from reputed healthcare organisations across the region and put together a panel (titled – ‘Asian Healthcare CIO Conclave’) that will seek to explore viable solutions to challenging questions facing the industry at the moment.
Contact Information
Programme Enquiry: Dipanjan Banerjee (dipanjan@ehealthonline.org M : +91-9968251626) Sponsorship and Exhibition Enquiry: Arpan Dasgupta (arpan@ehealthonline.org, M- 91-9911960753)
General Information Conference Venue The conference will be held at ‘Sunway Resort Hotel & Spa’, located within an 800-acre integrated “Resort within-a-City” landmark, comprising a collection of hotels, spa, conference and convention centres, theme park, mega shopping and entertainment mall, medical and educational facilities and a multitude of business and leisure facilities. It is just 35 minutes from Kuala Lumpur International Airport (KLIA) and 25 minutes from the city centre. Currency The monetary unit in Malaysia is Ringgit Malaysia (RM) and it is currently pegged at RM 3.60 to US$1.00. Major credit cards as well as Travelers Cheques in the principal currencies are accepted
Weather and Clothing Malaysia has an equatorial climate with uniform temperatures throughout the year. Temperatures range from 32°C during the day to 22°C during the night. Official Language Bahasa is the official language of Malaysia, while English is widely spoken and understood by local population. Official language of the conference is English. (Language translation facilities will not be available for conference attendees.)
http://www.e-asia.org/2008/ehealth/index.asp
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POWER HOSPITAL
Parkway Hospitals
Singapore
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arkwayHealth owns a total of 15 hospitals in South Asia providing 3,277 beds and the expertise of 1,500 accredited medical professionals in a wide range of specialist fields. It also operates over 45 International Patient Assistance Centres across the globe, bringing quality, integrated healthcare to patients wherever they may be. Parkway Holdings Limited is one of the region’s leading healthcare service providers with a network of hospitals and medical centres in Asia, including Singapore, Malaysia, India and Brunei. In Singapore, the Group also includes Parkway Shenton Pte. Ltd., a major provider of primary healthcare services; Medi-Rad Associates Ltd, a leading radiology services provider; and Parkway Laboratory Services Ltd, a major provider of laboratory services. Gleneagles CRC Pte. Ltd. also provides contract research services. 32
Parkway Holdings Limited (PHL) owns Parkway Hospitals Singapore Pte. Ltd., which runs three of Singapore’s premier private healthcare providers, East Shore Hospital, Gleneagles Hospital and Mount Elizabeth Hospital. Apart from this, ParkwayHealth has clinical programmes are founded on a reputation for quality outcomes and service excellence. Over 1,500 accredited medical specialists in Heart and Vascular, Neuroscience, Oncology, Musculoskeletal, Transplant and Cellular Therapy, Women’s and Children’s, Chronic Disease Management and Surgery support these clinical programmes. These include renowned experts in their fields to provide comprehensive, integrated care. Parkway Group Healthcare (Pte. Ltd.) makes excellent use of information and communicaion technologies (ICTs) by operating over 44 International Patient Assistance Centre (IPAC), accessible via www.ipac.sg and a 24-hour hotline. www.ehealthonline.org
PARKWAY HEALTH’S SERVICES
Network of Hospitals in Singapore EAST SHORE HOSPITAL: A 157-bed private general acute care hospital with an outreach specialist centre in Eastern Singapore, providing a wide range of medical and surgical facilities. East Shore Hospital has built a loyal niche among residents in Eastern Singapore and the region for their personalised care approach, convenient location and user-friendly services. East Shore is also accredited with Joint Commission International (JCI). GLENEAGLES HOSPITAL: A 380-bed private tertiary acute care hospital providing a wide range of medical and surgical services for the total management of patients. Gleneagles’ key strengths include its patient focus, user-friendly services, quality care, specialists’ expertise, and proven technology. Gleneagles is accredited with Joint Commission International (JCI). MOUNT ELIZABETH HOSPITAL: A 505-bed private tertiary acute care hospital. One of the largest in the region, Mount Elizabeth Hospital has an established reputation in Asia in private healthcare. It provides a wide range of medical and surgical services and is well known for the depth of expertise of its specialists, quality care of its nurses and staff, and state-of-the-art technology. Mount Elizabeth Hospital performs the largest number of cardiac surgeries and neurosurgeries in the private sector in the region. The hospital is accredited with Joint Commission International (JCI); and is the first private hospital in Asia to win the Asian Management Award for exceptional people development and management. Country
No. of Beds
China ParkwayHealth Medical Centres, Shanghai 14 Vietnam ParkwayHealth Medical Centres, HCMC Malaysia Gleneagles Intan, Kuala Lumpur 303 Gleneagles Medical Centre, Penang 212 Pantai Medical Centre, Kuala Lumpur 264 Pantai Cheras Medical Centre, Kuala Lumpur 200 Pantai Klang Specialist Medical Centre, Klang 250 Hospital Pantai Indah, Kuala Lumpur 250 Hospital Pantai Putri, Ipoh 69 Hospital Pantai Mutiara, Penang 250 Hospital Pantai Ayer Keroh, Melaka 180 Hospital Pantai, Batu Pahat 50 Brunei Darussalam Gleneagles JPMC Cardiac Centre
150
India Apollo Gleneagles Hospital, Kolkata
425
September 2008
General Practitioner (GP) Services Dental Services Laboratory Services Managed Care Radiology Services Dialysis Services Clinical Research Medical Assistance Procurement Services Homecare and Rehabilitation Hospital Development Hospital Management Renal Dialysis Healthcare IT Hospital consultancy and management services
The IT infrastructure Network Infrastructure: Parkway Health’s network infrastructure consists of distributed sites consisting of the three hospitals, a day surgery centre, 11 distributed offices and four radiology clinics. These sites are linked together via Private Leased Lines with speeds varying from 64Kbps to 4 Mbps. The network infrastructure design proposed encompassed a range of Cisco Catalyst Switches for high performance multi-layer switching at Gigabit speed in the core backbone and 10/100Mbps for the desktop and 1000Mbps for Application Servers. The Local Area Network runs on star distribution topology with Virtual network implemented. The network infrastructure is currently supporting IP, IPX, LAT and SNA traffic where the existing hospital and clinical applications are running. Network infrastructure is also currently supporting Radiology images traffic mainly between the three main Hospitals, voice and video in some of the distributed office like Singapore Power Building. Network Security Design consists of Firewall, Intrusion Detection System and Anti virus. It also supports remote access via VPN design for Intranet Application. They also have Internet bandwidth for e-Application traffic such as surfing Internet and email application. Parkway uses the INFINITT PACS system. They have also established teleradiology links to their Clinics in Shanghai. However they have no real EMR as of now. Applications: SAP-ISH/ISH-Med from SAP for our Hospital Information System Pharmacy system from Merlin PYXIS medstations from Cardinal Health CareVue system (for Critical care) from Philips Medical systems In-house Radiology Information System (RIS) T-Doc system for CSSD Oracle E-Biz Suite for Financials, Materials Management, Enterprose Asset Management. Migrating from SAP to Oracle for HR and Payroll 33
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They provide laboratory services in the following disciplines. Clinical laboratory services include: Biochemistry Haematology & Immunohaematology Special Chemistry (Immunology, Hormone, Therapeutic Drug Monitoring) Serology Body Fluids, Stool & Urine Analysis Microbiology Histopathology services include: Cytology Histology Triple Testing for Down’s Syndrome Cytogenetics services include: Prenatal Diagnosis Perinatal, Paediatric and Adult Karyotyping Special Tests (Fragile X, Fanconi’s Anaemia, Bloom’s Syndrome, Ataxia Telangiectasia, Fluorescent In-situ Hybridisation) Oncology Karyotyping
Business Intelligence from Business Objects Enterprise Application Integration (EAI) Webmethods
from
Parkway Laboratory Services Ltd (PLS) has laboratories on the premises of East Shore, Gleneagles and Mount Elizabeth hospitals, the three private hospitals owned by Parkway Group Healthcare, and a reference laboratory located in Ayer Rajah Crescent, which also houses their headquarters. They serve the needs of inpatients and outpatients at the three hospitals as well as other medical practitioners who operate within and outside the hospitals’ medical centres.
Revolutionary cancer treatment at PCC The Parkway Cancer Centre (PCC) in Singapore’s Mount Elizabeth Hospital gave new hope for cancer patients seeking treatment recently by being the first, and only centre in Southeast Asia to utilise TomoTheraphy technology as part of their cancer treatment programme. Dr Lee Kim Shang, Consultant Radiation Oncologist from the Radiation Oncology Centre of PCC said that this technology is a new, revolutionary way of treating cancer as the machine “can deliver very accurate radiation into the tumour and at the same time reducing the radiation in the surrounding healthy cells...It looks like a big CT Scanner, instead of doing just scan, it also produces X-rays that are strong enough to treat cancer. It can be used to treat various cancer diseases such as lung cancer, breast cancer, head and neck cancer and spinal cord cancer is just among the list.” Each time a patient goes under the TomoTheraphy machine for radiation, this machine will do a CT scan first. From the CT scan one can check whether it is the right position. Once it is the right position, the patient is treated. If the position is different from the day before, the machine will tell you by how much it has moved, and then position the radiation to the correct spot. That way you can know that you are treating the right spot. Compared to conventional radiation, Tomo-Theraphy can lower the radiation exposure to healthy tissue surrounding the tumour, thus it potentially has less side effects because of targeted radiation and precise image guided positioning.
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2 nd International Conference & Exhibition
“ Telemedicine: Myths and Reality” 23-24 October 2008, Lviv Topical issues of telemedicine and eHealth in Ukraine and worldwide
Dear collegues!
Conference discussion topics:
On behalf of Association for Ukrainian Telemedicine and eHealth Development (National Member of Іnternatіonal Socіety for Telemedіcіne and eHealth) let me invite you to participate in the 2nd International Conference "Telemedicine: Myths and Reality”, that will be held in Lviv on 23-24 October, 2008. 1st Conference "Telemedicine: Myths and Reality”, organized at the fall of 2007 by Western Ukrainian Telemedicine Center “Meditech” and Association for Ukrainian Telemedicine and eHealth Development (AfUTeHD), became really a success story of the project, that put together more than 200 participants from 10 countries worldwide. High growth of interest in telemedicine and ehealth from different environments: physicians, managers and decisionmakers, medical and technical university officials, private sector and students, - has been ascertained. It demonstrates the necessity of regular realization of scientific and practical forums on issues of telemedicine, informatization and computerization in Health Care as well as unified electronic medical space formation. Also, it is very necessary to create scientific approaches and evidence base for development of Ukrainian ehealth. Due to organisation of such conferences and seminars it become possible to exchange ideas and achievments, to discuss and to create working groups. Gained experience and knowledge will ensure the future work on standardization of medical information systems, for an effective decision making, for understanding the routine ehealth and telemedicine usefulness. I am glad to welcome you to attend 2nd International Conference "Telemedicine: Myths and Reality”. I believe this year we will also present you high-grade scientific program, helpful practical recommendations. New ideas and the way of their realization will be our gift for you. Best wishes, Anton Vladzymyrskyy, M.D., Ph.D., Head of Executive Board of Association for Ukrainian Telemedicine and eHealth Development Organizers
Supported by
• Clinical telemedicine (teleradiology, teletraumatology, telepediatrics, teledermatology, telepsychiatry, emergency telemedicine etc.) • eHealth • Home and mobile telemedicine, telemonitoring • Hospital information systems and telemedicine networks • Medical electronic records, medical information safety • Technical and program solutions for telemedicine and eHealth • Informatization of Public Health • IT-managemant in Public Health and pharmacy • Telemedicine as certified education • Distance education • Transboundary telemedical projects • Deontology in telemedicine • Legal regulations of telemedicine functioning in Ukraine and abroad • Telemedical services payment About the Conference: Conference materials will be published in «Ukrainian Journal of Telemedicine and Medical Telematics» An exhibition of technical equipment and software for telemedicine and eHealth will be held during the conference. Please visit conference website: www.telemed.net.ua to find information on terms of registration and participation in conference. Deadline for abstracs submission - 1 September 2008 Conference venue: Large conference hall, Hotel “Dnister” Address: 6, Mateyka str, Lviv Ukraine
Our Partners
WESTERN UKRAINIAN TELEMEDICINE CENTER
To participate in conference, exhibition or sponsorship, please contact Conference Board: E-mail: conference2008@telemed.net.ua Tel./fax: + 380 32 2430055 www.telemed.net.ua
Media Partner
Technology Media Partner
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news review
BUSINESS
Growing Pharma, Biotech help Indian equipment market grow
SaskTel and Alcatel-Lucent launch remote monitoring
Growth in the pharmaceuticals industry that has been witnessing rampant outsourcing of clinical trials and drug discovery research to the country has influenced strong growth in the Indian laboratory analytical instruments market. Adding to this has been the increasing emphasis on environmental conservation as well as the growth in the biotechnology sector. Riding on this wave, the Indian market for laboratory analytical instruments is expected to register double-digit growth rates compared to the modest 3-4 % growth rate in other countries. New analysis from Frost & Sullivan, Indian Laboratory Analytical Instruments markets, finds that the market earned revenues of over 7.89 billion rupees in 2007 and estimates this to reach 18.07 billion rupees in 2011. Support from the government and huge investments have helped accelerate the pace of development and mitigate potential bottlenecks, enabling the country to become the hub of biotechnology R&D activity. Also witnessed is a growing emphasis on preservation of the ecosystem through total environmental conservation. Laboratory analytical instruments being critical in these sectors, their growth is expected to remain unscathed in the future. The Indian laboratory analytical instruments market is highly price sensitive. End users such as the government, research institutes, and the pharma industry are very focused on their needs, procuring only the best of equipment with all features enabled at a highly competitive price. There is a distinct movement toward the procurement of value-enhanced products, but a reluctance to pay a higher price for such devices is also evident. To remain competitive in the market, foreign suppliers are forced to shed a portion of their margins to enable them maintain prices at acceptable levels. Efforts are being directed toward inspiring sales through brand equity image. The best way forward for foreign suppliers is to either set up joint ventures with local manufacturers or go the whole hog and establish their own manfuacturing facilities in India.
France-based Alcatel-Lucent and SaskTel have launched LifeStat Remote Monitoring and Health Management, a service that records and transmits daily blood glucose and blood pressure readings, automatically creating confidential, easy-to-use reports that can be viewed online by the client, their caregivers and the client’s healthcare professionals. The ongoing development and support of the LifeStat platform and applications will be managed by SaskTel and Alcatel-Lucent through their Salveo project, which is based in Saskatchewan, Canada. The Salveo project is funded by the two parties with the primary objective of becoming a world leader in health and wellness telemonitoring software applications. “LifeStat is a tremendous success story for SaskTel, Alcatel-Lucent and the Province of Saskatchewan,” said Ken Cheveldayoff, Minister of Crown Corporations for the Province of Saskatchewan. “Not only will LifeStat result in healthier people globally, it has created 20 new technical and professional positions in this province.” “The LifeStat technology may hold the key to a new paradigm of diabetes and chronic illness management in primary care. We are looking forward to using this technology to introduce standard clinical diabetes management in the patient’s home with the help of the Home and Community Care team and the patient’s family physician,” said Dr Sheldon Tobe, Sunnybrook Hospital Ontario. SaskTel will market and sell the LifeStat service directly to consumers and healthcare providers in Canada, while Alcatel-Lucent will market and actively sell the Salveo platform to its global customers outside of Canada under the name Alcatel-Lucent Health and Wellness Application. Future LifeStat applications will include monitoring and reporting for chronic illnesses such as congestive heart failure, Chronic Obstructive Pulmonary Disease (COPD) and asthma.
IFC to invest INR 55 crore in Rockland hospitals World Bank group member International Finance Corporation has said it will invest INR 55 crore (USD 14 million) in Delhi-based Rockland Hospitals to support its expansion plans. Rockland Hospitals plans to expand its facility in the national capital and set up a 250-bed hospital in Manesar, Haryana. “IFC will provide 10 million dollars through equity investments and another 4 million dollars in convertible preferred shares to Rockland Hospital,” IFC said in a statement. The project will help broaden access to high-quality health care and good administrative and patient care to common people, it added. “This project demonstrates IFC’s commitment to social sector development. It also aligns with our strategy to invest in health care, one of India’s largest service industries where the private sector’s involvement is most critical,” IFC Director for Health and Education Guy Ellena said in a statement. IFC, a member of the World Bank Group fosters sustainable economic growth in developing countries by financing private sector investments. 36
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TAKE Solutions’ Pharma suite has four new Indian clients
Perot Systems to support health insurance program
TAKE Solutions announced recently that its worldwide business in regulatory document management and electronic submissions software arena is making quick inroads in the Indian market. The addition of new clients to TAKE Solutions’ globally renowned PharmaReady suite, makes the product very well entrenched in the Indian market. Amongst others, key customers in India are Ajanta Pharma, Alembic Ltd., Alkem, Dabur, Emcure Pharmaceuticals, Marksans Pharma and Serum Institute. With eSubmissions becoming mandatory in many of the countries in the West, more and more Pharma companies in India are realising the need to update their processes and procedures to the eSubmissions platform. With a 100% implementation and submissions success rate, customers in 12 countries are putting PharmaReady to constant use across 4 continents, with an install base of several thousand satisfied users. The PharmaReady suite of software distinguishes itself from the marketplace by being relevant to a wide range of global life sciences customers and prospects. This includes branded and generic bio-pharmaceutical companies in various stages of their research and application process as they seek approval from global regulatory agencies. Unlike many of its competitors, TAKE Solutions has near shore support centers located in Chennai, India for the Asia Pacific customer base that makes it very convenient for users located in this part of the world. TAKE’s offices in North America serve as the support centres for the North American and European customer base.
The Commonwealth of Massachusetts’ Health Insurance Connector Authority, also known as Health Connector, and Perot Systems, a provider of IT services, has announced that the company will provide IT and business process services to support the state’s innovative program to assist low-income Massachusetts residents in choosing the appropriate plan of coverage for each individual’s healthcare needs. The Health Connector’s Commonwealth Care program has been deployed to ease the financial burden of health insurance costs, and provide benefit coverage options to residents of Commonwealth of Massachusetts. Perot Systems’ expertise in the healthcare industry combined with its ability to provide technology will improve operational efficiencies and drive down the administrative costs of the program. By providing service and technology support, Perot Systems will help the Commonwealth Care program to achieve the landmark goal of providing healthcare coverage for many of its uninsured residents. The timeframe for the agreement is for three years, and some of the responsibilities will be shared with both Vecna and the Public Consulting Group.
ICICI Venture eyes stake in KIMS An ICICI Venture associate fund and a Singapore-based private equity (PE) player are in talks to invest INR 300 crore in Kerala Institute of Medical Sciences (KIMS). The hospital will use the fund for Indian and overseas expansion. KIMS CMD M Sahadulla said, “We have been talking to several PE players to fund our expansion plans. We have now zeroed in on two funds—an ICICI associate fund and a Singaporebased healthcare focused PE player.” However, he did not disclose the amount of stake that KIMS would offload to these two funds. Mr Sahadulla added that apart from funds from PEs, KIMS was also looking at a strategic partner who would stay with the hospital for a longer period. “We would like our partners to stay with the hospital for 5-7 years instead of exiting the hospital within 3-4 years with 25% annualised returns,” he said. KIMS plans to list the company in five years. India’s largest PE fund, ICICI Venture, has a healthcare-focused fund, I-Ven Medicare, which has a corpus of USD 250 million. The fund has already invested in several hospitals in the country, mostly in regional hospitals in tier-II and III cities. A source said that KIMS has had initial discussions with I-Ven Medicare. However, KIMS has not finalised the valuation of the hospital and the investment plans. KIMS is the first venture of KIMS Healthcare Management, started by a group of doctors and entrepreneurs. The hospital, which was commissioned in 2002, runs a 450-bed multi-specialty hospital in Thiruvananthapuram.
September 2008
Fortis plans medical institute in Punjab, to invest INR 100 cr Medical service provider Fortis Health Care plans to set up an institute, which will also house a cancer research hospital, in Punjab at an initial investment of INR 100 crore. “We have submitted a detailed plan to Punjab Government to upgrade the healthcare services in the state which includes setting a medical education centre that would include nursing school, OPD centre and a large cancer hospital,” Fortis Healthcare CEO Shivinder Singh said. State officials said Fortis’ plans include setting up a chain of medical centres on a private-public-partnership model. The total investments in the initial phase would be to the tune of INR 100 crore, the officials said. The plan is to set up a large hospital, with capacity of 100-250 beds linked to the OPD services, the officials said, adding the firm was looking at replicating the model in other parts of the state. A high rate of cancer in Punjab, particularly in Malwa region, and absence of proper treatment facilities force people to go to hospitals in neighbouring state of Rajasthan. The hospital would also help in providing medical care to the patients coming from across the border, officials said. According to the data available with the government a large number of patients from countries like Afghanistan and Pakistan come to India via Amritsar for treatment and there is a big demand for a quality private hospital in the region. The company had earlier said it was targeting to own 40 hospitals by 2011 and it can be through acquisitions, setting up greenfield facility or through PPP model.
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Intel gets FDA OK for personal health system Intel Corp, the world’s biggest computer chip maker, recently won clearance from the US Food and Drug Administration to sell an inhome health monitoring system for patients with chronic conditions. The system, called Health Guide, combines an in-home patient device as well as online access that enables health care professionals to monitor patients and remotely manage care. It incorporates interactive tools for personalised care management and integrates vital sign collection, patient reminders, multimedia educational content and feedback, and communications tools such as video conferencing and e-mail. The Health Guide system can connect to specific models of wired and wireless medical devices, including blood pressure monitors, glucose meters, pulse oximeters, peak flow meters and weight scales. It also stores and displays collected information on a touch screen and sends to a secure host server, where health care professionals can review the information. Sources said the system would initially be marketed to insurance companies, healthcare providers and governments. The company is still doing pilot studies and initial results suggest using the system will save money. Medical device makers Medtronic Inc and St. Jude Medical Inc already have remote monitoring systems for heart patients. Burns said he viewed those systems as complements, rather than competitors, to Health Guide. Intel said it expects Health Guide to be commercially available from health care providers in the United States and the UK late this year or early next year. The system could be expanded to include patients just discharged from the hospital, as well as the generally healthy population looking to stay well.
Piramal Health inks marketing deal with US co BioElectronics Piramal Healthcare is set to clinch yet another in-licensing deal. The company has concluded a marketing deal with US-based firm BioElectronics to market the latter’s pain management equipment, ActiPatch. The deal is likely to be announced sometime next month, sources said.
Confirming this, Piramal Life Sciences vice-chairperson Swati Piramal said, “We have a strong marketing and distribution network and we are capitalising on that. We have a team that is continuously on the look out for such alliances. The product is going to be launched in August.” This alliance, she added, was solely intended for marketing. BioElectronics is the developer and marketer of ActiPatch, a medical device, which delivers pulsed electromagnetic frequency (PEMF) therapies to accelerate healing of soft tissue injuries.
Lawson eyes S. Asia via India presence Taking its operations in South Asia to the next level, ERP software, applications and services provider Lawson Software has formally opened its first office in India in New Delhi. The company has so far been servicing clients in India and Sri Lanka through partnerships with Symphony Services and ETP International. The India office will help the company build its South Asia presence and forge new partnerships, said Harry Debes, president and chief executive officer, Lawson Software. “We have been investing USD 7-10 million annually over the last three years in expanding our presence in the Indian market through our partnership with Symphony Services. With new partnerships with companies like KPIT and Ptex Solutions being added in recent times, we hope to continue adding clients in niche areas like equipment rental services and distribution. These will be focus areas for Lawson in India,” Debes said. St Paul, Minnesota-based Lawson presently has over 400 customers in Asia in targeted industries like fashion, food and beverage, equipment service and rentals, distribution and manufacturing. Lawson saw a turnover of USD 854 million during fiscal 2008, a significant portion of it being realised by the acquisition of Intentia International during Q4 of 2006. “We focussed on sectors with huge growth potential like healthcare, retail, maintenance, distribution and manufacturing which had not received the attention they deserved from larger players operating in the ERP space. The focus will continue to be on verticals like these, not on client size or deal size,” Debes said. The company cornered 60% of the US healthcare ERP market in 2007, according to research firm Gartner. It presently has 4,500 hospitals on its client list worldwide. 38
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news review
WORLD
Computer aided knee replacement surgery Computer aided knee replacement (also known as computer aided knee arthroplasty) is attracting a large number of medical tourist to hospitals in India. The less invasive nature of this medical procedure, will also help increase the popularity in India of the total and partial knee replacement surgeries. In this procedure, a computer is installed with medical surgery software and is connected to a surgery infrared camera and specialised surgical instruments. The surgeon, to perform the knee replacement, uses this “knee surgery computer system.” This allows for more precision and accuracy during the surgery. The surgeon can see the computer generated image real time while preforming the knee operation. The alignment of the knee replacement implant is more accurate (accuracy of 0.5 mm and 0.5 degrees) and predictable compared to surgery with naked eyes. The system acts as a GPS for the human body helping the surgeon by providing real-time navigation information and enhanced 3D visualisation. The International Society for Computer Assisted Orthopaedic Surgery is a non-profit organisation working towards the growth of this field. Other advantages of computer aided knee replacement surgery are smaller incisions, as it is a minimally invasive surgery, faster recovery, less bleeding and lower chance of blood clotting, less pain, easy on patient and doctor, reduces chances of human error, increased implant longevity as it reduces chances of bad alignment requiring revision surgeries. The total knee replacement usually lasts about 10 to 15 years. With the computer assisted orthopedic surgery the knee replacement can last up to 30 years. The associated price and cost of the Knee replacement surgery in India, Costa Rica and Mexico is about 50-80% less that what is in the USA.
Mobile rehabilitation of heart patients Scientists are in the final stages of launching a mobile phone with a miniature heart monitor and a GPS device that would help keep track of rehabilitation of patients thousands of kilometres away. “The programme allows people who have been in hospital for a heart attack or heart surgery to undergo a six-week walking exercise rehabilitation programme wherever it’s convenient, while having their heart signal, location and speed monitored in real time,” said Dr Charles Worringham of Queensland University of Technology’s Institute of Health and Biomedical Innovation. The ‘Cardiomobile’ system works by the patient attaching to their chests a mini ECG (electrocardiogram or heart signal) monitor and wearing a cap with a lightweight GPS receiver, both connected to a mobile phone via Bluetooth. Patients phone in at the start of their scheduled session and then their heart signal, location, speed and gradient are monitored in real-time over the web by a qualified exercise scientist, who guides the patient’s programme and checks their progress. If there is any problem with the heart signal they immediately contact the patient, and consult with the cardiologist if needed. The unique ‘Cardiomobile’ monitoring system, which has been developed by Gold Coast company Alive Technologies, is being further developed and tried.
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Apollo, Dhaka accredited by JCI for quality of healthcare Apollo Hospitals Dhaka (AHD) recently achieved the prestigious accreditation from Joint Commission International (JCI), the international accreditation body, becoming the first hospital in Bangladesh to have this certification. With this accreditation AHD confirms its standing with other JCI accredited hospitals in South Asian and South East Asian countries which include: Thailand, Singapore, Malaysia and India among others. Joint Commission International’s on-site evaluation of AHD occurred in September 2007 and was conducted by a team of international healthcare experts, including a doctor and an administrator. “Healthcare organisations around the world want to create environments that focus on quality, safety and continuous improvement”, said Karen Timmons, Chief Executive Officer (CEO) of JCI. “Accreditation meets this demand by stimulating continuous systematic improvements in an organisation’s performance and the outcomes of patient care. The community should be proud that AHD has made a commitment to quality and safety.” JCI is a US based accreditation body dedicated to improving the quality of healthcare through voluntary accreditation. It’s uniform, high standards for patients care and safety, are designed to be adaptable to local needs thus accommodating legal, religious and cultural factors within a country. Standards focus on the areas that most directly impact patient care. These include access to care, assessment of patient, infection control, patient and family rights and education. JCI standards also address facility management and safety, staff qualifications, quality improvement, organisational leadership, and information management.
World’s largest online medical encyclopedia planned A plan to create the world’s largest online medical encyclopedia was announced recently. Known as Medpedia, the site will be free and available to the public when it launches at the end of this year. Physicians, medical schools, hospitals and health organisations are volunteering to build a comprehensive clearinghouse for information about health, medicine and the body. The goal is to create Web pages with easy-to-understand information on 30,000 diseases, more than 10,000 prescription drugs and thousands of medical procedures. People can get a sneak preview of the site at www.medpedia.com. Participants include the UC Berkeley School of Public Health, Stanford School of Medicine, Harvard Medical School, the National Institutes of Health, the national Centers for Disease Control and Prevention, the Federal Drug Administration and many other organisations. Medpedia is urging qualified doctors, biomedical researchers and clinicians to apply to become content editors at the site.
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New technology helps visually impaired Internet users IBM Research has developed a unique Social Accessibility collaboration software, which allows Internet users to improve Web accessibility, particularly for those who are visually impaired. The new collaboration software enables users with low or no vision to report Web content accessibility issues they faced on specific Web pages. In addition, any Internet users who wish to aid in improving Internet accessibility can respond to such requests from visually impaired users by using the tool to contribute alternative text to solve the reported issue. For example, if a visually impaired individual wants to find out what image is showing, existing screen reading software may not have a description of the photo. Whenever visually impaired users face such difficulties, they can report it by using the collaboration tool and ask for adding an improved alternative text to describe the image. The request then is automatically sent to a server hosting the Social Accessibility Project Website. Internet users who are registered to the Social Accessibility Project can see this request on the project Website, and may decide to respond to this request by using the collaboration tool by clicking “start fixing it” button, and type a short description. The short description will automatically be transformed to an external metadata. The next time any visually impaired person tries to revisit the Web page showing the photo image, screen reading software will read the alternative text from the metadata to give better explanation of what the photo shows. Metadata consists of useful information such as description of the content and the physical location of the particular content. By having external metadata to reside at the Web server, Web content will remain unchanged while making the Web more accessible. In order to encourage participation in the project, the Social Accessibility Project Website and collaboration tool are available free of charge on IBM alphaWorks Services website.
Smoking cessation campaigns via SMS in London Pharmacies in London plan to launch a text messaging service to validate smoking status and invite ‘quitters’ for smoking cessation services in addition to using the system for ‘follow-up’ over the next year. The adoption of the Patient Care Messaging service, provided by iPLATO, has been driven by the successful use of the system for similar campaigns in GP surgeries across 34 PCTs. The pharmacies using iPLATO’s Patient Care Messaging for Pharmacies service, will receive support via best practice techniques for launching the text messaging service, enabling them to fulfil their growing role in Public Health. A representative from one of the pharmacies said, “We are excited about the opportunity to improve engagement with our patients through innovative technology. For any broad patient communication solution we are always concerned with privacy and data protection. The PCT has developed guidelines to ensure patient safety that we adhere to. According to these guidelines, patients can opt out of the service at any time by simply telling their pharmacist or any staff. We would encourage all customers to hand in their mobile number so that we can reach them with this new service.”
World Bank announces USD 520 m Malaria project for India In a bid to help combat Malaria and other fatal diseases in India, World Bank has announced a US$ 520 million scheme, the largest such project by the world body in any country. Over 100 million people in India will be provided prevention services and treatment under the scheme designed by the Indian government, the UN World Health Organisation (WHO) and the Global Fund to Fight AIDS, Tuberclosis and Malaria. Welcoming the scheme, UN Secretary-General’s Special Envoy on Malaria congratulated both the World Bank and the Indian Government for their “tremendous commitment” to combating malaria and like diseases. More than two million cases of the disease are reported yearly in the country, causing India to lose nearly 80 million days in productivity annually. “Malaria continues to be a major threat to the lives of millions of poor Indians through premature death, disability, and unnecessary suffering,” said Isabel Guerrero, the World Bank’s Vice President for South Asia, when the body’s new initiative that will cost US$ 520.75 million was announced. Falciparum malaria, a severe form of the disease, which is often fatal, is on the rise in India due to increased resistance to chloroquine treatment, which was previously the primary anti-malaria drug, the world body said. “This project uses the latest science on malaria control, including a new highly effective drug regimen, to effectively address this problem,” Guerrero noted. 42
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NHS launches online one-stop advice-shop for mums-to-be
Indian researchers on way to creating vital part of human eye
The first NHS online maternity guide, offering a wealth of information on pregnancy and birth, at just the click of a mouse, has been launched. The new Pregnancy Care Planner gives the latest and most comprehensive advice on all aspects of pregnancy, from getting pregnant, early pregnancy, the scans, to the birth, and the most up to date comparative guides to what is on offer at local maternity units. Health is the most researched subject on the internet, and pregnancy is the most researched health subject. This new service is available on the national NHS website, NHS Choices and the link to the planner is www.nhs.uk/pregnancy. All one needs to do is type in their postcode, and choose which units to compare, and one can make up ones mind on what services they would like to discuss with the midwife, based on the best and most up to date information and data. Pauline Esson, the Head of Midwifery at Lewisham Hospital said, “The lack of a comprehensive NHS online maternity guide has become marked in recent years. “Just at the time that people are demanding more and more online information, we haven’t had a reliable place to direct people to. I will definitely use this planner as back up to care and will print out the key sections for expectant parents without internet access.” Key features in the Planner include a personalised NHS Choices pregnancy account, which allows users to be sent information of interest to them; an online birth plan, update as you go, discuss with your midwifery team, print out and keep with you during the labour; advice on how to best prepare for pregnancy, what is healthy, the best time for conception; information for dads, etc. NHS Choices is the national public website for the NHS providing comprehensive health information guides, accessible content on healthy living, and comparative ‘scorecard’ information on local health services.
Half a dozen eye hospitals in India are collaborating with a research centre here to create the inner layer of the cornea, the vital window of the human eye. If successful, this research may allow 14,000 eye transplants a year. Nichi-In Centre for Regenerative Medicine (NCRM) hopes to make corneal endothelium (inside cell layer) available on a commercial scale. NCRM eventually plans to set up a world class Corneal Endothelial Stem (CES)/Precursor Cell Bank at a cost of USD 8 million. The CES bank is expected to facilitate 14,000 eye transplants a year. The project is based on the findings of Japanese doctor Shiro Amano of the Tokyo University School of Medicine, who in 2002 found that the endothelium of the cornea contains stem cells (cells in initial stages of development) that can be multiplied several times in the laboratory. “The finding triggered worldwide research in creating corneal
Philips launches new handheld ultrasound system Royal Philips Electronics announced recently the launch of its advanced handheld ultrasound system, the Philips CX50 CompactXtreme. Designed to meet the needs of cardiologists for clear diagnostic data at the bedside, the new compact system combines the image quality expected of a traditional, premium, full-size system with the convenience of portability. “Following extensive research into clinicians’ needs, we’ve designed a laptop-sized system that can help them get to patients quickly - no matter where they are in the hospital or clinic - and which can produce high quality images regardless of the difficulty of the situation at hand,” said Anne LeGrand, senior vice president and general manager, Ultrasound, for Philips Healthcare. “Clinicians told us that small, portable systems are beneficial, as long as the image quality can help them make a confident diagnosis. If poor image quality from a handheld system results in inconclusive data, repeat exams may be needed at the cost of additional time and money. The CX50 was designed to consistently deliver high-quality images, even in technically challenging patients.” The CX50 CompactXtreme offers portability to address multiple scanning environments. Its built-in handle and battery allow users to pickup-and-go for quick responses. For added convenience, it has a cart designed specifically for the system for effortless maneuvering throughout the hospital. And a wheeled case supports easy travel to remote locations.
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cells for therapeutic use,” Samuel J K Abraham, lead researcher and director of the Chennai laboratory of the Nichi-In Centre said. The eye has three main parts. The first is the cornea, which is a transparent film like structure that transmits light into the eye. The other two are the lens and retina. During eye transplant, only the cornea is taken from the donor, not the whole eye. The black central portion of the eye has an outer layer, a middle portion and an inside layer (known as the endothelial layer). Eye fluid keeps the cornea alive for up to six hours, allowing time for harvesting it and transplanting it. The World Health Organisation says that in India, there are approximately 6.8 million people who are blind because their corneas are diseased. By 2010, this figure is estimated to go up to nine million. “About 100,000 people are in need of eye transplant every year, yet only about 10,000 are able to get donated eyes. The wait for a donor can be endless for the other 90,000,” eye specialists say. “Imagine what a boon it will be if an eye stem cell bank could provide these lab generated endothelial layer of the cornea,” S. Natarajan, chairman, academic research committee of the All-India Opthalmological Society and chairman of the Aditya Jyot Eye Hospital said. With the new technique, when cornea specimen from one eye donor is received, it could be used for 5-10 needy patients, he pointed out. Nichi-In is now growing the animal and human corneal inner layer cells on a nanoscaffolding. The research centre is hoping to begin phase I clinical trials on humans in 6 months.
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ZOOM IN
Connecting people, systems and services The European Commission has recently published a new draft of interoperability guidelines setting out a roadmap to achieve interoperable electronic health records (EHR) across the continent by the middle of the next decade.
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n the globalised world where information and communication technologies (ICTs) have broken down borders and reduced distances markedly, one still faces challenges in transferring critical medical data of ones own self, even while travelling within a region that accepts the same currency. The European Union was established by the Treaty of Maastricht in 1993, with the aim of developing a single market through a standardised system of laws which apply in all member states, guaranteeing the freedom of movement of people, goods, services and capital. The Union also launched the euro as common currency in the region in the year 2002 amidst much protest; however, the region is today seeing great benefit from the strong common currency. One issue that has, of late, come into the purview of the Union is that the ease of mobility and trade has also raised the necessity of better and stronger healthcare coverage to be provided to the citizens, no matter which Member State they belong to. Electronic Health Records Electronic Health (or Patient or Medical) Records have traditionally been understood as being the demographic details of the inpatient flow in hospitals. However, EHRs are more complex and need to be taken more seriously if one needs value return from the capture of data. A good EMR system would capture all data relating to both in/out patient flow and in the long run must be capable of providing Clinical Decision Support (CDS) and disease profiling, helping in developing and implementing solutions faster. Since, the 44
capture of clinical and demographic data is in a pre-determined format, it allows several clinical attributes to the data processing like, clinical decision-making by accessing a rules engine to provide alerts, reminders, clinical protocols, coding assistance etc. Need for interoperability Medical Informatics experts world-over have been advocating bringing about standards in the format of data capture, especially using ICD – 10 more widely for the greater good of public healthcare, also providing patients more control over their own medical records, and allowing interoperability between hospitals and doctors in different locations where the patient may be travelling. However, the myopic view of most healthcare service providers has kept this idea from becoming a reality. By interoperability, the EU Recommendation means, “The ability of information and communication technology (ICT) systems and of the business processes they support to exchange data and to enable the sharing of information and knowledge.” Achieving and maintaining cross-border interoperability of EHR systems implies managing a continuous process of change and the adaptation of a multitude of elements and issues within and across electronic infrastructures in Member States. Interoperability of electronic health record systems is claimed to lead to both social and economic benefits, and to be an appropriate means to: bring about better quality of treatment because of better information about the patient; improve the cost efficiency of medical treatments, and thus www.ehealthonline.org
prevent further rapid growth of healthcare budget deficits; furnish the necessary data for quality control, statistics and planning in the public healthcare sector which should also have a positive effect on public healthcare budgets. Community eHealth Action Plan (2004) The high-level eHealth Conference “Empowering the European Citizen through eHealth” was held in Cork between 5th and 6th May 2004 organised by the Irish Presidency and the European Commission. The Conference was an opportunity to demonstrate current eHealth tools and provided a forum in which to take stock of completed, ongoing or planned initiatives at European level. The objective of the Conference was to emphasise the benefits of the empowerment of citizens through eHealth solutions such as information, administration, homecare and telemedicine tools and services. The Conference identified a number of trends and challenges at stake, as echoed in EIPA’s eHealth research report (Mapping the Potential of eHealth: Empowering the citizen through eHealth tools and services). The European Commission adopted on 30 April 2004 an e-Health Action Plan that aims to improve access to healthcare and boost the quality and effectiveness of health services offered across Europe. The action plan identifies a number of major challenges for wider implementation of eHealth systems and services, including for example the commitment and leadership of health authorities, the interoperability of systems, data protection, high quality and accurate health information, a single market for eHealth allowing equity of access, access for all, improving the effectiveness of healthcare provision, ensuring effective knowledge management. It was suggested that by end 2006, Member States, in collaboration with the European Commission, should identify and outline interoperability standards for health data messages and electronic health records, taking into account best practices and relevant standardisation efforts. And by 2008 health information networks should be commonplace, delivering services over fixed and wireless broadband networks and making the most of networks within so-called “grids” to boost computing power and the interaction between different systems. Draft Reccomendations The Recommendation proposes a set of guidelines that ought to be attained by individual Member States to ensure the minimum level of compatibility and communication with fellow Member States. The guidelines address the following four objectives: To outline and agree the principles on which there should be broad agreement and engagement in regard to cooperation on shared and interoperable eHealth information. To enable interoperability between health information shared among different healthcare systems, To resolve the various challenges of achieving cross-border interoperability of EHR systems in the Community by building appropriate networked systems and services that cover the entire continuum of care, and that are underpinned by the appropriate legal and regulatory, medical and care requirements. September 2008
To assess not only the benefits, but also the barriers, hurdles and potential threats to achieving eHealth interoperability, and to identify the necessary preconditions and relevant incentives to overcoming these. The ultimate goal of the Recommendation is, therefore, to contribute to creating a means whereby authorised health professionals can gain managed access to essential health information about patients, subject to the patients’ consent, and with full regard for data privacy and security requirements. Such information could include the appropriate parts of a patient’s electronic health or medication record, patient summary, and emergency data accessible from any place in the Community. To achieve this, Member States are invited to undertake actions at several levels, namely: Overall political level - where the partners need to commit politically and strategically to the implementation at local, regional and national level of EHR systems that are capable also of interoperating with EHR systems in other Member States; engage in active cooperation with other Member States and relevant stakeholders to ensure the adoption and implementation of standards that make this feasible and secure; reserve adequate resources, for example by means of direct incentives, to invest in such systems; accompany implementation of EHR systems by strong involvement of users and other stakeholders in establishing adequate governance, management, public-private partnerships, public procurement, planning, implementation, evaluation, training, information and education; help raise awareness among relevant stakeholders such as local and regional authorities, health professionals, patients and industry of the benefits and need for interoperability of EHR systems. The organisational level - It is essential to create an organisational framework and process that will enable crossborder interoperability of EHR. This should be based on a roadmap, developed by Member States, which covers a fiveyear period and provides details with regard to agreement on a European governance process to establish guidelines for developing, implementing and sustaining cross-border interoperability of EHR covering management for reliable identification of patients and authentication of health professionals as well as other relevant issues; consider policies and incentives to increase demand for procuring eHealth services to enable interoperability of EHR; analyse the factors which render the standardisation processes leading to higher levels of interoperability a long, complex and expensive activity, and devise measures to speed up these processes. The technical level - Compatibility of EHR systems at the technical level is the essential prerequisite for interoperability, and Member States should undertake a comprehensive survey of existing technical standards and infrastructures that may facilitate the implementation of systems supporting cross-border healthcare and the provision of healthcare services throughout the Community, especially those related to EHRs and exchange of information. Consider standardised information models and standards-based profiles to be part of national or regional specific interoperability specifications; commit to the development of any necessary additional standards, preferably open standards on a global scale. 45
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The action plan identifies a number of major challenges for wider implementation of eHealth systems and services, including for example the commitment and leadership of health authorities, the interoperability of systems, data protection, high quality and accurate health information, a single market for eHealth allowing equity of access, access for all, improving the effectiveness of healthcare provision, ensuring effective knowledge management. The semantic level - Semantic interoperability is an essential factor in achieving the benefits of EHRs. The Member States should establish an appropriate mechanism in cooperation with the relevant standards development organisations, the Commission and the World Health Organisation, to involve national research centres, relevant industries and stakeholders in the development of health semantics to advance in implementation efforts of interoperable EHR systems; wherever possible, consider the suitability of international medical-clinical terminologies, nomenclatures and classifications of diseases, including those for pharmacovigilance and clinical trials; the establishment of competence centres for multilingual and multicultural adaptation of international classifications and terminologies should also be encouraged; agree on standards for semantic interoperability to represent the relevant health information for a particular application through data structures (such as archetypes and templates), and subsets of terminology systems and ontologies responsive to local user needs; consider the need for a sustainable reference system of concepts (ontology) as a basis for mapping multilingual lexicons that take into account the difference between professional healthcare languages, lay terminologies and traditional coding schemes; support the widespread availability of methodologies and tools for incorporating the semantic content into practical applications, as well as the development of relevant human capacity and skills in this domain. The level of education and awareness raising - Member States should increase awareness about the benefits of and need for standards in EHR systems and their interoperability among producers and vendors of ICTs, healthcare providers, public health institutions, insurers and other stakeholders; pay particular attention to education, training and dissemination of good practices in electronically recording, storing and processing clinical information as well as in gaining informed 46
consent of the patient and lawfully sharing patientâ&#x20AC;&#x2122;s personal data; provide parallel information and training, including awareness raising, for all individuals, in particular patients. Certification of electronic health record systems - There is a need for a mutually recognisable conformity testing procedures that are valid throughout the Community or which serve as a basis for each Member Stateâ&#x20AC;&#x2122;s certification mechanism. Therefore, Member States should apply properly the existing eHealth standards and profiles, namely those related to interoperability of EHR systems, in order to enhance the confidence of users in those standards; put into place a joint or mutually recognised mechanism for conformity testing and certification of interoperable EHRs and other eHealth applications, such as the techniques and methodologies offered by various industry consortia; consider the industry self-certification and/or conformity testing activities as a mechanism to reduce delays in bringing interoperable eHealth solutions to the market; take into account national and international practices, including those which exist outside Europe. Protection of personal data - Member States should ensure that the fundamental right to protection of personal data is fully and effectively protected in interoperable eHealth systems, in particular in EHR systems; Member States should lay down a comprehensive legal framework for interoperable EHR systems. Such a legal framework should recognise and address the sensitive nature of personal data concerning health and provide for specific and suitable safeguards so as to protect the fundamental right to protection of personal data of the individual concerned. Monitoring and Evaluation - Member States should consider the possibilities of setting up a monitoring observatory for interoperability of EHR systems in the Community to monitor, benchmark and assess progress on technical and semantic interoperability for successful implementation of EHR systems; undertake a number of assessment activities, which may include defining the quantitative and qualitative criteria for measuring the eventual benefits and risks (including economic benefits and cost-effectiveness) of interoperable EHR. Conclusion Europe currently has a leading position in the world, with patient data being stored electronically by 80% of all EUwide primary care physicians. About 70% of European doctors use the Internet and 66% use computers for consultations. Administrative patient data is electronically stored in 80% of general practices: 92% of these also electronically store medical data on diagnoses and medication. Using such eHealth applications, doctors and medical services have already improved healthcare in Europe although progress is still needed, for example to create more efficient administration and reduce waiting times for patients. The benefits could be even more widespread throughout Europe if these systems could work together, making it easier for people to receive treatment even when they are away from their home country. Source: www.europa.eu, published by the European Union and its institutions
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EVENT REPORT
Making the eHealth Connection 13 July-8 August, 2008 The Rockefeller Foundation Bellagio Centre Not all problems have a technological answer, but when they do, that is the more lasting solution. - Andrew Grove, Founder of Intel Corporation
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he Rockefeller Foundation held a conference series, Making the eHealth Connection: Global Partnerships, Local Solutions from 13 July to 8 August at the Bellagio Centre. The goal was to explore ways to use the recent proliferation of technology in developing countries to improve health, especially for the most vulnerable populations. The aim of the Bellagio meeting was to “build support for access to health information in the Global South by: Looking broadly at health information access solutions, experiences, and lessons learned Highlighting knowledge about and evidence of the ability of health information access to improve patient safety, equity, and healthcare quality Discussing state-of-the-art practices, tools, and avenues for further eHealth proliferation in the Global South Examining barriers to access and publishing health quality information Exploring the role of social networks, collaborative spaces, communities of practice, and virtual communities Seeding global alliances and networks on e-information access and policies. The conference series kicked off with a rousing keynote address by Dr. Tim Evans, Assistant Director-General for In48
formation, Evidence and Research at the World Health Organisation. Tim put the four weeks of Making the eHealth Connection into context by talking about the current state of eHealth, the immense opportunities it offers, particularly for the Global South and the promise and responsibility the conference holds. In the first week, the ‘Path to Interoperability’ session focussed on the challenges that the Global South faces. The other themes were Public Health Informatics and National Health Information Systems. One of the most fruitful features were the break-out groups. Through these, the key messages were formulated. Some of the points of consensus were: The need for an information and knowledge management system that is not another bureaucratic system defined to “As people have commented, provision of information is only one aspect - the people who need the information also need to know that they need it, know where to find it and have it accessible in formats and languages that they will readily understand.” - Carolyn Green, UK
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the local context and that addresses the demands of the different stakeholders/users, while allowing for contribution at the local level. The importance of building on what already exists and ensuring that what is produced is available to all via standards including a space for the convergence of global collaborations where further development can take place. The need to improve access to information and knowledge sharing highlighting that solutions should include a focus on improving human resource capacity, including the translation and localisation of information, free access to research and publishing to create a local knowledge base and well as some type of global virtual eHealth index. Eight key issues are at the heart of advancing eHealth and improving health systems in the developing world’s Global South region and these were a part of conference conversation: The path to inter-operability Public health informatics and national health information systems Access to health information and knowledge-sharing eHealth capacity building Electronic health records Mobile phones and telemedicine Unlocking eHealth markets. By gathering some of the world’s foremost experts and centring conversations around these topics, new and actionable answers emerged about how to fund, design and deploy eHealth systems in the Global South and around the world. In the second week, participants focussed on access to information and knowledge sharing organised by BIREME/ PAHO/WHO paralleled by the conference on eHealth capacity (organised by the AMIA/IMIA). The “mHealth and Mobile Telemedicine” session gathered 25 private sector and public health leaders to explore the challenges, opportunities and September 2008
way forward in building mHealth systems that can improve the access, efficiency and quality of health services in the developing world. The overarching goal of the Rockefeller Foundation conference is to develop a roadmap and global partnerships that support the use of emerging digital technologies to improve public health. mHealth session participants included representatives of Cisco, Google, Microsoft, Nokia, and Qualcomm, as well as the Earth Institute, Gates Foundation, MIT, and the UN World Health Organisation. Africa and South Asia in particular have some of the “The good news is that there is increased momentum in countries around the world to use eHealth to address pressing healthcare challenges, ranging from preventative care to pandemics. However complex questions remain about how to create sustainable eHealth projects, particularly for the world’s poor and vulnerable citizens.” - Ticia Gerber, Senior Advisor at Manatt Health Solutions
worst health indicators in the world along with a dearth of information on healthcare, sanitation, best practices and the like. The conference focussed on health/medical professionals and policy makers. The most important recommendation was the “drafting of the health information policy,” which should be part of health policy. Once this health information policy is in place it can be adapted/used by any ministry. Among the keynote speakers was President Paul Kagame of the Republic of Rwanda. In 2006 and 2007, President Kagame was awarded the ICT Africa Award, in recognition of his demonstrated excellence in promoting the use of ICTs for the overall development of the African continent. Outcomes The overarching goal of the conference was to develop 49
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“There is a great gap between demand and supply of health information in the South. At eHEALTH, we aim to bridge that gap.” - Ravi Gupta, Director, Centre for Science, Development and Media Studies
support for workable solutions and to give new impetus for collaboratively funding, designing and deploying eHealth systems in the Global South and around the world. eHealth is increasingly employed to address health system challenges and improve services, particularly for poor and
es when they do have access to literature/Internet resources to improve their skills, they do not have the time to do so. Liz Carrington from the UK raised the important issue of low-cost information dissemination strategies in developing countries. Week 2 saw some concrete proposals emerge. Some interesting suggestions include: The need for an information and knowledge management system that is not another bureacratic system, defined to the local context and which addresses the demands of the different stakeholders. The importance of building on what already exists and ensuring that what is produced is available for all. The need to improve access to information and knowledge sharing vulnerable populations. Yet a myriad of questions linger on the financial and incentive side of the equation regarding how to create viable and sustainable markets, adequate financing and incentives, and effective public-private sector partnerships for impact investment. eHealth markets are difficult to quantify due to their relatively undefined scope and constantly evolving technology offerings. ‘Making the eHealth Connection’ has prompted several debates and discussions in various fora. The Health Information for All (HIFA 2015) campaign saw eminent persons from the health domain debate issues and look for solutions to the lack of health-related ‘knowledge’ as Naina Pandita puts it. A lively debate on ‘health information’ versus ‘health knowledge’ continues. “One reason why medical professionals do not get access to the “right” information is because the 1st step they take is Google for it. We need to come up with solutions on how to re-package the information into meaningful knowledge that can be passed on further. Nester Moyo from the Netherlands commented on how the worldwide shortage of nurses and midwives leaves the existing workforce overworked and even in the few instanc50
“Mobile phone use is exploding across the developing world, offering the opportunity to leapfrog other applications and services on both the health and technology fronts.” - Mitul Shah, Senior Director of Technology at the United Nations Foundation
There were some grievances too. For example, there were no substantive comments on measuring the impact of information. As Siddharth Dutta puts it, “... sharing of unscientific data over net will have huge confounding problem to the mass. This must be peer-reviewed and scientific assessment done and then aired on net.” Professor Krishnan Ganapathy, Founder Member and Joint Secretary of the Telemedicine Society of India, and one of the conference organizers, said, “The conference’s focus on the nexus of eHealth and the Global South is notable... We hope this will illuminate a path for others to follow.” Hopefully, the conference will set the stage for long-term sustainable collaboration in the field of eHealth. www.ehealthonline.org
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EXPERT CORNER
The evolution of Surgical Systems robotics applied to medicine Robotic surgery has already become a successful option in neurological, urological, gynaecological, cardiothoracic, and numerous general surgical procedures. And all would agree that the future of robotic surgery is nearly as promising as the human will to invent better ways of accomplishing delicate medical procedures. We take stock of the current scene in robotic surgical intervention. Healthcare Practice, Frost & Sullivan
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ince the onset of the 21st Century, medicine has been witnessing a considerable revolution, especially in the bounds of the surgical rooms. Technological developments have been continually introduced with increasing use of new capabilities, which promise to provide better outcomes and more cost-effective processes. Innovative algorithms, robotic devices, telepresence, imaging systems, sensors and human-machine interfaces are likely to work cooperatively with surgeons in the planning and execution of surgical procedures. The motivation behind this trend is the minimal invasiveness of such procedures, which results in less surgical injury and reduced pain and morbidity associated to the surgery; it also reduces the period of hospitalisation, thus costs of procedures, although initial investments are considerably high. During the 1990s, the so-called laparoscopic revolution brought about a paradigm shift from traditional open surgery to minimal access technique. Favorable results triggered surgeons to adopt such technique for most surgical procedures. Nonetheless, laparoscopy faced its limitations. For example, the video camera held by the assistant was unstable and gave a limited 2-dimensional vision of the field, and the primary surgeon was forced to adopt awkward positions to operate with
September 2008
straight laparoscopic instruments, limiting maneuvering. Therefore, the growth of the laparoscopic field reached its ostensible plateau, and it seemed that only a new technological leap could spur further development. Robotic devices effectively addressed such limitations, thus revolutionising the potential of minimal access procedures. A surgical robot is a self-powered, computer-controlled device that can be programmed to aid in the positioning and manipulation of surgical instruments, enabling the surgeon to carry out more complex tasks. Robots are not intended to act independently from human surgeons or to replace them. Instead, these machines act as remote extensions completely governed by the surgeon, only acting as manipulators. Table 1 highlights advantages of robots when compared to laparoscopic systems. Instead of the flat, 2-dimensional image that is obtained through the regular laparoscopic camera, the surgeon receives a 3-dimensional view that enhances depth perception. The camera motion is steady and conveniently controlled by the operating surgeon via voice-activated or manual master controls, allowing solo surgery. Also, manipulation of robotic arm instruments improves the range of motion compared with traditional laparoscopic instruments, thus allowing the surgeon to perform more complex surgical movements. Moreover, robotic procedures present shorter learning curve as compared to laparoscopic technique. Although rapidly developing, robotic surgical technology has not achieved its full potential. The cost of this innovation is also rather high. The absolute cost of a robotic system is significantly higher than a laparoscopic one. Major part of the increased cost is due to the initial cost of purchasing the robot itself (estimated at USD 1,800,000) and yearly maintenance (USD 100,000). At present, Da Vinci, a device made by Intuitive Surgical, is the only product of its kind approved for clinical use by the FDA available on the market. The companyâ&#x20AC;&#x2122;s system has been used for noncardiac thorascopic procedures, prostatectomy procedures, cardiotomy procedures, cardiac revasculariation procedures, urologic surgical procedures, gyneco51
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logic surgical procedures, and pediatric surgical procedures. With over 10,000 procedures performed, it has the most supporting clinical evidence of any medical robotics system. The companyâ&#x20AC;&#x2122;s market success has spurred a great deal of interest in the industry, and is likely to spur market entry from other larger medical device and robotics companies. Once several technologies start to compete, the cost of surgical robotic systems will fall considerably, thus leading to more widespread use. Currently, there are more than 850 medical institutions and hospitals using Da Vinci around the world. United States is the country where the technology is most widespread, although Germany, Australia, Japan, and less developed countries like Brazil have been adopting such technology. Despite the fact that robotic technology is not of widespread use and is still in its infancy, it is expected to play an increasingly important role in the future of surgery and this cutting-edge development in surgery will have far-reaching implications. High costs are prohibitive to the proliferation of such technology, thus, it needs to be brought down before robotic procedures can become mainstream, everyday surgical procedures. Visionaries go further in the domains of surgical revolution, expecting robots to be less of a mechanical device than an information system - one that should be fused with other information systems. One proposed example of this kind of fusion is image-guided surgery, also called surgical navigation. Robot-assisted surgeons will be able to see real-time, three-dimensional scanner images electronically superimposed over the operative field that is displayed on the monitor. In other words, on the screen, human anatomy will be
Origins of Robotic Surgery The first documented use of a robot assisted surgical procedure occurred in 1985 when the PUMA 560 robotic surgical arm was used in a delicate neurosurgical biopsy, a non-laparoscopic surgery. The robotic system allowed for a successful procedure and the potential for greater precision when used in minimally invasive surgeries, such as laparoscopies, which typically utilise flexible fibre optic cameras. The 1985 procedure led to the first laparoscopic procedure involving a robotic system, a cholescystecotomy, in 1987. The following year the same PUMA system was used to perform a transurethral resection. In 1990 the AESOP system produced by Computer Motion became the first system approved by the Food and Drug Administration (FDA) for its endoscopic surgical procedure. The Da Vinci robotic surgery system broke new ground by becoming the first system approved by the FDA for general laparoscopic surgery in 2000. That is to say that with the Da Vinci system, for the first time the FDA approved a system, which is all encompassing of surgical instruments and camera/scopic utensils. Source:http://www.roboticoncology.com/history/
rendered translucent, and the surgeon will be able to determine the exact location of a tumor and more readily avoid damaging vital structures. In fact, with preoperative scanner images, surgeons could robotically practice their patientsâ&#x20AC;&#x2122; surgery the night before, and the robotâ&#x20AC;&#x2122;s computer could be programmed not to allow any mistake, or even correct those occurred. The evolution is a matter of time.
Laparoscopic Limitations
Robotic Surgery Solutions
Two-dimensional vision of surgical field displayed on the monitor impairs depth perception
Three-dimensional view of the field
Movements are counterintuitive (mirror-image effect)
Movements are intuitive
Unstable camera held by an assistant
Surgeon controls camera held in position by robotic arm, allowing solo surgery
Diminished degrees of freedom of straight laparoscopic instruments
Micro wrists near the tip that mimic the motion of the human wrist
Surgeon forced to adopt uncomfortable postures during operation
Superior operative ergonomics: surgeon comfortably seated on the control console
Steep learning curve
Shorter learning curve
Table 1: Laparoscopic limitations as compared to robotic solutions 52
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EVENTS DIARY
Seoul, Korea
17 - 19 December 2008 International Meet on Integrated Health Social and Economic Impacts of Extreme Events
http://www.aocr2008.org/
New Delhi, India
24 - 28 October 2008 12th Asian Oceanian Congress of Radiology
http://events.du.ac.in/
3 September 2008 CHIK’s Health-e-Nation’08
29 - 31 October 2008 Healthcare Operations Singapore https://www.ibc-asia.com/healthcare
Melbourne, Australia http://www.health-e-nation.com.au/
9 - 12 September, 2008 World Medical Tourism & Global Health Congress San Francisco, USA http://www.medicaltravelauthority.com/
24 - 27 September, 2008 Azerbaijan International Healthcare Exhibition (BIHE) Baku, Azerbaijan http://www.healthcare-events.com/
10 - 14 November, 2008 3rd Annual International Medical Travel Conference (IMTC) Seoul, Korea http://www.medicaltravelconference.com/
14 - 17 November, 2008 4th National Conference of Telemedicine PGIMER, Chandigarh, India meenusingh4@rediffmail.com
16 - 18 November 2008 Healthcare IT Summit
7 – 11 January, 2009 62nd Annual Conference of Indian Radiological & Imaging Association ‘09 Patna, Bihar www.iria2009.com
12 – 13 February, 2008 Map World Forum Hyderabad, India www.mapworldforum.org/2009/conference/gsi. htm
21 - 23 February 2009 Meditec Clinika 09 Hyderabad, India http://www.meditec-clinika.com
23 – 26 February, 2009 Global Healthcare 09
St. Petersburg, Russia
San Diego CA United States of America
http://www.primexpo.ru/hospital/eng
http://www.healthcareitsummit.com/us/
http://www.magenta-global.com.sg/healthcare/
13 - 14 October, 2008 3rd Annual Global Healthcare Expansion Congress
18 - 20 November 2008 Net Health Asia 2008
27 – 29 March, 2009 Medical Fair India
Shanghai China
New Delhi, India
Dubai, UAE http://www.healthcareexpansion.com
www.nethealthasia.com
14 - 16 October, 2008 Medical Tourism Congress India 2008
25-27, 2008 eHEALTH Asia 2008
6 – 10 March, 2009 European Congress of Radiology 2009
Kula Lumpur, Malaysia
Vienna, Austria
India
http://www.e-asia.org/2008/ehealth/
http://www.myesr.org/cms/website.php
30 September - 2 October, 2008 Hospital / Pharmatsiya
http://www.informedia-india.com/
23 - 24 October, 2008 2nd Intl Conf-Telemedicine: Myths and Reality
8 - 10 December 2008 4th Annual World Healthcare Innovation & Technology Congress (WHIT 4.0)
Lviv, Ukraine
Washington DC, USA
http://www.telemed.net.ua/
http://www. worldcongress.com
56
Singapore, Singapore
http://www.mdna.com/shows/medfairindia.html
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