‘e’nabling Care from a Distance: September 2011

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Special Focus Powering diagnosis page - 31

â&#x20AC;&#x2DC;eâ&#x20AC;&#x2122;nabling Care

from a Distance ...page 10

policy perspectiveDr kK Talwar, MCI chairman page - 8

In Person- Dr Arjun Kalyanpur, Chief Radiologist, Teleradiology Solutions page - 26

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Modern information and communication technologies have revolutionized healthcare systems, by transforming health administration, service delivery and care management. Rapid market maturity, heightened consumer expectations, increasing cost pressures and emerging medico-legal/regulatory requirements are driving the need for ICT solutions. The eHealth track in eIndia 2011 will bring together the entire community of health IT professionals, practitioners, end-users and decision-makers to deliberate upon the following thematic areas: National Health IT Infrastructure | Healthcare Reforms through ICT | Hospital Automation & Systems | Management (HMIS & ERP) | EMR Applications & Medical Informatics | Medical Imaging, RIS & PACS | Shared Services Infrastructure & Hosted Models; Clinical, Bio-Medical & Drug Information Systems | Telemedicine & Tele-health | Online and Mobile healthcare | Technology Standards and Interoperability.

past SPEAKERS Keshav Desiraju Additional Secretary Ministry of Health & Family Welfare, Government of India

Dr Ajay Singla Additional Secretary, Department of Health & Family Welfare, Government of NCT of Delhi

Vijayalaxmi Joshi Former Principal Secretary & Commissioner, Department of Health & Family Welfare, Government of Gujarat

Dr S Vijayakumar Special Secretary (H & FW) & Project Director, TNHSP

Dr Ashok Kumar Former DDG and Director, Central Bureau of Health Investigation Government of India

Anju Sharma Mission Director, NRHM, Gujarat

Dr Pervez Ahmed CEO & MD Max Healthcare Institute Ltd

Sangita Reddy Executive Director Apollo Hospitals Group

Dr Girdhar Gyani Secretary General, QCI

Maurice Mars Prof of Telehealth Dept of Telehealth, Nelson R Mandela School of Medicine, South Africa

Dr Shakti Gupta Professor & Head, Dept of Hospital Administration, AIIMS

Dr Dharminder Nagar Managing Director, Paras Hospitals

Dr Sanjeev Bagai CEO, Batra Hospital & Research Centre

Amod Kumar MNH Project Director, IntraHealth

Babu A CEO, Aarogyasri Healthcare Trust, Government of Andhra Pradesh

Dr BS Bedi Advisor-Health Informatics, C-DAC, Government of India

Dr Balaji Utla CEO, Health Management & Research Institute, Hyderabad

UK Ananthapadmanabhan President, Kovai Medical Centre & Hospital, Coimbatore

And many more...

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contents cover story ‘e’Nabling Care from a Distance By Rachita Jha

news 16 Corporate Updates

Implementing An Electronic Medical Record System

“Research needs proper attention in our educational culture”

By Dr Karanvir Singh

Dr KK Talwar, Chairman, MCI

event report

hospital ceo interview

ICT Becomes ‘Healthy’

in person

Dr Arjun Kalyanpur, Chief Radiologist, Teleradiology Solutions

30 Wireless Technology

expert corner

policy perspective

“Teleradiology has made its greatest impact in the emergency setting”

24 Product Watch

PPP model is important for improving the current healthcare scenario in India Gaurav Malhotra, CEO, Medfort Hospital

power hospital

SevenHills Health City – Technology for Better Patient Care By Suresh Kumar

special focus Powering Diagnosis By Dhirendra Pratap Singh

september / 2011 www.ehealthonline.org

zoom in

Analysis of an Unsuccessful Mission: PHRs by Google

By Dr Sanjay P Sood & Meenu Kohli Puniah

volume

issue

The Enterprise of Healthcare

President Dr. M P Narayanan

Editor-in-Chief Dr. Ravi Gupta

gm Finance Ajit Kumar

dgm strategy Raghav Mittal

programme Dr. Rajeshree Dutta Kumar specialist partnerships & Sheena Joseph Alliances Shuchi Smita, Juanita Kakoty, Ankita Verma Editorial Divya Chawla, Rachita Jha, Dhirendra Pratap Singh, Sonam Gulati, Pragya Gupta, Shally Makin (editorial@elets.in) Sales & Jyoti Lekhi, Fahimul Marketing Haque, Shankar Adaviyar, Rakesh Ranjan Mobile: +91-8860651635 (sales@elets.in) Subscription & Gunjan Singh Circulation Mobile: +91-8860635832 subscription@elets.in Graphic Design Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore

inbox graduates may weaken the idea and will become non productive. Previous attempts by various governments and medical colleges in the country have failed because graduates compensate by depositing money with the government in order to avoid the postings. The Bachelor of Rural Health Care Course should be taken up only in those Districts of the country where there are chronic shortage of doctors in the rural health centres.

With the cost of private healthcare escalating ` 30,000 will get exhausted within a few hours of stepping into a hospital. Why does not the Government think of revamping government hospitals and make them efficient and deliver quality care to people? Do they think they can make money from the insurance companies? Sridharan R on- Planning Commission frames universal health insurance plan

Dr B.G.Ranganath Professor on- Panel backs mandatory rural posting for doctors

The implementation of this scheme of compulsory posting of medical graduates to serve in rural primary health centres was long overdue. The Government has taken a bold decision to put it into action. However clauses like forefitting the postings by depositing compensation to the government by the medical

This information is very helpful for the readers. Thanks a lot for giving us good compilation. Siva Tekumudi on - Government to drive e-Health innovations

Web Development Zia Salahuddin, Anil Kumar IT infrastructure Mukesh Sharma, Zuber Ahmed

Events Vicky Kalra

human resource Sushma Juyal

legal R P Verma

Accounts Anubhav Rana, Subhash Chandra Dimri Editorial Correspondence eHEALTH, G-4 Sector 39, NOIDA 201301, India, Tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D-320, Sector-10, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta ÂŠ All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisherâ&#x20AC;&#x2122;s permission.

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Rationalising

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Medical Care Only 25 percent of Indiaâ&#x20AC;&#x2122;s specialist physicians reside in semiurban areas, and a mere three percent live in rural areas. As a result, rural areas, with a population approaching 700 million, continue to be deprived of proper healthcare facilities. Telemedicine is a potentially miraculous method that promises improvements to healthcare delivery systems, bettering quality and access. A major goal of telemedicine is to eliminate unnecessary travelling. Acquisition, storage, display, processing and transfer of images represent the basis of telemedicine. Patientâ&#x20AC;&#x2122;s records can be sent via text, voice, images or even video and medical advice offered from a remote location on Internet or off-line as digital content. The cover story of this issue focuses on video-conferencing solutions for telemedicine. The story includes an overview of the latest technology and its market presence. The Special Focus section of this issue features Computed Tomography (CT), which forms one of the most established segments in the overall imaging market. It is not only one of the key drivers, but it also accounts for a major chunk of the imaging market. CT Scanners provide probably the widest range of diagnostic capabilities amongst all imaging modalities currently available. Last month we organised the first eHealth World Forum, held in conjunction with the eWorld Forum 2011, in New Delhi. The event drew participants and visitors from across the country and worldwide. A plethora of activities ranging from keynote speeches, panel discussions, workshops and technology showcase made for a great rendezvous. eHealth World Forum also recognised some of the best projects, initiatives and practitioners of healthcare through the eHealth World 2011 Awards. And finally the best of the best healthcare technologies were showcased at the eHealth World Expo. For those who couldnâ&#x20AC;&#x2122;t join us in this technological revelry, we bring an exclusive and exhaustive report of what came out of this event and how the practitioners and industry experts are charting the path of future development of eHealth in India. Look into this issue for a detailed report of eHealth World Forum.

Dr. Ravi Gupta ravi.gupta@elets.in

september / 2011 www.ehealthonline.org

policy perspective

â&#x20AC;&#x153;Research needs proper attention in our educational cultureâ&#x20AC;? Dr KK Talwar, Chairman, Medical Council of India is working towards strengthening and providing high quality medical education, which is meaningful to the growth of medical services in the country. In an interaction with Dhirendra Pratap Singh, he shares insights about the medical education scenario in India

What is the role of MCI in enhancing and streamlining medical education in India? The Medical Council of India was established in 1934 under the Indian Medical Council Act, 1933, now repealed, with the main function of establishing uniform standards of higher qualifications in medicine and recognition of medical qualifications in India and abroad. The objectives of the Council are maintenance of uniform standards of medical education, both undergraduate and postgraduate, recommendation for recognition/de-recognition of medical qualifications of medical institutions of India or foreign countries and permanent registration or provisional registration of doctors with recognised medical qualifications. The number of medical colleges had increased steadily during the years after Independence. It was felt that the provisions of Indian Medical Council Act were not adequate to meet with the challenges posed by the very fast development and the progress of medical education in the country. Hence, the Medical Council of India came into being for streamlining medical education in the country. According to you, what should be done to improve the quality of medical education in our country? There is a lot of work to be done to ensure that the quality of medical education being provided in the country maintains the highest standards. Our team is working at understanding the problems and challenges at hand and ensuring that we have a solution that is not just workable but also brings in good results. The need to streamline medical education was an urgent one. Besides basic

SEPTEMBER / 2011 www.ehealthonline.org

medical education there is also an urgent need to look at higher medical research programmes and the education provided by private players in the field of medicine. The Medical Council of India had already issued a notification announcing nationwide common entrance examination for admissions to medical colleges in the country which the Centre promptly withdrew following protests by southern states. The Central government is also considering for inclusion in the 12th plan a major programme to support high-focus states to set up or expand medical colleges. In the modern age of technology, faculty training is also an important part of medical education. What steps has been taken for faculty development in medical colleges? We have Faculty Development Programmes to improve the quality of medical training by training the teachers. The aim of these programmes is to sensitise teachers about new concepts in teaching and assessment methods, to develop knowledge and clinical skills required for performing the role of competent and effective teacher, administrator, researcher and mentor, to assist clinicians to acquire competency in communication and behavioral skills and update knowledge using modern information and research methodology tools. The Medical Council of India has made it mandatory for all medical colleges to establish Medical Education Units (MEUs) or departments in order to enable faculty members to avail modern education technology for teaching. In order to boost this activity, MCI has been conducting Faculty Development Programmes through selected Regional Centres, since

policy perspective

“The Medical Council of India has made it mandatory for all medical colleges to establish Medical Education Units (MEUs) or departments in order to enable faculty members to avail modern education technology for teaching”

July 2009. These Centres are located at institutions which have trained manpower in Medical Education Technologies (MET). MCI has restructured itself, so what are your plans to bring reforms in the regulatory process for better medical education in India? We want to make regulatory and assessment processes more objective. They should be more transparent and in public domain. We have constituted an academic council to look into this which consists former dean of AIIMS and heads of medical education wings. This is one thing that MCI has done. Secondly, we want to improve quality of education in medical colleges. The quality of medical education in medical colleges is deteriorating and MCI is public eye. So, we have tried to create such centres for training of teachers of colleges in the emerging fields such as tele medicine. We are making the profession attractive again. Bright students are not coming into medicine. Earlier, medicine was one of the top professions but now, due to various reason students don’t find medicine course charming. Under graduate seats have increased. Today

society needs specialties. Every student who enters into medicine wants to do post graduate. Student is asking himself that why I should invest my career in medicine. Post graduates seats need to be increased. Of course private colleges, capitation fees are the issues and younger students from poor families can’t afford high college fees. Our system is such that students are scared to take loan from banks. We cannot change the system overnight. Most of the brightest students still live in rural areas. We have to create options for them. We cannot afford to send them cities for these academics. We should come into the government sector so they may more affordable rather than private sector. Also, we are looking that how can we increase teacher pool. What needs to be done with medical education to bridge the rural-urban healthcare divide? This is a serious issue that how we can send doctors in peripheral areas. Our rural healthcare system should be addressed on priority. The rural health infrastructure should be improved. sEPTEMBER / 2011 www.ehealthonline.org

cover story

‘e’Nabling Care from a Distance If the government has to make ‘Health for All’ a reality, it has to leapfrog the infrastructure gap of hospitals and healthcare centers using technology By Rachita Jha

elemedicine is not new to the country and has evolved in its technology and reach over the years. In addition to the global optimism on the telemedicine equipments market, the article aims to find out the market trends, innovations in video conferencing solutions for telemedicine in India. The cost of healthcare delivery for government around the world is on the rise as they negotiate challenges such as access, quality, and lack of doctors, nurses and hospitals. If we continue on the current model of brick and mortar traditional healthcare services, it would take decades before any country can train enough medical professionals and caregivers or build enough hospitals to solve these challenges. Video conferencing as a technology is fast catching pace among the corporate houses and has also found its rightful place in the healthcare sector as the popular platform for interaction between doctors and patients remotely located in space and time. Technology today makes it possible for a patient ailing in a far-flung village in a state to connect with the leading doctor in a super specialty hospital and get tele-consultations at much lower cost. Although in India, the telemedicine equipments market is still at a nascent stage; globally the telemedicine industry is experiencing excellent growth rates and is poised for a CAGR of around 19 percent during 2010 – 2015. The US and Europe remain the dominant markets that have seen significant support from the government and private players apart from rise in their ageing population that demands enhanced equipments for home treatment. Asia on the hand, has a huge growth potential that is waiting to be tapped as the cost benefits of telemedicine services makes it a preferred technology option for treatment of patients anywhere at any time.

september / 2011 www.ehealthonline.org

cover story

High definition tele-presence Across the globe, telemedicine is certainly on the rise. From continuity of operations to the training and retention of staff to patient diagnosis over video, the idea of telemedicine has come a long way in the last decade. With HD video conferencing tools now more affordable and easier to deploy than ever before, hospitals, clinics and rural health centers find that there is little difference in a face to face video call and actually being there in person. A report states more than 54 percent of people in India would be happy to deal with their doctor or health provider on a video call – moreover, with the current availability of one doctor for 1,700 people, the more proficient use of video conferencing technology promises to be the way forward to make healthcare services accessible to all especially in the rural areas. “The use of new and advanced communication technologies in the practice of medicine is changing the face of healthcare in India as they improve access to quality and affordable medical services regardless of location or time. Solutions for health care based unified collaboration solutions i.e. real-time high definition audio and video conferencing or tele-presence are used by numerous private and public healthcare institutions for multiple applications, hospital administration, and medical education for improved patient care,” said Neeraj Gill, Managing Director-India & SAARC, Polycom. Dr Arjun Kalyanpur, Chief Radiologist, Teleradiology Solutions mentions about a tie up with Cisco where Teleradiology Solutions have been implementing telemedicine for Raichur for over a year. He says, “RXDX, a multi speciality health care provider, set up by Teleradiology Solutions in Bangalore has been providing telemedicine consultations to villages in Raichur district (Gillesgur, Bichalle etc) in Northern Karnataka. Using the digital stethoscope, cardiologists at RXDX have been able to diagnose complex congenital heart disease and suggest intervention. A dedicated telemedicine doctor tracks the patients, their follow-up and arranges specialist intervention at the nearest tertiary care center if needed. The villagers have adapted amazingly well to these virtual doctors!”

Technology trends Moving away from a piece meal approach that required the companies to provide only the VC components, the hospitals today demand telemedicine as a package solution for an easy user experience in terms of having an integrated solution connecting different components such as VC hardware, switching equipment, software. “Until now the demand was limited to pure video conferencing solutions, which provided only audio and video capabilities. Customers expected only the basic features in video conferencing for telemedicine.

“The latest trends in VC for telemedicine includes web based video conferencing online services for multi-point conferencing” Vishal Gupta Vice President, Cisco Services & Healthcare Business Unit.

However the market trends are changing rapidly; and the hospitals now expect a more holistic solution which is easy to set up and maintain” informs Vishal Gupta, Vice President, Cisco Services & Healthcare Business Unit. The market is also moving towards more holistic and integrated solutions, in which the videoconferencing capability is just one component. The customers expect the solution to provide the complete functionality including audio, video, medical data, prescription, and the ability to integrate with electronic medical record systems. Vishal Gupta adds, “The latest trends in VC for telemedicine includes a Web based (Internet) video conferencing online services for multi-point conferencing, dedicated (on-premise or data center based) video conferencing solutions (with software and hardware) for HD multipoint conferencing using conference bridges, wireless, mobile, and portable video conferencing solutions for healthcare.” The global technology in VC for telemedicine has now moved to the cloud as the next wave of revolution in high performance based tele-presence for hospitals and academic institutions. Cloud-based technologies, services and software applications have an advantage that they are delivered from the Internet rather than a dedicated enterprise network in a single location, and therefore have a multiplier effect in its collaborative use on information sharing via secure real-time audio and video content. september / 2011 www.ehealthonline.org

cover story

“Cloud-based solutions allow doctors to invite patients to participate in discussions with superior HD quality” Michael Helmbrecht VP Product Marketing, LifeSize

Reflecting on the potential of cloud for telemedicine, Michael Helmbrecht, VP Product Marketing, LifeSize says, “Two of the ‘hot trends’ in VC today are cloud-based solutions and mobility. Cloud-based solutions are attractive for telemedicine applications where a doctor needs to see a patient on a regular basis without having to physically travel to the patient’s location (or vice versa) but needs businessclass quality and flexibility in how it’s deployed. Our technology allows doctors to invite patients to participate in ongoing discussions, for free, with superior HD quality, data sharing capability and built-in, standards-based encryption and enterprise firewall traversal. In a similar way, mobile solutions that allow doctors to connect with patients, administrators or other physicians, via their own mobile device – such as an iPhone, iPad or Android Smartphone – are a growing trend in telemedicine.”

ternational Telecommunications Union (ITU) and the Internet Engineering Task Force (IETF). Products that adhere to these standards allow users to participate in a conference, regardless of their platform.” Apart from these, there are many standards available for Video & Audio Codecs, transports protocols, video and PC window sizes, Security which might be applicable for video conferencing irrespective of the application where it is used.

Challenged by bandwidth Availability of high bandwidth for real time video conferencing in tele-health is a core requirement gain good quality images that can be used for medical personnel education, peer consultation, patient education and direct patient care. With new telecommunication platforms and device upgradation in cameras, monitors, and coder/decoders keeping the rugged rural environment in consideration, the performance of video conferencing in low bandwidth conditions continues to be an area of research and innovation. “Usually to support good quality video conferencing, there is a minimum requirement of network bandwidth which continues to remain a challenge in certain parts of India. New open standards such as H264 High Profile – embedded in all our systems today – enable to reduce bandwidth utilisation for High Definition Audio and Video communications by 50 per cent on average, which translates into considerable savings in bandwidth cost and in the net-

Global standards There are various organisations involved in the standard setting for telemedicine equipments. These include evaluation guidelines for telemedicine/telehealth systems that have been provided by The Office for the Advancement of Telehealth, which is part of the Office of Rural Health Policy, located within Health Resources and Services Administration (HRSA) at the US Department of Health and Human Services. Elaborating on the same Vishal Gupta says, “The Standards and Guidelines from the American Telemedicine Association includes Practice Guidelines for Videoconferencing-based Telemental Health, Core Standards for Telemedicine Operations and others for specific telemedicine areas. In addition, there are Healthcare technology standards like HL7 (Health Level Seven - for exchange of medical information) and DICOM (Digital Imaging and Communications in Medicine image exchange standards) and Telecommunications standards are set by the United Nations agency, In-

september / 2011 www.ehealthonline.org

“Using the digital stethoscope, cardiologists at RXDX, a multi speciality health care provider have been able to diagnose complex congenital heart disease and suggest intervention” Dr Arjun Kalyanpur Chief Radiologist, Teleradiology Solutions

cover story

Element-6 enables “tele-consultancy” between primary health care centers at remote location & expert doctors at main hospitals. It combines portability with capability of “real-time“ transmission to create powerful, flexible & economical tool to provide diagnostic healthcare services in rural areas in most efficient & cost effective way.

KEY FEATURES Video conferencing Comprehensive medical records

The system includes, 12 lead ECG, blood pressure, blood glucose, oxygen saturation, spirometery, stethoscope, as standard parameters and it is on site upgradable to other parameters.

Image capture & transfer Supports “real-time” & store & forward method Works with data cards & any network provider Flexible software architecture for easy upgradation Registered Office: EL 63-64, TTC Industrial Area, Electronic Zone, Mahape, Navi Mumbai - 400 710, INDIA Contact: +91-22-2761 1311, 4119 3100, 9323210142, Website: www.maestros.net, Email: vinayak@maestros.net

september / 2011 www.ehealthonline.org

cover story

Future tech • Web based (Internet) video conferencing online services for multi-point conferencing • Dedicated (on-premise or data center based) video conferencing solutions • Wireless, Mobile, and Portable Video Conferencing Solutions • Cloud-based telemedicine solutions

“New open standards enable to reduce bandwidth utilisation for high definition communications which translates into considerable savings in bandwidth cost” Mr. Neeraj Gill Managing Director-India & SAARC, Polycom

work infrastructure required,” avers Neeraj Gill, Managing Director-India & SAARC, Polycom. Network speed and access is less and less of an issue in India as many states have deployed state wide area networks (SWAN) and start leveraging that infrastructure to provide various public services like health, education and others, he adds.

Interoperability The major challenges in the VC telemedicine equipment market are flexibility and interoperability. Being able to deploy VC broadly throughout a hospital network or among regional clinics and at-home patients alike can be challenging, especially if different solutions such as endpoints, desktop software, etc don’t work together. “Customers should look for solutions based on open standards to avoid vendor lock-in which ultimately leads to higher integration and mi-

september / 2011 www.ehealthonline.org

gration costs. We have our solutions based on open standards allowing healthcare institutions using other vendor products to communicate and collaborate,” says Neeraj Gill. Globally there is the Unified Communications Interoperability Forum (UCIF), a non-profit alliance of worldwide technology leaders designed to help global organisation be more productive by enabling standards-based, cross-vendor interoperability of UC hardware and software across enterprises, service providers and consumer clouds. As a member of this consortium Helmbrecht says, “Using proprietary solutions, for example, can make deployment incredibly difficult, especially for users that want HD quality and collaborative features like the ability to share patient records and x-rays directly from the system. We believe that interoperability is a key component in delivering products that drive the ubiquity of video communications and are on open and interoperable standards with all of the major players in the market.” The need of interoperability standards has been much felt in India as these will make the telemedicine system more flexible and efficient in its collaborative model.

Way forward Until now the advent of technology in the remote areas for tele-health has faced much resistance and cultural roadblocks as resistance to change and the preference of consultations and visits to clinics was the mainstay. People in India are used to travel and have in-person check-ups and interactions with the specialists. “However, with Tele-presence and High Definition visual communications you literally feel like you are in the same room as the consultation is life-like and highly interactive. The best way to improve healthcare is to provide real-time communication and collaboration over high definition audio, video and content anytime and anywhere,” says Neeraj Gill. With recent developments in cloudbased solutions doctors can invite patients to meet with them face to face 24/7 at no cost to the patient. “The opportunities for this technology in India are truly endless. From remote access to specialty care in neonatology, telepsychiatry, oncology, emergency care, nephrology and radiology to rural telemedicine, pharmaceutical research, medical education, home health monitoring and administrative meetings devoid of costly travel and headache for physicians, healthcare in India can improve vastly through the use of this technology,” opines Helmbrecht. As VC equipment becomes simpler and more cost effective to deploy, manage and use, training and retaining staff is also a real benefit to healthcare organisations. The value of the technology is massive and the best part is that it’s all available today.

news Corporate Updates

Wipro Technologies launches cloud-based portal for clinical trials

Wipro Technologies, the Global Information Technology, Consulting and Outsourcing business of Wipro Limited (NYSE: WIT) announced a secure

cloud-based productised solution called “Wipro Clinical Collaboration Portal”, to help its customer base of Drug Development Owners (Sponsors), CROs (Clinical Research Organizations), clinical sites and regulators to significantly improve collaboration capabilities for Multi-region clinical trials. Clinical trials for global studies require close collaboration between partners and regulators across multiple regions to conduct multi-region clinical trials effectively and rapidly. The portal platform will reduce the clinical trial cycle time by 20-30 percent by speeding up communication and document exchanges between all the stakeholders – the sponsor organisation, the

staff of the CRO along with clinical site coordinators and principal investigators. This Portal platform can be leveraged as an enterprise level solution to increase efficiency and lower the cost of clinical operations. There is an intensifying need in the market for a platform that can centralise information, manage financing, facilitate accurate reporting, automatic scheduling and provide the ease of patient recruitment. This need for increased collaboration in clinical trial operation elements, coupled with the need to cater to different styles of recruiting patients, for different therapeutic areas and identifying the best clinical sites that can perform clinical studies.

Dell to tap NextGen for electronic medical records platform

US EMR market to reach $6 billion by 2015

NextGen Healthcare Information Systems Inc. has entered into an agreement with Dell in the Health IT marketplace to jointly market health information technology products and services to medical practices, hospitals and physician networks. Although, the financial terms of the partnership were not disclosed. Under the agreement, computer giant Dell will market, sell and support NextGen’s ambulatory EHR, practice management, inpatient clinicals and inpatient financials products as components of Dell’s electronic medical records platform for hospitals and physicians. Using the latest cloud technology platform, Dell will also host NextGen applications in an effort to simplify access and data management for Dell and NextGen clients. Dell also

The ‘US Electronic Medical Records (EMR) Market, 2010-2015 (Market Share, Winning Strategies and Adoption Trends)’ analyzes the EMR market by end users, components and applications, and studies the major market drivers, restraints, and opportunities. A substantial growth rate (more than 16 percent) of the U.S. healthcare IT spending and the initiatives taken by government towards development of a nationwide healthcare information network are expected to push EMR implementation across the healthcare sector in the U.S. The rising demand for the healthcare cost containment and need to improve the quality of healthcare service are driving the growth of the EMR market in the U.S. The U.S. EMR market is expected to grow from $2,177 million in 2009 to $6,054 million in 2015 at an estimated CAGR of 18.1 percent during the forecast period 2010-2015. Though large-sized healthcare practices prefer on-site/client-server based EMR systems, web-based EMR solutions or ASP models are gaining higher popularity within the small-sized healthcare practices and private physician offices.

SEPTEMBER / 2011 www.ehealthonline.org

becomes the “hardware platform-ofchoice” for all NextGen products, as well as for NextGen’s internal use. EMR will leverage the capabilities of both organizations to build on the strengths of our success and capitalize on unprecedented market opportunities as mentioned by Patrick Cline, president of Quality Systems. The adoption and use of electronic health records are a major component of the healthcare reform law approved last year. Healthcare prov i d e r s could receive funding to support the installation of health information technology systems under the American Revitalization and Recovery Act. NextGen has been preparing for the growing use of electronic health records over the years.

event Report

ICT Becomes ‘Healthy’ The first eHealth World Forum was held from 1st -3rd August 2011 to create a platform for dignitaries from all over the world and discuss emerging issues in depth in the areas of IT and technology in the healthcare services sector

eHealth World Forum, held in conjugation with the eWorld Forum, aimed at providing a unique platform for knowledge sharing in different domains of ICT in healthcare Conceived and produced by CSDMS and Elets Technomedia, the event was coorganised by the Department of Information Technology (DIT), Ministry of Communications and Information Technology, and Department of Science and Technology, Government of India. The forum was followed by eHealth World 2011 Awards, which were instituted with the primary aim of felicitating and acknowledging unique and innovative initiatives in healthcare. Health IT is undergoing a paradigm shift inviting greater initiatives from the industry and such events encourages converging and planning recommendations for reforming policies in the sector.

Government and private sector Initiatives in Development and growth of healthcare sector The first session of day one of eHealth track started with a vision address delivered by Anju Sharma, Mission Director, NRHM on Government Initiatives in healthcare. She deliberated that, “Gujarat has been an enthusiastic state to bring quality healthcare to the citizens with a long range of programmes such as Chiranjeevi & Balsakha Yojana (PPP), 108 EmergencyTransport and e-Mamta Mother & Child tracking (IT application). We have district quality accreditation boards Quality Assurance Group (QAG), Quality Improvement Programme (QIP), NABH.” She added, “Gujarat is the first state which has accredited PHCs in tribal areas by NABH, blood banks, food and drug laboratory and of course the hospitals to involve quality consciousness into the system. The most talked about programme initiated by Gujarat in the year 2006 is the Chiranjeevi Yojna which is a unique PPP initiative to partner with private sec-

L-R: Dr P Saxena, Anju Sharma, Dr Pervez Ahmed

tor facilities for BPL and tribal mothers. There is an evident reduction in number of maternal deaths and we could infer to have saved approximately 893 mothers.” Talking further she said, “The Bal Sakha scheme provides expert care to newborns up to one month by private pediatricians / trust hospitals free of cost. The emergency ambulance 108 was initiated in the year 2007, which answers 99 percent calls and so far has attended total emergencies to be around 15, 51,718.” Illustrating Gujarat’s healthcare IT initiatives she said, “e-Mamta mother and child tracking web based application is uniquely designed management tool being executed. It is credible tracking system that would enable health workers to reach above mentioned goals.” She concluded that in healthcare delivery innovation is important because there are facing challenges in healthcare delivery of access, availability, affordability and quality. Dr Pervez Ahmed , CEO and MD, Max Healthcare elucidated on the scope of PPP modalities and their challenges in the Indian healthcare scenario. He said, “It is important to know who the enablers of healthcare are. Private sector and public sector need to understand the societal need by involving private sector and increasing GDP for health budget.”

Anju Sharma

Dr Pervez Ahmed

Dr P Saxena

Amod Kumar

SEPTEMBER / 2011 www.ehealthonline.org

event report

Dr Shreeraj Deshpande

Anjana Agarwal

Prof Maurice Mars

Dr Karanvir Singh

He further added, “Delhi has 38,000 private hospital beds and 3500-4000 beds are contributed by the major private players like Max, Apollo and Escorts and the rest of them are contributed by the 15-25 beds nursing homes. The problem lies in the unregulated sytems. We have to look into a different model of delivery. Max also works through a PPP model by giving revenue to the government and through insurance company cover approximately 4000 people are given treatment at much lower prices.” Dr Ahmed concluded that, “Success of any partnership is when they have mutual benefit. The obligation should be clear in terms of transparency, incentives and regulatory framework. A proper system can thus provide high quality healthcare at affordable cost.” Dr P Saxena, Director, Central Bureau of Health Intelligence (CBHI), Ministry of Health and Family Welfare, Government of India majorly emphasised on the healthcare system in India & flow of information between stakeholders. He said, “The flow of information takes place with effective IT application and maintains family based records. The information is compiled from CHCs and PHCs and reported to the State/ UT Headquarters on a weekly/monthly/quarterly basis in the prescribed format which was further strengthened and improvised by the CBHI and NRHM.” He then briefly explained the work structure of CBHI. It collaborated with WHO to develop medical record education and training programme and use International Classifications of Diseases (ICD) for coding of mortality and morbidity. The work primarily focuses on compiling entries related to health sector policy reform

Gp Capt (Dr) Sanjeev Sood

L-R: Anjana Agarwal, Amod Kumar, Dr Shreeraj Deshpande

SEPTEMBER / 2011 www.ehealthonline.org

database of India and being updated from time to time. It also maintains HS-PROD, which is a web-enabled database that documents and further creates a platform for sharing of information on good practices and innovations in health services management. He concluded, “IT in health sector has linked district hospitals with tertiary level hospitalsplanned in the 11th Plan. He also mentions that IDSP and NRHM have brought together use of IT and satellite communication for information flow, video conferencing, education and guidance and inventory and GIS, mapping of all government health facilities.”

Synergies for Long Term Gains through Health Insurance The second session was a panel discussion moderated by Amod Kumar, PD, Manthan (MNH) Project, IntraHealth who believes that health insurance is a vibrant and expanding sector in India. The latest schemes such as Rashtriya Swasthya Bima Yojana (RSBY) and Aarogyasri are offered for uplifting rural health to improve health financing. RSBY is basically a programme initiated by Ministry of Labour Development, Government of India for rural families. The programme issues a card for the head of the family to get a health insurance with which they can be treated in the hospitals affiliated to the programme. Today mass coverage of BPL families is done by RSBY and the scheme has been very successful so far. Dr Shreeraj Deshpande, Head – Health Insurance, Future Generali India Insurance Co Ltd discussed his company’s role in synergising long term gains by creating insurance policies to deliver and upgrade healthcare services. Future Generali has 18 percent of share in the health insurance sector. The role of technology in insurance is used for distribution of health insurance, customer service and data flow and capture. For the rural population, they have incorporated web enabled common kiosks which are a single window concept for financial products. He added, “The process of reimbursemet presently takes around 20 days and we plan to shorten it up to 3-4 days to hold the customers’ interest.” He also mentioned that the company focuses on web insurance of policies, web enrolment of members in corporate, eCards and eEnrolment of members and dependents, customers can access their policy coverage information online as well as seek information online.

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SEPTEMBER / 2011 www.ehealthonline.org

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Dr Neena Pahuja

Dr SB Gogia

Dr BS Bedi

He further elucidated, “Data transfer from insured to hospitals to TPAs/insurers save time and cost. Uniform billing patterns/uniform discharge card formats/uniform hospital records formats will facilitate immediate transfer of information. He concluded, “With such innovations and developments in the technology, we will have smooth electronic data flow from insured to insurer, diagnostic centre to insurer, hospital to TPA/Insurer and insurer to insured. It will help better fraud detection as well as fraud management.” Anjana Agarwal, CIO, MAX Bupa discussed about Max Bupa and its role in leveraging better policies in health insurance systems. She stated that they were the first to have an integrated system which does not give space for any paper work. “As a philosophy, the company tries to set up services in house which is not being handled by the vendor including enrolment, claim processes and handling services or any queries. The way insurance is visualised, the planning for insurance is easily done by the urban population

L-R: Dr Karanvir Singh, Dr SB Gogia, Gp Capt (Dr) Sanjeev Sood, Dr Neena Pahuja, Prof Maurice Mars

B Girish Babu

but that is least on the priority list. The populations still do not believe that it will be of any gain to them. Insurance provides an advantage and indirectly the insurers gain”, said Anjana Agarwal. She concluded the session by mentioning that MAX Bupa are more of a wellness and a partner programme. They are trying to dwell from a reactive approach to a proactive approach.

Information and Communication Technologies for Achieving Millennium Development Goals in Healthcare Dr Rajendra P Gupta

SEPTEMBER / 2011 www.ehealthonline.org

This session started with the discussion on role

of ICT in achieving MDGs. Prof Maurice Mars, Prof of Telehealth, Dept of Telehealth, Nelson R Mandela School of Medicine, South Africa delivered the keynote address with focus on role of telemedicine in India and African countries. He said, “People who need ICT live in the rural areas and at the bottom of the pyramid. According to WHO report 2006, Africa has 24 percent of the disease burden but only 3 percent of health workers command less than one percent of world health expenditure. Thirty one African countries have 10 doctors or fewer per 100,000 people whereas in India, there are 60 doctors per 100,000.” He added, “Developed countries spend 2 – 2.5 percent of their health budget on health ICT where as in US, it is US $ 55 per person and in Africa, it is US $ 0.70. Implementation of telemedicine in the developing countries face major problems related to high telecommunication costs, low internet penetration, lack of literacy and computer literacy and language.” Prof. Mars highlighted the role of private sector in facilitating the benefits of ICT in healthcare. Gp Capt (Dr) Sanjeev Sood, Hospital & Health Systems Administrator SMC, Air Force Station, Chandigarh focused on MDGs. He said, “Benefits of ICT should be made available to the healthcare sector. Most sectors in general and healthcare in particular lag behind due to various barriers, such as, lack of resources and initial capital costs involved in implementation of technology projects.” Dr Karanvir Singh, Consultant Surgeon andHead, Medical Informatics, Sir Ganga Ram Hospital delivered his presentation with focus on ICT in healthcare. He said, “Adverse incidents in hospitals compromises patient safety cost to the government reaching to billions of dollars each year. It has been the aim of every ‘medical organisation’ to improve its safety record. The ideal solution is to improve processes and ensure adherence to the extent that no care provider, in any situation, can cause a patient related adverse incident. Enterprise of wide computerisation can help to a certain extent in achieving this aim.” Dr Neena Pahuja, CIO, Max Healthcare said, “In the recent past, there have been certain positive developments in this field that have provided the requisite impetus for much greater IT adoption in hospitals in India. Privatisation and corporatisation of hospitals coupled with growing awareness of the benefits of IT solutions is driving this trend.”

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In this session Dr SB Gogia, Consultant Plastic Surgeon, Past President IAMI said, “Healthcare Informatics, is a resource organisation for Healthcare Information Technology (HIT), consisting of IT savvy doctors, community health specialists, IT personnel, telecommunications experts and sociologists. from Society for Administration of Telemedicine (SATHI) which has been involved in implementing the Healing Touch Project, which was sponsored by OXFAM Trust India. As project consultants our role was to pilot a sustainable telemedicine system which could also provide a roadmap for the future.”

Strategies for Developing and Implementing Telecommunication, Wireless and Mobile Healthcare Services Dr Rajendra Prasad Gupta, Member, Executive Committee, Telemedicine Society of India delivered the keynote address with focus on strategies for implementing ICT in healthcare services. He said, “If we start creating hard infrastructure, we might build a few facilities in rural India; but for sure, we will not be able to maintain and sustain the hard infrastructure in rural India in the long run. Also, absenteeism of doctors will continue to be a perennial problem for rural India. According to Economic Survey 2009-10, only 13 percent of rural population has access to PHC and only 34 percent of rural population has access to diagnostic centers (CCF).” He said, “It is a fact that has not been accepted by policy makers that it is nearly impossible under the current rural infrastructure and payment terms to get good doctors to work in rural India. Rural India needs to extensively leverage the 3 G and WIMAX technology and adopt preventive care model to avoid pain, suffering and high cost of healthcare.” Dr BS Bedi, Advisor, Health Informatics, Centre for Development for Advanced Computing (CDAC) spoke about the innovations and implementation of ICT in healthcare. He said, “The lack of information is now being planned and collected by the health information system. We are adding 18 million mobile handsets per month. Health delivery will go down right to the bottom of the pyramid with the help of mHealth.” He added,“With introduction of computers and technology, the databases are now organised and created on computers at block level in specialised primary healthcare centres.”

L-R: PS Ramkumar, Dr BS Bedi, Gp Capt (Dr) Sanjeev Sood, B Girish Babu

B Girish Babu, Chief-Care Rural Health Mission, CARE Foundation said, “Quality of healthcare and its access is very important. We need to focus on primary healthcare especially in rural areas.” PS Ramkumar, Scientific Expert-International Telecommunication Union, United Nations said, “In India, nearly 38 percent people cannot read/write and 8 percent of urban population is computer literate. We have to accelerate preventive care without waiting for the latest technologies. We should prioritise investment on alternative technologies based on care scenarios and enhance utilisation by launching graded e-Services in step with infrastructure roadmap.”

PS Ramkumar

Anil Swarup

Initiatives and Developments in Medical Technologies and Clinical Diagnostics Chaired by Dr Ashok Seth, Chairman, Cardiac Sciences, Fortis Escorts Heart Institute, the session ‘Initiatives and Developments in Medical Technologies and Clinical Diagnostics’ focused on the technological advancements that have transformed the way diagnosis and treatment are performed now-a-days. Anil Swarup, Director General, Labour Welfare, Ministry of Labour and Employment, Government of India also participated in this session and gave a special talk on how RSBY, with the help of technology, has transformed the lives of millions of people living below the poverty line by providing them cashless and paperless health insurance. Dr Ashok Seth kicked off the session by sharing insights into the revolutionary advancements that have taken place in the medical technology industry. He said, “The innovations, initiatives

Dr Ashok Seth

Dr Harsh Mahajan

Dr SK Verma

SEPTEMBER / 2011 www.ehealthonline.org

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L-R: Dr Punit Nigam, Dr Ashok Seth, Anil Swarup, Dr Sakti Gupta, Dr SK Verma, Dr OP Yadav, Dr Aparna Ahuja, Dr RD Lele, Dr Harsh Mahajan, Dr Sanjeev Bagai, Rohit kumar

Dr Ramchandra Lele

Dr Shakti Gupta

Dr OP Yadav

Dr Sanjeev Bagai

Dr Aparna Ahuja

and enterprising solutions in terms of diagnosis, therapeutics and newer models of healthcare delivery have been reflected in the growth over the past two decades and the way healthcare is delivered, today.” Dr Harsh Mahajan, Honorary Radiologist to the President of India and Medical and Managing Director, Mahajan Imaging elucidated the role of digitisation in revolutionalising the field of radiology. “In past, taking scans and making films out of them was a huge task. Transferring these images from one place to another was also difficult and required a lot of time and effort. Today, with development of infrastructure and technology, capturing, storing and transferring images has become an easy task,” he said. Talking about the key challenges in clinical diagnostics, Dr SK Verma, Consultant and Head, Department of Clinical Biochemistry, Safdarjung Hospital said, “In the US, FDA approval is required for all diagnostic technologies. However, in India, there is no system for approval of any authority for producing diagnostic kits. Also, lack of enough research and development in the country restricts technology innovations and most of the technologies used in diagnostic labs are imported from outside.” Explaining the role of information and communication technologies in enhancing patient care, Dr Ramachandra Lele, Director-Nuclear Medicine, Jaslok Hospital said, “Human memory based medicine is increasingly unreliable. ICT plays a crucial role in high quality healthcare and electronic medical records and computerised prescriptions are the essential ingredients for change.” Terming EMRs as the most potential change agents, he said, “We generate tremendous data in our clinical practice and EMRs can provide possibilities for research.” Dr Shakti Gupta, Head of Department, Hospital Administration and Medical Superintendent, AIIMS talked

SEPTEMBER / 2011 www.ehealthonline.org

about technology for safe patient care in healthcare institutions. Talking about relevant technologies for patient safety, he said, “Computerised Physician Order Entry systems and Computerised Decision Support Systems can resolve the medication and human error issues to a large extent, thereby enhancing patient safety.” Dr OP Yadava, CEO, National Heart Institute differed from others and said, “Science and Technology has to develop in tandem with the society, therefore all international technologies and trends will necessarily not be effective in our country. As we develop technology, we must also evolve our human resources and get them on the same platform.” Pointing out to the issue of high cost of technology, Dr Sanjeev Bagai, Sr Consultant Paediatrician & Nephrologist, Nephron Clinics & Edmed Healthcare said, “We are extremely fortunate to be practicing in an era cutting-edge technology. Even today, a routine protocol for screening all newborns for inborn errors of metabolism does not exist. The cost for screening a newborn is way beyond the reach of a common man.” Talking on IT implementation in labs, Dr Aparna Ahuja Lab Director, Gurgaon Reference Lab, SRL said, “At SRL, we have a homegrown information system called CLIMS, which is Clinical Lab Information Management System. Since SRL caters to various hospitals also, CLIMS can be easily integrated with the Hospital Information System of the hospital to ensure timely delivery of reports.” Elucidating the major challenge, Dr Punit Nigam Metropolis Healthcare said, “Technology itself is not the solution. How you adapt this technology and what you deliver is what matters.” The session ended with an interesting talk by Rohit Kumar, Managing Director, Health Sciences, South Asia, Elsevier who focused on technology enabled medical literature and Elsevier’s role in publishing evidence based scientific literature with the who’s who of the world. “Elsevier has put a lot of its content online including articles that go back to the first issue of lancet. We are establishing a very strong and robust publishing programme for the Indian market and we are putting all content online in context of a global knowledge base.

Redefining Medical Education to Bridge the Rural-Urban Healthcare Divide Rohit Kumar, Managing Director – Health Sciences, South Asia, Elsevier, elucidated that the

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education system can be reformed by changing the way healthcare professionals access information in the field of medicine. He further added, “We have been predominantly a rural population so we are rapidly urbanising the healthcare industry which is poised to grow about 21 percent by 2021. A lot of it will be fuelled by demographic changes and aspirational changes. On the down side, our healthcare spending is among the lowest in the world. People pay for healthcare services unlike other countries like Europe and UK where the government provides free healthcare. The latest MCI data shows about 40,000 seats this year and 23,000 seats for PG course. We are gradually improving but we do lack in the infrastructure in villages.” Rohit Kumar concluded, “Our role is to make sure that we have localised content available as a publisher and make them available to the users. We are creating project MBBS consult which will train the faculty in the villages to customise knowledge effectively with the combination of animation, videos, graphics, simulations and assignments. We even have built a simulator rabbit online for medical students which will be launched soon. We will soon have evidence based scientific content online so that the students can get access to authentic information”. Dr AK Agarwal, Professor, IGNOU School of Health Sciences, explained the need to encourage doctors to go to villages and treat the rural people. He believes that medical colleges train the students in a manner that they look forward to work in the metro cities. There are very few initiatives done to make the medical education appropriate and affordable to vast majority of population in the rural areas. He said, “Medical education is skewed towards tertiary care and high-end technology in urban areas, neglecting the development in remote areas. We need to shift towards transformative learning to develop leadership qualities to produce enlightened change agents for medical education. Our doctors do well in the UK and USA because they have good systems. Medical education is one such area which needs better systems.” Dr Vaidyanath Balasubramanyam, Domain Consultant, Medical E Learning, President, Bangalore, added, “If we do not have the right content for the right audience the whole exercise is meaningless.” He majorly focused on the content development and technology to reach

L-R: Dr V Balasubramanyam, Prof AK Agarwal, Prof TK Jena, Dr SS Kulkarni, Rohit Kumar

the students. There are various ways to teach and learn concepts through flash animations and 3-D processes. There are three domains in medical technology, first is, disseminating through snapshots and pictures, second is applying knowledge into actual situational experiences such as virtual rabbit and third is skill development. Dr SS Kulkarni, Advisor to various educational institutions, discussed about the mindset of developing educational institutions. He said, “In this urban civilisation, we see the urban doctors are not properly trained and the technological content is not available in the best of the colleges. The systems can only be implemented when there is a strong policy of the government and will of the people to work. We need to train the manpower in the education system as people lack faith in the doctors who are at the primary and secondary healthcare centers which draws them to tertiary healthcare providers leading to high cost of treatment.” Dr TK Jena, Professor, IGNOU School of Health Sciences, said, “There are various challenges being faced by the people in the system which includes unwillingness of doctors, inadequate facilities and absence of referral system.” He added, “Rural areas are devoid of basic facilities like water, electricity, transport. There is no need of a demarcation or a divide between the rural and urban healthcare services.” He concluded the session by addressing the solutions for overcoming challenges by redefining medical education for capacity building, expansion of utlisation of health infrastructure for medical education and developing district level hospitals as academic hubs, which holds the key to change in health scenario of the nation.

Dr Punit Nigam

Rohit Kumar

Prof AK Agarwal

Prof TK Jena

Dr V Balasubramanyam

SEPTEMBER / 2011 www.ehealthonline.org

news

Corporate Update

SYSMEX CS-2100i/ CS-2000i available with aggregation technology Coagulation station CS-2100i/CS-2000i is a fully automated blood coagulation analyzer which is equipped with an optical fiber that supplies light at five wavelengths and a detector capable of receiving light in multiple wavelengths (multi-wavelength detection). The CS-2100i / CS-2000i is able to simultaneously measure multiple parameters using coagulation, chromogenic, immunoassay and aggregation methods. The CS 2100i/CS 2000i is capable of simultaneously measuring multiple parameters using clotting, chromogenic, immu-

nogenic and aggregation methods more accurately. It is a true random access system with 10 channels independently testing. Using Multi-wavelength technology, a pre-analytical check for interfering substances in the sample (Hemolysis, Icterus, and Lipemia) is also performed prior to sample testing. CS-2100i/CS-2000i with its advanced technology enables user to incorporate aggregation in a routine run, using reaction cuvette pre-loaded with a stirrer bar to accurately measure platelet-based Ristocetin Assay. When a pre-set condi-

Corporate Update

Carestream Health India rolls out compact dry laser imager

The search for a dry laser imager, which is not cumbersome to operate and within modest budget, ends with the latest CARESTREAM DryView 5700 Laser Imaging System. Carestream Health, the worldwide provider of dental and medical imaging systems and Healthcare IT solutions, has recently unveiled the CARESTREAM DryView 5700 Laser Imaging System in the Indian market. A photo-thermo graphic film printing solution for low to mid volume print applications, the CARESTREAM DRYVIEW 5700 is an ideal solution for computed radiography (CR), digital radiography (DR), computed tomography (CT) and magnetic resonance (MR) imaging applications. The CARESTREAM DryView 5700 Laser Imaging System caters to specialized radiology needs of clinics, imaging centers and other medical imaging service providers. A slew of special features also contribute to the uniqueness of the CARESTREAM DryView 5700 Laser Imaging System. Printing 45 to 85 films per hour, the table top design of the CARESTREAM DryView 5700

SEPTEMBER / 2011 www.ehealthonline.org

Laser Imaging System enables easy placement, while simplified packaging and software wizards quicken installation. A simplified film loading and user interface make it easy to operate. The use of unique Automatic Image Quality Control (AIQC) also contributes to the system’s ease of operation by ensuring superb images with no operator intervention. An intuitive user interface also speeds operation and eliminates the need for training.

tion is programmed, the CS-2100i/CS2000i will automatically perform another test parameter to provide further information on the abnormal sample. It provides a maximum of 12 data points for each calibration performed, for a maximum of 250 assay parameters, together with keeping 10 calibration sets per lot of reagent and upto 10 lots of reagents per parameters. A highly reliable system of QC checks using K-control, Levey-Jennings or Multi-rule (Westgard Rules) monitoring is offered with a maximum of 1,200 data points being stored at any one time.

Wireless Technology

Mobile health industry set for exponential growth in Asia The Asian region has the world’s fastest growing mobile markets with 2.6 billion mobile subscribers in early 2011 and an average annual growth of over 25 per cent. Sophisticated applications that transform mobiles into medical devices have also seen explosive growth making inroads into clinical practice to assist with diagnosis, treatment recommendations and patient compliance. More than 500 million smart phone users will be using health apps by 2012, and by 2014, more people will access the web via a mobile or smart device rather than their PCs or laptops. The massive potential for growth in the Asia Pacific health industry will be explored at the HIMSS Asia Pac’11 Conference. As part of the thought leader sessions on the first day of the HIMSS AsiaPac 11 Conference, Jorge Martinez Navarrete, Economic Affairs Officer, United Nations ESCAP, will talk about mobile technologies for healthcare. HIMSS Asia Pac’11 also features a Mobile Health Symposium on 20th September, which will be opened by Charlene S. Underwood, chairperson of the HIMSS board. The symposium, to be chaired by Dr Chong Yoke Sin, CEO of Singapore’s Integrated Health Information Systems (IHiS), will feature mobile health experts from around the world who will share experiences on harnessing the technology to further improve public health outcomes.

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“Teleradiology has made its greatest impact in the emergency setting” Teleradiology Solutions provides teleradiology services to hospitals around the globe, which includes interpretation of all non-invasive imaging studies, namely CT, MRI, ultrasound, nuclear medicine studies and digitised X-rays. Dr Arjun Kalyanpur, Chief Radiologist, Teleradiology Solutions, in an interaction with Dhirendra Pratap Singh, shared his perspective on teleradiology in India. Excerpts:

Please tell us about Teleradiology Solutions’ operations in India. Teleradiology Solutions’ headquarters and central reading hub is in Bangalore where our IT, HR and operations are located. In addition, we have reading centers in Delhi, Hyderabad and Mumbai (we also have overseas reading centers in the US and Israel). In our campus in Bangalore we have a clinic with a diagnostic center, RxDx, which has digital X-ray, digital mammography, high-end ultra sonography and 64 slice CT. In addition we have a state of the art training center, Radgurukul, with a 90 seat auditorium where we conduct CME training programs. We also run a not for profit foundation, the Telerad Foundation that provides radiology reporting services free of cost to hospitals in remote areas as well as supports a teaching website www.radguru.net

Dr Arjun Kalyanpur Chief Radiologist Teleradiology Solutions

SEPTEMBER / 2011 www.ehealthonline.org

How have you seen the advancement in the field of radiology over last few decades? Which areas of healthcare have mostly been benefited through such technologies? There have been dramatic advances in the field of radiology in the past few decades. It is hard to believe that even as recently as in the 70s, conventional imaging and sonography were the mainstay of imaging. Today the imaging armamentarium includes multidetector row CT, MRI with a host of advanced sequences, PET-CT, digital mammography, etc.

In Person INTERVIEW

While all segments of healthcare have benefited from such technologies, those that have seen the greatest benefits have been the subspecialties particularly neurology/neurosurgery, oncology, orthopedics and cardiology/cardiac surgery. What are the services that you are currently offering in India? Enlist the countries and hospitals to whom you are providing your services. What model do you follow? We are supporting the Ramakrishna Mission Hospitals in Itanagar and Brindavan in this manner, as well as several other centers in remote places. We also report diagnostic scans and radiographs for hospitals in Chhattisgarh, Haryana, Jharkhand, UP, Bihar, Tamil Nadu and Karnataka. Apart from reporting for over 80 hospitals in the US, we are also reporting for Singapore (11 clinics and hospitals run by the National Healthcare group), the Maldives (Indira Gandhi Memorial Hospital), and also report for centers in Indonesia, Denmark, the Netherlands, Germany, Croatia, Georgia, Guam, Puerto Rico and Thailand. Depending on the region and the requirement, we have different models in place. In the emergency reporting model, we deliver reports within 30 minutes to emergency departments anywhere in the world, or 15 minutes in the case of acute stroke exams. In the subspecialty model we report complex CT, MRI, PETCT etc examinations with a 12 hour turnaround time. We also offer offsite 3D post processing services and image analysis for clinical trials. Our technology division TeleradTech has developed an integrated RIS-PACS-teleradiology workflow named RadSPA which has several installations through the country (and abroad). This technology is focused on optimising radiologist efficiency and convenience by bringing the images to the radiologist anytime anywhere, and can be utilised on a purchase model or a pay-per-use model. What is the current market trend of Teleradiology in India and worldwide? There is greater acceptance of teleradiology throughout the world, a trend that is linked with greater penetration of broadband technology and the need to reduce healthcare costs, and fuelled by the pervasive radiologist shortage that threatens to become a crisis. As we have seen, teleradiology had its origins and has made its greatest impact in the emergency setting, and this is the segment that continues to grow, especially in the situation where it can be used to optimally staff hospital casualty departments after hours (by having a single radiologist at a centralised reading hub reporting simultaneously for multiple emergency rooms, rather than have a radiologist at

each location simultaneously). The other segment that is growing rapidly is in the setting of locations where radiologists (especially subspecialists) are hard to find. This extends from remote locations to even tier 2 cities where the explosion in medical imaging diagnostics has resulted in the installation of high-end imaging facilities without the corresponding radiologist expertise being available, and spans both hospitals and imaging centers. It also seems the only way to cope with staffing shortages in diagnostic radiology and increasing costs in healthcare overall.

The radiology market in India is growing very fast with investment being poured in as a result of Indiaâ&#x20AC;&#x2122;s recent economic growth, resulting in a profusion of highend imaging technologies. The latest technologies are today unveiled in India simultaneously with the west What are the current technology trends in Teleradiology? These are very exciting times from a technology perspective. What has emerged over the last several years is that RIS and PACS are no longer adequate to efficiently conduct teleradiology operations. What is needed is an integrated RIS-PACS with a strong teleradiology workflow component that allows for efficient image distribution across a local, regional or even a global enterprise, and which allows the image data to flow towards the appropriately subspecialist radiologist that is on the reading schedule at the time. As radiology groups grow in size and begin to span several centers, the need for such distributed teleradiology workflow becomes ever more critical, in order to reduce operational inefficiencies and optimise the utilisation of that precious resource, i.e. radiologist time. The other interesting trend is the use of mobile technologies such as the ipad and iphone to interpret scans in the emergency setting, which can benefit clinicians as well as radiologists, and greatly reduce the time to treatment, thereby directly impacting on patient outcome. Finally the integration of technologies such as 3D and CAD into teleradiology workflow, and the use of data mining tools to extract performance and quality data, represent technology trends that will further optimise quality and efficiency within radiology. SEPTEMBER / 2011 www.ehealthonline.org

INTERVIEW

In Person

trust and brings us immense satisfaction. Additionally, it is our aim to provide high quality diagnostic reports to all parts of India, Africa and to places anywhere that there is a need. The radiology market in India is growing very fast with investment being poured in as a result of Indiaâ&#x20AC;&#x2122;s recent economic growth, resulting in a profusion of high-end imaging technologies not just in the metros but even at the Tier II and III level, which is the way it should be. The technology gap between west and east has disappeared and the latest technologies are today unveiled in India simultaneously with the West, another heartening trend. And consumers are becoming more enlightened about their healthcare and diagnostic needs and more discerning of their choices, thanks to the availability of information on the internet today, also a positive trend, as it means that they will expect quality imaging, which they deserve, and will cease to be manipulated by corrupt practices in our system such as referral fees and the like.

What has been your marketing and business strategy in India? Do you provide services for rural population in India? How do you see the radiology market in India? In India, so far the market for reporting services is nascent although rapidly growing and evolving. We have had no serious marketing efforts and have focused more on growing the services of our Foundation, to provide services to hospitals in areas of need. However, as our technology division has seen keen interest and growth with deployment of its cutting edge RadSPA teleradiology platform (which has been developed with input from our own radiologists) all over the country, we are seeing a need for reporting services emerging in parallel at a rapid pace. We remain committed to provide services to the rural population in India through the Telerad Foundation, which is our not-for-profit entity and is supported by the parent organisation, Teleradiology Solutions. Our goal is to reach out to all hospitals that are themselves working without the motive of profit in areas of need and to support them with remote radiology reporting services. Our reporting for the Ramakrishna Mission Hospitals in Itanagar and Brindavan has been greatly appreciated by their

SEPTEMBER / 2011 www.ehealthonline.org

What do you predict will happen within radiology in the next 5-10 years in India? What are your future plans? My concern is that we will be facing a major shortage of radiologists in India over the next 5-10 years. Although it is good that radiology is a highly competitive postgraduate degree today that attracts the best medical graduates, this is a double edged sword in that we will have some outstanding radiologists but not enough competent radiologists to meet our countryâ&#x20AC;&#x2122;s needs. I therefore see the need for and utilisation of teleradiology growing rapidly in our country. For example it can and will be used to optimise staffing within a hospital system (as with some of the large corporate hospital groups that have hospitals in multiple cities) as well as to link multiple imaging centers in a city, so a single radiologist can report for all the centers at once. And finally teleradiology as an outsourced service will become an increasing trend. In this regard, we plan to continue to focus on quality of reporting and constant technology innovation to meet and exceed the expectations and standards of the healthcare industry. The use of innovative teaching practices, including online radiologist training, such as we currently offer through our Radguru site, will become increasingly important over the next decade. The other major challenge will be to train enough radiologists to meet our requirements of the future. One of the hurdles we face in this aspect is that currently, the National board (NBE) only allows centers with a 100 beds to train radiologists. We believe that this needs to be changed.

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GE adds ipad connectivity to Emr GE Healthcare this week unveiled Centricity Advance-Mobile, a native Apple iPad application designed for primary care physicians in small practices that are using the Centricity Advance cloud-based program to access their patients' EMRs. GE chose to develop the iPad app because the tablet is used by more physicians than other tablets on the market, according to Mike Friguletto, vice president and general manager of GE Healthcare IT's Clinical Business Solutions. It's no surprise then to hear him say that the company has no current plans to put Centricity Advance-Mobile into other mobile devices. The announcement is another sign that the iPad (along with health apps developed to run on them) is the dominant tablet of choice among physicians. As mobile health (mhealth) becomes more pervasive, companies like Apple and Microsoft are eager to push their products into the lucrative healthcare market. GE said its Centricity Advance-Mobile turns the iPad into a digital "notepad" that the clinician can use when completing summary notes. The mobile application enables immediate response to patient requests, such as prescription refills and emailed questions, and allows a physician to attend to tasks even when away from the office. In addition, physicians can now use their iPad to order, digitally sign, and route a new prescription to a pharmacy.

Mobile phone software improves diabetes management

Software added to basic cell phones can help patients with diabetes significantly reduce a key measure of blood sugar over one year, according to a study published in Diabetes Care, the journal of the American Diabetes Association, the Wall Street Journal reports. The study -- conducted by researchers at the University of Maryland School of Medicine -- involved 163 patients and 26

primary care physicians in Baltimore and outside the Washington, D.C., area. Three groups of patients taking various diabetes medications received mobile phones with diabetes management software, while a fourth group received usual treatment. Patients with cell phones would enter their blood glucose levels and would receive a text message if the reading was considered too high or too low. The phone also would send "retest" reminders to patients. In addition, the software allowed physicians and nurses retrieve data through a secure website. The researchers sought to compare changes in hemoglobin A1C measurements.

At the beginning of the study, the average A1C readings for patients were above 9 percent, which is considered an increased risk of developing complications such as heart, kidney and eye problems. The American Diabetes Association recommends that A1C levels be less than 7 percent. After one year, patients using the mobile management system had an average decline in A1C levels of 1.9 percentage points, compared with a 0.7 percentagepoint decrease among patients not using the mobile phone system. An average drop of one percentage point can be significant in reducing the risk of complications.

Hitachi installs first scenaria ct scanner Hitachi Medical Systems America Inc. (HMSA) today announced the first Scenaria CT scanner has been installed in North America and is available for clinical use at Radiology Imaging Associates in Prince Frederick, Maryland. The new Hitachi SCENARIA™ 64-slice CT responds to today’s challenge to simultaneously provide excellent image

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quality across a wide range of routine and advanced applications with the most sophisticated dose reduction* technologies and in an ergonomic package that accommodates the patient comfortably. “We are very excited about our relationship with Radiology Imaging Associates and are proud to see our first installation in a facility dedicated to excellence” said Sheldon Schaffer, Vice President and General Manager, MRI & CT. SCENARIA includes a comprehensive package of enhanced dose reduction and awareness features highlighted by Intelli IP™ Iterative Processing, Intelli EC™ 3D automatic exposure control and Dose Check that notifies the operator before scanning if a scan protocol selected will result in a patient dose higher than reference levels. With the slimmest 64-slice gantry and a more compact footprint, SCENARIA is an ideal upgrade from an older CT.

Special Focus article

Powering Diagnosis CT scanners facilitate visualisation, characterisation, and measurement of biological processes at the molecular and cellular levels in humans and other living systems

By Dhirendra Pratap Singh

he late 70s and early 80s saw entry of first ultrasound and single slice translate-rotate CT scanners in India, suddenly emerging like sphinx and transforming the status of imaging technology from just simple hardware producing flat two dimensional images into orthogonal cross-sectional images of higher special and temporal resolution which revealed much more in terms of human anatomy and offered higher accuracy in diagnosis. This placed the radiologist in the driverâ&#x20AC;&#x2122;s seat in the clinical world and brought

greater respect to him as the one whose acumen was necessary to get the diagnosis in most cases which was based on management of the diseases. Molecular imaging enables the visualisation of the cellular function and the follow-up of the molecular process in human body without perturbing it. Thus, it was quickly adopted by the medical fraternity, giving a noninvasive method with clarity . This technique helps improve the treatment of diseases such as cancer, neurological and cardiovascular diseases by optimising the september / 2011 www.ehealthonline.org

article

Special Focus

New Technology, New Prospects Dual source CT scanners are the latest revolution in the field of CT imaging. There are multi-slice CT scanners which have the capability of rapidly scanning large longitudinal (z) volume with high z-axis resolution. Multi Slice CT is a light speed VCT. Its unprecedented coverage speed allows clinicians to capture whole organs in a second, the heart in 5 beats, or go head to toe in less than 10 seconds. In the course of a Single Photon Emission Computed Tomography (SPECT) scan, a three-dimensional image is obtained by rotating the detectors of the gamma camera around the patient. For evaluation, slices in any orientation can be reconstructed from the original three-dimensional scan. SPECT is a well-established imaging method that is widely used in modern nuclear medicine diagnostics. In particular, tomographic scans have almost completely replaced planar acquisitions in the fields of cardiology and neurology. PET scanning is a nuclear medicine procedure that deals with positrons. The positrons annihilate to produce two opposite travelling gamma rays to be detected coincidentally, thus improving resolution. With the introduction of improved instruments allowing acquisition of whole body images in under an hour, applications in oncology have opened avenues for expanded clinical use of PET.

Future in radiology will see enhanced efforts towards greater use of molecular imaging to be able to detect lesions before they attain even pin-head size and which are yet only at cellular levels

pre-clinical and clinical tests of new medication. They are also expected to have a major economic impact due to earlier and more precise diagnosis. CT scanners facilitate visualisation, characterisation, and measurement of biological processes at the molecular and cellular levels in humans and other living systems. Molecular imaging is a key component of 21st century cancer management. The global efforts for quantitative imaging of tumor can lead to a more robust and effective monitoring of personalised molecular cancer therapy. Treatment for cancer is traumatic as the disease grows inaccurately and partial diagnosis often leads to more traumas. Molecular Imaging can be very useful not only in oncology but in many more clinical areas. High end imaging modalities need better image management and archival systems. The diagnostic outcome of molecular imaging is necessary to

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be made available to clinicians treating the patients. Healthcare IT and molecular imaging go hand in hand. If one wishes to exploit the real advantage of these systems, other should ensure effective distribution of these images to clinicians and integration with electronic medical records. When a hospital plans to buy a multi-crore, hitech equipment, the initial few months of planning are typically spent over the question, â&#x20AC;&#x153;What return on investment (ROI) can we expect?â&#x20AC;? Most imaging equipments have gone through this phase and have matured in terms of both utility and viability. Molecular Imaging, the latest technology wave in diagnostic imaging is not an exception. But for a diagnostic consultant return on investment is measured differently. How many times is a life saved due to timely diagnosis? How many times the quality of life has dramatically improved the treatment with accurate predictions and visualisation of the disease? Answers to these questions are the basis for real ROI.

Market The demand for medical imaging products in the US market was $21.4 billion in 2010. The main causes of this growth are technological advances, along with an ageing population and changing trends in healthcare approaches. New scanners with expanded testing capabilities are also being adopted widely by hospitals and outpatient facilities to improve quality of care. Medical imaging equipment has posted demand of over $16 billion in 2010, which is 6.8 percent higher than the annual growth in the last two years. Picking up the biggest pace will be multi-slice CT scanners, due to investment in the systems by hospitals and outpatient facilities replacing older systems. Due to the popularity of new hybrid PET/CT systems, the systems offer dual anatomical and metabolic scanning capabilities. Other drivers of the demand include the ongoing replacement of conventional analog machines with digital x-ray and radiographic fluoroscopy systems. Faring better will be nuclear medicine and ultrasound equipments. New four-dimensional (4D) imaging systems and new laptop and hand-held devices for point-of-care systems will also abet the overall growth for diagnostic ultrasound equipment. Worldwide, medical imaging consumables have expanded 3.6 percent annually to $5.3 billion in 2010. Finally, the market for contrast agents have seen the moderate growth in x-ray, CT and MRI studies on body regions where the targeted organ or tissue needs visual enhancement due to its masking by nearby invivo matter. In this product group, nano-sized compounds hold the best growth prospects as they are expected to greatly improve MRI-generated images.

Special Focus article

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 •  •  •      •    •     

                 

                   • 

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•   •     •   •    

•    • 

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          

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september / 2011 www.ehealthonline.org

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article

Special Focus

CT Scanners:

Setting new standards in the treatment of heart disease (Non-invasive alternatives) Compared to the other imaging modalities, how are CT Scanners unique and what do they offer to radiologists? CT Scanners provide probably the widest range of diagnostic capabilities amongst all imaging modalities currently available. It basically creates a three dimensional reconstruction of the inside of the human body using a large series of two dimensional X-Ray images taken around a single axis of rotation. It gives us the ability to see individual body parts, be it the vessels, the heart, lungs, brain, muscles, bones etc. in detail which was never available earlier. Using complex computer algorithms, isotropic and virtual imaging has become a reality today. For example, it is setting new standards in the diagnosis and treatment of heart disease by providing a simple non-invasive alternative to the invasive angiogram performed earlier to see the condition of the blood vessels of the heart. What was the investment made by your centre in installing CT Scanners? The cost of installing a CT scanner can range from around $200,000 to a few millions depending on the type of scanner and the additional features purchased with the equipment. We currently have two of the highest-end 64 detector 500 slice/second CT scanners, two 16 slice multi-detector CT scanners and one single slice scanner. The combined investment in these machines can be estimated to be more than 2-3 million dollars. What is the current market trend of CT Scanners in India and worldwide? In India, the CT scanner is now finally

using the high-resolution imagery of the CT scanner, it is now also being used to make “made to order” or “patient specific” implants and prosthesis for surgeries which involve replacement of the joints or any other body part.

Dr Harsh Mahajan, Medical and Managing Director, Mahajan imaging centre percolating to the tier 3 and lower cities as more and more physicians are realising the benefits of using a CT scanner for diagnostic purposes. In the big cities, the trend is moving towards utilisation high-end equipment as most big hospitals and diagnostic centres are acting as referral centres for difficult cases. What are the current technology trends in CT Scanners? The applications of the CT scanner are limited only by the imagination. Currently the role of CT scanners is moving into the domain of virtual imaging wherein virtual colonoscopies, virtual bronchoscopies and more recently, virtual angioscopies are slowly becoming effective alternatives to the invasive scans which are done for the same purposes. In one of our centres, we have a research tie-up with an Indian company which has developed a CT-Guided Robotic Biopsy system to help a radiologist or a pathologist take a biopsy sample from any part of the patient with highest accuracy. Also,

The medical equipment market in India is growing at an annual rate of 15 per cent and is expected to touch $ 4.98 billion by 2012. Indian health imaging market is expected to double from the existing `1,575 crore in the next five years. X-ray, ultrasound, CT and MRI would drive this domain collectively accounting for 68.6 percent of the health imaging market. Teleradiology holds

september / 2011 www.ehealthonline.org

What are the challenges that cropped up while implementing CT Scanners? In the early days, one of the main challenges that one faced was that of educating the physicians about the usefulness of the technology. One needs to teach along with self-assessment to make sure that what one says is being delivered. This is generally true with any new technology that we look to introduce and it is a phenomenon that is probably true throughout the world. Also, earlier the radiation exposure that was associated with CT Scanning was very high and hence we as radiologists ourselves were a little reluctant to use the technology on younger patients. What is the future of CT Scanners you see? The future of CT Scanners lies in Low Radiation Dose Imaging. There is currently, in three of our centres, a technology which greatly decreases the radiation exposure to the patient. In fact, there is a technology which is just coming out of the R&D phase, which will enable us to perform a CT scan in the same radiation dose as an X-Ray. There are many new and exciting things happening on the software side as well, which are helping acquire images with very high spatial resolution, minimising artifacts and in-turn revolutionising the diagnostic capabilities of CT Scanners.

90 percent of the market share in the country, growing at 50 percent per year. Since the days of X-ray, various technologies have exploded the radiology market. Major evolution has been noticed in the domain of CT, MRI and ultrasound, while digital radiography and teleradiology has given a whole new meaning to diagnosis.

Special Focus article

september / 2011 www.ehealthonline.org

article

Special Focus

CT market is growing at a 12 percent per annum in volume terms and we expect close to 350 units to be sold in the country this year. We expect to gain market share across the segments since we are present across the spectrum. CT is witnessing growth across segments like corporate, diagnostic chains and government hospitals. Pay per use is another model to cater to the demand of the growing market. Hitachi and Trivitron is looking at these opportunities to fasten the growth and Paul Stephen, General Manager, Imaging Division, achieve its objectives. Trivitron Healthcare Pvt. Ltd. has an- Trivitron Healthcare nounced a strategic partnership with Hitachi Medical Systems to provide high end imaging solutions such as CT, MRI, Digital X-ray and Ultrasound systems. Trivitron is currently present in imaging market in India through a joint venture between Trivitron Healthcare & Hitachi Aloka Medical Ltd (ATMT) which offers Ultrasound & Color Doppler. This strategic association will enable Trivitron cater to a larger medical imaging market worth `5000 crore as against its current market coverage which is estimated at `500 crore in India in imaging segment. It will also enable Trivitron Hitachi to become market leader with over 20 percent market share over a three year period.

Cardiac Imaging Cardiologists believe that cardiac CT will become the ultimate differentiating tool for determining the treatment path for all low and intermediate-risk patients. A CT scan can reveal the overall deposition and composition of calcified and lipid-based plaque as well as stenoses. With cardiac CT angiography, there is no risk of vascular damage, heart attack or stroke; after the scan the patient can resume normal activities immediately. An ECG signal is used to gate data acquisition so that only a relatively narrow phase of the heart cycle is used for image reconstruction, the phase being selected in order to minimise motion artifacts. Since the introduction of 64-slice CT in 2006, several more-advanced models have been introduced for cardiac imaging. A 320-slice CT can capture the entire heart volume in one phase of a single heartbeat. A dual-source CT that, combined with high-pitch spiral acquisition mode, can do the same.

Refurbished Equipments There is a rampant market for old and refurbished medical devices in India that come quite cheap. The increase in medical procedures has stimulated demand for greater number of imaging equipment in hospitals. Many institutions require a second or third equipment to cope with the increasing demand for low-cost refurbished equipment as they are unable to invest in

september / 2011 www.ehealthonline.org

new equipment due to limited funds. It is estimated that high field machines account for 12 percent share in Indian CT Scanner market. The escalating need to procure high-end but inexpensive medical imaging equipments promises further growth of refurbished medical imaging equipment market. Along with new technology in medical equipment there is an emerging trend of â&#x20AC;&#x2DC;affordable buyingâ&#x20AC;&#x2122;, which is the basis of refurbished medical equipment business. Experts believe that buying refurbished medical equipment does not necessarily means sacrificing on quality. Buying refurbished equipment can save sometimes over 50 per cent of what you would normally pay for brand new equipment. But, there are some negative impacts of such equipments as well. Buying a discontinued product can be very risky as no parts are manufactured anymore and the customer has to depend on vendor stock or used parts from another seller or manufacturer. The buyer must understand that the most crucial aspect of a refurbished equipment vendor is his track record in the business and the quality of service support.

Future The future of molecular imaging is very promising and the hospitals and other healthcare providers will need to prepare themselves for this futuristic technology. The investments in infrastructures as well as technology are definitely worth it. PET CT scanners can be immediate actions, as this fusion of molecular imaging has already shown its unprecedented growth in cancer diagnosis and management. But there should be provisions for expansion of this into a more promising radioimmuno-based imaging and individualised therapies. Setting up small peptide synthesisers and use of positron emitter generators like 82Rb, 68Ga will prove its worth in the next five years. These are modules required for molecular imaging of gastro-neuro-endocrine tumors, cardiac perfusion and metabolic imaging. Molecular imaging (MI) will assume an ever more important role in furthering our understanding of human disease and patient care in the future. Strategic planning for investment on MI modalities is a key to success. Future in radiology will see enhanced efforts towards greater use of molecular imaging to be able to detect lesions before they attain even pinhead size and which are yet only at cellular levels. By understanding the molecular basis of disease and developing methods to detect and treat changes in the body at the molecular level, physicians will be able to identify diseases in the earliest possible stages. This will by far remain the major focus of research and development in clinical medicine in the 21st century.

EXPERT CORNER

Implementing An Electronic Medical Record System The case study highlights the importance of implementing an electronic medical record (EMR) system in the hospitals for effective management and increasing efficiency By Dr Karanvir Singh

n electronic medical record (EMR) system, which is the computerised equivalent of a paper case sheet containing patient medical data, is what really distinguishes a standard enterprise resource planning (ERP) solution from a hospital information system (HIS). The EMR component in an HIS is generally believed to be the most difficult to implement. Often hospitals implement the other components first, leaving the EMR last because of the difficulties involved. Doctors are usually mobile, while computers are not, and although laptops and tablet PCs are making inroads into this they still have a long way to go. Doctors are also more pressed for time and barely have enough time to open the paper case notes of a patient to scribble a few cryptic notes. Also, doctors are well known for being resistant to change, more than hospital clerical staff. Doctors love to get data but hate to enter data. Our initial HIS roll out had been of outpatient registration and the laboratory and imaging services in 2005. We have added more modules as the years have gone by. EMR capabilities were introduced 2 years ago. We had expected a strong resistance from doctors but were instead greeted by a flood of demand from doctors requesting EMR implementation in their departments, and the roll out has been surprisingly smooth. Analysis of why this happened contrary to our expectations is likely to benefit other sites that are trying to implement EMRs. Introduction of a new system works best with a carrot and stick policy. In our implementation we had more carrots than sticks. The first 'carrot' was an automated discharge summary. All departments used to type discharge summaries on a word processor. Patient data was lost over time since it was next to impossible to locate the word processor file of a patient after a few months. What we offered them were EMR screens where they could enter clinical data which

would then be picked up by a separate module that would print it in the form of a discharge summary. All this would be backed up by industry grade security ensuring data availability even decades down the line. This immediate return offered by an automated discharge slip, even though much less than the returns from data retrieval at a later date is what tipped the balance. We realised that something as trivial as an automated discharge summary should not be underestimated as a force that could influence EMR adoption and it is something other sites would do well to keep in mind. The other 'carrot' was availability of analysable data. If doctors could analyse the huge volume of entered clinical data they could get more research

SEPTEMBER / 2011 www.ehealthonline.org

EXPERT CORNER

material and many more publications. While designing the EMR screens we ensured that free text typing was restricted as much as possible and data was captured in a granular fashion resulting in the data being immediately available for data analysis. Structured data entry is of crucial importance in a good EMR. We were fortunate to own a very good business intelligence software (Speedminer from Hesper, Malaysia) which we quickly adapted to clinical data analysis. Within days of EMR data entry being started in a department we were able to provide them with dashboards showing clinical data in the form of analysable charts. Starting just 2 years back, we have now reached a stage where about 95% of admitted patient's clinical records are being entered into the EMR (about 160 patients per day), and we expect to have 100% data entry within months. The lesson is that it is not a good idea to introduce the EMR until 'carrots' are ready, which in our case were the discharge summary module and the data analysis module.

â&#x20AC;&#x153;We are very close to reaching a stage of 100 percent clinical data entry in our inpatient records. Considering our outpatient workload (nearly 1500 patients/day), implementing EMR use in the outpatients will be another challengeâ&#x20AC;?

During the process of our EMR implementation questions arose regarding data confidentiality. Doctors like to restrict browsing of entries in paper case records to only doctors directly involved in the care of their patient. In our EMR, while it is possible to configure such restrictions, we opted not to, as doing so would restrict visibility of these EMR entries to only the main care provider after the patient's discharge and would exclude access to a lot of patient care data from subsequent care providers. In such situations one has to strike a balance between availability of patient's medical data with the aim of improving medical care, and data confidentiality. Another issue is the legal implications of switching over completely from paper records to electronic medical records. Although the Indian IT Act 2000 allows presentation of digitally signed electronic records in lieu of paper records in a court, there has

SEPTEMBER / 2011 www.ehealthonline.org

been no precedence in India of a legal suite being fought based entirely on electronic medical records. We hence ask doctors to make duplicate entries, once in the paper case sheet and once in the EMR, although daily rounds notes are not entered in the EMR. A new complexity was the ICD-10 clinical coding system used. Although fairly comprehensive, it is not easy to use and locating the appropriate ICD code is a difficult exercise for doctors sometimes, even though the entire coding list had been preloaded into the system. We hence provided them access to the very helpful ICD coding section of the WHO website which helps in locating the appropriate code . Doctors often use medical transcriptionists to make entries on their behalf but we insist that they perform the coding at least themselves. The use of medical transcriptionists is a compromise we have made. To ensure that the quality of data entered was not compromised we modelled the patient paper records template to mimic the EMR screens. The doctors enter data in the paper records at the time of clerking the patients and the transcriptionist types this into the EMR. All EMR entries are then checked by a doctor before discharge of the patient. We are very close to reaching a stage of 100 percent clinical data entry in our inpatient records. Considering our outpatient workload (nearly 1500 patients/day), implementing EMR use in the outpatients will be another challenge. It is common to see good EMR implementations, with nearly paperless workflows in many hospitals where the workload is not crippling and where it is possible to maintain ideal computerized workflows even if each computerized workflow step takes some extra user time. The story is very different as hospitals approach saturation limits in the work load they can handle. Every minute increase in processing time necessitated by computerisation of workflows, as often occurs at areas of intensive data entry, can lead to a derailment of the entire computerisation process. Implementing a HIS in such a situation requires the implementers to squeeze the very last drop of efficiency from the system and plan things very differently from what they would otherwise have been.

AUTHOR Dr Karanvir Singh, Consultant Surgeon and Head of Medical Informatics, Sir Ganga Ram Hospital, New Delhi

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HOSPITAL CEO interview

“PPP model is important for improving the current healthcare scenario in India” Medfort Hospitals is providing superior healthcare services by offering compassionate patient care and clinical excellence in Diabetes and ophthalmology. In conversation with eHealth, Gaurav Malhotra, CEO, Medfort Hospital talks about Medfort’s journey and how it is working to position itself as a preferred healthcare provider.

What was your objective behind starting the healthcare facility like Medfort Hospital? The diabetes mellitus management market in India is large and rapidly growing. India is estimated to have 50 million diabetics today, a number expected to touch 90 million by 2030. We estimate the market in the top 35 cities alone to be worth ` 3,000–5,000 cr. On the other side around 10 percent of Indian population suffers from some form of visual impairment which means more than 12 crore Indians need attention by ophthalmologists. 85 percent of this population is predominantly driven by cataract and refractive errors, thus eye care services present a significant business opportunity. In a market with growing opportunities in both these segments, there are very few organized players. There is a Pan-India market leadership position that is yet unoccupied in both the Diabetes Care and Eye Care segments. Lack of any organised Pan-India player provides an opportunity for rapid scale-up. We believe that these market segments, with the inherent mis-match between burgeoning demand and largely unorganised supply, are at an inflexion point in their maturity graph. As of now, what are the different technologies installed at this hospital? Leadership in technological advancement is our sustainable competitive edge. One of the major constituents of our investment is in acquiring latest cutting edge technologies and providing it first time to Indian patients. Clinical excellence is complemented by the breakthrough technologies at Medfort`s centers of excellence. We have some innovative and path breaking

SEPTEMBER / 2011 www.ehealthonline.org

technologies in Eye-care like “Customlens”, a new femtosecond laser procedure for performing the key steps in the cataract surgery procedure like anterior capsulotomy , lens fragmentation and corneal incisions. The future of refractive surgery, beyond the development of new systems and algorithms, lies in the combined correction of presbyopia, myopia, astigmatism and hyperopia. CRYSTALENS is another technological breakthrough for treatment of cataracts. It is the first presbyopia correcting IOL introduced into the market and is currently the only FDA-approved accommodating IOL. We have specialised technologies like Dexa for measuring Bone mineral density and advanced equipment for foot care. Is the public-private partnership model workable in the health sector? What do you think are the limitations? Yes the PPP model in Healthcare can be successful in India and it is important for improving the current healthcare scenario. We need to understand that all the stakeholder’s have divergent views on the strategic intent of the PPP model. While private players are driven mainly by profit motive, govt. aim is to provide healthcare for “common man”. Public private partnership model is workable in the health sector provided the project objectives and risks associated are established clearly by both. Developing performance measurement metrics coupled with growth and expansion strategy, establishing clear and frequent communication with stakeholders to ensure transparency would be other critical factors for success. The PPP should essentially focus on ensuring that it

HOSPITAL CEO interview

Gaurav Malhotra CEO, Medfort Hospital SEPTEMBER / 2011 www.ehealthonline.org

HOSPITAL CEO interview

In India, healthcare sector has emerged as one of the most progressive service industries. The Indian healthcare industry is expected to register earnings of ` 12, 60,000 crore by 2020

is not loss making. Private partners can widen the whole aspect of healthcare in the nation by not only widening the coverage of foreign assistance programs but also help in achieving government`s developmental goals along with the formulation of sound and viable projects across the disease states. What do you think ails public hospitals in India? The pertinent question is how many of us have access to these “centers of excellence” more so when there is a wide chasm between clinical excellence and the patient care experience. Moreover much has to improve in government hospitals right from the basic relationship management with the patients to the optimum utilisation of the available technology. Government must focus on 360 degree up gradation of Hospitals from Paramedical Staff`s skills up gradation, infrastructure facelift, Superior patient experience across stages of treatment, optimum utilisation of the resources, proper utilisation and not exploitation of the doctors to a healthy awareness and education about the services and comfort for general public . Most importantly there is absence of financial discipline with large funds available but not being utilised effectively and efficiently. Lack of accountability across services for both support and medical along with no clear ownership for quality control and accreditation makes the situation worse. What is your assessment of the health sector in the country today? What steps are being taken to ensure medical facilities are made available to all? In India, healthcare sector has emerged as one of the most progressive service industries. The Indian healthcare industry is expected to register earnings of ` 12, 60,000 crore by 2020. The growth is at a much rapid pace than it was anticipated according to the Investment Commission of India (ICI). The sector has experienced phenomenal growth of more than 12 per cent per annum in the last four years. The growth is expected to be driven by a number of

SEPTEMBER / 2011 www.ehealthonline.org

factors which cover rising life expectancy, increasing income levels of Indian households, higher penetration of health insurance and growing incidence of lifestyle-related diseases in the country which has led to more spending on healthcare delivery, stated the recently published ICI report. Which in your opinion are the most significant developments in medical research in the country today? Clinical research organizations are planning to scale up their operations in the Asian region, especially in India, to tap the emerging opportunities of contract research from the US and European countries. There is a slow geographical shift from the Western part of the world to Eastern regions in the clinical trial space due to the cost arbitrage, talent pool and huge patient population. The government is examining a proposal to set up a venture capital fund for promoting drug discovery in the country. Earlier, the government had announced to set up an US$ 2.14 billion venture capital (VC) fund to finance drug discovery projects in India. The proposed funding of US$ 2.14 billion which includes substantial contribution from the private pharmaceutical industry under the public private partnership (PPP) model is expected to provide favorable environment for drug innovation in the country and to make India a hub for new drug discoveries. India is among the top five governments in the world funding research and development in neglected diseases, with particular focus on diseases like leprosy and dengue fever. India’s total pharmaceutical industry market is expected to touch US$ 20.9 billion in 2014. R&D spending at India’s top 25 drug companies soared 17 percent in 2008-2009. Some progressive state Governments have also launched health insurance schemes targeted at specific sections of the population and these have also improved access to healthcare. Social and community insurance schemes have also taken off in India. The total population with some form of insurance cover however continues to be low – more aggressive efforts are needed by both the Government and the private players to enhance the penetration of health insurance. Regulatory reform including enhancing the limit of Foreign Direct Investment (currently capped at 26 percent) may also be necessary to stimulate private sector efforts in improving financial access to healthcare. Use of Information Technology can help hospitals improve access, reduce costs and improve quality. Government should provide incentives to hospitals to seek NABH accreditation and IT enablement by allowing 100 percent tax exemption for expenditures related to accreditation and IT enablement.

Power hospital

SevenHills Health City â&#x20AC;&#x201C; Technology for Better Patient Care

SevenHills Group has over two decades of experience in the healthcare sector. It is one of the first paperless hospitals in India, providing quality healthcare and valuable expertise By Suresh Kumar

he SevenHills hospital in Visakhapatnam is a comprehensive healthcare multi-specialty tertiary care services to more than 50 million people across six states - Andhra Pradesh, Orissa, Chhattisgarh, Jharkhand, and parts of West Bengal and Bihar. The group currently has two hospitals, located in the cities of Mumbai, Maharashtra and Visakhapatnam, Andhra Pradesh. The hospital has been providing affordable healthcare services at the highest level for the past 25 years. In Mumbai, SevenHills health city is a 1500 bedded multi-specialty tertiary care facility. The hospital is built on a sprawling area of 17 acres with 2 million sq.ft built up area and is unarguably Indiaâ&#x20AC;&#x2122;s largest private healthcare service provider. The hospital in Mumbai also ensures affordable and quality healthcare services in a patient friendly environment with strong belief in ethical and transparent medical practices supported by a world class integrated healthcare delivery system. SevenHills offers state of the art in-patient and outpatient facilities, focusing on the comfort and safety of patients and their loved ones. The hospital offers cutting edge technology for diagnostic and therapeutic procedures. It is the only hospital in India having escalators and high speed elevators to ensure fast and smooth connectivity. SevenHills Hospital, Mumbai is one of the first paperless hospitals in India. Gone are the days of

SEPTEMBER / 2011 www.ehealthonline.org

hand-scrawled notes, scribbled prescriptions, big charts, patient queues, and lost patient records. Today, all this information and critical details are no more than a click away. Realising how IT is fast bringing a makeover of the healthcare industry and changing the face of traditional doctor-patient relationship, the management at SevenHills wanted to implement technology to gain optimum operational efficiency. With three decades of experience in healthcare, instead of first building a process and then implementing a hospital information system, the hospital built in all the processes with SevenHills e-Health, the e-Healthcare suite. SevenHills e-Health is a healthcare IT solutions company with a strong healthcare domain. The SevenHills e-Health HIS caters to the needs of the hospital and makes the usage as simple as possible for the doctors and the medical staff. The emphasis is laid to use the HIS system for all functions in the hospital. SevenHills hospitals have implemented a one-stop data warehouse of records of patients and treatment histories that can be consulted by authorised experts, keeping patient confidentiality uppermost in mind. With SevenHills e-Health the hospital has integrated almost all processes in the hospital, right from the front office registration to doctor consultation, investigations, the complete in-

Power hospital

patient treatment, more so even the collection management. Among the many modules implemented, the main ones are operations, inventory, clinical collection management, marketing & forecast, PACS, workforce management and integration with finance are all seamlessly connected and are available at a press of a button to the designated staff. Every patient at SevenHills hospital is allocated a unique health identification number (UHID) along with a registration card. This UHID provides the complete details of the patient’s medical history as recorded in HIS at any point of time during subsequent visits. Once the patient gets registered they are then directed to a Medical Officer who captures the patient’s problem, history, allergies and vitals and records in SevenHills e-Healthcare suite. Based on the data collected the medical officer refers the patient to the concerned doctor. When the patient meets the doctor, all their details collected by the medical officer appear on the doctor dashboard and the doctor can view the vitals and the history of the patient entered thereby can immediately work on diagnoses of the patient. This process allows doctors to concentrate more on diagnosis. The e-Healthcare suite is equipped to allow doctors to access results of all tests, images from radiology and so on anywhere and at anytime. With SevenHills e-health, now the doctor raises the lab orders/ service orders/ medication orders for the patients directly in the system, which reduces the errors as it is the doctor feeding the data themselves. At SevenHills hospital the complete hospital workflow, right from patient registration to discharge, including consultation, prescription, investigations, doctor and nursing notes, billing, inventory management are now automated. Patient safety in terms of correct medication, correct dose, allergies to various drugs, etc is taken care of by SevenHills e-Health suite. PACS is integrated, so all the images are available online for all who have the administration rights to access the data. This in turn helps to create a paperless environment, where doctors and other medical staff can access online in a more cost-effective, secured and accurate manner. The aim is to enhance patient safety with generation of instant alerts and reducing medication errors. This system has eliminated the need for large medical record charts as everything has been posted online with due care for data security. The SevenHills e-Health system is fully secured; no unauthorised user can access the patient’s records. The doctors can access the results of all tests, images from radiology and other patient details using their ID. Images of radiology, endoscopy, and echocardiography can also be accessed by doctors any-

One of the unique technologies at SevenHills health city is the pneumatic tubes in the hospital connecting the wards to the laboratory and pharmacy time within few clicks. At any point in time, real-time data is available from the ICU and bedside monitors in the hospital. At SevenHills health city each ICU bed has a bedside system. The nurses and doctor’s access and update patient vitals and details on the HIS real time. One of the unique technologies at SevenHills health city is the pneumatic tubes in the hospital connecting the wards to the laboratory and pharmacy.

IT implementation at SevenHills Health City Token generation for Patient Queue Management at OPD, Lab and Pharmacy; Digital Signage Solution at the waiting area for each doctor has the waiting token displayed. Besides that the display signage displays education of better health care; Computer on wheels (COWS), Laptops, smart hand-helds in the wards for nurses and doctors to track and enter the data real time. Bedside computer for all the critical care beds to capture real time data; deployed Wi-Fi across the hospital; centralised inventory management with the help of Pneumatic tube across the hospital; two way audio-video communication facility between the operation theatres and 300 seater auditorium and 150 seater saeminar hall in the hospital. Speech enabled e-Healthcare Suite increases physician satisfaction and supports hands-on or handsoff clinical documentation.

The roadmap ahead SevenHills hospitals is working to implement a portal for making online registrations, lab/investigation reservations, payment gateway and online information availability to the patients about their complete health history in the hospital. The hospital is also going to deploy RTLS(Real Time Location System) which will help to improve patient safety and the quality of care by reporting whereabouts of the patient at all times, and also it can be helpful in asset tracking.

AUTHOR Suresh Kumar, GM IT – SevenHills Group

sEPTEMBER / 2011 www.ehealthonline.org

Building capacity | Connecting people | serving citizens Driving Economy | breaking barriers

1-3 December 2011

Bangabandhu International Conference Center, Dhaka, Bangladesh

organisers

co-organisers

www.e-asia.org a2i programme

in association with

Bangladesh Association of Call Center & Outsourcing

partner publicationS

Realizing Digital Nation eASiA 2011, with the slogan Realizing Digital Nation, is an annual international Information and Communication Technologies (ICT) for development event with the objective of reinforcing technology and knowledge-centric growth and needs of Asia vis-à-vis Bangladesh, through capitalisation of market economy and boosting human development. This event commemorates the 40th birth anniversary of Bangladesh and celebrates the progress of Digital Bangladesh agenda

of the government. Digital Bangladesh by 2021 vision is a 21st-century globalized-world form of a vision of equitable prosperity portrayed by the founding father of the nation 40 years ago. Since then, Bangladesh has made significant progress in human development index and ranks third in the world. Conference Highlights: Plenary and technical sessions, Focused workshops, Seminars, Discussion round tables, Debates & more ...

Exhibition: Showcasing projects, programmes, Government Initiatives, Initiatives by Private sector agencies/ corporations, Demonstrating innovative ICT products, solutions and applications, etc. Target Audience: Policy-makers, Senior government officials, Industry leaders, International development, agencies, Civil society, Academia, and Investors, etc.

It is our pleasure to announce ‘call-for-papers’ for the eASiA 2011- Asia’a Premier ICT Event. The papers should be based on, but not restricted to, the following themes: 1. Building Capacity 2. Connecting People 3. Serving Citizen 4. Driving Economy 5. Breaking Barriers Selected papers will be given an opportunity to present at the eWorld Forum 2011 • Last date for Abstract Submission: 20th September 2011 • Notification of Acceptance of Abstracts: 1st October 2011 • Last date for Full Paper Submission: 20th October 2011 • Notification of Acceptance of Paper: 1st November 2011

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Analysis of an Unsuccessful Mission

PHRs by Google This analysis is an attempt to delineate the causes that may have led to the shocking abortion of a possible revolution in the domain of personal healthcare information management By Dr Sanjay P Sood & Meenu Kohli Puniah

“I

n the coming months, we’re going to retire two products that didn’t catch on the way we would have hoped, but did serve as influential models: Google Health (retiring January 1, 2012; data available for download through January 1, 2013) and Google Power Meter (retiring September 16, 2011)” as announced by Google on 24th June, 2011. Google Health’s much ballyhooed launch in 2008 had created waves in the Health Information Technology (HIT) industry at global level. Google’s objective behind launching their PHR was to extend their consumer-centric approach towards healthcare and wellness. Positive predictions about Google Health were majorly pivoted on the trust that “Google” had gathered based on their incomparable search utility, Gmail – their flagship product and Ad Words – Google’s advertising system. Such was the impact of Google’s announcement about their offering for creation and management of Personal Health Records that HIT analysts and experts not only went ahead to put on record that Google Health would create a strong “network effect” but even claimed that it had the potential to set “de-facto standard”. The findings of this study will eventually facilitate a better understanding of the PHR from user and the provider’s perspectives.

Personal Health Records (PHRs) Adoption and promotion of PHRs has gained impetus owing to a number of factors such as implemen-

SEPTEMBER / 2011 www.ehealthonline.org

tation of EMR by the healthcare industry mandate by 2014, the need to let consumers have control over their information and the benefits of having medical data backed up by users in case of accidental loss by natural calamities. Almost all web based PHR providers run with the motives to provide services that assure password protection and security of sensitive medical data like information pertaining to treatment, diagnosis, laboratory and imaging results and also the dosage and frequency of medications.PHRs enable the patient or an individual to takenecessary actions in situations that were earlier perceived to be controlled by the providers of medical services and information. The platform provides them with the authority to act as managers of their personal data and the freedom to be decisive.

The Case of Google Health Google Health’s model was aimed at data control and privacy, the patients or the subscribers had the privilege to import their health information from other sources like Electronic Medical Records (EMRs), hospitals, pharmacies and laboratories etc. and decide who they want to give access to for sharing their medical information and records. Since only the patient could pull the data into the system, voluntarily, therefore, Google Health was free from terms of service of the HIPAA. As per Frost and Sullivan’s Ryan Ohlin, one of the key reasons for Google Health’s inability to attract subscribers has been that it relied solely on general public-patients,doctors and it did not make any efforts to develop a network in the health information technology industry with others in the value chain across healthcare. Hence, it has been largely felt that Google Health could not extend its user base beyond a limited group of users that comprised of enthusiasts and technology lovers. It is worth including here that Per-

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sonal Health Records are yet not popular among the advocates of the technology especially doctors who could have influenced the patients to adopt it. Thus, people remained unacquainted with Google Health and ineffective market strategy was the reason as the masses were never introduced to the concept of PHR’s – a gap is still prevalent. According to Chilmark Research’s founder John Moore, “Google also struggled to sign additional partners to create a richer ecosystem and was way behind Microsoft in importing biometric data.” A major reason that has impeded the acceptance of PHRs has been the reluctance of Healthcare Management Organisations to share their patients’ EMR details with PHR providers like Google Health and Microsoft Health Vault. The hospitals not only fear losing control over their patients’ data but also fear losing customers to their competitors. Furthermore, the hospitals also feel that revealing sensitive information to the third parties may expose their mistakes, if any, on their part thus leading to a dent in their reputation. A similar instance came to light when a patient Dave deBronkarty, a tech-savvy kidney cancer survivor, who tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health in 2009, found errors in his diagnostic codes after he imported his record, which of course got the media hype and was in Boston Globe newspaper in no time. Another factor contributing to the challenges with respect to the adoption of PHR systems is that hospitals or provider organisations do not get any monetary benefits by providing or sharing data, it is more of an overhead and brings with it a fear to lose revenue by handing over the details to patients. Technical flaws or shortcomings prevalent in any product or business seem to have been there in Google Health as well and contributed to its recent decision. Perhaps Google Health ventured too soon into a market that was messed up by providers- who did not reflect a promising attitude towards the flow of information; all of them use proprietary formats for data storage and retrieval. Google Health had to solve this chaos first to make its services captivatingand carve a niche for itself. Furthermore, another reason for Google Health to stumble could be, despite having the elements of a Web 2.0 platform where users can add some value to the existing information, and have the freedom of manipulating the content stored by them, they still did not have an open and easy access to what they had to input in. Retrieval of information was a barrier in utilising Google Health’s marvelous participatory Web 2.0 platform. Thus, there were virtually no enhancements and participation on the part of the users.

Conclusion Following various reviews and comparisons about Google Health and other providers, in the field of personal health information management, it can be deduced that from user’s perspectives there have been no major issues. Surveys reveal that personal health records in certain cases have been widely deployed, some of these are fully integrated into ambulatory or hospital based electronic medical records and the users are satisfied with the utility, user interface and security as well. A recent study by Frost and Sullivan on the future of PHR’s indicates that the PHR market generated US $ 312.2 million in 2010 and it is estimated that revenues will reach US$ 414.8 million in 2015, representing a compound annual growth rate (CAGR) of 5.8percent. These figures are based on

“Technical flaws or shortcomings prevalent in any product seem to have been there in Google Health as well” the evolving market trends and introduction of new care models, the increasing use of mobile health applications which provides the users a reliable interface to secure their information and above all the keenness of patients and their loved ones to keep track of their data. Google Health had a number of intelligent and smart competitors who are heading strong in this emerging market and trying to make the most of its voluntary quit. Microsoft took no time to announce ways and means for Google Health users to migrate to Microsoft’s Health Vault. There is a lot to learn from Google’s decision to part but it is in no way the end of the PHR revolution that seems to be promising enough to shape our future.

AUTHOR Dr Sanjay P Sood, Head, State eGovernance Mission Team Chandigarh Administration, Chandigarh.

AUTHOR Meenu Kohli Puniah, Lecturer,GianJyoti Institute of Management & Technology, Mohali.

sEPTEMBER / 2011 www.ehealthonline.org

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G-Rail a strong, functional fully reversible profile4100 conforming HTM66,series offers comprehensive range of accessories to suit all suit all 4100 fixingispossibilities. Elegantand in design and function, is suitableto for use with up4100 lighters foraimproved ambient hospital ward lighting. fixing possibilities. Elegant in design and function, 4100 is suitable for use with up lighters for improved ambient hospital ward lighting. Synthetic Synthetic wall and ceiling fitting allowtorail 4100 with to comply with theNEN-3134 European NEN-3134 for special care rooms requiringfacility. anti-static facility. special care rooms requiring anti-static wall and ceiling fitting allow rail 4100 comply the European standard forstandard IV Bag Holders

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‘Healthcare Technology Resource Guide 2011-12’ magazine is pleased to announce the release of 3rd edition of its annual ‘Healthcare Technology Resource Guide 2011-12’, to be published in the month of October 2011. It is our pleasure to provide yet another opportunity for vendors and suppliers of health IT, medical equipments and devices to reach key people in hospitals, clinics, diagnostic centres, medical research institutes and various other stakeholders in the healthcare industry. Being the ‘only one-of-its-kind’ for the Indian market, this annual directory is a comprehensive compliation and showcase of latest products and solutions in Healthcare IT & Medical Technology space, helping healthcare deliverers to keep abreast about latest technologies, while facilitating their purchase decisions and planning.

Key features of the directory • Brand Profile- Detailed company profile of all advertisers (one page complimentary company profile with every full-page commercial advertisement) • Directory Listing- Alphabetical wise listing of vendors/solution providers with company name & contact details • Product matrix- This graphical representation will list various products being offered by each company Benefit to advertisers • 1 Year shelf life • Wider visibility and reach among decision makers • Strong brand presence and strategic positioning • Complimentary product profiling with matching page space • Maximum ‘return on investment’

For editorial queries contact: Shally Makin, shally@elets.in, +91 9999143088 For advertising queries, contact: Rakesh Ranjan, rakesh@elets.in; +91 8860651635