eHealth September 2013

asiaâ&#x20AC;&#x2122;s first monthly magazine on The Enterprise of Healthcare

volume 8 / issue 09 / september 2013 / ` 75 / US $10 / ISSN 0973-8959

Inside Story Understanding Health IT Benefits is Crucial

Bestof West Hospitals eHealth Magazine

The rise of Western India as a healthcare hub

Zahabiya Khorakiwala, MD,Wockhardt Hospital

Vishal Beri, COO, Hinduja Healthcare Surgical

Dr Sujit Chatterjee, CEO, Hiranandani Hospital

Dr Ramakant Panda, Vice Chairman and MD, Asian Heart Institute

Bomi Bhote, CEO, Ruby Hall Clinic

ehealth.eletsonline.com

volume

issue

contents

ISSN 0973-8959

Dr Damodar Raut

cover story Understanding Health IT Benefits is Crucial

cover story Pankaj Vaish, CEO, HealthFore Technologies

Srinath Bettadpur, CEO, Spigot Software

Alok Anand, Head â&#x20AC;&#x201C; Marketing, India & SAARC, Polycom

Dr Cliff Bleustein, Director- Global Healthcare Consulting

Dr Raj Sarda, Senior Vice- President, Health Management and Research Institute

Srividya-Thyagarajan, CEO, HTC Global Services

special focus (West Hospitals)

Minister, Health & Family Welfare and Micro, Small & Medium Enterprise, Government of Odisha

Shivam Parikh, HOD-IT, CIMS Hospital

Zahabiya Khorakiwala, MD, Wockhardt Hospital

expert speak

Dr Amitava Sengupta, Director, Mother & Child Unit,Paras Hospitals, Gurgaon (NCR)

Dr Akil Khan, Vice Chairman, Enso Care

Sunder Krishnan, EVP & Chief Risk Officer, Reliance Life Insurance

Dr Ramakant Panda, Vice Chairman & MD, Asian Heart Institute

Lilavati Hospital, Mumbai

Goenka Hospital, Gandhinagar, Gujarat

Jaslok Hospital, Mumbai

Bomi Bhote, CEO, Ruby Hall Clinic,

Vishal Beri, COO, Hinduja Healthcare Surgical

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eIndia Special Coverage

asia’s first monthly magazine on The Enterprise of Healthcare volume

issue

september 2013

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta group editor: Anoop Verma

Editorial Team

WEB DEVELOPMENT & IT INFRASTRUCTURE

Health Sr Assistant Editor: Shahid Akhter Assistant Editor: Monalisa Sr Correspondent: Sharmila Das governance Assistant Editor: Rachita Jha Research Assistant: Sunil Kumar Sr Correspondent: Nayana Singh education Sr Correspondent: Pragya Gupta, Mohd. Ujaley Correspondent: Rozelle Laha Sales & Marketing Team National Sales Manager: Sunil Kumar, Mobile: +91-9910998067 Assistant Manager: Vishukumar Hichkad, Mobile: +91-9886404680 (South) Manager - Sales: Douglas Digo Menezes, Mobile: +91-9821580403 (West) Assistant Manager - Sales: Bhupendra Singh, Mobile: +91-9910998066 (North) Subscription & Circulation Team Sr Executive - Subscription: Gunjan Singh, Mobile: +91-8860635832

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editorial

India Needs Improved Healthcare Infrastructure The estimates presented by Shri Ghulam Nabi Azad, Health Minister of India, in the Lok Sabha reflected a rather gloomy picture of our healthcare infrastructure. India has only one government hospital bed for 879 people on average. This ratio begins to look nearly 10 times as bad in a state like Bihar, but improves dramatically in Manipur. Even though Andhra Pradesh has maximum number of medical students in the country, it has only one government hospital bed for every 2,230 people. In India, public health is a state subject. But under the National Rural Health Mission, the Central Government is providing lot of financial support to states to strengthen their health systems including new constructions and upgradation of public health facilities. It has already been in the news that the Central Government is going to open eight new AIIMSs, and upgrade 19 medical colleges and institutions to provide tertiary healthcare services that will add about 11,390 additional beds. Hence, as far as the availability of government hospital beds is concerned, lot of improvement can be expected. But the dream of providing quality healthcare to all Indians can only become true when we have enough participation from the private sector. This is already happening in a big way. Healthcare is one of Indiaâ&#x20AC;&#x2122;s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. The private sector investments in healthcare is also due to Indiaâ&#x20AC;&#x2122;s thriving economy, which is driving urbanisation and creating an expanding middle class, with more disposable income to spend on healthcare. In this issue of eHEALTH, we have focused on the hospital sector in the country. Through a series of interactions with some of the key players in the Western region, we have analysed the work that is being done by the private hospitals to bring efficiency in the healthcare related services that they provide. Moreover, we have insights from a slew of Health IT providers too. This issue also has coverage of the eINDIA Health Summit 2013, which we had organized on 23-24 July, 2013, at Hyderabad International Convention Centre, Hyderabad. We have tried to present a summary of the views of all the speakers who participated the prestigious summit. Reading the report on eINDIA 2013, you do get a holistic view of the healthcare initiatives being undertaken in the country.

Dr. Ravi Gupta ravi.gupta@elets.in

September / 2013 ehealth.eletsonline.com

policy

Infrastructure Deficiency

is a Key Challenge

â&#x20AC;&#x153;Our priority is to eradicate the infrastructure deficiency in order to provide basic necessities which are required for a doctor to live and serve in rural areas,â&#x20AC;? says Dr Damodar Raut, Minister, Health & Family Welfare and Micro, Small & Medium Enterprise, Government of Odisha. In conversation with Mohd Ujaley, ENN

Dr Damodar Raut

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Large number of children are underweight and adolescent girls are anaemic in Odisha. How government is planning to tackle the problem? I agree with you, not only large number of children are underweight and adolescent girls are anaemic but even 22 percent newly born babies in tribal areas are also underweight. This is a typical situation because newly born babies, who are dying within a specific time, are counted into Infant Mortality Rate (IMR) and rest are not surviving for more than 30 or 40 years of their life. As per my understanding more than 6400 to 7000 newly born babies are dying annually due to heart attack in Odisha. The only remedy is surgical intervention, and unfortunately that is yet to be fully materialised. We need to focus on childcare programmes and initiatives. We have Shishu Bhavan, we will have to make it full-fledged hospital for childcare. Second question that you have raised about anaemia, 53 percent women in the rural areas suffer from anaemia. It is a very challenging situation. Now, under the Rural Health Mission (NRHM), we are trying to give some supplementary to the women and children and also under Integrated Child Development Services (ICDS), we are trying to provide nutritious food to the pre-primary and primary school children. But you must understand that situation is so tight that it will take some time to control the problem.

Awareness about healthcare among tribal people is very low, what steps have you taken to bring more awareness? There are many reasons for less awareness about healthcare in tribal areas, superstition is one of them. Traditionally, tribal people have got some belief that has to be broken and appropriate awareness should be created among them. In the long past,

Health & Family Welfare The primary objective of the Department of Health & Family Welfare is to ensure adequate, qualitative, preventive and curative health care to people of the State. The main functions of the Department are as follows: • Ensure that resources for health are evenly distributed and that essential health services remain accessible to everyone. • To provide healthcare services to all particularly to the disadvantaged groups like scheduled tribes, scheduled castes & back ward classes. • Focus on affordable quality healthcare to the people of the State, not only through the allopathic systems of medicine but also through the homeopathic & ayurvedic systems. • Provide greater access to primary health care by bringing medical institutions as close to the people as possible or through mobile medical health units, particularly, in the underserved & backward districts. • Improve healthcare in the KBK districts of the State. • Eliminate diseases like polio & leprosy from the state & prevent as well as control other communicable diseases. • Reduce maternal, infant & neo-natal mortality rates. • To improve hospital services at the primary, secondary & tertiary levels. • Impart training to doctors, nurses and other paramedical staff to upgrade their skills & knowledge to improve quality healthcare in the state and improve medical education in the State.

“More than 6400 to 7000 newly born babies are dying annually due to heart attack in Odisha. The only remedy is surgical intervention, and unfortunately that is yet to be fully materialised” Central Government came up with a scheme intended to create awareness in tribal areas but it failed. We are trying to bring certain qualitative improvement in tribal areas by constructing hostel to accommodate tribal girls. Similarly, the stipend has been enhanced to three fold and also we are trying to put special health service centres in tribal areas. We are also working to provide safe drinking water to tribal people. We are trying lot of things, but it is such a complicated task that within a year or two, we may not be able to change everything. However will surely get positive results.

Technology is an important component of healthcare. Where do you see ICT in healthcare in Odisha? Technology is definitely an important component. In Odisha, we are implementing ICT system in our hospital to record the details such as number of patients, diseases they are suffering and type of treatment offered to them. We have created a separate website to provide this information. But I must say that ICT alone, at this moment may not serve the purpose because the people, who are the beneficiaries, are not adequately educated

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policy

and aware. So modern technology is really helpful but may not yield good results in tribal areas. Dedicated volunteers and honest salarlied employees with dedicated service will fetch better results.

For dedicated service, MBBS doctors are required but young doctors are reluctant to go to the rural areas. How will you achieve it? I agree with you that young doctors are reluctant to go to rural areas but that is happening due to lack of infrastructure in those areas. Now, under NRHM, our first priority is to eradicate the infrastructure deficiency. We are trying to provide basic necessities which are required for a doctor to live and serve in rural areas.

NGOs are very active in Odisha, but results are not very satisfactory. What is the way forward? Till the end of 6th Five Year Plan, we were entirely dependent on the government, but when it was found that government alone could not do it, a decision was taken that we should involve Non-Government Organisations (NGOs) in our development process so that there will be healthy competition. Today, in every forum there is NGOs and in a state like Odisha, there are 7500 NGOs, but I don’t find the sincerity of the service. There are multiple problems. In the long run, especially in healthcare, we are focusing on creating centre of excellence such as AIIMS to provide better healthcare to our people. Not only NGOs, the result of large number of central government policies are also not very satisfactory because people in the planning commission do not take into account the diversity of the State while formulating a policy. Work cultures, food habits, religious beliefs of tribal people are different from others. Thus, it is

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National Rural Health Mission (NRHM) NRHM aims is to provide effective healthcare to rural and urban population throughout the state with special focus on the backward districts with weak human development and health indicators especially among the poor and marginalised groups like women and the vulnerable sections of the society. Key initiatives of NHRM in Odisha are as follows: • Accredited Social Health Activist (ASHA) The ASHA is appointed to take steps to create awareness and provide information to the community on determinants of health such as nutrition, basic sanitation & hygiene practices, healthy living condition for working conditions, information on existing health services and timely utilization of health & family welfare services. • Mainstreaming AYUSH Mainstreaming of AYUSH in the health care service delivery system to strengthen the existing public health system. • Formation of Rogi Kalyan Samities Rogi Kalyan Samiti is a management structure, which is a registered society, acting as a group of trustees for CHC/ hospitals/ to manage the affairs of the hospitals. • Mobile Medical Unit Mobile Medical Units have been envisaged to provide preventive, promotive and curative health care in inaccessible areas and difficult terrains, which are underserved or unserved areas under usual circumstances. • Strengthening PHC/CHC/UGPHC to Indian Public Health Standards To provide optimal expert care to the community and to achieve and maintain an acceptable standard quality care in terms of assured services to make the services more responsive and sensitive to the needs of the community. • Untied funds to Sub-Centers The aim is to increase functional, administrative and financial resources and autonomy to the field units.

very tough to implement the policy with mandatory guidelines. Out of 60 tribal species, 42 types live in district of Kalahandi-BalangirKoraput (KBK) alone, there way of life is not identical. So without considering these factors, if you formulate a project, it will not be very fruitful. Therefore, we have to respect the diversity of India and that was imagined by late Biju Patnaik.

Few institutes of national importance have come up in Bhubaneswar, how happy are you with them? I am happy with the establishment of

institutes of national importance in Odisha and I believe change will definitely come but may not be of desired extent due to peculiar situation. For example, in 1991 census, total population was 3 crore 90 lakhs, in 2011 census, the population has gone upto, 4 crore 16 lakhs. In 1991, the representation of tribal population was 24 percent but in 2011 census it has gone down to 22 percent whereas general population has increased in the tune of one crore. It is a serious problem; therefore, we have to give special attention to tribal welfare. I am sure institute such as AIIMS, IIT, IIM will bring welfare in the society.

cover story

Health IT Special Coverage

Understanding

Health IT Benefits is Crucial When serving healthcare to countryâ&#x20AC;&#x2122;s 1.2 billion people is real challenge, the Health IT services can be a real game changer Sharmila Das, ENN

ealthcare IT market is demarcated into two segments of buyer and the provider. The provider market in India is highly fragmented. Experts say around 94 percent is unorganised and dominated largely by small/midsized IT providers. Moreover, IT uptake is limited to custom developed software for usages like billing and patient scheduling. Having said, there are instances of using complete HMIS in medical institutions too. A few institutions are also using Electronic Medical Records (EMR), Radio Information System (RIS), Picture Archiving Communication System (PACS) tools. The benefits even extend to alert patients by sending Short Messaging Services (SMS) reminding them about their next medical checkups and so on. IT allows healthcare providers to collect, store, retrieve, and transfer information electronically and also helps in sustaining point-of-care delivery at low

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costs and in less time. It is continuing to digitise the healthcare system. Vasukumar Nair, Director, 21st Century Informatics says, “The good signs are that the budget allocation for healthcare in the GDP is rising and that the healthcare market is growing at a rate of 18 to 20 percent. When it comes to healthcare IT market, apart from existing institutions and their expansion projects, green field projects too have shown an equivalent growth. But the current healthcare IT opportunities are so huge that even existing hospitals have a lot of market opportunity”. Karthik Tirupathi, CEO, Napier Healthcare Solutions says, “Various research studies have highlighted India as the fastest growing healthcare IT market in Asia worth more than USD 609 million in 2013. In a price sensitive market where affordability is paramount, annual IT spending is estimated to be at USD 191 million and we can expect it to reach over USD 1.5 billion by 2020 growing at a rate of 25 percent each year”. Research says the provider market for healthcare IT is the fastest-growing market with the highest revenue generated from the applications of clinical information systems, such as integrated solutions of EHR, PACS, CPOE, and RIS. Amongst these, integrated EHR is the fastest-growing segment due to the financial support provided by the Health Insurance Portability and Accountability Act (HIPPA) act.

Upcoming trends Cloud Computing has emerged as a silver-lining model for the healthcare IT industry. It enables the management and migration of huge amount of data, saves costs, offers anytime access from multiple mobile devices, provides high availability for large backup data storage, and is easy to use. Cloud Computing is offered as a private Cloud, public Cloud, and hybrid Cloud. Each model has its own

“A meaningful use of EHR will be the trend of 2013. The healthcare industry is three years into meaningful use, an ambitious incentive program to convince hospitals and private practices to use HER software. NABH is bringing standards and strengthening them with amendments. The rule of protecting patient data, into the 21st century becomes essential. The same goes for telemedicine. On top of that, healthcare finally seems ready to benefit from big data, cloud services and other disruptive technologies that have dramatically changed other vertical industries”.

“In the overall IT enterprise spend, healthcare is a vertical and honestly it’s not a big vertical at the moment. While the growth rates are higher, the sheer volume of contribution is slightly lower. Health IT vertical is 3-4 percent of total IT market, which is not great. There are about 500 companies in India in the private enterprise space, which have a turnover in excess of `1,250 crore. Among these, hardly ten healthcare organisations would feature in this. Actual base and size of this segment is smaller, however growth pace is much much higher”. Alok Anand, Head – Marketing, India & SAARC, Polycom

Haji Mazhar Pasha, President and Managing Director, Netripples Software Group advantages and disadvantages. However, in terms of security, public cloud computing services are preferred by the healthcare industry in order to be HIPPA compliant.

Growth drivers The growth has been majorly attributed to developments like-rising incomes, easier access to high quality healthcare facilities, greater awareness about personal health and hygiene, favorable government policies and greater penetration of health insurance etc. Also Internet penetra-

tion has increased remarkably giving an impetuous to online healthcare. All these factors directly and indirectly have been giving good reasons to the hospital/clinic administrators to use Health IT more aggressively.

Perspective from Health IT Thought Leaders Yao Weimin, VP-Corporate Affairs, Huawei India says, “The Indian healthcare industry, which comprises hospitals, medical infrastructure, medical devices, clinical trials, outsourcing, telemedicine, health insur-

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cover story

Health IT Special Coverage

“The good signs are that the budget allocation for healthcare in the GDP is rising and that the healthcare market is growing at a rate of 18 to 20 percent. When it comes to healthcare IT market, apart from existing institutions and their expansion projects, green field projects too have shown an equivalent growth. But the current healthcare IT opportunities are so huge that even existing hospitals have a lot of market opportunity”. Vasukumar Nair, Director, 21st Century Informatics “When it comes to Process Automation and Digitisation, the market is nascent in India at this point of time. However, some of the leading hospital chains are already engaging with us, as leaders driving Healthcare Automation using Enterprise Content Management (ECM) and Business Process Management (BPM) to streamline their operations, build competitive advantage, and drastically reduce cost of service.” Diwakar Nigam, Managing Director, Newgen Software Technologies Ltd ance and medical equipment, was valued at USD 79 billion in 2012, and is expected to reach USD160 billion by 2017. As per 2012 statistics, TechNavio’s analysts forecasted the Global Healthcare IT market to grow at a CAGR of 5.3 percent over the period 2012-2016. In the past few years India has made commendable progress in terms of leveraging healthcare IT in order to ensure healthcare access for otherwise inaccessible segments of the population”. Alok Anand, Head – Marketing, India & SAARC, Polycom, says, “In the overall IT enterprise spend, healthcare is a vertical and honestly it’s not a big vertical at the moment. While the growth rates are higher, the sheer volume of contribution is slightly lower. Health IT vertical is 3-4 percent of total IT market, which is not great. There are about 500 companies in India in the private enterprise space,

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which have a turnover in excess of `1,250 crore. Among these, hardly ten healthcare organisations would feature in this. Actual base and size of this segment is smaller, however growth pace is much much higher.” Diwakar Nigam, Managing Director, Newgen Software Technologies Ltd says, “When it comes to Process Automation and Digitisation, the market is nascent in India at this point of time. However, some of the leading hospital chains are already engaging with us, as leaders driving Healthcare Automation using Enterprise Content Management (ECM) and Business Process Management (BPM) to streamline their operations, build competitive advantage, and drastically reduce cost of service. The opportunity for IT led transformation is huge, but the challenges faced by the Indian healthcare industry, comprising of healthcare provid-

ers, payers, pharmaceuticals, and medical equipment manufacturers, are unique. In the coming years we expect huge traction from the Indian Healthcare industry.” Haji Mazhar Pasha, President and Managing Director, Netripples Software Group says, “A meaningful use of EHR will be the trend of 2013. The healthcare industry is three years into meaningful use, an ambitious incentive program to convince hospitals and private practices to use HER software. NABH is bringing standards and strengthening them with amendments. The rule of protecting patient data, into the 21st century becomes essential. The same goes for telemedicine. On top of that, healthcare finally seems ready to benefit from big data, cloud services and other disruptive technologies that have dramatically changed other vertical industries”.

Challenges for Health IT providers Market forces are changing the landscape of Health IT. The market for proprietary patient health record systems is growing and consolidating. Competition is increasing. The separate roles of developers, vendors and integrators are merging. These commercial efforts may help establish de facto standards for security, portability and interoperability. However, challenges for Indian Health IT providers are decade old- to deal with the mindset of caregivers where IT seen as an extra expense and not an enabler.

Conclusion Indian healthcare is a story of paradoxes. In one side, we have highly developed multi & super specialty hospitals; on the other we have villages and semi urban villages deprived of basic healthcare services. In this context of disparity in accessing healthcare, IT that includes mHealth, telemedicine can play a bigger role.

The second issue of the most awaited e-Radiograph is here! The overwhelming response received for the first issue of e-Radiograph has been an extremely satisfying experience for us. Thank you! The second issue, focuses on yet another critical topic â&#x20AC;&#x153;Imaging of Degenerative Diseases of Lumbosacral Spineâ&#x20AC;?, along with illustrative case studies which involves certain imaging challenges.

The second issue is ready for you now! Topic: Imaging of Degenerative Diseases of Lumbosacral Spine Guest author: Dr. Rammohan Vadapalli, MD

IMAGING OF LUMBOSACRAL SPINE DEGENERATION

cover story

Health IT Special Coverage

‘IT Reduces Cost of Cure ’

‘With a maturing private healthcare sector, hospital chains have become the primary consumers of healthcare IT solutions,”says Pankaj Vaish, CEO, HealthFore Technologies earlier known as Religare Technologies. In conversation with Sharmila Das, ENN What are your views on the current market scenario of Indian health IT? Health IT can help overcome several challenges that are facing the healthcare sector today like accessibility, portability, affordability, awareness but one of the biggest advantages it offers is enabling patient-centered coordinated care. The use of systems like ERP/ HIS/ EMR can significantly improve the operational and clinical efficiencies of hospitals. The past few years, have witnesssd an emerging trend of healthcare organisations enhancing their budget allocations on IT investments beyond traditional limits of one percent of their budgets. IT sector in India is gradually moving to public hospital setups utilising external funding (eg World Bank, IFC, PPP models, etc) to enable this. One is also seeing the Ministry of Health & Family Welfare at the centre working with organisations like FICCI to roll out country-wide standards for EMR and EHR. Privatisation of health insurance will be another driver to increase adoption of health IT in India.

How will privatisation of medical insurance trigger more IT adoption? Kindly explain. Health insurance in India is at a dismally low level. Eighty percent of the

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patients pay the cost for treatment out of their pocket expenses, and only three percent are covered through private health insurers. As medical insurance coverage expands,the payer organisations start to play an important role in the system, which is absent right now. Once people have health coverage they can deal with any kind of medical issue without directly having to worrying about the payment for treatment. The payer organisation on the other hand, will have to ensure that claims being paid out are for the right treatment and at the right price. Hospitals will be forced to look for IT systems to ensure correct clinical

identified medical problems. An integrated IT application that covers clinical and clinical support systems can help deliver care that is safe, efficient, cost effective and timely.

Why do you think the healthcare industry is a complex one? Healthcare is not a traditional system that has a hierarchical structure. It is a complex adaptive system. It has a complexity which is next to the telecom industry, probably even more so because of the enormity of the medical field, continuous changes in treatments, medicines & procedures, and unique requirements around data

‘Without integrated IT systems in place, treatments become more expensive and time consuming, while quality of healthcare services suffer too’ procedures and patient records, fees and billing details and timely claims settlement. Furthermore, with payer mandated capitated payments, hospitals will be driven to look at innovative methods to increase productivity of their assets and operations, where again the role IT comes in as a business enabler. IT has the capability to implement systems to enable validation of a clinician’s advice or prescription against

security, privacy & trust. Healthcare has multiple independent stakeholders, each acting with their own selfinterest. So, there is no single entity that is ultimately in-charge. IT has the challenge to ensure that various sub-systems within a healthcare setup talk to each other and remove the layer of additional burden or the adverse benefits that have been driven by various stakeholders. The current system is driven by per-

What kind of solutions do you provide to the healthcare sector in India?

pankaj vaish Solutions at a glance • • • • •

Magnum Infinity HIS is a web-based Hospital Information System for managing the workflow processes across the multi-site healthcare enterprise. Magnum Infinity PACS is a cloud-enabled, enterprise class PACS, offering a comprehensive solution for digital imaging. Mediphone service, launched in partnership with Airtel, provides 24X7 medical advices to Airtel mobile subscribers, giving them the ability to consult a doctor on demand, over the phone from anywhere, at any time. Medi-Consult platform, we offer corporates and health providers, extension of the “doctor on call” service to their users and patients. The infrastructure business lines offer customers managed IT services from networking to complete data centre management.

verse incentives where the approach, is to maximise patient visits and tests ordered. In the US where healthcare is the most advanced, it is estimated

that all this leads to 30 percent wasteful spending to the tune of USD 765 billion of USD 2.5 trillion total healthcare spend per year.

HealthFore Technologies has three broad business lines – the Products business, the mHealth business and the Supporting Managed Infrastructure business. Magnum Infinity HIS is a webbased Hospital Information System for managing the workflow processes across the multi-site healthcare enterprise.It is an integrated platform that has an administration subsystem for patient scheduling, admit, discharge and transfer (ADT), billing subsystem for invoicing and claims management, clinical subsystem for clinical charting, computerised physician order entry (CPOE) and result management, clinical support subsystem for lab, radiology, pharmacy and OT operations, and a comprehensive back office subsystem for inventory & procurement management and financial accounting. Magnum Infinity PACS is a cloud-enabled, enterprise class PACS, offering a comprehensive solution for digital imaging. The mHealth business provides health and wellness solutions, to providers, corporates, health aggregators and consumers, using innovative combination of IT and telecommunications, with traditional medical care. These solutions are offered over telephony and Internet channels maximising their availability and affordability.Our Mediphone service, launched in partnership with Airtel, provides 24X7 medical advices to Airtel mobile subscribers. With the Medi-Consult platform, we offer corporates and health providers, extension of the “doctor on call” service to their users and patients. With Medi-Consult, our partner in the insurance space is able to provide unique and round the clock medical offerings to its policy holders. The Chronic Disease Management (CDM) solutions are working for health providers to help their patients better manage chronic and lifestyle ailments.

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cover story

Health IT Special Health IT Coverage

Bringng Parity in Healthcare Costs

Gopal Verma, Chairman, E-Meditek Global Private Limited, has recently come up with a health card, named ‘Medicash Plus’ that does away with negotiating at doctors’ clinics. In Conversation with Sharmila Das, ENN Tell us about your newly launched Medicash Plus. What kind of benefits would it offer to end consumers? Today with high interest and high inflation rates not every individual is able to generate household savings. But every family has some amount of health related expenses every month that can be estimated at around 17 percent, which is very huge. Any amount incurred on health and fitness also ensures your continued healthiness which ultimately amount to your productivity and consistency at work. Therefore we identified ways on how we can reduce this 17 percent.

‘The special card swap machine which is called Point- of- Sale Terminal in banking language has been loaded with a speed application which while swapping ensures that only agreed tariffs and discounts are charged from the customer’ Our research says Indian healthcare is not so organised and regulated. Consequently the service pricing differs for various reason, from provider to provider, from doctor to doctor, without any considerable and acceptable parameter. For a layman it is very difficult to find out if the doctor is charging appropriate fee or not. Secondly, the profession of medical service is such that asking a discount is not in practice. We have targeted our product towards lower middle class. Additionally, we have identified good practice doctors, diagnostic centers, pharmacies, dentists etc, and entered a special pricing for our cardholders. Under this special pricing, all

Gopal Verma

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these providers have also agreed to offer discount which ranges between 7-40 percent. So the entire system and process has been designed in a way that our card-holder does not have to ask for discount. The special card swap machine which is called Point- ofSale Terminal in banking language has been loaded with a speed application which while swapping ensures that only agreed tariffs and discounts are charged from the customer.

Have you associated with any hospital for this product? Hospitals have been consulted for offering discounted doctor consultation services. The product we have launched covers both hospitals and private clinics. The hospitals we have talked to have agreed to offer discount on OPD consultations and OPD services just like a private clinic of an individual doctor or polyclinic where multi purposes doctors come and practices.

You have mentioned the card offers automatic discount between 7-40 percent. How does this happen? Take an example of a doctor; if his fee is `500 and he has agreed for 25 percent discount, customer just needs to offer the card for `500. Let the doctor swap for `500 and my system will calculate his discount and will generate the recipient the net amount. So it’s a hassle free process which does away with negotiating and asking for discount. My system will work and give credit instantly.

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Health IT Special Coverage

Agent-less

Technology Ace Data Devices is the brainchild of two forward-looking IT professionals, Neeraj and Anuj Mediratta. Neeraj Mediratta, CEO, Ace Data says, “Ace came into being in 1995, long before the term ‘data storage’ was coined”. In conversation with Sharmila Das, ENN Neeraj Mediratta

How effective is your newly launched ‘Backup Vault’ that you have provided to Apollo Hospitals? Backup Vault is a data protection solution. Hospitals have various kinds of data. They have patient record data and applications, administrative records, internal mailing and many other allied applications which help in hospital administrative functions. The way our solution cut across is that, it is broad spectrum solution that helps handling in the databases, application, user data, patient record etc. It’s a single solution which takes care of all kinds of data. It comes as a package which is a capacity based usage. For example if they have 10 terabyte of data they pay for the size of data they have. Another unique feature of the solution is that it is an agent less technology. Unlike the other backup technology available in the market they have modules. However, our solution has a very neat deployment, regardless of what kind of data it is, what volume of data it is, it runs for everything and in a hospital environ-

ment this solution works because the rate of change of data is very frequent in that situation it needs a protection system. The solution we provide helps to save the change in every three minutes which makes the solution reliable and effective.

Apart from this particular solution what other solutions do you have for data storage for Indian Healthcare? We are basically into data storage. There are solutions which concentrate on data protection like ‘Backup Vault’ solution, and others are hardcore solutions which keep the data on premise and then there are archival solutions for long time storage. In hospitals it is important to keep records for a longer term.

Do you provide any kind of training to the hospitals where your solution is deployed? Yes. When we deploy this solution we do provide training and along with that, within the solution we do offer 24 x 7 remote monitoring and onsite sup-

port. It comes as a package and the entire ownership belongs to us.

In data storage, what kind of technology do you have to secure data as for hospitals it is very important to secure data? The solution we have is compliant to global standards and comes with a security standard of 140 to 250 with inscriptions. So the moment the data leaves the user it gets in scripted and is secured in amongst the best standard available globally and that’s a part of the solution.

How has been the response of the solution in the health market? What is your opinion about the data storage market of healthcare? The response has been good, but as this is a new way to handle technology the adaption is going to take time. It’s about a year now that we have introduced it and for us healthcare is not the only industries we work with. We have media, real estate, corporate but if you see the market itself data is growing double every two years now.

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Health IT Special Coverage

The Rise of Hospital

Information System The medical fraternity is working towards the adoption of technology driven management solutions. Srinath Bettadpur, CEO, Spigot Software, gives insight on the changing attitudnal shift among professionals to Sruti Ghosal, ENN Srinath Bettadpur

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Give us an overview of the work that Spigot Software is doing in the healthcare domain. Spigot Software’s main focus is on IT in healthcare. We focus on providing software products for the healthcare industry (clinics, polyclinics, nursing homes, and diagnostic centres, small and big hospitals) with a wide range of product offerings which help to increase the efficiency, productivity and accuracy of information and also realtime provisioning of information to the management for effective decision making.

According to you how has HIS simplified healthcare delivery in India? In India, the trend of using HIS for broad based need is picking up and healthcare providers are appreciating the benefits one would reap by effectively using the HIS in their systems. Also, in the near future more and more healthcare institutions will actually adopt the automation of healthcare processes. So we have rightly positioned ourselves in this spectrum and want to provide a full-fledged Hospital InformationManagement System. As a matter of fact, there are not too many strict guidelines or strict legislations where it is mandatory for the hospitals or the healthcare units to mandatorily use an HIS software. Even if there are few guidelines or legislation, enforcement on the usage of software is not there. Once this aspect is mandated by the government, the HIS/HMS market will grow much more rapidly than the others.

How important is Cloud Computing in today’s market ? Are you coming up come with any software pertaining to this? Cloud Computing is important and it is the newest emerging trend in technology, which at any point of time will be the biggest thing for the healthcare industry. However, there are certain points which should be kept in mind.

Healthcare IT in India is still at its inception level, so adoption of Cloud may take some more time. People still believe in the traditional concept of having complete control on their own IT infrastructure (including hard-

“There may be still a notion among healthcare personnel that automated systems may not directly benefit their core business and probably slow down their productivity. Indian healthcare IT market is still not mature, the pricing also remains a very big challenge” ware, software and networking) and prefer it to be on their own premises. By the very nature, using Cloud raises to suspicion from the users about the level of security that a cloud service provider can offer. However, definitely in the coming years cloud will see popularity and the industry, if not going for public Cloud will definitely go for private Cloud.

IT literacy is one of the biggest challenges in India. What are the challenges that you have faced while approaching the companies? The healthcare personnel are highly technosavvy and prefer to use tech-

nology that helps them in their core business. However, with regard to use of automation software or a management information system, still there is a long way to go. There may be still a notion side of healthcare personnel that these automated systems may not directly benefit their core business and probably slow down their productivity. It’s not that literacy is not there, healthcare professionals are aware of the IT automation software (including HIS), however they still doubt whether the use of such an automation system will cut their productivity. This is one of the challenges that every healthcare IT service provider need to work on if one has to be successful in the industry. The second biggest challenge is, since Indian healthcare IT market is still not mature, the pricing also remains a very big challenge. It takes some more time for a high quality HIS/HMS product to be sold at a price it deserves and it has still some way to go there to reach a level of understanding on the right pricing for these products.

What are your future plans of expansion? Core idea into the future is to stick on to whatever good things we are doing on the HIS/HMS software product front. Add more modules into the current HIS/HMS product suite and make our product an allencompassing software product suite that cuts across all aspects of hospital management. Another goal is to ensure that our software products becomes more patient centric and help the public to get all the benefits of an automation system to help them take right decisions at the right time in realtime. We want to be a definite leader on the Cloud environment and mobile space. We have already got modules in the mobile space and our plan is to add more in that area.

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HMIS has Enabled Proactive

Public Health Management Ashok Tiwari, Chairman and Managing Director, Vayam Technologies Ltd, talks to Monalisa, ENN, about the second phase of HMIS Project and role of IT in Public Healthcare

country with more than 1.27 billion population calls for a robust public healthcare mechanism, which is crucial for nation building. The fact that nearly 68 percent of the population reside in rural India makes it a herculean task by all measures. While sustained efforts by policy makers, officials, healthcare providers and field coordinators are continuing, it all boils down to the crucial link of information and data analytics. Aimed with monitoring and evaluating the physical and financial performances of its health programmes, National Rural Health Mission (NRHM), under the Ministry of Health & Family Welfare had launched Health Management Information Portal in 2009 in collaboration with Vayam Technologies Ltd. The portal uses web-based Health Management Information System (HMIS) interface and generates periodic reports on the status of various important health indicators of the health sector. Currently in its fifth year of implementation, HMIS is gearing up to for its second phase. In the last five years, HMIS has facilitated quick and efficient flow of information starting from the Facility-level, up to District, State and the Centre.

Phased manner

Ashok tiwari

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â&#x20AC;&#x153;HMIS has enabled the policy makers to monitor the important health indicators like IMR, MMR, and Immunisation, etc in a better way, adopting a proactive approach in handlingthe delivery of health services using HMIS data. When you have access to real-time data and also have tools for data analysis, you

can plan in advance,” says Ashok Tiwari, Chairman and Managing Director, Vayam Technologies Ltd. Earlier manual systems were used to record health records in hard copieswhich posed their own challenges such as time lag and manual errors. The project was rolled out in a phased manner, with pilot done on selected districts. “The first step was to rationalise the data formats, remove duplication and freeze the formats. After that we developed the software that was hosted and then rolled out to district level. We monitored it for a year, after which we launched it across the nation,” says Kapil Tyagi, Associate Vice President,Vayam Technologies Ltd. “Over the years we have upgraded the application so that now it can be implemented to the SubDistrict and Facility Levels as well. Today most states are reporting the data to the Facility Level,” he adds.

Mindset change Looking back at the journey, Ashok Tiwari recalls (the) many roadblocks that the project had to face. “Change man-

Data Analysis Matters The real power of collated data is unleashed only when it is accurately analysed. Data Warehouse and Business Intelligence (DWBI) is a part of HMIS which is used by key decision makers. Although the Minsitry has been using DWBI from the beginning, the second phase shall empower the State Health Departments with this tool. “In order to analyse the impact of a particular scheme, you need data from primary as well as secondary sources. Primary data gives wisdom to react in the situation, whereas secondary data gives additional information needed for analysis and data triangulation” explains Kapil Tyagi, Associate Vice President,Vayam Technologies Ltd.

practically coming to them on a realtime basis. That’s a big empowerment which has happened,” says the CMD. “Manpower training is now a crucial aspect of our services. As solution integrator, we not only help implement

“We are now upgrading the licenses that will give the State Health Departments access to Data Analytics tools. Also, Phase II will see adoption of Geographic Information System,” agement is always a challenge. There were issues of adoption of technology at lower level, connectivity, bandwidth, etc. Also priorities were an issue. recalls the CMD. “The real adoption of technology comes only when people realise that it is actually empowering them with the information on time. In NRHM, the realisation has come now. People have realised that the information that was earlier coming to them had a lot of missing links, but now it’s

an IT solution but also ensure that the application is utilised in its true spirit,” he adds.

Second innings The first phase really helped the government officials to finalise their data formats. Vayam Technologies is now working with NRHM on the second phase of HMIS which is likely to be rolled out shortly. “We are now upgrading the platform that will give the State Health Departments access to Data

A system is needed whereby data from different silos – those residing in your system and even those outside – can be put in a warehouse. A single repository or data layer is created for the middle or top management to interact and do the analysis. “Once this layer is prepared, DWBI tools can be implemented to generate , Standard Reporting as well as Ad Hoc Reporting. It also has Drill Down Capability, whereby one can dig deeper into details from the Centre Level to the Facility Level. DWBI also enables the user to apply statistics on the data, in case one wants to do forecasting or predict trends,” says Tyagi.

Analytics tools of HMIS that were till now residing only with the Central Ministry,” informs the CMD. Earlier, states were reporting data and the center was publishing analytical reports “Moreover, Phase II will see implementation of GIS, so that the data will be available to the management for spatial analysis as well,” he adds. “Though some amount of analytics was introduced in the first phase, you will see much more refined outcome of analytics in this second phase. Data analytics was always there. But once you create a layer of GIS, then the look and feel of the analysed information is far more user-friendly. It builds additional information, which is perceptible and that makes all the difference,” says the CMD. The pace of growth of Health IT in rural healthcare is not as it should be, but it is definitely growing. “The best thing is that with field data capture, the rural masses are made aware of their rights and entitlements. This awareness is an effective tool of empowering them and that itself becomes a catalyst for change,” says the CMD.

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Visual Collaboration Can Revamp Healthcare With eight of the top 10 US hospitals and 13 leading pharma companies using its solutions, Polycom is transforming the way organisations teach and deliver healthcare globally. Alok Anand, Head – Marketing, India & SAARC, Polycom, talks to Monalisa, ENN, about the scenario in India Give us an overview of the solutions offered by Polycom for the healthcare sector? Our focus lies in visual collaboration that enables the healthcare community to support patient centered care and remote consultations, independent of geographic locations. Two of our leading solutions are RealPres-

ence Experience (RPX) – which offers the experience of real-life, faceto-face interaction in an all-inclusive video wall – and Open Telepresence Experience (OTX) – which offers vibrant video, audio and content collaboration in an immersive environment. Image quality is absolutely nonnegotiable in healthcare. Therefore, we have systems which are high definition using less bandwidth, have high speed and are specifically designed to zoom into details.

While major hospitals and pharma companies are deploying your solutions worldwide, what is the scenario in India?

Alok Anand

Most private and large hospitals in India are choosing teleconferencing solutions, but for generic applications, such as general meetings, collabora-

An early adopter Global pharmaceutical company, Dr Reddy’s Laboratories recently deployed Polycom Solutions to accelerate drug development and time to market. These include: • Two Polycom RPX solutions at corporate centres in Hyderabad (India) and Bridgewater (New Jersey, USA) to display samples of drugs and generics for real-time inspections with FDA officials, product reviews with co-workers and sample showcases for buyers • Polycom RealPresence Mobile video solution enables its executives to join critical internal meetings from anywhere while on the move.

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tions and administration purposes. They are not yet deploying them for telemedicine or delivery of healthcare services. The demand and usability for telemedicine solutions still need to be generated. And this is mainly because it’s a new concept that requires change of mindset. Moreover, hospitals do not have large IT departments and their initial focus on technology is getting the equipments in place. Actual utilisation of core technology comes much later.

But do you see any scope for change? Definitely. There is need for video collaboration – both in government as well as private hospitals. Government hospitals focus on serving large number of patients with limited infrastructure and resources. On the other hand, private hospitals aspire to reach out to patients beyond geography and boundaries and utilise their specialists more. In both the cases, the answer lies in videoconference solutions. It offers a big scope for medical tourism too. Pre-procedure consultation and post procedure care and follow-up can be handled through video collaboration, thus ensuring continuity in healthcare for overseas patients. Video is a great alternative in times of crisis.

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Technology that Pays Well As health insurance policies are becoming complex, the job of payer organisations is getting tougher. Diwakar Nigam, Managing Director, Newgen Software Technologies Ltd, talks to Monalisa, ENN, about how solutions such as BPM and ECM can streamline operations and reduce costs Could you please share an overview of the Health IT market in India? Driven by the structural reforms introduced by the Government in the past few years, and recent developments in the private sector, the healthcare industry in India is evolving at a fast pace, and so are its technology requirements. When it comes to Process Automation and Digitisation, the market is nascent in India at this point of time. However, some of the leading hospital chains are already engaging with us, as leaders driving Healthcare Automation using Enterprise Content Management (ECM) and Business Process Management (BPM) to streamline their operations, build competitive advantage, and drastically reduce cost of service.

What kind of solutions is Newgen Software Technologies Ltd offering to the healthcare sector in India and abroad? We have built solutions for Healthcare Payers â&#x20AC;&#x201C; Health Insurance companies and Third Party Administrator (TPAs). These include Healthcare Provider Document Management and Hospital Process Automation; Healthcare Payer Processes Automation including Claims Repair, Appeals and Grievances, Enrollment Process, Complaint Tracking; and Provider Contract Management. Newgen has partnered with leading Indian and global healthcare organisations to transform healthcare operations. For example, one of the leading

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hospital chains has automated its Patients Records Management for bringing in efficiencies and better customer service. Similarly, we are engaging with several other leading healthcare organisations for end-to-end automation of their key processes, including customer on-boarding, medical case management, billing and discharge processes, and so on.

In what ways are you gearing up to meet the new market requirements? Integrating technology enablers such as Cloud, social, mobile, and analytics into our offerings, we are prepared with our stack of solutions, to facilitate the evolution of the Indian Healthcare sector.

Our BPM solutions take care of every aspect of operations of payer organisations, starting with policy issuing to keeping track of claims, tests and medical procedures and processing of claims

diwakar nigam

We have made available our ECM and BPM solutions on the Cloud platform, allowing healthcare organisations to tap the advantages of a hosted infrastructure, such as the ability to quickly ramp up the scale of operations without huge capital expenses, especially at a time when the Indian Healthcare market is poised for rapid growth.

How do you perceive the growth trajectory of Newgen Software Technologies Ltd in the coming years? Newgen registered a 33 percent growth in revenues in fiscal year 2012-2013, with India contributing a major 33 percent of the total revenues. In the coming years we expect the momentum to continue, with over 30 percent growth YOY.

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Cloud is Acting as a

Game Changer

Calsoft Labs has been actively working in the healthcare sector for the last ten years. Somenath Nag, Director - Business Development & Marketing, Calsoft Labs, interacts with Sruti Ghosal, ENN, about the journey so far Give us an overview of the work Calsoft Labs is doing in the Indian healthcare sector. Calsoft Labs is a part of the ALTEN Group which is focused on product engineering services. In the healthcare sector, its main contribution is through technology solutions. Calsoft Labs has two wings – software engineering and embedded engineering. Calsoft Labs has been actively working in healthcare sector for the last ten years.

How would you measure the significance of Cloud Computing in the Pharma Industry? There are two parts in the Pharma Industry – research & development and production after the research is done. Today Cloud Computing can help both the areas in a major way. Huge amount of data is involved in research and development. Even for production, multiple clinical trials are done, involving varied data. In order to manage such data, the Pharma Industry requires a sophisticated Laboratory Management System. Cloud Computing has proved to be beneficial in every manner. Many Pharma companies have now gone paperless, thanks to Cloud. It is costeffective as one doesn’t need to spend too much on IT infrastructure. Moreover, the Pharma Industry is governed by many regulations and deals with multiple data which have to be stored

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Somenath Nag

Cloud Computing has enabled many pharma companies to go paperless. It’s cost-effective too as one doesn’t need to spend too much on IT infrastructure properly. Cloud can help address this issue too.

What technological innovations are you planning to bring in the healthcare space? Currently, the Indian Healthcare sec-

tor faces the challenges of accessibility, infrastructure and quality. We need technology to overcome these problems. The healthcare system in the USA is 50 years ahead of the Indian healthcare system. Our main focus lies on new technologies such as Cloud Computing. We are providing the hospitals with technology that will help them store patient records on Cloud. In terms of accessibility, there are Primary Healthcare Centres (PHCs) which don’t have a specialist. If they have a telemedicine facility on their tablet, delivery of quality healthcare will take a giant leap. So Calsoft Labs is trying to tackle mobility and connectivity issues through Cloud Computing. Our main objective is to implement the learnings from developed nation into India and help healthcare providers improve the quality of healthcare.

What are some salient features that give Calsoft Labs an edge over its peers? There are a couple of areas that differentiate us from the other companies We bring in our best practices and learnings from the advanced nations and built products which are very specific to the Indian healthcare market. We are among the very few companies who actually work from Chip to Cloud. Not many companies who are working in the deliverance of software services in healthcare sector will actually be able to do that.

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Cloud based HIS, Revolutionising

Indian Healthcare

Focused on healthcare domain for the past 18 years, Akhil Systems has around 150+ hospitals and medical colleges projects (with hospitals ranging from 20 beds up to 1,800 beds) running across India and worldwide. Rekha Takkar, Director, Akhil Systems, in conversation with ENN What kind of positive impact in healthcare IT sector growth has on the healthcare delivery segment? An active adoption of IT solutions is crucial to making healthcare delivery more patients centric and efficient. IT is expected to play a major role in helping healthcare service providers overcome future challenges as well as in meeting the needs of their information-dependent industry. The positive impacts on the healthcare delivery segments are: • Interconnection between multiple facilities • Improving the workflow of the hospitals • Boosts revenue of hospitals • Paperless workflow

Rekha Takkar

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• Bridge India’s rural-urban users equally • Delivering timely information to care providers • Provides analytics for more effective and efficient care to each patient The innumerous existing factors that impacts the Indianhealthcare industry; four primary and vital factors are found to play major roles and are hierarchically arranged as Financial outcomes ,Workflow efficiency ,Decision making , Patient Safety.

What kind of business process solutions do you offer for hospitals and physician practice groups? We provide following healthcare products for different segments on Client Server and Web Based platform like: Care Enterprise HIS, Miracle HIS, PACS MIRACLE EMR: This is a Webbased solution designed for complete automation of a single Clinic with Single Specialty, Multispecialty Polyclinic and Chain of Clinics. This product is also CCHIT (USA) certified & meeting ARRA Guidelines and hosted on Cloud for USA Customers. Patient Clinical Information is also available on Patient Portal which can be accessed by the Patient or Doctor from anywhere anytime. This can be integrated with Hospital Information System also if required by any of the hospital. It has inbuilt templates for over 50 specialties. Care LIS/RIS: Designed for complete automation Single LAB and

Chain of Laboratories & Radiology Centers. The application will also offer interfaces with Lab Machines, Barcode, and PACS for online viewing of Radiology Images on the Doctors Computers. It can generate variousstatistical reports and Turn-around Time (TAT) report. It has user-defined result templates.

What are your business plans for India? What opportunities you foresee of the Indian healthcare IT sector? Akhil Systems has launched new webbased EMR and HIS solution which is completely internet-based and is hosted on cloud computing. This provides flexibility of accessing the software anywhere and at any time. Akhil Systems has gone up a next level by developing add-on modules such as Web-based Electronic Medical Records, Patient Portal, SMS/Email Connectivity, Online Lab results, and coming up very soon with Mobile Device Interface. Inspired by our previous partnership with Enabledoc (USA) to whom we have provided our EMR which is running successfully in more than 30 clinics in US, we have launched our EMR solution in India as well for doctors. Also, we are planning our HIS to be hosted on cloud. It will be on SaaS model and be available on nominal monthly rental. This will revolutionise the Indian healthcare scenario.

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IT Adoption is on Rise Narendra Nayak, Director & Account General Manager, CSC India, says newer hospitals are keen to adopt world class enterprise IT solutions. In conversation with Sharmila Das, ENN How the Indian Health IT market is growing and in what percentage? What is the current market size? At CSC, we are witnessing fast organic and inorganic growth in the Indian healthcare. There is an increasing need for matured integrated Hospital Information Systems (HIS) that include best international practices for Indian hospitals that are growing at a fast pace. Currently the Indian Health IT market is fragmented with offerings from smaller to medium players and a few enterprise players. But this is changing with newer hospitals that want to set up world class enterprise IT solutions from day one of their operations with integrated ERP and HIS systems. Health IT adoption in Asia-Pacific region is moderate, with 18 percent of the global healthcare spending, but growing. Current healthcare and health IT spending in Asia-Pacific region is around USD 6B and is estimated to grow at 18 percent annually.

What are the components (like EHR/EMR/HIS etc) of Health IT in India? In the Indian health IT context, currently Hospital Information Systems (HIS) is the strongest segment that caters to at least 70 percent of the clinical automation needs for running the business. Most of small and medium sized hospitals in India are today focus on getting themselves a basic Patient Administration System (PAS) developed by a local vendor or developed in-house. These enable

Weakness: Low IT budgets, little or no regulation, cost pressures, lack of awareness, (in many cases) no CIO/ senior IT person in hospitals to drive initiatives.

What kind of solutions you provide to hospitals or to Indian healthcare?

Narendra Nayak

them to automate billing, ADT and departmental functions like laboratory, radiology, pharmacy etc. The clinical aspects of hospital automation are largely unavailable. The need for an HIS with an element of EMR for hospitals is felt under two circumstances, when the hospital grows and the basic application cannot handle the increased load or when a reputed entity comes up with a Greenfield project. EMR in India is currently more prevalent in large super-specialty hospitals like Medanta Medicity, Kokilaben Dhirubhai Ambani Hospitals, The Fortis Group etc.

What are the top five strengths and weaknesses of Indian Health IT? Kindly explain. Strengths: High growth, access to the best solutions available in the market, increase in the number of reputed business houses, corporate entities setting up state-of-the-art hospitals.

For over 35 years, CSC has been improving standards of patient care by providing innovative and cutting edge solutions for healthcare organisations globally. Our solution offerings for our healthcare customers to manage their hospital operations span across consulting and IT software, products & Services.

In providing solutions to hospitals and to others, what kind of challenges you face? What are your suggestions to improve it? Some of the main challenges are: lack of standards; change management; delays in setting up infrastructure; weak internal IT teams; lack of senior management focus; and user resistance. Unless there is complete conviction and sustained pressure from top management/ promoters, the Health IT adoption gets affected. We believe that hospitals need to engage with strong IT partners with significant healthcare focus, depth of knowledge and offering portfolio to help them to achieve the best solutions to their needs. End-to-end buying will also help them (HIS, ERP, Infra, all from the same provider) thereby preventing â&#x20AC;&#x2DC;blame-gameâ&#x20AC;&#x2122; scenarios.

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Simple and Integrated IT Solutions Vasukumar Nair, Director, 21st Century Informatics, gives a simple analogy by saying ‘How well you drive the car matters more than the model of car you have’. In conversation with Sharmila Das, ENN How the Indian health IT market is growing and by what percentage? There are many reports providing different numbers. All the reports convey a positive double digit growth for healthcare IT. The good signs are that the budget allocation for healthcare in the GDP is rising and that the healthcare market is growing

Vasukumar Nair

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at a rate of 18 to 20 percent. When it comes to healthcare IT market, apart from existing institutions and their expansion projects, green field projects too have shown an equivalent growth. But the current healthcare IT opportunities are so huge that even existing hospitals have a lot of market opportunity.

What kind of solutions do you provide to the healthcare sector in India? 21st Century Infomatics offers innovative healthcare informatics solutions for healthcare service providers such as hospitals, diagnostic centres and specialty clinics among others. Our products and solutions are simple, integrated and configurable healthcare process solutions. Our solution offerings include Healthcare Information System (HIS), Clinic Information System (CIS), Laboratory Information System (LIS), Advanced Imaging System and Electronic Medical Records (EMR). These solutions are process driven, professionally made with input from practicing clinicians and are open to make the

system ‘tailor-made’ for different sub-specialities.

In providing solutions to hospitals and to others, what kind of challenges you face? We find a portion of the market still considers healthcare informatics solutions as just another medical equipment purchase. The reason for this misconception is that it is often not easy to assess and measure the benefits of healthcare informatics solutions using clinical and diagnostic disciplines of automation. It is difficult to develop a strong business case necessary to attract a reasonable budget to procure a best-in-class product. Another factor is the poor track record of HIS/HMS vendors and the implementation issues. In addition, the challenges of fulfilling the ever-changing requirement scenario most often leave the users dissatisfied with the products offered and their applications. Many healthcare organisations face the challenge of data interoperability. Interoperability is essential as with DICOM, HL7, and other clinical standards. Our healthcare systems definitely require reliable and secured interoperable standards. We have observed that interoperability and data standardisation are the key areas to be covered in our solutions. Dearth of good talent in healthcare informatics in the provider space is also a challenge.

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Customised Solutions for

the Indian Healthcare Dr Cliff Bleustein, Director - Global Healthcare Consulting, Dell Services, who joined Dell in 2013, talks generously with Ekta Srivastava, ENN, about the emerging market of Healthcare IT and new developments The Healthcare IT sector in India is on a constant growth path. What kind of positive impact will this growth have on the healthcare delivery segment? Health IT in India over past five years has seen transformational change. Led by private players, IT is being adopted in an accelerated pace with government also catching up quite fast. We are also seeing government focus around Healthcare IT policy and guidelines, especially around EHR/EMR standards. Traditionally, Health IT adoption in India used to be more to do with telecommunications, hardware, networking, etc. That is changing now, with focus and interest shifted to adoption of a better and wider set of software. Currently, in 2013, Gartner estimates India Healthcare IT for physician and hospital market to be approximately USD 1 billion. If you also add healthcare payer and Life Sciences IT market, the number is about USD 1.7 billion. These numbers include hardware, internal services, software, IT services and telecommunications. The healthcare provider market is expected to grow at an accelerated pace in the years to come at upwards of seven percent year on year for next 3-5 years. Software and internal IT services spend is increasing faster.

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Dr Cliff Bleustein

Could you please share an overview of the solutions that Dell Services is offering to the Indian healthcare industry? In addition to a host of solutions that we have for the developed healthcare IT markets in the West, we are also focused on bringing solutions customised for Indian healthcare market. One of them will be Cloud based solutions set covering most of the requirements of an Indian healthcare customer â&#x20AC;&#x201C; including HIS, ERP, EMR and other value added solution stack. We are also offering mobility solutions, social media and analytics customised for healthcare customers.

What are some of the advantages that set Dell Services ahead of its peers in India? Dell brings in a huge healthcare IT ex-

perience of over 20 years, especially from a healthcare provider IT perspective, which, very few of our peers are able to bring to the table. Dell has been ranked number one globally in healthcare IT services by Gartner for the third consecutive time this year. We do end-to-end services for healthcare providers, right from revenue cycle services to electronic medical records implementation and support. We are a complete solution provider â&#x20AC;&#x201C; across services, infrastructure, hardware and software, which again is a big differentiator.

What are the new trends of Health IT in India and what are the emerging new technologies? We are expecting to see a considerable interest in a combination of HIS and ERP, especially on cloud. Also, EMR adoption is steadily increasing in private and government sector, though it will take higher impetus from government to accelerate the same. However, clearly EMR adoption is expected to be the next big wave of healthcare IT trend in the near future. We are seeing a high level of interest in mobility solutions for healthcare workers including doctors and nurses. Clinical, financial and other operational analytics are generating quite an excitement but willingness to invest in them is yet to be seen.

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Cloud Computing Ensures Flexibility and Agility Sadanand Reddy, Managing Director, Goldstar Healthcare Pvt Ltd, has decades of experience in modern hospital management and has contributed significantly to the development of HIS. In conversation with Ekta Srivastava, ENN, he talks about the power of Cloud Please tell us about the Hospital Management and Information System, developed by Goldstar? Goldstar Healthcare Private Limited has developed complete comprehensive Hospital Management and Information System that provides end-toend modules/features. The solution is developed on latest Microsoft dot net technology supports on MS SQL database and addresses all the departments in the hospital. The modules are integrated with each other based on the functionality. GHMIS is designed as per functional facet and divided into three categories of modules namely: Main modules, Support modules and Enterprise modules. All the modules are integrated based on the desired functions as: patient administration, patient clinical care, ward management, resource management, financial management, HIS reports.

With over two decades of exposure and experience in healthcare, how do you visualise and evaluate the IT transformation? If we look at 10 to 15 years back, HMIS means only billing software either Out Patient or In Patient Billing some places registration and doctor appointments.

Sadananda Reddy

Today the healthcare industry is undergoing a substantial transformation and is progressively more looking to improve service delivery under the impact of an evolving end user profile, disease patterns and increasing healthcare costs. According to research firm Frost & Sullivan, a large number of healthcare facilities in this region are leveraging Information and communication technology (ICT), to boost service delivery and improve ROI. Cloud Computing and Cloud Services not only addresses the challenge of rising healthcare costs by significantly reducing capital expenditure for healthcare providers, it also provides them with the flexibility and agility they require in the dynamic Asia-

Pacific market. The global market is estimated to grow at a CAGR of 7.0 percent to reach USD 56.7 billion by 2017 from USD 40.4 billion in 2012 due to the significant demand for clinical information technology, administrative solutions and services. The major factors driving the growth of the HMIS Market across the globe are rise in pressure to cut healthcare cost, growing demand to integrate healthcare systems, high rate of return on investment while using healthcare systems, government initiatives, rise in aging population, growing demand of CPOE adoption in order to reduce medication errors, and rise in incidences of chronic disorders. However, a few factors restricting the growth of the market are the fragmented nature of the HCIT market, high initial cost of HCIT solutions and high maintenance cost of the HCIT systems.

In what way do you assist in enhancing operational efficiency? Our team of experts, who has extensive knowledge more specific with healthcare sector with various discipline will assist on the healthcare projects from inception till commissioning. The focused approaches that provide innovative solutions to the customer and the entire process shall be monitored through our collective approach.

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Telemedicine with Enormous Breakthrough K N Bhagat, Founder, OTTET Telemedicine Network, in an interaction with Ekta Srivastava, ENN, shares his vision for better accessibility in healthcare through telemedicine What do you see as the benefits of telemedicine and telehealth? With telemedicine we can have access to quality healthcare not only to the rural population living in far flung areas, but also to the people of urban and semi-urban areas. Telemedicine has a tremendous role, a large and very big role in a heath care delivery system. This bridges the gap of demand supply mismatch doctor wise - facility wise so that medical relief will not be beyond the means of the people. It is the only way to fulfill the constitutional obligation which will not be pos-

sible otherwise even within 100 years. It provides vital health statistics and disease indicators which are required for planning and implementing national level health programmes.

How have the patients and the healthcare professionals felt about this tele-health programme? The patients have felt and expressed their gratitude for the accessibility of quality healthcare which was not possible earlier. This not only saves time but also reduces out of pocket expenditure. Eminent healthcare professionals have confessed that this is one of the best method for increasing the accessibility to majority of population. This is very convenient for Pre-Surgical Investigation, Post Surgical Follow-ups and Planning.

Telemedicine provides access of the specialist to rural areas. However, because the specialistâ&#x20AC;&#x2122;s time is still limited to fixed time periods, how can a specialist devote time to telemedicine versus the local immediate needs with which he or she is already overbooked ?

K N bhagat

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Specialists can provide consultation in their leisure time, with the help of vital statistics and investigation report of the patient that is available with them by accessing the Patient Health Record (PHR) in the telemedicine network. This help the specialists

to provide tele-consultation in lesser time, which otherwise would have taken longer time had the patient visited physically. Progress of the disease and subsequent follow-up consultation will also take lesser time as all digitised data like, ECG, CT, MRI is available with the specialists for diagnosis. This not only benefits the patients, but also enriches the knowledge of the general practitioners participating in the consultation with specialists/super specialists.

How telemedicine is bridging the gap between doctors and patients ? Telemedicine network comprising of trained skilled manpower, even at a remote place, gives the opportunity to the patient to access specialists and super specialists in the network. Because of the use of technology and availability of easy-to-use and highly reliable biomedical devices in the network, telemedicine is able to bridge the gap of demand and supply mismatch, doctor-wise and facility-wise as it readily provides vital parameters and investigation reports so that the doctor can give advice through tele-consultation to distantly located patients.

What leadership and governance structure supports your organisation, and more specifically, your care management infrastructure ? OTTET has Admin, IT, Medical, Fi-

nance and Legal wings apart from Technical Advisory Board of eminent personalities. School of Telemedicine & Biomedical Informatics, SGPGIMS, Lucknow (National Resource Centre for Telemedicine under Ministries of H&FW and IT under Government of India) is the technical partner for training and standardisation. Connectivity with medical colleges, DHHs and other super-specialist hospitals and group of hospitals of national and international repute exists with periphery so as to provide access to quality healthcare anywhere and anytime.

What are the most critical foundational elements for an organisation embarking on population health management ? Determination, dedication, selection of right technology and manpower, support of government and financial institutions are the most critical foundation elements for an organisation embarking on population health management.

How does telemedicine fit into the system’s broader care coordination strategy? Telemedicine is the only branch of medicine where you can ‘Love All and Serve All’, because hospital cannot serve without physical contact. Telemedicine has unlimited potential in bridging the gap doctor wise and facility wise. If consultants do not go to villages, villagers will come automatically through telemedicine.

What do you see as the main challenges in implementing and expanding telemedicine services ? Lack of awareness amongst the beneficiaries, service providers, professionals, and administrators, Identification of right technology and equipments, Trained and dedicated manpower, Unavailability of ade-

Strength areas • • • • •

Exploring potential of employment generation for creating a mass of semi-skilled productive workers to provide access to healthcare of 51,000 villages The project has access to quality healthcare to the rural population living in far-flung areas. It has provided globalisation of medicare along with de-commercialization of medicare This is a unique enterprise built on PPP model which is first of its kind in the country in such dimension Creating a mass of semiskilled productive health workers to provide healthcare at the doorstep, the project has the involvement of the government partners for design, implementation of network under strict guidelines The project aims at generating potential employment among unemployed rural youth and women segment of the society

Key challenges • •

To meet the requirement of bandwidth, partnered with different service providers and created skilled manpower combining Public Health with IT using local unemployed youth Selecting and deploying eHealth infrastructure at no costs to government and synergy of overnment, corporate and civil society for sustainable development

“Eminent healthcare professionals have agreed that this is one of the best method for increasing the accessibility. This is very convenient for pre-surgical investigation, post surgical follow-ups and planning

What steps are you taking to ensure a streamlined patient experience at OTTET Telecare ?

quate bandwidth for virtual consultations, Attitude to serve.

What role does mobile plays in the healthcare space?

How do OTTET telemedicine and clinical initiatives help meet the long-term objectives of high-quality,longitudinal care delivery? OTTET establishes viable network and infrastructure through dedicated and trained manpower with the capa-

bility of providing quality healthcare in Tele-consultation,Tele-Ophthalmology, Tele-Pathology and Tele-Radiology. It yields rich dividend in protecting and promoting health of the People with long term health benefits.

OTTET’s integrated distribution platform across physical and virtual touch points ensures a systematic approach of early identification and link to quality healthcare through tele consultation for preliminary diagnosis, expert opinion, scheduling appointments for hospital visit etc.

Mobile is a very versatile equipment for ICT platform. It is the most reliable instrument which can be used in ad-hoc or emergency cases. With the evolution of smart phones and mobile apps, the day is not far when each and every single individual will have access to quality healthcare with just a push of a button.

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Health IT Special Coverage

Boosting the Power

of Speed Dialing Bipul Parua, Co- Founder & CTO, Knowlarity Cloud Telephony Software Solution, shares his views with Ekta Srivastava, ENN, on solutions that are helping reduce response time during emergencies and on other healthcare IT developments Could you please share an overview of the solutions that Knowlarity system India is offering to the Indian healthcare industry?

Bipul parua

Speed dialing is a great option but there is a limit on the number of people you can put on speed dial. Knowlarity provided a solution that was remarkably simple. A recorded message is speed dialed to ten contacts at the press of a button. The recorded message can be customised to provide details about the patient - ward no, name of the attending doctors, type of illness – any information that would help getting things moving fast during Code Blue situations.

Talking about the four broad segments of the Health IT market – Software, Hardware, Infrastructure and Services – where does Knowlarity System India fall in?

With Cloud IVR Services, you can easily write a service that takes ‘user response’ to ‘execute’ an action Knowlarity offers Cloud Telephonic solution. We have been doing telephony with the intelligence of the Internet and real time information. So you can set up any receptionist for your organisation then it will automatically forward the call to the intended person and you can see all the things in real time at your desktop and they can be sending into your mobile also. Even you can see

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like if I go to the hospital and have to check any report, I will get an sms in my mobile and can directly access the report in a particular website. It is helping in making information regularly available and in real time, like whenever it is needed. And yes the healthcare IT market is growing very fast.

all the things that are happening in the organisation in your mobile.

How has the Health IT market evolved in India in the past five years? It has lot of automation, in terms of medical devices and in terms of how the patient’s record is access. So now with the IT what being done is

We provide a Cloud solution and we can replace their existing telephony hardware with our cloud solution. It will be a combination of services plus infrastructure also. We will replace the telephony infrastructure to bring to our cloud, so that they can do it in more efficient way and providing the services to the other.

What are some of the advantages that set Knowlarity System India ahead of its peers? In terms of technology, reliability, scalability, service and the feature we are far ahead of the other companies. If you come to us we have solutions for integrated healthcare software. It very nicely plug in to the system.

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‘Healthcare is growing by more than 15 percent per annum’ DesignTech Systems Ltd, a leading solutions provider in healthcare and product life cycle management, has introduced a range of healthcare solutions. Founding Director, Sachin Chougule, in conversation with Ekta Srivastava, ENN The healthcare IT sector in India is on a constant growth path. What kind of positive impact will this growth have on the healthcare delivery segment?

Sachin Chougule

The acceptance of IT as an enabling tool is still not picked up in India. An overall investment in the healthcare sector is growing by more than 15 percent per annum (pa) as compared to investments in healthcare IT products at less than 10 percent pa.

Growth Drivers: Health IT Usage

There is no lack of IT literacy or awareness in this segment. However, the seriousness to accept IT as a real differentiating and enabling tool, willingness to invest in it and leveraging as competitive advantage is generally lacking in the top management/owners of our healthcare organisations. With international medical tourism opportunities, globalisation and increasing regulatory pressure healthcare organisations will also have to accept strategic role of IT tools soon.

• The requirement of cashless payments or insurance and speedy settlements of claims need IT enablement

What are some of the advantages that set Designtech System India ahead of its peers?

What are your business plans for India? ? DesignTech Systems offer four different products for the following market segments- Asclepius Clinic for Clinics and Practitioners, Asclepius Lite or Professional for Small or Medium size hospitals and Asclepius Enterprise for Large Hospitals. Our ERP caters to patient management, billing, LIS, RIS and inventory management and seamlessly integrates all the allied services of the hospital. The unique and modern concept of Workflow Management Framework enables hospitals to reduce overall time to process transactions.

Security is an integral aspect of Health IT Infrastructure. What’s your take on this? The majority Indian healthcare organisations today have not yet accepted the role of IT as an enabling tool. The top management and owners are not ready to invest and leverage IT for

IT illiteracy and lack of awareness often act as initial obstacles for health IT players. Did you face similar challenges?

• Increase in medical tourism is making hospitals invest in stateof-the-art IT set-up to attract overseas patients • Current market size, as per Gartner Group report, is `5,000 crore and is growing at the rate of 7 percent per annum better effectiveness and productivity. The awareness and seriousness about security is no doubt a long way to go. Even the India Government has not yet laid down any guidelines or standards for healthcare organisations.

Most of the HIS solutions available are service based and require enormous customisation to implement contrary to this. As a product we offer managed code and fully tested product. Being a product it can be installed and implemented in a shorter duration. Having built our latest version on Microsoft Workflow foundation we deliver a comprehensive workflow and decision support system. Our distributed architecture enables hospitals to install our products on a wide range or hardware configurations without impacting performance, this protects the hospitals hardware investment.

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Connecting

Last Miles

Dr Raj Sarda

How have the patients and the healthcare professionals felt about this tele-health programme? There has been varied response from different locations. In Digwal (Andhra Pradesh) Telemedicine Centre, the response has been very encouraging . On the other hand in Araku Valley, initially patients were not so forth-coming. There were numerous social barriers which stem from tribal cultural beliefs for example in Araku pregnant women are not supposed to leave their village during their pregnancies. HMRI conducted many information, education and communication activities to earn the trust of local communities. Now situation is far better and beneficiaries are readily coming to centre with the help of locally recruited health workers.

How does telemedicine fit into the system’s broader care coordination strategy? Demographic change, rising incidence of chronic disease and unmet needs for more personalised care are trends that demand a new, integrated approach to healthcare in India. Advanced information and communication technology provides an opportunity to realise care integration, superseding today’s chain

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Dr Raj Sarda, Senior Vice- President, Health Management and Research Institute, talks to Ekta Srivastava, ENN, on the subject of telemedicine in rural areas

“Any citizen can call ‘104’ and render medical information and advice, avail counselling services, request directory information, or lodge a service complaint against any public health facility”

training community health workers, traditional birth attendants, deploys paramedics and state-of-the-art technology to screen for and monitor risky pregnancies, and connects women with Obstetrician /Gynecologists via video conferencing. Unique Electronic Health Record is maintained for each beneficiary and biometric fingerprinting is used to authenticate patient records and doctor prescriptions. Most of ASARA lab devices are integrated with HMRI’s telemedicine software which decreases manual error in data entry.

of disjoint responses to discrete threats to health. Telemedicine provides specialist expertise in the remotest areas. Electronic Health Record generated after consultation also facilitates better maintenance of patients case history resulting in convenient and accurate follow up.

What role does mobile plays in the healthcare space?

How do ASARA telemedicine and clinical initiatives help meet the long-term objectives of high-quality, longitudinal care delivery? ASARA aims to decrease maternal and neonatal mortality in tribal populated Araku Valley, Andhra Pradesh by

There has been a rise in mobile based solutions in various sectors including health. HMRI is already has an experience of operating Health Information Helpline in five states. Any citizen can call ‘104’ and render medical information and advice, avail counselling services, request directory information, or lodge a service complaint against any public health facility. Remote monitoring of patients, Health record Keeping in phones and health related apps are some expected areas of expansion. m-Health space is still nascent and it has a long way to go.

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Taking Patient Care to New Heights Srividya-Thyagarajan, CEO, HTC Global Services, talks about the advantages and disadvantages of adopting IT in the Indian healthcare. In conversation with Sruti Ghosal, ENN How the Indian Health IT market is growing and in what percentage? What is the current market size? Indian Healthcare IT spending is expected to touch USD 977 million in 2013 with an increase of about seven percent compared to 2012. The spending is expected to be in IT software and hardware services, IT staff and telecommunications. Of this, spending on Internal IT staff is expected to be the highest 18 percent compared to the other categories. Spending on external IT services will be the next highest 9.7 percent and will reach Rs 14.5 billion (USD 267.5 million).

What are the components of Health IT in India? Which one is the strongest? Kindly support your opinion with facts & figures. Basic Hospital Information Systems (HIS) is the most prevalent module amongst PACS, RIS, EMR and other clinical systems. Electronic medical record (EMR) services have a high growth potential at an estimated CAGR of 13.5 percent from 2009 to 2016.

What are the new trends of Health IT in India? The market trend is expected to move towards Cloud Computing whereby most hospitals will aspire to adopt web-enabled Hospital Management Systems and Lab Information Sys-

tems (LIS). There are a few vendors who have Cloud based products currently that are scalable. mHealth is one area which has major scope in India, especially in the field of Health Information Delivery.

What kind of solutions do you provide to healthcare sector in India?

Srividya-Thyagarajan

Balancing Act Strengths • Availability of IT resources not only in metros but even in tier II and III cities / towns • Ease of adaptability in new set-ups • Large number of IT vendors to choose from Weaknesses • Lack of regulatory authority for quality and interoperability standards • Lack of IT training in medical curriculum • Health insurance still in nascent stage • Extreme variation in the data qualifying • Get immediate medical attention

We provide IT services such as Cloud based HIS, EMR solutions, mobile based services, web page and portal development, Health Integration Services to integrate providers, hospitals, labs, pharmacies and patients, health analytics, IT Infrastructure management. We have different models to suit the customer needs (onsite, remote development and support, professional services, managed services etc).

In providing solutions to hospitals, what kind of challenges you face? The typical challenge has been the awareness of IT as something beyond a HIS product. Most hospitals simply invest in an HIS/ EMR product and expect everything to automatically fall in place. While an HIS/ EMR product is just one component, there are many more problems that IT can resolve. Hospitals that recognise the value of technology and leverage IT services in all aspects of their operations will definitely be able to take their patient care and profitability to an entirely new level.

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BestofWest Hospitals

special focus

In terms of revenues and employment, healthcare is one of the Indiaâ&#x20AC;&#x2122;s largest sectors. The sector is now expanding rapidly. A substantial part of the total healthcare spending in the country is being done through the private sector. Some of the most popular hospitals in our cities are being run by the private sector. There are many factors that have attracted private investors to hospital based healthcare business. The primary factor is related to the rise in demand for hospital care in India. Since independence in 1947, life expectancy in India has more than doubled, rising from 28 years to 69 years in 2009. The economic growth of the last fifteen years means that a substantial part of Indiaâ&#x20AC;&#x2122;s population can now afford to spend more on healthcare. In the coming decades, larger proportion of the households is expected to move from poverty, and there will be more people using the services of modern hospitals. On several occasions the central and state governments have taken decisive initiatives in facilitating the expansion of hospital chains. In the pages that follow we have covered some of the key hospitals from the western region of India.

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Best of West

Hospitals

‘Our objective is

to set a benchmark’ Says Dr Ramakant Panda, Vice Chairman & MD, Asian Heart Institute, one of the safest heart surgeons in the world. He has revolutionised the faith of people on cardiac care in India after our Prime Minister, Dr Manmohan Singh was being treated by him. In conversation with Rachita Jha, ENN, Dr Panda, Padmabhusan awardee, shares his excitement on the future plans

Dr Ramakant Panda

Photo:Akshay Gala

What has been the inspiration behind starting Asian Heart Institute? The journey of Asian Heart Institute (AHI) started during my training days in the USA, where my work involved me to go to hospitals in city and sub-urban areas to retrieve heart for heart transplantation. There I saw that heart transplants or cardiac care and hospital infrastructure, even in the remotest of hospitals were far better than any other hospital in India. I realiSed the gap in terms of infrastructure in our country. I thought of putting a new model in India in cardi-

ac care, and that’s the whole concept behind AHI. I returned to India in 1993 and in January 2003 we opened the hospital. In short span of three years we were the first heart institute to receive International Accreditation, ISO-9000 and other certifications. The very objective of this hospital was not to make money but set a benchmark, in whatever we do.

AHI started as a cardiac care hospital. What is the next step? Asian Heart will remain a cardiac speciality hospital only. We are in plans expansion. In the new building two-

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Best of West

Hospitals

three specialties will be introduced. These include Orthopedic Institute as with aging population is leading to a lot of cases of orthopedic and joint related ailment’s are Robotics and Minimal Invasive surgery as the trend today is to have lesser cuts that are more convenient to the patient and gives faster recovery and Cosmetic Surgery and Reconstructive Surgery Institute. Government has given a go ahead to us for expanding our business and we have also got fire clearance. Unfortunately, due to paucity of land in Mumbai we can only move up vertically. We have purcahsed the requistie Floor Space Index from Government and are in process of design and development. We have plans to entre new cities and states in India such as Orissa and Assam.These will be multi-speciality, while the focus will be on Cardiac, Orthopedics, Minimal Access and Cancer.

Kindly tell us about the current trends in healthcare market? The trend worldwide, especially in the US is to have a chain of single-speciality hospitals within the banner of

have a huge setup and in that have optimum number of beds per speciality as a seperate institiute. That way right care to the patients can be given. We are looking to follow this trend and have three other speciality institutes within the same campus.

Robotic-assisted surgery is an upcoming medical technology in India. What are your comments on that? Robotic surgery is a major innovation and robotic technology in the medical field plays a vital role in almost all areas of surgery. The reason for it becoming popular in India is that globally the trend is moving towards minimum cuts and robot-assisted surgery can easily perform this function better than conventional laparoscopic surgery. This is also a boon for the patients as they recover much faster and blood requirement is not there. AHI was the first hospital in the country to do the third generation, robotic surgery with simulator. Although the treatment modality is costly today, that is so every time new technology comes in the market, with more adop-

“Plans are on for Orthopedic Institute, Robotics and Minimally Invasive Institute, Cosmetic & Reconstructive Surgery Institute” a large hospital in the same campus, rather than having one multi-speciality hospitals within one building. Thus, now they have seven to eight hospitals with 100-200 beds and each catering to a single specialty within the same premises. The reason is that technology is changing rapidly and with each speciality getting an infrastructure, team of single specialist and space dedicatedly within the same campus empowers them to emerge as independent excellence centers for the hospital. So, abroad the trend is to

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tion of the technology in hospitals, the cost will gradually reduce. The use of robots in surgery will revolutionise the way surgeries are performed in India.

Are there any landmark case study you would like to share with us? AHI is recognised as the centre to do any heart surgery that is inoperable anywhere in India. One of the landmarks achieved recently, is about a man of 52 years from Oman, who had been treated with multiple surgeries

“The trend is, instead of having a huge set-up, have separate single speciality units for each department, which is way better and more cost-effective healthcare that can be given to patients” in the past, and was facing problems. Everything that can go wrong with one’s heart was wrong with his, and we had to fix that. He was an extremely high risk patient. We operated upon him, and there were six procedures done simultaneously on him, we had to reconstruct his breastbone, repair one valve, bypass and other supporting surgery, and within 10 days he was discharged after full recovery.

What would be your key recommendations to the government? In India, the healthcare industry is at par with international counterparts. While the only point is that there is lack of trained people. There is huge gap in terms of the percentage at which the healthcare industry and the trained population is growing. Also to make healthcare and investment friendly industry, I recommend the Government to announce attractive tax benefits or incentives similar to hospitality and IT sector. Second for the healthcrae sector, is insurance sector that needs attention to ensure benefits reach to all. Third would be make significant in investment in infrastructure so that we get more trained people coming in into the sector.

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Your patients rely on you to be there with them. And you can rely on Agfa HealthCare in the same way, as your partner in image management. Because we cover the full patient workflow, from Digital Radiography, to RIS, PACS and speech recognition, through to the EPR. It is a complete portfolio that supports you and your patient from start to finish. And it is all built on the firm foundation of Agfa HealthCareâ&#x20AC;&#x2122;s extensive and proven experience. Insight. Delivered. Learn about Agfa HealthCare at www.agfahealthcare.com

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Hospital With Quaternary Care A believer in power of technology to offer advanced care to patients, Dr Sujit Chatterjee, CEO, Hiranandani Hospital, envisions investments in best-inclass & futuristic technologies at the heart of growth engine of the hospital Tell us about the inspiration behind the launch of the hospital? What super/multi specialty & emergency services you offer? The inspiration to commission the hospital was the ENT surgeon of the millennium, the illustrious, Padmabhushan Dr L H Hiranandani. We offer over 80 super-specialty services from Interventional Cardiology, Orthopedics, Oncology, Transplant surgery, Bariatric surgery, Human reproduction, Rheumatology Neurology and Neurosurgery among others. In addition, we have general specialities as General Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, ENT, Ophthalmology, Dentistry, Dermatology and Anesthesiology. A quaternary care hospital like ours offers every conceivable form emergency care service. This will include from a lacerated wound to complex road traffic accidents, from heart attacks to bleeding inside the brain we tackle all of it.

Why do you think multi-specialty hospitals are gaining popularity these days? What are the advantages these types of hospitals cater? These hospitals can provide holistic solutions in healthcare. Also in case of complications there is a multi-disciplinary team approach. The overall outcome for the patient is thus better. The hospital also will have a wider menu of investigations if required to be performed.

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systems for surgery to the CUSA for the hepatic transplant surgery. From CT scanners that are ultra-high speed to high definition ultrasound to linear accelerators with rapid arc. Here we are arguably the first hospital in Mumbai to start with this modality of therapy.

Kindly update us on any of your landmark initiative on any treatment modality/department infrastructure?

Dr Sujit Chatterjee

What are the technological advancements your hospital has introduced lately in the different verticals? We have all the technological features that include EMR, HIS, PACS, LIS and online services for our patients. We have designed our own HMS, which reflects on the in-house technology capabilities at the hospital. We believe in complementing technology with outstanding human values.

What are the modern equipments you have deployed in diagnosis and treatment? A hospital like ours has all possible investigative modalities from the intravascular ultrasound in Cardiology to computer navigated joint replacement surgery and from minimal access surgery to high definition optical systems for diagnosis. From automated anaesthesia stations to cardiac output monitors and from intelligent coagulations

We started a very successful programme in Primary Angioplasty in Myocardial Infarction (PAMI). Our data when presented prompted the US FDA to request us to be a part of their study for the Robotic arm utilisation in angioplasty. The programme is running from strength to strength. We started with Platelet Rich Plasma (PRP) which helps in sports medicine and we now have a fairly large patent following. The results have been outstanding as more and more sports persons have benefited from the same. As far as the PAMI procedure was concerned we have seen that there has been an increase in the number of youngsters getting severe heart attacks. Thus the team was trained and repeatedly on how to recognise an evolving heart attack or an ongoing even. Then we have the team arrange the cath lab and move the patient within 90 minute door to needle period and the Cardiologists have trained the staff to have the patient on the table and as soon as they arrive the procedure starts and this has prevented the heart from being damaged as is the usual case in heart attacks.

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Best of West

Hospitals

Providing Quality Care with a Human Touch At the forefront of medical technology, Lilavati Hospital today is amongst the best tertiary care providers in the country

irm on its commitment of the state-of-the-art facilities, best medical expertise, research, education and charitable endeavours, the hospital has won the trust and confidence of people from all walks of life - national and international. Based on a powerful Sanskrit inspiration, Sarvetra Sukhi Na Bhavantu, Sarve Santu Niramia which means ‘let all be blissful, let all stay healthy’, the hospital has focused its operation on providing quality care with a human touch, which truly reflects the essence of its motto ‘More than Healthcare, Human Care. The hospital started with 10 beds and initially had only 22 doctors. Today, it boasts of 314 beds with one of the largest Intensive Care Units (ICUs), most advanced operation theatres, more than 300 consultants and manpower of nearly 1,800. Hospital caters to around 300 In-patients and 1,500 Out-patients daily.

New arrivals The hospital has always put a foot forward in having the best-in-class technology continuum across all segments of medical treatment as they aim to provide premium quality of care and hospitality to patients. Amongst the latest is 3Tesla MRI with latest Philips Ingenia having digital technology that improves the image quality, is faster and is equipped with advance software leading to increased diagnostic applications. Unique digital broadband MR architecture captures the pure and

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increased signals with greater diagnostic accuracy. Extend ultra-large field-of-view gives extended coverage for whole body MRI and its wide bore leads to less claustophobia. In addition, the hospital has Somatom Definition Flash – a second generation dual source CT scanner that is also the world’s fastest and safest CT scanner. The dual source technology optimally reduces harmful radiation thus ensur-

ing a healthier scan for the patients. Now, whole body CT scan is possible with flash speed of 4.5 seconds while entire heart can be scanned in 250 mili-seconds nearly quarter beat with no breath hold at all. Installation of machine at Lilavati Hospital is the 1st installation in western region and only 2nd in entire India. Hospital is now equipped with advanced 4D ECHO machine which in addition to enabling accelerated 3D ECHO also helps in performing technologically advanced tests for newer therapies in treatment of heart failures.

Accolades

Highlights • 314 bedded hospital including 72 intensive care beds • 12 state-of-the-art well equipped operation theatres • Lilavati Kirtial Mehta Medical Trust is an approved research organisation by the Ministry of Science and Technology, having all modern facilities necessasry for conducting reserach

Efforts and hard work put in by team Lilavati Hospital has resulted in various awards and accolades. Mr Chetan Mehta, Trustee, Lilavati Hospital & Research Centre said, “These esteemed awards were only possible with the commitment, dedication and devotion of all our staff members. This recognition reiterates our motto which is ‘More than HealthCare, Human Care. It is an honor to know that we are able to contribute significantly to our country’s rapidly growing Healthcare industry’. The hospital started with 10 beds and initially had only 22 doctors. Today, it boasts of 314 beds with one of the largest Intensive Care Units (ICUs), most advanced operation theatres, more than 300 consultants and manpower of nearly 1,800. Hospital caters to around 300 In-patients and 1,500 Out-patients daily”

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Hospitals

Taking Tertiary Care to the Last Mile A respite from the rush and promise of quality tertiary care comes to the town and villages of Gandhinagar through Goenka Hospital

oday, as a patient enjoys comforts of hospitality matched to five-star hotels at the best of hospitals in the metro cities, there is another reality in the remote villages where-in a patient has to struggle for basic ambulance services to ensure he makes it to hospital in time. Realising these harsh realities of the healthcare divide, a decision to set up 100 bed hospital was made by promoters of Bholaram Education Society at Gandhinagar Gujarat. Goenka Hospital

is the first corporate multi-speciality hospital in Gandhinagar which meets all medical and emergency facility, and today is the life support of not just denizens in Gandhinagar but also other parts of North Gujarat and Rajasthan. Spread over 20 acres of land located in the outskirts of Gandhinagar, Gujarat, the hospital was inaugurated on 17th October, 2010, to cater the emergency needs of 160 villages with close to 20 lakh population surrounding Gandhinagar. Till date, more than 20,000 patients including diagnostic visits, OPD and IPD have been successfully treated at the hospital.

Bringing global to local With a mission to serve the society at large and to provide the best medical and health care facility available globally to the local people of Gujarat, the hospital is open 24 hours seven days a week and 365 days in a year. Committed to give highest standard of care, the hospital has ensured that all departments are well-equipped and staff trained. A dedicated and advanced team of doctors that include super specialty consultant, specialty consultant,

critical care specialist, medical officer and other highly qualified and dedicated para-medical staff supported by team of experienced and talented administration department ensure that all patient needs are met. â&#x20AC;&#x153;Our team is backed by massive and advanced medical infrastructure so that the treatment to the patient should not be compromised. With in-house round-the-clock radiology and multi slice CT scan department, pathology department with fully atomised machines, emergency and trauma department, advance critical care unit, NICU and PICU, modular OT with Hepa Filter and laminar air flow makes our team more confident to treat and cure the patient with no waste of time,â&#x20AC;? says Dr Manoj Kodwani, Senior Medical Administrator, Goenka Hospital.

Healthcare for all The hospital is partner to state government in delivery of many of the health schemes for BPL population. â&#x20AC;&#x153;We aim to provide the best healthcare facilities to patients in rural areas or them it is difficult and unaffordable to approach high-end specialty hospitals in cities, especially in case of an emergency, says Dr Kodwani. This is against the popular trend wherein most of the hospitals are striving to deliver five-star hospitality and tertiary care to their elite class, Goenka Hospital in Gandhinagar is working to deliver tertiary care services to those at the bottom of the pyramid.

september / 2013 ehealth.eletsonline.com

SPECIAL Focus

Best of West

Hospitals

World-class Care

for Every Patient Powered by state-of-the-art medical technology and a patient-friendly approach, Jaslok Hospital promises affordable and quality healthcare for all

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Leap of faith In the late 60s, when the establishment of large private hospitals was not common, one family decided to take a bold step in a new direction and channel change. The Chanrai family, with business interests in many countries, was equally steeped in philanthropy, having supported many small and large projects. Jaslok Hospital founders, Jasoti and Lokoomal Chanrai, had a vision - to bring to Mumbai an ultra-modern medical facility that will provide quality healthcare to all regardless of their caste, creed or financial ability. Seth Chanraiâ&#x20AC;&#x2122;s vision was brought to reality largely by his brother-in-law Dada Mathradas Assomull, under the medical guidance of Dr Shantilal Mehta. The result of their single-minded effort was the establishment of Jaslok Hospital & Research Centre on July 6, 1973, which was inaugurated by the then Prime Minister Indira Gandhi.

Pursuit of excellence Over the years, true to its foundersâ&#x20AC;&#x2122; vision, Jaslok Hospital has vlived up to its reputation as a charitable hospital of merit, but has also adopted several breakthrough technologies to usher in medical miracles. Today, Jaslok Hospital & Research Centre is one of the oldest tertiary care, multi-specialty trustrun hospitals of the country attracting patients from all over India and abroad. The institution now has around 35 established specialities and these are growing steadily. The departments are equipped with state of art equipment and manned by trained and dedicated staff many of whom now run train-

Milestones Highest number of kidney transplants done in Mumbai First ICSI baby in Southeast Asia First in practice of Deep Brain Stimulation Surgery for Parkinsonâ&#x20AC;&#x2122;s Disease Trans Aortic Valve Impingement (TAVI) performed for the first time in India First hospital in Southeast Asia to install MR Guided Focused Ultrasound Surgery Unit First state-of-the-art Stone Centre in Mumbai. Lithotripsy and Upper Tract Endourology (PCNL and URS) established way back in 1989 Largest series of Endo Venous Laser Treatment of Varicose Veins in the country First Solid state dedicated Cardiac Camera in Asia

ing programmes. Jaslok is now a fullfledged teaching institution and conducts postgraduate courses as well as a nursing school and being recognised by the National Board of Examinations in 22 specialties. Whatâ&#x20AC;&#x2122;s amazing is that the hospital has over 25 specialist doctors, all leaders in their fields, who have been part of the hospital since its inception! For them, itâ&#x20AC;&#x2122;s like being a part of a family - the Jaslok Family. And it is this spirit that keeps the hospital focused on what the Chanrai family had originally envisaged.

Landmarks Some of the landmarks set by the hospital include, the Department of Assisted Reproduction and Genetics of Jaslok Hospital has faciliated the birth of 5500 babies and boast of the PGD lab

â&#x20AC;&#x153;Going forward we would strive not to enhance state of art medical technology but also state of art patient care servicesâ&#x20AC;?

Dr Tarang Gianchandani, CEO & Director Medical Services, Jaslok Hospital

in India in 1999 for testing certain genetic disorders using FISH technique. The Digital Subtraction Angiography department was the first in India to have 3D rotational angiography, to perform the first coil embolisation of aneurysm and the start carotid stenting in this region. It is the first hospital to conduct Laser Prostatectomy using the HPS 120 watts KTP Laser. This is the First HPS 120 Laser in Asia. Jaslok Hospital has today one of the most advanced and sophisticated Computer Navigation System in the world for Hip resurfacing, Hip replacement and Knee replacement. It has the first Neuro-urology Centre in Asia to successfully perform Lattisimus Dorsi Dynamic Myoplasty for Atonic bladders.

Vital statistics The hospital has 364 beds, with 75 ICU beds and 265 consultants available round-the-clock for patients. A team of 140 fully trained doctors across 35 established multiple speciality and super-speciality segments are present. The hospital also has academics wing with in-take capacity of 25 BSc Nursing degree graduates from the College of Nursing that the hospital conducts.

september / 2013 ehealth.eletsonline.com

SPECIAL Focus

Best of West

Hospitals

Blending Technology with

Personalised Care

The vision and commitment of Bomi Bhote, CEO, Ruby Hall Clinic, has transformed the hospital into an internationally recognised destination for healthcare. An engineer at heart, he shares the growth story with Rachita Jha, ENN

Please tell us about the journey of Ruby Hall Clinic Pune? Ruby Hall was founded by Dr Grant in 1959. He started with two beds and today we have more than 700 beds. Over the years we have raised our hospital according to the changing demands. We began with internal medicine department and gradually expanded to radiology and cardiology departments. The number of ICU beds has considerably increased, and so have the rooms. Today we have more than 130 beds in ICU alone. Recently, we have seen cardiology coming up in a big way in the city.

Please share your views on the adoption of technology at Ruby Hall? We have built this hospital with the vision that no patient should go abroad for medical need. An engineer at heart, I wanted all the latest technologies, equipments and treatment modalities to be available under one roof. I also wanted that doctors use IT to have round-the-clock access to their patients’ medical records, as they are on the move and should be able to view reports of MRI, CT Scan, Angiography, etc, anywhere, anytime on their iPads. We have always been ahead than others in the adoption of technology. Today, we have close to 400 computers in the hospital and most of the documentation is in electronic for-

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“We are looking at starting a 150-bedded dedicated cancer hospital at Amanora Park, Pune, where we will offer more radiation-driven treatment modalities” mat. We are trying for all our documentation and electronic records to go on Cloud. We have begun with MIS. We have now developed inhouse expertise on the best suited IT solutions in partnerships with IT vendors. The cost benefit of IT adoption has been enormous. The major saving is on the plugging of pilferage and loss control, which bring major profits for the hospital.

What are your expansion plans? We have plan to expand within Pune itself. This includes one hospital at Hinjewadi, since that part of the city has no hospital. We are also looking at starting a 150-bedded dedicated cancer hospital at Amanora Park, where

we are adding four linear accelerators and another PET scan machine and have more radiation-driven treatment modalities. We have plans to set up a new hospital for the upper class and overseas patients who want healthcare services on a priority basis. Also our hospital at Wanowri is already functional. 60 to 70 percent of patients come from outside Pune, from peripheral areas and other parts of Maharashtra. So we have 12 peripheral diagnostic centres located at various cities across Maharashtra. These are small set-ups with CT, MR, OPD facilities so that our consultants can go and conduct OPDs. This helps us to reach out to a larger set of population.

Special focus

Best of West

Hospitals

Designed for

Medical Excellence

Vishal Beri, COO, Hinduja Healthcare Surgical, elucidates the exciting journey of Hinduja Group into boutique hospitals in Mumbai How is the hospital different from PD Hinduja Hospital? As a group we have always been known for the P D Hinduja Hospital that has been a benchmark in healthcare for over six decades. However, we realised over time that as the occupancy started picking up we need to accommodate growing needs and trying to cater to the entire spectrum of patients was becoming a challenge. The realization that each section of population has separate needs, from the general ward to the suite room, prompted us to start a boutique hospital-that caters to additional sections of the population while the cornerstone would remain to be excellence in medical care. Our model is a blend of medical excellence, personalised care, aesthetic design , in an accommodating environment that is holistic, given the relatively smaller number of beds in the model. We are now two years into operations, focused on surgical specialities and it has been a successful journey for the Hinduja group as a new venture. We have seen that this benefits the patient, the hospital and the healthcare industry even as it addresses certain specific needs of the patient population.

Please share some of the key surgical specialities and your model of operations? The spectrum of specialities includes General Surgery to more complicated like Orthopedic Surgery, Minimal Access Surgery, Cardiac Surgery, Neu-

vishal beri

rosurgery and GI Surgery. Taking cue from the current trends in the market, our consultants are on â&#x20AC;&#x153;fee for serviceâ&#x20AC;? model along with few full-time doctors. We have with us the leading medical and surgical consultants across the city and ensure our patients get the best service. Today there are close to 200 doctors working with us spread across multiple specialities.

What are your views on trends of hospital market in India? The Indian healthcare market is expanding and it is in an exciting phase. The number of hospitals is growing in India which is a boon for the patients as they now donâ&#x20AC;&#x2122;t have to travel across large distances to get quality care and service. On one hand we have the smaller or single specialty hospitals today taking care of specific medical needs of the patients, thus providing them an option instead of long wait-

ing hours in the larger hospitals. This is a win-win situation in more than one way, for both the hospital and the patient, as the patient gets high quality of care at lower cost, treatment comparable to a larger hospital, the hospital itself has smaller overheads and teams to manage thus making it a viable business proposition all round. On the other hand, with large corporate houses now entering the hospital sector, we have large chains of hospital that have multi-city presence. There is scope for emerging partnerships that can be formed as the market is currently fragmented. To illustrate the point, if a central repository of patient records is maintained and shared amongst hospitals, we can slowly move towards the trend in the West, where super large groups of 1000-2000 beds create an ecosystem of excellence. In India today this is possible only in cases of larger corporate hospital groups and works within the group. Emerging corporate group presence and partnerships will enhance the process of seamless functioning through optimum utilization of technology in healthcare segment.

What are the growth plans ahead? We are now on the threshold of expanding this business model. The idea was to perfect the set-up of a boutique hospital at one location and then look at replicating the same in. So we are now more or less ready to move into the next stage of expansion.

september / 2013 ehealth.eletsonline.com

SPECIAL cover story Focus

Best of West

Hospitals

Modern Technologies

Help Save Lives Shivam Parikh, Head of Department – IT, CIMS Hospital, speaks about some of the latest IT initiatives taken by the hospital What are the key medical services on offer? Patients are having a hard time finding the right doctor for a particular disease, treatment or problem. Multispecialty hospitals provide a single point of care window ensuring that the patient feels comfortable each and every time he/she visits. CIMS hospital is a multi-specialty hospital which includes specialise departments focusing on cardiology, cardio thoracic surgery, critical care, dentistry, dermatology, endocrinology, gastroenterology, gynecology and obstetrics, orthopedics and joint replacement, neonatology and pediatrics, nephrology, neurosciences, onco-surgery, preventive healthcare, sleep medicine, physiotherapy, urology and more. We are a fully functional 180 bedded hospital and will be expanding soon. We have invested into the best and latest medical equipment to provide excellent care in all the services that we provide.

Please tell us more on the emergency services at the hospital? We have one of the best emergency services across the state of Gujarat. We have four ambulances which provide coverage not only to Gujarat but also to Rajasthan, Madhya Pradesh and Maharashtra. The trauma and ER department at CIMS Hospital is renowned for round-the-clock care. We always have doctors available to treat emergency cases. CIMS Hospi-

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Our pathology is integrated with hospital information system ensuring patient information is available to the doctor at a single point” Shivam Parikh

tal is both accredited with NABH and NABL standards.

What are technological advancements your hospital has introduced lately? We have implemented various technological advancements at CIMS Hospital. These include our own in-house and cloud EMR called HEAL that will be launched next month - which allows patients to track their weight, height, food intake and proactively suggest various methods to stay healthy and fit. Our EMR also allows us to move to a totally electronic environment whereby in the next two years we expect to go completely paperless. Added to that we are also using Patni’s Hospital Information Management System which also will integrate into our EMR allowing patients to access their medical reports anywhere, anytime and every time. We

have an OPD in house developed software called VICTORY which records over 1000 unique elements focused on Cardiac Care. This year we are working with the American College of Cardiology (ACC) in the United States on integrating Victory with their own registry to assist with sharing of information to create and build outcomes. We also provide online appointments through our web portal and also offer career opportunities through interactive in-house developed portal called Victory care.

What are the modern equipments you have deployed in diagnosis and treatment? ? CIMS hospital boasts for the world’s fastest angiography in a flat five seconds using the latest technologies we have one of the most modern and fully functioned Cathlab in India.

SPECIAL Focus

Best of West

Hospitals

Up the Value Chain to

Quaternary Care

Zahabiya Khorakiwala, MD, Wockhardt Hospital is setting benchmark of quality healthcare delivery system in cities that lay barren to tertiary care ecosystem. In conversation with Rachita Jha, ENN, she shares her journey and future plans of the group able number of nursing homes but no tertiary care hospitals. In many cities, we were the first tertiary care hospitals such as Nagpur, Nasik and proved the affordability and business proposition in these cities. And we have not looked back ever since. Also, going forward, these would continue to be our focus. Going ahead, we now want to go up the value chain to quaternary care that would include organ transplant facility in these cities.Plans are on to start our operations in North India as well.

Tell us more on your plans to strengthen your expertise in the cardiology?

Zahabiya Khorakiwala

Please tell us about the vision of the group in hospitals business? We began our hospital business in 1980s in Bangalore; it was a80 beds heart hospital. The tipping point for the group was our collaboration with Harvard Medical School to enhance the value in healthcare delivery system. The relationship gave us an insight in our expertise in healthcare. After our presence in the metro cities, we found a need for quality healthcare services in tier II cities, where there is reason-

We began our focus with emergency care especially in cardiology since our inception, and today it contributes 30-40 per cent of our business. Emergency care and management is critical for tertiary care. Our objective was to streamline the operations from the time the patient enters the emergency to the time the ballooning happens in the Cath Lab- as this period is life saving for the patient. The international standard for door-to-balloon time is 90 minutes, and following our process innovation strategies in our hospitals we have brought-it to 70 minutes. This is a benchmark of our quality standards inclinical parameters. We have been the first to introduceintravascular ultrasound (IVUS) in our Cath Labs in tier II cities such as Rajkot, Nasik. Also, we have Fractional Flow

Reserve (FFR) technology available that offers the doctors the data intelligence on the decision-making in borderline case. These have made us ahead of the curve and contemporary.

Tell us some more about the new project at Goa? The Wockhardt Institute of Aesthetics at Goa is thefirst Institute of its kind in the country to be certified by NABH. The institute is known for its range of aesthetic surgeries and also for the fact that it is one of the first institutes that carries out such surgeries within a super-specialty hospital in a dedicated facility. It also has a substantial number of reconstructive surgeries that are carried out on patients with birth defects or trauma cases.

How do you ensure the same quality standards are replicated across all your hospitals? We believe in setting the best practice standards in our services, continuously improving performance and exceeding the expectations of our patients as well as their families.The core values of excellence, respect, teamwork, integrity and caring are essential for the well being of our staff and our patients. Because of our emphasis on high teamwork we bring together all the necessary disciplines and skills from the many resources of our organization to serve our patients better and attempt to set the Wockhardt Care in a league of its own.

september / 2013 ehealth.eletsonline.com

ZOOM IN

MazikCare Ensures

Good Turnaround

Razi Ahmed, Country Manager / CEO, India, MazikGlobal Inc, feels Indian healthcare needs to think about adopting integrated IT solutions in a more cohesive way What was the objective behind the launch of MazikCare? With changing dynamics of Indian healthcare, the industry is seeing more patients and tighter budgets than ever. Healthcare organisations are feeling the need for new technology. A comprehensive and agile healthcare system is required to manage your business adaptability and increase productivity. MazikCare works as a backbone that your center relies on to maintain the tempo and resilience needed to support your constituents. MazikCare, the only fully integrated healthcare system running on Microsoft Dynamics AX, brings your whole healthcare world together into one powerful, seamlessly integrated, end to end solution.

Brief us about your solution MazikCloud? MazikCloud makes provisioning machines with specific templates easy, and managing them a cinch. As the only control panel able to manage both Microsoft and VMware, Mazik Global has made a dashboard that is capable of handling the workload of your company, no matter how extreme it is. With MazikCloud’s 360° view, you get an immediate and comprehensive assessment of your resources across your entire distributed network including private and public clouds, all from an easily navigable portal. Services authoring allows you to create various productivity and business

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ready templates for different applications such as SharePoint, CRM, Dynamics AX, and others. These can be shared within or outside the organisations to help improve efficiency. The ITIL process integration with MazikCloud allows you to rearrange your computing needs more efficiently so that your organisation can take advantage of the economies of scale that larger public clouds can provide. With such solutions Mazik can help you simplify cloud management.

Kindly brief us about your product the ‘MazikCare’? MazikCare is a comprehensive but simple to use HIS System built as a vertical solution on MS Dynamics AX platform. It is an integrated platform based solution encompassing all the clinical (doctor, nurse, wards,

ICU, OT), administrative (front office, scheduling, eMRD, etc), support functions (pharmacy, CSSD, nutrition, food and beverage, housekeeping etc), ERP (MM, Financials, HR etc) and out-of-box BI. The USP of the product is: • Detailed & elaborate module listing with inbuilt workflow’s • Out-of-Box BI • Analytics and Decision Systems like activity based costing etc. • Global practices for Indian Ecosystem • Web enabled, deployable in both central & decentralised model, cloud ready • Truly a HIS 2.0 product • Can be scaled out into smaller modules to meet market requirements.

PIN*****

A Global Conference on Financial Inclusion & Payment Systems

FIPS 2013

24 - 25 October 2013, Eros Hilton, New Delhi

Key Speakers

Professor M S Swaminathan Former MP, Rajya Sabha, MSSRF, Chairman, Conference Advisory Committee, FIPS

Ela Bhatt Chairperson, SEWA & Founder Chairperson, Women’s World Banking

Shuvalaxmi Panse Chairperson & Managing Director, Allahabad Bank

S S Mundra Chairman & Managing Director, Bank of Baroda

R K Dubey Chairman & Managing Director, Canara Bank

M Narendra Chairman & Managing Director, Indian Overseas Bank

Sudhir Kumar Jain Chairman & Managing Director, Syndicate Bank

Archana Bharagava Chairperson & Managing Director, United Bank of India

Ramnath Pradeep EX-CMD, Corporation Bank

Mehboob Chowdhury Chairman, Citycell, Bangladesh

A P Hota Managing Director & CEO, National Payments Corporation of India (NPCI)

Sunil Chandiramani Partner & National Director, Ernst & Young LLP

Restoring the very essence of inclusive growth is at the radar of Financial Inclusion and Payment Systems (FIPS), 2013. The Conference will have vibrant rounds of discussion on the various challenges that are being faced in having effective financial inclusion in the country. The Global Summit comprises: Conference, Exhibition and Awards.

FIPS Awards

PIN*****

AWARDS

FIPS Awards aim to recognize the seminal role that various organizations have been playing in the areas of Financial Inclusion, Banking Technology, Payment System, Mobile Banking, Health Insurance and other verticals.

Financial Inclusion Financial Inclusion • Health Insurance

• • • • • • • • • •

Health Insurance Financial Inclusion in Financial Inclusion in Health Sector Sector Health Organisation ofthe theyear year Organisation of Access to Access to banking banking and and financial financialservices services Capacity building and Capacity building and financial literacy financial ICT basedliteracy innovation ICT based innovation

Categories Banking Technology Banking Technology

• • • • • • • • • •

Health IT Health IT Technology in Rural RuralHealth Health Technology in Infrastructure Industry Infrastructure Initiative Initiative Institutional Infrastructure Institutional Infrastructure Initiative Initiative Internet Banking Service Internet Security Banking Initiative Service Security Initiative

Payment Systems Payment Systems

• HealthPayments Payments • Cashless Cashless Health • Online Health Payments • Online Health Payments Online Payments • Online PaymentsSolution Solution • Mobile Payments Solution • Mobile Payments Solution of the Year of the Year • Multi-Channel Payments • Solution Multi-Channel Payments Solution • Contactless Payments • Project Contactless Payments Project

Mobile Banking Mobile Banking

• • • • • • • • • • •

Health Serviceson onMobile Mobile Health Services Online Health Services Online Health Services Overall Mobile Overall MobileBanking Banking Application Application Mobile Application Design Mobile Application Design Multiplatform Service Multiplatform Service Tablet Application Tablet Application many more... many more... ORGANISERS

Conference & Award Queries: fips@eletsonline.net Kartik Sharma, +91-8860651635, Nayana Singh, +91-8860651642

Sponsorship Queries:

Partner Publications

Ragini, ragini@elets.in, +91-8860651650

fips.eletsonline.com

PRESENTS

Special Report

Government Initiatives for Better Healthcare Dr Vishwas Mehta, Joint Secretary, Ministry of Health & Family Welfare, Government of India

Dr Naveen Kumar Dhamija, Dy Commissioner (Training & Telemedicine), Ministry of Health & Family Welfare, GoI We have more than 70 percent rural population and the medical expert available in the country is also 70 percent. However, they are available in cities and metros only. We should look at the potential of using ICT to improve this scenario when we know that we have 74.04 percent literate population. As per TRI January 2013 records, we have 893 million telecom subscriptions, 137 million Internet users as on June 2013 data, over 900 million mobile users which is the second largest mobile users in India. Prof SK Mishra, Head Department of Endocrine Surgery, SGPGI Telemedicine

Health is one subject for which we all are concerned about whether we like it or not. It is a fact that 6000 villages of our country do not have access to primary healthcare. Our medical colleges and doctors are focused in 5000 towns and cities. The medical education itself being the legacy of British Medical Education System is urban and hospital centric. After spending years in getting medical degrees, doctors have the tendency to work in cities. That is why any initiative to touch lives of rural people and provide access to basic healthcare to them canâ&#x20AC;&#x2122;t really make any difference.

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We expect to build a virtual national medical university where there will be virtual classrooms in each and every medical college with facilities for video conferencing in real time. Also facilities should be such that multiple institutions can participate. This is possible by creating a unique project national medical college network. This network should be a secure network where all the patient related information is fed. Dr V Balasubramanyam, Domain Consultant-Medical E-learning, St Johnâ&#x20AC;&#x2122;s Medical College, Bangalore I feel for a better healthcare delivery, information is more important. If you want to know how medicine was practiced five years ago, you will need to read text books. If you want to know how medicine was practiced two years ago, you can read a journal. However, if you want to practice medicine now or in near future then switch to e Learning.

Technology for Efficient Hospital Management UK Ananththapadmanabhan, President (Operations& Projects), Kauvery Hospitals, Trichy India needs a healthcare system that can cater to the demands of 1 billion people. Health insurance in India is growing, it’s about 20 percent. But it has impacted technology a lot. When health insurance people pump money into the hospital, they expect to be more efficient and cost effective. Once we drive the tariff, we want to improve the productivity due to the technology. Another innovation is the patient ID card with Barcode. Most of the IT initiatives have reached a good many hospitals whether it is barcode, computerised plastic card, software integration of laboratory equipment, bar-coding capital assets, video conferencing or computerised MIS reports across the group. Dr Sai Praveen Haranath, Consultant Intensivist and Pulmonologist, Apollo Hospitals The total cost of healthcare in India is about 103 thousand crore some years ago and it’s estimated to be about 283 thousand crore in last year. There are approximately 70,000 ICU beds in India but there is huge need because about five million patients actually require ICU admissions every year and there is a huge shortage of beds. The cost of intensive care is about six times higher than the cost of regular care. Telemedicine is a way forward. We need to deploy enough resources to use efficient software and technology to make sure that the patient’s care is prioritised.

Dr Sanjeev Sood, Hospital & Health Systems Administrator, NABH Empanelled Assessor, Healthcare Quality Management & IT Consultant, Chandigarh When we talk about efficiency, it means how we are using technology to get more output with fewer resources; could be man, material, money or time. Technology is able to bring efficiency and tackle inefficiencies in hospitals. The use of technology has been mandated by WHO for achieving Millennium Development Goal with the cooperation from the private sector. ICT is most powerful technology which can enhance the operational efficiency of hospitals.

september / 2013 ehealth.eletsonline.com

PRESENTS

Special Report

Innovative Diagnostic

for Improved Radiology Dr N Eshwar Chandra, Secretary, Indian Radiology & Imaging Association (IRIA)

Dr Anand Abkari, President, Indian Radiology & Imaging Association ((IRIA)

From the golden day of 8th November 1895, when William had invented the Xrays, the field of radiology has taken a lead role paving the way from diagnostic to management and interventions. Continuous advancement has led to many various diagnostic techniques like Ultrasound, Doppler, color Doppler technology, computerised stenography, and this new generation MD Innovation per se means something CT and now what CT scanners, Magnetic Resonance Imaging (MRI) innovative, different in use, original, and many more. very new and most important which set its foothold in the market Dr Palle Lalitha Reddy, Vice President, Central IRIA & Consultant and the society. Innovations in Radiologist, Yashoda Hospital radiology finally would benefit the With lot of rapid advancements, now we patients Top innovations in the have better interactions between the radiology and that underlines the fact that diagnostic plays the major clinicians and the radiologist because as radiologist I will know the situation but role in day to day practices of the how could the clinician know about it. Now clinicians. they can always call up and say would you suggest an ultrasound or MRI for this Dr R Powar, Radiologist, patient. So we are more than happy to tell CARE Hospitals them what will be the best option because the primary goal for us is to make the imaging and scan tailor made to suit the patientâ&#x20AC;&#x2122;s disease and its financial status. Dr Harsha C Chadaga, Senior Consultant & Head of Radiology Operations, Columbia Asia Hospitals Kinematic applications are the need of the day. EMR perfusion is where see various applications from head to toe. The innovations in the field of MRI and CT is the revolution of the patient management, which decrease the time and continuous innovation will further enlarge the diagnostic accuracy.

september / 2013 ehealth.eletsonline.com

The number of images or numbers of scans being done is increasing rapidly. Also there is a limitation that more and more complex technology is coming and in terms of the patient it becomes evidence based practice. As we all know, the treatment decision is based on imaging reports itself and thus it becomes imperative to get the report early because if you get the diagnosis early, turnaround time will also we Improved.

PRESENTS

Special Report

IT in Health The Way Ahead Srinivasan Ramakrishnan, Former DG, C-DAC

Munender Soparna, CIO, Dr Lal PathLabs We have implemented document management system. As far as our SOP is concerned, we archive each prescription from every patient. We have a patient portal and through this particular portal we have implemented eCommerce facilities for online registration. Scheduling and payment gateway is already integrated with that tool. One can upload and download report using their login details. BK Murali, Managing Director, Hope Hospital The 25 Major industries shamelessly copy ICT from the other industries to improve their services but except one which is the healthcare industry. Hope Hospital is an enterprise level SaaS based hospital information system which integrates different hospital systems modular and can be accessed with common web browser.

Effective healthcare delivery is the value of integration. Healthcare delivery system includes some points like prevention, access, diagnosis, delivery, monitoring and the efficiency is the relative population, health improvement for each rupee spent. Second is equity, equity ensures good health outcomes which are shared by entire population and the third is quality, quality is relative effectiveness of healthcare system and medical intervention.

Dr Jaijit Bhattacharya, Director, Government Advisory, HP, South Asia

Girish Kulkarni, Practice Head-Health Care, Mazik Tech Solutions Pvt Ltd

Telemedicine implemented in few big places show some time technologies that being implemented are right while social engineering is wrong. Some time technology is wrong but social engineering is right, some time right kind of stakeholder is not available etc.

Building IT service today is about building facility department who is going to do it. Itâ&#x20AC;&#x2122;s all about a stronger and robust medical grade network, integrate them, manage them and reduce your operational expenses.

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Building Effective PPP Model for Indian Healthcare

Dr Rajiv Kumar Jain, Additional Chief Health Director (Admnistration), Central Hospital, Northern Railway In the last five years, the goal was on lowering maternal and infant mortality, malnutrition among children, anemia among women and girls and to address fertility issues. Unfortunately, none of the goals have been met. We have increased publically sponsored health coverage like Rajiv Gandhi Swasthya Bima Yojana. We need good investment on mHealth, telemedicine, need to increase use of Ayush and micro health insurance. We face disproportionate supply and infrastructure in terms of doctor, nurses and beds. K Rajasekhar- Senior Technical Director, National Informatics Centre, Hyderabad

P J Binu- Senior Engineer, Health Informatics, CDAC, Thiruvananthapuram

Dr Anant R Koppar, Chairman and CEO, KTwo Technology Solutions Pvt Ltd

There should be affordable and easily accessible services and the proper implementation with an eye on continuing cost control. In the PPP model, relationships donâ&#x20AC;&#x2122;t go far; we need continued partnership model where the private party will work with the public enterprise for good of the citizen at large. Subodh Satyawadi, CEO, GVK Emergency Management and Research Institute

In a PPP model, there are health services under RTI. Information related to government health services should be provided within 48hours. In some time, we will able to create standardised electronic medical records and will have different technologies service oriented architecture, web services, cloud which will facilitate free flow of information to central repository.

Data management system is a clinically information system with comprehensive electronic medical records for oncology care implemented at Regional Cancer Centre, Thiruvananthapuram. It covers various clinics- head and neck clinic, breast clinic, pediatrics clinic, chest and gastro etc, it integrated to existed HIS and telemedicine system.

There is a need of partnership. Nowhere have we achieved Millennium Development Goals, if we want to achieve the goal, we have to ensure healthcare for all. It will bring lot of benefits, costefficiency, higher productivity, accelerated delivery, customer focus and enhance the social service.

september / 2013 ehealth.eletsonline.com

PRESENTS

Special Report

Cashless Claims in Health Insurance Somil Nagpal, Senior Health Specialist, World Bank The arrival of private insurance and Third Party Administrator (TPA) which happened as recently 2001 led to investment and claim processing systems. A system that could help process and also help improve the business intelligence environment and create better management information is need of the hour. Dr Selvavinayagam, Joint Director, TNHSP/DPH, Government of Tamil Nadu The interest of the insurance companies in ensuring cashless claim is limited. We have introduced standalone diagnostic center under the insurance coverage scheme and have been verifying the beneficiaries through our call centers. We have toll free, 24hours working call centers where they can contacted to address the grievances. Dr Muralidhar Joshi, Director, Joshi’s Institute of Pain on Healthcare Regulations: How to Cope You cannot drive a vehicle without a driver, either you have to drive or have to employ a driver that’s the regulating authority. You cannot run a show just like that and working places like anesthesiology is such critical area where life and death is just the matter of three minutes. We call it reversible loss of consciousness. If it fails to reverse then it call irreversible and that’s where come Indian Regulatory Authority (IRA). We require definite regulating authority at all levels and not only for that thing but secondly also for the drugs which are required for the patient.

september / 2013 ehealth.eletsonline.com

Dhananjaya Reddy, CEO, Aarogyasri Health Care Trust

If you look at the statistics, in India almost 63 percent borrow for medical need and 12 percent sell assets. If you look into the rural areas, the poor patients already are suffering from various categories of problems, especially the farmers. This scheme has been initiated with the intension to give patient some kind of coverage, so that patients can be treated without paying money. The goal of the scheme was basically to provide cashless quality medical cover to all the families in the State of Andhra Pradesh.

cover story Expert Speak

Do you think Neonatology services in our country stand at par with the advanced countries of the world? Neonatology is the specialty that deals with babies from birth to 28 days of life and this field has seen vast advancements in the last three decades globally. By now, our country also has advanced to a tertiary level of care. Comparing a premier tertiary care neonatal unit of the West with large units in metropolitan cities of India, we can see, comparable, high end care and facilities. The care and survival of pre-term, extremely low birth weight (ELBW) babies with a birth weight of <1000 grams was uncertain

“The care and survival of pre-term, extremely low birth weight (ELBW) babies with a birth weight of 1000 grams was uncertain about three decades back. Now, with a highly developed level of care being available along with major advances in neonatal intensive care the intact survival of the micro preemies has become a distinct possibility” about three decades back. Now, with a highly developed level of care being available along with major advances in neonatal intensive care the intact survival of the micro preemies has become a distinct possibility. Altogether, it has been a big leap for us and the advances are evident in metropolitan cities and second tier cities too. However, considering

september / 2013 ehealth.eletsonline.com

Caring for Your

Bundle of Joy Dr Amitava Sengupta, Director: Mother & Child Unit, Head: Department of Neonatology & Pediatrics, Paras Hospitals, Gurgaon (NCR), India; Chief Advisor: 49th Annual National Conference of IAP (Pedicon 2012); National Faculty: NNF-IAP Advanced NRP; delves into the detail of Neonatal care in India. He shares his thoughts with Sharmila Das, ENN the enormous size of our country, it is difficult to spread the advancement equally to all regions and corners. To achieve this goal, we have to work dedicatedly to spread the message of new-born care and disperse knowledge to the neonatal care givers across the nation and aim to significantly reduce the Neonatal Mortality Rate (NMR) in the various states.

Don’t you think the Government run hospitals should also give due emphasis on this specialty? What is your take on this? Neonatal Mortality Rate (NMR) is the number of deaths occurring in infants during the first 28 days of life, per thousand live births. It is gratifying to know that the lowest NMR recorded was 7 in Kerala as per 2010 statistics. In my belief, government hospitals like AIIMS and Safdarjung have given due attention to neonatology services. Keeping in view the huge load, we should appreciate that the delivery of care in such institutions is bridged with the game of enormous numbers. AIIMS New Delhi has one of the country’s premier Neonatal

Tertiary Care Units. In the NCR and other states, there are many government hospitals that also provide good infant care and are moving forward to deliver better care and facilities. Kalawati Children’s Hospital, New Delhi is an example of a government institution with a large and efficient neonatal care unit. However, looking at the large volumes, giving the same level of care and facilities to all may not always be possible.

The care and management of premature babies is an integral part of Neonatal Intensive Care. In this regard, what are the modern devices and neonatal programmes Paras has brought to its Neonatal Intensive Care Unit? The Mother and Child (M & C) Unit at Paras Hospitals boasts of highly efficient Neonatal and Pediatric units. This M & C unit is one of its kinds where the department of “Neonatology and Pediatrics” is housed under one roof along with the department of “Obstetrics and Gynecology” with a single Director.

The Neonatal division has a level IIIB tertiary care unit with 15 beds, and recently celebrated its 7th birthday. We have “state of art” facilities which include computerised digital servo controlled warmer beds and advanced digital monitors, which display heart rate, oxygen saturation, non-invasive blood pressure and many other parameters. Our special monitoring equipment can measure intra-arterial blood pressure, which is used for continuously monitoring critically ill neonates. In our unit, each neonatal bed is equipped with an advanced monitor,

ensuring a one to one patient monitor ratio. Computerised digital syringe pumps are used to deliver intravenous fluids, electrolytes, nutrition (e. g amino acids, intra-lipids), blood components and other products. The unit has high end, ‘state of art’ ventilators and other respiratory support devices for the micro preemies and critically ill neonates. Non-invasive Positive Pressure Ventilation (NIPPV) is a newer mode of ventilating newborns, which has also been introduced in our NICU since last three years. Our highly skilled neonatologists

are often placing PIC lines for long term therapy. “A peripherally inserted central catheter (PICC or PIC line) is a special form of central venous access that can be used for a prolonged period of time (e.g. for extended antibiotic therapy, or total parenteral nutrition). In this mode, the catheter is placed in a major blood vessel leading to the heart.” We have an ongoing “Developmental Supportive Care” (DSC) programme in our unit since last 18 months. This involves a broad category of interventions designed to minimise the stress of the NICU envi-

“A peripherally Inserted Central Catheter (PICC or PIC line) is a form of central venous access that can be used for a prolonged period of time (e.g. for extended antibiotic therapy, or total parenteral nutrition). The catheter is placed in a major blood vessel leading to the heart”

DR Amitava Sengupta

ronment. These interventions include elements such as control of external stimuli (auditory, visual, tactile, vestibular), clustering of nursing care activities to avoid disrupting sleep, positioning or swaddling of the preterm infant and calming techniques. We are in dialogue with the National Neonatology Forum of India (NNF-I) regarding the module and concepts that we have pioneered in our unit. Hopefully our programme will be taken up at a national level under the aegis of NNF-I in course of time and we would spread the message of DSC across the country.

september / 2013 ehealth.eletsonline.com

ZOOM IN

Checking Blood Pressure at Home Pays Off Simple tests, like blood pressure monitoring is simple, and efficiently done at home. Sridharan Mani, Director & CEO, American Megatrends India Pvt Ltd, discusses the growing need and utility of health monitoring gadgets

eart disease, hypertension and diabetes are few examples of silent killers that take a huge toll of life globally. The American Heart Association recommends regular home monitoring for everyone with high blood pressure. This helps the healthcare provider to determine if the treatments are working effectively. To detect the early signs of silent killers, one must check their vitals consistently at regular intervals. Only regular monitoring can ensure and identify the silent killers and therefore, keep them at bay. According to Heidi Godman, Executive Editor, Harvard Health Letter, “Checking blood pressure at home pays off.” He points out that 72 percent of high BP patients kept their BP

Key facts

under control when they did regular BP monitoring at home.

Device quality and accuracy Consumer grade monitors are often believed to be lacking in quality and accuracy when compared to clinically approved monitors. Most of the consumer grade monitors sold in the market is not validated by authentic agencies like AAMI or BHS. A study was conducted on “Home sphygmomanometers: validation versus accuracy” found that out of five hundred automatic blood pressure monitors, 72 percent of the units showed incorrect readings. The research revealed that the devices meeting British Hypertension Society’s (BHS) standards are more likely to be accurate.

• Cardiovascular Diseases (CVDs) are the number one cause of death globally: more people die annually from CVDs than from any other cause • An estimated 17.3 million people died from CVDs in 2008, representing 30 percent of all global deaths • Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke • Low and middle-income countries are disproportionally affected: over 80 percent of CVD deaths take place in low and middle-income countries and occur almost equally in men and women (Source: WHO)

september / 2013 ehealth.eletsonline.com

Sridharan Mani

Affordability Approved vital monitoring devices are 3 to 4 times more expensive than those of non-approved devices. Affordability of standards approved device is a key issue.

Usability Many of the automatic home monitoring devices sold in the market are semi-automatic and require regular calibration. One has to calibrate the devices from time to time to ensure the readings are accurate. Some of the devices have limited storage and may lack in providing comparative reports. Comparatively, clinical grade devices are bulky and not portable. An ideal home monitoring device should meet clinical standards, remain usable, portable and also be affordable.

zoom in

How Low

Can You Flow?

nalysing the available data from the new Software 4 log on his hospital’s Dräger Primus machines, Dr Laws, has been able to help members of his department assess their individual performances regarding low and minimal flow anesthesia, adapt their routines and reduce their consumption of volatile gases by up to 40 percent Sunderland Royal Hospital is a 970-bedded acute hospital serving a local community of 330,000 residents in one of the cities of North East of England. David Laws received his training in medicine and anaesthesia in this region and since 2001, he has worked as a consultant anaesthetist at City Hospitals Sunderland, NHS Foundation Trust. The reduction should have impacted the patients, in terms of a better breathing circuit and gas conditioning, for his hospital, which will be required to spend less on anaesthesia agents, and for the environment, since smaller volumes of greenhouse gases will be released. Dr Laws, who has been the department’s audit coordinator for the past ten years, believes that “The best measure, would be to monitor the degree to which volatile anaesthesia was being wasted while administering anaesthesia, as it is both - the most costly anaesthetic component delivered and also a significant contributor to environmental pollution.” The latest Software 4 update produces a summary of each anaesthetic delivered, stating the date, time, duration and total carrier gases consumed per administration. Importantly, it also now summarises volatile agent consumption (ml liquid) and volatile agent uptake (ml liquid) for each case.

Utilising volatile ratio Using this new parameter, Dr Laws can now calculate not only the efficiency of volatile anaesthesia by case, but also the average volatile cost per hour. The figures generated would be extremely powerful since they would be based on a very wide sample-data from the hospital’s 21 operating room Primus machines. Having devised a suitable new way of demonstrating the efficiency of volatile anesthesia, Dr Laws then needed to prove its utility, make the results widely available and introduce the concept of using it as a measure of individual and departmental performance. Gaining universal acceptance for a new approach that his colleagues were likely to regard as an intrusion into their personal anaesthetic practice was always likely to be problematic. However, as Dr Laws explained, “There was a need to improve our use of sevoflurane quickly as we were threatened with a significant restriction on its availability in order to reduce anesthetic department drug costs. According to Dr Laws, “Whether anesthetists employed appropriate flows during anesthesia was previously regarded as a personal matter and, moreover, one that was best left unexplored. However, when measuring the efficiency of circle breathing system used by monitoring volatile consumption, uptake ratios have proven to be an excellent method of analysing aspects of the performance of the anesthetic department and individuals within that department. We have achieved a significant reduction in volatile drug costs with an enhancement in the quality of patient care assisted by the objective data that can be derived from the Dräger Primus anesthetic machine logbook.”

september / 2013 ehealth.eletsonline.com

POLICY Expert Speak

‘We plan to invest USD 50 million in Indian healthcare’ “We plan to include value added services and free treatments for the extreme bottom of the pyramid patients with the help of IT innovation, cutting edge technology,” says Dr Akil Khan, Vice Chairman, Enso Care. In Conversation with Rachita Jha, ENN What made Enso Care venture into healthcare in India? We decided to enter into a PPP to create a meaningful impact on overall Indian society. We have chalked out plans of investments of USD 50 million with an appetite for more projects with various other state governments too. Currently we have won tenders for Maharashtra and Punjab Governments for diagnostics facilities in 43 civil hospitals, 22 in Maharashtra and 21 in Punjab. GE is a renowned Original Equipment Manufacturer (OEM) and we are proud of our association with them. We plan to include value added services and free treatments for the extreme bottom of the pyramid patients with the help of IT innovation, cutting edge technology and well-trained medical staff. We are currently investing time in building our management bandwidth and operational capabilities to execute the job at hand as quickly as possible.

Tell us more about the PPP with Government of Maharashtra? Currently, 38 district and other large hospitals under Government of Maharashtra cater to about 100 million people. It is estimated that in a year, these 38 hospitals would be referring over 100,000 CT scans, 50,000 MRIs, 300,000 Color Doppler studies, 900,000 x-rays and 40,000 mammography examinations required for early

september / 2013 ehealth.eletsonline.com

a special boost with the inclusion of 20 screening mammography units for early breast cancer detection. The financial investment of 150 crore as part of the consortium with leading healthcare companies and will together set up advanced diagnostic facilities at 22 government district and women hospitals, run operations on 24*7 hour basis and provide services at government recommended rate cards for the benefit of larger population.

DR akil khan

detection and treatment of diseases. However, in the absence of quality diagnostic imaging infrastructure, these studies are quite often referred to private centres which substantially increases the cost of treatment. The PPP agreement with Government of Maharashtra is the largest in terms of scale. Public Health Department, Government of Maharashtra has signed this ` 150 Crores PPP project to advance healthcare in the State of Maharashtra. The package includes installation of four units of 64 slice CT scanners, 13 units of advance 16 slice CT scanners, eight units of cutting edge 1.5T MRI with 16 channels, 22 high end digital radiography systems, 39 Color Doppler’s and 39 analog x-ray units. Women’s health is given

What are the advantages of PPP model in healthcare for government? This unique opportunity as provided by this PPP will change the dynamics of healthcare in India, with the largely divided middle class and the underprivileged getting diagnostic services to begin with, at zero cost or at heavily subsidised costs and also getting global standards both in equipment quality on Wipro, GE equipments and international delivery with Enso Care. I congratulate the mammoth efforts of Maharashtra Government and their efforts will surely make a difference to 100 million hearts in the state. Plans for any other states apart from Maharashtra are Punjab, Tamil Nadu, Gujarat, Rajasthan, Karnataka, and Uttar Pradesh. Apart from diagnostics, we also are looking out for partnerships in fields of pathology, tele-model and general practitioner model in India.

Expert Speak

Insurance

A Tech Savvy Sector Sunder Krishnan, EVP & Chief Risk Officer, Reliance Life Insurance and Member - ISACA India Task Force shares the latest developments in the sector How has the regulations evolved in the life insurance industry? Some landmark announcements by the Government have been liberalization of insurance in the year 1999 and opening up the sector to private sector. Unit Linked Insurance Plan guidelines 2005 - regulating sale of ULIP also ULIP guidelines 2010 post a turf war with SEBI for regulating profit margins of insurance companies and protecting policy holders. Spate of other reforms to protect policy holders including setting up of IGMS - Integrated Grievance Management System - a unique initiative in the international arena. In addition, Product Guidelines of 2012 sweeping changes in product margins - impacting all products being revamped with effect from October 2013. Compared to US who is an advanced economy and is on a consolidation phase, India health insurance industry is in nascent stages. However, it is a sunrise industry and has immense potential.

Your views on move by IRDA to include banks as insurance brokers? This is a dynamic move by IRDA to provide freedom of choice to the ultimate customers of the banks. In the current

- where customers were posed only seven questions and based upon their answers an appropriate insurance policy was offered. With sweeping regulatory changes and all products being revamped by all the insurance companies - the focus is now more on getting the basics right.

Tell us on the role of technology in managing insurance claims and frauds across hospitals to make it easier for patients to cover their medical cost?

Sunder Krishnan

system bank customers are forced to purchase insurance policies of the bank promoted insurance companies.

Tell us some of the innovative products at Reliance Life? Reliance Life had launched several innovative products in the past. To name few of them, Automatic Investment Plan - a ULIP plan that automatically managed investments of the customers in a systematic manner. And second is Connect to Life

â&#x20AC;&#x153;India health insurance industry is in nascent stages. However, it is a sunrise industry and has immense potential.â&#x20AC;?

Indian insurance industry is one of the top customers of the technology world. While on the architecture side companies use Service Oriented Architecture with multiple portals connected to various business applications, on the operating system space -OS400 - most insurance companies use sturdy and legacy systems running on AS 400 platform with DB2 database. Technology based applications which connect the hospitals and TPA ensure that policy holder details are captured in the systems and merely through a card customers are able to connect to the insurance company for lodging claims.

How an insurance organisation can gear up for best practices in risk management to keep up with emerging technologies? To keep pace with emerging technologies insurance companies conduct IS risk reviews and IS Audits both at the pre and post implementation stages.

september / 2013 ehealth.eletsonline.com

cover Launchstory Pad

CARESTREAM DR X-Evolution at Erlanger Children’s Hospital (US) Optimises Image Quality Children’s Hospital at Erlanger, US. Recently implemented a CARESTREAM DRX-Evolution with Carestream’s long-length imaging software to optimise image quality for all types of X-ray images including long-length exams for pediatric surgeons and other specialists. In addition to trauma and intensive care services, the hospital offers pediatric specialists in all major areas of care including orthopaedics, cardiology, endocrinology, gastroenterology, neurology and oncology. Carestream software adjusts the exposure discrepancies between images and compensates for the latitude differences, therefore providing presentation that is individually optimised for each image and its corresponding anatomical region. The image-processing

Power

Packed magazineS

algorithm then stitches the individually optimised images together to create a smooth and seamless composite image for diagnosis. The CARESTREAM DRX-Evolution DR Room is a versatile digital radiography system with configurable, modular components that combine to fit the space, workflow and budget requirements of each healthcare facility. This system can perform a wide variety of general radiographic exams with convenience, productivity and patient comfort. Optional cesium iodide DRX-1C detectors offer high Detective Quantum Qfficiency and can lower X-ray exposure when compared to CR cassettes or gadolinium scintillator detectors.

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expert speak

Keeping Health

on the Right Track SAP has recently released TracOHealth that tracks the health of children using HANA platform under the National Rural Health Mission (NRHM) on the UIDAI platform. Mathew Thomas, Vice President, Strategic Industries, SAP India Pvt Ltd talks to Monalisa, ENN, about the initiative

here is a huge gap between demand for healthcare and delivery of services. There is a gap of 2.2 million beds and we are aspiring to fill that gap. This is separate from normal CSR related activities.

This application is called TracOHealth. It is at POC stage, but the app is available. It can be leveraged into various things, for instance, tracking vaccination, nutritional deficiency, and diseases. HANA delivers the speed of tracing this information.

Solutions from IT There are two aspects of IT solutions. One is about enabling a robust backend, which optimises and improves the financial management, supply chain, inventory management. SAP has great expertise in that. The second aspect is about managing operations through information management systems which are industry-specific solutions, such as patient management, clinical management, electronic medical records, collaborative e-care management, etc. These solutions provide you the data required. But how do you utilise that data is the bigger question. Expending information through mobility platform is a good idea as it enables two-way communication. Creating a software infrastructure to run or manage the data is again going to be an expensive thing. Cloud is a good platform to host this data – state-wise and district-wise. Instead of putting money in building application, it can be utilised in strengthening the application.

Infant Mortality We have created a pilot with three

TracOHealth

Mathew Thomas

The TracOHealth is aimed at allowing an inclusive approach to better collaborative outcomes in the area of child-health. The solution helps in maintaining all the health related

“TracOHealth, powered by SAP HANA, will empower our customers to deliver new and innovative services to address current challenges in real-time without disrupting their business operations” districts in a northern state in India covering 45000 students. The government’s aim is to reduce the number of deaths per thousand infants. If we are able to capture that information, it shall help the government reduce that number. We gave a data capture device to NRHM facilitators who capture the raw data. This is EMR. They captured demographic data, and the diseases that are prevalent in a village or a particular community.

information for a lifetime of every child across India. Further, TracOHealth leverages the power of Aadhaar (UIDAI) to uniquely identify beneficiaries and has been designed with the ability to work even in the remotest corners of the country. Powered by SAP HANA, with both web and mobile interfaces, TracOHealth provide real time analytics that help health authorities optimize resource utilization.

september / 2013 ehealth.eletsonline.com

cover Report Event story

SAP Surges Ahead

By Ekta Srivastava,ENN

n quest of business productivity and efficiency SAP HANA forges ahead with applications and innovations in mobile, analytics and cloud. SAP ERP Foundation Extension organised a group session at the Taj Palace, New Delhi on August 7th, 2013 that aimed to augment and boost the critical core processes - such as finance, human resources, IT management, manufacturing, procurement, sales, service and compliance The session spilled with innovative insights in healthcare and helped in laying the ground work for rewiring between entrepreneurs, investors and consultants in the healthcare domain. Panelists who participated in the round table discussions included secretaries from Ministry of Health and Family Welfare namely Dr Vishwas Meheta, Joint Secretary, Nikunja Dhal, Joint Secretary, Dr (Prof) Jagdish Prasad, Director General Health Services, Dr Rajiv Shrivastava - Deputy Director (I/C), Dr Ashish Gupta - Executive Haryana State Health

september / 2013 ehealth.eletsonline.com

Resources and representatives from Dell and others. The discussion include seven sessions, Government Initiatives in Healthcare: The Road ahead, SAP case study: Technology and Healthcare services, Demonstration of Next Generation Healthcare Solutions: TracOHealth and SanGenix by SAP and Dell, Medical education: An Integrated Initiative of Public and Private Sector and SAP case study: Technology and Healthcare Services. “Dr Vishwas Mehta speaking on medical education said, “Medical education is the work of Medical Council of India (MCI) and we are still managing with the same old and outdated British era rules and regulations. To regulate the national health infrastructure, we need 1:17 patient-doctor ratio. Private nursing homes are growing up because there is a huge gap between demand and supply”. Speaking on where on the portal should patient seeks information, Nikunja Dhal opined, “Once we notified the Emer-

gency Medical Response (EMR) to the respective hospital we will provide funding only if they conform to those standards. In the commission itself, we have people from private set-up, we would actually mandate it with state government. We are speaking to the state and we also need voluntary collaboration from National Health Insurance Authority (NHIA). Dr (Prof) Jagdish Prasad said, “Technology has great relevance in medical studies. For instance, telemedicine needs to be used extensively in the medical colleges, however, only a few practioners are using it at the moment and the Government has not implemented it fully. Moreover, Internet penetration is lacking, which needs to be upgraded as well. We are always open to Public Private Partnership (PPP) model, but if you consider the situation in India, industrialists don’t want to invest in hospitals. They all must invest 10 percent of their profit for people. If they do so, our country will be best in the world’’.

news

pharma

Drug Companies Seek PM Role in New Pricing Enforcement Top domestic drug makers have urged the prime minister’s office to intervene in the manner the new drug pricing control order is being implemented, complaining that ‘all sections of the pharmaceutical industry are frustrated’. The major gripe of leading Indian drug firms is that by mixing up the concept of ‘brand’ and ‘product’ while fixing prices of essentials drugs under the new DPCO, the national pharma pricing authority has managed to pull down ceiling prices of many medicines, way below what was earlier envisaged. “This could compromise availability of some products in the long term” said a letter of Indian Pharma Alliance, an industry body of top domestic pharma firms, addressed to the PMO. The new policy, passed by the cabinet, set a mandate to arrive at a price cap for each essential drug by a market based pricing formula.

More Adverse Drug Reaction

Monitoring Centres Planned To improve patient safety and reduce the risk associated with the use of medicines, the Union Health Ministry is all set to increase the number of adverse drug reaction (ADR) monitoring centres in medical colleges in the country from 100 to 150. The process of setting up the centres has already started and they will be commissioned by March 2014, Drug Controller General of India G.N. Singh said on the sidelines of a workshop on ‘Secured medicines and robust pharmacovigilance He said the national coordination centre for pharmacovigilance had evaluated 54,000 adverse drug reactions from the 100 centres in the last one-and-a-half years.

Glenmark Gets USFDA Nod for Alcohol Abstinence Drug Glenmark Pharmaceuticals today said it has received US health regulator’s approval to market generic version of Forest Laboratories’ Campral Delayed Release Tablets, a drug used for alcohol abstinence, in the American market.

Biocon Launches Psoriasis Drug Biocon Ltd is launching its novel biologic Alzumab in India for the treatment of chronic plaque psoriasis, a skin disease which afflicts 1-2 percent of the country’s population. The 24-week, 40 vial treatment is priced at `7950 per vial, which is at least 50 percent lower than competing drugs, said chairman Kiran Mazumdar-Shaw. She added “Alzumab offers superior safety and similar efficacy profile compared to other existing therapies, and has long remission period with low opportunistic infection rate.” India approved Alzumab for treating plaque psoriasis earlier this year. The company worked on the drug for a decade and spent ‘tens of crores’ in developing it, marketing head Rakesh Bamzai said. He said that Alzumab did not lead to side effects such as heavy liver damage that immunosuppressant drugs treating psoriasis can cause.

september / 2013 ehealth.eletsonline.com

Health Ministry to set up Expert Panel to Frame Biotech Law The health ministry is planning to set up an expert panel to frame regulations for biotechnology industry as well as products manufactured by them. The move comes in the wake of increasing interest and investment by companies in biotechnology and biologics. The idea is to have proper norms and regulation to monitor development, manufacture as well as sale of biotech products in the country, an official said.

New drug to tackle TB tested

A new drug, found to be effective on mice, has shown promising signs in treating tuberculosis, reports international journal Nature. The report’ Discovery of Q203, a potent clinical candidate for the treatment of tuberculosis’ published in Nature Medicine, elaborates how the synthetic antibacterial compound inhibits the synthesis of ATP — a source of energy for most of the cell’s enzymes — and thereby blocks tuberculosis growth. A team led by Kevin Pethe, a microbiologist at the Pasteur Institute Korea in Seoul, investigated more than 120,000 compounds over five years, infecting mouse immune cells with Mycobacterium tuberculosis — the bacterium that causes TB — and observing whether it inhibited bacterial growth. The molecule belongs to a new class of synthetic chemicals with no similarities to existing drugs. The drug termed Q203 is highly effective against multidrug-resistant TB.

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