eHealth May 2017 Issue

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INSIDE FEATURES ♦ New rules for medical devices: Shaping India’s MedTech Growth Story ♦ Emergency Care: Lessons from Karnataka

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ASIA’S FIRST MONTHLY MAGAZINE ON THE ENTERPRISE OF HEALTHCARE Volume 12

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Healthcare IT Bridging Gaps to Enhance Quality Greater integration of IT in healthcare has beneﬁtted the country by lowering the treatment costs, increasing eﬃciency, reducing human error and improving patient care and satisfaction. With India moving towards its goal of “Health for All”, IT is set to play much greater role in the times to come.

Shaping India’s MedTech Growth Narrative

CONTENTS

MAY 2017 | VOLUME - 12 | ISSUE - 05

The recent decision of the government to put in place new rules for the medical devices industry, which was long awaited, is set to boost the government’s ‘Make in India’ campaign by providing beneﬁcial environment for domestic manufacturers.

AIIMS: Precursor of 1st Digital Revolution in Healthcare AIIMS has undergone a transformation in providing a relatively far better experience than it was earlier known for among patients and for its related services.

MAY / 2017 APRIL / 2017 ehealth.eletsonline.com

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Industry Perspective

Abhijit Potnis Director Technology Solutions - India and SAARC, Dell EMC

Rekha Jain Director, Akhil Systems Private Limited

Ninad Chhaya COO, WITS Interactive and Co-Founder and COO, GoPhygital

Daniel Ng Senior Director APAC, Cloudera

Conference Report

Healthcare Information Systems market in India has immense growth potential driven by an estimated 14,000 hospitals across the country.

Srikanth Jadcherla Chairman iMedrix Systems Pvt Ltd

Features

A three-year pilot project to reduce infant and maternal mortality and morbidity in Karnataka has been initiated jointly by India and Singapore.

Rajiv Bhalla Managing Director Barco Electronic Systems

The Karnataka Healthcare Summit-2017 has set a milestone for the sector by pushing for restructuring the healthcare delivery system.

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editorial

Indian Healthcare using IT for Universal Healthcare With its established legacy in Information Technology (IT) sector, India is well on its way to transform its healthcare sector by marrying its IT capabilities with the goal of universal healthcare, considering the existing wide gaps in the healthcare delivery system. Considering the deep impact of IT in the healthcare sector, our cover story in the latest issue revisits the key components underlying this transformation process that will eventually change the way healthcare services are delivered in India. New Rules for Medical Devices, which turned effective recently, are set to change the manufacturing scenario of medical devices and equipment in the country. To gauge the impact the new rules are likely to have on the industry and enable our readers better understand the heart of the matter, the current issue of eHealth magazine carries a special feature, Shaping India’s MedTech Growth Narrative, with updates on new classiﬁcation scheme in place to push the Indian medical device sector’s growth. The Karnataka Healthcare Summit-2017, organised jointly by the National Health Mission and Suvarna Arogya Suraksha Trust (SAST), the Department of Health and Family Welfare, Government of Karnataka, and Elets Technomedia Pvt Ltd, on April 11, at The Lalit Ashok in Bengaluru, served as a convergence point for various healthcare stakeholders to provide a ﬁllip to the healthcare sector. The latest issue also carries a conference report of this key summit, which served as a unique platform for knowledge sharing -- bringing under one roof thought leaders, government policy makers and key decision makers, healthcare providers, diagnostics and lab innovators, health tech companies that are swiftly transforming the healthcare space in Karnataka, in particular, and India, in general. In line with our efforts to provide unique platforms to the healthcare industry to speak in one voice regarding the relevant issues concerning the sector, eHealth magazine takes pride in announcing the 7th Healthcare Leaders Forum (HLF) to be held on June 30 at the hotel Royal Plaza, New Delhi. Themed ‘Creating a Road Map for Inclusive Healthcare in India,’ HLF 2017 seeks to bring together the healthcare industry stakeholders to deliberate, discuss and provide a new direction to the industry by creating a future roadmap for the sector’s growth. Looking forward to our readers’ feedback.

Dr Ravi Gupta Editor-in-Chief

ravi.gupta@elets.in

MAY / 2017 ehealth.eletsonline.com

Cover Story

HEALTHCARE IT Bridging Gaps to Enhance Quality

Greater integration of IT in healthcare has benefitted the country by lowering the treatment costs, increasing efficiency, reducing human error and improving patient care and satisfaction. With India moving towards its goal of “Health for All”, IT is set to play much greater role in the times to come, writes Vivek Ratnakar of Elets News Network (ENN).

ndian healthcare industry competes with the best in the world in terms of technology, infrastructure, specialist doctors and nurses. The country has the finest and one of the largest pools of doctors and paramedics in South Asia, with many of them being of global repute. However, due to the sheer size of the country, technology holds the key to delivering quality healthcare to the people - 70 per cent of whom live in rural areas.

Deep Impact of ICT in Healthcare

Healthcare IT is leveraging India’s large reservoir of knowledge and expertise in traditional medicines and biotech-

MAY / 2017 ehealth.eletsonline.com

nology to achieve healthcare goals. “The 21st century has brought advanced technology and research. Our treatments are now more accurate, drugs more effective, and hospitals and labs are far more efficient. Large scale integration of IT and communication facilities has made it possible to consult with experts from every corner of the world. For example, a team of specialised doctors can overlook and guide a critical operation remotely by using video conferencing and nano-tech cameras,” says Dr Sushil Shah, Founder and Chairman at Metropolis Healthcare Ltd. On a smaller scale, digitalisation of patient records has

Cover Story made it easier for doctors to access reports, make notes, and discuss outcomes instantaneously. The process has reduced risks of miscommunication between doctor, patient and care staff while improving treatment planning. This automated system is especially beneficial for patients working with a multi-disciplinary team of experts. “Telemedicine facilities, online therapy, open online forums and many such technologies are changing the way the healthcare industry used to function and is making it more easier for consumers to gain access to information and make informed decisions. The overall consensus is that IT has drastically improved the quality of healthcare in India and will continue to do so in the years to come,” adds Dr Shah.

Big Opportunities for Healthcare IT

According to Dr Suchita Markan, Assistant General Manager at Biotech Consortium India Limited (BCIL), the rural India accounts for 70 per cent of the population but 80 per cent of the health infrastructure is in the private sector. “The medical insurance coverage is a mere 5 per cent, limited almost entirely to the urban, educated, middle classes in India’s larger cities. This gap makes out a strong case and represents a huge opportunity to deliver healthcare services from urban to rural areas through use of IT tools such as telemedicine as India has very good mobile coverage in the rural areas,” says Dr Markan. As per WHO report, India is placed in the category of critical shortage of health service providers with 0.7 doctors and 1.5 nurses per 1,000 people. “The WHO average mandate is 2.5 doctors per 1,000 people. According to the Planning Commission (now NITI Aayog) we are short of 1.54 million doctors and 2.4 million nurses to match the global patient to doctor ratio. This offers itself as an opportunity for integration of IT with the healthcare ecosystems wherein limited skilled manpower in Indian healthcare sector must be IT enabled to increase their efficiency for effective healthcare delivery to patients in remote locations,” observes Dr Markan.

IT Advantage in Healthcare

IT is gaining momentum in penetrating the healthcare service delivery in India, driven by the need to reduce costs, enhanced efficiency and increased health awareness among citizens. “Health information technology involves the designing, development, use and maintenance of information systems, specifically for the healthcare industry. With respect to the diagnostics industry, Health IT is central to LIMS – Laboratory Information Management System – which ensures standardisation of reports across India and other global markets. This digital data also helps us understand healthcare patternsacross different sectors and create trend based reports for consumers,” says Dr

Shah. According to Dr Markan, adoption of IT into the healthcare systems can have several advantages including improvement in quality of service by turning hospitals more efficient in terms of reach and delivery of service. “Integrated electronic medical records facilitate quality research as data is made available in structured manner which helps in studying trends and identifying disease outbreaks etc. Also, by means of creation of electronic patient record, each patient’s blood group, reports of investigations etc, can be documented and made available easily without manual errors,” she says.

Key Challenges

Challenges in integrating IT into the healthcare system in India, which include lack of standardisation, lack of inhouse IT expertise, reluctance of medical, nursing and other staff to change, and the fear of technology failing are among the key hurdles in adoption of IT in health. Although, majority of the private sector has adopted technology and IT as an integral part of their operations for efficient service delivery and there are also few success stories to cherish. However, there is a strong need to upscale IT adoption in healthcare system in India in both public and private sector alike and full integration of systems to unleash the immense potential that this sector offers. “The Healthcare IT sector is facing its own set of challenges including issues related to initial investments, lack of in-house IT expertise, manpower training requirements, reluctance by the staff to change management systems and lack of confidence in adoption of newer technologies etc,” says Dr Markan.

What Next?

With an exponential increase in the world of telecommunication technology and development of 4G, it is imperative that broadband wireless technology be exploited and used to develop mHealth. While mBanking, mCommerce, mEntertainment is becoming a reality, we need to develop mHealth, according to Dr Shah of Metropolis Healthcare. “The number of ‘Hospital on Wheels’ are very few and has potential to grow with increased facilities for real time two way audio video contact with main headquarter. Virtual skills laboratories are where large number of medical and surgical procedures is simulated on virtual patients are now a reality in advanced countries. We need to have such learning and development centres. To achieve all this, IT should be a part of the medical curriculum. Similarly, applications of IT in healthcare should be taught to all IT students,” he adds.

MAY / 2017 ehealth.eletsonline.com

Special Feature

SHAPING

India’s MedTech Growth Narrative The recent decision of the government to put in place new rules for the medical devices industry, which was long awaited, is set to boost the government’s ‘Make in India’ campaign by providing beneficial environment for domestic manufacturers. The new rules have improved norms for obtaining license and conducting clinical trials, and reduced manufacturer-regulator interface by promoting digital platform, write Dr Jitendar Sharma, Director and CEO, AMTZ and Srinivasa R Pilli, Senior Manager, AMTZ for Elets News Network (ENN).

s the up-to-date regulatory practices in India were not fully geared to meet the requirements for medical devices sector in the country, India’s Ministry of Health and Family Welfare released long-awaited new medical device and in vitro diagnostic (IVD) regulations on January 1, 2017 that will take effect in January 2018. The Medical Device Rules 2017, issued by the Ministry’s Central Drugs Standard Control Organisation (CDSCO), primarily separates norms for medical devices manufacturing from the longstanding Drugs and Cosmetics Act, 1940. The new rules have improved norms for obtaining li-

MAY / 2017 ehealth.eletsonline.com

cense and conducting clinical trials, and provides for reduced manufacturer-regulator interface by promoting digital platform. The move will boost the government’s ‘Make in India’ campaign by providing beneficial environment for domestic manufacturers that could lead to greater longterm investments. The rules are aimed to standardise and regulate medical devices manufacturing industry on par with international standards. The new rules have been framed in conformity with Global Harmonisation Task Force (GHTF) framework and follow best international practices that are expected to boost India’s local medical device manufacturing industry.

Special Feature New Classiﬁcation Scheme

The medical devices could range from simple devices such as thermometers and disposable gloves to radiology machines and implantable devices such as stents and artificial joints. Medical devices and IVD’s have been classifiede into four categories based on their risk type — Class A, B, C and D — where A and B are low risk devices such as x-ray, CT, MRI, etc. C and D categories have higher risk quotient such as stents and other implantable devices. For approvals and licensing in devices falling under category C and D, the Central Government will be directly involved. The government is outsourcing the task of auditing manufacturers of devices categorised as Class A and Class B, the local equivalent of Europe’s low to moderate risk Class I and Class IIa groupings. Notified bodies, which could be “any institute, organisation or body corporate,” will audit producers of such devices to verify their conformance with the quality management system. The notified bodies will be accredited by the National Accreditation Body, which could itself be an outside firm or institute appointed by the government. The regulatory authority takes account of the probability that harm will occur by modifying the evidence requirements at the conformity assessment stage rather than modifying the classification rules. Probability of harm is influenced by factors such as whether the technology is regarded as mature; the device type is the source of many adverse event reports; the device’s manufacturer has a sustained experience of the device and the technologies it embodies; or the device user is a lay man. The hazard presented by a medical device depends substantially on its intended use and the technology it utilises. Consequently, the classification rules stipulated in this regulation factors in whether the device is life supporting or sustaining; is invasive and if so, to what extent and for

how long; incorporates medicinal products, or human/animal tissues/cells; is an active medical device; delivers medicinal products, energy or radiation; could modify blood or other body fluids; is used in combination with another medical device. A further advantage of a rules-based system of classification is that it is easily adapted to accommodate innovative technologies.

Clinical Trials Norms Relaxed

Clinical trials are one subject tackled by the new rules. Applying drug regulation to devices forced the four-phase clinical trial process on developers of medical equipment, despite much of the rest of the world having a more streamlined pathway. The new rules have a two-phase clinical trial process, in which safety is assessed in a small number of patients before a larger pivotal efficacy study is initiated. Subjects injured in trials are eligible for compensation.

Indian Certiﬁcation for Medical Devices (ICMED) Scheme

As a step forward, Andhra Pradesh MedTech Zone (AMTZ)

Figure 1

Proposed General Classiﬁcation System and Regulatory Controls Class

Risk Level

Medical Device Examples

IVD Device Examples

Low - Risk

Bandages / Tongue Depressors/ Surgical Retractors

Clinical chemistry analyser/ prepared selective culture media

Low-Moderate Risk

Hypodermic Needles / Suction Equipment

Vitamin B12, Pregnancy selftesting, Anti-Nuclear antibody, urine test strips

ModerateHigh Risk

Lung Ventilator / Bone ﬁxation plate/Infusion Device

Blood glucose self-testing HLA typing, PSAscreening, Rubella

High - Risk

Heart Valves / Implantable Deﬁbrillator/ Pacemakers

HIV blood donor screening, HIV blooddiagnostic

Classiﬁcation System for Medical Devices& IVDs Note: The examples of medical devices provided in Figure 1(1 and 2) are for illustration only and a manufacturer of such a device should not rely on it appearing as an example but should instead make an independent decision on classiﬁcation, taking account of its design and intended use. Central licensing authority CDSCO may, from time to time, make additions or deletions in such list of medical devices or modify the class of any medical device.

MAY / 2017 ehealth.eletsonline.com

Special Feature recently signed an MoU with the Quality Council of India (QCI) to promote Indian Certification for Medical Devices (ICMED) Scheme in India. AMTZ and QCI would be working closely in this direction by joint selection of agencies for promotion of quality in medical devices and even facilitating manufacturing of recognised technologies at AMTZ. Developed in collaboration with AiMeD, QCI and the NABCB – ICMED is a quality certification scheme for medical devices in the country with an aim to enhance patient safety, and increase consumer protection along with providing much needed product credentials to manufacturers to introduce confidence among buyers. It also aims to bring down the substantial time and cost-run to obtain globally accepted quality certification for Indian companies and eliminate the malpractices of sub-standard or fraudulent certification or quality audits. The Scheme has been launched with two levels of certification: ♦ ICMED 9000 certification which is ISO 9001 plus additional requirements ♦ ICMED 13485 which is ISO 13485 plus additional requirements The MoU was signed by Dr Jitendar Sharma, Chief Executive Officer, AMTZ and Dr RP Singh, Secretary General, QCI in the presence of Dr Kamineni Srinivas, Health and Medical Education Minister, Government of Andhra Pradesh; Dr Poonam Malakondaiah, Principal Secretary-Health Medical & Family Welfare, Government of Andhra Pradesh; Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AiMeD); Anil Jauhri, Chief Executive Of-

MAY / 2017 ehealth.eletsonline.com

Figure 2 HIGHER

REGULATORY REQUIREMENTS

LOWER

DEVICE CLASS

Conceptual illustration of regulatory controls increasing with Device Class Note: indicates increasing regulatory controls as the device class progresses from Class A to Class D. ficer, National Accreditation Board for Certification Bodies (NABCB); and Mrutunjay Jena, Joint Director, NABCB and other distinguished guests.

AMTZ to Host New Help Desk of Medical Devices Rules, 2017

Last year, the Government of Andhra Pradesh established the country’s first medical technology manufacturing park, Andhra Pradesh MedTech Zone (AMTZ), in Vishakhapatnam. Andhra Pradesh Chief Minister N. Chandrababu Naidu laid the foundation stone of AMTZ. Making a humble start from Vishakhapatnam, AMTZ is carving its own path to glorious successes month after month. AMTZ has received good response. AiMED has lauded AMTZ for commencing booking of plots and the dedicated business park for medical device manufacturing was also applauded at the Indian Medical Device Conference – 2017, one of the largest events for the Indian pharmaceutical market. It was recently decided that AMTZ will be hosting the Government of India’s Help Desk of Medical Devices Rules, 2017 to bridge knowledge gaps for manufacturers. KL Sharma, Joint Secretary, Ministry of Health and Family Welfare, Government of India, permitted AMTZ to host a dedicated help desk for understanding and smooth implementation of Medical Device Rules, 2017. The Help Desk would facilitate information on following changes of Medical Devices Rules to Manufacturers: ♦ Regulation of Medical Device with Classification System ♦ Licensing Authorities and functions of Notified Body ♦ Manufacture of Medical Devices for Sale and Distribution ♦ Import & Labelling of medical Devices ♦ Clinical Investigation of Medical Device and Clinical Performance Evaluation of IVDs ♦ Import or Manufacture Medical Device which does not have Predicative Device ♦ Duties of Medical Device Officer, Medical Device Testing Officer and Notified Body ♦ Registration of Laboratory for carrying out test for evaluation ♦ Sale of Medical Device.

Special Feature

MAY / 2017 ehealth.eletsonline.com

Case Study

AIIMS

The Precursor of First Digital Revolution in Health Care The All India Institute of Medical Sciences (AIIMS) has undergone a transformation in providing a relatively far better experience than it was earlier known for among patients and for its related services, V Srinivas, the 1989-batch IAS officer, who served as the Deputy Director, Administration, AIIMS from December, 2014 to March, 2017, shares a case study with Elets News Network (ENN).

t was 3 am on a Tuesday on January 14, 2015, when Delhi recorded a minimum temperature of 5 degrees celsius. Khemraj and Mohanlal were waiting outside the Raj Kumari Amrit Kaur Out Patient Department (RAK OPD) at the All India Institute of Medical Sciences (AIIMS). Khemraj had arrived in Delhi from Bihar with his

MAY / 2017 ehealth.eletsonline.com

five-year-old son Mohanlal, braving the severe Delhi winter for medical consultations in the department of pediatrics. With great difficulty he could get accommodation at the Rajgarhia Vishram Sadan. He was told that he should reach RAK OPD by 3 am to stand in queue to seek an appointment the following day.

Case Study As they waited at the gates of the RAK OPD they noticed that they were being accompanied by several thousands of other patients. Consultations in AIIMS were not easy. Mohanlal was diagnosed with acute neuro-developmental disorders and the consultations were possible only in AIIMS. He had no idea where the department of pediatrics was and there was nobody to guide him. Still, he clung on in blind hope. He was jostled around to the registration area at 8.30 am when the RAK OPD gates finally opened. From there, he was jostled around again to the pediatrics department OPD at 10.30 am. They waited outside to meet the clinicians of pediatric neurology. There were nearly 140 patients at each clinician’s chamber on that particular day. Hours passed before they got their turn to meet the clinicians at 12.30 pm. The AIIMS pediatricians examined Mohanlal. He was advised to undergo CT scan and MRI scan for a clearer diagnosis. The consultation charges in AIIMS were Rs 300 per test as against Rs 30,000 per test charged outside. Affordable health care is not easily available in India. Both of them had to stay back for two days more for their CT scans and MRI tests. Another long wait in queues for the next two days loomed. They underwent similar experience by standing early morning queues to get the CT scan and then the MRI done. The whole experience left them exhausted. Their second consultation was scheduled three days later. It was a tough experience for them. Following the diagnosis and prescription, they were asked to return a year later. On January 31, 2016, they returned to AIIMS. Little could they believe that they could come to AIIMS at 8.30 am instead of 3 am and their consultations would be completed in two hours with doctors, who seemed more cheerful. The AIIMS e-Hospital Project and the AIIMS OPD Transformation Project had transformed AIIMS into a patient-friendly hospital saving patients’ wait times, having

electronic records, exit OPD counters and easier access to clinician’s consultation rooms. There were patient care coordinators and patient care managers to help them reach the pediatrics OPD. They could wait in a comfortable air-conditioned waiting space without being jostled around. They found their patient records were available online and consultation timings could be firmed up at the exit OPD counter. The transformation was unbelievable. Little did Khemraj and Mohanlal realised that they were now part of the first digital revolution in health care.

The Background

Rajkumari Amrit Kaur had founded AIIMS as the apex Medical Sciences University of India where the brightest doctors would pursue the trinity of goals of patient care, medical education and medical research. As the AIIMS brand got established and its fame spread far and wide, it attracted patients from all over India – 35 lakh OPD patients in 2014-15 alone. Receiving on an average 10,000 OPD patients per day, having 62 departments, 3,100 doctors, and 10,000 nurses, AIIMS represents the ultimate in India’s tertiary care. While the institute comprising highly driven professionals works with clockwork precision, the overwhelming patient flow proved impossible for a manual system to handle and required significant systemic changes in terms of improved digital practices and process re-engineering. Although AIIMS accorded highest priority to every patient, the patient journey was time consuming and exhausting.

AIIMS, UIDAI and DeiTY Collaborate for Reviving the Defunct E-Hospital Project in January 2015

Patients were amazed to see the impact of the e-Hospital project which was the government’s big initiative to create

Patients were amazed to see the impact of the e-Hospital project which was the Government’s big initiative to create an electronic platform for large hospitals.

“

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Case Study tion of the software so that the Online Registration System could be established. This was followed by the collaboration between AIIMS and Pay Gov for creation of a payment portal. Every module of the e-Hospital project was taken up for implementation in a time bound manner. The e-Hospital project necessitated transparency in OPD appointments. It also necessitated that the clinician’s OPD diaries are placed in public domain. Clinicians who had very high patient loads were encouraged to adopt caps on the number of patients to ensure simplification.

AIIMS -TCS Collaboration for Process Re-Engineering in APRIL 2015

an electronic platform for large hospitals. Prior to January 2015, the implementation of the e-Hospital project was neither effective nor well coordinated. Significant policy interventions were necessary if the e-Hospital project was to be revived. The first step in the Digital AIIMS project was the creation of an effective linkage between AIIMS, Unique Identification Authority of India (UIDAI) and the Department of Electronics and Information Technology (DeiTY). Ram Sewak Sharma had served as Director General UIDAI and was serving as Secretary, DeiTY. Sharma and V Srinivas, who was serving as the Deputy Director-Administration AIIMS, envisaged creation of an Aadhaar platform based unique health identification number for every patient visiting AIIMS. The patient could log into the AIIMS OPD Appointment System (ORS.gov.in) and submit a request for an appointment online using the Aadhaar number. The verification of the demographic details of the patient was based on one-time password which was sent to the mobile phone number of the patient registered in the Aadhar data base. The Unique Health Identification Number gave an individual digital identity to every patient visiting AIIMS. The patient could use the UHID for his entire lifetime and every consultation visit was documented by the system. The next significant step in the Digital AIIMS project was the strengthening of the AIIMS-DeiTY-NIC collaboration. Prof MC Misra, Director AIIMS, Sharma and Srinivas would convene meetings at AIIMS regularly to establish an effective tripartite collaboration. The e-Hospital project proceeding at the snail’s pace, suddenly gained significant momentum with the launch of Digital India Initiative. With the top administrative leadership involved, there was a new urgency in DeiTY, AIIMS and NIC for early comple-

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AIIMS is a very process driven organisation. There are registration forms, payment forms, consultation cards, MRI forms, CT scan forms and several slips that required to be filled. The AIIMS-TCS collaboration for the AIIMS OPD Transformation Project was conceptualised at ministerial level. N. Chandrasekaran, CEO of TCS and Girish Krishnamurthy, Senior Vice President of the company, visited AIIMS to identify the implementation modalities. They worked closely with Director of AIIMS Prof Misra and Srinivas. The approach was to facilitate faster registration; to build larger patient waiting areas; introduce new signages, screening at the entry point; employ patient care coordinators at the registration and consultation areas; and the rather unique exit OPD counters for all follow-up patients.

The First Digital Revolution in Health Care

In January 2016, OPD patients and attendants entered a new state-of-the-art Patient Registration Centrewith 50 registration counters – each one having a computer terminal equipped with the e-Hospital software. New cadres of officials – nursing informatics specialists, patient care coordinators and data entry operators – were introduced at AIIMS. Kiosks were set up at many places and the dashboards depicted the patient journey. They did not have to waste time in long queues to see clinicians. The patient care coordinators guided them to the pediatrics OPD within no time. The nursing informatics specialists gave them a plastic UHID card for future references. The registration time was reduced to a mere 40 seconds for all new appointments with UHID numbers generated from the online registration system. Fast track queues were created, where the patients who had already registered themselves under the online registration system, could get their OPD cards and move quickly to the patient waiting areas. The entire approach was one of empathy and efficiency. The most innovative feature of the AIIMS transformation model was the introduction of exit OPD counter. It enables to schedule next appointments along with all tests in an orderly manner. Patients thus had a systematised experience from the point of entry to the point of exit. They found the entire experience as ‘very satisfying’. On August 15, 2016, Khemraj and Mohanlal heard Prime Minister Narendra Modi commending the AIIMS e-Hospital project for pan India replication in every major hospital.

Case Study

MAY / 2017 ehealth.eletsonline.com

Feature

EMERGENCY CARE Lessons from Karnataka

Road Safety and Emergency Care Programme of Karnataka is among few attempts by State governments to understand the critical healthcare issues related to road safety. The important lessons learnt from this programme will prove to be of immense help in ensuring quality road accident emergency care in India, writes T Radha Krishna of Elets News Network (ENN).

ailure to adhere to road safety norms, like non-communicable diseases, is emerging as a major cause of concern in India as it leads to disability, morbidity and increased mortality. To take on the challenges posed by road safety, there is a need for inter-sector coordination among stakeholders. One of the important pillars of road safety management is the post-crash care, which includes hospital care, trauma care and rehabilitation. Karnataka Health System Development and Reform Project (KHSDRP) was a World Bank-aided project under the Department of Health and Family Welfare, Government of Karnataka, which aimed to improve health service delivery and public-private collaboration for the benefit of underserved and vulnerable groups in the State. The Road Safety & Emergency Care Programme was taken as a component of KHSDRP in its additional financing phase, which came into effect on January 22, 2013 and closed on March 31, 2016. It was decided to conduct a pi-

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lot programme on the two road safety corridors in collaboration with Karnataka State Highway Improvement Project (KSHIP) to determine how State-wide investment contributes to the State’s overall road safety strategy. Two state highways – Belgaum to Hunagund (186 kms) and Maddur to Mysore (53 kms) – were proposed and approved. Three district hospitals and 22 taluka hospitals were taken up in this project. The component included activities related to: (i) enhanced capacity on the strategic direction for road safety initiatives within the health sector in Karnataka; (ii) improved pre-hospital services for road traffic injury (RTI) emergencies; (iii) improved post-crash services in hospitals for road accident emergencies; and (iv) improved monitoring and evaluation. The initial step was to understand the situation on these two corridors. There was no reliable information regarding emergency care which has always been a part of healthcare delivery in all levels of government hospitals. Hence,

Feature the first activity decided was to conduct a situational and baseline survey on the corridors. The situational analysis would infer the current status and initiatives on road traffic injuries, existing emergency care and rehabilitative services available. The baseline survey would give an insight to what resources might be required to scale up services in hospitals, training necessity, the present private and public health care services, availability of transport and utilisation of services. Taking the help of local medical colleges of the districts of Mandya, Belgaum and Bagalkote the baseline and situational analysis was done which also included ‘black spots’ as recognised by the department personnel in the casualty. The mapping of blood banks, ambulances, police stations, private hospitals in Mandya, Bagalkote and Belgaum was done.

The Programme activities were considered under three titles:

Pre-hospital – Improving transportation by providing well equipped ambulances and Surveillance of ‘drink and drive’. Hospital – Recognising the levels of trauma care and essential needs procurement of equipment; preparation of trauma care guidelines; capacity building; introduction of injury reporting system. Post-hospital – Rehabilitation - District programme coordinators were hired to collect data of manpower and equipment at district and taluk hospitals, details of road traffic injuries and deaths from the police and compared them to the hospital data. On analysis, it was found the figures did not match, as the department was not able to collect data from private agencies. To improve the pre-hospital care, 112 casic and 48 advanced life support ambulances were procured and handed over to EMRI 108 (emergency response service). They were strategically placed at points where ‘black spots’ were identified and the personnel being trained for emergencies ensured the victims were handled appropriately to avoid further injury. Seventy-five breath analysers with printer were procured and distributed to the corridor districts to improve enforcement of ‘No Drink and Drive.’ The department had no comprehensive precise guidelines to treat emergencies at different levels of healthcare facility. It was proposed to develop the baseline of number of personnel at each level of institutions, infrastructure, kind and number of equipment, type of service to be provided at each level of care. Preparation of guidelines meant it had to be adaptable to the resources available in a Government Hospital. Dr Manjul Joshipura, the co-author of WHO trauma care guidelines and the Director of AcadName of the District

No.of No. of Admissions Injuries

Mandya 51207 Bagalkote 31458 Belgaum 65784

20065 5697 16323

emy of Traumatology, Ahmadabad, was hired to develop “Essentials for Trauma Care and Clinical Trauma Care Guidelines.” In a well-organised system, referral criteria for transfer to a higher centre were defined and staff trained to quickly identify such patients and arrange transfer so that the patient outcomes are improved. Trauma care training is given by only few institutions across the country. The project had to train 678 doctors and specialists, 1,309 staff nurses in advanced life support training and 320 lab technicians in basic life support training. This training was conducted by MS Ramaiah Advanced Centre for Learning in Bangalore. Only five batches of ATLS and three batches of BTLS could be conducted. Meanwhile, trauma care equipment were procured for district and taluka hospitals of Mandya, Bagalkote and Belgaum depending on the level of services provided and the specialists available at the hospitals. The baseline survey and the observations of the consultants had shown that the quality of injury description and entry in the casualty register is of poor quality. Each hospital followed different type of format making it difficult to compile and analyse. The injury reporting system format was prepared after brain storming of different level of doctor groups and agreed upon. New registers were procured and provided to all taluk hospital and district hospitals of Mandya, Bagalkote and Belgaum. It was compiled in an excel sheet. The Injury Reporting System was started from October, 2014.

The Injury reporting system in three districts. * March 2015-Jan 2016

After completion of the activities, it was found that the government sector health department plays an enormous role in trauma care. The data proved that mild to moderate injuries were missed out as they attend outpatients and maybe sometimes compromises between parties of the accidents fail to give exact figures on morbidity. Additional budget needs to be allocated for consumables and drugs for health care facilities on the highways. Health care personnel trained in emergency care on the highways have to work as a team which improves the outcome of victims. “Harisha Mukhyamanthri santhwana Scheme” a pioneer scheme under Suvarna Arogya suraksha scheme empanelled health care facilities which provides financial assistance for the treatment given during the golden hours is justified. * KSHIP - II is a World bank funded project under PWD which has taken up Road Safety Programme – Safety corridor demonstration in 2 State Highways.

No. of RTA attended in Gov. Hospitals*

Falls

Burns

Drowning Poisoning Animal bite

Assault

Others

9984 837 3872

974 645 1145

142 126 331

37 28 22

4829 1401 4121

348 281 2047

1769 481 1599

2483 942 5170

MAY / 2017 ehealth.eletsonline.com

Industry Perspective

All-ﬂash Storage Pushing IT Transformation in Healthcare

Today, technology is playing an important role in transforming the various segments of healthcare sector. As the healthcare industry is counting the various beneﬁts of flash storage, Dell EMC’s all-flash storage portfolio, expertise and proven offerings are helping the healthcare sector transform itself, says Abhijit Potnis, Director Technology Solutions - India and SAARC, Dell EMC, in conversation with Rajbala of Elets News Network (ENN). Tell us about the Dell EMC flash storage portfolio. As traditional organisations are challenged by new business models from new age organisations, the digital transformation is top of their agenda. Such organisations are looking at

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ways to optimise their investments in their current applications (also known as platform 2) environments) and at the same time invest that money into new age (also known as platform 3) applications. As a result, CIOs are currently look-

ing at ways to modernise their data centres to bring in agility, speed and efﬁciency in operations. Storage plays a very important role in data centres achieving these goals, therefore, CIOs are intensely looking for storage infrastructure.

Industry Perspective

MAY / 2017 ehealth.eletsonline.com

Industry Perspective

IT plays an essential role in improving healthcare, how is your flash storage portfolio helping healthcare to perform at its best? Health IT, better known as health information technology, consists of designing and creation, using information systems for the development of the healthcare industry. The role of flash storage in the healthcare industry has been incredible. Driving performance and efficiency benefits through all-flash arrays have allowed healthcare organisations worldwide to drastically improve patient outcomes making the process more productive. All-flash solutions have helped IT teams to meet the requirements of initiatives such as evidence-based care, electronic health record (EHR) systems and big data analytics. Healthcare organisations can further leverage efficiency, compliance and outcomes with all-flash storage. Dell EMC has helped Baptist Health address desktop management challenges by deploying a single 10TB X-brick Dell EMC XtremIO all-flash array, a 1350 user VMware Horizon View VDI environment, VMware vCenter,

MAY / 2017 ehealth.eletsonline.com

and Cerner Instant Access. Apart from this, we have also worked with Boston Scientiﬁc by deploying XtremIO, which is capable of maintaining high performance even during patching operations and while rolling out new desktops. The single XtremIO X-Brick not only radically simpliﬁed what had been a time-consuming process, but was also cost-effective. Also, Vidant Health chose Dell EMC XtremeIO to transform its Epic HER and support delivery of new strategic IT initiatives. In the wake of the growing need for data usage, what are the challenges and opportunities for companies and your organisation? Data is very critical for any organisation, and hence it must be protected at all cost. With the growing need for data usage, we see plenty of opportunities and threats which have emerged for various organisations. An enterprise can leverage data by collating information from across

their particular industry. This gives them a competitive edge by highlighting the potential gaps that need to be ﬁlled to beat their competition. The challenges still remain as security concerns with rising cyber-threats and the need to implement better data storage solutions. Inefﬁcient handling of data can lead to problems, with different verticals not using data in the right way in the organisation. What are the emerging storage trends in 2017? The storage trends in 2017 focuses on cloud-to-cloud backup, containers and non-volatile memory express. Cloud-to-cloud backup lets enterprises to transfer data stored from a particular cloud service to another. Container virtualisation is expected to dominate in 2017 in areas such as data protection, storage consumption and motility. An increase in shipments for server models along with hybrid and all-flash storage arrays is expected in 2017.

All-flash solutions have helped IT teams to meet the requirements of initiatives such as evidence-based care, electronic health record (EHR) systems and big data analytics. Healthcare organisations can further leverage efficiency, compliance and outcomes with all-flash storage.

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To complement this transition, Dell EMC had announced 2016 to be the “Year of All-Flash”, as solid state drives overtook traditional disk-based arrays for primary storage. With nearly 40 per cent share in the all-flash market, Dell EMC is expanding its portfolio to help customers modernise data centres. The launch of VMAX all-flash added to an already robust flash portfolio with the market-leading XtremIO all-flash array and all-flash conﬁgurations of the Unity Series. Our flash storage options offer a wide variety of data services, including capacity-saving data reduction through de-duplication, thin provisioning, space-efﬁcient snapshots, advanced encryption, delta differential-based replication and industry-leading security features. Further, the flash industry will keep on advancing itself and bring-in new innovations to serve the requirements of the major verticals like healthcare to manage the complexity across the network.

Industry Perspective

MAY / 2017 ehealth.eletsonline.com

Industry Perspective

Cloudera

Big Data Takes a Giant Leap in Healthcare Clouderaâ&#x20AC;&#x2122;s data management and analytics platform makes it easy and affordable for data infrastructure to continually derive the most value from the data streaming, data at rest, and data in motion being produced by all internal and external data sources and IoT sensors. Daniel Ng, Senior Director, APAC, Cloudera, highlights the scientific and technological innovations that are driving change for healthcare organisations and transforming the ways of treatments, in an interview with Rajbala of Elets News Network (ENN). How are innovations in the technology space changing the pharmaceutical industry? Like other industries, the healthcare and pharmaceutical sectors have transformed according to trending

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digital era and are effectively dealing with the arising issues by adopting big data and other technologies. As a matter of fact, big data and technology proved beneficial during epidemics before (preventing) and af-

ter (cure) they occur. One of the most common applications of big data and technology is signal detection and surveillance during patient intake. We have seen the health systems today often use Cloudera offerings

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Industry Perspective to ingest real-time streams of data from electronic health record (EHR) systems using the Health Level Seven (HL7) standard. As big data technology is completely open to all types and formats of data, it is suddenly possible to analyse multiple EHR feeds with clinical text as they stream in and apply intelligence to them. Notably, big data and technology has helped fight Zika, specifically in identifying patients that might otherwise escape detection due to caregiver errors or other factors. In the case of Zika, a single error or delay in diagnosis can lead to major consequences and adoption of big data can lessen this. Big data and technology helps the medical industry gain a deeper understanding of who has a particular illness, who is likely to have it, how it is spreading, and how to avoid it in the future. How is Cloudera’s enterprise-ready data management and analytics platform helping the pharma and healthcare sectors to manage and derive more value from their data management mechanisms? Cloudera supports industry to solve the big data problem with its open source platform for large-scale data processing, discovery, and analytics. For example, IMS Health (American company that provides information, services, and technology for the healthcare industry), has recently selected Cloudera enterprise to support its big data factory. Their collaboration with Cloudera has accelerated and enhanced data acquisition, processing, and warehousing in the factory. Hospitals in France are utilising big data and machine learning systems designed to forecast admission rates, leading to more efficient deployment of resources and patient outcomes.

Also, our work with Cerner has detected sepsis early enough for successful treatment. And, as a result, hundreds of lives saved and hospital re-admission rate has decreased significantly. Scientific and technological innovations are driving change in healthcare sector which also transformed the lives of patients worldwide. Till date, Cloudera has partnered with some of the leading organisations, including pharmaceuticals, biotech, health systems, and research labs. In a data-driven world, data is a huge asset for the pharmaceutical industry, what kind of framework or solution does Cloudera deploy to optimise the big-data structure, while supporting additional applications and future requirements of the industry? We believe that data can make whatever is impossible today, possible tomorrow. As a global platform for machine learning and advanced analytics built on the latest open source technologies, we work collaboratively with the open source community on R&D efforts so that innovation is accelerated and the quality of software is enhanced. From healthcare organisations, to banks, telcos, governments, and more, we have served major industry brands to help solve their most challenging problems with Cloudera Enterprise, the fastest, easiest and most secure modern data platform. With Cloudera Enterprise, customers can efficiently capture, store, process, and analyse vast amounts of data, empowering them to use advanced analytics to drive business decisions quickly, flexibly, and at lower cost. Moreover, for successful integration of the technology, we also offer comprehensive support, training, and professional services.

Tell us about the Hadoop/open source platform and its impact on the operations of a pharmaceutical company. Brief us about any recent deployments done. Apache Hadoop and the larger opensource ecosystem are at the centre of the big data revolution, enabling healthcare organisations to cost-effectively drive change and improve the lives of patients worldwide. Some of the most powerful changes made possible are in the areas of precision of medicos and genomics. With solutions that contribute to the sequencing of the human genome and providing insights into population health, terminal illnesses are now treated more effectively and chronic diseases are managed in better way. We have seen a national children’s hospital rely on our big data platform to better understand its patients, their conditions, and the quality of care they receive. We have also seen the use of sensor data to better understand and treat chronic diseases like Parkinsons. By partnering with the Michael J. Fox Foundation and Intel, we have begun to identify patterns through wearable monitors that can track patient symptoms and provide continuous feedback.

We believe that data can make whatever is impossible today, possible tomorrow. As a global platform for machine learning and advanced analytics built on the latest open source technologies, we work collaboratively with the open source community on R&D efforts so that innovation is accelerated and the quality of software is enhanced.

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MAY / 2017 ehealth.eletsonline.com

Industry Perspective

MAY / 2017 ehealth.eletsonline.com

Industry Perspective

Augmented & Virtual Reality

Overcoming Limitations in Healthcare Technology adoption has spun the way healthcare and pharma industries are operating these days. These industries are on the forefront in adoption and integration of virtual reality, augmented reality and mixed reality, says Ninad Chhaya, COO, WITS Interactive and Co-Founder and COO, GoPhygital, in conversation with Rajbala of Elets News Network (ENN). What is the scope of augmented reality (AR), virtual reality (VR) and mixed reality (MR) in pharma and healthcare sectors? With the introduction of faster and smarter technology, pharma and healthcare have progressed fast. Virtual, augmented and mixed reality are helping companies and researchers

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to adopt newer ideas leading to the improvisation of equipment maintenance, patient care, etc. Few examples of how these technologies are being used in the healthcare sector are: ♦ Patients can describe their symptoms better through augmented reality

♦ Nurses can find veins easily with augmented ♦ Pharma companies can provide more innovative drug information ♦ These technologies can assist surgeons ♦ Invoking empathy - Healthcare companies are currently using virtual reality to demonstrate what it

Industry Perspective

Technology integration supports physical therapy, pain management, hospital or doctor visit, surgical training, maintenance of labs, etc. Doctors use augmented reality as a visualisation and training aid for surgery. It may also allow collection of 3D data sets of a patient in real time using sensors like magnetic resonance imaging (MRI), ultrasound imaging, or CT scans. Interestingly, these technologies would provide surgeons access to all types of data simultaneously which will enhance their field of view with more efficient information. Augmented Reality might also be useful for training purposes. Virtual instructions could help surgeons to implement required steps instantly. What are the key factors hampering the growth of augmented reality and virtual reality (in pharma and healthcare)? According to me, the two key factors for augmented reality and virtual reality not getting acceptance in the main stream are cost and time. If such technologies are executed well, they can deliver results on a completely different level as compared to the usual methods. High cost, lack of clear regulatory guidelines for medical use, scarcity of trained healthcare professionals to operate devices are some of the key factors hampering the growth of augmented reality and virtual reality in the industry. However, high cost could impact the adoption of augmented reality and virtual reality devices. The choice and investment on the technology will influence the delivery of VR experience. Moreover, such technologies will go mainstream once the headsets become more affordable and accessible, along with the quality of content improving across the board. On the other hand, augmented reality as a technology and a medi-

High cost, lack of clear regulatory guidelines for medical use, scarcity of trained healthcare professionals to operate devices are some of the key factors hampering the growth of augmented reality and virtual reality in the industry.

“

feels like for a patient to experience medical conditions such as migraines and vertigo. ♦ Treatment for Post Traumatic Stress Disorder - By using virtual reality simulations, patients relive their most traumatic events in a safe and controlled environment.

um is growing at a really rapid pace and businesses across the globe are adopting it to meet their business objectives. This is primarily because unlike VR, which needs investment in specific hardware to experience the content, augmented reality can be experienced on any smartphone/tablet, which is getting cheaper and more powerful. Companies in this industry need to adopt these technologies depending on what the end objective is. Return on investment should not be looked at just from a pure cost perspective but also from the value that the investment delivers. Matter of fact is that these technologies have the potential to deliver truly engaging, potentially life changing experiences. Creating awareness for the technologies beyond these two verticals could change the way companies interact with their audience. What is the success rate of these technologies in upcoming years from India perspective? AR, VR and MR are slowly being adopted in India among the healthcare, retail, entertainment, education, and various other industrial sectors. With hardware getting faster, smarter and cheaper, the scope of implementing these technologies in India is starting to take-off. Currently, there are numerous AR and VR apps available on multiple platforms. As compared to a website or a mobile app which most brands use as a current means to engage with their users, VR, AR/MR has the potential to give a greater emotional resonance to objects and topics. By engaging users, the technology creates a highly compelling and enjoyable experience.

Users experience multiple scenarios in real time without the need for making decisions based on one-dimensional representations. In addition, the Gartner Hype cycle for emerging technologies, 2016, states that AR and VR are expected to become a driving force for businesses in the next 5 to 10 years. These technologies bring immersive opportunity and leveraging them will not help save time and money, but also transform ideas/experiences that could possibly disrupt the current business landscape in India. How have augmented and virtual reality technologies in healthcare are offering high growth opportunities for players active in the industry? Augmented reality and virtual reality are gaining prominence among medical personnel for various applications ranging from surgical training to rehabilitation. Various healthcare IT-enabled companies are venturing into the AR/VR healthcare market to capitalise on the high growth opportunities they offer. According to reports, the projected multi-billion dollar market is expected to grow at a robust double digit CAGR during 2016–2024. Internationally, medical schools like the John Hopkins School of Nursing, pharma companies like Abbott and GlaxoSmithKline Pharmaceuticals Ltd, have already incorporated AR and VR into their business practices. Moreover, these technologies carry enough potential to enhance the learning process, provide high-level interaction with the learning content, and can foster active engagement by students and trainees to adapt to entire new capabilities and experiences.

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Feature

TAKING MCH CARE

in Karnataka to the Next Level

A three-year pilot project to reduce infant and maternal mortality and morbidity in Karnataka has been initiated jointly by India and Singapore with an aim to share knowledge and skills in managing high-risk pregnancies, obstetric and neonatal emergencies, strengthen work systems and processes, writes T Radhakrishna of Elets News Network (ENN).

T 34

he Singapore International Foundation (SIF) in partnership with Singapore’s largest healthcare group, the Singapore Health Services, (SingHealth) together with the State Institute of Health and Family Welfare (SIHFW), Government of Karnataka, has

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launched a three-year training programme to reduce infant and maternal mortality and morbidity in Karnataka and create sustainable healthcare improvements for the community. This collaborative effort titled – “Enhancing Maternal

Feature

Over the next three years, a multidisciplinary healthcare specialist volunteer team comprising obstetricians, neonatologists, midwives and senior nurses from Singapore General Hospital’s Department of Obstetrics and Gynecology and Department of Neonatal and Developmental Medicine, will train 200 healthcare professional from tertiary and secondary care government hospitals in Karnataka.

“

and child Health (MCH) Services Programme” – is designed to share knowledge and skills in managing highrisk pregnancies, obstetric and neonatal emergencies, strengthen work systems and processes as well as to enhance the capacity of healthcare workers in delivering higher quality accessible and affordable care for pregnant women and babies. Over the next three years, a multidisciplinary healthcare specialist volunteer team comprising obstetricians, neonatologists, midwives and senior nurses from Singapore General Hospital’s Department of Obstetrics and Gynecology and Department of Neonatal and Developmental Med-

icine, will train 200 healthcare professional from tertiary and secondary care government hospitals in Karnataka. Over a series of training workshops, the specialist team will equip participants with the necessary skills and knowledge to address some of the key factors contributing to maternal and newborn deaths. Out of the 200 trained Indian healthcare professionals, 40 master trainers will then train another 200 more medical professionals, cascading the impact within the community. As estimated, 100,000 pregnant women and their newborn babies in Karnataka are expected to beneﬁt from this enhanced MCH care. This partnership will see the three collaborating organisations draw on their community networks to share best practices and leaning journeys at a symposium in Karnataka. A study visit to Singapore will also take place to facilitate the sharing of knowledge and experiences of Singapore’s journey in enhancing MCH services. The launch event was held at the VikasaSoudha recently and was attended by both Singapore and Indian partners and stakeholders, including Principal Secretary to Government, Health and Family Welfare Department, Dr Shalini Rajneesh, IAS, Consul General Roy Kho, Republic of Singapore, Singapore International Foundation Governor Lian Wee Cheow, Professor Tay Boon keng and Associate Professor Chua Yeowleng from SingHealth.

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Industry Perspective

Delivering Miracle Health Solutions for Quality Patient Care

With more than two decades of dedicated effort to help hospitals go paper-less, the healthcare IT solutions offered by Akhil Systems are gradually transforming the healthcare landscape in India. Rekha Jain, Director, Akhil Systems Private Limited, in a conversation with Elets News Network (ENN), talks about the journey so far and the various challenges that the company faces to help hospitals deliver quality healthcare across the world. Tell us about your journey into healthcare IT. Driven by the passion for business, Akhil Systems was established in 1994 which marked my journey as the Director of the company. With just a handful of trustworthy employees,

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we began our journey with a vision to become a healthcare information technology (IT) leader. It was quite difficult for us in the late 20th Century to convince and encourage healthcare setups to adopt IT owing to resistance to change as well as lack of aware-

ness. We struggled in the initial stage of the business but subsequently we got few orders from South India. Right from the beginning, we knew that by maintaining a good reputation in the industry with equal stress on product advancement and dedicated support

Industry Perspective

What are the key benefits hospitals draw from adopting solutions by Akhil Systems? Our Miracle HIS (Hospital Information System) comes with countless benefits, as it has the capability to facilitate a “no-paper” working environment in hospitals. Complete digitisation of hospitals offered by our HIS reduces the chances of human errors. The digitisation has helped hospitals to seamlessly connect with patients with the help of an excellent communication system. Through our healthcare solutions, patients can book their appointments and even pay for it while comfortably sitting at home. Moreover, if patients want to get their sample collected from home then they can place a request through our solutions. They can see their lab reports, prescriptions, bills and provide feedback through mobile-based applications and patient portal. Adopting healthcare solutions by Akhil Systems ensures automation of all processes which ensures improved patient care. Having done pioneering work in HIS domain, what are the current challenges for you? In the last 23 years, we overcame numerous hurdles to establish the company as one of the leading providers of healthcare IT solutions. The current challenges we face include development and implementation of Electronic Medical Records (EMR), or Electronic Health Records (EHR), which facilitates digitisation of patients’ health information. We have developed an EMR that conforms to all the healthcare standards, but despite that the acceptance of EMR is still very low especially in India. Making doctors overcome the hesitation of using EMR is still a challenging task. Share with us your recent experience in implementations of HIS solutions.

With the state-of-art Miracle HIS put to use by the best names in the professional circles, the hospitals are now able to provide world-class healthcare to their patients. We implemented and interfaced the best in class technology, which facilitates delivery of improved quality of care.

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will get us orders through referrals. Soon, orders started pouring in from different regions of India, pushing the growth of our business and workforce. I got the support from all the Akhilians who worked tirelessly to chase the vision of the company.

Recently, we have implemented our New Miracle HIS version in Delhi’s BLK Hospital, Moolchand Hospital and Venkateshwar Hospital; Gurgaon’s Pratiksha Hospital and Pernod Ricard Hospital; SPS Hospital in Ludhiana; Nemcare Hospital in Guwahati; Kiran Hospital in Surat; Al-Falah Medical College in Faridabad; and Teerthankar Mahaveer Medical College in Moradabad, among others. So far as our global footprint is concerned, we have implemented our HIS solutions in Lagoon Hospital in Nigeria, and many other leading hospitals in Qatar, Nigeria, Myanmar, Bangladesh and Saudi Arabia. It has been a great and reveling experience to implement and work with leading healthcare professionals

through our projects. With the state-of-art Miracle HIS put to use by the best names in the professional circles, the hospitals are now able to provide world-class healthcare to their patients. We implemented and interfaced the best in class technology, which facilitates delivery of improved quality of care. Although the implementation of HIS is not a cakewalk and we faced many hurdles, the excellent support from the professionals at the hospitals and the dedicated efforts of our implementation team helped us overcome every hurdle. By adopting the Miracle HIS from Akhil Systems, now hospitals are one step closer to realize their goal of becoming a truly paperless healthcare facility.

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Industry Perspective

HEALTHCARE INFORMATION SYSTEMS ERP to Strategic Planning and Beyond

Healthcare Information Systems market in India has immense growth potential driven by an estimated 14,000 hospitals across the country, along with the corporatisation of the healthcare provider space, growth in the health insurance market, and the development of medical tourism, writes leading healthcare IT company SoftLink International for Elets News Network.

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Industry Perspective

Trends in India

There are an estimated 14,000 hospitals in India, excluding the private clinics and nursing homes. This factor should be enough to drive the HIS market in India along with the corporatisation of the healthcare provider space, growth in the health insurance market, and the development of medical tourism. However, the HIS market in India is still in the early growth stage. In terms of technology adoption, the

SoftLink’s PANACEA HIS is HIPAA compliant, HL7 conformant with seamless integration to CIS, RIS and PACS.

In this modern age of digitisation, an investment in hospital automation will lead to efficient utilisation of resources and dynamic planning for future growth.

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The prognosis for successful Healthcare Information Systems (HIS) implementation is really great. It is expected to increase legibility, reduce medical errors, shrink costs and boost the quality of healthcare. There exists a potential for HIS to significantly increase the overall quality of health, which is evident by the investments that are currently being pumped into the healthcare IT (HIT) development and adoption. HIT consists of a wide range of networking technologies, clinical databases, electronic medical or health records, and other specific biomedical, administrative and financial technologies that generate, transmit and store healthcare information. In the past, HIS was focused on management of patients’ information, clinical records, accounting, and automated transactions. Now cloud computing, ultra-portable and powerful devices like laptops and smartphones, increased options for archiving and digitising information into readily accessible formats brings an interesting future for HIS.

Indian market is far behind its Asia Pacific counterparts such as Australia, Japan, South Korea, Singapore, and Malaysia. Undoubtedly, Indian hospitals have been very late in realising the advantages of information technology (IT). Lack of awareness, the low priority given to financing of IT-related investments, lack of suitable solutions, as well as the absence of professional decision making has led to low penetration of HIS in this high-potential market. HIS market in India was valued Rs 7.6 billion in 2013 and is expected to reach Rs 19.1 billion by 2018.

HIT Solutions by SoftLink

Incorporated in 1997 by Mr. Prakash Kamat (Chairman&MD), SoftLink International leverages two decades worth of product development and extensive R&D to offer cutting edge technology products in Healthcare-IT sector. SoftLink focuses on three key areas of healthcare automation namely Hospital Information System, Cardiology and Radiology. SoftLink's PANACEA - a Hospital Information system is fully integrated single solution ERP built exclusively for healthcare allows to access a real time patients' data across the hospital network. PANACEA is in its seventh release which is completely Cloud enabled, browser based Solution, with all clinical modules, EMR, Labrotory Information System, Blood bank etc besides core HIS modules like Appointment Scheduling, Admission, Discharge, Billing etc. As a complete ERP for Hospital, it also covers backend modules like Inventory Management, HR, Finance, Asset Management etc. PANACEA is HIPAA Compliant, HL7 Conformant and supports Snomed CT, ICD 9 & 10 code for diagnosis. It provides interfaces with smart card, barcode, RFID tags, Voice recognition and Lab equipment etc. In line with Digital India initiative, AADHAR card integration for government Hospitals is also available. PANACEA's analytical tools help hospital managers in efficient planning of resources, decision making which advances in improved discharge process turnaround time.

Future Scope of HIS

Currently the HIS is used by hospitals at departmental and institutional level only. Since many hospitals are expanding their business globally through different sister branches, there will be a shift from institution-centered or departmental hospital information system towards regional and global HIS. The inclusion of patients and healthcare consumers as HIS users, use of HIS data for health care planning as well as clinical and epidemiological research are some future lines of development in HIS.

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Industry Perspective

PATIENT-CENTRIC Services Driving Healthcare IT

As a global leader in the visualisation sector, Barco offers clear and colour-accurate networked visualisation solutions beﬁtting a modern control room, and enable unsurpassed precision with the detailed, high-quality image processing for a variety of healthcare applications. Rajiv Bhalla, Managing Director at Barco Electronic Systems, highlights the technology which raises clinical productivity and patient comfort across the industry, in a discussion with Elets News Network (ENN). What kind of innovative products and technology Barco provides to the healthcare industry? With a legacy of superior image quality and smart technological innovations, Barco has a solid reputation for delivering dependable display systems and visualisation solutions that are central to the provision of quality healthcare. Our comprehensive prod-

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uct offerings include leading-edge displays for radiology, mammography, surgery, dentistry, pathology and modality imaging, along with clinical displays for healthcare specialists, digital operating room (OR) systems and point-of-care devices. For surgery segment, we have developed Nexxis, an OR-over-IP platform for the integrated digital operat-

ing room. Built on a high-bandwidth IP platform, Nexxis offers a flexible and scalable surgical environment that enhances workflow efﬁciency and team collaboration. In addition to that, the company has also designed a complete line of high-accuracy surgical and endoscopic displays to meet the speciﬁc image-guided surgery requirements in the digital operating room.

Industry Perspective

Tuberculosis Health Action Learning Initiative

THALI is Committed to End

THALI’s Key Principles for TB Prevention and Care Health-seeking behaviour of people with symptoms

Evidence based diagnosis Standard, evidence-based treatment

TB notification by providers Treatment follow through

MULTISECTOR PARTNERSHIPS Medical Education Institutions

• Establish the vision to end TB. • Have the political & administrative will to support TB elimination.

• Educate students & budding health professionals on RNTCP & STCI. • Promote Standards for TB Care among health professionals.

Ministry of Health

Academia & Professionals

• Oversee the National TB Program as its steward. • Foster & facilitate multisector collaboration to eliminate TB.

• Support RNTCP program management through evidence & capacity building, regulatory & technical support.

Other Government Ministries

Corporate & Private Funders

• Adopt & promote RNTCP guidelines for employees & partners. • Support & influence adoption of Standards for TB Care (STCI).

• Invest in TB prevention & care for long-term returns. • Adopt standards-based TB screening & management for employees.

Affected Individuals & Communities

Traditional Donors

• Educate themselves on key standards & demand quality care. • Establish a cultural movement to fight stigma against TB.

• Coordinate with state and with each other when planning investment. • Address gaps, innovations and learning needs.

Private Health Service Providers

Media

• Adopt Standards for TB Care. • Complement the public sector in bearing the burden of TB care.

• Inform people about TB. • Highlight good practices, community insights, failures & challenges

Civil Society Organizations

Schools, Colleges & Youth

• Be the interface between communities & service providers. • Enable access to quality services & fill gaps in service delivery.

• Influence communities, families & peers to demand quality TB care. • Be the generation to end TB.

Government

for

tub a fut ure without

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Industry Perspective For better and enhanced consumer experience, Barco designs the devices which are customised and engineered to meet the medical requirements and follow the latest design speciﬁcations. Company’s customised solutions are fully medically certiﬁed, tested in-house, produced in-house and provide outstanding performance. For dentistry segment, we have developed a brand-new dental display range that meets all imaging needs including infection control, precise images, and an attractive, versatile design, etc. How are you leveraging ICT initiatives to enhance your offerings? What could impact the growth of health-IT? Thanks to constant innovations and major technological advancements, the impact and influence of ICT is growing across industries and market segments. The healthcare industry is no exception; almost all critical and non-critical healthcare processes, from patient registration to monitoring, are now being enabled by technology. Our networked visualisation solutions are the next evolution of this tech-driven health care approach, and are making patient care more user-friendly and accessible through a wide range of highly-customised solutions. There has been a tangible shift towards more patient-centric services in recent times and will drive greater growth for the Indian healthcare-IT segment. The push for smart healthcare systems has already seen increased demand for cutting-edge software to support core medical processes and hardware which enables

ready access to information at the point of care. With industry standards also making the integration of different patient care systems simpler and more convenient, the sector is set to witness massive business growth in the near future.

news, however, is that the country is making rapid strides in tech adoption and innovation. Given the rate at which the country is progressing, it is not difﬁcult to envision India emerging as the global tech hub within a decade.

What are the major opportunities and challenges you face in the Indian market? One of the major operational challenges for networked visualisation solutions in India is to have a strong partner ecosystem; the solutions for different markets are quite complex and involve multiple technologies, stacks, and hardware. There is also a need to breakthrough the technological barrier. Despite being the largest exporter of skilled IT workforce in the world, technology in India is still largely the domain of certain privileged sections of the society. Despite the roadblocks, we have managed to carve our own niche in a journey of over two decades and have established Barco as the leader in the Indian visualisation industry. With the country now rapidly integrating tech into all aspects of its functioning, there is an immense scope of opportunity for us to build on our strong market position and deliver high-quality networked visualisation solutions to businesses across the country.

What are the strategies you are looking to implement, and where do you see Barco in India in the next three to ﬁve years? Barco provides networked visualisation solutions to smart cities across the world and is the single largest source for control room solutions. Convergence and collaboration are the future drivers, and Barco has already established its leadership position in these areas. We also plan to work closely with the government to support the ‘Make in India’ and ‘Digital India’ initiatives. We believe it is a win-win way of creating an entire ecosystem that will facilitate industry collaboration for promoting latest manufacturing technologies.

Is India comparable to the global setup in terms of demand and technology utilisation? India still has some way to go before it can catch up with the more developed countries when it comes to technology and utilisation capability. The good

Which activities Barco is undertaking to scale up its R&D efforts? Barco has its hardware and software lab in India, and we plan to expand it further in line with the increase in our contribution in production development. With our current setup in India, we are increasingly becoming a part of product development by deﬁning architecture and standardising software development aligned with Barco divisions and measurability at every stage. Our goal is to scale up not just in numbers but also the quality of our output.

There has been a tangible shift towards patient-centric services in the recent times and it will drive growth for the Indian healthcare-IT segment. With industry standards making the integration of different patient care systems simpler and more convenient, the sector is set to witness massive business growth.

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Host Partners

#HLF_Karnataka healthsummit.eletsonline.com/karnataka/ Department of Health and Family Welfare

NHM Karnataka

Suvarna Arogya Suraksha Trust

Supported By

Conference Report @ehealthonline

KR RAMESH KUMAR Minister For Health & Family Welfare, Government of Karnataka

KK SHAILAJA TEACHER Minister for Health and Social Welfare, Government of Kerala

MARKING A PARADIGM SHIFT IN

HEALTHCARE

The healthcare sector is witnessing a paradigm shift, with the focus of government policies shifting towards providing inclusive and value-based healthcare. The Karnataka Healthcare Summit-2017 set a major milestone for the sector by pushing for restructuring the healthcare delivery system by adopting new innovations, replicating fresh models and initiatives to make it more outcome focused. The summit has marked a new beginning in the Indian healthcare space by underscoring the need to make a collaborative and focused effort to take healthcare to publicâ&#x20AC;&#x2122;s doorstep. MAY / 2017 ehealth.eletsonline.com

Conference Report Executive Summary The Elets Healthcare Summit in Karnataka witnessed congregation of policy makers, district and taluk health officers, district surgeons, technical experts, hospital, insurance companies and several private players operating in the healthcare segment - all under the same roof. The day-long summit, held on 11th April, hosted by the Government of Health & Family Welfare, the National Health Mission and Suvarna Arogya Suraksha Trust with the support of Elets. The summit had two segments wherein panellists on one side hosted discussions on wide range of themes. The companies on the other got an opportunity to showcase their products and devices through an expo exhibition. The summit witnessed discussions on various aspects of quality healthcare delivery including – leadership and governance, health financing and CSR initiatives, significance of PPP model in healthcare, role of Self Help Groups and the important role being played by ICT in healthcare to make delivery of quality health services more inclusive. Inauguration of the Event by the Karnataka Health Minister, KR Ramesh Kumar The summit was inaugurated by K R Ramesh Kumar, Minister for Health and Family Welfare, Government of Karnataka along with Shailaja Teacher, Minister for Health and Social Welfare Minister, Government of Kerala, Dr K Rajeshwara Rao, IAS, Joint Secretary of Ministry of Health and Family Welfare, Government of India, Dr Rathan Kelkar, Mission Director, National Health Mission and Executive Director, Suvarna Arogya Surakhsa Trust, and head of companies including The New India Assurance Company, Biocon Foundation and PerkinElmer Pvt. Ltd. This session emphasised on the aspect of ‘health for all’ as being the mandate of Karnataka and Kerala Government and representatives from the Central Government further emphasised on new healthcare policies that aim at a more inclusive approach towards extending healthcare coverage and access to citizens. The representatives of private companies talked about the increasing role of insurance and CSR initiatives which aid the government’s efforts towards securing better healthcare for all. Panel 1: Leadership and Governance in Healthcare Delivery In the first session, panellists deliberated on the role of leadership and governance in healthcare delivery. The panellists included speakers from organisations such as Public Health Foundation of India, United Nations Development Programme (UNDP) and head of Manipal Hospitals among others. Panellists covered a host of issues while speaking about their experiences in using artificial intelligence in improving healthcare, conducting cost benefit analysis and targeting specific interventions to address the gaps in supply chain management of health delivery systems. The key takeaway from this session was that health remains a public good and even with the advent of technology, role of government leadership remains more of an art than a science. Innovation in government leadership demands: experimentation, rejection of outdated policies, asking correct questions, data driven decision making, incentives for service providers and sufficient budgetary outlay towards health. Panel 2: Strengthening Coordination – Self-Help Group Model for Health The second panel comprised local leaders from Karnataka and Kerala along with experts from the UNESCO who emphasised on the self-help group (SHG) model of health. The example of Kudumbashri in Kerala as a classic case of decentralised decision making was extensively deliberated upon and the speakers mentioned the success of this initiative in a state where health seeking behaviour of people remains high. The lesson learnt was that Kudumbashri holds a legal backing and through its bottom-top structured approach, it provides sufficient incentive to grassroots community which further enables participation in the scheme. Other speakers emphasised that a message that ‘health is a value of life’ must be disseminated in the community and at family level. This session and its takeaways remained vital for various district and regional health officers from Karnataka who participated in the summit. Panel 3: Best Practices from Healthcare Delivery from Indian States The third panel comprised representatives from the Governments of Karnataka, Kerala and Puducherry who shared their experiences and views on health services delivery in their respective states. The session was led by Dr Rathan Kelkar from Karnataka.

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Conference Report Executive Summary He emphasised on the poor awareness about health insurance and assurance in India building on a National Family Health Survey for which stated that just 17% of Indian people are covered by health insurance. He cited example of Karnataka which has over 90% coverage in tertiary care as a testament to this. He also underlined the successful model of Self Help Groups (SHGs) being used in Kerala and stated that Karnataka should study this model to introduce community participation with the aim of improving health coverage awareness. Following his opening remarks, representatives from Kerala and Puducherry made presentations about their respective health schemes in implementation. Kerala, in particular, highlighted its schemes which are targeted at specific health conditions rather than at specific population, which makes it easier to eliminate/reduce the impact caused by serious health conditions across the State. The highlight of the presentation from Kerala was the acknowledgement of the difficulties the State faced in scaling up initiatives from pilot projects to large scale programmes. From Puducherry, the highlight was their spending on healthcare which is 10% of their budget and over 2.5% of their GDP. Puducherryalso has a well-functioning patient referral system from government to private hospitals being examined by Karnataka. Panel 4: Health System Financing and CSR in Healthcare The fourth discussion was focussed on the theme of health system financing management and CSR initiatives in healthcare. Chaired by Dr Sudha Chandrashekhar, Director (Medical Management), SAST, this session involved panellists from WHO and private companies and foundations discussing their CSR stories. The representative of WHO provided an extensive presentation on various forms of health financing models prevalent across the world and touched upon best practices emanating from Turkey, Brazil, Thailand, Ghana, the Philippines, China, the US and Maldives. The takeaway from these best practices reveal that states must focus on the entire “health financing architecture” and invest in strategic purchasing and targeted financing in order to be responsible towards outcomes and deliveries under health management systems. The source of funding must be diversified and pooled together for streamlined financing flows. It was further emphasised that EHR and revamping supply chain management would remain game changers for health industry in India. A discussion on designing appropriate Public Private Partnership (PPP) models and stronger contracts between hospitals and government also followed. Another takeaway included the benefits that private sectors draw from government financing and thus partnerships between government and private sector must be a two-way route where they mutually work for each other’s benefits. Panel 5: ICT in Healthcare Led by Dr Rathan Kelkar, this diverse panel various players in the healthcare sector, from grassroots workers to technology companies developing tools. Dr Kelkar began by stressing the government’s commitment to using ICT in healthcare by stating that about 40 different softwares were currently being used in healthcare by the government. However, he also maintained that the government is working towards bringing the data together in such a way that it is easier to draw conclusions and report findings from the data collected by all of these softwares. He emphasised the importance of ICT in healthcare by giving various examples of how IT has been used and is being used in Karnataka. Following him, other panellists also made strong points for the use of ICT in healthcare. Panellists stressed that technology companies must recognise the need for IT in health and develop solutions to the identified problems rather than provide solutions for non-existent problems. The idea of ‘technology for the sake of technology’ was endorsed on this panel which called for useful technical solutions in health. The highlight of this session was the acknowledgement of challenges that ICT in health faces including that of adoption and implementation challenges. These range from slowing the speed of the physician, making treatment impersonal, increasing costs etc. Apart from this, maintenance and continuity of IT, data privacy of people, corruption in IT adoption by government and introducing IT as a subject in medical education were also discussed. The session was concluded with Dr Kelkar outlining the proposed and ongoing initiatives in health in Karnataka such as virtual clinics, capacity building through IT, improving data analytics etc.

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Conference Report Highlights

SUMMIT HIGHLIGHTS Chief Guest

Guest of Honour

KR RAMESH KUMAR Minister For Health & Family Welfare Government of Karnataka

KK SHAILAJA TEACHER Minister for Health and Social Welfare Government of Kerala

Co-Programme Chair

DR RATHAN KELKAR Mission Director, Department of Health & Family Welfare, Government of Karnataka

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Conference Report Inaugural Session

450+

15+

Delegates

Knowledge Sessions

Exhibitors

EVOLVING AN EFFECTIVE HEALTHCARE ECOSYSTEM

Evolving an effective healthcare ecosystem is a prerequisite for various government departments and other stakeholders in the healthcare sector. The inaugural session stressed on efforts undertaken to overcome key healthcare challenges through policy push, technology adoption, financial interventions like health insurance, quality infrastructure development, providing social security and integration of various programmes and initiatives to deliver outcome-based results. MAY / 2017 ehealth.eletsonline.com

Conference Report Inaugural Session

KR RAMESH KUMAR Minister for Health and Family Welfare Government of Karnataka

KK SHAILAJA TEACHER Minister for Health and Social Justice Government of Kerala

The main objective of Karnatakaâ&#x20AC;&#x2122;s Health and Family Welfare department is to provide quality healthcare services to the people. Health for All, Health Everywhere is the motto of the government. Our mission is to provide comprehensive and quality health care services to ensure equitable access, redress regional imbalances, stabilise population and make AYUSH systems integral part of health care.

For evolving an effective healthcare ecosystem, it is a prerequisite that various government departments and those who deal with various aspects of public health should work in tandem so that the weak links in the healthcare chain can be identified and cured or replaced. There are serious efforts being made by the union and state governments to improve the quality of healthcare delivery to the people at large.

DR K RAJESHWARA RAO Joint Secretary, Ministry of Health and Family Welfare, Government of India

DR RATHAN KELKAR Mission Director, National Health Mission, Government of Karnataka

The National Health Policy, which is in place, gives a strategic direction for the development of health sector. In the context of the policy, investments are expected to be doubled for infrastructure, Human Resource, and technology. This is one of the important landmarks and perhaps it will trigger a lot of developments in the near future in the health sector.

Today, we are facing various challenges in the healthcare. We have overcome many of them, while we are still fighting against some. These challenges are on as we move on. Itâ&#x20AC;&#x2122;s not so easy to provide health services to all. Nevertheless, the health as topic has been taken up by the society itself, and the society has been evolving strategies to overcome the public healthcare concerns.

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CREATING

a Road Map for Inclusive

HEALTHCARE

IN INDIA

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• • •

• •

• • •

• • • • • • • • • • •

Conference Report Inaugural Session

Key Takeaways

♦ Providing health services to all is a daunting challenge. Increasing awareness has led the society to take on the challenges and evolve strategies to tackle public healthcare concerns. ♦ Only 17% of population in India is covered by health insurance and as much as 80% of expenditure on health is out of pocket or not covered under the health insurance, which is the single biggest factor for pushing middle class families to the below poverty line. ♦ India has six independent insurance companies apart from 22 General Insurance Companies, which take care of health insurance needs of the entire country. ♦ One of the major challenges faced by health insurance companies is exhorbitant rates charged by hospitals for treatment and drugs. There is a need to have regulations in these two areas to make affordable healthcare a reality. ♦ To ensure highest level of standards at PHCs, a data-driven approach needs to be adopted. The eLAJ clinic model by Biocon Foundation, which digitises records of patients and also integrates health camp data. eLAJ has three interconnected modules: registration, clinical consultantion and diagnostic. Telemedicine can be built into this model for specialist consultation. ♦ Insights on the quality of air, water, food and materials help ensure the safety of entire communities. ♦ Besides six AIIMS that are already functional and AIIMS Rae Bareli that is under construction. As mnay as 13 more AIIMS are announced. Out of which, five AIIMS have been approved by the cabinet. ♦ In India, more than two- thirds of expenditure on health is through Out of Pocket (OOP) which is the most inefficient and least accountable way of spending on health. ♦ A new mission -- ARDRAM -- is being implemented in Kerala, which is primarily intended to modernise the public hospitals and make them patient friendly. ♦ Kerala’s new health policy aims not only to make structural modifications but also lay down a holistic health scheme to integrate modern medicinal system with the AYUSH streams. ♦ The Government of Karnataka this year allocated Rs 5,118 crore for the Department of Health and Family Welfare, which is more than the previous budget allocation. ♦ Five Super Speciality Hospitals to be established in Karnataka at a cost of Rs 25 crore each for treatment of cancer, heart diseases and other lifestyle diseases. ♦ One ambulance service to be provided in a radius of 10-15 km for population of every 35,000 in Karnataka. ♦ Under National Health Mission, dialysis centres to be established in 114 taluks of Karnataka. ♦ AYUSH Treatment Centres to be established under NHM in all taluk hospitals of Karnataka. ♦ Extension of e-Hospital programme to 206 community health centres and 2,353 PHCs in Karnataka under NHM.

JAYASHREE THACKER President, PerkinElmer (India) Pvt Ltd PerkinElmer had been present in India since 1984 through a channel partner. From 2007 onwards, PerkinElmer (India) is operating as a 100% subsidiary of its parent organisation from Mumbai with regional offices across the country. We also have a diagnostic lab in Chennai. We deliver innovative solutions in the areas of diagnostics, life sciences, and applied markets. Our solutions help scientists, lab professionals and clinicians answer important questions linked to the impact of environment on human health.

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Conference Report Inaugural Session

TL ALAMELU Director and General Manager The New India Assurance Company Ltd In India, only 17% of the population is covered by health insurance. A study shows that the single biggest factor for pushing middle class families to the below poverty line (BPL) is mainly expenditure on health. People struggle to come up while health issues push them down. As much as 80% of expenditure on health is out of pocket or not covered under the health insurance. Of which, 28% is the borrowed money. That is how people survive health issues in India.

The main focus of the summit was on four thematic areas: Best practices in healthcare delivery, leadership and governance to healthcare delivery, strengthening coordination – self-help group model for health, information communication technology in healthcare. DR SUDHA CHANDRASHEKAR Director (M), SAST Gratitude is a powerful process and I have the pleasant task of expressing our thanks to everyone involved in the event through their presence today or assisting in organising this health care summit. Health translates beyond boundaries and Honarable Health Minister of Kerala has taken time off from her state to be here today and share her thoughts.

RANI DESAI Head, Strategy and Operations, Biocon Foundation We have developed Primary Health – eLAJ clinic model, which combines EMR has been developed especially for the primary healthcare. It can be installed at any PHCs in the country. eLAJ digitises records of patients and also integrates health camp data. eLAJ has three interconnected modules such as registration, clinical consultation and diagnostic. These modules talk to each other’s database effectively. We can also build telemedicine into this for specialist consultation.

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Conference Report Plenary Session 1

LEADERSHIP AND GOVERNANCE IN HEALTHCARE DELIVERY Governance and leadership in health are crucial features of the countryâ&#x20AC;&#x2122;s developmental goals and are intricately related to issues linked to fixing accountability and strengthening the healthcare delivery system. The session, Leadership and Governance in Healthcare Delivery, highlighted innovative ways to redress the limited institutional capacity in India, measures undertaken by the Government of Karnataka to fill delivery gaps and how leadership needs to align itself with changing paradigm.

DR PRIYA BALASUBRAMANYAM KAKKAR Senior Public Health Specialist, Scientist and Director Public Health Foundation of India Governance in health is being increasingly regarded as a salient theme on the development agenda. Leadership and governance in building a health system involve ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system design and accountability. The need for greater accountability arises both from increased funding and a growing demand to demonstrate results.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 1 DR ALEXANDER THOMAS President AHPI and ANBAI

DR SHACHI ADYANTHYA Senior Project OďŹ&#x192;cer, National Health System Strengthening, UNDP

Innovation is driving health sector in Karnataka. One of the innovations that the Government of Karnataka has undertaken is to run specialist courses for doctors in the State by the National Board of Examinations (NBE) to address the shortage of specialist doctors... The Board at present conducts postgraduate and postdoctoral examinations in 54 disciplines.

The Ministry of Health and Family Welfare is currently rolling out an innovative electronic vaccine intelligence network called eVIN across 12 states in India. eVIN aims to support the Government of Indiaâ&#x20AC;&#x2122;s Universal Immunisation Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in these states. The technological innovation is implemented by the UNDP with financial support from Gavi - The Vaccine Alliance.

DR AJAY BAKSHI MD and CEO Manipal Hospitals

TL ALAMELU Director and General Manager The New India Assurance Company Ltd

How does healthcare delivery impact Governance? How do we build organisations and leaderships to manage new paradigm better? It is really matter how do we use knowledge for the betterment of individual, community, society, etc. In my view, the modern sense of leadership listens and asks right questions.

As part of innovation, the New India Assurance has introduced Cancer Medical Expense Policy. The idea behind introduction of the policy is to spread awareness for the prevention of the disease. This policy has helped the New India Assurance reaching a large number of people.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 1

Key Takeaways ♦ Governance and leadership in health are linked to the need for greater accountability arising from increased funding and a growing demand to demonstrate results. ♦ One of the innovations that the Government of Karnataka has undertaken is to run specialist courses for doctors in the State by the National Board of Examinations (NBE) to address the shortage of specialist doctors. ♦ The Ministry of Health and Family Welfare is currently rolling out an innovative electronic vaccine intelligence network called eVIN across 12 states in India. ♦ eVIN aims to support the Government of India’s Universal Immunisation Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points. ♦ eVIN has been rolled out in 371 districts of Assam, Bihar, Chhattisgarh, Gujarat, Himachal Pradesh, Jharkhand, Madhya Pradesh, Manipur, Nagaland, Odisha, Rajasthan and Uttar Pradesh. ♦ There are only 8 diagnostic labs per 100,000 people in India and 70 per cent of the diagnostic industry functions without pathologists, biochemists or microbiologists. This poses a challenge for ensuring quality services.

DR CHARUSHEILA RAMKUMAR OncoStem Diagnostics Ltd OncoStem’s focus is on developing tests to identify patterns of recurrence in various cancers. While most cancer treatment is primarily geared toward preventing cancer recurrence, the knowledge of a patient’s risk of recurrence is critical in tailoring personalised therapeutic strategies.

PROF KSHAMA HIREMATH Director and Co-founder, Trident Diagnostics, Bangalore Sixty to seventy per cent of medical conditions depend on diagnostic and laboratory tests. The Indian Laboratory and Diagnostic Market is touted to touch US$5.5 billion by 2020. Presently, approximately 100,000 diagnostic laboratories are functioning in India of which only 1% of the diagnostic labs are accredited.

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Conference Report Plenary Session 2

BEST PRACTICES IN HEALTHCARE DELIVERY FROM INDIAN STATES As India moves closer to its Universal Health Coverage goal, lessons from innovative programmes initiated by various states can play a crucial role in realising it. The session, Best Practices in Healthcare Delivery from Indian States, highlighted some of the unique programmes that are making healthcare in the country people-friendly and affordable.

DR RATHAN KELKAR Mission Director, National Health Mission and Executive Director, Suvarna Arogya Suraksha Trust, Department of Health and Family Welfare Government of Karnataka Karnataka is the first state in India to move towards universal health coverage (UHC) for all its citizens. The UHCâ&#x20AC;&#x2122;s objectives include equity in access to health services, i.e., everyone who needs services should get them and not just those who can afford them; the quality of health services must be good enough to improve the health of those receiving the services; and people should be protected against financial risk, thus ensuring that cost of availing these services does not put them at risk of financial harm.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 2

Key Takeaways

♦ Karnataka covers more than 90% of its population (APL and BPL) in tertiary care. The National Health Mission, Karnataka, augments primary healthcare, while secondary healthcare is provided through a mix of schemes – both state as well as central. ♦ Tertiary care schemes are implemented by Karnataka in assurance mode as opposed to insurance mode. The scheme implemented for BPL families was commended by the World Bank which found a reduction of up to 64% in out of pocket expenses. ♦ The Government of Karnataka has announced the convergence of all health insurance schemes; inclusion of all the families under UHC; and continuation of Yeshaswini scheme. All schemes to be brought under the control of Department of Health and Family Welfare. ♦ The State Health Mission in Kearala will work to ensure the success of Ardram Mission, which will be implemented in three stages in Government Medical College Hospitals, District Hospitals, Taluk Hospitals, Ayurveda and Homeo Hospitals and Primary Health Centres. ♦ A Task Force and a full time Chief Executive will be in charge of managing the day to day affairs of the Mission. Additional Chief Secretary of the Health Department will serve as the Mission Secretary and the Chairperson of Task Force.

DR NEETA VIJAYAN MP Senior Programme Manager, RCH, National Health Mission, Government of Kerala

KV RAMANA Director, Department of Health Puducherry UT

Ardram Mission is a project to make government hospitals people-friendly by improving their basic infrastructure. Government hospitals can be made people friendly to a large extent by ensuring that out-patient medical checkup and other investigation facilities are timely available. This would also enable the hospital administration to give adequate attention to in-patient services.

The Government of Puducherry has given utmost priority to the healthcare. We offer free-medicare to all its citizens. As much as 2.5% of Puducherry’s GDP is being invested on healthcare. Eight to ten per cent of planned budget goes to the Department of Health and Family Welfare. Increasing demand for cardiac surgery and lack of skilled manpower has led to signing of an MoU between the Department of Health and Lifeline Hospital, Chennai on PPP mode.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 3

STRENGTHENING COORDINATION â&#x20AC;&#x201C; SELF-HELP GROUP MODEL FOR HEALTH One of Indiaâ&#x20AC;&#x2122;s inherent strengths is self-help groups, which are efficiently making the last mile delivery of healthcare services a reality. This session highlighted that having already several achievements under their belt, the successful models of self-help groups across the country can be replicated elsewhere and the cumulative learnings from their experiences can make a huge contribution in strengthening the very fabric of the Indian healthcare system.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 3

Key Takeaways ♦ Karnataka Health System Resource Centre channelises technical assistance and provides capacity-building support to Karnataka State Government to strengthen the Public Health System in the state. KSHSRC also acts as facilitating agency for Civil Society action. ♦ Kudumbashree, a community organisation of Neighborhood Groups (NHGs) of women in Kerala, has been recognised as an effective strategy for the empowerment of women in rural as well as urban areas – bringing women together from all spheres of life to fight for their rights or for empowerment. ♦ Kerala has a high female literacy rate of 86.2%, a low infant mortality rate (IMR) of 12 (against the national average of 40 a favourable sex ratio of 1032 female/1000 male, low maternal mortality rate (MMR) 0.8/1000 and a high life expectancy of 74 female/70 male. ♦ Self-help groups are seen as instruments for goals including empowering women, developing leadership abilities among poor people, increasing school enrollments, and improving nutrition and the use of birth control.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 3

DR SM SADHANA Executive Director, Karnataka Health System Resource Centre Government of Karnataka KSHSRC was started in 2009 to technically assist the Department of Health and Family Welfare, Government of Karnataka to build the capacities of the officers of the Department. KSHSRC proactively identifies the issues, gaps, deficiencies in the health system and works towards solving them. It has expanded its activities by entering into collaboration with like-minded agencies who work in health – research, strengthening public health, hospital research and health policy.

DR DIVYA S IYER Sub-Collector, Thiruvananthapuram District, Government of Kerala

PROF DR AMINA ATHER Directoral Jury for Sustainable and Community Outreach, Public Health, UNESCO

Kerala is ensuring participatory model of healthcare. ‘Kudumbashree’ is one such great example. Kudumbashree is Kerala’s State Poverty Eradication Mission, which was launched on May 17, 1998. The Mission aims to eradicate absolute poverty within a definite time frame of 10 years under the leadership of Local Self Governments formed and empowered by the 73rd and 74th Amendments of the Constitution of India.

The system of Self-Help Groups was started 70 years ago. Self-Help Group (SHG) is a small voluntary association of poor people, preferably from the same socio-economic background. They come together for the purpose of solving their common problems through self-help and mutual help. The SHG promotes small savings among its members. A SHG may be registered or unregistered.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 4

HEALTH SYSTEM FINANCING MANAGEMENT Healthcare financing and management is the key to ensuring access to quality and affordable healthcare services in India. But there is no perfect health financing model, and there is a need to understand the entire health financing architecture to make it work. CSR in healthcare, as followed by Karnataka, can be one of the many ways to raise resources to fund healthcare initiatives.

SUDHA CHANDRASHEKAR Director (Medical), Suvarna Arogya Suraksha Trust, Department of Health and Family Welfare, Government of Karnataka â&#x20AC;&#x153;Resources are important for functioning of operations smoothly. So how to raise resources? When we visit district or taluk hospitals we feel that resources or funds allocation to them are always less. There are many ways to raise resources. Corporate Social Responsibility (CSR) is one way of raising funds. How can we do local resource mobilisation to meet some of the critical needs! Two aspects are important. One, how to raise resources, and another, how to manage them?â&#x20AC;?

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 4 PRIYANKA SAKSENA Technical Oﬃcer World Health Organisation

RAVI BHANDARI CEO Shalby Ltd

Achievement of Universal Health Coverage (UHC) has been adopted as a health system goal by many governments, including India. UHC means access to needed quality health services for everyone without financial hardship. Progress towards UHC depends on all aspects of health systems.

Shalby Hospitals is a chain of Multispecialty Hospitals. It has nine hospitals having full-fledged operations across six locations in Western and Central India and three more multispecialty medical facilities in various stages of completion and commissioning by the end of 2016. This will help the group to cross 2,500 beds mark from its current installed capacity of 1,700 beds.

NEERAJ LAL Cluster Head & Vice President Rainbow Children’s Hospital

Key Takeaways ♦ Corporate Social Responsibility (CSR) is one of the best ways of raising financial resources in health sector. Mobilisation of local resource to meet critical needs should also be stressed upon. ♦ For UHC to be effective, all people and communities should be able to use promotive, preventive, curative, rehabilitative and palliative health services of acceptable quality as per their need. ♦ Turkey’s Unified Health Transformation Programme is an excellent example of strengthening and reforming the health system to improve performance both in terms of equity and efficiency.

Rainbow Hospital for Women and Children has 15 glorious years of excellence in child care, women care and fertility. It is the first corporate children’s hospital in India, started on November 14, 1999 on Children’s Day. Setting the benchmark in neonatal and paediatric intensive care, Rainbow has played a major role in saving thousands of critically ill children and has emerged as one of the best children’s hospital in the country.

♦ In terms of innovative financial models for healthcare, Ghana’s National Health Insurance Service stands apart. ♦ Philippines’ tobacco taxation is a major source of finance for health sector. ♦ Successful reforms in health financing have features like mandatory enrollment with progressive contributions.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 5

ICT IN HEALTHCARE ICT in healthcare should be designed in such a way that it should be able to develop a secure environment and maintain a uniform flow of information, according to experts who addressed the session, ICT in Healthcare, at Healthcare Summit Karnataka. The use of technology must be linked to the quality and efficiency of the services delivered. To address the ‘real problems’ should be pivotal to the use of information technology in healthcare.

DR SANJAY SHARMA Secretary, Telemedicine Society of India, Karnataka Chapter Why do so many seemingly great technologies fail to penetrate the healthcare system? Many new technologies do not address the real problem. Technology is worth nothing if it does not solve an important problem or improve lives. No one wants to pay for new technologies. Patients, physicans, hospitals as well as insurance companies think that someone else should pay for new technology… Moore’s law predicts that every two years the cost of computing will fall by half. Computers make things better and cheaper. In healthcare, new technology makes things better but more expensive.

MAY / 2017 ehealth.eletsonline.com

Conference Report Plenary Session 5

Key Takeaways ♦ Many new technologies fail to penetrate the healthcare system because they do not address the real problem. ♦ ICT in healthcare should be calibrated to solve important problems or improve lives. ♦ A mechanism needs to be evolved to get clarity as to who should be paying for the adoption of new technologies. ♦ Often the basic design requirements for medical IT systems stem from the needs of hospital administrators, insurance companies, and other stake holders, whose priorities have much more to do with collecting data for billing and administrative purposes than providing doctors with tools to support their work. ♦ Technology in healthcare is increasing costs. Moore’s law predicts that every two years the cost of computing will fall by half. Computers make things better and cheaper. But in healthcare, new technology makes things better but more expensive. ♦ Even a well-designed tech product can become user unfriendly if it takes more than a few minutes to use, as doctors lack time. The quality of the care can be enhanced through reasonable cost-effective methods, decreasing the clinical dispute, increasing customer satisfaction and bringing in more profit or value for money.

NAGESH RANGAPPAN CEO iMedrix Solutions Pvt Ltd

DR PUNEET MEHTA Medical Superintendent and Head of the Unit Billroth Hospitals

The fact that we, as a Silicon Valley entity, do all our lead R&D in India speaks volumes to the quality of our founding team in India. We will be evolving our roadmap further, primarily out of Bangalore to make a telemedicine aggregator. This scalable architecture, called the IOT telemedicine stack, is being developed both in the US and India jointly.

Billroth Hospitals, which is a National Accreditation board for hospitals (NABH) certified, aims to provide standard health care with its world-class facilities and infrastructure. Our state-of-the-art technology and well-qualified doctors and nurse practitioners contribute to the success of the institution by providing maximum care and support to the patients.

MAY / 2017 ehealth.eletsonline.com

Conference Report Felicitation Ceremony

(L-R) Karnataka Health Minister KR Ramesh Kumar felicitating Dr K Rajeswara Rao, Joint Secretary, Ministry of Health & Family Welfare, Government of India.

(L-R) Kerala Health Minister KK Shailaja Teacher and Karnataka Health Minister KR Ramesh Kumar felicitating TL Alamelu, Director and GM, The New India Assurance Company Ltd.

(L-R) Jayashree Thacker, President, PerkinElmer Pvt Ltd, being felicitated at the Karnataka Healthcare Summit 2017.

(L-R) A reprsentative of HSCC (India) Ltd being presented with the PSU Leadership Award.

(L-R) Dr Shachi Adyanthaya, Sr. Programming Officer, UNDP India being felicitated by Dr Rathan Kelkar, Mission Director, National Health Mission, Karnataka.

(L-R) Rani Desai, Head, Biocon Foundation, being felicitated by the Karnataka Health Minister.

Leaders in the healthcare space are vigourously pushing the sector to the next level through their innovative ideas and firm belief that India can emerge as a major global healthcare hub. Recognising their key role in transforming healthcare space, the Karnataka Healthcare Summit-2017 felicitated leaders in healthcare space for their significant contribution to the field.

MAY / 2017 ehealth.eletsonline.com

Conference Report Expo With several leading healthtech companies showcasing their latest products and solutions, the Karnataka Healthcare Summit-2017 emerged as a convergence point for leading technologies and innovations in healthcare space.

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