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FEBRUARY 2020, VOLUME 4 ISSUE 2 `200 INDIA MED TODAY

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AHPI

Special Issue

INTERVIEW

Dr Girdhar Gyani, Director General, AHPI Dr H Sudarshan Ballal, Chairman, Manipal Hospitals Dr Alexander Thomas, Founder-Member and President, AHPI Dr Naresh Shetty, President, MS Ramaiah Memorial Hospital

HEALTHCARE

REIMAGINED WITH NEW OPPORTUNITIES

FEBRUARY 2020

Amidst fierce competition, rapidly emerging technologies and changing regulatory requirements healthcare providers can still succeed with new opportunities

PULSE

GROWTH GRAPH: CLINICAL DIAGNOSTICS

INNOVATE

NEW TOOLS FOR ONCOLOGISTS

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Re-imagining Healthcare THERE ARE many challenges in the healthcare delivery Industry, but there is also an opportunity to reach out to one of the largest and diverse patient population globally.

The healthcare delivery in India is largely serviced by private players who are under tremendous pressure to deliver better health outcomes whilst managing evolving consumer needs, behaviors and treatments, along with the significant shifts in the policy environments. These changes cover all aspects of the ecosystem and operating models, providing a significant challenge for the entire healthcare industry.

Our cover story looks at this situation and suggests innovative opportunities and trends for the advancement of the industry in the new decade. We also look at the new developments in oncology management through our popular section ‘innovate’. We also talk about the diagnostic segment of the industry and look at how lab diagnostic is growing in India.

The healthcare delivery in India is largely serviced by private players who are under tremendous pressure to deliver better health outcomes at minimal costs The issue also highlights the workings of a dynamic organization Association of Healthcare Providers (India). The AHPI Global Conclave is being hosted at the MS Ramaiah Medical College on Feb 7-8, 2020.

The theme of this year’s conclave is re-imagining healthcare for the next decade. Different stakeholders will come together to debate on the dimensions of challenges faced by the industry and recommend solutions for the same. In addition the 6th edition of ‘AHPI AWARDS for Excellence in Healthcare’ in defined categories will be presented on eve of 7th February 2020.

As always, if you have any comments or would like to submit an article, please don’t hesitate to contact me at mneelam.kachhap@indiamedtoday.com

this publication. While we try to keep the information timely and accurate, we make no guarantees. The views and opinions expressed in the magazine do not necessarily reflect the official policy or position of IndiaMedToday or the publication. Information on IndiaMedToday should not be used as a substitute for professional healthcare advice. Readers are advised to always seek specialist advice before acting on information contained in this publication. Never disregard professional medical advice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing.

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FEBRUARY 2020

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CONTENTS

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UPFRONT

22

SPECIAL FEATURE

COVER STORY

15

Healthcare Reimagined with New Opportunities

Amidst fierce competition, rapidly emerging technologies and changing regulatory requirements healthcare providers can still succeed with new opportunities

Developments in LabDiagnostics Driving Better medical treatment

IMPACT

24

From Front Lines to Real Solutions

03 Editorial 05 Letters 06 News roundup 42 Events listing

INTERVIEW

Dr Girdhar Gyani

26

Director General, AHPI

Dr H Sudarshan Ballal Chairman, Manipal Hospitals

Dr Alexander Thomas

PULSE

Dr Naresh Shetty

35

President, MS Ramaiah Memorial Hospital

39

Growth Graph: Clinical Diagnostics INNOVATE

New Tools for Oncologists Breakthrough in cancer diagnosis using big data analytics

4

February 2020

32

Founder-Member and President, AHPI

Association of Healthcare Providers (India) works with many stakeholders to find real solutions to care delivery in India

20

29

The pulse of Indian clinical diagnostic industry

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LETTERS SLOWDOWN IN EXPANSION

T

here is an overall slowdown in expansion plans of private healthcare players. The government has to increase its intent to collaborate with private sector, so that they understand the financial modus operandi of the private players better. Budget must pay attention to the financial viability of private healthcare by relooking at the pricing controls, reviewing the existing rates of the Government healthcare schemes,

releasing the money stuck with CGHS, ECHS etc. which hugely affects the already hit liquidity balances of the existing players. Unless these are addressed in concrete terms, it will be difficult for new entrants to seamlessly operate in the current business scenario.

Dr. Alok Roy, Chairman of Medica Group of Hospitals

The growth trajectory for the Indian pharmaceutical industry is likely to remain at 10-13% in FY2021, on the back of healthy demand from the domestic market given increasing spend on healthcare along with improving access. The aggregate revenues of ICRA sample of 21 entities registered growth of 12.4% & 12.0% in Q1FY20 and Q2FY19 respectively on Y-o-Y basis leading to H1 FY2020 growth of 12.2%.The aggregate R&D spends of top few domestic companies moderated to 7.1% in H1 FY2020 from 9.0% in FY2017, 8.8% in FY2018 and 7.8% in FY2019.

A major focus must be given to the home healthcare industry which is one of the ways to realize the government’s vision of affordable healthcare for all. However, current taxation policies and regulations do not cover home healthcare and diagnostic tests and other at-home aspects still form a large part of people’s out of pocket expenses.

Home healthcare is not recognized as a mainstream sector and should be brought under the ambit of governmental schemes like the Ayushman Bharat yojna.

Meena Ganesh, MD & CEO, Portea Medical

Gaurav Jain, Vice President & Co-Head, ICRA

In budget 2020, we would like to urge the government to introduce zerorating GST on healthcare services, provision for liberalized FDI regime for investments in health infrastructure and medical innovation fund and import duty relief for lifesaving equipment. It will help in bringing down the expenses of healthcare significantly.

Chander Shekhar Sibal, Senior Vice President, Fujifilm India

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X OF T MI IGH CLINICAL OUTCOME EXCELLENCE

INTERIVEW

JANUARY 2020, VOLUME 4 ISSUE 1 `200

Mayank Bathwal, CEO, Aditya Birla Health Insurance

DR. SUBRAMANIA IYER, HOD, PLASTIC & RECONSTRUCTIVE SURGERY, AMRITA HOSPITAL

INDIA MED TODAY

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Before Ayushman Bharat Yojana was introduced, very few people had any kind of health insurance, thus the government should also consider on introducing measures to increase health insurance penetration. The industry expects tax deduction cap for medical insurance under Sec. 80D. This could be a huge relief for those who are apprehensive about the rising healthcare costs. The government should also consider reducing GST slab for health insurance premiums paid, tax benefits for health checks ups and should also focus on primary care and prevention as these could be driving factors for customers to invest in health insurance. To sum it all, these measures would help in increasing health insurance penetration in India as well as bolster a culture of preventive healthcare in India.

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CHANGING DYNAMICS OF

RADIOLOGY

NORTH-SOUTH DIVIDE IN ORGAN TRANSPLANT

BUSINESS Innovative business models will lead growth in the new decade

OPERATIONAL & SUPPLY CHAIN EFFICIENCY

MAY 2019

APPROACH

JULY 2019

BETTER PATIENT EXPERIENCES

Organ Transplantation Gaining Momentum In Northern India, But Southern India Is The Hub For Organ And Tissue Transplantation

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NEWS ROUNDUP GOVERNMENT RELEASED 250 CRORES TO PRIVATE HOSPITALS, OUT OF 1000 CRORES OUTSTANDING Consequent to submission of a memorandum and meeting with the Hon’ble Union State Finance Minister Shri Anurag Thakur in the month of December 2019, during which he was provided with details of outstanding amount of Rs 350-crores from 10-hospitals out of 1000 empanelled with CGHS. Hon Minister did appreciate the issue and assured us all possible help. Our member hospitals have also been repeatedly meeting with CGHS officials. All these efforts have resulted in CGHS releasing Rs 250-crores to hospitals in past one month, which we see as positive sign. We are also being told by CGHS officials that they were soon expecting additional budget under RE and by which substantial outstanding dues may get cleared as soon as

possible.

While the total outstanding is close to 1000 crores, the approved outstanding from CGHS as on date itself stands at 450-crores, which hospitals should get forthwith.

IMA & AHPI will continue to insist that all outstanding amount are paid on urgent basis, as the hospitals having being pushed to the brink of unsustainability will be constrained to suspend cashless services.

The Indian Healthcare industry is passing through a crisis phase. Hundreds of Crores are due to be paid by CGHS/ECHS to private hospitals. The outstanding are pending for past several months. Hospitals are unable to pay salaries to the employees.

While outstanding issue has pushed hospitals to the brink of unsustainability, the reimbursement rates for various medical procedures under CGHS have not been revised since2014, whereas the hospital expenses continue to grow to match inflation related

Chahal Patwari with his parents and treating doctors from Narayana

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February 2020

expenses. Studies carried out by various institutes show that rates of many procedures under CGHS do not cover even the operating cost incurred by hospital.

NARAYANA HEALTH CITY PERFORMS YOUNGEST HEART TRANSPLANT End stage heart failure is one of the conditions mired with high mortality. Around 1/4th of the children who suffer from end stage heart failure die within 6 months and a majority of them do not survive beyond two years of age. The pediatric cardiology department of Narayana Health City has brought a ray of hope to children suffering from end stage heart failure by successfully performing a heart transplant surgery on a child as young as 4 years of age. The transplant surgery has the unique distinction of being Karnataka’s youngest heart transplant. Dr. B R Ravikanthe

Gowda, Additional Commissioner (Traffic), Bengaluru City Traffic Police, Dr Kishore Phadke, Convenor, Jeevasarthakathe, Dr. Varun Shetty, Consultant-Cardiothoracic Surgery & Heart Transplant, Narayana Health City and Dr. Thiruthani Kumaran, ConsultantCardiothoracic Surgery & Heart Transplant, Narayana Health City were present at the event wherein the case study was elaborated.

Hailing from Kolkata in West Bengal, Master Chahal Patwari, the 4 year old heart transplant recipient was suffering from Dilated Cardiomyopathy since the time he was 2 years of age. Though he was under treatment his condition did not improve, rather it started deteriorating. In fact, the disease had weakened his heart’s ability to pump and he was not in a condition to even eat or play.

The family’s search for a quality pediatric cardiac care brought them to Narayana Health City, Bangalore. On admission the child’s condition was very critical. The pediatric team under the aegis of Dr. Shashiraj Subramanya, Consultant Pediatric Cardiologist & Heart Transplant Physician, Narayana Health City, did a thorough evaluation of the child. As the only treatment for end stage heart failure is heart transplant, the medical team advised the family to register with Jeevasarthakathe.

The family registered with Jeevasarthakathe in February 2019. In India, owing to the lack of awareness and participation in organ donation, especially heart donation, heart donation is still at its nascent stage. Although no official statistics is available, hundreds of end stage heart failure patients die every year waiting for a suitable heart. After a long wait of around 11 months, the child received a suitable heart on December 21st 2019 and the doctors successfully performed the surgery. He was discharged from the hospital within 15 days after surgery and now leading a near normal life. In fact, the doctors say, heart transplant can be successfully done in selected cases with excellent outcome in children as young as less than 1 year age.

Discussing about the transplant, Dr. Julius Punnen, Heart & Lung Transplant Surgeon, Narayana Health City, said, “Apart from blood match the crucial aspect is the weight match.

A patient can receive heart from someone who is about two and half times heavier than himself or herself. In this case as the team had ensured the child was healthy as well as had an optimal weight we could find a matching donor and save his life by performing the heart transplant.”

The transplant surgery lasted for around 4 hours. After the surgery the child was discharged within 15 days bringing an end to his 11 month long hospital stay.

BONE MARROW-ON-A CHIP PROVIDES NEW RESEARCH DIRECTIONS FOR SHWACHMANDIAMOND SYNDROME A new research tool that mimics the behavior of diseased bone marrow provides a new strategy for understanding the bone marrow disease, Shwachman-Diamond syndrome (SDS), and hopefully, developing new treatments. With SDS, bone marrow fails to produce blood cells normally, leading to bone marrow failure and an increased risk of leukemia.

In a research paper published January 27 in Nature Biomedical Engineering, researchers describe how damaged bone marrow from SDS patients performed in the new tool, known as the organ-on-a-chip (Organ Chip).

The bone marrow Organ Chip was developed in the lab of Donald Ingber, MD, PhD, at the Wyss Institute for Biologically Inspired Engineering at Harvard University and a member of the Vascular Biology Program at Boston Children’s. The chip was evaluated with SDS bone marrow samples housed in the SDS Registry at Boston Children’s Hospital.

“We need to find better ways to treat SDS to either prevent leukemia or risk-stratify patients to figure out who would benefit from earlier intervention,” says co-author Akiko Shimamura, MD, PhD, director of the Bone Marrow Failure and Myelodysplastic Syndrome Program at the Dana-Farber/ Boston Children’s Cancer and Blood Disorders Center. Shimamura also co-directs the SDS

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NEWS ROUNDUP national registry maintained at Boston Children’s Hospital in collaboration with Dr. Kasiani Myers at Cincinnati Children’s.

In the paper, researchers describe how the bone marrow Organ Chip effectively provides a model system to develop new treatments for SDS. “This model can be used for biological studies and for drug screening,” says Shimamura. “In my lab, we have identified some potential therapeutic targets for treating SDS that we hope to test with the new bone marrow chip.”

MOTHERHOOD HOSPITAL SUCCESSFULLY OPERATES ON A 1-DAY-OLD BABY A team of Paediatric Surgeons at Motherhood Hospitals Kharadi successfully operated upon a 1-day-old baby. Baby Ruchika (name changed for confidential purposes) was born with a congenital defect, wherein there were fluid filled cysts being formed in the lung cavity. It was a delicate and critical condition wherein the survival and later the prognosis

Motherhood Press Conference

8

February 2020

of the baby could have been compromised.

The doctors at the hospital helped a newborn baby girl breathe freely by initially removing fluid from the cyst that was present in her left lung by aspiration process and later performing a lung lobectomy (surgery to remove one of the lobes of the lung) immediately 1 day after birth. The baby is now home and doing well.

Dr Rajeshwari Pawar, Gynaecologist -Obstetrician, Motherhood Hospital Kharadi, Pune highlighted, “The foetus was diagnosed to have a type 1 Congenital

the growth of the underlying healthy lungs and would have become unusable. Likewise, heart compression could have invited foetal heart failure. A decision was taken to operate upon the baby immediately after birth and the couple was referred to Dr Pranav Jadhav, Paediatric Surgeon, for further counseling.”

A multidisciplinary counselling was given to her and after that a baby girl Ruchika, weighing 2.5 kg was successfully delivered on December 13, 2019. The baby was shifted to the NICU as she encountered difficulty in breathing and had to be given continuous

Cystic Adenomatoid Malformation (CCAM), and it is a developmental defect where there is a benign lung lesion that appears before birth as a cyst or mass in the chest.

It is also known as Congenital Pulmonary Airway Malformation (CPAM). The macro cyst present on the left side of the segment of the lung affected the lung tissue pressed the heart vessels and shifted the heart from its normal position, thereby occupying a lot of space in the chest. This type of CCAM happens 2 to 3 in 1, 00,000 live births. If left untreated, it would have compromised

positive airway pressure therapy (CPAP), to help her breathe easily, and expand the lungs! Once, the baby was stabilized, a lung lobectomy surgery was performed on 2nd day of birth by Dr Pranav Jadhav and Dr Kalpesh Patil (Paediatric Surgeons). Surgery took around one hour. “It is a delicate and complicated procedure to remove the lobe of the lung that is the portion of the diseased lung. The baby was growing well and accepting feeds very soon after surgery”, added Dr Tushar Parikh Chief Neonatologist at Motherhood Hospital Kharadi, Pune.

Sameer Shariff CEO signing up wit RCNi

DKMS BMST FOUNDATION INDIA CONDUCTS BLOOD STEM CELL DONOR DRIVE AT BENGALURU DKMS BMST Foundation India, a non-profit organization conducted a blood stem cell donor registration drive at ‘Lalbagh Botanical Gardens’ in Bengaluru. Alongside the colorful and bright ongoing flower show at the botanical garden, the organization conducted awareness sessions amongst people towards blood cancer and the need for blood stem cell donation to save lives. The drive saw over 100 registrations.

MOBILE LEARNING PLATFORM FOR HOSPITALS IN INDIA Impelsys Inc, launches iPC Health, an end-toend mobile learning and upskilling solution for the healthcare sector. The mobile-first platform brings a much-awaited solution to impart ‘on-the-go’ training and education for hospital staff and in turn deliver better outcomes and save lives. Present at the unveil were Honorable Karnataka Deputy Chief Minister Ashwath Narayan CN, CEO Impelsys Sameer Shariff , Mr Phil Smithers,

Global Sales & Marketing Head, Royal College of Nursing (RCNi) amongst other dignitaries from the healthcare industry who collectively acknowledged and stressed upon the need of a systematic multi-level learning approach that can improve the way healthcare is delivered in the country today. iPC Health is a first-ever advanced and comprehensive learning interface that will offer certified ‘anytime anywhere’ education programs rendering upskilling, advanced learning and compliance training for healthcare professionals in India. The solution hosts multiple digitized courses curated by knowledge partners and noted domain experts from across the world such as RCNi, American Heart Association, Wolters Kluwer and many other leading medical education publishers.

Introducing iPC Health, CEO Impelsys Sameer Shariff said, “In India, skill development and access to quality healthcare clearly are the two areas of improvement. iPC Health is curated to bridge the skill gap and ensure standardization across the healthcare sector in the country. Our aim is to enhance learning and professional expertise of healthcare personnel and help hospitals manage their greatest assets-their people effectively. This will in turn create an impact by improving the quality standards of healthcare services in the country”.

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NEWS ROUNDUP PIRAMAL DIVESTS ITS DRG BUSINESS FOR US$950 MILLION Piramal Enterprises Limited announced that PEL DRG Dutch HoldCo BV, a 100% subsidiary of PEL and the holding company for Decision Resources Group (DRG) engaged in healthcare insights & analytics business, has signed a definitive agreement for the sale of DRG to Clarivate Analytics plc, a global leader in providing trusted insights and analytics, for a sale consideration of US$950 Million (includes $900 million on closing and $50 million to be received at the end of 12 months from the date of closing). This transaction is subject to shareholder approval and is expected to be completed by end February, 2020.

PEL had initially invested US$650 Million in 2012 to acquire DRG out of which $260 Mn was infused as equity. It has realized 2.3x its initial equity investment in INR terms. Ajay Piramal, Chairman, Piramal Group said,“We are pleased to have grown DRG’s market leadership over the last few years and believe that through this combination, Clarivate, with its size and scale, is well positioned to further accelerate DRG’s growth potential. This transaction demonstrates our continued commitment to create sustained

Discussing the case at the press conference

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February 2020

long term value for all stakeholders. Along with the ongoing equity capital raise in PEL, this transaction not only further strengthens the company’s balance sheet but also marks another step towards significantly unlocking value in future.”

PREGNANCY IN A RARE CASE OF INTRACRANIAL ROSAI DORFMAN DISEASE

A 38-y-o lady was diagnosed with a rare condition called Rosai-Dorfman Disease (RDD) at Vikram Hospital. Patient had been married for 12 years and had undergone 2 cycles of IVF but was unable to get pregnant. After she was diagnosed with RDD, she had given up hopes of pregnancy. Patient discovered she was pregnant within three months of the chemotherapy and continued the pregnancy despite the risk of teratogenicity.

Elaborating on the criticality of the case, Dr. Shashikala Ksheerasagar, Consultant Obstetrician & Gynaecologist, Vikram Hospital, said, “Our team of doctors categorized this case as high risk pregnancy and handled such a case for the first time. The case was very challenging from the beginning as the patient had a spontaneous pregnancy following

chemotherapy for RDD, the Obstetric team faced many challenges managing the patient in the presence of co-morbidities like Gestational Diabetes Mellitus (GDM), Anemia, Sub clinical hypothyroidism, Allergic bronchitis, Progressive symptom of RDD like diplopia (Visual disturbance double vision), and cerebellar ataxia (difficulty in walking) and Headaches.”

Roopa’s health continued to deteriorate where she had difficulty walking, visual disturbances & managing day to day activities like cooking, housekeeping and as pregnancy advanced, she was heavily dependent on her husband for performing even the smallest of tasks such as eating food, medication, etc. If condition was untreated, she would have headaches, severe visual disturbance and incapability to walk. She would have continuously raised intracranial pressures which could lead to herniation of brainstem and sudden death.

It was a challenge handling her, an elective C/S was done, and patient closely monitored post operatively. Post pregnancy lactation was an issue as she had a delay in initiation of lactation. Two and a half months after delivery patient underwent radical stereotactic radiation for the intracanal lesion. Following radiotherapy, patient made a good recovery

and was able to handle her baby, her household chores independently,” added Dr. Ksheerasagar.

care management with the aim of improving and prolonging patients’ lives.”

MERCK LAUNCHES MOBILE PRIMARY HEALTH AND PALLIATIVE CARE UNIT IN KOLKATA

PAIN FOR BIG PHARMA AS US FDA WARNINGS DOUBLE

Merck, a leading science and technology company, under its corporate social responsibility (CSR) program facilitated the launch of a Mobile Primary Health, Cancer Screening and Palliative Care Unit (mobile medical units) in Kolkata in association with Global Cancer Concern India (GCCI) a not for profit organisation that will manage the mobile medial unit and implement the health program. The mobile medical unit was flagged off by Anandram Narasimhan, Managing Director, Merck Specialties Pvt Ltd., Prof. (Dr.) Subir Ganguly, Ex-HOD, Dept. of Radiotherapy, R G Kar Medical College, currently Consultant Physician, Dept. of Radiation Oncology, Apollo Gleneagles Hospital, Dr. P. N. Mohapatra, Medical Oncologist, Apollo Gleneagles Hospital and Dr Harvinder Singh Bakshi, Chief Executive Officer, GCCI. The mobile medical unit will provide primary health services, cancer awareness, cancer screening and palliative care to the economically underprivileged in the slums of Kolkata. The unit will be operational for three years.

Speaking on the importance of this initiative, Anandram Narasimhan, Managing Director, Merck Specialties Pvt Ltd said, “Providing access to health is one of the core pillars of our corporate responsibility work.

With an increasing incidence of cancer and the limited infrastructure for patient support in the country, it is imperative that we extend our support in this disease area. We are happy to partner with GCCI to roll out this mobile medical unit that will help address many unmet needs in cancer management.

The project aims to create awareness of cancer symptoms, encourage early detection, primary and palliative healthcare for underprivileged cancer patients in Kolkata.

We remain committed to the cause of cancer

18% of new products to be delayed; strong balance sheets cushion credit metrics Warning letters issued by the US Food and Drug Administration (FDA) to large Indian pharmaceutical firms1 more than doubled in the first ten months of calendar 2019 compared with 2018. This will impact about 180 abbreviated new drug applications, or 18% of the total pipeline of large drug makers, delaying new product launches, a CRISIL analysis of current regulatory actions, including adverse observations on FDA audit indicates. The US market accounts for more than a third of overall revenue of the big drug makers or Rs 55,000 crore of sales annually.

Says Sameer Charania, Director, CRISIL Ratings, “With intensifying regulatory scrutiny, sales growth from the US market will drop to 10-11% during fiscals 2020-22, compared with a growth of 16% in fiscal 2019. Large players are banking heavily on successful launch of complex generic products – these filings have risen to about 25% of the overall new product pipeline from nearly zero three years ago. A substantial delay in resolution of regulatory issues and/or heightened scrutiny could derail the US growth story.”

A similar trend was noticed in calendar 2015, when FDA scrutiny of Indian drug makers had intensified largely citing data integrity issues by and large. Consequently, US revenue growth had dropped to 6% in fiscal 2017 as new product launches got delayed amid inherent price erosion.

SUN PHARMA AND ROCKWELL MEDICAL ENTER INTO LICENSING AGREEMENT FOR TRIFERIC IN INDIA Sun

Pharmaceutical

Industries

recently

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NEWS ROUNDUP announced that one of its wholly owned subsidiaries has entered into exclusive licensing and supply agreements with Rockwell Medical Inc. (Rockwell), to commercialize Rockwell’s Triferic, a proprietary iron replacement and haemoglobin maintenance drug, for treating anaemia in hemodialysis patients in India. Triferic is approved in USA. As per the terms of the agreement, Sun Pharma will be the exclusive development and commercialization partner for Triferic during the term of the agreement, subject to its approval in India. In consideration for the license, Rockwell will be eligible for upfront and milestone payments as well as royalty on net sales. The financial terms of the agreement are confidential.

NIKHEL GOEL JOINS CARESTREAM HEALTH INDIA AS COUNTRY GENERAL MANAGER

Carestream Health India announces the

Fujifilm at IRIA 2020

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February 2020

appointment of NikhelGoelas Country General Manager - India & Indian Subcontinents. In this capacity Nikhel will be responsible for the business of Carestream Health in India, Bangladesh, Bhutan, Maldives, Nepal and Sri Lanka.

Prior to joining Carestream,Nikhel was working with Meril Life Sciences as Vice President – Marketing & Strategy (International Business)and had earlier worked with Johnson & Johnson Medical, Kotak Mahindra Bank, CitiBank and HDFC Bank.

Nikhel completed his MBA in Marketing and International Business from Symbiosis Institute of Foreign Trade, and Bachelor studies in Arts. He brings more than 17 years of experience in leadership roles—with more than 10 years in healthcare—across diverse businesses including consumables and capital equipment.

“It is indeed an honor to join Carestream Health, an organisation with a strong legacy and brand reputation worldwide. I look forward to working with the talented team in

Carestream and to take this legacy to newer heights,” said Nikhel.

FUJIFILM SHINES AT 73RD ANNUAL IRIA CONFERENCE Fujifilm India Private Limited, one of the leaders in Healthcare industry, displayed its latest medical systems at the 73rd National Conference of the Indian Radiological and Imaging Association (IRIA). The three-day long conference is scheduled from 23rd – 26th January 2020 at MMCC, Gandhinagar, Ahmedabad, India. As part of the event, Fujifilm will be displaying its latest medical devices like FDR - Smart F, FDR - D-EVO II, FDR - SE Lite, FCR - Prima T, Full Field Digital Mammography (FFDM) - Amulet Innovality and Synapse PACS. Commenting on the association with IRIA 2020, Haruto Iwata, Managing Director, Fujifilm India said, “Today’s healthcare enterprises are entirely focused on improving the quality of

healthcare and we at Fujifilm are principally committed at bringing advanced imaging strategies keeping in mind the industry needs.

With increasing digitalization and use of AI in healthcare, we aim to provide our users high value care with the cutting edge technologies.

As trailblazers in healthcare sector, we are proud to showcase our wide range of medical systems at the 73rd National Conference of the Indian Radiological and Imaging Association.

We have designed these technologies to offer comfortable, efficient procedures and help clinicians deliver the best possible patient outcomes.”

“At Fujifilm, our key focus areas are Early Detection of Breast Cancer, End T.B Program, Early Detection of lung cancer and colon cancer through state-of-the-art products likes Full Field Digital Mammography, FCR & FDR Systems, Endoscopy Systems. We are even focused on digitization Tele radiology and AI for faster and quality diagnosis of Breast Cancer, Tuberculosis and Lung Cancer. With such associations, we will continue to innovate and provide high quality medical solutions that contribute to better healthcare facilities and services in India” added Chandrashekhar Sibal, Senior Vice President - Medical Division, Fujifilm India.

The company also announce the launch of two books at the conference i.e. Full Field Digital Mammography - CEDM written by Dr Rashmi Sudhir from Indo American Cancer Hospital, Hyderabad and FDR - “Digital Radiography the Power of Imaging” (A book on case done by users). The books highlight the emerging technology in diagnosis and management of breast cancer. It further highlights unique technologies by Fujifilm that offer solutions to support this diagnosis at an early stage.

GURUGRAM HOSPITAL USES BOVINE JUGULAR VEIN IN A RARE LIVER TRANSPLANT

A rare and complex liver transplant was carried out by a team of proficient doctors at Artemis Hospitals, Gurugram. They

Successful Liver Transplant Surgery of year old child by surgeons of Artemis Hospital, Gurugram

performed a 14-hour long rare surgery called Monosegment (Segment 3) liver graft transplant on a one-year-old girl child from Saudi Arabia. Baby Fatima (name changed) underwent an extremely rare living donor Liver transplant (Monosegment), where only 1 out of 8 portions of liver was used to provide a new liver to the baby.

The surgery called Monosegment (Segment 3) living donor liver transplant is the first reported case of Delhi NCR in which monosegmented liver graft has been used.

Beside this use of bovine jugular vein in liver transplant has been reported for the first time in the world, to provide an inflow of blood to the newly transplanted liver as baby was born with absence of bile ducts and under developed portal vein.

Managing the child during such a long surgery was a tedious and tricky task; it was meticulously and successfully handled by a team of specialist doctors and paramedics.

Born as a third child to parents Ahmed and Sarah, the child had unusually prolonged and deep jaundice months after her birth. Doctors in Saudi Arabia diagnosed her with a rare disease called biliary atresia which is found in 1:16000 live births. The developments of bile ducts in such children are absent. Fatima

underwent biliary bypass surgery at a local hospital in Saudi Arabia before coming to India.

Due to the unsuccessful and unsatisfactory outcome of biliary bypass surgery, she was advised Liver Transplantation by the doctors in Saudi Arabia. However, considering her poor nutritional status and body weight (5.2kg) doctors in Saudi Arabia were reluctant and unwilling to perform such a complex liver transplant and she was referred to India.

INDIAN COBRA GENOME AND VENOM GENES DECODED In the January 2020 issue of Nature Genetics, scientists from SciGenom Research Foundation (SGRF), India, AgriGenome Labs, India, MedGenome, India/USA, SciGenom, India, and Genentech, a member of the Roche group, along with a team of international collaborators from academia and industry report the sequencing and assembly of a high-quality genome of the highly venomous, medically important Indian cobra (Naja naja).

Using a combination of cutting-edge genomic technologies, the authors have assembled the most contiguous genome of this iconic

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NEWS ROUNDUP

Dr. Praveen Gedam Dy.CEO NHA and Mr. Anil K. Rajput, Senior Vice President, Corporate Affairs, ITC in the presence of Dr. Indu Bhushan, CEO, NHA

venomous snake.

Venom is a complex mixture of proteins encoded by genes that have been co-opted by some snakes as they evolved some 100 million years ago. In the Indian cobra genome, the authors identified 19 key toxin genes primarily expressed in the venom glands.

“Targeting these 19 specific toxins using synthetic human antibodies should lead to a safe and effective antivenom for treating Indian cobra bites” said Dr. Sekar Seshagiri, President, SGRF, former Staff Scientist at Genentech, and lead study author. Currently, antivenom is produced by immunizing horses with extracted snake venom and is based on a process developed well over 100 years ago.

This process is laborious and suffers from a lack of consistency leading to varying efficacy and serious side effects.

Globally each year, accidental contact with snakes lead to over 100,000 deaths.

Over 400,000 individuals suffer permanent disabilities, including amputation.

India alone accounts for 2.8 million snakebite cases that lead to about 50,000 deaths annually,

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primarily attributed to the Indian cobra, common krait, Russell’s viper and saw scaled viper, infamously called the ‘big four’.

“The Indian cobra is the first of the ‘big four’ deadly snakes to be sequenced. This is a major step towards understanding its venom components and it will effectively change the way antivenom is developed” said Dr. George Thomas, Chief Operating Officer, AgriGenome Labs, India. He further added, “This study has provided a very high-quality reference genome that will make assessment of the Indian cobra genetic diversity possible and practical. It will be an important resource for conservation of this revered and feared Indian snake”.

NHA AND ITC E-CHOUPAL SIGN MOU TO RAISE AWARENESS ON AYUSHMAN BHARAT

National Health Authority has signed an MoU with ITC e-Choupal to enable farmers across the country to avail benefits under Ayushman

Bharat PM-JAY. Through this collaboration NHA and ITC e-Choupal will spread awareness about AB PM-JAY scheme and conduct outreach and training activities. Implemented by the National Health Authority along with its State counterparts, AB PM-JAY, is India’s flagship public health insurance/assurance scheme, and the world’s largest publicly funded health assurance scheme.

The MoUs was signed by Dr. Praveen Gedam Dy.CEO NHA and Mr. Anil K. Rajput, Senior Vice President, Corporate Affairs, ITC in the presence of Dr. Indu Bhushan, CEO, NHA. The two organisations have come together to spread awareness about the AB PM-JAY to help eligible farmers have a better understanding of the scheme and seek hospital treatment for serious illnesses through the scheme. Through this partnership, millions of farmers would be able to access the information via 6,000 e-choupals. E-choupal means “village meeting place” will constitutes a network of rural kiosks, providing number of information and communication related services for rural population.

COVER STORY

HEALTHCARE

REIMAGINED WITH NEW OPPORTUNITIES

Amidst fierce competition, rapidly emerging technologies and changing regulatory requirements healthcare providers can still succeed with new opportunities Author: Liz Forsyth, Fiona Stuart and Evan Rawstron; KPMG Australia

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COVER STORY

H

gratification, as they have become accustomed to 24/7 ealthcare and life sciences are facing access to personalised and on-demand services – whether major challenges – technological it be ordering a pizza, booking a cab or managing finances. change with vast disruptive potential, As a result, patient’s and the community’s expectations a constrained funding environment, regarding the healthcare experience are changing. changing population needs and Millennials and Baby Boomers are entering new life stages, consumer sentiment all create drivers fuelling a different set of future needs. Millennials are the and opportunities for transformation in the industry largest group entering their prime spending years and hold and adjacent markets (e.g. aged care and smart home different views on health and wellness. Most require less solution providers). The fundamental problem is how healthcare services and are not fully engaged yet, to sustainably deliver high quality, accessible but will become more important consumers care to the people who need it at the that drive new needs, preferences and right time, in the right place and with The ageing expectations. The ageing population the right intervention. Solutions population (65+) (65+) is forecast to grow substantially that have worked well in the past, is forecast to grow to be in excess of 8 million, or 22 like reducing length of stay and substantially to be in percent of the total population increasing workforce productivity, excess of 8 million, or by 2054. As Baby Boomers reach are not sufficient for this challenge.

22 percent of the total retirement, they are living a longer, However, new technology, service population by 2054. healthier life than previous generations, and business models create the but also have a higher rate of chronic opportunity to influence the demand, illness, requiring more complex care. utilisation and supply levers.

A provider’s ability to engage with consumers according to their needs and preferences – depending The Changing Consumer on their current place in life and their health – will result Consumer expectations, regardless of age or industry, in a better experience for both the consumer and clinician. are higher now than ever. Consumers expect immediate

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February 2020

it is important to note that the pressure to change is accelerating with the digital revolution. We anticipate an increasing focus on self-management while well, and an increase in complementary and alternative therapies (e.g. naturopathy, acupuncture, meditation) being integrated into conventional medical treatment programs.

Personalised and Connected Health Advances in connected devices, including sensors, wearables and implantables that enable consumers and clinicians to pro-actively track and manage health, anywhere, anytime, and from any device.

Due to increased connectivity, patients are privy to a wide knowledge base driven by their friends, family and accessibility to people ‘in the know’. Patients and their families are seeking support communities where they receive insights and leads for new treatments. A study conducted in Australia found that social media in healthcare can improve self-management and control and enhance psychological well-being, while also leading to more equal communication between patients and healthcare professionals. 

Disruptive Market Forces At global and domestic levels, new entrants from adjacent sectors, start-ups, technology players, as well as incumbent providers are disrupting the traditional market. Many are focused on providing niche solutions that address specific problems and unmet needs. But it’s important to note that solving broader issues pervasive across the value chain (e.g. significantly influencing demand, utilisation and supply levers) will require extensive integration and collaboration – it’s unlikely that a solution in isolation will move the needle.

Innovations in Treatment

Innovation in medical treatment – ranging from virtual reality training for rare surgeries, bio-printing synthetic organs, and early steps on the path to making aging a treatable condition.

The increasing use of electronic medical records in acute care opens an alternative to evidence-based practice for clinicians when the evidence doesn’t exist. Randomised controlled trials giving rise to evidence-based New Trends and Opportunities practice remain the gold-standard, but there A look at the global healthcare scenario are innumerable instances where – for reveals a number of trends and ethical reasons, due to the rarity of the The increasing use opportunities that have the potential condition, complex co-morbidities of electronic medical to impact healthcare industry over or in paediatrics – research hasn’t records in acute care time. been undertaken. Data analytics is opens an alternative opening up the information stored to evidence-based in the unstructured clinical notes, Health On-Demand practice for clinicians deep within the medical record, to  The rise of prevention and when the evidence allow clinicians to draw conclusions outcome based healthcare models doesn’t exist on the best treatment for their patient – placing consumers firmly in control when there is no published best practice. of their own health and wellness.

Quantum computing is another key enabler Solutions that aim to improve individuals’ in the medium term horizon that has the power to health in a holistic way over greater periods of time and dramatically improve protein folding and drug discovery provide sustained improvement are more likely to gain through probabilistic modeling of how the human body traction with consumers. While this is already ingrained reacts to stimuli. We predict that Quantum Computing will in private and public healthcare sector strategies, and is mature, and become mainstream in the next 5-8 years. increasingly being incentivised by healthcare funders, 

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COVER STORY The falling costs of genome-sequencing, coupled with advances in data science unlocking unprecedented levels of insight and precision medicine.

Gene therapy is an experimental technique that uses genes to treat or prevent disease. In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient’s cells instead of using drugs or surgery.

CRISPR allows scientists to edit genomes with unprecedented precision, efficiency, and flexibility. In April 2017, Chinese scientists announced they applied the technique to nonviable human embryos, hinting at CRISPR’s potentialto cure any genetic disease. 

Hybrid Workforce Advances in artificial intelligence, medical robotics and autonomous vehicles paving the way for hybrid healthcare workforces.

The future of medicine will rely on an even closer relationship between humans and advances in AI – when AI is combined with the work of clinicians. As covering machine learning, cognitive computing and AI evolves, we anticipate it complementing the effort of deep learning domains. AI already has a footprint in doctors – not entirely replacing them the healthcare industry, from assisting clinicians with diagnoses to the design of treatment plans. AI is being used in: Better Physical Environment Clinician decision support: for electronic medication  A renewed understanding of how physical, spatial management systems to alert doctors to potential and digital environment design can improve drug interactions patient healing, recovery time and the Drug discovery: mining patient patient experience.

Gene therapy biological data and scientific literature We now have a deeper is an experimental to determine why some people understanding of how the technique that uses genes survive diseases to gather insights environment can contribute to to treat or prevent disease. to improve current therapies and healing and improved recovery In the future, this technique create new ones. Also used to look time.

We predict a much greater may allow doctors to treat for patterns in scientific literature adoption of multidisciplinary a disorder by inserting a to dramatically expedite drug design when designing gene into a patient’s discovery and research healthcare facilities.

Currently, cells instead of using Oncology: help detect abnormalities this understanding is culminating drugs or surgery in X-rays and MRI’s in many forms – with hospitals Precision medicine: to perform complex experimenting with: genomics processing to provide assistance in creating Human-centric change: Changes derived from highly customised treatments for individual patients empathising with patients, for example widening the Revenue assurance: mining unstructured clinical bathroom door in patient rooms, or creating family and notes to identify conditions or complications that friend pods in waiting rooms instead of rows of chairs. weren’t coded and improving the quality and timeliness Interior and spatial design: This could involve of complex coding. Other studies have shown that incorporating art, indoor gardens, landscapes and patient outcomes are improved and costs reduced water features to reduce the stress of patients and their 

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February 2020

the potential improve overall patient wellbeing, reduce families. Also considers the flow of people between microbial threats and reduce the length of hospital spaces, and embedding intuitive way-finding. stays. The environment can play a crucial role in helping Acoustics: Reducing noise sources and to improve to normalise rest-activity cycles, sleep patterns, mood sound proofing with sound-absorbing ceilings and and pain, in addition to enhancing the overall patient carpeting, coupled with music selection and verbal cues experience. from the environment.

Lighting: Exploring how light can be used Conclusion to benefit patients. There are interesting The environment Healthcare organisations do not developments in the circadian rhythm can play a crucial role need to predict the future, but lighting space which utilised our in helping to normalise rather position itself for multiple natural alignment to the daily rest-activity cycles, outcomes. Working out how to rotational cycle of the Earth. Light sleep patterns, mood deliver high quality healthcare is used to control our rest-activity and pain, in addition to to more patients with different cycle, while also influencing our enhancing the overall and more complex needs and less immune system and potential for patient experience funding, while responding to broader healing. Research has shown this may market disruption and consumer help promote tissue recovery and enhance expectations, is a significant challenge for patient ability to handle microbial threats. the entire healthcare industry. It requires a vision Microbial transmission: Applying outside-the-box and actionable strategy that considers the conscious thinking on ways to prevent pathogen transmission – for trade-offs that need to be made on relative focus areas, example the largely ignored area of handle design, and change initiatives and capabilities. how push plates instead of pull handles can significantly reduce contamination. Also, using antimicrobial coating on high frequency areas such as handles, switches and Source: Healthcare reimagined: Innovation trends, predictions taps. In a healthcare environment, these benefits have and actions for healthcare leaders, 2018, KPMG Australia.

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INNOVATE

New Tools for Oncologists Breakthrough in cancer diagnosis using big data analytics A TEAM of researchers from NUS has discovered a new personalised tool to detect cancer, predict patient survivability and how well a cancer patient would respond to immunotherapy. This tool is a speciallydesigned cancer ‘scorecard’ to be used with the standard blood test for cancer (also known as liquid biopsy).

This ‘scorecard’, which the team termed as the Tumour Matrisome Index (TMI), is a panel of 29 selected genes produced in the extracellular matrix (ECM) of the human body. ECM is the space around cells and provides structural and biochemical support to surrounding cells, behaving like a scaffolding.

In a series of studies, the NUS team found that these 29 genes had appeared repeatedly as a consistent factor in patients diagnosed with non-small-cell lung cancer (NSCLC) which accounts for approximately 85 per cent of all lung cancers.

The research was led by Professor Lim Chwee Teck from NUS Biomedical Engineering and recent PhD graduate Dr Lim Su Bin. Prof Lim explained, “TMI can be used together with liquid biopsy, which is less invasive and less painful for the patient compared to conventional tumour biopsies.

As it only requires a blood test instead of day surgery, it can be done more frequently over the course of treatment, providing doctors with real-time information on how the patient is responding to treatment. Tissue biopsy is often done at the start and end of treatment, while liquid biopsies can be done frequently, allowing doctors to track more efficiently how well treatment is progressing. This is a big step forward in personalising cancer treatment and

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ensuring better patient outcomes.”

To develop and validate the TMI “scorecard”, Dr Lim used big data and predictive analysis of over 30,000 patient-derived biopsies.

“Parallel analyses in over 30,000 patientderived biopsies revealed that the TMI scores are closely associated with mutational load, tumour histopathology, and predictive of patient outcomes,” she said.

Cancer diagnosis Using public datasets of healthy individuals and cancer patients, the team noticed that cancer patients had a higher set of TMI scores.

Testing a person’s TMI signature can determine if someone has cancer or not.

They also examined the 29-gene TMI in 11 major cancer types - lung, pancreas, prostate, kidney, stomach, colon, ovary, breast, liver, bladder and melanoma. The team found that the TMI scores distinguish cancers from normal tissues, and that each cancer type has a specific TMI signature.

So far, the TMI signature can diagnose with certainty someone with lung cancer, but further validation is required for the other 10 cancer types.

Predicting the effectiveness of cancer treatment The team also showed that TMI scores could be used to predict how successful a patient might react to cancer treatments, such as immunotherapy. Immunotherapy is the process where the body’s own cells are used to attack cancer cells as a form of cancer treatment. It is preferred over chemotherapy, which is more commonly used, as it is much

Professor Lim Chwee Teck (left) and Dr Lim Su Bin (right)

less invasive and has shown to have better efficacy.

Predicting cancer survival and recurrence rate Cancer tumours can either spread to different parts of the body (metastasize) or return (recur) if unsuccessfully treated. Determining if a tumour is likely to metastasize or recur was previously a challenge as it is often done through macroscopic imaging techniques which could often be nonspecific.

A patient’s TMI scores could give a better gauge on his or her survivability, the team found. In their work with NSCLC the team found that high TMI scores were consistently associated with early recurrence of cancer and metastatic spread, leading to an increased risk of death.

For cancers such as colon, liver, renal, and breast cancers, the higher the TMI scores, the higher the risk of cancer recurrence or metastasis, and hence, the lower the patient’s chances of survival.

However, for gastric and ovarian cancers,

the opposite holds true: the higher the TMI scores, the lower the risk of cancer recurrence or metastasis and the better the chances of survival. “There might be other factors in the gastro-intestinal microbiome, such as the presence of intestinal microflora, which affects the patient. This requires more study,” said Prof Lim. The team’s findings were published in two scientific journals — on 15 August 2019 in the Proceedings of the National Academy of Sciences and on 22 May 2019 in the Nature Partner Journal’s Precision Oncology.

Next steps Moving forward, Prof Lim and his team plan to collaborate with their clinical collaborators to conduct further clinical tests to validate the use of TMI on other cancer types. This will determine how accurate and specific TMI will be in the diagnosis and prognosis of patients via liquid biopsy or blood test. This has great potential in becoming a standard test not only in detecting cancer, but also predicting patient survivability.

Using big data analytics, the researchers have developed novel cancer scorecard to detect cancer, predict patient survivability and determine patient suitability for immunotherapy treatment

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SPECIAL FEATURE

Developments in Lab-Diagnostics Driving Better medical treatment

Jatin Mahajan, MD, J Mitra & Co.

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LABORATORY DIAGNOSTICS are the first line of defence towards better health and fitness. The entire healthcare industry is dependent on laboratory diagnostics for ascertaining the ailments and deciding on the correct course of treatment, surgery and medication. Laboratory diagnosis is an important part of medical treatment as it determines the cause of diseases or disorders.

In fact, 70 per cent of the medical decisions are based on diagnostics.

The laboratory diagnostics segment in India has witnessed tremendous changes in the past 20 years. The significant developments have been in the areas of cost reduction, quality and reliability enhancement, time reduction, increased convenience and accessibility, apart from the overall increase in the portfolio of diagnostic tests provided.

There are many diagnostic companies in India offering diagnostic products and services of premium quality. From a masses perspective the diagnostics segment has become more evident because of extremely-huge, multicity, multi-outlet large format central labs, pathology labs and corporate hospital chains, and the various marketing and brandbuilding initiatives undertaken by them. This has ensured that the regular neighbourhood pathological outlets are complemented by the central labs enhancing the professional and service attribute of the industry. Their digital persona and online presence are ensuring that the patients no longer have to travel to them, but the laboratory services reach out to the patients

at their location and at their convenience. Thus, accessibility of preventive care has become one of the most important developments driven by internet growth and the emergence of capitalrich venture funds that have fuelled the growth of this segment. The emergence of central labs has resulted in massive reduction of overhead costs, and thus significant reduction in the overall pricing of various diagnostic tests. This has been further catalysed by the growth of collection centres, leading to better utilisation of assets and resources.

Automation of various diagnostic tests have come as a boon for the industry majorly cutting down the turnaround time for accurate and reliable results, while ensuring that a greater number of tests can be handled at the same time. This has also resulted in reduction in lab-related errors, and further lowering of the prices.

The growing corporate sector is focussing more on the well-being of their employees, promoting proactive preventive and wellness check-ups. This coupled with proliferation of insurance companies, has fuelled the shift to a more proactive diagnostic check-up approach.

Internet and the increase in awareness has also ensured that diagnostics services are now proactively sought, as against the earlier doctor-driven approach. The newer generation is increasingly embracing complete diagnostic check-ups for themselves and their family, as part of the prevention is better than cure mantra. People now are opting for early wellness testing and diagnosis as it increases

the chances of a positive outcome, saving lives and cost of treatment. The consumer behaviour is shifting towards convenience and quality.

Convenience has driven the home collection and online reporting practices in the industry, and quality has created the needs for service providers who can ensure accurate results with a quicker turn-around time at a reasonable price.

With the advent of NABL accreditation driven by Quality Council of India, more and more diagnostic labs are moving towards adopting their standardisation and quality assurance. This is leading to a great degree of uniformity in the quality standards, which

is adding to the quality and reliability of laboratory diagnostics. Diagnostic services play a vital role in spotting the health problems and informing medical interventions that make the integrity of the test a crucial aspect as the doctor takes the decision based on these reports.

With the self-imposed standardisations, quality assurances and uniformity, the diagnostics segment has further enhanced their credibility and contribution to the healthcare industry as well as to the masses.

The diagnostics industry would continue to bloom and drive the overall health and fitness of the public that they so dedicatedly serve.

Laboratory diagnosis is an important part of medical treatment as it determines the cause of diseases or disorders. In fact, 70 per cent of the medical decisions are based on diagnostics

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IMPACT

From Front Lines to Real Solutions Association of Healthcare Providers (India) works with many stakeholders to find real solutions to care delivery in India ESTABLISHED IN the year 2012, the Association of Healthcare Providers (India), is the apex body of the private healthcare providers with membership strength of thousands of hospitals. The effectiveness of AHPI has been vastly improved with creation of 14 state and regional chapters across the country, to deal with state related issues. AHPI is registered as a not-for-profit organisation undertaking advocacy for INTERNATIONAL CONTRIBUTIONS

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AHPI in collaboration with the Royal College of Surgeons, CMC Vellore and the GoK, developed a course to provide capacity building in the area of pediatric surgery for surgeons in district hospitals.

AHPI developed Standards on Green and Clean Hospitals, have been adopted internationally United Accreditation Foundation (USA) and Bureau VERITAS. The national communication movement in healthcare heralded

by AHPI has gone international with involvement of Malaysia and Nepal.

AHPI is a constituent member of the Indo-African Health Science Meeting: Multi-Agency Collaborative Approaches to Health.

AHPI has been engaged by UAE in building capacity in their healthcare initiatives including developing accreditation standards for Neurophysiology, Radiology, Physiotherapy and Pharmacy.

February 2020

healthcare industry in its totality with Union & State governments.

AHPI works across all strata of the society to engage with regulatory bodies and other stakeholders including the IMA, enabling its member organizations to deliver appropriate, cost-effective and quality healthcare services to the community.

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Actively involved with MOHFW and NITI AYOG on continuous basis aimed at making quality healthcare affordable for patients and sustainable for healthcare providers.

Worked with QCI and NABH in the area of quality and healthcare, as part of the team which conceived and introduced the concept of entry level accreditation at the grass roots. AHPI is also working closely working with QCI to ensure that adequate numbers of assessors are trained for entry level accreditation to meet the requirements of IRDAI. As part of empowering the medical community, AHPI has been successful in ensuring that the much sort after PGDMLE course being offered by the NLSIU is now being offered offsite, whereby faculty from NLSIU conduct classes and examination at the place of enrolment of candidates in the hospital. The first offsite course was inaugurated at CMC Vellore. AHPI and NLSIU is working with professional societies to come up with custom made courses for respective specialties. AHPI also works closely with the NLSIU in

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organizing roundtable discussions on relevant topics.

Worked with NABH and the World Bank to develop a guidance manual for pre-accreditation entry-level standards for small healthcare organisations.

Successfully lobbied with the IRDA to make entry-level accreditation mandatory for all empanelled hospitals, thus improving quality at the grass roots.

AHPI was instrumental in ensuring the formation of Health Insurance forum of IRDAI. Worked with the India Backbone Implementation Network to improve the quality of elderly care in India resulting in an allocation of INR 5000 crores in the FY 20152016 Union Budget.

Worked closely with ISRO to improve on patient safety along with SEMI in Emergency and ISCCM in Critical Care Departments.

Coordinating the formation of a Legal cell and litigation mediation platform, under the aegis of National Law School of India University and AHPI to support Hospitals

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in handling Medico-Legal cases.

AHPI played a key role in the recognition of the CPS (College of Physicians and Surgeons of India) PG courses, resulting in the muchneeded creation of intermediate specialists.

National Medical Commission Bill 2017 – several suggestions offered

by AHPI have been accepted and incorporated by the parliamentary standing committee on health in this regard.

AHPI works closely with HSSC in promoting availability of skilled workforce across the healthcare system of our Country.

AHPI is actively supporting the initiative by QCI to recognize Gram Panchayats working towards improving quality at the grass root level.

National Education Policy: - AHPI has been in discussion with the members of the National Education Committee and have had discussions on medical education policy under the aegis of the committee chairman, Dr. K Kasturirangan. AHPI under the guidance of Dr. Alexander Thomas has given recommendation for the draft National Education Policy to be released shortly.

Healthcare industry GST matters is being negotiated with the Government. An appointment is being sought with the new Finance secretary to follow up and discuss the issue of GST. Ayushman Bharat – AHPI is in constant dialogue with NITI AYOG and National Health Authority to ensure successful implementation of the universal health coverage. AHPI has submitted pricing details of some of the procedures to MOHFW and has strongly recommended to fix prices of procedures scientifically, without which many hospitals will not be able to come forward to be part of this ambitious scheme.

AHPI prepared comparative study of rates under 8-state government insurance schemes and rates offered

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under PMJAY to point out anomalies. This has been appreciated by NHA and will help in restructuring of rates under PMJAY. Submitted paper on incentivizing private sector in setting up hospitals in deficient tier-II/III areas to NITI AYOG, which has been circulated among the state governments for implementation. This is vital step in making PMJAY success.

AHPI & ICMR - committee to explore practicality of reuse of single use devices, maintaining patient safety. The Government of India has constituted a committee headed by ICMR of which AHPI is a constituent member to evolve strategies regarding reuse of single use devices while ensuring patient safety.

AHPI has been assisting NIMHANS, an institute of National importance, in their efforts towards obtaining NABH accreditation.

AHPI worked for the introduction of “Nurse Practitioners” courses to empower nurses to work more efficiently at primary healthcare centres.

The Association of Nurse Executives – India (ANEI) was formed under the auspices of AHPI. AHPI closely works with other National Associations, IMA, AIMED & OPPI. AHPI is the chair of the Steering Committee for the Health and Environment Leadership Platform [HELP], Public Health Foundation of India (PHFI) and has been instrumental in enrolling its member hospitals into this group where air quality monitoring is taking place. HELP currently has 25 members representing over 6000 healthcare institutions and 27,000 physicians in India HELP is part of the Global Green and Healthy Hospitals community which has 982 members from 50 countries AHPI is on the Advisory Board to the UNESCO-NBE Steering Committee on the Teaching of Bio-Ethics in the PG Medical Education Curriculum.

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AHPI has been in dialogue with ESIS, ECHS, public sector and other agencies to improve patient care.

Working with MOHFW to suggest methods to reduce the cost of medical education (MBBS & PG).

Health Communication: Through efforts of AHPI, communication has been introduced as a standard for NABH accreditation, and into MBBS curriculum from this year, and will be introduced into Post Graduate curriculum from the year 2020.

The 3rd edition of book; Communicate. Care. Cure was released and Hon’ble Prime Minister and Hon’ble Health Minister have endorsed the book through messages. The book is available worldwide on Amazon.

The book has been found to be of immense value to healthcare professionals and patients.

The Rajiv Gandhi University of Health Sciences [RGUHS] syndicate has approved the book Communicate. Care. Cure. by Dr. Alexander Thomas 3rd edition for training the faculty of RGUHS and also decided to recommend the book to the colleges under RGUHS for its students.

The same is being replicated at other institutions across Karnataka both for the faculty and students.

CGHS Dues and rates: AHPI and IMA have joined hands to jointly address issues relating to the huge backlog due to hospitals by the Govt. of India under CGHS and the long overdue revision of empanelled rates, last carried out in 2014. A joint press meet was held on the 19th Dec 2019 at New Delhi. A similar joint press meet is scheduled to be held at Bangalore on 13th Jan 2019 Nurses Emolument Case: Delhi Government has issued orders to implement Jagdish Prasad committee recommendations of emoluments for nurses in private hospitals. AHPI has initiated dialogue with Delhi Government to fix minimum wages in the manner as is done in Kerala.

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SPECIAL INTERVIEW

Leading Change in Healthcare Dr Girdhar Gyani, Director General, AHPI

Today, we have more than 500-accredited hospitals and about 3000-certified hospitals by NABH. This has spread culture of patient safety and it would have huge impact on reduction in medical errors and thereby on morbidity and mortality.

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DR GIRDHAR GYANi, is widely recognised as founder of healthcare quality in India. During his tenure as Secretary General, Quality Council of India (2003-2012), Dr Gyani played pivotal role in formulation and operating of National Accreditation Board for Hospitals and Healthcare Providers (NABH), for the first time in the country. He was Principal Coordinator in developing of accreditation standard for hospitals and getting it accredited

by International Society for Quality in Health Care (ISQua). This was followed up with development of standards for Blood Banks, Radiology Centres, Dental Clinics, Wellness Centres, and AYUSH Hospitals.

NABH has been the single most important initiative which has dramatically changed the healthcare scenario in INDIA, bringing Patient Safety at the centre stage. NABH has emerged as key criteria for evaluation of hospitals for variety of government and private paying schemes.

Currently Dr Gyani is working as Director General, Association of Healthcare Providers (India). AHPI represents vast majority of healthcare providers in India and its mission is to build capacity in Indian health system with focus on patient safety and affordability.

Here he talks about developing quality standards for healthcare providers in India and its progress over the years.

You’ve been the Secretary General of QCI. What first drew you to healthcare quality and patient safety?

When I joined QCI, its mandate was primarily to establish national accreditation structure for conformity assessment bodies (CABs) for

management systems like QMS, EMS, and food safety etc. This is requirement under WTO whereby equivalence of certification, inspection and testing is established through national accreditation body and which is signatory to multi-lateral agreement through international accreditation forum (IAF). Healthcare does not figure in such an arrangement.

It was April 2005, when question was raised in Parliament that patients wanted to come to India to seek medical treatment and they wanted to ascertain on how to choose hospital with respect to quality and patient safety. This task was assigned to QCI and I readily accepted the job, although as said above, it was not in the charter of QCI. We worked with the help of small dedicated team of clinicians and came out with standard for accreditation through newly created board NABH in Feb, 2006.

Given your work, you’ve certainly witnessed many changes in quality care in healthcare over the past decades.

What are the most important changes, and how do you think these changes enhance healthcare delivery today?

Till the launch of hospital accreditation in Feb 2006, we did not have any formal recognition about quality in healthcare. During initial years, it was difficult to convince hospitals and doctors to follow accreditation framework. It required sustained efforts through series of awareness workshops that hospitals began to appreciate that accreditation was beneficial in improving patient safety. Soon government of India provided incentive to accredited hospitals

through additional reimbursement money through their schemes i.e. CGHS, ECHS and ESI. This helped in raising demand for accreditation.

Today, we have more than 500-accredited hospitals and about 3000-certified hospitals by NABH. This has spread culture of patient safety and it would have huge impact on reduction in medical errors and thereby on morbidity and mortality. The push by payers including government and insurance companies is working well. The hospitals are taking accreditation seriously as they realize that such a framework would help them to reduce cost of poor quality and improve brand value. Today, most of our clinicians speak the language of quality and patient safety and which in larger perspective, is going to help in achieving sustainable development goals (SDGs).

be time in near future, when hospitals will put clinical outcomes in public domain and public at large will chose the hospitals based on such performance indices.

What are your suggestions to overcome these challenges?

The first and foremost requirement is to make good the deficiency in healthcare infrastructure in terms of hospital beds and number of doctors/ specialists. Once it happens, the regulators and payers need to incentivise the hospitals having accreditation. Public at large needs to be made aware of patient safety and its linkages with accreditation. Empowered population would be best driver on quality/ accreditation.

Requirement to establish accreditation came as an opportunity and I am happy that I accepted the challenge

How has your work contributed to your development as a patient safety and quality champion?

Requirement to establish accreditation came as an opportunity and I am happy that I accepted the challenge. I was privileged to get support from industry and few dedicated professionals, who rallied around and made things happen. I have been recognized by industry for this more than I expected. I always believed that I was first among the equals who came forward to work as team. My only contribution was that I believed in true spirit of empowerment and got the results.

Healthcare delivery in India faces many challenges. What according to you are the primary constraints for patient safety and quality?

The quality thrives in competition. In India, we have huge shortage of resources. We have 16lakh beds against requirement of 40-lakh beds.

We have 0.65 doctors against requirement of 1.0 per 1000 population. Over and above there is huge shortage of specialists. As per government account there is 80 per cent shortage of specialists in 6500 community health centers (CHCs). In such a scenario, it is difficult to build quality. Whatever little is achieved through NABH is results of self-motivation by hospitals coupled with a bit of regulatory push and incentives from payers. Hopefully there would

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27

SPECIAL INTERVIEW What is government’s role in providing quality care and ensuring patient safety?

Healthcare of late has become political agenda.

Soon it would be election agenda. Governments would be hard pressed to show results in terms of availability and accessibility of healthcare services. It would therefore be in fitness of things that it provides incentives for private sector to set up hospitals more so in tier-II/ III cities. This looks difficult task as healthcare industry is passing through difficult time.

Governments are coming with social welfare schemes including Ayushman Bharat, which are to be delivered largely through private sector. The reimbursement rates for these schemes have come out to be illogical and below the operating cost. These needs to be worked on scientific basis. Over and above the payment through existing schemes like CGHS, ECHS, and ESI and by many state government schemes are delayed for months, driving hospitals to the brink of unsustainability.

Under these circumstances, no new investment

DECEMBER 2019, VOLUME 3 ISSUE 12 `200 INDIA MED TODAY

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TRENDS

2020

Your message for the readers.

Healthcare is emerging as largest employer in the country. It therefore needs to be nurtured with utmost care. India has huge potential and should have been exporting healthcare workforce including doctors, nurses and allied healthcare workers. However this sector remained neglected over the years and only in 2015 with advent of new health policy, government has begun to put focus. It is time that government engages with private sector and turn around things in fast forward mode. Other important area is to focus on Promotive and Preventive healthcare including nutrition, drinking water and sanitation. It is said that if nutrition and drinking water are taken care, the expenditure on curative healthcare can be halved besides improving quality of life among population.

Subscribe to IndiaMedToday and get 20% discount + Extra FREE issues Indiamedtoday magazine reports on the issues and trends that are shaping the business of healthcare in India and abroad today. Each month, the print magazine discusses long-term strategies to meet the challenges posed by an evolving healthcare marketplace. In every issue, our readers discover the practical advice, analysis, and receive and insight on management trends, innovative 12 + 3 FREE issue. concepts, market strategies and real-world solutions they need to navigate the changing landscape of the business of healthcare.

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INTERVIWE

is going to come. Government needs to take this issue on priority. With payment crunch, the hospitals would be constrained to compromise on quality and that would be detrimental for patient safety.

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SPECIAL INTERVIEW

Leading Change as a Physician Leader Dr H Sudarshan Ballal, Chairman, Manipal Hospitals A CLINICIAN par excellence, excellent teacher and a compassionate physician, Dr. H. Sudarshan Ballal, Chairman, Manipal Hospitals, is an influential thought leader in the Indian healthcare industry. As a leader Dr Ballal, evaluates effective strategies to drive organizational change. His work includes building consensus among key constituents to achieve mission and cultural alignment and deploying state-of-the-art change management strategies.

As a young doctor Dr Ballal was the best outgoing student (Blue Ribbon awardee) of the Kasturba Medical College, Manipal and a recipient of many Gold Medals in MBBS and M.D. and later had his further training in the USA and had the distinction of being one of the few physicians with three Board certificates in Internal Medicine, Nephrology & Critical Care.

He has the rare distinction of being appointed as Professor of Medicine with St. Louis University School of Medicine (USA) and is also Adjunct Professor of Medicine at Manipal University.

He has the distinction of setting-up the first postgraduate training Centre in Nephrology in Karnataka and performed the first cadaver kidney transplantation in Karnataka.

After working as a Consultant in Nephrology and Transplantation at the St. Louis University School of Medicine, he moved back to India to head the Nephrology Unit at Manipal Hospital, Bangalore. Dr Ballal has been with Manipal Hospital, Bangalore ever since its inception as the Director of Manipal Institute of Nephrology & Urology and later served as Medical Director and Chairman of Medical Advisory Board. He is also the Chairman of Stempeutics Research Pvt. Ltd.

He was conferred the fellowship of the Royal College of Physicians, London for his contribution in medicine.

Here Dr Ballal talks about navigating the complex challenges facing healthcare delivery and the health care industry as well as his leadership journey.

You have been the Chairman of Manipal Hospitals for the past five years, can you explain how your experiences as a physician helped you become a leader and change agent at Manipal Hospital?

I do believe my experience as a senior physician was a great asset in my current role. I could look at the issues impartially from both sides of the table and also it was a lot easier to bridge the gap between the doctors (white coats) and the administrators (blue coats) as the doctors have a lot more respect for one of their own in the post that I am in currently.

One of the things I have noted about you is that you had a clear vision, which is certainly important for a leader, but also for leading a major change effort.

Can you talk about setting your vision when you started as Chairman at Manipal Hospitals?

A few things that are very close to my heart in addition to the usual business growth that everyone aspires for are: a. Patient centricity – I wanted everyone to know that in our profession “Patient is King” and all our efforts were to make sure

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SPECIAL INTERVIEW that the patient was the most important person in our organisation. b. Ethical practice of medicine which is very close to my heart and we make sure it is taken with the seriousness it deserves. c. Work on earning back the trust of our patients and bring back the sacred patient doctor relationship. d. Bring in Postgraduate (PG) training through DNB and other fellowship programs in our hospitals such that we now have one of the largest non-medical college training PG programs in our hospitals.

How did you achieve this vision and what helped you along the way?

Fortunately, we have very good people both in administration and among the medical fraternity who also believe in these values and hence it was easy to implement our vision.

JANUARY 2020, VOLUME 4 ISSUE 1 `200 INDIA MED TODAY

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RADIOLOGY BUSINESS Innovative business models will lead growth in the new decade

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CT SCAN USE IN ORTHOPAEDICS

LIVING LEGEND, HANS RINGERTZ

What are the biggest changes you are most proud of, that have happened at Manipal under your leadership?

There are a lot of things that I’m proud of at Manipal Healthcare, but our expansion in the field of healthcare with many new hospitals across the country without compromising on our values; is something that tops this list.

Closely followed by our efforts to make us one of the leading and most sought after PG training centres outside of medical schools in the country. Besides there are a number of changes on the operations side to not only make our hospital more agile but also continue to deliver safe and quality patient care.

How can a physician leader help to advance the quest for improved patient safety and better quality at a lower cost?

Subscribe to IndiaMedToday and get 20% discount + Extra FREE issues Indiamedtoday magazine reports on the issues and trends that are shaping the business of healthcare in India and abroad today. Each month, the print magazine discusses long-term strategies to meet the challenges posed by an evolving healthcare marketplace. In every issue, our readers discover the practical advice, analysis, and receive and insight on management trends, innovative 12 + 3 FREE issue. concepts, market strategies and real-world solutions they need to navigate the changing landscape of the business of healthcare.

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We are very focussed on Quality and patient safety and we have some of the best in the field monitoring it all the time. Unfortunately, quality and patient safety comes with certain costs but we will not compromise on quality and patient safety for the sake of saving costs Being involved with the Manipal University, are you seeing a change in the way medical students are being taught for the next generation of practicing physicians and leaders?

Yes, of course! One of the great achievements of Manipal Academy of Higher Education (MAHE) is that we train our students to be independent and not parrot what is taught to them. We also emphasise soft skills and ethical practice of medicine, which is the need of the hour Healthcare is moving more towards quality metrics, risk arrangements and value-based care. What are your thoughts on these recent developments?

There has been a major churning in the healthcare space and the move towards universal health coverage with a launch of Ayushman Bharat has been a game changer.

Our challenge is to make this viable without compromising quality and affordability.

I honestly believe all across the globe and especially in our country, the focus should be preventive and primary care and creation of wellness rather than treat illness. This is much more cost effective way of making the nation healthy than focus on in-patient and tertiary care What advice do you have for younger physicians?

This is still a great noble profession to be in but has a very long gestation period before you taste success. It is a marathon run and not a sprint. Get into this profession with your eyes wide open and only if you are passionate about what you do and are willing to sacrifice and wait before you achieve success in life.

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SPECIAL INTERVIEW

Guiding Healthcare Delivery Improvement Dr Alexander Thomas, Founder-Member and President, AHPI

Dr. Thomas has played a significant role in bringing communication to the fore within the healthcare sector. His book Communicate.

Care. Cure. A Guide to Healthcare Communication was first published in 2012

32 February 2020

DR. THOMAS has served the healthcare sector in India for over 30 years, and holds positions in several national associations: he is the Founder-Member and President of the Association of Healthcare Providers of India (AHPI), Founder-Member and President of the Association of National Board Accredited Institutions (ANBAI), Founder-President (2012-2017) and Patron of the Consortium of Accredited Healthcare Organizations (CAHO). In these roles, he has effected farreaching policy changes within the healthcare landscape, especially in the area of healthcare communication.

Dr. Thomas has played a significant role in bringing communication to the fore within the healthcare sector. His book Communicate. Care.

Cure. A Guide to Healthcare Communication was first published in 2012, filling a niche in the healthcare industry that had long been empty.

Before that, there was no single publication in India on the role of effective communication for patients, healthcare providers, and healthcare administrators. It has served as a guide to effective communication for healthcare professionals at all levels and shown the impact that communication can have on the quality of care provided by an institution. In 2013, this initiative was awarded the prestigious Quality Council of India (QCI) – DL Shah Award.

Building on the success of the book, training workshops for healthcare communication have been conducted nationwide, igniting a dynamic communications movement that won the QCI – DL Shah Award for an unprecedented second consecutive time in 2014. Hundreds of trainers have reached thousands of healthcare professionals, benefitting millions of patients across India. Both the first and second editions of

this book have sold thousands of copies, with the resulting communications movement drawing much-needed attention to the importance of healthcare communication. The third edition of the book was released in September 2019.

You’ve been Founder-Member and President of the Association of Healthcare Providers of India (AHPI) for 10 years. What first drew you to the association?

After 4 decades of mission service ( including 9 years as CEO of Bangalore Baptist Hospital) I found myself wondering what I was going to do after I retired. Through my work I had experience the plight of healthcare providers first hand. I was also aware of the difficulties of the patients.

At that time I had an urge to work for the people to make healthcare equitable. Working along with Industry leaders like Dr Giridhar Gyani, Dr Devi Shetty and Dr Prem Nair, we instituted an organization that would work towards healthy India, encompassing society, community and common man at grass root.

Thus, Association of Healthcare Providers, India (AHPI) was born. I am currently tPresident of the organization.For the past couple of years I have used my experiences to strengthen the organization that not only works for equitable healthcare but help providers bring in improvements to be able to serve patients better.

How has it contributed to your development as a healthcare leader?

These past few years with AHPI, initially as Executive Director and now as President have greatly contributed to my development as a

healthcare leader. This opportunity has allowed us to create an uniformed voice for the industry.

AHPI allowed us to bring all the healthcare providers under one umbrella.

Given your tenure, you’ve certainly witnessed changes in healthcare over the past decade. What are the most important changes, and how do you think they affect healthcare delivery today?

The biggest change in the Indian healthcare today is thelaunch of Ayushman Bharat — PMJAY in 2018 (world’s largest government healthcare scheme), where 50 crore marginalised beneficiaries have an opportunity to get access to hospital care. So far, 8,000 private hospitals have joined the programme but bigger, multispecialty hospitals are yet to empanel.

The rates of different packages are under review and we have stressed on the importance of quality care and a neutral costing study to enumerate the rate. The government, through the NITI AAyog and the National Health Authority has been requested to review these rates as they are far short of even basic rates for quality and does not cover even the direct costs of the surgeries.

It is no surprise that the private health sector contributes around 70 per cent of all the hospitals and around 40 per cent of total hospital beds (PwC 2007) because the government spends 1.4 percent of GDP on healthcare. We need a leap in healthcare spending. Not only in creating infrastructures but also investing in workforce development. There is one government doctor for every 10,189 people in India, whereas the WHO recommendation is 1:1000. We need to develop a system that can focus on skilling and upgrading medical workforce. Here, again the private sector can play a vital role in the skill development of doctors, nurses and health workers.

Then, from a decade ago when doctors were highly respected, we have come to a stage where nursing homes, doctors and medical professionals are been attacked everyday both physically in their workplaces and also by the media. All in all they need a lot of empowerment to deal with the present situation.

The health care industry faces myriad challenges. What do you envision as long-term goals for the association in preparing hospitals to meet such challenges?

At AHPI we aspire to actively work with the government, policy making institutions, various commissions and committees on proposed legislation, regulations and other reforms, which can enable healthcare providers to deliver affordable healthcare services. We engage with government and work together to provide a good environment so that ultimately quality affordable care is available and accessible to the common man.

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SPECIAL INTERVIEW We collaborated with the Indian Institute of Space Technology and the Indian Institute of Science to introduce a course on technology for medical professionals to better equip them to serve the patients.

We also encouraged continuous development of medical professionals by disseminating courses and training its members in various skills through conferences, workshops and seminars Since 3 years, AHPI has been liasoning with the Central Govt for the CGHS and ECHS empaneled hospitals, however the response was not very encouraging. Recently the IMA joined hands with AHPI in addressing the issue. As a result of this concerted effort, the Central Govt has released a sum of Rs.1000 crore towards clearing of CGHS backlog and another Rs. 1300 crore towards ECHS. What do you see as the association’s primary objectives over the next year?

We should expand our impact through affiliations with other nationally recognized

organizations who are willing to partner with us to work toward equitable healthcare. In this regard, AHPI has strategic partnerships with national organisations like the Public Health Foundation of India (PHFI), IMA Consortium of Accredited Healthcare Organisations (CAHO), Association of National Board Accredited Institutions ( ANBAI), and NATHEALTH . We also work with regional organisations in each region like FHAK and PHANA in Karnataka We should expand our outreach to nonmedical organizations who are willing to partner with AHPI to train its members on ethical standards, healthcare service delivery, innovative medical technology and applied research for the betterment of patient safety and community wellbeing. We work with apex bodies like the Indian Space Research Organisation (ISRO), National Law School of India University (NLSIU), IISC, IIMB, XIME etc to reach these goals.

We will also work closely with the key stake holders i.e. the Government and the Society to realise the universal health coverage – Ayushman Bharat.

AHPI partnered with PHFI and The Live Love Laugh Foundation for Course on common mental disorders

34 February 2020

SPECIAL INTERVIEW

Astute Administrator Dr Naresh Shetty, President, MS Ramaiah Memorial Hospital HE IS a brilliant academician, with an astute sense of business and a passion for excellence.

He is the most sought after mentor at work and has a knack for technology and a great sense of humor. In fact, his ability to not only identify the problem but also see the solution at once has made him quite popular with his co-workers.

His reputation as a progressive administrator is a testimony to his brilliant leadership.

Dr Naresh Shetty, the President of MS Ramaiah Memorial Hospital and celebrated orthopaedic surgeon with an expertise in trauma and arthroplasty, is an easy-going learned man. He can talk to people from all walks of life, conversations are his forte and he can hold his own in front of a7-y-o as well as a 70-y-o with equal interest.

If his life was a movie it would be called ‘Light at the End of the Tunnel’. He has seen the best and worst of life, from struggles of a life in Mumbai to the opportunities education in medicine provides. From living in a cramped one-room flat to enjoying the life in a villa; Dr Shetty has experience life in a way few others can claim and it has made him humble. He could have been a Naval Officer but he found his niche in orthopedic surgery. He perused medicine at the behest of his father and succeeded in his quest for excellence.

Over the years, his diligent work led to much recognition, both within and outside

In the first year, I lost my father and so it was also a very difficult and emotional year; but gradually, I found my bearings and this was only due to my close friends and relatives who were my pillar of strength

India. Chief among them are the International Youth Exchange Programme Award by the Rotary International in 1993 and How medica Fellowship in 1993, HongKong.

His strong humanitarian side is the main distinguishing quality, driving his work today, as he takes on many roles at the hospital and outside. Excerpts from the interview.

Memories of childhood…

I was born in Udipi district which was part of South Kanara. I was the second offspring in a large family. My father moved to Bombay in search of better opportunities when I was quite young. He initially worked in an Industrial unit but his heart was always in business. One fine morning, he resigned from his job and started his own restaurant. Shetty’s were always known in Bombay for Udipi Restaurant and my father added one more to that list. I remember, we initially lived in a very cramped place but as the business improved we moved on a better place. My parents were a strict disciplinarian.

They ensured that I went to a convent school to have the best of education. Of course, I had to go through occasional beatings for not doing homework and spending more time on sports ground but it was all a part of growing up and was fun.

At the crossroads, choosing medicine My first ambition was to become a Navel cadet and travel around the world. It was a dream that remained unfulfilled. I had attended many classes and was also interviewed, but my parents were keen that I take up medicine since there was no doctor in the family and that is what I did, though very reluctantly. However, today I have no regrets. I have made my parents dream a reality. I believe that parents can only do what is good for the child.

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SPECIAL INTERVIEW Wonderful college days Oh! That was a lot of fun. I did my MBBS from JJMMC, Davangere. It was quite difficult initially getting used to the new environment. Not only were the subjects difficult but we had to go through multiple introductory engagement sessions with the seniors (ragging) in the first year. We were so scared that we hardly used to go out. But looking back, I think it was more fun and I realise that it has also made me stronger.

I also made some good friends from the senior batches and this ensured a constant supply of text books and notes from the senior mates.

I saved a lot on books and had readymade answers to help with our theory exams. In the first year, I lost my father and so it was also a very difficult and emotional year; but gradually, I found my bearings and this was only due to my close friends and relatives who were my pillar of strength.

Becoming an orthopaedic surgeon Funnily my choice was between Dermatology and Orthopedics. Everyone used to make fun of me for thinking of two extreme specialties; one very conservative and the other more action packed. However, I chose orthopedic because of an accident that had happened in my younger days. I had badly injured my right ankle and was very happy to see it heal. I also got to know the doctors who treated me. Another factor was that some of the teachers I adored were from this specialty. They were smart, articulate and great teachers. I used to idolise them and so the choice became quite easy.

Learning Surgery I did my MS from KMC, Mangalore under a very dynamic teacher - Dr M. Shantharam Shetty. In fact, my days in Mangalore during my post-graduation were some of the best times of my life. We had some great teachers who exemplified what teaching was all about. They were such great human beings and thought leaders. Their approach towards the patients or peers was simply outstanding. They treated us so well and yet they were very firm on discipline and decorum to be maintained. You just had to follow their style and manners to become a better person. I felt inspired and enjoyed my

36 February 2020

work as well as the atmosphere of the college.

I learnt both soft skills and the art of surgery from my teachers in KMC, Mangalore. Truly, it was an amazing experience.

My first case My first independent surgery was a memorable experience. It was during my final year and we had an ongoing exam at the time. I was given a shoulder case to operate and my Prof. P.K. Usman was to assist me for this case. I started nervously but he never interfered as I went through each steps of surgery. He watched like a hawk but never talked till I had finished.

After the closure, he said something which I have not forgotten till date. His said, “Naresh, I have given you the MS degree even before your Exams. Well done.” This acknowledgement of my skills was the wind beneath my wings. It has been more than three decades since but those words still bring a sense of pride and joy to me.

Changes in the field of Orthopaedic surgery So much has changed in the last three decades in orthopaedic surgery. Today, orthopaedic surgeons have improved both in skill and outcome. In our days, there was no C - Arm nor some of the power equipment. We worked long hours, duration of surgery was long and required a lot of hard work. It was physically draining. There were times when, after a day’s work we would be so tired that we would overcome with sleep even before dinner.

Things have changed now, a lot of sub -specialties have also grown which has really revolutionised the management of many challenging problems in orthopaedics. We have lot of good things to offer our patients so that they can have a better quality of life with better outcomes.

Enjoying Teaching I really liked teaching and without appearing pompous, I must say, I was a popular teacher. I had my share of admirers among students and still have some great relationship with some of our alumni.

Even today, I would prefer to spend time with young students, enjoying the joy of giving and getting enriched. Importantly, they keep me young and on my toes. I really miss out on

Favorite food - Kori Rotti (Coastal Cuisine) Favorite movie - The God Father Favorite music - Old Hindi songs Unwind activity - Reading & listening to music Do you enjoy sports - Has been very integral part of my life. Can miss on my sleep but not on my game of badminton Favorite Game -Shuttle Badminton. Used to play hockey in younger days and was a middle distance runner Favorite book -The Atlas Shrugged by Ann Rand Life is…beautiful. Make the most of it. Live every moment and make it count.

Friendship is…about having people who are of your kind crazy and freaking out.

Struggle is…part of growing up .It has made me better and wiser. More important, one becomes empathetic.

Reward is…incentive to become better human being. Be thankful for all the blessings from the Almighty. I cannot ask for more; good friends, an understanding family and a supportive employer.

some fun times with students.

Shift from active practice to administration It has been 22-years since I was requested to get in to administration.I never liked it but like many things in my life, it was obligatory for me. Once I took it up, I pushed myself hard to understand its intricacies and its needs. All physicians are leaders in their work, departments but leading a healthcare organization is a different kind of challenge. Today, I can safely say, to be a good administrator, you need to have plenty of common sense. You need to have a lot of empathy. Life is never easy when you are leading a diveres team as the MSR group. You are constantly under surveillance and problems keep coming constantly. But to get ahead of your reservations and solving the problems, is what keeps life interesting.

The MSR Hospital experience I guess, initially I was like a fish out of water. I struggled through those early days with various departments. I went home with lot of dust as we were building the new tertiary hospital. Each day was a new learning experience, weekends were for unlearning and relearning. I learnt the hard way that it is quite lonely at the top, you have no friends. The management has high expectations, patients want quality treatment almost free, the doctors want newer and better technology faster and the staff wants better salary. Managing such diverse expectations is not easy; to keep everyone happy is an art, craft and science in itself. There was a learning curve, no doubt, but over a period

Today, we have more than 500-accredited hospitals and about 3000-certified hospitals

by NABH

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SPECIAL INTERVIEW of time, you get smarter.

The two decades of experience has really taught me some great lessons and made me a better human being. I have evolved over a period of time to become more practical. Today, I listen with patience, understand the needs and show empathy where ever possible. The opportunity and experience of all these years has truly been worthwhile and fulfilling.

Any regrets Actually, I am in a happy place right now. I have done my bit but it has been a lot of hard work. I have spent sleepless nights over many problems but I found solutions at the end of the day. My only regret is that society has not really understood the stress that we doctor undergo.

In addition the digital age and the advent of social media has made life miserable. A doctor is a soft target for anyone with a social media tool. Instead of bridging the communication gap social media is used more for voicing frustration rather than understanding.

Another thing I would like to point out is that doctors have been getting the short end of the stick from the policy makers. The policy makers do not realize that a doctor in India is

38 February 2020

Today, orthopaedic surgeons have improved both in skill and outcome. In our days, there was no C - Arm nor some of the power equipment.

We worked long hours, duration of surgery was long and required a lot of hard work. It was physically draining actually doing 10-times more work than their western counterpart. Yet, they are pushed in to doing more and more work which is other than their core domain. They are criticised, battered and subjected to humiliations. The physicians’ patience is at breaking point. You cannot expect first world treatment with so many loads and so little support.

The government needs to look into the imbalance of doctor patient ratio, enhance it, reduce the cost of education and then raise its expectations. Blaming doctor’s for all the faults in the system will not solve any problems.

PULSE

Growth Graph: Clinical Diagnostics The pulse of Indian clinical diagnostic industry

Team IMT

INDIAN DIAGNOSTICS industry is highly competitive with standalone centers having approximately 47 per cent market share, 37 per cent for hospital-based diagnostic centers and remaining 16 per cent for organized diagnostic players. Low entry barriers, low capital expenditure requirements and minimum regulatory supervision make it easier for new competitors.

There are two segments in diagnostic industry in India - pathology testing services and imaging diagnostic services. Pathology testing or in-vitro diagnosis involves the collection of samples, in the form of blood, urine and stool and analyzing them using laboratory

equipment and technology to arrive at useful clinical information, in order to assist with the treatment of diseases. This segment includes biochemistry, immunology, hematology, urine analysis, molecular diagnosis and microbiology. Imaging diagnosis or radiology involves imaging procedures such as x-rays and ultrasounds, which help mark anatomical or physiological changes inside a patient’s body, in order to assist doctors to diagnose a disease. The imaging diagnostic segment also includes more complex tests, such as computed tomography scans and magnetic resonance imaging and highly specialized tests, such as positron emission tomography scans.

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PULSE India’s diagnostic industry is expected to grow at a CAGR of approximately 16 per cent to reach approximately Rs 802 billion (USD 12.3 billion) in the financial year 2020

Pathology testing is often the preferred first line of diagnosis for a majority of diseases and thus contributes to a major portion of the diagnostic industry. Given the high volumes of pathology testing conducted in India, it accounts for more than half of the revenue of the Indian diagnostic industry. The pathology business is highly scalable as blood samples can be shipped to a remote, centralised location to achieve economies of scale. In contrast, imaging business operators have to install diagnostic equipment close to the patient.

Imaging services cannot be centralized and, as a result, are difficult to scale up.

Market overview The Indian diagnostic industry is estimated to grow at a CAGR of approximately 16.5 per cent to approximately Rs 596 billion (USD 9.1 billion) between 2015 – 2018 period. For the next two years, India’s diagnostic industry is

expected to grow at a CAGR of approximately 16 per cent to reach approximately Rs 802 billion (USD 12.3 billion) in the financial year 2020. Within the diagnostics market, the pathology segment is estimated to contribute approximately 58 per cent of total market, by revenue, in the financial year 2018, while the remaining 42 per cent is estimated to be contributed by the radiology segment.

Key Players In India, there are four major chains of diagnostic players with a pan-India presence.

They are Dr. Lal PathLabs Limited, Thyrocare Technologies Limited, SRL Diagnostics and Metropolis. There are a few regional players who have a strong footprint in a particular region such as Quest Diagnostics (North India), Suraksha Diagnostic (East India), Suburban Diagnostics (West India) and Medall Healthcare (South India), among others.

Financial profile of the four leading pan-India diagnostic chains, for the year 2018: Company Name

Operating Revenue (Rs million)

Dr. Lal PathLabs Limited

10,569

SRL Diagnostics

8,540

Metropolis

6,472

Thyrocare Technologies Limited

3,560

Geographic Split of Revenue, India North: 72 per cent East: 13 per cent West: 7 per cent South: 7 per cent Others: 1 per cent North: 32 per cent East: 20 per cent West: 27 per cent South: 18 per cent Others: 3 per cent North: 7 per cent East: 3 per cent West: 54 per cent South: 28 per cent Others: 8 per cent North: 24 per cent East: 17 per cent West: 31 per cent South: 26 per cent Others: 2 per cent

EBITDA Profit After Tax per cent (PAT) per cent 25

16.3

18.9

-

27.2

17.3

40.7

26.2

Source: Annual report and company websites of respective labs

40 February 2020

Competitor profile of the four leading pan-India diagnostic chains, for the financial year 2018: Company Name

Domestic Presence

International

Accreditations

No. of Centers

No. of Reference Laboratories

Dr. Lal PathLabs Limited

Pan- India

Bhutan, Sri Lanka, Myanmar, Malaysia, Tanzania, Nigeria, Saudi Arabia, Maldives, Ethiopia, Kenya, Ghana, Uganda, Qatar, Kuwait and UAE

NABL,ISO,CA P, CDC (USA)

Clinical Labs- 193 Patient service centers – 2,153 Pickup points - 5,624

National: 1 at Delhi Regional: 1 at Kolkata

SRL Diagnostics

Pan- India

Dubai, Sri Lanka, Nepal, Congo, Africa, Middle- East, Hong-Kong, Maldives and SAARC countries

NABL,ISO,CA P, APLAC

Clinical Labs- 364 Patient service centers – 1,078 Pickup points – 6,271

Regional: 4 laboratories, each at Mumbai, Gurugram, Kolkata and Bengaluru.

Metropolis

Pan- India

Nepal, Nigeria, UAE, Oman, Ghana, Kenya, Zambia, Mauritius and Sri Lanka

NABL,ISO,CA P, CDC (USA), ILAC, APLAC

Clinical Labs- 106 Patient service centers – 1,130 Pickup points – 8,500

National: 1 at Mumbai Regional: 12 laboratories, each at Rajkot, Guwahati, Raipur, New Delhi, Surat, Bengaluru, Kochi, Pune, Chennai, Kolkata, Kenya and Sri Lanka.

Thyrocare Technologies Limited

Pan- India

Nepal, Bangladesh, Gulf

NABL,ISO, CAP

Authorized Service providers – 3,379 Collection points - over 30,000

National: 1 at Navi Mumbai Regional: 8 laboratories, each at New Delhi, Mumbai, Patna, Kolkata, Bhopal, Hyderabad, Coimbatore and Bengaluru.

Note: Numbers updated as on March 2018. NABL - National Accreditation Board for testing and Calibration Laboratories, ISO- International Organization for Standardization, CAP - College of American Pathologists, APLAC - Asia Pacific Laboratory Accreditation Co-operation, ILAC - International Laboratory Accreditation Cooperation, CDC - Centers for Disease Control and Prevention, CLIA - Clinical Laboratory Improvement Amendments.

Growth Stimulators Progressing Privatization and Publicprivate Partnerships Though the number of healthcare facilities available in India is increasing, the emphasis on growth is occurring more in Tier I and Tier II cities. Large parts of rural areas do not have basic facilities and most people in rural and semi-urban areas have to travel to nearby cities to get access to healthcare facilities.

Hence, many of them avoid these checkups and this large market remains untapped. Private companies are expecting to expand by entering into tie-ups with the government, especially to tap the rural market. An increase in the expansion of the private healthcare sector and the quest for quality healthcare is expected to drive growth of the diagnostic industry across India.

Promotion of Health Awareness Private healthcare companies, hospital groups,

diagnostic chains and health insurance firms carry out various health awareness programs as part of their marketing activities. These activities have increased overall health awareness levels with people focusing more on their fitness, health and well-being.

Increasing Spend on the Preventive and Wellness Segment With the growing awareness for preventive care and individual and corporate wellness, diagnosis and predictability of diseases at the early stages of occurrence is expected to be higher. Early diagnosis at point of care, monitoring of health and disease conditions with data enabled predictive capability for managing human health and risk is expected to collectively drive the diagnostic and healthcare sector as a whole. Hence, pan India diagnostic chains with an established brand name are best positioned to capture this growth in the diagnostic market.

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EVENTS AHPI GLOBAL CONCLAVE 2020 Date: 7-8 February, 2020 Location: Ramaiah Medical College,

Auditorium City: Bengaluru Organizer: Association of Healthcare

Providers, India (AHPI) Click: http://ahpi.in/ahpi_global_conclave/

index.html Contact: Shikhar Gupta - Assistant

Director 9540859694

H

ealthcare has firmly become political agenda and that makes it receiving dueattention by policy maker sand powers that be.Government will be promoting social welfare health insurance schemes, it will bringe normous pressure on hospitals to financial sustain owing to inherently lowre imbursement models.

CRITICARE 2020 Date: February 26-27, 2020 Venue: Hyderabad International Convention Center City: Hyderabad

The 26th Annual Conference of “Indian Society of Critical Care Medicine”, CRITICARE 2020, will have exciting and informative scientific programme that will be broad and varied, encompassing plenary lectures, breakout sessions and workshops by renowned National & International experts.

The programme will feature streams with a wide variety of topics, taking into consideration conference theme, ‘PRECISION IN INTENSIVE CARE” enabling visitors to tailor the programme specifically to their own interests and clinical practice, as well as information packed Pre Congress Workshops.

SMART HEALTH CONFERENCE Date: March 5-6, 2020 Venue: Bombay Convention & Exhibition Center City: Mumbai Organizer: Smart Hospitals & Medical Fair India Contact: drsalil@hosconnnconsulting.com

The “Smart Hospitals” platform was created to

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February 2020

Hospitals will be expected to partner the government led initiatives forclean drinking water, nutrition, clean environmentan duse of tele-health in screening for NCDs. It will give push for hospitals to be truly LEAN, GREEN and SMART. Allinall, healthcare is going to be in new AVATAR in next decade. The AHPI conclave will capitulate all dimensions of this AVATA Rand how it will impact all stake holders including Patient, Provider, Payer, Pharmaceuticals, Medical Technology and Government/Regulating Bodies etc.

The conclave will also encompass the unique blend of 6th edition of ’ AHPI AWARDS for Excellence inHealthcare’ in defined categories and will be presented over Galad inneroneve of 7th February 2020.

help the Small and Midsized Hospital Owners to rethink their business models, create new opportunities by evolving newer smart ways of delivering healthcare. The intent was to bridge an existing gap as medical conferences hardly ever touch the business side of healthcare. Managers diving in from FMCG have done the greatest disservice by commoditising healthcare. It is high time doctors and doctor managers take charge of this business side.

Medical Fair attracts a diverse group of healthcare professionals, from established players to those looking to renovate / upgrade their facilities to those who are just starting out. It is thus the right platform to introduce business management skills as well as technological interventions to make Healthcare affordable to all stakeholders.

MEDICAL FAIR INDIA 2020 Date: March 5-7, 2020 Venue: Bombay Convention & Exhibition Center City: Mumbai Organiser: Messe Düsseldorf GmbH Contact: JoshiS@md-india.com

MEDICAL FAIR INDIA is India’s leading Trade Fair for the medical and healthcare industry.

For the last 25 years, Medical Fair India has

been successfully addressing the various needs of Hospitals, Health Centres& Clinics. The main segments on display at MEDICAL FAIR INDIA 2019 include: medical products and devices, laboratory technology and diagnostics, clinic and health centre furniture, and the health IT segments now so on trend the world over as well as mobile health solutions.

MEDICAL EXCELLENCE AWARD 2020 Date: March 7, 2020 City: Bengaluru Contact: Event Director, 98867 62460

The APN Medical Excellence Awards 2020 is conceptualized with an aim to promote the Medical Tourism of Karnataka along with AYUSH systems of Govt.of India. Here, APN felicitate organizations and individuals for their contributions to the industry by innovating for increased efficiency, affordability and improved performance of healthcare delivery at large.

APN invites CXOs of hospital chains, medical directors, owners/promoters of hospitals and diagnostic centers, consultants, thought leaders, industry stalwarts and domain experts to congregate at the Medical Excellence Awards 2020.

MEDICALL 2019 Date: April 3-5, 2020 Organiser: HITEX Exhibition Center Izzat Nagar City: Hyderabad Contact: Mr. K Sundararajan, 91-7305789789 Click: info@medicall.in

Medicall is India’s largest B2B trade fair for medical devices and hospital supplies. Approx.

750 exhibitors and 15,000 trade visitors from over 20 countries, among them physicians, but also biomedical engineers, sales people, decision makers, consultants and hospital owners, are represented at this important industry event. In addition to the presentation of the best and the latest medical and medical-technical equipment, software, supplies and other devices the market has to offer the fair mainly serves as a platform to exchange knowledge and experiences among renowned industry experts. Various conferences and innovation awards in different categories complement the event.