IndiaMedToday Feb 2018 by IndiaMedToday

FEBRUARY 2018, VOLUME 1 ISSUE 5 `200

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PAVING THE WAY FOR QUALITY TRANSFORMATION PATIENT BEHAVIOUR AND PATIENT SAFETY

COST-IMPLICATIONS OF IMPROVING QUALITY CARE

HEALTHCARE

QUALITY IN

Dr Alexander Thomas

Dr Giridhar Gyani

Dr Harish Pillai

Co “A nc HP la I G ve lo -K ba oc l hi ”

CHANGING TIMES

EDIT NOTE www.indiamedtoday.com

FENRUARY 2018 EDITORIAL

BOARD OF ADVISORS

Editor Neelam Kachhap editorial@ indiamedtoday.com

Dr Dr Dr Dr Dr

Alexander Thomas Girdhar Gyani Prem Kumar Nair Bhabatosh Biswas Alok Roy

ART & PRODUCTION

CONSULTING EDITOR

5Th eLLemenT sTudio Prasshant

Dr Libert Anil Gomes Dr Murali Poduval

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ARE HOSPITALS IN INDIA INVESTED IN THE IDEA OF QUALITY AND ACCREDITATION THE RECENT health ranking of Indian states done by NITI Aayoghas again reiterated the need for systematic investment in human resource and improvement in health system and service delivery bu both central and state governments. The state health ranking has brought to focus, the right policies and programs that have been shown to work in real life and that are a good fit for the community. In the next phase the government district hospitals will be ranked and Amitabh Kant the CEO of NITI Aayog has made it clear that good performers will be encouraged and non-performers will be named and shamed. The hospitals will have to show success in health outcomes, governance and information, and key inputs and processes. One of the major challenges identified by the NITI Aayog in the recently released ranking is quality accreditation of public health facilities. According to the NABH which is the quality accreditation certifying body in India, drivers of quality and accreditation do not exist with the same level of urgency in the government hospitals as it does in the private healthcare set-up.

One of the major challenges identified by the NITI Aayog in the recently released ranking is quality accreditation of public health facilities With NITI Aayogâ&#x20AC;&#x2122;s continuous focus on ranking of healthcare good credible data will be available in India for the government and the private providers to push the agenda of quality and Patient safety ahead. In time to come, quality and patient safety will be encouraged by the government with incentives for the provider and benefits for the patients to invest in healthy lifestyle. Ultimately this will bring down thecost of healthcare delivery in India. However, no strategy for quality care can be meaningful unless it involves the perspective of the patient as ultimately the end goal all this activity is a healthy and happy nation.

Editor M Neelam Kachhap

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FEBRUARY 2018

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CONTENTS APPROACH

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UPFRONT

KNOWLEDGE IS POWER! How patient empowerment improves patient safety

OPINION

BUDGET 2018 ANALYSIS Much awaited Health initiative: value laden but ambiguous.

COVER STORY

03 Editorial 05 Letters 06 News roundup 48 Ask the expert 50 Events

AHPI GLOBAL CONCLAVE SPECIAL 26 Procedural costing and Patient safety

Dr Alexander Thomas,

President, AHPI

29 Future of Healthcare will be Quality Driven Dr Giridhar Gyani,

Director General, AHPI

HEALTHCARE QUALITY IN CHANGING TIMES

Healthcare today is grappling with twin burden of rising cost of care and enhancing outcomes. Investing in quality improvement and accreditation will ensure a culture of safety and organization success.

32 Leadership for quality enhancement Dr Harish Pillai,

CEO - Aster Medcity, Cluster Head â&#x20AC;&#x201C; Kerala, Aster DM Healthcare

FEATURES IMPACT

HOW A NEW COLLAGEN MATRIX IS TRANSFORMING CARDIAC -SURGERY

16 4

February 2018

A readily available collagen matrix without any cells or cell remnants or antigens is a much desired product in correcting heart defects.Prof Leon Neethling.

WHY FOCUS ON PEDIATRIC EMERGENCY MEDICINE? OBITUARY

COL SUNIL KUMAR PANDURANG MATWANKAR

16-17 FEBRUARY 2018 Hotel Le meridien Kochi, Kerala

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LETTERS

y heartiest congratulations to this government for investing in creating a swasthbharat by launching the Ayushman Bharat programme. Such ambitious out of the box thinking was a burning need of the hour and the government has not disappointed. The initiative to cover 10 crore families with 5 lakh per family/per year with insurance cover for secondary and tertiary healthcare will be a gamechanger.”

DR Prathap Reddy Chairman, Apollo Hospitals

The big move towards the path of Universal Healthcare Coverage under the flagship National Health Protection scheme which will bring 50cr citizens with Rs 5 lac/family for secondary and tertiary care hospitalisation is transformational for the country. The question to answer is how will the scheme be funded and executed given the fact that health is also a state subject. This move coupled with the announcement of 24 additional govt medical colleges and hospitals gives healthcare the centre stage in this budget. In addition the increase in tax exemption for senior citizens on health insurance premium and medical expenditure is a good move. This was also the opportune time for the FM to give infrastructure status to the healthcare sector and provide the much needed acceleration to capacity creation in the sector. The reduction in corporate tax for SME businesses with revenues up to Rs 250cr is a step in the right direction to push the agenda of their growth and the Rs 10k cr outlay for the telecom infrastructure under Govt projects including the support for establishment of indigenous 5G centres with IIT Chennai is an excellent move.” Vishal Bali Co-Founder & Chairman, Medwell Ventures

The announcement of the National Health Protection Scheme to cover 10 crore “vulnerable” families and provide them up to Rs 5 lakh per family per year in secondary and tertiary care institutions is one the key healthcare highlights in Budget 2018. While this is a laudable development, the Government will need to scope and plan the implementation with utmost diligence as it may cripple the existing limited medical infrastructure in the country.

Healthcare schemes are focus of this year’s budget. It is vital that they are implemented and monitored effectively and efficiently so that they enable providing high quality patient care and that they truly benefit the citizens.While there’s a lot in the budget for the healthcare sector, some items in our wish list remain. These include an increase in public spending on healthcare, universal health coverage, public private partnerships, implementation of GST to lower the cost of running of hospitals, digital healthcare and incentivizing healthcare innovation, research and technology. On the whole1 this budget marks the importance of social sectors and the government’s focus on healthcare for the common man is a step in the right direction for India’s health. Gautam Khanna CEO at PD Hinduja Hospital & MRC

This is a comparatively much better budget for healthcare delivery system of the country. The initiative on the Universal Health Care is commendable. This will surely be one of the world’s largest healthcare program that proposes to cover 10 crore vulnerable families, with approximately 50 crore beneficiaries. The scheme for creation of 1.5 lakh Health and Wellness centres, which are intended to provide free essential drugs and diagnostic services, will definitely make healthcare much more accessible to the people. However, no allocation has been made in the Budget for Private Public Partnership or even engaging private healthcare organisations in healthcare delivery by the government.” Dr Prem Nair Medical Director, Amrita Institute of Medical Sciences, Kochi, Kerala

Dr Ashwani Bansal Director – Strategy & Operations, CIMS Hospital

Despite a significant rise in allocation to the health sector in the Budget 2017-18, the overall government expenditure on health remains extraordinarily low amounting to 0.3% of GDP and continues to be much lower than the health spends of comparable developing economies. It is also of concern that despite the complex challenges in the healthcare sector, a significant portion of health funds remain unutilized.These issues continue to remain unaddressed. A. Vaidheesh President, Organisation of Pharmaceutical Producers of India (OPPI)

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NEWS ROUNDUP NMC BILL: AHPI K’TAKA RAISES CONCERNS, 3 POINTS HIGHLIGHTED To overcome the challenges being faced by the health sector in India, as highlighted by the Honorable Parliamentary Standing Committee in its report submitted to the parliament on March 8, 2016; the Government of India came up with the draft National Medical Commission (NMC) Bill 2017, aimed at creating of robust medical education regulatory system. As per the committee report, there are huge gaps in availability of qualified doctors, specialist, and super specialist, and a huge geographical mal-distribution of medical colleges under which 2/3 medical colleges are in the regions representing 1/3 population. Moreover, the medical education regulatory framework is grossly inadequate and ineffective on ground. There is total disconnect between medical education system and needs of healthcare delivery system in the country. Keeping above in view there has been long

February 2018

pressing need to reform medical education. Accordingly, Government of India came up with the draft National Medical Commission bill 2017, aimed at creating of robust medical education regulatory system. Considering that reforms in health systems of nation are closely linked with nation’s medical education system, it is important that new system by way of NMC should be able to meet the challenges as mentioned above and take our health system to next level and make universal health coverage (UHC) a reality in near future. There are however, certain areas of concern in the draft bill that need to be addressed if the objectives of having world class regulatory framework are to be fulfilled. These are as follows:  The proportion of elected representatives from medical fraternity in the proposed NMC 2017 is to the extent of 20% which is grossly inadequate and undermines the principles of democracy. This needs to be enhanced appropriately.  The founding principles of modern medi-

cine are evidence-based and are rooted in standard treatment protocols, which have nothing in common with the traditional systems of medicine (AYUSH). Therefore, mixing up of these systems of medicine through bridge courses will in no way be appropriate. On the contrary it will undermine the patient safety and pave the way for promoting quackery.  Following successful completion of the MBBS examination enforcing another National Licentiate Examination is superfluous. However, those aspiring to do postgraduate courses can be made to appear for common PG-entrance examination. Voicing his opinion, Dr BS Ajaikumar, Karnataka state president Association of Healthcare Providers of India said, “The draft NMC bill addresses the needs of healthcare across India, but there are certain parts which leave the door wide open for corruption. We should learn from history and ensure that the same mistakes and pitfalls are not replicated. An autonomous and independent body govern-

ing licensing, standardization, accreditation, governance and monitoring of medical education is the need of the hour. For this, I strongly recommend minimum government involvement and representation in the Committee and more participation of relevant stakeholders, in the same. Moreover, there should not be any bridging course for AYUSH doctors to practise Allopathic medicine. The Allopathic education criteria needs to be looked at realistically, thereby meeting the requirement rather than taking ad hoc firefighting decisions that will result in chaos.” According to Dr Thomas Chandy, Advisor, Association of National Board Accredited Institutions (ANBAI) Karnataka Chapter, “Medical education in India, particularly needs a serious spruce up. The NMC Bill will once and for all resolve the issue of equivalence between MD/MS & NBE degrees and there will be no disparity.” Speaking at the conference, Dr Alexander Thomas, President AHPI, said, “The bill should endeavor towards providing quality, affordable and accessible healthcare to the common man.” Dr V Narendranath, Joint Secretary, The Consortium of Accredited Healthcare Organisations (CAHO), “A comprehensive NMC Bill, will be instrumental in monitoring the quality of medical institutions, thereby ensuring the quality of medical graduates and in turn the quality of healthcare delivery.”

MASICON 2018 CONCLUDES IN MUMBAI MASICON 2018 is annual conference of ASI, Maharashtra state was held from Jan 25-28, 2018 at Grand Hyatt, Mumbai. The four day conference saw more than 1200 delegates from across India, in addition to delegates from Bangladesh, South Africa and Vietnam and speakers from Nepal, Germany and USA were part of the discussion. The objective of conference was to train more than 100 young, budding surgeons from peripheral Maharashtra for various procedures where they were trained on porcine models under the guidance of experts. The conference highlighted a talk by Col Lt Rai on the Kargil

war and a masterclass on fistula in Ano. Dr Roy Patankar, Gastroenterologist & Director, Zen Hospital said, “To provide optimal benefits for patients, we are glad to train more than 100 young surgeons from peripheral Maharashtra along with well-known surgeons from across the country shared their experiences and knowledge on this platform.”

ADMEDUS LAUNCHES ADAPT® TECHNOLOGY IN INDIA In a significant development for Indian patients requiring treatment for structural or congenital heart disease and defects, Australian company Admedus Limited in partnership with Syncronei Medical India Pvt Ltd, and supported by the Australian Trade and Investment Commission (Austrade), is pleased to introduce its ground-breaking and clinically-superior ADAPT® technology in India. From January 30, 2018, physicians in India will have access to the transformative power and significant patient benefits of ADAPT® engineered tissue and Admedus’ flagship product CardioCel®, a bio-scaffold for the management of congenital and adult structural heart abnormalities. “In a country with approximately 50 million cardiac patients and 280,000 babies born annually with a Congenital Heart Defect (CHD), the introduction of our disruptive ADAPT® technology is a significant opportunity for India’s physicians to provide life-changing outcomes for their patients,” said Admedus CEO Wayne Paterson. “CardioCel® has been available in North America and Europe for some time but this is the first time Indian physicians and patients have had access to Admedus’ world-class ADAPT® technology,” he said. Primarily used in restorative structural heart repair and reconstruction, ADAPT® treated tissue provides unparalleled resistance to calcification, delivering transformative repair with long-term durability that enables native cells to successfully grow and differentiate through the entire repair, without calcification or toxicity.

“Our clinically superior ADAPT® products, invented and manufactured in our state-ofthe-art manufacturing facility in Australia, are the only ones to have achieved nine years without calcification or degradation, providing Indian surgeons with a potential lifetime solution for their patients,” Mr Paterson said. To support the launch of CardioCel® in India, ADAPT® inventor and Admedus Vice President of Cardiovascular Technologies Professor Leon Neethling will deliver acomprehensive series of meetings and presentations with physicians in major health centres across India to demonstrate the product’s clinical applications and benefits. The official launch activities follow the announcement of 22 November 2017 whenAdmedus had received regulatory approval to launch our CardioCel® product in the India, with Syncronei Medical India Pvt Ltd appointed as exclusive commercial partner managing all sales, marketing and distribution. This is an outstanding opportunity for Admedus as it continues to develop as an innovative and bankable business delivering clinically-superior healthcare solutions. Admedus and Syncronei Medical are looking forward to working closely with Indian clinicians, health officials and key opinion leaders (KOLs) to build productive long-term relationships focused on helping to improve the health outcomes and quality of life for Indian patients with heart disease.

TRIVITRON HEALTHCARE JOINT VENTURE FOCUSED ON THE AFRICAN CONTINENT

Trivitron Healthcare Private Limited, India’s leading medical technology company, together with the Investment Funds for Health in Africa, a leading private equity investor in the healthcare sector in Africa, are excited to announce the launch of Trivitron Healthcare Africa B.V., a new medical technology company focused on the African continent. THA will provide highquality medical devices and instruments with reliable after-sales service support across Africa, thereby improving access and affordabil-

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NEWS ROUNDUP ity of medical equipment across the continent. In its first phase of operations, Trivitron Healthcare Africa will be headquartered in Dubai, United Arab Emirates, with a direct presence and sales and service infrastructure in four major hubs: Nairobi, Kenya; Johannesburg, South Africa; Lagos, Nigeria and Algiers,

Algeria. The company will leverage these hubs to support neighbouring countries and manage an extensive channel partner network across the African continent. THA’s initial offering will include a complete range of products and after-sales service support in laboratory medicine, medical im-

aging, critical care, operating room and renal care. The company will not only distribute and support products manufactured by Trivitron in their nine USFDA, CE certified factories in India, Finland and Turkey; but it will also distribute and support products from other leading multinational corporations. In addition, THA will have an exclusive Projects division capable of executing turnkey hospital projects in the African continent. THA is already working with a leading healthcare group in East Africa to support the design and equipping of its new flagship hospital in Nairobi, Kenya. The company will also have a Multi-Vendor Biomedical Engineering Services division to ensure support for healthcare providers across Africa, and focus on academic initiatives, offering paramedical and super specialty support courses in association with reputed academic institutions from India and Europe. THA is in advanced discussions with the International Finance Corporation (“IFC”), a member of the World Bank Group and investor in many of the leading healthcare providers in Sub-Saharan Africa, for a debt investment to support its growth strategy. Dr. GSK Velu, Chairman and Managing Director of Trivitron said, “This is a first of its kind venture between the leading medical technology company in India and a leading healthcare private equity investor in Africa, with support from IFC.” “IFHA has long seen an opportunity to improve access to quality healthcare services by creating a provider of high-quality, affordable medical equipment and services. IFHA is excited to partner with Trivitron and IFC to turn this vision into a reality.” said Max Coppoolse, the Managing Partner of IFHA.

AXIO BIOSOLUTIONSRAISES $7.4MN IN SERIES B ROUND FROM RATAN TATA’S RNT CAPITAL AxioBiosolutions, the first Indian company to launch an emergency haemostat for trauma

February 2018

care, has raised $7.4mn in a Series B funding round led by Ratan Tata’s RNT Capital along with existing investors Accel Partners and IDG Ventures India. Masterkey Holdings was the advisor for the transaction. The company plans to use the funds for expansion to new markets, while continuing to work on high-impact medical products. AxioBiosolutions’ flagship invention, Axiostat, is a patented and CE-approved product that has prevented countless deaths due to haemorrhage and grievous injuries. The innovative first-aid dressing stops uncontrollable bleeding within just 2-3 minutes of its application, thus saving lives. Axiostat is the de-facto product of Indian armed forces after being used in surgical strike to save life of solider and is now an essential part of their field kit. Catering to the Indian Armed Forces, BSF, NSG, para-military forces, hospitals and emergency services not only in India, but across the globe, the home-grown first aid dressing is disrupting the wound care market. Commenting on the latest funding, Leo Mavely, Founder and CEO, AxioBiosolutions said, “We are glad to welcome RNT Capital to partner with us in this journey, along with Accel Partners and IDG Ventures, who continue to support our vision. Uncontrolled bleeding is one of the leading causes of death from traumatic injuries. We are grateful to make a meaningful impact in this space by saving lives of innocent victims. We are fortunate to have investors who recognize this and who are committed with us to make the first global woundcare brand from India. The current round of funding will help us expand into new markets and introduce more products in the wound care and drug delivery space.” Barath Shankar Subramanian, Principal, Accel Partners stated, “We invest in disruptive and innovative companies that build products keeping the Indian consumer in mind, while having global ambitions. Axio is well-poised to disrupt the wound care industry. In the last few years, we have seen the company transform into a global player and we are excited to be a part of this transformative journey” Ranjith Menon, Executive Director, IDG Ventures India further added, “The medical de-

Leo Mavely, Founder, AxioBiosolutions, with the products

vice market in India is in a fairly nascent stage, especially in the startup sector. We believe that Axio has demonstrated that it is possible to build world-class products to cater to the Indian as well as the global markets. The team has cemented some strategic partnerships and will continue to lead the wound care management space through technology innovations”. Headquartered in Boston, AxioBiosolutions has its corporate office in Bengaluru and GMP-certified manufacturing facility in Gujarat. The company has built a strong R&D structure, with multiple patents to its credit in the wound healing, mucoadhesive drug delivery and hemostats space.

CARESTREAM HEALTH UNVEILS NEW MEDICAL IMAGING, HEALTHCARE IT PRODUCTS

Carestream Health demonstrated its expanding portfolio of medical imaging and healthcare IT systems at the 71st annual conference of the Indian Radiology & Imaging Association which was held in Mumbai from the 25th to the 28th of January. This year the IRIA was combined with the 17th Asian Oceanian Congress of Radiology, making this a not-tomiss event in the annals of Radiology conferences in India. With the theme Explore, Invent, Transform, Carestream invited attendees to explore and

advance Radiology, through innovative means which create a positive impact on patient care. The company displayed an interactive touch wall which offered a first of its kind, unique experience of Medical Imaging workflow. The fascia was once again futuristic and revolutionary in the true sense, especially in world of Indian Radiology. The interactive touch wall exhibited the company’s innovative Imaging solutions for Acquiring, Collaborating and Sharing, medical Images. The Acquire interactive wall showcased the following products, highlighting the key benefits of each while displaying the workflow;  The DRX-Evolution Plus, is a fully automat-

ed, ceiling suspended digital X-ray system with greater flexibility, extended tube column and a high performance Carestream generator. The forward looking design of the DRX Evolution Plus is devised to accommodate advanced imaging applications in the future.  DRX-Revolution is Carestream’s mobile xray system with a fully automatic collapsible column. Powered by a wireless DRX detector, this x-ray room on wheels drives like a dream and providing fast and highquality images  The DRX Plus Detector: The DRX Plus detectors are lighter in weight, faster and more reliable than the earlier versions of the DRX family. Its Ingress protection rating and advanced enclosure design provides

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NEWS ROUNDUP total protection against intrusion, dust and water.  The Vita Flex CR System: The reason for the Vita Flex CR ‘s popularity includes its compact size, user-friendly nature, option for the radiologist to carry out simple repairs onsite, and a mini-PACS option to view images on the go. On the Collaborate section Carestream displayed its’ Vue Clinical Collaboration Platform. Carestream’s healthcare IT portfolio includes a Unified Core architecture for its Clinical Collaboration Platform that enhances security and complements healthcare providers’ existing IT systems. This architecture delivers clinical image data acquisition, viewing, sharing and analytics, and allows healthcare facilities to add these features as needed. Physicians can use the company’s Vue Motion universal viewer to easily view and share patient medical images and reports using mobile devices. On the interactive Output touch wall, the display included; Carestream’s Managed Print Solutions (MPS) which has brought about a revolution in the system of ordering, purchasing and stocking of x-ray films. The system, which operates through a dedicated web-portal designed by Carestream’s team of specialists, has made the entire process completely automatic The CarestreamMyVue Center Self-Service Kiosk, which is the future of patient enabled imaging. This self-service radiology kiosk improves patient experiences by allowing them to print, store or share radiology images and reports while maintaining their privacy. It also helps busy radiology departments overcome challenges in meeting the expectations of growing patient populations amid reductions in operating budgets and staff thus improving workflow productivity while reducing capital and operational costs. The DRYVIEW 5700, DRYVIEW 5950 & DRYVIEW 6950 laser printers. The DRYVIEW 6950 Laser imagers’ extremely sharp 650 ppi resolution on every film size, provides exceptional image quality for general radiography and mammography. The highlight of the exhibit was Carestream’s award winning OnSight 3D Extremity

February 2018

System which produces detailed three-dimensional cross sectional images of injuries to bone or soft tissue in upper and lower extremities. It performs both 2D and 3D extremity exams which includes weight-bearing studies, thus enabling physicians to view these body parts under natural load. A huge advantage to the patient is reduced radiation exposure which is 50% lower than that of standard full-body CT. “From design features that ensure patient comfort and convenience to technologies that allow patients to view and manage their diagnostic images and X-ray systems that enable rapid diagnosis and timely treatment our advanced solutions support our customers in delivering true Patient-Centered Care. This focus has enabled us to develop products like the MyVue Centre Self Service Kiosk, Onsight 3D Extremity System ,Vue Clinical Collaboration platform and several other products. In 2018, we will continue to deliver on our promise of helping customers do their jobs better, faster and more cost- effectively” said SushantKinra, Managing Director, Carestream India. Products displayed though this interactive touch wall, coupled with new products on the floor highlighted the company’s focus on creating inventive and elegant solutions that offer customers a smarter way forward.

PREMAS LIFE SCIENCES-INCELLDX SIGN DISTRIBUTION AGREEMENT AFTER SUCCESSFUL STUDY AT AIIMS INSTITUTE Premas Life Sciences Pvt., Ltd. and IncellDx, Inc. announced today they have signed an exclusive distribution agreement. The commercial partnership brings the power of cell by cell multiplex diagnostics for solid tumors carcinomas that can now be analyzed for molecular and protein biomarkers by flow cytometry. Included in the deal are: IncellDx’s patented single-cell assays for quantifying PD-L1 on tumor cells and immune cell subtypes; patented single-cell assay for HPV E6/E7 mRNA detection in cervical samples; and, its incellPREP

single-cell preparation kit for solid tissues including tumors. Researchers at AIIMS, New Delhi have completed a successful study utilizing IncellDx’s next generation (3Dx) investigational molecular assay which quantifies E6, E7 mRNA overexpression in single cells simultaneously with the measurement of cell cycle and cell proliferation, the hallmark of progressive disease. Praveen Gupta, Managing Director of Premas Life Sciences commented: “India’s molecular diagnostics market needs a refreshing change with IncellDx’sOncoTect assays that offer revolutionary single cell proteomic and genomics marker based diagnostic and more importantly a prognostic solutions for early detection and staging for cancer patients with more targeted immuno-onco therapies. India’s cancer burden is increasing and IncellDx offers a perfect path for highly effective companion diagnostic not just to researchers but also to patients. We are indeed delighted to be a part of this change.” Bruce Patterson MD, CEO of IncellDx commented: “We are excited about this opportunity to bring molecular testing to the flow cytometry field in a region of the world with a great appetite for innovation in the molecular space. The hallmark of cancer research is the quantification of oncogenes and the downstream effects on cell cycle which we have incorporated into a clinical assay. However, as cytology samples contain a heterogeneous mixture of normal and abnormal cells, it is critical that we are able to carry out quantification at the single cell level.” IncellDx is a molecular diagnostics company dedicated to revolutionizing healthcare one cell at a time. By combining molecular diagnostics with high throughput cellular analysis, the company’s focus is on critical life threatening diseases in the areas of cancer, specifically lung, cervical, head and neck, bladder, cancers.

INDEPENDENT TASK FORCESET UP TO DOWNSTAGE ORAL CANCER

On the occasion of World Cancer Day, 4 Feb-

ruary 2018, an Independent Oral Cancer Task Force has been launched to develop a strategy for oral cancer control in India over the next decade. This multidisciplinary task force comprises leading specialists who will contribute their expertise to address the burden of oral cancer. The mission of the task force will be to ideate, educate and engage stakeholders, thereby effectively down-staging oral cancer in India. The expected outcome would be to develop a national, cost-effective, patient-centric and sustainable oral cancer control program. Oral cancer which is the most common cancer in India amongst men (11.3% of all cancers) and the third most frequently occurring cancer in India amongst both men and women, has seen high incidence of mortality and morbidity that is preventable. Most often, oral cancer is preceded by visually detectable, oral potentially malignant disorders, which present a unique opportunity for the early detection of lesions. Hence it is vital to strengthen the strategies to down-stage oral cancer.

Speaking on the occasion Dr KiranMazumdar-Shaw, Founder & Managing Trustee, Biocon Foundation and Convenor of the Oral Cancer Task Force said, “Treatment of oral cancer is a multidisciplinary approach, involving the efforts of dental practitioners, surgeons, medical and radiation oncologists and researchers. The task force that we have established reflects this multidisciplinary requirement. We have therefore come together as a group of independent professionals to constitute a task force to ideate, educate and engage stakeholders, in order to effectively down-stage oral cancer in the next decade.” Emphasizing the need for the Task Force, Dr. G K Rath, Head, National Cancer Institute, AIIMS said, “Mortality and morbidity of oral cancer is very high in view of presentation at an advanced stage but this is largely a preventable disease. National Cancer Institute India has been created for this purpose as a centre of national importance which will conduct

research into all aspects including prevention, early diagnosis and management. This is the largest single healthcare project of India.” Dr PankajChaturvedi, Professor and Head & Neck Cancer Surgeon, Tata Memorial Hospital, Mumbai said, “Oral cancer is the most common cause of cancer-related death among Indian men. It is not only an unnecessary human loss but also a huge loss of productivity for India. It is time to wipe out the stigma of India being the oral cancer capital of the world”. “Oral cancer is primarily related to the use of tobacco which is very common in India. The best way to prevent oral cancer is to stop tobacco use completely. Through this task force, we aim to create awareness and work on ways to prevent and enable early detection of cancer.” said Dr. Kumar Prabhash, Medical Oncologist, Tata Memorial Hospital. The Guest of Honour, Dr K B LingeGowda, Director, Kidwai Memorial Institute of Oncology, commended the efforts of the task force to down-stage oral cancer in India.

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NEWS ROUNDUP ICICI LOMBARD LAUNCHES SOLUTION TO TRANSFORM OPD HEALTH INSURANCE CICI Lombard General Insurance, one of the leading general insurance companies in the country has launched a health insurance app — ‘IL TakeCare’ in collaboration with Practo, the leading healthcare platform. This oneof-its-kind solution covers Outpatient (OPD) expenses of all its customers. The app meets key customer requirements with respect to their primary healthcare needs. This includes hassle-free, real-time claim authentication of expenses such as doctor consultation, medical tests, pharmacy spends etc. It also empowers the user to access a cashless network comprising of specialized doctors. The app thus addresses a key problem of customers wherein they were hitherto required to pay for OPD expenses from their own pocket. The ‘IL TakeCare’ application works in sync with Practo’s ‘Trinity’ technology to allow customers to make cashless visits with doctors including those who operate stand-alone clinics. The IL TakeCare app also allows users to book a network diagnostics centre for medical tests and receive the results on the app, which automatically becomes an online repository of medical records. They can also buy medicines at discounted rates and pick them from a medical store or get delivery at their home. ICICI Lombard General Insurance, MD & CEO, BhargavDasgupta said, “At ICICI Lombard, we are focused on introducing innovative solutions that make life easy for our customers. Our ‘IL TakeCare’ app is a step forward in this direction and caters to a large and currently neglected aspect of healthcare – outpatient expenses towards consultation, diagnostics and medicines. With this unique solution, we are addressing a critical need of customers to avail affordable outpatient facilities and treatment. We are happy to partner with Practo to introduce a solution, that will allow our customers to get a cashless experience for doctor consultations at clinics.”

February 2018

Practo Founder and CEO, Shashank ND said, “Practo has been working towards simplifying the healthcare experience for consumers. Today we are launching our Trinity technology to help patients get a paperless and cashless consultation experience at neighborhood clinics. It will also help the doctor community provide a better, more seamless experience to their patients. Trinity is an important step in our efforts to build a connected healthcare platform. We are delighted to partner with ICICI Lombard to bring Trinity technology to their customers.”

DR B D ATHANI HAS BEEN APPOINTED THE DIRECTOR GENERAL OF HEALTH SERVICES

Dr B D Athani, Special Director General of Health Services, has been appointed the Director General of Health Services with full powers.Dr Athani takes over from Dr Jagdish Prasad, who proceeded on earned leave for 15 days. “In pursuance of this ministry’s OM No. C-14011’01/2015-Vig./CHS dated January 16, 2018, Dr Jagdish Prasad, DGHS is to proceed on earned leave for 15 days w.e.f. January 16, 2017, afternoon. The competent Authority has decided to assign the charge of the post of DGHS with full powers to Dr B.D. Athani, presently posted as Spl. DGHS,” a Ministry of Health & Family Welfare order said. Dr Athani joined DGHS as a Special DGHS in 2015. He was earlier the Medical Superintendent of the Safdarjung Hospital, New Delhi.

5 YR OLD KID WITH FACTOR VII DEFICIENCY SUCCESSFULLY TREATED FOR BRACHIAL PLEXUS AT WADIA HOSPITAL 5 yr old DeepikaYadav from Raichur district, Karnataka was successfully treated for a very rare birth defect with a very rare blood clotting disorder at BaiJerbaiWadia Hospital, Parel. She was having right sided brachial plexus injury

and Factor VII deficiency. Brachial plexus injury is about nerves of the upper limb are stretched inadvertently during difficult delivery leading to poorly functioning arm. Factor VII deficiency is a blood clotting disorder that causes excessive or prolonged bleeding after an injury or surgery. With factor VII deficiency, your body either doesn’t produce enough factor VII, or something is interfering with your factor VII, often another medical condition. Factor VII is a protein produced in the liver that plays an important role in helping your blood to clot. It’s one of about 20 clotting factors involved in the complex process of blood clotting. The brachial plexus is the network of nerves that sends signals from your spine to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord. Babies sometimes sustain brachial plexus injuries during birth. Deepika had a very limited ability to lift her right arm above shoulder and on MRI; she had a posterior dislocation of the humeral head. She was evaluated and advised surgery of the right shoulder by shoulder muscle transfer. During a routine work up investigations for surgery, it was revealed a persistent deranged bleeding profile (prolonged Prothrombin time) which was not corrected even on medication. After further thorough evaluation by the team Wadia it was notified that Deepika had a disorder in which Factor VII was deficient. The hematologists advised Factor VII administration whose cost was very expensive. A 1 mg vial of rNOVO7 costs Rs.48000 and as per estimate by hematologists she would require at least 18-19 vials which cost 9 lacs approximately. Due to financial constraints of the laborer father who had 6 dependents the surgery was deferred. Dr. Minnie Bodhanwala, CEO, Wadia Hospitals says, “After consultation with the hematologists of Wadia Hospital, they played a vital role of making a protocol for the surgery. This surgery was performed under cover of Factor VII infusion (rNOVO7) uneventfully. The rNOVO7 was given every 4th hourly for the

48 hours and then reduced to 8th hourly after that. It has now been stopped and there is no bleeding. Without this treatment she would have bled uncontrollably, and surgery would have been impossible for this child. This child needed corrective surgery to reconstruct the shoulder, or which would result in inability to use the arm.” Deepika’s Father says, “We had approached many hospitals in Karnataka but was unsuccessful in our endeavor. BJ Wadia hospital stepped up to this challenge and treated my daughter free of cost and we are very grateful to them”. “We at Wadia Hospitals are always ready to take such challenge to operate and treat such cases. This case was one of its kinds and the rarest one. Fewer than 200 cases of such cases are reported globally till date and our medical

team has successfully performed once again”. says Dr Minnie.

FAIRFAX INDIA CHARITABLE FOUNDATION JOINS HANDS WITH GOVT OF ODISHA FOR AFFORDABLE DIALYSIS SERVICES Kidney disease is on the rise worldwide and in India the burden of Chronic Kidney Disease (CKD) & End Stage Renal Disease (ESRD) is increasing rapidly. Unfortunately increasing costs mean widening of the gap in bringing accessible healthcare to the lesser-privileged. With the aim to provide free dialysis treat-

ments across the state, Fairfax India Charitable Foundation joins hands with Government of Odisha offering 127 dialysis machines free to use to offer free dialysis services to parts of the state where there are no or poor dialysis facilities available for patients. As per information from various stake holders, Odisha alone contributes to almost 3.5% of the ESRD patients in India which comes to about 32,929 ESRD patients. It is estimated this population will cross the figure of 70,000 patients by the end of 2020. Current total dialysis delivery capacity is capable to provide regular dialysis to only 2300 ESRD patients leaving more than 90% ESRD population remaining underserved or un-served. Speaking on their association with this noble cause, Mr. Abraham Alapatt, CEO, Fairfax India Charitable Foundation said, “This is a

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NEWS ROUNDUP part of the larger Fairfax India Group level commitment to raise the resources between our companies, friends and well-wishers to support a self-sustaining low cost dialysis program in parts of India where patients today have no or limited access to this lifesaving service. The MoU we are signing today with the National Health Mission of Odisha will enable access to quality dialysis services free of cost by delivering more than 110,000 dialysis sessions per year.” He further added, “Our target is to deploy 1000 machines with carefully chosen 150 centres. This will be capable of collectively offering 900,000 dialysis sessions per year at costs that are about 40% lower than current market rates. Our mission is to serve the poorest Indians who need dialysis the most. This partnership will include over 465 machines deployed across government district hospitals in 10 states via a unique PPP model – in partnership with the Ministry of Health and carefully chosen private service providers in each state.”

HISTORIC DEAL SIGNED BETWEEN PANACEA BIOTEC& SERUM INSTITUTE OF INDIA Panacea Biotec Ltd. (PBL) is delighted to announce the collaboration with signing of two long term agreements with Serum Institute of India Pvt. Ltd. (SII) and SII’s wholly owned subsidiary, BilthovanBiologicals B.V. (BBIO). Under the collaboration SII is entitled to manufacture & sell fully liquid Whole cell Pertussis (wP) and Salk based Injectable Polio Vaccine (IPV) based Hexavalent vaccine (DTwPHepB-Hib-IPV) developed & commercialized by Panacea Biotec, a first of its kind in this category. Under the collaboration, broadly the following will be achieved: Serum Institute of India will ensure supply of IPV bulk to Panacea Biotec, an important constituent of the Hexavalent vaccine, from its wholly owned subsidiary BBIO, a bioengineering and pharmaceutical company,

February 2018

registered in The Netherlands having technology and expertise for making the IPV, earlier possessed by only 3 other vaccine manufacturers in the World. In next 2 years both SII and PBL will work together to get this wP-IPV based Hexavalent Vaccine introduced in the National Immunization Program of Government of India and developing countries by working closely with key stakeholders including but not limited to National Governments, World Health Organization (WHO), Global Alliance for Vaccines & Immunization (GAVI), Bill and Melinda Gates Foundation (BMGF) and other United Nation Agencies, etc. Speaking on the occasion Dr Rajesh Jain, Joint Managing Director, Panacea Biotec said that millions of children in developing countries with an annual birth cohort of approx. 121 Million will get an easy access to a fully liquid Hexavalent vaccine containing six very important antigens to protect against six dreaded diseases i.e. Diphtheria, Tetanus, Pertussis, Hepatitis B, Haemophilus influenza type B & Polio. Dr. Rajesh Jain added that it is the first fully liquid wP-IPV based hexavalent vaccine in the World which Panacea Biotec has developed making India proud under Government of India’s Make in India Program and currently being marketed in India under brand name EasySixTM. A beaming Mr Adar C. Poonawalla, C.E.O. & Executive Director, Serum Institute of India, said, “It is an historic deal where in two major vaccine Companies in India have come forward to join hands to address unmet needs of both Private & Public Market globally. With the convenience of ‘Six in one’ it has potential of over 250 million doses in next 3-4 years with a market size of over $1.25 Billion annually.” R K Suri, Senior Advisor, who orchestrated the mega deal between two big Vaccine players said, “It marks beginning of a new Era in vaccine landscape and heralds a new business model, ‘Collaborate yet Compete!’.”

OPTRASCAN COMPLETES MASS VALIDATION OF FUTURISTIC DIGITAL

SOLUTION TO FIGHT CANCER The war against Cancer just got a worthy and powerful ally in OptraSCAN’s end-to-end Digital Pathology platform and solutions that seeks to bring in greater objectivity and precision in both cancer diagnosis and research. The path-breaking solution has successfully completed the mass validation of its whole slide digital scanner with the continued support of the Government of India’s Biotechnology Industrial Partnership Programme (BIPP) and is in keeping with the Prime Minister’s call for ‘Make in India’ initiatives. The Digital Pathology platform is thebrainchild of Pune’s very own biomedical engineer and reputed technocrat-entrepreneur, also the founder and chairman of Optra Group of Companies AbhiGholap, who has bagged 17 intellectual rights patents. The maker’s mission is to make digital pathology easily accessible through an affordable and socially responsible business model for the benefit of masses. Speaking on the occasion, Gholap said: “India has long been recognized as ITServices country, though recently, Infosys founder Mr. Narayana Murthy had expressed disappointment over the fact that India had not produced any earth-shaking invention to delight global citizens for the last few years. Hopefully, OptraScan’s latest work should fill the lacunae. In fact, we are poised to do away with the 150 year old Optical Microscopes and bring in much-needed objectivity in pathological diagnosis and research. By removing subjectivity in microscopy and replacing it with digital pathology, we hope to make cancer diagnosis more precise. Soon multinational companies will license technology from us and this will great benefit people on a mass scale.” He further added: “Confined earlier to only research applications, OptraSCAN now offers a perfect tool for transition from conventional microscopy to digital pathology for the effective acquisition of Whole Slide Images, viewing, sharing as well as analysis and management of digital slides and associated metadata.”

OptraSCAN solution will enable easy and quick transformation from conventional microscopy to digital pathology through digitization of glass slides, assistance in analysis and interpretation of images, realtime sharing of images for expert opinions there by aiding early detection and treatment. With the successful completion of mass validation and positive response from leading Cancer Research and Treatment Centers, established big hospitals, diagnostics laboratories operating across India with hub & spoke model and leading academic and research institutes, OptraSCAN is well positioned to jump startand commercialize its end –to-end digital pathology solutions which includes a small footprint, high and low throughput WSI scanner, an integrated image viewer and image management system, image analysis and CARDS ( computer aided region detection system).

AHPI & HSSC CONDUCTED SUCCESSFUL HEALTHCARE CAMPUS PLACEMENT DRIVE FOR RURAL YOUTH Skilling the rural youth and ensuring placement is one of the key areas of thrust, being promoted by the Governments both at the centre and at the State levels. Recently, more than 200 Healthcare Sector Skill Council [HSSC] certified Home Health Aide [HHA] and General Duty Assistant [GDA] youth participated in the Mega Job Mela organized by HSSC Karnataka with the support of AHPI at Sri Rama Hospital Centre ,Dodballapur, Bangalore Rural. Among those who attended, 62 were appointed letters for placement in super specialty hospitals of Bangalore like M.S.Ramaiah Memorial Hospital, ASTER CMI hospital, Columbia Asia Hospital, Sri Rama

Hospitals, Dodballapur, Portea Healthcare, Adityavani Facility Services, Winage Elderly Services. Each hospitals had set up separate booths for verifying documents and interviewing candidates. Dr Alexander Thomas, President AHPI, Dr VC Shanmuganandan, State Nodal officer, HSSC Karnataka Chapter were present at the event to encourage the youth. “Activities like this will help improve the quality of care and work towers social upliftment of the society,” said Dr Thomas. “This job mela has explicitly shown to the world that even the youth from rural backgrounds can be trained and provided an opportunity to work in multispeciality healthcare set-up. This is a realization of the dream of skilling the rural youth and placing them in mainstream of healthcare delivery,” said Dr Shanmuganandan.

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INTERVIEW

IMPACT

A READILY AVAILABLE COLLAGEN MATRIX WITHOUT ANY CELLS OR C ELL REMNANTS OR ANTIGENS IS A MUCH DESIRED PRODUCT IN CORRECTING HEART DEFECTS WILLIAM MORRIS Leonard (Leon) Neethling is a well-known personality in cardio-vascular tissue engineering. Prof. Neethlingâ&#x20AC;&#x2122;s experience is spread over 5 decades beginning in 1981 from University of Free State in Bloemfontein, South Africa where he started his career in adult cardiac surgery and later obtained his PhD in Cardiothoracic Surgery in 1984. He was the founder of the first human heart valve bank in South Africa in 1985. He trained in homograft cryopreservation at the National Heart Hospital in London under the guidance of Dr Donald Ross, the inventor of the Ross-procedure. From then on Prof Neethling has only strengthened his knowledge and experience in tissue engineering. Prof Neethling has authored thirty peer-reviewed publications and has presented 45 international conference presentations. Currently serving as Vice-President Cardiovascular Technologies of ADMEDUS Ltd and professor at School of Surgery at University of Western Australia, Prof Neethling has many awards and accolades to his name namely, Muller-Potgieter Medal (1994),

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Faculty of Health Science Award (1997 & 1998) as well as the Medical Scientist Associationâ&#x20AC;&#x2122;s Medical Scientist of the Year Award (1997). Recently he was in India to meet and dialogue with Cardio-thoracic surgeons in India and spread awareness about the new tissue engineering platform and collagen scaffold. He sat down with M Neelam Kachhap to talk more about the same. Excerpts from the interview. How has cardio-thoracic surgery changed over the years?

In the past five decade the discipline of Cardiothoracic surgery has seen huge changes and advancements. If we look at heart- lung machine technology for example, what we used earlier in the 80s and what we use today is a day and night difference. Every specific function of cardio-thoracic surgery has seen advancements that are benefiting the patients. With respect to heart valves, in those days we had the mechanical heart valves and this prosthesis improved enormously in the last 30-40 yearsin terms of the physiological dynamics of this prosthesis.

Tissue heart-valves were introduced in earlymid 70s and similarly a lot has changed here too especially the technology of improving the longevity of these prosthesis.

PROF LEON NEETHLING

What do these developments mean for the patient? How has patient prognosis changed over the years?

Patient prognosis has improved a lot. The downfall of any mechanical heart, valve even though the valve can last forever is the anticoagulation of the patients which is a high risk in many ways. So over the last 10-15 years the focus has shifted to tissue heart valves specifically with lower risk. The downfall of the tissue heart valve is that they calcify a lot and quickly in young patients. Now-a-days the sort of cut off point for the tissue heart valves varies between the age of 60. Below 60-years of age, usually a mechanical valveis recommended but if the patient is above 60-years tissue valve is recommended.In the older population the improved tissue heart valvesgive a life span of 8-10years. The problem is we want to address heart valve disease in younger patients as well. And therefore all researchbasically is focused on improving tissue processing and tissue heart valves processing and thatâ&#x20AC;&#x2122;s where our technology comes in where we have spent 3035 years trying to improve the quality of the tissues that is being used in heart valves and thatforms the basic platform technology that we have designed, formulated and tested. Tell us about the new product?

Cardiocel is a tissue engineered product. Basically we use a bovine pericardium-a sack around the bovine heart and we expose it to a tissue engineered process. It takesapproximately three weeks to manufacture the final product which can be used for cardiovascular application. This product has been developed and testedin pre-clinical studies since the mid-80s and we eventually started testing it in humans in 2008. The first clinical trials were initiated in 2008 where we were required to have 25 participants as per FDA and regulatory authoritiesâ&#x20AC;&#x2122; requirement but we had30 young children and newborns for justification. Since 2008, we have got over 10,000 implants predominantly in

pediatric patient groups which vary from day old babies up to 16yrs old. We have also used it in adult patients where we cover basically the whole spectrum of cardiovascular disease. Is there a similarproduct available in the market?

There are several competitors in the market and the products vary from animal tissue to synthetics. The competitors that we have compared our platform technology with show that there is a big significant difference between the two groups of products. The conventional current products are all regarded a biological patch where as we produce a biological scaffold which is from a functional point of view quite different compared to just a patch. How are patches different from scaffolds?

With a biological patch the original product is basically treated with a chemical solution

and then sterilised and stored in a chemical solution. With the production of a scaffold we basically take out all the possible factors responsible for calcification which includes phospholipids, nucleic acids such as DNA and RNA and we remove cell and cell remnants. All those factors play a role in calcification of products so we modify the original patch into a scaffold by means of tissue engineering. The whole difference is that they might look similar but the over-all composition is different as our scaffold consists of the collagen matrix without any cells or cell remnants or antigens. How does this change the longevity of the product?

The current products in the market place have got a calcification potential which varies from as early as 2-3 years in young patients and upto an average of about 6-8 years in adult population. So you can say that they are very prone to calcification. Because these products calcify they usually lead

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INTERVIEW

IMPACT to mal-function in f the application and failure of the implant.When this happens the implant needs replacement. Our product has now shown in several series of studies that have been done worldwide that our product does not calcify. The longest follow-up that we’ve got without calcification and with proven clinical evidence is 10 years and that is a significant improvementin what is available in the market. What is the anti-coagulant need with your product?

For our product we don’t use any anticoagulant in fact no medication is required. After the surgery is done the patients’ body accepts the implant and that is one of the key factors and the key positives of our product is that it is highly bio-compatible. In other words there is no form of rejection by the body, with all the other products you get a localized inflammatory response which in many cases becomes a chronic inflammation over time and that inflammation is usually responsible for the calcification. Pls can you share the prognosis of the patients from your first clinical trial. These patients are all doing well. We can without any doubt show with Echocardiography that there is no calcification in those implants. We had no implant related adverse event reported by these patients, or their general practitioners. We have had no graft related mortalities overall. What age group did this patient population belong to?

These are all pediatric patients which varied ages from 26-days- old to 13 years. The longest follow up in adult repairs is basically in mitral valve repairs and they are now going on for almost 5 years without calcification. This specific study was conducted in the Netherlands by the Leiden group (Prof Klautzand they have just released a publication which is in press). How about re-interventions?

In the 10-year group, we have no graft related re interventions, so in our first Phase-2 clinical trials we haven’t seen graft related re-interventions. In the global setup of the application of the technology, we had a very small number

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of re-visits in very hard challenging areas but we could not clearly indicate that it was product related. We did have restenosis in the small pulmonary artery in a very small number of patients and this happens with all the products that are available. What training if any is required to work with this new product?

Currently, no additional training is required; the product is used in the same way as it was used all these years. There are no specific modifications that would make it difficult for the surgeon to use, so from that point of view no training. One of the big advantages of our product which is not present in the current products is that the majority of the current products have to go through a rinsing procedure before it can be used in the patient. We designed our manufacturing in such a way that our product can be taken out of the jar and used immediately, which is a very good and big attraction to surgeons when they have one stage when they want to use the patch and don’t have to wait 20min putting it through rinsing procedures to wash off all the toxic chemicals. It’s a time-consuming exercise which can waste surgical time.With our product they can open the jar and use it immediately. What partnership and collaborations are you looking for with Indian surgeons and hospitals?

We have not scheduled any surgeries this weekbutwe are going to present the technology at the Indian Society for Cardio-thoracic and Vascular surgeons later this week in India. We will also be visiting different cities to give presentations on this technology. Where is this technology available globally?

Worldwide we cover the whole of North America, Canada, the whole of Europe, the Middle East, North Africa; we have got approval in all these countries. We have used it in big units in most of North America, we have used it in several hospitals in Canada, we have used it in all of Germany, Italy, Belgium, Greece, Scandinavia, Australia, New Zealand. We are in the process of getting approval in South Africa, although we did the first Phase 2 clinical trial

there. In the Middle-East we Saudi-Arabia, Kuwait, Jordan, etc,. What are the various sizes available?

There are different sizes of valvesto accommodate pediatric and adult patients. There is range of valve sizes, however this product is the tissue used to repair the valve. For example, in the pediatric population where there is malfunction in the aortic or mitral valve or any parts of the valves, a small piece of this tissue is basically used to mend the diseased valve; in some cases the whole valve is reconstructed, in some cases one or two leaflet are reconstructed. Further some babies are born with septal defectsand our product can be used for closing thesedefects in the top or lower pump chambers. It is also used to correct defects in the large vessels, some babies are born with under developed main aortic arch, and it can be used to repair that as well. It is probably the most universal and welldesigned product in terms of its function, its durability, its biocompatibility. How long do the surgeons have to wait for the product from the time of order?

Usually that is one of the big differences between our product and the products currently in the market. To manufacture the current patches it takes approximately 7days and then it is packed in a jar and shipped for application. Our product goes through very well planned tissue engineering with several steps and it takes us 21days to produce a batch of devices. Our quality control is probably one of the highest in the world because out of every batch we manufacture, we reject about 30% of products. Even if it does not comply with one of the quality assurance tests during the final inspection, the whole batch gets rejected. The shelf-life of the product is two years and storage requirements temperature above 0 and below 35 degrees centigrade. We have done a validation for 3 years and it passed all our validation studies, so within the near future we should have a final approval for 3 years. The product is manufactured in Perth, Western Australia.

COVER STORY

HEALTHCARE

QUALITY IN

CHANGING TIMES Healthcare today is grappling with twin burden of rising cost of care and enhancing outcomes. Investing in quality improvement and accreditation will ensure a culture of safety and organization success M Neelam Kachhap

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COVER STORY

ospitals in India are beginning to embrace accreditation as a means to improve performance and be relevant. However, according to NABH the national accreditation certifying body in India, the number of hospitals voluntarily coming forward for accreditation is just a fraction of the large number of hospitals currently functioning in India. The drivers for quality healthcare in terms of regulation, policy and market forces are not focusing on quality and patient safety in totality. There are serious discussions about the quality of care provided in hospitals, both in private and public sector. And reports in the media highlight issues of medical negligence, medical error, poor

February 2018

patient safety, etc. in Indian hospitals. Some level of urgency is created when events like Max Hospital, Delhi and BRD Medical College, Gorakhpur is brought out in the media but these are sporadic episodes and is not translating into a coherent policy initiative. However, private players who are striving for excellence in healthcare delivery realize that quality is both a business imperative and an ethical imperative. In the current healthcare landscape in India, the mounting competitive and financial pressure, quality and outcomes including excellence in delivery are key market differentiators. Therefore, quality must be given due visibility and highest priority at all levels of the organization.

It’s all about leadership Effective leadership is the backbone of any successful organization. It has been linked to a wide range of functions. At the healthcare set up effective leadership is crucial for timely care delivery, successful outcomes, including system performance, system integrity and efficiency. According to experts successful hospitals— defined as those hospitals that rank high on objective measures of quality and safety—tended to have leaders who were more skilled in quality and safety issues and who devoted more time to discussion of quality and safety during working hours. Insight into how leadership in healthcare settings can positively influence quality was provided by a study of hospitals in the US and England, which found that boards of high-quality hospitals used more effective management practices to monitor and improve quality. According

to this study, these practices include structured use of data to enhance care, both by setting specific quality goals and regularly monitoring performance dashboards. They also included explicitly using quality and safety performance in the evaluation of high-level executives and focusing on improving hospital operations. The development of the capacity of different groups at healthcare set-up for leadership as a shared and collective process will ensure direction, alignment and commitment towards quality care. A good leader promotes continuous development of the knowledge, skills and abilities of staff at all levels in order to improve quality of patient care, safety, compassion and the patient experience. They consistently encourage, motivate and reward innovation and introduce new and improved ways of working.

A good leader promotes continuous development of the knowledge, skills and abilities of staff at all levels in order to improve quality of patient care, safety, compassion and the patient experience

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COVER STORY In fact many experts describe patient safety and quality as being two sides of the same coin. Both quality systems and patient safety are positively related with each other

February 2018

Two sides of the same coin Patient safety is indistinct part of the delivery of quality care. In fact many experts describe patient safety and quality as being two sides of the same coin. Both quality systems and patient safety are positively related with each other. Patient safety is often considered a component of quality, so that practices designed to improve patient safety usually lead to an improvement in overall quality of care. The notion of patient safety is necessarily linked to adverse events. Measuring adverse events and errors is fundamental to patient safety. There are multiple sources of information: patient records, administrative databases, other databases, etc. Healthcare will always involve risks,but these risks can be reduced through the effectivemanagement of adverse events. Traditionally,

adverseevent reporting has been seen as a way of identifyingthe guilty party. This punitive approach has led toemployees being hesitant to report adverse events. This also becomes in our environment where courts are pronouncing hefty compensations to patients who complain of medical errors. The legalities of practicing medicine has become complex with ill-defined laws and undefined vicarious responsibility. However, the healthcare set-up should encourage error reporting and should develop a comprehensive patient safety programme, which needs to beimplemented within a safety culture. A safety culturecan be described as an organisationalbehaviour thatencompasses sharing beliefs and values and thatcontinuously seeks ways to reduce harm to patientscaused through unsafe patient care practices.

Twin challenge of patient safety and cost burden Patient safety and quality care cannot be attained without appropriately investing in quality measures. This is an added cost for the hospitals, one that is huge and necessary. Today hospitals have been pushed to decrease patient costs while improving care. In India, quality of care has more to do with the perception of quality rather than measurable outcomes. Healthcare delivery in India is a complex subject, and patient tends to attribute quality more by perception. In the past few years, we have seen many healthcare facilities seek practical and creative ways to improve care and lower costs but the sustainability of these low-cost models is threatened in a perceived quality environment. The principal driver of patient safety and quality efforts should be the fundamental desire for clinicians and administrators to do the right thing and prevent harm to their patients. Today, information technology has disrupted many aspects of healthcare delivery hand has the potential help clinicians and administrators deliver quality care at lower costs. both low- and high-tech aspects of technology can be used to improve the safety of patient care.But the need of the hour is to bring these various thoughts together and weave a cohesive narrative that identifies the role of technology in providing safer care.

Quality is not static Quality is a tool for continuous improvement. It does not stop with certification or accreditation standard, which is an excellent way to establish basic framework for quality governance. In fact the true quality journey starts after this certification. Internal audits are a good way to keep abreast with the changing times and making sure that there are no gaps in quality healthcare delivery. Investment in an in-house multi-disciplinary team representing major functions at hospitals and trained by experts is a good move. Focusing on continuous quality improvement improves efficiency of the system and reduces cost. A multi-disciplinary team comprised of professional from various departments should take up continuous quality improvement projects focusing on improving operational efficiency, reducing wastage and building a cooperative culture. Research to gather evidence Measurement, assessment, andimprovement of quality of careis imperative for a better healthcare delivery environment in India. This requires involvement of healthcare professionals, consumers, and policymakers and it is important to focus on research on quality measurement and improvement. While the overwhelming imperative has been on cost reduction of healthcare

little attention has been devoted to improving quality care research. Indian research and data is required to substantiate the quality of care the healthcare institutes provide vs cost and quality improvement efforts. And this research should be across hospitals both in the private and public domain so that credible data is available to make much more informed decisions and policy reform. This evidence and data will also help shape patient and general perception of healthcare delivery in India.

Today hospitals have been pushed to decrease patient costs while improving care. In India, quality of care has more to do with the perception of quality rather than measurable outcomes www.indiamedtoday.com

November 2018

Executive Chairman Dr. K. Hari Prasad

Executive Co-Chairman Dr. Mahesh Joshi

SEMI Board

President Dr. Imron Subhan

Genaral Secretary Dr. Narendra Nath Jena

Joint Secretary Dr. S. Saravana Kumar

Treasurer Dr. Sateesh Kumar K.

Organising Committee Waiting to See You All Dr A N Venkatesh Dr Akkamahadevi Dr Anil Kumar V R Dr Aruna C Ramesh Dr Ashok A Dr Banuprasad Dr Bevin D Silva Dr Deepak T S Dr Firoz Torgal Dr Hariprasad

Dr Harish K S Dr Harshita Sridhar Dr Jaganmohan Reddy Dr Kallesh S Dr Karthik Pandian Dr Keshavamurthy M R Dr Kingsley Robert Gnanadurai Dr Kumaraswamy Dr Mabel Vasnaik Dr Mahesh Mylarappa

Dr Manjunath B H Dr Mohan W D Dr Murali Mohan Dr Muralidhara K Dr Naga Nischal Dr Narasimhachar Dr Narendra S Dr Nishant Hiremath Dr Pradeep Nagaraju Dr Priyanka M K

Dr Roopa K P Dr Samir Dr Santosh S Dr Saurav Mahanta Dr Shailesh Shetty Dr Shalini Nalwad Dr Shashivadhan R Dr Shiv Shankar Dr Sneha Kundoor Dr Srinath Kumar T S

Dr Srinivasulu Chitty Dr Sudeep Bhandari Dr Surendar Sampath Dr Surendra E M Dr Tamorish Kole Dr V Vijuwilben Dr Venugopal P P Dr Vijay Joseph Marapaka Dr Vivekanand C Mr Vinil Kumar C C

SEMI VICE PRESIDENTS, STATE BOARD MEMBERS & SEMI WELL WISHERS

AHPI GLOBAL CONCLAVE-2018 Is Quality Healthcare Sustainable? “Issues, Concerns & Solutions”

16-17 FEBRUARY 2018 Hotel Le meridien Kochi, Kerala

AHPI GLOBAL CONFERENCE SPECIAL

INTERVIEW

PROCEDURAL COSTING AND PATIENT SAFETY

WE NEED TO APPROACH THE ISSUE OF COST IN A SYSTEMATIC AND SCIENTIFIC MANNER DR ALEXANDER Thomas has spent more than three decades in healthcare delivery and has played a key role in advancing progress in India’s healthcare landscape, especially in the areas of quality and communication. He is one of the Founder Member and the President of the Association of Healthcare Providers of India (AHPI), President of the Association of National Board Accredited Institutions (ANBAI), and Founder President (2012-2017) of the Consortium of Accredited Healthcare Organisations (CAHO). He is a consultant with the World Bank and Chairman, Health Sector Skills Council, Karnataka. He is on various committees constituted by State and Central government for the improvement and advancement of various facets of healthcare delivery in India. He has served as the Member-Secretary, Task Force for Karnataka Public Health Policy, Chairman – National Conclave NCD 2017 and Convenor – National Medical Education Policy, Ministry of HRD,GOI. He has received many awards and recogni-

February 2018

tion for his exemplary work, prominent among them are Emeritus Teacher Award (2014) by the National Board of Examinations for his contributions to the field of medical education; the Distinguished Service Award (2016) by the Indian Medical Association for his services to the community and the medical fraternity;Emergency Medicine Quality Forum2018 Quality Champion – Outstanding Individual award for his significant contribution and relentless effort towards EM Excellence. His recent publications include the Handbook of Healthcare Quality (2016), the Guidebook for Pre-Accreditation Entry-Level Standards for Small Healthcare Organizations (2015), and Communicate. Care. Cure: A Guide to Healthcare Communication (2014). He is working towards building a think-tank of eminent personalities to guide the future of healthcare of India. Recently a unique study was undertaken in the state of Karnataka on procedural costing Dr Thomas was the Chairmen of the committee that did the study. M Neelam Kachhap caught

up with him for a fireside-chat to know more about the study and issues regarding patient safety.

DR ALEXANDER THOMAS, President of the Association of Healthcare Providers of India (AHPI)

Pls tell us about the study and its objectives?

Ensuring patient safety is pivotal to the outcome in any healthcare procedure. The patients should not get compromised care due to lack of funds. The objective of thestudy was to compare the actual cost of various procedures in selected hospitals empanelled under the scheme, as against the reimbursement being made by the various Government welfare schemes (Vajpayee Arogya Shree (VAS), Yeshasvini and CGHS). This is a prototype study based on available data, incorporated into the approved clinical pathway, and aimed at comparing the cost incurred with the reimbursement being made by the Government Schemes. Why is this unique study?

This is probably for the first time a costcomparison study for 20 common medical procedures has been done. The study looks at the actual cost of procedures carried out in private, non-profit and government hospitals and the reimbursements made by the government. Most importantly, the costing was done as per clinical pathway endorsed by the respective associations and validated on ground by IIM-B and NABH. Can you tell us about the people involved in the study?

The study was conducted under the aegis of Government of Karnataka and the committee on procedural costing was co-chaired by the Director of Health, Government of Karnataka. The other collaborators were IIM (Bangalore), AHPI, CAHO, NABH, CMC Vellore, the Medical Department of ISRO, the Health and Family Welfare Department of Government of Karnataka, the General Insurance Council of India along with community representatives, and four specialty associations: Association of Cardiovascular-Thoracic Surgeons, Neurosciences Academy, Orthopedic Society and Association of Surgical Oncology. The techni-

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AHPI GLOBAL CONFERENCE SPECIAL

INTERVIEW

PROCEDURAL COSTING AND PATIENT SAFETY

cal committee recognized the need to approach the issue of cost in a systematic and scientific manner. This Pls can you tell us about the Clinical pathway methodology?

In order to have a common platform for comparing the costs across hospitals for a particular specialty, there needs to be a standard pathway for the treatment of each of the procedures/surgeries concerned. The clinical pathway for each of the procedures/surgeries for each of the 4 specialties was defined by the Cardiothoracic Surgery, Neurosurgery, Surgical Oncology and Orthopaedic Societies, which are independent clinical bodies. All the hospitals were asked to provide the cost in line with that specified in the clinical pathway. For all the indirect costs

February 2018

considered, the overheads in terms of the heads considered and the apportioning of the same was done according to the logic as specified by each of the hospitals. In addition, two phases of verification audits were conducted by the IIMB team and the NABH team respectively. What are the main findings of the study?

The main findings based on actual data taken from government and private hospitals showed that:1- The different government schemes have different rates for the same procedure 2- Private hospitals are providing treatment at subsidized rates for most scheme patients being treated by them as reimbursement rates are lower than the actual cost.

How will these findings affect healthcare delivery in India?

Recently, there has been a lot of talk about the high cost of healthcare delivery and various state governments have indicated that cost of medical procedures should be regulated. This would safeguard gullible patients who are made to pay exorbitant amounts for medical procedures. At the same time, patientsâ&#x20AC;&#x2122; safety should not be compromised. At present, patient safety is under considerable strain on account of the serious lacuna in reimbursement by Government in relation to Government health insurance schemes across the country. This was a prototype study and a more extensive confirmatory study including all procedures needs to be carried out.

AHPI GLOBAL CONFERENCE SPECIAL

INTERVIEW

FUTURE OF HEALTHCARE WILL BE QUALITY DRIVEN

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 it’s mission is to build capacity in Indian health system with focus on patient safety and affordability. Here he talks about the challenges of quality in healthcare delivery and patient safety, in conversation with M Neelam Kachhap What does quality healthcare encompass?

Like in any sector, quality in healthcare stands for ‘Value for Money’. The quality has two dimensions; one is measurable and other is by perception. Both are important. Healthcare being a complex subject, patient tends to attribute quality more by perception. It is therefore important that hospitals lay equal emphasis on soft side of treatment which sometime we refer to as managerial quality. Quality in healthcare is formally described in terms of Structure, Processes and Outcomes. There are quality accreditation standards, which specify requirements with reference to these aspects. The accreditation standards are certifiable by independent designated agencies,

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INTERVIEW DR GIRIDHAR GYANI, Director General, Association of Healthcare Providers (India)

by which consumers can make informed choice for particular hospital. Is there a difference between perceived quality and technical quality in healthcare?

As I mentioned above, perceived quality comes more from managerial aspects. Here hospital gets compared with any other service institute say like hotel. How patient is received, how the patient is seen? How the patient is heard?How the patientâ&#x20AC;&#x2122;s needs are met?All these make up for perceived quality. Technical quality is what we term as clinical quality, by which clinical outcomes are monitored and measured. This quality actually decides whether hospital has defined protocols and follows standard treatment guidelines etc. It is obviously difficult for patient to understand about this aspect of quality and is best left for accrediting agencies. What resources (in the form of organizations, funding, training and information) are available nationally?

At the time of independence, the healthcare was confined to public sector. It was well structured by way of rural infrastructure by way of subcenters, PHCs and CHCs to provide for primary and secondary care. To supplement we had district hospital and teaching hospital to support for secondary and tertiary care. As population went on growing, this infrastructure proved to be in-sufficient. With government not able to allocate matching resources, private sector took the lead and began investing in secondary and tertiary care, more so in tier-I/II cities. Today we have 1.4 per cent of GDP coming from government, whereas private sector investment has grown to be about 3.6 per cent. Another key resource is human resource by way of doctors, nurses and allied health workers. This resource creation is highly regulated and somehow our regulatory framework has failed to respond to the growing demand. What resources are most important to improve quality in health care?

Human resource is most critical factor, without which health outcomes or quality cannot be improved. WHO has recently released rank-

February 2018

ing of 191-countries in terms of health system reforms. Countries with lesser spending on healthcare have higher ranking than India. Likewise BRICS nations, having higher spending than India, occupy lower ranking. The key is how effectively a country utilizes resources including manpower. India suffers not only from lack of doctors and nursing staff but also suffers with skewed presence of healthcare facilities. The two factors are inter-linked. As there is shortage of doctors, they are not available for tier-II/III cities and therefore private sector is unable to invest in such locations. Can government hospitals get accredited? How will it help them?

Accreditation basically helps hospital to define and establish quality governance framework which directly impacts patient safety and

which is important whether hospital is government or private. As we are aware, millions of medical errors are reported to occur in developing nations, it is necessary that all hospitals adopt accreditation standards. Somehow accreditation got projected as marketing tool for medical tourism, which is wrong. In most developed nations, paying agencies link accreditation with empanelment as accreditation is seen as best cover to safeguard the investment under insurance. Similarly in many nations, the regulation is linked with accreditation, which symbolizes governmentâ&#x20AC;&#x2122;s concern for patient safety of population. Is India ready to embrace quality and accreditation in healthcare?

Accreditation means patient safety and therefore all stake holders should pitch for accredi-

tation. To begin with payers including government and insurance companies must link accreditation with empanelment of hospitals. This can become single most important step as driver for accreditation. IRDA has issued directive that all healthcare organizations must take at least entry level NABH certification without which they will lose empanelment with insurance companies. This directive needs to be strictly enforced. Similarly government insurance schemes must offer incentives to hospitals to take accreditation as done by CGHS. In the long run, we need to make this as movement by aggressive awareness among the community by projecting accreditation as the mark of patient safety. Before doing this, we need to build capacity by training healthcare professionals so that hospitals are enabled to implement accreditation standards.

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INTERVIEW

LEADERSHIP FOR QUALITY ENHANCEMENT

EFFICIENCIES IN THROUGHPUT TIME, CLINICAL OUTCOMES AND SERVICE EXCELLENCE THREE MANTRAS FOR RUNNING COST EFFECTIVE CARE MODELS WITHIN INDIA ONE OF the most influential leaders in the Indian healthcare industry, Dr. Harish Pillai is the CEO of all Aster DM Hospitalsin Kerala. An expert in hospital administration, quality and brand management, business strategy, product launches and joint ventures, Dr. Harish Pillai has played a significant role in the development of the healthcare industry in India and the Middle East & North Africa (MENA) by setting new benchmarks in quality and patient care. He is a Member of the Joint Commission International (JCI) Standards Advisory Panel; President of Association of Healthcare Providers (AHPI) â&#x20AC;&#x201C; Kerala Chapter; National CoChair for Medical Value Travel Committee in Federation of Indian Chambers of Commerce and Industry (FICCI); Elected secretary of the

February 2018

Kerala Medical Value Travel Society (KMVTS); visiting faculty at Tata Institute of Social Sciences (TISS) Mumbai and Administrative Staff College of India (ASCI) Hyderabad. In an interaction with M Neelam Kachhap he talks about leadership engagement and empowerment for quality care in Indian Healthcare landscape. Good leadership plays an extremely vital role in creating a culture of delivering quality care. Your thoughts

It goes without saying that empowered leadership is essential and is the key ingredient of creating an edifice of quality delivery in healthcare. The emphasis should always be on team based models and participative governance, where

DR HARISH PILLAI, CEO, Aster Medcity, Cluster Head â&#x20AC;&#x201C; Kerala, Aster DM Healthcare

everyone within the system has a stake in ensuring the safety and production of optimum results within a compassionate and affordable environment. This is a recipe for sustainability within an Indian context. Leadership includes Clinical as well as Non-Clinical areas where we need to ensure that the clinicians, nurses, paramedical staff and all the support teams are all at the same level. The increasing cost of delivering quality care has remained one of the biggest challenges healthcare leaders face today. How can leaders overcome this challenge?

There are proven models worldwide which exist in an ecosystem of high input cost and are still able to

sustain themselves by investing in robust systems, processes and costing methodologies where wastage has been eliminated. A great premium is attached to efficiencies in terms of throughput time, clinical outcomes and service excellence which are the three mantras for running cost effective care models within India. What are the other challenges faced by healthcare leaders in achieving quality care?

The biggest challenge we face within our country is the shrinking talent pool where demand far exceeds supply at all levels, viz. Clinical as well as Non-clinical. There must be an integration between academia and industry in a cohesive manner to produce more healthcare work-

ers who can be trained as per expectation of the sector. The recent deliberations at the Central Government level regarding the NMC Bill will hopefully improve the supply of clinical talent for the country. What leadership strategies should leaders employ for achieving excellence in quality care?

The main strategies to be adopted are: a. Evidence based systems b. Training in algorithms c. Standardization of processes and d. Investment in technology The adoption of these internal strategies will reduce the variations that can result in adverse outcomes both in Clinical and Service Excellence.

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AHPI GLOBAL CONFERENCE SPECIAL

INTERVIEW

LEADERSHIP FOR QUALITY ENHANCEMENT

In the present scenario of policy and regulatory challenges for private providers hindering functioning of healthcare organizations what are your mantras for success?

We need to move away from the socialist mindset that anything private is seen with scepticism and suspicion. Private capital needs to be considered as an equal partner in the nation building process. At the same time, private sector needs to put its house in order by setting up robust governance systems and becoming more transparent and price sensitive to the needs of the vulnerable communities to which we serve. Greater dialogue and discussion between stakeholders would reduce the distrust which is currently seen. A long term engagement with patient communities, NGOs and the Government is required to rebuild the trust and improve credibility for all of us.

February 2018

What chnges if any will help boost private healthcare providers’ success in Kerala?

of private capital for Healthcare within the State.

a. Setting up of new green field projects within Kerala is a challenge due to the multiplicity of regulatory authorities. Towards the concept of improving its national ranking on the Ease of Doing Business, the Government of Kerala should come up with a one-shop window for all regulatory clearances for green field projects b. There must be confidence building measures from regulatory authorities that the rules of operating a business within the state are not arbitrarily changed in the middle of the financial year. More subsidies need to be provided in the form of soft loans towards investing capital in land, building and machinery, while softening of the rates for utilities – electricity and water will be a big boost towards increasing the investment

Anything else you would like to add?

The recently announced Union Budget is an inflection point in India’s healthcare sector. The so called, National Health Insurance Scheme, which is supposedly the largest in the world will increase accessibility and affordability for 500 million of our citizens who were otherwise deprived of the same. Its successful implementation requires empowered and engaged leadership at both public and private sector levels. We need to work upon increasing allocation towards GDP for healthcare for successful and cost-effective implementation across the country. The various state governments also need to engage with the Central Government with their contribution to ensure that we are able to provide affordable and high quality care for the masses.

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APPROACH

KNOWLEDGE IS POWER! Dr Aniruddha Malpani, MD, Medical Director HELP – Health Education Library for People, Mumbai

February 2018

WHEN WE think of medical errors, we usually refer to the mistakes which doctors and nurses make when taking care of patients. However it is not uncommon for errors to be caused by clueless patients and poorly informed care givers as well. Thus, many patients will self-diagnose themselves using Dr Google; while others will be non-compliant, and not follow their doctor’s advice as to what tests they need to do, resulting in a delay in timely diagnosis and treatment. The truth is that patients can provide a very

valuable barrier against medical errors. Patient safety is not just the doctor’s responsibility – it’s the patient’s as well! Patients must play an active role in preventing medical mistakes, and one of the commonest mistakes patients make is that they leave everything upto their doctor. This kind of passive approach may make sense during an emergency, but is completely flawed for most elective medical treatment, and can lead to disaster if you are unlucky enough to end up in the hands of an incompetent doctor.

The empowered patient An empowered patient assumes responsibility for managing their health, and this reduces the risk for errors. For example, they will call the clinic and make sure that they get the results of the lab tests the doctor has ordered, rather than wait passively for the clinic to phone. Patients today want to exercise the power of choice when it comes to deciding the medical care that is being provided and the manner in which it is provided. When patients actively participate in the treatment plan because they have crafted it in partnership with their doctor, they are much more motivated in complying with the doctorâ&#x20AC;&#x2122;s advice and this helps reduce the risk for slips and mistakes. Sharing Ideas As patient care becomes increasingly demanding, sharing the responsibility with the patient is an idea good doctors are happy to welcome. In the past , the tools for patient engagement were very limited. However, in the networked era that we currently live in, this approach

Many patients will self-diagnose themselves using Dr Google; while others will be noncompliant, and not follow their doctorâ&#x20AC;&#x2122;s advice as to what tests they need to do, resulting in a delay in timely diagnosis and treatment can benefit the patient greatly. Doctors should make sure their patients are aware of the pros and cons of a particular procedure before they are asked to select a treatment option. Similarly, patients should not expect their doctors to spoon-feed them, and should come armed with a list of doubts and questions for their appointment with the doctor. When Patients take charge Doctors respect patients who want to take

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APPROACH charge of their health. This approach enhances patient safety, and patients are then committed to complying with the doctor’s advice, as the treatment plan has been formulated after taking their preferences into consideration. This buy-in from the patient ensures compliance. Doctors can use the 5-step SHARE Approach for shared decision making. Step 1: Seek your patient’s participation Step 2: Help your patient explore and compare treatment options Step 3: Assess your patient’s values and preferences Step 4: Reach a decision with your patient Step 5: Evaluate your patient’s decision What can patients do? Patients too need to do their bit and understand the doctor’s limitation in terms of his ability to help a patient – doctors are not omnipotent. The patient should learn to trust a doctor for his professional expertise and appreciate the fact that he may be overworked; he is human too and can sometimes snap for no evident reason. Patients should have realistic expectations of the treatment. Doctors are not magicians, and it can take time for the treatment to act. When patients do their homework independently and try to find out more about their medical con-

February 2018

dition, it makes it easier for the doctor to explain the various medical procedures and options they can explore together. One important thing is to keep the doctor informed about any changes in their medical condition. Doctors are not omniscient! And comply with the doctor’s medical advice. What can doctors do? Be polite, considerate, honest and patient  Treat patients with dignity – not just as a medical statistic or another case  Respect a patients’ right to privacy and confidentiality  Support patients in caring for themselves  Provide them with information and access to credible sources of medical information A good doctor must not only be a skilled clinician, but he has to take his excellence one notch higher, by keeping an open ear and learning how to empathize. He should constantly try to improve the quality of the medical services he provides, and have the courage to own up to a mistake when something goes wrong and a patient suffers. The doctor-patient partnership is based on mutual respect. Both need to be accountable and responsible; to themselves and to each other as well. 

Patients too need to do their bit and understand the doctor’s limitation in terms of his ability to help a patient – doctors are not omnipotent

Hosur Hosur Hosur Road Road Road Bangalore Bangalore Bangalore

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OPINION

MUCH AWAITED HEALTH INITIATIVE: VALUE LADEN BUT AMBIGUOUS Viren Shetty, Director and SVP of Strategy at Narayana Hrudayalaya Ltd

February 2018

26 MILLION children were born in India last year. One million of them won’t live long enough to celebrate their 5th birthday. Hidden among the nameless statistics would have been the next Saina Nehwal, the next Abdul Kalam, or the next Narayana Murthy. With the loss of hundreds of unknown geniuses, our country is poorer by several orders of magnitude. It’s even more painful to learn that most of these deaths could have been prevented if those children had access to better food, sanitation, or healthcare. Such statistics on healthcare are so dismal that they’ve long lost the ability to shock an average Indian. In the light of such bleak healthcare statistics, the Finance Minister announced two major healthcare initiatives. The first is an insurance program that aims to provide 100 million families with a health cover of up to Rs5 lakh. The second is the establishment of 1.5 lakh health and wellness centers that will dispense free primary care, medicines and diagnostics across the country. One of these programs might radically transform the healthcare land-

scape across the country while the other may not cause much of an impact. I predict the clinic program won’t be successful because it fails the math test. Building 1.5 lakh clinics with an allocation of Rs1200 Crore is about Rs80,000 a clinic. This would be just enough to build a zinc sheet shack with some basic instruments. Setting up a clinic in a rented building with an accredited pharmacy, space for all the diagnostic equipment (excluding MRI & CT scans) and consulting rooms, will cost anywhere from Rs80 lakh to Rs1.6 Crore. Similar programs in the past haven’t been able to scale because they forgot to take operating expenses into account. A doctor with a basic degree would expect a salary of anywhere from Rs50,000 to Rs1 lakh a month. One can only guess the amount that would get spent in free medicines, but it isn’t a trivial number. Add in other operating expenses like rent, salaries and maintenance and one can see why Rs1200 Crorewon’t go very far. Many in the healthcare industry agree that the insurance program, dubbed Modicare, is the

much better initiative. Two thirds of all Indians currently pay for their healthcare expenses out of their own pockets or by borrowing from others. They suffer from information asymmetry regarding the nature of their ailment and have a weak bargaining position vis a vis the healthcare provider. The government-run hospitals offer mostly free services, but their infrastructure is overburdened, and quality of care is often dismal. Private healthcare providers may offer better quality, but their services come at a price that most people canâ&#x20AC;&#x2122;t afford. Offering insurance to the bottom 40% improves their lot in two important ways. First, they become empowered consumers and providers will fight hard to earn their business. This flips the power dynamic towards the consumer and forces the healthcare industry to operate more in line with other well-functioning markets. Secondly, the insurer acts as an intermediary who, in theory, will negotiate better rates with healthcare providers on behalf of the consumer. There are many reasons this ideal situation may not come to pass, but most of us have good reason

Finance Minister announced two major healthcare initiatives. The first is an insurance program that aims to provide 100 million families with a health cover of up to Rs5 lakh. The second is the establishment of 1.5 lakh health and wellness centers that will dispense free primary care, medicines and diagnostics across the country to believe that this initiative can only improve the situation from where we are today. What is most surprising about this initiative is that it took so long for the central government to launch it across the country. The south-

ern states â&#x20AC;&#x201C; Karnataka, Andhra Pradesh, Tamil Nadu and Kerala have had medical reimbursement schemes for more than a decade. There are many studies that have pointed to lost GDP thatâ&#x20AC;&#x2122;s easily attributable to reduced productiv-

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OPINION ity because of poor healthcare services. While healthcare isn’t technically a fundamental right, disease affects all classes of society and any political partyshould see the political sense in making healthcare accessible to everyone. It’s difficult to speculate on the lack of political will to tackle healthcare challenges in India but one might hazard a couple of guesses. In advanced economies with aging populations – such as the US and the UK, healthcare is one of the most important election issues. India has a relatively younger population with food & jobs as more pressing concerns, so voters may tend to push healthcare to the back of the line. Another reason could have been that since NGO’s and the private sector have been so effective at providing cost effective healthcare, the government didn’t feel a pressing need to improve the services at public hospitals. The proof of the pudding is in eating it and everyone is keenly awaiting the details of the 2018 National health protection scheme (the 2017 version of NHPS wasn’t implemented).

February 2018

Critics of the program have pointed out that the amount allotted won’t be sufficient to cover 100 million families or that a premium of Rs1,100 won’t be sufficient to cover major ailments. What’s undeniable is that healthcare is being recognized as an important issue and the government’s effort towards addressing this is commendable. Ideally, the government would merge all the existing state health schemes with the national program, but this will bedifficult to implement. A state like Karnataka has several healthcare schemes running simultaneously and they have different models – from 100% cashless, to 25% co-pay, and from self-funded initiatives to government-funded schemes. NitiAayog has indicated that they are open to exploring various insurance models and will tailor each according to the needs of the state. This flexibility will be important because different states have different levels of success in working with the central government. In my opinion, the best health insurance program for a country like India will be like the

National Health Savings Account of Singapore. This would be a bank account that is compulsory for every citizen. The government contributes a base amount into every person’s account and this is drawn down to access a basic level of services. Employers are also required to contribute a percentage of the individual’s salary. Finally, individuals can also top up their health savings account if they’d like to access complex services or special treatment. The government negotiates different rates with public and private hospitals, depending on their level of specialization, and people can choose which facilities to access based on their remaining cover. It has worked extremely well in Singapore because the system treats public and private healthcare facilities on par with each other, while acknowledging that each healthcare model has its own strengths and weaknesses. India has a massively underutilized private healthcare sector that’s eager to be a part of this program. We gladly welcome the opportunity to build a healthy nation.

FEATURE

WHY FOCUS ON PEDIATRIC EMERGENCY MEDICINE? In India, 28.2% Population is in the age group of 0 – 14 years, are we equipped to treat these kids who require specialized skills for handling emergency care.

Dr Indumathy S Scientific Committee Chair

Dr Srinath Kumar TS, Past President - SEMI

Dr Suresh Gupta, Past President - STEP

EMERGENCIES AND accidents are commonplace in all parts of India. India faces the dual challenges of a developing nation and a developed nation due to rapid economic growth and urbanization. Our nation faces the challenges of emergencies related to infectious and communicable diseases and those related to chronic diseases and trauma. About 20 per cent of all emergency visits are related to trauma. As emergency healthcare systems are maturing, this is a high time to consider the special requirements of the pediatric patient with respect to environment, equipment and staff skills, ensuring that these meet the global standards. In an ideal situation, all health care facilities without a dedicated pediatric emergency department, should atleast have a lead doctor and a lead nurse for pediatric emergencies, but this is yet to be achieved. Improvement in workforce and staff training is a priority and a strategic improvement in the whole network of healthcare is needed to ensure a well-functioning system of pediatric emergency care (PEC). PEM Sub-Speciality In 1988, the American College of Emergency

Physicians (ACEP) recognized the need of Pediatric Emergency Medicine (PEM) and formed a full committee to make it a reality and in 1990 PEM sub-specialty was established but unfortunately in our country it’s not been establisheds till. There is a void in availability of PEM training and knowledge sharing in India. Recognizing this need the society for Trauma and Emergency Pediatrics (STEP) was formed by Dr Sunit Singhi, Dr Suresh Gupta, Dr Indumathy Santhanam and other team members to establish PEM as a sub specialty in India. In 2014 DrGupta, Dr Santhanam and STEP board members submitted the proposal to NBE to start Fellowhsip in PEM which will be beneficial for the Society. Further, Dr Santhanam and their team created Pediatric Emergency Medicine Course (PEMC) to create awareness about PEM and spread the knowledge across the nation which eventually gained importance outside the country. Looking into the need of PEM as sub specialty the Society started the Fellowship programs, and has 6 centers with 30 Fellows getting trained through the program. Pressing need As all of us are aware 28.2% Population comprises 0 –

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FEATURE

14 years age group which implies for the same number of emergencies. The common causes of mortality in children are birth asphyxia, pneumonia, TB, trauma, disasters which can be treated and we can send the child with least mortality. We should question ourselves are we equipped to treat these kids who require specialized skills for handling them, further to when a child is involved the whole family is involved hence the requirement of PEM. Unless the specific needs of children are considered, children will continue to have a lower standard of care than adults. To ensure good emergency care for children, there is a need to realize the importance of age appropriate equipment along with trained PEM staff while paying attention to the differences, and often making simple changes to practice, for example sharing of ideas between pediatric

February 2018

and emergency staff, some joint training and having a lead doctor and nurse for pediatric issues. Improving emergency care for Kids Pediatric Emergency Medicine (PEM) is aimed towards improving the emergency care of children in India as there is a general lack of good emergency care for children. For optimum emergency care, there are unique skills needed to treat acutely ill infants, children and teenagers. Parent anxiety, drug dosing and dangerous drugs in pediatrics, emergency physician burnout, Pediatric ems, dosage and calculation knowledge, hospital administration, teaching programmes, disaster management, differences between adult and child pediatric critical care and foremost pediatric examination is an art.

This specialized training doesn’t necessarily reside solely with pediatric doctors and nurses, or with emergency medicine personnel. Pediatric emergency care is a mixed skill-set. There is a strong argument that EM staff can benefit from the non-surgical skills, communication skills and holistic practice of pediatric staff. However it is equally true that pediatric staff can benefit from the organizational, critical care and trauma skills of EM staff. Therefore mixing the two staff groups and/or training staff in Pediatric Emergency Medicine (PEM), is of benefit to The STEP Society was formed in the year 2009 http://www.stepindia.org.in/ with a mission to • To Promote Pediatric Emergency Medicine(PEM) as a specialty in India • Enhance the quality of pediatric emergency medical care in India • Raise public awareness of the scope of pediatric emergency medical services • Enhance and optimize Emergency and Disaster Preparedness and Response with

all who are involved. Paediatric Emergency Medicine Training can be added on after core training in either EM or pediatrics. PEM is a superspecialty of EM if done after EM core training. At the same time, it is a superspecialty of paediatrics if pursued after essential paediatric training. 10th NAPEM The 10th National Assembly on Pediatric Emergency Medicine(NAPEM) is a flagship conference of The society for Trauma and Emergency Pediatrics supported by Society

•

• •

reference to special need of children and adolescent in India To encourage pediatric research activities by combining the efforts of individual institutions. To facilitate and coordinate research activities among the participating institutions. This organization pledges to formally work together with our colleagues in India for the greater good of people in India

for Emergency Medicine India and Endorsed by Association of Health Care Providers of India. This year’s course with a theme of Pediatric Emergency Medicine Unleashed will be held from April 6-8 th, 2018 at M S Ramaiah Medical College, Bangalore, India. Our motto is ‘saving a child in emergency will save a family for a better future of this Country’. As emergency physicians what else can we give back to our nation?On behalf of NAPEM 2018 team we request all to support and motivate doctors to attend the conference to know more and save more lives.

staff with Emergency Medicine skills

staff with Pediatric skills

Pediatric Emergency staff

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OBITUARY

A TOWERING PERSONALITY Col Surekha Kashyap, Professor, Department of Hospital Administration, AFMC, Pune

February 2018

COL SUNIL Kumar Pandurang Matwankar was born on 22 August 1944 in Indore. His father, (Late) Major PJ Matwankar, was an army doctor who had taken Emergency Commission in 1962 after the Indo China war. His mother, a quiet but strong lady, was the backbone of the house, staying back in Indore for the children’s education while her husband got posted to various places. Col Matwankar completed his matriculation in Indore in 1959, and wanted to join NDA due to his strong interest in sports and NCC. His father persuaded him to complete a technical course first, so he completed his MBBS from MGM College, Indore and joined the Army Medical Corps in 1968, immediately after internship. His first posting was to MH Khadakwasla, where he interacted closely with NDA cadets. He used to say that the lessons he learnt then, came in handy later during his tenure as Training Officer at AFMC, Pune. He subsequently served in hostile areas of Mizoram and Nagaland, where he received his first Chief of Army Staff Commendation in 1971. He was sent on a prestigious two year deputation with the Government of Bhutan, and also served as DADMS of an Infantry Division, and as MO in two Field Hospitals. He completed his Masters in Hospital Administration from AFMC, Pune in 1982 after having already acquired an MD in PSM. Lt Col (later Brig) RK Rakshit, who was then HoD, became his friend, philosopher and guide for life.

He commanded three military hospitals at Mhow, Nasirabad and Jaipur, where he brought about patient friendly transformations. But the appointment for which he will be most remembered at AFMC was as Training Officer, where his skills in managing the medical students were to become the stuff of legends. He recognized each student, ‘by the back of their heads’ as one of them put it, remembered their names and batches, and kept track of all their extracurricular activities. He cared for them deeply, evenly balancing discipline and welfare. His talented and gracious wife, Mrs Suneeta Matwankar, has been a true partner in all his endeavors, complimenting and supporting him throughout. Most students remember knocking at their door at odd times, only to be welcomed by the couple with a delicious home cooked meal. For his outstanding contribution to the organization, he was again conferred with the Chief of Army Staff Commendation in 1991. His tryst with AFMC did not end with his tenure as Training Officer. As luck would have it, he returned to the college in 1994 as Professor & Head of the Department of Hospital Administration. In his four year long tenure, he went on to be the guiding force behind more than 20 post graduate students of the specialty. He was the founder member of the Western Regional Chapter of the Academy of Hospital Administration in Pune, and remained its Regional Director since inception until June 2017. He spearheaded and guided several research

projects, the most notable being the mammoth task of revising the Scales of Accommodation for Armed Forces Hospitals, published in 2003, which is still used as authority in all hospital projects in the Armed Forces. In 1998, after bidding goodbye to the uniform, Col Matwankar started his second innings in the civil stream as Vice President of Reliance Industries, with whom he remained associated till 2005, planning and overseeing the creation of Dhirubhai Ambani Hospital in Lodhivali and managing the complete restructuring of Sir HN Hospital & Research center at Mumbai. For the past decade, his services had been sought as a consultant by state governments for reviving and planning medical colleges and hospitals in Allahabad, Indore, Varanasi and Pune. He was socially very active, regularly organizing reunions with his batch-mates, and had quite a following on his Facebook page, where he was an avid commentator on everything happening in the country and beyond. In November 2016, he achieved his lifelong dream of organizing a national conference on Safe and Sustainable Hospitals (SASH 2016) at AFMC, Pune under the aegis of the Academy of Hospital Administration. The conference, with an unprecedented footfall of 852 delegates, was inaugurated by Honâ&#x20AC;&#x2122;ble Lok Sabha Speaker, Smt Sumitra Mahajan, and was a spectacular success. Never one to rest on his laurels, he was reviewing the line plans for the super specialty wing of MGM Medical College till 19 Jan 2018, when he left for Hyderabad to attend a national conference, where he was scheduled to chair a session. But fate willed otherwise. His large heart, which had comforted, guided, counseled and loved so many for so long, stopped beating on 20 Jan 2018. A committed family man, he leaves behind an ageing mother, his loving wife and sons, Sujeet and Sachin, adoring grandchildren and other members of his extended family. A towering personality, Col Sunil Kumar Pandurang Matwankar will live on in the hearts and souls of all his family members, friends, colleagues and students whose lives he touched and illuminated. Such men do not die.

He commanded three military hospitals at Mhow, Nasirabad and Jaipur, where he brought about patient friendly transformations www.indiamedtoday.com

Q&A

ASK THE EXPERT

Running a private medical practice in India comes with the risk of lawsuits and property damage. As a medical professional, you are probably well aware of the devastating effects of legal cases and security threats that await doctors who face the blunt of an angry patient. We encourage you to share your queries and concerns regarding legalities of practicing medicine in India to learn more about legal framework, legal cases and the experience of fellow doctors

Prof ( Dr ) R K Sharma, President, Indian Association of Medico-Legal Experts , New Delhi will answer questions from our readers. Please send in your queries to editor@indiamedtoday.com

Q: A14-year-old girl is brought for MTP by parents.Parents do not want police to be informed. Can a doctor perform MTP on a 14-year-old girl with parents’consent? Dr. TS Jain, Medical Director Max Smart Super specialty Hospital Saket, New Delhi Ans: Age of consent for sexual intercourse is 18 years for unmarried woman and 15 years for married woman.A 14 year old girl who is pregnant has been raped and it is a case of statutory rape. It needs to be informed to police. Since she is minor, consent can be given by parents for MTP but doctor should not go ahead with MTP till clearance from police is received. In such cases, police will usually ask doctor to preserve fetus for DNA fingerprinting to fix responsibility. Q: It would be great help if you suggest who is eligible to sign the witness in consent forms. Medical Records Professional Ans: Many hospitals take signatures of their staff as witness in consent form. It should be avoided as it can be stated in court that staff was your employee so he can be biased in favour.The following should be priority of witness in consent form: Spouse or parents / guardian, any relative, any friend, any accompanying person or any unrelated person. If any of the above are not available, any other patient can be witness. Q: I am a resident in orthopaedics, suppose, with help of my colleagues in Forensic and Pathology department I enter Post Mortem room and dissect or study exposure of some of body, (while FMT/Patho people are doing post mortem)

February 2018

whose anatomy I am not aware about, can I be persecuted ? Name withheld Ans: You must understand conducting postmortem on a dead body is a serious medical work. Unauthorised persons are not allowed to witness it . You cannot dissect dead body on your will to learn anatomy. You can be prosecuted for destruction of evidence and disrespect to dead body. No organ or viscera can be taken out just like that. Q: Pls could you share information on the actual legal position of doctors and hospitals regarding DNR. A terminally ill patient who has no scope of survival by CPR and the treating doctors and family agree on not resuscitating the patient; I have heard two conflicting views in this scenario over the last four days. One saying withholding a therapy is not in the patient’s best interest ie CPR is acceptable, while a medic-lawyer who held a workshop at our hospital suggested that not performing a CPR is criminally liable. The UK practice allowed doctors alone to judge the best interest of the patient and having taken the family in confidence, could document DNR in red capital on file and chart. What’s the Indian legal position of DNR. Name withheld Ans: Answer- “Do not resuscitate policy” or DNR has no legal status in India, till we are conscious, we have command over our body but the moment the person becomes unconscious, next of kin is empowered to take any decision. Even consent given during life time for organ donation can be over-turned by next of kin. After death, the dead

body becomethe property of the next of kin and they are absolute owner. Q: Recently a couple came for IVF conception who is under treatment by me. Consent was taken for the cycle from both partners but 1st cycle was unfruitful. Husband’s semen sample was preserved for next cycle. Now the day before the couple was to come for ovum pickup for the next IVF cycle husband faced an unfortunate accident and could not survive. Now the wife wants to conceive using her husband’s semen sample but the mandatory consent from husband isn’t available as he is no more. Now as we cannot do IVF with only wife’s consent. Assuming even if we take previous cycle consent as continuation of care the husband’s family may raise objection in future over their son’s sample being used after his death without husband’s consent, as that would give the forthcoming child right to Father’s property. So what should be the legally safe way out for the doctor in best interest of wife and the family? Name withheld Ans:This is an unfortunate situation for the wife and makes for an interesting case. I think as husband had consented before death and she is widow and has legal rights over the property of her late husband (semen deposited in semen bank is

also property), there should not be any problem in inseminating her with semen of her ex-husband. If you want to avoid troubles for yourself, ask widow to approach high court for direction in this case. If high court grants permission, you can do it without any problems. Q: Can doctors make their own as well as their family members’ medical certificates when they can treat themselves? Any laws/statutory guidelines are there in support or against it? Can a doctor prescribe scheduled H & L drugs for himself ?Are there any rules regarding this? Dr. Ambika P Patra, Assoc. professor Ans: There is no bar on doctor that they cannot give medical certificate to self and family members. Doctors can prescribe any drug like schedule H or L. However, doctor should issue medical certificate to self / family members only when he is actually treating self/them and it should not be more than 14 days at a stretch. After 14 days, new certificate can be issued. (This is as per Delhi Medical Council Guideline) Q: I am an orthopaedic surgeon and practicing in district hospital in Gujarat where we have 4-5 anaesthetics for around 20 operating

surgeons(general surgeon,gynec,ortho etc.) Usually anesthetics’ schedule is tight and they are always in hurry. Most of the times they leave when closure starts without shifting the patient to the ward or recovery room. What are the liabilities of operating surgeon and anesthetics if any immediate post-op complicationoccur and anesthetics is not present in OT. Name withheld Ans: Please remembers this may amount to abandoning patient and will invite severe punishment in criminal and civil negligence. Postoperative care is responsibility of anesthetist and surgeon both. Surgeons will be held responsible as they carry vicarious responsibility.Greed for more patients should not be at the cost of patient safety. All surgeons should ask anesthetist to stay till everything is settled, if he is not agreeing, do not hire him at all. If all surgeons follow this, every anesthetist would fall in place. Disclaimer: This material has been prepared for informational purposes only, and is not intended to replace, and should not be conveyed or constitute legal advice. You should consult professional lawyer and legal advisors before engaging in any legal matter.

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EVENTS AHPI GLOBAL CONCLAVE 2018 Date: Feb 16-17, 2018 Organiser: AHPI Venue: Le Meridien City: Kochi Click: www.ahpi.in Contact: Shikhar Gupta, Assistant Director

Shikhar.ahpi@gmail.com

ealthcare industry will play key role to make the economic growth inclusive all over the globe. On one hand it is key social sector contributing to Human Development Index of nation; on the other hand it provides employment to large segment of population per unit investment. Rightly therefore the healthcare is fast emerging as ‘election

agenda’ in all the developing nations. Governments accordingly are working on plans to provide ‘Universal Health Coverage’. Considering that private sector is playing key role in providing healthcare in general and tertiary care in particular, the mission of ‘Health for All’ can be possible only through joint collaboration between public and private sectors including the allied healthcare industry. Keeping above in view, AHPI has chosen the theme for its 5th Global Conclave as; “Is Quality Healthcare Sustainable? Issues, Concerns & Solutions”. The conclave will also encompass the unique blend of 4th edition of ‘AHPI Awards for Excellence in Healthcare’ which will be presented on the eve of 16th February 2018.

INDIA HOSPITAL DESIGN & BUILD SUMMIT 2018

Date: March 23- 24, 2018 Organiser: National Accreditation Board for

Date: Feb 22-23, 2018 Organiser: Quest Conferences, Quest on the

Venue: VigyanBhawan City: New Delhi Click: http://www.nabh.co Contact: paulson@nabh.co

FRONTIER Venue: Le Meridien City: Gurgaon Click: http://www.hospitaldesignbuildsum-

mit.com Contact: Upendra Joshi, Conference Co-ordinator upendra@questconferences.com ndia Hospital Design & Build Summit 2018 is scheduled during 22-23 February, 2018 at Hotel Le Meridien Gurgaon Delhi NCR, India. The theme for the summit is “Transforming Hospitals”. The event is being organized in association with AHPI, IGBC, CIDC and HIMSS India. The aim of the summit is to Leveraging the latest innovations and best practices in Hospital Build in India to deliver cost-effective projects with effective Project management for timely completion of hospitals.

1ST NATIONAL HEALTHCARE QUALITY CONCLAVE 50

February 2018

Hospital and Healthcare Providers

ational Accreditation Board for Hospital and Healthcare Providers (NABH), a constituent board of Quality Council of India is announcing its first National Healthcare Quality Conclave. The two-day event will be attended by doctors, nurses, pharmacists, healthcare professionals, local community groups, local involvement networks, local council, voluntary sector organisations and local businesses. The topic of discussion will revolve around medications management; Infection Control and Prevention; Patient Rights and Communication; Use of Quality Tools; Antibiotic Policy Implementation; Medication Inventories Management; Information Management: Capture (Forms & Formats), Storage and Retrieval of Patient Records; Innovations in Training; Quality Improvement Initiatives in Public SystemsState- Secretary Health; Cost of Quality V/S Cost of Non-Quality.

INTERNATIONAL CONFERENCE ON BEST PRACTICES IN HEALTH CARE MANAGEMENT Date: March 8-9, 2018 Organiser: Xavier Institute of Management

& Entrepreneurship Venue: XIME, Electronics City, City: Bangalore Click: www.xime.org Contact: ximeconference@gmail.com

nternational Conference on “Best Practices in Health Care Management’’ is being hosted in partnership with Association of Healthcare Providers India (AHPI) at XIME, Bangalore. The conference aims to highlight innovations in Healthcare Delivery System in India and several foreign countries including Russia, UK, China, Spain and Germany. The panel will also deliberate on the Healthcare Delivery System – For Hospitals of the Future. Over 20 Indian speakers will showcase Innovative Business model of 9 leading hospitals and deliberate on Hospitals of the future and other conference themes. Several Foreign speakers will share insights from Europe and other countries.

10TH NATIONAL ASSEMBLY ON PEDIATRIC EMERGENCY MEDICINE (NAPEM) Date: April 6-8, 2018 Organiser: The Society for Trauma and

Emergency Pediatrics, India & Society for Emergency Medicine, India Venue: MS Ramaiah Medical College City: Bangalore Click: www.napem2018.com Contact: napem2018@gmail.com APEM is designed to meet the needs of all health care providers caring for pediatric patients, in both rural and urban settings. The highlight of this year’s conference will be on Triage in paediatric emergency, Newer practices in PEM, Transport of sick children, PEM residency training,PEM awareness,Prehospital care systems, Challenges in establishing PEM, Innovations in PEM, Paediatric Trauma resuscitation.