IndiaMedToday May 2019

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Why investing in smart health transformation is a good idea OF LATE the cost of healthcare has been rising rapidly. At the same time, hospitals are under pressure to deliver high quality healthcare at lower prices. And to add to this, hospitals are expected to have a strong bottom line and be profitable.

On the other side, the healthcare seeking behavior of the people has changed drastically. This has brought unconventional players to the market. Now traditional healthcare providers have to face stiff competition from software companies in some segments.

Patients are more empowered and want to be part of the treatment decision making, which the hospital is expected to facilitate. The revolution in the hospitality industry has led the patient to expect inpatient experience equivalent to a hotel stay. Convenience is of utmost importance and patients expect on-demand services that fit their expectations. Not only this, the patients’ attendant and visitors also want hospitals to pay attention to their needs.

The revolution in the hospitality industry has led the patient to expect inpatient experience equivalent to a hotel stay Out-Patient expectations are also increasing as demand for more consultation time and ease of movement at the hospital is heightened.

Besides, healthcare providers have also realized that there may be significant gains in heeding to some of the industry trends especially, where operational efficiency is concerned. A connected hospital where clinical services are integrated with information network enhancing accessibility even at the point of care is desired.

This is where the smart hospital concept comes in. The smart hospital framework focuses on operational efficiency, clinical excellence and patient centricity. It’s true that a number of providers are now digitized and have some form of HER. But that is not what smart hospital concept envisions.

How does smart hospital work? Where should providers invest? How to partner with the patient to build data and ultimately how analytics can benefit not only the hospital but the patient. These are some of the questions we have tried to answer through our special issue on ‘Smart Hospitals”.

And even if we have been able to discuss only a handful of ideas these represent potential opportunities for providers to differentiate themselves, offering affordable, quality care by creating a truly connected healthcare delivery system.

Do send feedbacks on editorial@indiamedtoday.com

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Editor M Neelam Kachhap

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CONTENTS

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APPROACH

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UPFRONT

27

Financial Planning Day Care Center

Surgical therapy gives a new lease of life for Parkinson’s patients

30 INNOVATE COVER STORY

Smart Hospitals Moving towards an evolving healthcare system

IMPACT

Does the Nurse Practitioner Education Solve Visibility Issues of Nurses

Next Step for Ocular Surface Disorders

Moshe Rogosnitzky, CEO of Ocular Discovery and co-researcher of the AIIMS collaboration shares with Divya Ramaswamy Ocular Discovery’s work and research perspective

INTERVIEW

555 Manish Technique

04 Editorial 06 News roundup

SPECIAL FEATURE 34 Smart Healthcare Facility – A personalised experience

Ajit Ashok, Director, Marketing Solutions, Big Data & Analytics, Philips Innovation Campus and Member Healthcare WG, IET IoT Panel

36 5 Tips for Healthy Financial Planning

Deepak Bagati, Executive Vice President and Group Business Head–SME Business Bajaj Finance Limited

38 7 Effective Strategies for Purchasing Equipment Parvathi Radhakrishnan, Co-Founder and Marketing Strategist, Zepnur Health

POST EVENT 41 Successful Hospital Strategic Management Summit 42 SYMHEALTH 2019

Dr Manish Kumar Gupta speaks to Divya Ramaswamy about his innovative surgical technique

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NEWS ROUNDUP AXIO BIOSOLUTIONS EXPANDS FACILITY, BECOMES WORLD’S LARGEST CHITOSAN MEDICAL SPONGE MANUFACTURER India’s leading innovative medtech company, Axio Biosolutions, recently expanded its state-of-the-art manufacturing facility at Gujarat Pharma Techno Park in Ahmedabad, India to over a million units annually and has become the largest chitosan medical sponge manufacturer globally.

As the first-ever Indian company to design and launch a novel haemostat for moderate to severe bleeding, Axio Biosolutions has been consistently disrupting the wound care management industry. Its manufacturing facility is ISO 13485 certified and GMP approved, with an ISO 7, Class 10000 clean room. Now, with the cutting-edge factory that is 75 per cent automated, boosting the annual capacity to over a million units, the company

is all set to conquer new frontiers.

Commenting on the latest development, Gourav Maheshwari, Director – Finance & Operations, said, “Our products are proudly made in India for the global market. With this expansion along with USFDA clearance for our products we are closer to realising our aspirations to become a global medtech company from India. We have created more than 100 jobs for local community with a significant contribution of women staff, we believe this facility will set a benchmark for medtech manufacturing in India“ Axio Biosolutions recently announced its top-notch Scientific Advisory Board, comprising Dr Shiladitya Sengupta, Assistant Professor of Medicine at Harvard Medical School, as Chairman and Dr S V Mahadevan, Professor of Emergency Medicine at Stanford University, as member.

Last year, the company raised $7.4mn in a Series B funding round led by Ratan Tata’s UC- RNT, along with existing investors Accel Partners and IDG Ventures India.

Axiostat Variants, Military, Emergency, Cardiovascular and Dental

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Headquartered in Cambridge, Axio Biosolutions has its corporate office in Bengaluru. The company has strong R&D with multiple patents to its credit.

NAVIA LIFE CARE LAUNCHES NAVI - A FIRST VOICE BASED VIRTUAL ASSISTANT FOR DOCTORS

Navia Life Care, an innovative healthcare technology startup launches Navi - a first voice-based virtual assistant for doctors. Navi like any other virtual assistant is an application that can understand voice commands and complete tasks for a user but with a slight difference that separates it from the rest.

It creates and completes a digital prescription for the patient which can be printed or sent via an SMS. Thus making it not only a mere passive listening device that will respond once it recognises a command but also record and analyze both the doctor’s behavior and the patient’s medical history.

Besides, using a unique algorithm it shall also predict possible re-modification, diagnosis, medication schedules and investigations for patients, thus recommending them to doctors.

Kunal Kishore Dhawan, Co-founder, and CEO of Navia has expressed his delight by saying: “Navi will be helping doctors create digital prescriptions through a speech-to-text engine, converting voice inputs into structured prescriptions. And this is going to make Navi an innovative, useful and accessible means to strengthen the doctor-patient bond in India.”

He further added, “For a typed prescription, it takes anywhere between 45 seconds to 2 minutes, whereas by using Navi – the voicebased assistant, this time is reduced to less than 1 minute per prescription. Thus, with Navi, doctors will be able to use their time effectively with reduced chances for errors.”

IIT ROORKEE RESEARCHERS DEVELOP A NEW NON-INVASIVE METHOD OF DETECTING BREAST & OVARIAN CANCER Researchers at the Indian Institute of Technology Roorkee have identified a new method of detecting Breast & Ovarian cancers, two of the worst forms of cancer, which are responsible for approximately one third of all cancers that occur in women and one fifth of all cancer related deaths worldwide.

The research published in the journal, ‘FASEB Bioadvances’ details the use of Whole Saliva as a body fluid for early detection of Breast and Ovarian cancers, as opposed to the traditional method of using blood samples. The research team led by Prof Kiran Ambatipudi from the Biotechnology Department at IIT Roorkee got a breakthrough in identifying certain proteins present in the saliva, which act as potential biomarkers indicative of Breast & Ovarian cancer metastasis.

The team compared the samples from healthy individuals against the samples collected from stage IV Breast & Ovarian cancer patients and Ovarian cancer patients

who had undergone at least three cycles of neoadjuvant chemotherapy. The salivary proteins were analyzed by mass spectrometry indicative of pathophysiology of breast and ovarian cancers and were compared to healthy and ovarian chemotherapy subjects.

Collectively, 646 proteins were identified, of which 409 proteins were confidently identified across all four groups. In addition to 409 identified proteins, 352 proteins were common in all groups, while 57 were either present/absent exclusively in one group or common in any two/three groups.

Speaking about the research, Prof Ambatipudi said, “Due to the heterogeneous and asymptomatic nature of breast and ovarian cancers, their early detection has been difficult using traditional methods such as mammography, blood flow patterns by color‐flow Doppler imaging and transvaginal ultrasound examination, due to high diagnostic costs and radiation exposure. Our attempt was to utilize saliva as a non-invasive sample source to identify specific protein biomarkers, which indicate breast & ovarian cancer metastasis. In patients who have undergone three cycles of chemotherapy, the salivary proteins can also act as an indicator of the patient’s response to chemotherapy.”

“Although it is essential to clinically validate these proteins in a large cohort of subjects but the results of the present study serve as an initial step towards the development of salivabased clinical tests.”, he added

COLUMBIA ASIA GURGAON HELPS 55-YEAR-OLD WOMAN TO BECOME MOTHER OF TWINS When Mrs Hooda lost her only son aged 25, two years ago, she had not expected to live the joys of being a mother again. However, with the help of doctors of the Columbia Asia Hospital Gurugram, 55-year old Mrs Hooda became a proud mother of twins – a boy and a girl, and one of the instances of rare postmenopausal pregnancies in the country.

According to the doctors at the Columbia Asia Hospital, her pregnancy was a challenge at many fronts – she was past her natural age of conception and her uterus had shrunk after she reached menopause; continuous hormonal therapy during the pregnancy helped her to continue. She also spent 2 days in ICU due to high and often fluctuating blood pressure.

We were acting against the natural physiology and hence, we were mindful of the risks. But, at the same time, we were determined to offer the best of our efforts. She came to me in her second month and trusted me to take care of her. Based on our in-depth knowledge of her medical conditions accompanied by the intensive monitoring, we could successfully carry her pregnancy to the eighth month and delivered her through Elective Cesarean Section, said Dr Amita Shah, Chief of Obstetrics and Gynaecology. Though healthy, the babies weighed about 1.4 kg and had to be kept under observation at the neonatal intensive care unit (NICU) for nearly 3 weeks, and discharged at 1.7 kg,” says Dr. Sachin Jain, Consultant Neonatologist, Columbia Asia Hospital, Gurugram.

TRANSASIA BIOMEDICALS DONATES HEMATOLOGY ANALYZER TO SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES Transasia Bio-Medicals Ltd., India’s Leading In-vitro Diagnostic Company has donated its newly launched hematology analyzer, H 360 to Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore.

This is in support of the institute’s most urgent need for essential instruments, for more precise diagnosis, faster treatment and improved outcomes.

The H 360, is a three part differential fully automated hematology analyzer, developed at Transasia’s European subsidiary - Erba Europe. With its ability to detect CBC and WBC Differential with high precision and accuracy, H 360 will be useful in screening of

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Transasia donates instrument to Sri Sathya Institute

anemia & its causes, indicating the presence of hemoglobinopathies, helping in detection of cytopenia, septicemia or leukemia and platelet related pathologies & disorders.

Speaking on the occasion, Suresh Vazirani, Chairman & Managing Director, Transasia BioMedicals Ltd. said, “I am immensely proud of Transasia’s continuing association with the Sri Sathya Sai Institute of Higher Medical Sciences in aid of a very noble cause. The impact of the good work done by the institute has benefited not only the poor patients in Bangalore but also those from the nearby areas. At Transasia, we believe in operating with a higher purpose, with an unwavering focus on ensuring equitable and affordable access to diagnostic facilities. In the more than two decade long association with the institute, Transasia has provided its instruments to the institute. This latest version of the instrument will be able to offer four more extra parameters for in-depth analysis.

Dr. Sundaresh D C., Director, Sri Sathya Sai Institute of Higher Medical Sciences, added,

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“We are thankful to Mr. Vazirani and Transasia for supporting us with the analyzer. Transasia has a long-standing legacy of offering quality and affordable diagnostic solutions and I am sure that the additional parameters being offered by this new analyzer will provide more diagnostic value and aid in early and accurate diagnosis.”

AIMED WELCOMES DTAB’S MOVE TO REGULATE ALL MEDICAL DEVICES

“While we welcome the steps being taken by DTAB to consider to phase in Regulation of all medical devices however we notice with great concern that many key strategic aspects of the Road Map discussed with the Indian Medical Devices Industry Associations are missing and are not committed anywhere viz.- all medical devices need to be regulated under a separate medical devices specific law; separate and clear regulations from

drugs required; representation on DTAB ( drugs technical advisory board) by medical devices industry nominees & regulatory expert as a special invitee till we have medical devices technical advisory board; constitution of MD - EAG (medical devices- expert advisory group) to aid DTAB & MoH in rolling out medical devices regulations in a phased manner,” pointed out Rajiv Nath, Forum Coordinator of AIMED. DTAB in the meeting deliberated the matter and agreed to notify all medical devices as Drugs under the Section 3(b)(iv) of the Drugs and Cosmetics Act, 1940 and also to provide exemptions in the Rule 90 of the Medical Device Rules, 2017 during the transition period.

The Board further agreed that CDSCO should be strengthened with respect to manpower and infrastructure to regulate all medical devices.

The Board further recommended to include specialists like dentists and ophthalmologists in the category of experts to be recruited.

The Board also recommended that

manpower and infrastructure in all States should also be strengthened and an advisory may be issued to all the States in this regard. Registration of all Manufacturers & Importers of all Non Notified Medical Devices at earliest on voluntary basis initially and then mandatory.

“We request the Govt. to stick to earlier assurance given to the Industry by MOH&FW in 2016 of 4 steps - of starting with Medical Devices Rules (MDR), initially experimenting with a few Electronic Devices under MDR, MDR to be amended as per experience gained after 6 months of introduction and simultaneously draft Bill of a Medical Device Patient Safety Bill to be reviewed and passed

by Parliament and the MDR to be tweaked to fit with eventual Medical Device Law.” Said Mr. Rajiv Nath “While we complement CDSCO & MoH&FW in listening to our requests to

bring in a separate regulatory framework for medical devices independent of Drugs and carry forward the initial rolling out of regulations from the launch of Medical Devices Rules earlier in Jan 2018 to a logical conclusion and in a phased manner, but much more needs to be done and in a more planned manner in place of a piecemeal approach. We regret to note certain important strategic directions are missing.” Added Nath Thankfully a re-start of the process that had stalled has been made. Let’s hope MoH&FW will act stop procrastinating in the need to ensure patient safety and encourage domestic manufacturing that had been negatively impacted in absence of a predictable regulatory environment.

“It’s imperative to have a separate Law as Devices are engineering items and not medicines - an X Ray machine by no stretch of imagination can be called a Drug so continued

attempts to regulate Devices as Drugs is illogical & incorrect. The Medical Devices Rules has risk proportionate controls correlating to risk classification of devices. Similarly the law and penal provisions need to be risk proportional as you can’t have the same penalty for a manufacturing failure of a spectacle as is for a contact lens or for a intraocular lens.

Additionally we are all aware of the pitfalls in the current regulatory framework of Drugs that do not Regulate the quality uniformly and equitably from state to state in absence of a central national singular regulatory authority and we don’t wish to fall Under the same issues for Devices too. The DTAB meeting is silent on this and regretfully no representative of medical devices industry or a regulatory expert is invited to these important meetings that decide the fate of the industry.” Said Nath.

In absence of regulatory approval a start and entrepreneur is challenged to prove his medical is safe to be used on patients and has good quality though the Quality Council of India does provide a voluntary certification scheme.

There is an urgent need for an integrated and calibrated development policy to put ‘Make In India’ initiative in medical devices sector in top gear, reduce high import dependency on foreign made devices in order to promote indigenous manufacturing of drugs and devices as a regulatory approval to an indigenous product will go a long way in making India a global robust hub for medical devices manufacturing and fulfilling Govt’s ambitious mission of making quality healthcare affordable for common masses”

MEDICA SUPERSPECIALITY HOSPITAL, THE BENGAL CHAMBER ORGANISE HEALTH TECH, 2019 IN KOLKATA Healthcare industry is undergoing rapid transformation especially in this disruptive era.

Technology has become intrinsically related

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NEWS ROUNDUP and linked to almost all facets of work flow within the healthcare systems to optimise and speed up efficiency as it affects all stake holders involved namely the patients, providers and payers. The system involves massive use and transfer of data among all stake holders. As the industry is edging towards being the fastest service centric sector, there is a gradual shift about using a centralised data to give the best to end users.

The application of technology to radically improve performance and human care has become a trending topic for healthcare organisations across the globe. Digital technology is touching the lives of every human being today in one way or the other, said Dr. Alok Roy, Former President, The Bengal Chamber of Commerce and Industry and Chairman, Medica Group of Hospitals.

Dr Roy was speaking on the sidelines of Health Tech 2019 – Technologies for Universal Healthcare, jointly organised

by Medica Superspecialty Hospital and The Bengal Chamber of Commerce & Industry to be held over two days between 12th and 13thApril, 2019, in Kolkata. Indrajit Sen, President, The Bengal Chamber stated, “Apart from providing the best healthcare facility to all patients, The Bengal Chamber IT committee proposes that both public and private healthcare systems adopt blockchain based Electronic Health Record (EHR) where entire summary, prescriptions, reports to the respective unique citizen id stored on the blockchain platform.”

The highlight of the opening day was the release of Knowledge Paper “Reimagining Health Information Exchange in India using Blockchain” drafted by Pricewaterhouse Coopers Private Limited. “Indian healthcare is on the cusp of transformation by adopting the Ayushman Bharat and moving to attain the goal of Universal Health Care (UHC). It has been facing challenges of affordability, quality of care and availability of adequate skilled resources for a long time. Add to this, the various limitations of existing technology that has led to challenges around meaningful health information generation, ownership, storage, standardization, security

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Dr. Guruprasad B

Dr. Rajesh Raykar

and exchange. Blockchain offers a solution to these challenges by providing a trust enabled information exchange platforms for the healthcare ecosystem to generate, store, and exchange meaningful health information in a secured manner,” stated Arnab Basu, Chairperson, IT Committee, The Bengal Chamber of Commerce and Industry and Leader - Technology Consulting, PwC India.

Last year’s topic highlighted the significance of two emerging technologies – Artificial Intelligence (AI) and Internet of Medical Things (IoMT) in addressing some of the key challenges of healthcare like accessibility and affordability. It helped understand the various use cases of these two technologies that can be leveraged in the Indian healthcare technology ecosystem in a disruptive manner. Over the last 12 months we have seen greater adoption of these technologies and similar papers/work has raised awareness about these disruptive technologies in the Indian healthcare organizations. There are several government initiatives also on similar technologies.

Many private healthcare providers and equipment majors have also adopted these technologies and these are maturing quite fast in India.

SPARSH HOSPITAL APPOINTS SENIOR NEUROSURGEON CONSULTANTS

SPARSH Hospital announced the appointments of Senior Neurosurgeon Consultants for its Neurology and Neurosurgery departments in order to provide core support to the trauma center comprising of highly qualified & acclaimed neurosurgeons trained in both India & overseas. Dr Guruprasad Bettaswamy and Dr Rajesh Raykar are the specialists appointed in the Neurosciences department.

Dr. Guruprasad, who specialises in Neurosurgery, has over a decade of experience in this field, with a special interest in treatment of complex spinal procedures like C V junction anomalies, minimally invasive spine surgery and sacral tumours. He has completed Mch from SGPGI and went on to complete his subspeciality fellowship in Skull Base & Complex, with training in both endoscopic and micro neuro surgical procedures.

Dr Rajesh R Raykar, has gained extensive experience in Neurosurgery from prestigious institutions in India, Japan, Korea and Shanghai. Dr. Rajesh completed Mch from from KMC Manipal and has gained over a decade

of experience in complex neurological cases.

He has expertise in handling Image Guided Surgery Stealth Station 7 Navigation system to perform complex intracranial and spine surgeries and also specialises in Functional Neurosurgery and Chronic Pain Management.

SANKARA EYE FOUNDATION, INDIA WINS IMC RAMAKRISHNA BAJAJ NATIONAL MILESTONE MERIT NATIONAL QUALITY AWARD FOR OPERATIONS FOCUS Sankara Eye Foundation, India has become the first recipient of the IMC Ramakrishna Bajaj Milestone Merits Recognition Award for the year 2018 in the Operations Focus category.

The Indian Merchant Chamber, Ramakrishna Bajaj National Quality Awards are the most

reputed awards in Quality across India. This year a new category – Milestone Merit awards were introduced.

This award was in recognition of Sankara Eye Foundation, India offering high quality eye care through processes that helped it maintain standards above national benchmarks and the strive of the entire organization to continuously improve their journey in performance excellence path. What was notable was that this award was given from organizations from domains as diverse as manufacturing, education, healthcare and service industries. The award was received

by Dr Geeta Fulari , Manager Quality, Sankara Eye Foundation India from the Chief Guest Dr. Farokh Udwadia (Emeritus Prof. of Medicine Grant Medical), in the presence of Industrialist Mr. Niraj R Bajaj (Chairman, IMC RBNQ Award Trust), quality guru Mr. Suresh Lulla (Co chairman, IMC Quality), Mr. Ashish Vaid (VP IMC) and Mr. Amit Mangrulkar (Director General, IMC).

Nउल्टा (NULTA) PARTNERS WITH PHONEPE AND TISS TO HELP PATIENTS DEAL WITH MENTAL HEALTH ISSUES

Roy de Souza, a serial entrepreneur focused on curing cancer has funded nउल्टा (nULTA), a leading online consultation platform that connects patients to specialist doctors. The app has partnered with PhonePe, India’s leading digital payment apps, using the iOS and Android and iCALL helpline staff (run by TISS) to help counsel customers dealing with mental health issues and with MBBS doctors to answer the medical questions.

According to a report by Deloitte Touche Tohmatsu India, the overall Indian healthcare market, which is worth around $100 Bn, is likely to grow at a CAGR of 23% to reach $280 Bn by 2020, thanks to smartphone and Internet adoption.

Speaking on the occasion, Roy de Souza,

Sankara IMC Award

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NEWS ROUNDUP Founder, nउल्टा (nULTA) said, “We are delighted to partner with PhonePe and TISS to provide our users with safer and seamless consultation experience. We partnered with PhonePe and iCALL, a mental health awareness project by TISS to help patients deal with their issues. Whenever they need, these PhonePe app users (iOS and Android) across India can contact a qualified doctor or qualified counselor right from the PhonePe app - without installing any new apps.”

Commenting on the partnership, Rituraj Rautela Head of In-app category PhonePe, said, “We are very excited with this new and unique addition to our in-app platform.

Healthcare is a key focus area for us and we are really happy to partner with nULTA which provides counselling for mental health issues.

Our rapidly increasing user base will get to avail nULTA’s services through their PhonePe app without the hassle of installing multiple apps, and enjoy the comfort and sense of security while making payments through PhonePe.” Speaking on the occasion, Tanuja Babre, Programme Coordinator, iCALL, TISS, said, “Mental health facilities in India are still quite insufficient owing to the limited number of services being offered as well as, the inadequate number of trained and supervised professionals. We partnered with nULTA to help the clients in need of counselling services get consultation through iCALL which endeavours to provide professional counselling sessions transcending geographical distances while ensuring confidentiality.”

RAVIGANESH VENKATARAMAN APPOINTED AS THE NEW CEO, CLOUDNINE GROUP OF HOSPITALS Cloudnine Group of Hospitals, India’s leading chain of maternity, childcare and fertility care group of hospitals headquartered in Bengaluru, has announced the appointment of Raviganesh Venkataraman as its Chief Executive Officer.

He joins the company on April 17, 2019 and

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Raviganesh Venkatraman

will be based out of the corporate office in Bengaluru. Akash Malik, outgoing CEO has been with the Cloudnine group of hospitals for six years and had expressed his ambition to pursue other entrepreneurial opportunities beyond healthcare.

As the CEO, Raviganesh will be responsible for driving and overseeing the development and execution of Cloudnine’s corporate strategy, business developments, M & A, systems and policies across the company in doctor and customer relationship management, delivery excellence, quality, building top talent and leadership development.

NIRAMAI TO DEVELOP AI BASED SOFTWARE FOR DETECTING RIVER BLINDNESS

Artificial intelligence-based Indian healthtech company Niramai announced that it will develop an artificial intelligence (AI)-based computer-aided software for controlling spread of River Blindness. Niramai will leverage its innovative Thermalytix™ technology to detect the presence of live adult worms of Onchocerciasis which causes river blindness and significant disability.

Thermalytix™ is currently being applied to early stage breast cancer detection. This innovative non-invasive detection method is expected to help assess the efficacy of new drugs being developed to control the disease by killing the adult worms, potentially accelerating the elimination of river blindness, which has today infects ~17 million people in Africa. This project has been made possible through support from Bill & Melinda Gates Foundation.

A clinical expert collaborating with NIRAMAI, Professor Dr Christopher L King from The Centre for Global Health and Diseases, Cleveland, said, “Onchocerciasis, more commonly known as river blindness, is the world’s second leading infectious cause of blindness. NIRAMAI technology can be a valuable tool to detect infectious live worms in a non-invasive way and help with the global effort to eliminate this very disabling disease.” About half a million people are blind or visually impaired due to the disease which is caused by a parasitic worm living under the skin in humans, spread by black fly bites. In addition to blinding, onchocerciasis is a chronic systemic disease capable of causing extensive and disfiguring skin disease, chronic itching, musculoskeletal complaints, weight loss, alteration in host immune responses and possibly epilepsy and growth impairment. Onchocerciasis can have considerable impact on social relationships in poorest communities. Therefore, its control and elimination has been a high priority. It has been categorized by Gates Foundation as one of the high-opportunity target diseases under the strategy to address NTDs (Neglected Tropical Diseases).

QUALITY PRIMARY CARE KEY TO ADVANCING UNIVERSAL HEALTH COVERAGE: WHO

The World Health Organization has said quality healthcare services for people at the community level across all age groups, wherever they live and whenever they need them, without financial hardship, is

fundamental to advancing universal health coverage for achieving health and well-being of everyone, everywhere.

“A well-functioning primary care system that meets most of a person’s health needs, throughout the life course, is central to universal health coverage,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, on World Health Day, celebrated every year on 7 April. The theme of the day this year is Universal Health Coverage, ‘Health for All: Everyone, Everywhere’.

Universal health coverage or UHC is WHO’s number one goal globally. In the WHO South-East Asia Region, UHC has been a flagship priority program since 2014. The Region has seen encouraging progress, with essential health service coverage improving in all countries, along with the availability of doctors, nurses and midwives. There is also growing inter-country collaboration to improve access to quality medicines through the South-East Asia Regulatory Network.

However, more needs to be done as, despite progress, around 800 million people still lack full coverage of essential health services and at least 65 million people are pushed into poverty because of health spending, most of which

goes on medicines, Dr Khetrapal Singh said.

“As a large share of outpatient care is delivered by private providers and financed by out-of-pocket payment, we need new approaches to address the double challenge of protecting people from financial exploitation and poor-quality care, while harnessing the private sector’s extensive assets,” the Regional Director said.

BD CELEBRATES 70 YEARS OF BD VACUTAINER® WORLDWIDE

Dialogue 2019 Leadership Summit organized

by BD Life Sciences – Preanalytical Systems in India marked the success of 70 years of BD Vacutainer® worldwide. Considered as the gold standard in sample collection, the summit was attended by leading names from the industry: Dr. A Velumani, founder and CMD, Thyrocare, Om Manchanda, CEO, Dr LalPath Labs, Dr. Nandakumar Jairam, CEO, Columbia Asia Hospitals, Dr. Vandana Jain, Head, Head - Accreditation of Medical Testing Laboratories, Dr Navin Dang, Founder, Dr. Dang Labs, Sanjeev Vashishta, CEO, Pathkind,

Dr. Shubnum Singh, Director, Max Group of Hospitals & Healthcare Sector Skill Council Chairperson, Dr. Sanjay Arora, Managing Director, Suburban Diagnostics and Girish Mehta, CEO, Eurofins. The discussions held at the event brought forth impactful insights garnered from like-minded, visionaries with a focus on quality and patient outcomes for advancing the world of health.

Speaking about the legacy of BD Vacutainer® Pavan Mocherla, Managing Director, BD–India & South Asia, said “With our work in market development, innovation and commitment towards advancing healthcare and improving patient outcomes, we aim to maintain the gold standard created by BD Vacutainer®. What might appear to be a simple plastic/glass tube, is an epitome of dedicated science, with years of expertise and experience packed into it.

However, our work does not end there. Training of healthcare workers to manage sample collection optimally is invaluable for accurate diagnosis and treatment outcomes; hence, BD has been committed to capability building.

Looking back at the 70 years of innovation and the road ahead excites me about the opportunity we have to shape the everevolving diagnostics industry in India.”

BD

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NEWS ROUNDUP CIPLA MEDPRO ACQUIRES A STAKE IN CONNECTED HEALTH COMPANY BRANDMED In recognition of the importance of the critical shift to a more patient-centric, integrated and predictive healthcare environment, CiplaMedpro South Africa (Pty) Limited, whollyowned subsidiary of Cipla Limited and South Africa’s third largest pharmaceutical company in the private sector, will acquire a 30% stake upon closure in the connected healthcare company, Brandmed (Pty) Limited. In February, Cipla had announced a similar partnership in India with Wellthy Therapeutics to offer a clinically-validated digital disease management platform to patients in cardio-metabolic health.

Following the Definitive Agreement, Cip Tec will make an upfront payment of $22 million to Pulmatrix in exchange for assignment of all rights for Pulmazole in relation to pulmonary indications to Cip Tec. Thereafter, both parties

will equally share costs related to the future development and commercialization of Pulmazole, and equally share worldwide free cash flow from future sales of Pulmazole.

Pulmatrix will remain primarily responsible for the execution of the clinical development of Pulmazole, and Cip Tec will be responsible for the commercialization of the product.

The partnership will be overseen by a Joint Steering Committee with equal representation from both companies.

Cipla Technologies LLC and Pulmatrix entered into Definitive Agreement for the Development and Commercialization of

Pulmazole.Transaction marks Cipla’s entry into specialty respiratory segment, building on inroads made into the specialty business in the recent past.iSPERSE™ formulation of the anti-fungal drug itraconazole will enable inhaled drug delivery and on-label treatment of ABPA, a condition that affects over 2 million worldwide. Definitive Agreement lays ground for Phase 2 study, and partnership between the two companies for future development and commercialization costs as well as revenues from worldwide sales.

SYNGENE INTERNATIONAL AND BIRAC SET UP CENTRE FOR ADVANCED PROTEIN STUDIES (CAPS) Syngene International Ltd., a leading global contract research organization, announced the opening of its Centre for Advanced Protein

From left: DhananjayPatankar (VP – Biopharmaceutical Development, Syngene International Ltd.), Dr. RenuSwarup (Secretary – Department of Biotechnology, Government of India), KiranMazumdar Shaw (MD – Syngene International Ltd.), Dr P.K.S Sarma, General Manager & Head – Technical BIRAC and Dr. Madhvi, Senior Program Manager, BIRAC

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Studies (CAPS) by the Secretary, Department of Biotechnology, Government of India. The Centre has been set up in collaboration with the Biotechnology Industry Research Assistance Council (BIRAC) at Syngene’s campus in Bengaluru and will host a state-of-the-art GLP accredited analytical laboratory.

Regulatory approval of complex biological molecules involves extensive and advanced analytics including assessment of physiochemical characteristics, efficacy, immunogenicity (antidrug antibody), contamination, strength and more. All these tests need to be performed in a GLP compliant analytical facility. Availability of appropriate certified facilities at affordable costs is a challenge that the start-ups, SMEs/MMEs and the academia in India, have to often face.

CAPS will help address this challenge and will be a big boost in advancing biopharma research and product development in India.

Spread across an area of 2000 sq. ft, the Centre will run under the ‘Innovate in India’ program of the National Biopharma Mission, Department of Biotechnology, announced by the Government of India.

WORLD’S FIRST GENERIC ERIBULIN FOR TREATMENT OF METASTATIC BREAST CANCER LAUNCHED IN INDIA Emcure Pharmaceuticals, a leading integrated global pharmaceutical company from India, today, announced the launch of the world’s first generic version of Eisai Pharmaceutical’s Halaven (Eribulin) for the treatment of metastatic breast cancer (MBC). Emcure will be marketing the drug under brand name ‘Eribilin’, with an aim to offer high-quality and costeffective treatment option to breast cancer patients in India.

Eribulin is a non-taxane inhibitor of microtubule dynamics and remains effective in MBC previously treated with an anthracycline and a taxane. Eribulin is a complex API derived from a marine natural product called

SainathIyer, President Business Strategy &Speciality Business, Emcure Pharmaceuticals ltd, Adwait Gore, Medical Oncologist, Prince Aly Khan Hospital, Mumbai, Dr. MukundGurjar, Chief Scientific Officer, Emcure Pharmaceuticals ltd

Halocondrin B. “Emcure’s R&D resources are equipped with technical competence and stateof-the-art development facility to develop such complex generics. Generic Eribulin is a landmark achievement of Emcure’s R&D efforts both in API manufacturing and formulation,” said Dr. MukundGurjar, Chief Scientific Officer, Emcure Pharmaceuticals. Emcure will manufacture generic Eribulin at its state of the art plant at Hinjewadi in Pune and market it at a cost which will be approximately 40% less than the innovator brand bringing hope to millions of breast cancer patients in India.

The drug would currently be marketed in India, however Emcure plans to register the brand in international markets as well, wherever the drug is about to go off-patent.

CIPLA LAUNCHES NIVEOLI™, INDIA’S FIRST EXTRA-FINE ICS-LABA COMBINATION HFA INHALER Cipla Limitedlaunched Niveoli™, India’s first

extra-fine particle beclomethasone-formoterol combination hydrofluoroalkane (HFA) inhaler for adults, targeting drug delivery to the small airways.Niveoli™ is a proprietary Cipla inhaler, and the latest offering from Cipla in respiratory inhalation therapy that addresses an unmet need associated with obstructive airway diseases (OAD) such as asthma and chronic obstructive pulmonary disorder (COPD).

Asthma and COPD are lung conditions that affect the ability to breathe. Extensive research and an evolved understanding of the diseases over the years has shown the significant role of small airway disease in asthma and COPD. A recent meta-analysis showed that small airway disease is prevalent in 50-60% of asthma patients. Another study has indicated that routine lung function tests can underestimate problems in the small airways. Small airway disease is a common feature of COPD and gets worse with increasing severity of the condition.

Niveoli™’s novelty and strength lies in HFA propelled delivery of extra-fine particles of beclomethasone, an inhaled corticosteroid (ICS) and formoterol, a fast-onset long acting beta agonist (LABA) to the small airways.

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DETAIL NEWS

WHO RELEASES FIRST GUIDELINE ON DIGITAL HEALTH INTERVENTIONS If digital technologies are to be sustained and integrated into health systems, they must be able to demonstrate longterm improvements over the traditional ways of delivering health services

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WHO RELEASED new recommendations on 10 ways that countries can use digital health technology, accessible via mobile phones, tablets and computers, to improve people’s health and essential services.

“Harnessing the power of digital technologies is essential for achieving universal health coverage,” says WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.”

Over the past two years, WHO systematically reviewed evidence on digital technologies and consulted with experts from around the world to produce recommendations on some key ways such tools may be used for maximum impact on health systems and people’s health.

One digital intervention already having positive effects in some areas is sending reminders to pregnant women to attend antenatal care appointments and having children return for vaccinations. Other digital approaches reviewed include decision-support tools to guide health workers as they provide care; and enabling individuals and health workers to communicate and consult on health issues from across different locations.

“The use of digital technologies offers new opportunities to improve people’s health,” says Dr Soumya Swaminathan, Chief Scientist at WHO. “But the evidence also highlights challenges in the impact of some interventions.”

She adds: “If digital technologies are to be sustained and integrated into health systems, they must be able to demonstrate long-term improvements over the traditional ways of

delivering health services.”

For example, the guideline points to the potential to improve stock management.

Digital technologies enable health workers to communicate more efficiently on the status of commodity stocks and gaps. However, notification alone is not enough to improve commodity management; health systems also must respond and take action in a timely manner for replenishing needed commodities.

“Digital interventions, depend heavily on the context and ensuring appropriate design,” warns Dr Garrett Mehl, WHO scientist in digital innovations and research. “This includes structural issues in the settings where they are being used, available infrastructure, the health needs they are trying to address, and the ease of use of the technology itself.”

DIGITAL HEALTH INTERVENTIONS ARE NOT SUFFICIENT ON THEIR OWN The guideline demonstrates that health systems need to respond to the increased visibility and availability of information. People also must be assured that their own data is safe and that they are not being put at risk because they have accessed information on sensitive health topics, such as sexual and reproductive health issues.

Health workers need adequate training to boost their motivation to transition to this new way of working and need to use the technology easily. The guideline stresses the importance of providing supportive environments for training,

dealing with unstable infrastructure, as well as policies to protect privacy of individuals, and governance and coordination to ensure these tools are not fragmented across the health system.

The guideline encourages policy-makers and implementers to review and adapt to these conditions if they want digital tools to drive tangible changes and provides guidance on taking privacy considerations on access to patient data.

“Digital health is not a silver bullet,” says Bernardo Mariano, WHO’s Chief Information Officer. “WHO is working to make sure it’s used as effectively as possible. This means ensuring that it adds value to the health workers and individuals using these technologies, takes into account the infrastructural limitations, and that there is proper coordination.”

The guideline also makes recommendations about telemedicine, which allows people living in remote locations to obtain health services by using mobile phones, web portals, or other digital tools. WHO points out that this is a valuable complement to face-to-face-interactions, but it cannot replace them entirely. It is also important that consultations are conducted by

qualified health workers and that the privacy of individuals’ health information is maintained.

The guideline emphasizes the importance of reaching vulnerable populations, and ensuring that digital health does not endanger them in any way.

WHO’S WORK ON DIGITAL HEALTH This guideline represents the first of many explorations into the use of digital technologies and has only covered a fraction of the many aspects of digital health.

In 2018, governments unanimously adopted a World Health Assembly resolution calling on WHO to develop a global strategy on digital health to support national efforts to achieve universal health coverage. That strategy is scheduled to be considered at the World Health Assembly in 2020.

Although WHO is expanding its focus on digital health, the Organization has been working in this area for years, for example, through the development of the eHealth Strategy

Toolkit in 2012, published in collaboration with International Telecommunications Union (ITU).

To support governments in monitoring and coordination of digital investments in their country, WHO has developed the Digital Health Atlas, an online global repository where implementers can register their digital health activities. WHO has also established innovative partnerships with the ITU, such as theBeHe@ lthy, Be Mobile initiative for the prevention and control of noncommunicable diseases, as well as efforts for building digital health capacity through the WHO Regional Office for Africa.

Over the years, WHO has released a number of resources to strengthen digital health research and implementation, including the mHealth Assessment and Planning for Scale (MAPS) toolkit, a handbook for Monitoring and Evaluation of Digital Health, and mechanisms to harness digital health to end TB. On 6 March 2019, Dr Tedros announced the creation of the Department of Digital Health to enhance WHO’s role in assessing digital technologies and support Member States in prioritizing, integrating and regulating them.

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IMPACT

DOES THE NURSE PRACTITIONER EDUCATION SOLVE VISIBILITY ISSUES OF NURSES Sunitha Solomon-Calvin, Ph. D. Research Scholar, MCON, MAHE, Manipal

A ROBUST healthcare system demands a competent healthcare workforce. The competence of the healthcare workforce depends, to a large extent, on the quality of the education and training they receive and nursing is no different.

Role of a Nurse According to the WHO report ‘The health workforce in India - Human Resources for Health Observer’ (2016), nurses have accounted for about 30.5 per cent of the total healthcare workforce in India. They have been playing a dynamic and crucial role in healthcare for many years.

They have usually been the first healthcare professional that a patient interacts within a healthcare setting and the person seen most during their treatment and care. Many times the last person they see in their life. Nurses are responsible for evaluating patients’ needs and diagnosing illnesses and are an integral part of the comprehensive standards of care and health promotion. They even advocate on behalf of the patiens and the community to help optimise health, enable and empower patients by striving for access to healthcare services irrespective of race, gender and ethnicity and promote health for all. They also play the role of mediator to create collaboration between various institutions to ensure the health of the population. Indeed, nurses are the backbone of the healthcare system and are known for selflessly working round the clock with compassion and care.

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Understanding Nursing Many research studies have time and again shown that nurses are considered as the most trusted and many a times, the most important health professional sought out by patients for their healthcare. The Interdisciplinary Nursing Quality Research Initiative, is a body of research implementation created in 2005 that helps to generate, disseminate, and translate research on how nurses contribute to and can improve patient care quality. It has been examining specific processes of nursing care, viz., coordination of care, administration of medications, introduction and inclusion of evidence-based protocols, and has correlated these with better and improved client outcomes. Despite these predominant findings, the nature of nurses’ work in clinics, hospitals, healthcare centres and even in homecare settings is not well understood bythe public, the policymakers or even the other healthcare professionals in India.

Visibility Issues Professional visibility of nurses, the way that nursing appears to other disciplines and the consumers of the healthcare is still degrading.

They are still considered as handmaidens to the physicians and at times lesser than some of the technicians on the team. The hierarchical structure of healthcare and perceived authority and direction of the hospital policy keeps the nursing personnel from utilising their evidence-based knowledge upto their full potential and standards. This has also caused

the nurses to lack personal confidence and feel that their profession is characterised by fewer career advancement options. They also tend to waver from taking the leading role in care and shy away from taking credit for the work they do. This is more so in India where the rank of women itself is on the lower side of the scale.

Devaluing the work done by nurses and paying them lower compensation is a reflection of the status of women in our society.

Licensed Profession In spite of all odds in the practice of nursing, the profession has undergone immense change. Nursing has progressed from an occupation to a fully licensed profession, with members that provide a broad range of services independently, and in a variety of professional relationships with other providers.

This evolution has changed how nurses are educated and clinically prepared. Although nursing education has evolved over the years,

with general training giving way to degree courses in nursing, the trend of visibility often seems to remain the same. Improvement of this trend will only change when the nurses equip themselves to take up the reins of leadership in their own areas and advocate for their rights by giving voice to their needs and requirements.

They have to do so, to gain autonomy in practice and get the credit that rightfully belongs to them. The fraternity of nurses in the western countries have taken a step forward and it is time that we Indians do the same.

Nurse Leadership One of the ways that this change is taking place is through the Nurse Practitioner Education.

The concept of independent practice by nurses has gained significant momentum within India’s health policy circles as well. According to a review done by Nanda and Lobo (2018), evidence across the world has been highlighting the advantages of the progressing of nursing

According to the WHO report ‘The health workforce in India - Human Resources for Health Observer’ (2016), nurses have accounted for about 30.5 per cent of the total healthcareworkforce in India

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IMPACT profession through nurse practitioners degree.

Systematic review and meta- analysis point out that the care provided by nurse practitioners and general practitioners are similar in quality and health outcomes, especially at the primary care level. Further trials and systematic reviews have reported increasing numbers of patients approaching nurse practitioners as the first point of care, along with higher satisfaction linked to longer consultations with nurse practitioners than general practitioners, as well as decreases in costs of consultation by 12.5percent. The recent Brooke Institution report (June 2018) also showed that this health reform could help improve access and keep costs down without decreasing quality of care.

Nurse Practitioners The role of nurse practitioners is influenced by the healthcare demands of the population, and the social, political, economic and technological factors within the country. India is embarking on this pathway and has been encouraged to bring on several reforms in the healthcare sector at all levels making it imperative to have nurse practitioners at the primary as well as the hospital care level. This will make the nurses have an enabling role in making the health and wellness centres operational and cost effective. It will also be important for the nurse

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practitioner to have a public health leadership role. A National Medical Commission Bill that intends to authorise nurse practitioners to perform an active role towards improving the Indian healthcare sector has been set forth and is hoped to make a vast difference in the healthcare sector.

Training Demands The International Council of Nurses defines Nurse Practitioner as a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice. A nurse practitioner is a certified nurse who works to provide the right care, treatment and medication to the patients. They can diagnose and treat some of the health conditions at par with the physicians. In order to practice, the nurse practitioner has to complete a Master’s degree in nursing, clear the required licensure examinations conducted by the authorities and have to be registered in their respective local or state nursing council. Competency based training is the major approach and nurse practitioner education is based on competencies adapted from International Council of Nurses (ICN, 2005), and National Organization of Nurse Practitioner Faculties (NONPF) competencies (2012).

The Nurse practitioner program has a strong clinical component and utilises a competence-based training approach. The curriculum in India comprises of three major areas namely core courses, advanced practice courses and critical care speciality courses.

Through development of competencies and accreditation, the program aims to enhance service delivery and improve health outcomes.

Strong clinical component and competencybased training enables the nurse practitioners to demonstrate clinical competence based on sound theoretical and evidence-based knowledge.

Nurse practitioners can be certified in a particular specialty area as per need and interest. Some of the areas that are prominent

are family nurse practitioner, obstetrics and gynaecology nurse practitioner, cardiology and cardiovascular nurse practitioner, adult – gerontology acute care nurse practitioner and primary care nurse practitioner, neonatal nurse practitioner, primary care paediatric nurse, family psychiatric/mental health nurse practitioner, critical care/acute care nurse practitioner, oncology nurse practitioner, emergency care nurse practitioner, neurology nurse practitioner, and anaesthesia nurse practitioner, to name a few. The more commonly recognised responsibilities of the nurse practitioner also include healthcare provider, educator, consultant, researcher, administrator, and coach. Currently there are about 19 institutions that are recognised to offer the course since the time INC has first initiated the course in 2016.

The specific clinical roles of the Nurse practitioners include and are not limited to Patient selection and admission into ICU and discharge when care is successfully completed; problem identification through appropriate assessment; selection and administration of medications or devices or therapies; patients education for use of therapeutics; knowledge of interactions of therapeutics; evaluation of outcomes and recognition and management of complications and untoward reactions. Their job profile also includes providing counselling services to patient, checking medical histories of the patients and also performing minor surgical procedures. They are also prepared and qualified to assume responsibility and accountability for the care of critically ill patients under their supervision.

Better Career Progression There is an increasing demand for qualified and experienced nurse practitioners. In addition, reasons like aging populations, shortage of healthcare practitioners and growing healthcare sector due to improvements in healthcare practice provides unending promises and wonderful opportunities for nurse practitioner certification and a wide range of career opportunities. However, establishment of policies on the use of evidence in practice is required. Nurses with

a Master’s degree should be encouraged to provide evidence, read nursing research and use evidence to improve and change nursing practices. It is also important for the healthcare community to be open to and accept nurse-led models of the delivery of care to achieve the goals of the overall health system. The provision of basic nursing education of a high quality will automatically pave the way for expanding the role of nurses in the health system.

The first step in initiating independent nurse practice is to acknowledge that nurses have the requisite capacity and then strive for progressive changes. It would also be useful to consider the factors that have influenced the successful implementation of independent nurse practice in other countries and adapt the lessons learnt to the Indian context. This might bring about better changes in the visibility structure of the profession in the days to come and allow for better health outcomes for the community at large and the country. Nurse Practitioner education and practice will be the Nurses approach to fulfil the WHO goal of Health for all through Universal Coverage.

The International Council of Nurses defines Nurse Practitioner as a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice www.indiamedtoday.com

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COVER STORY

SMART

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HOSPITALS MOVING TOWARDS AN EVOLVING HEALTHCARE SYSTEM

Author: Divya Ramaswamy, M Neelam Kachhap

H

ospitals have constantly been evolving based on changing patient expectations and advances in technology. This has not only paved the way for consumeroriented healthcare services but also has made hospitals rethink models of healthcare delivery.As the healthcare seeking behavior and market dynamics evolved, healthcare providers improved their sizes, services and created improved revenuegenerating verticals as well.

With the advent of the Ayushman Bharat Schemethere will be marked shift to value-based care; and new risk-sharing arrangements will have to be formed, where clinical outcomes as well as cost savings can be the new standard for empanelment. Accordingly, hospitals will begin merging; creating new healthcare delivery model with the idea of improved cost management and standardisation within a combined group.

This is where smart hospitals are set to play a larger role. A smart hospital is not only connected or digital but it takes into account the capabilities of the healthcare personnel, physicians and the patient experience to create a cohesive environment for better healthcare delivery while trying to reduce costs.

According to Dr George Mathew, Chief Medical Officer, North America, DXC Technology, “The Smart Hospital aims to balance

clinical outcome excellence, operational and supply chain efficiency and strong patient, provider experiences using technology. It encompasses and overlaps other constructs, such as the continuous learning healthcare system, connected care and other technology-enabled care paradigms that extend the reach of hospitals beyond their four walls. Underlying the Smart Hospital concept is the ability to take data collected through claims, EHRs, wearable devices and unstructured data (such as social media) and perform robust analytics on this information.” Dr Mathew the clinical expert and healthcare thought leader has authored a white paper on smart hospitals called ‘Emergence of the Smart Hospital and beyond: What’s next for providers?’

It is estimated that healthcare providers around the world are adapting smart hospital framework.

This wave will hit India soon and the providers who are ready for this change will survive through the difficult healthcare delivery landscape in India.

As per a Frost & Sullivan’s report, 10 percent of hospitals across the globe are expected to become smart hospitals by 2025 with a market opportunity of approximately $11 billion.

Smart hospital is an idea that allows providers to offer healthcare as a service by channeling technologies like mobile, connected sensors with existing expertise and analytics to provide a bouquet of consumer-friendly health services with competitive pricing and optimal use of specialized resources. But for this to happen healthcare providers have to re-look at their fixed costsbuildings, salaries, equipment and other overhead and must change it into variable cost.

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COVER STORY Why do we need smart hospitals?

The goals of smart hospitals include enabling greater operational efficiency, clinical excellence, and patient centricity. Traditional approaches that focus on improving just the user experience isn’t sufficient anymore. Although digitization is great, human control is what makes it efficient and that is why, all entities including people and machines must act smart. An interactive system between humans and computers to handle all the complexities is the need of the hour. Hence, we need smart approaches that deliver significant results from the world of big data.

Foundation of Smart Hospital

The ability to provide valuable services that weren’t possible earlier is what makes a hospital truly smart. Smart hospitalsan intelligent way of associating patients, physicians, and machines enable the following: Improved patient care via electronic health record (EHR) - a digital version of a patient’s paper chart containing the entire medical and treatment history of patients. Patients will be able to navigate through the system and gain a proper, affordable level of care at the right times. In the coming years, DISHA (Digital Information Security in Healthcare Act) will enable the digital sharing of personal health records with hospitals and clinics, and between hospitals and clinics; it will be the basis for the creation of digital health records in India.

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Amazingly accurate diagnosis- Artificial intelligence and machine learning show great potential in radiographic assessment, and this improves the accuracy in the diagnosis of neurological diseases and cancer. Indian companies like CARING (Centre for Advanced Research in Imaging, Neuroscience and Genomics) brain child of Mahajan Imaging, focuses on performing cutting-edge scientific and clinical research and helping radiology and genomics companies develop world-class clinically relevant products.

New clinical routine in operating rooms that include computer-generated surgical steps, robots performing surgeries with 3D images of the surgical field generated inside the patient’s body. This was catapulted into medicine with the advent of Google Glasses a wearable computer with integrated camera and heads-up display. However, there has always been interest in visualizing surgical image now highdefinition, fully digital surgical microscope for stereoscopic viewing are also available.

Improved workplace models that allow workforce flexibility such that doctors, nurses and other healthcare professionals deliver care outside the hospital premises.

New technology and creative thinking have expanded opportunities to support healthcare professionals’ work-life balance, no matter where they work. A number of apps in India are providing consultations and second opinions. In fact, clinical expertise combined with artificial intelligence is winning the race in this arena.

Digital workflow solutions can offer increased job satisfaction, retention and improve the relationship between the patients and healthcare providers.

Cost-effective supply chain management. Remote tracking of medical devices, materials and predicted inventory needs to providecost-effective supply chain management using radio frequency identification (RFID) or real-time location system (RTLS). Robotic pharmacy is another idea that is taking roots in India, with hospitals already experimenting with automated pharmacy services.

Remote monitoring via bluetooth-enabled devices, approved mobile apps, and telemedicine solutions let doctors and nurses monitor patients. This has been experimented with in the form of tele-ICU and telemonitoring with mixed results. A consumer-friendly advancement is being awaited for a more widespread adaptation.

Focused health centers that are designed around patient-flow with focus on key revenue-generating areas.

Data life cycle management: Data is the new currency and healthcare generates a lot of data. With the impending

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COVER STORY

DISHA Act coming in, the healthcare providerwill be pushed to look at new ways of handelling data. The Smart Hospital concept is based on seamless access to data and its storage, use and security will be something that the hospital provider will have to think about. Data is an asset and its optimal use will benefit healthcare providers.

Security: Often an after thought in the past, security has become integral to the healthcare provider. More focus is required to build on access controls, encryption, governance and monitoring as a smart hospitals will have multiple connected data streams outside the hospital.

Cyber-attacks and ransom ware are real threats and so hospitals will have to focus on cyber security measures and contingency planning.

What Is In It For Me Over the last three decades, the patient empowerment movement has slowly evolved from being a paternalistic model (with the healthcare providers taking charge) into one that gives the patients all the information and power in decision-making. In this regard, a smart hospital is a logical step forward. Healthcare providers can improve patient engagement by partnering with patients to collect and control access to their health data.

Smart hospitals use the latest digitized networking infrastructure to optimize, redesign or create new clinical processes, management systems, and potential infrastructure to achieve better patient care, experience, and operational efficiency. The smart hospital concept widens the reach of hospitals beyond four walls by working around other

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constructs like connected care and the continuous learning healthcare system.

Road Ahead Developing a smart hospital is more than just combining connected devices on a high-speed networking infrastructure. It involves completely integrating technology and digital capabilities into everyday functioning. It means rethinking the care processes, management systems, and also the infrastructures to invent a new method for delivering care. This can be achieved when hospitals strive to achieve excellence in healthcare delivery. Once decided, the entire organization should commit to the smart hospital agenda. “There should be a commitment from the top- the leader should be made to follow an allocated budget and clear targets associated with cost containment, revenue, and patient experiences. Also, a flexible, partner-focused approach to procurement is needed for the pace of innovation in medical technology. Moreover, it is essential to establish a learning culture that motivates the hospital staff to upgrade their skills constantly, especially with the new technologies that are changing the ways of working,� says Dr Mathew.

For long, hospitals have been reluctant in adopting emerging technologies and practices due to the involvement of big investments. But with the constant reiteration of the importance of digital connectivity, hospitals will be compelled to get smarter by embracing the latest trend. Besides helping patients, these changes will also benefit the hospitals themselves by scheduling for better operational efficiency, digitizing asset tracking and personnel management.

APPROACH

Financial Planning Day Care Center Dr Dheeraj V Mulchandani, Consultant General and Laparoscopic Surgeon; Director, Dr. Mulchandani’s Medical Services

DAY CARE surgery or Ambulatory surgery is not a new concept to Indian surgeons, the ancient Ayurvedacharya, Shushrut, in his work, mentions the use of ambulatory surgery centuries ago. With the advent of Modern Medicine, the ancient art died a natural death.

The change in the concept of surgical practice and the introduction of Private Practice has lead surgeons to find ways and means to refine and redefine their art and to make it more patient friendly.

The desire to keep up with the newer developments, the increased cost of hospitalisation, many fold increase in the inflow of patients from the rural areas to the metropolitan cities for treatment, lack of hospital beds, along with the fear of the word `Surgery`, has led the surgeons to rethink the art of Day Care Surgery. In the west, the concept of day care surgery has been in place for over four decades.

Financial feasibility To start a center, first examine the outpatient case numbers to determine whether a Day Care Surgery Centre will be financially feasible. DCS revenue is equal to the number of procedures that can be performed at the centre multiplied by the expected revenue for these expected procedures. As a general rule, in a reasonable market, a center focusing on higher revenue procedures can be profitable with as little as 2,000 procedures per year. With lower revenue cases, this number can jump to 3,000 to 3,500 procedures. With a country like ours, where the numbers are not a problem and more and more people are opting for day care surgery without having the need to be admitted to a hospital facility, this should not pose a problem. Even the insurance companies are beginning to see the light and are offering complete coverage for day care procedures. A first step to take prior to es-

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APPROACH

Day care surgery or Ambulatory surgery is not a new concept to Indian surgeons, the ancient Ayurvedacharya, Shushrut, in his work, mentions the use of ambulatory surgery centuries ago 28

May 2019

tablishing a Day Care Centre is to prepare a proforma income statement as part of performing a feasibility study.

A pro-forma analysis and feasibility study should rely on sound medical data regarding projected case volumes, case mix, scheduling preferences and their expected reimbursement rates. The doctor’s involvement will not only ensure sound data but accomplishes two other important tasks. First, it provides a chance to inform potential partners about the expectations, risks and profits. Second, it gives you a real opportunity to assess each doctor’s commitment to the project, if you plan to make it into a truly complete Day Care Centre with multispecialty running simultaneously.

The case volume and revenue rate data collected are the key assumptions upon which the revenue part of pro-formas are built. The greater the accuracy and certainty of these two

types of information, the greater the accuracy and reliability of the final pro-forma projections. The doctor partners, if any, involved in the project should be fully committed to the project from the outset. There are few changes that will negatively impact the financial outlook for a new center as much as the departure of a core doctor during the later stages of development. While a project can recover from a minor setback or challenge during the early planning stages, it is more difficult to correct severe problems that occur later in development.

Counting cases is a crucial component of the development process. Regardless of which specialties you develop the center around, be it purely surgical or a mixture of surgery, orthopedics, ENT and Urology, it is critical to understand the surgical case volume represented by each specialty.

Attendance at meetings to discuss develop-

ment of the new facility is another good indicator of the likelihood of the project’s success.If after two meetings to investigate and develop a project your key doctor’s attendance remains strong, then the project will most probably see the light of day. Every surgeon likes the concept of developing a center, but it is the core group that remains after two initial meetings that tells you whether the excitement is real or not.

Capital requirements The typical development of a stand-alone Day Care Surgery requires a cost of approximately INR 25000 to 35000 or more per square foot to become operational. Additionally, money is also needed for equipment. Of the total budget amount, a substantial portion of the money can be provided through debt financing without guarantees. However, a certain portion of the debt may require personal guarantees.

Moreover, a cash capital contribution of a substantial amount must also usually be contributed to the venture. Typically, anywhere from INR 1.5 Crore (on the low side) to 3 Crore is required as an equity cash contribution in total by the owners.

A DCS should typically initially issue one hundred ownership units. These units will be issued to members based on the amount of capital that each member contributes to the centre. For example, if each unit costs INR 100,000 and a member will own 15 units, he or she will contribute INR 15,00,000. The amount of capital required depends upon the size of the project, whether the DCS will be a rent or ownership premises and the amount of debt to be secured. The equity plus the debt borrowed from lenders equals the total amount of money needed to develop the project.

The operating agreement will set forth the dates on which the capital must be contributed.

Typically, all or a significant portion is contributed at the signing of the operating agreement.

In some situations, part of the capital will be due at a later date, such as upon receipt of a certificate of need or perhaps six months after the initial signing.

Working with experienced lenders will facilitate the financing of the DCS. It can be tempting to work with a friend or a local

bank, but this could be a mistake. Often with DCS, time is of the essence and problems occur which are normally much better handled by an experienced lender than by a friend. For the best result, look for a lender with specific financing experience.

Expense management Surgery centers tend to have a level of fixed costs that generally require certain revenue to become significantly profitable and still cover the necessary expenses. Centers with INR three to seven Crore in annual revenues can, on average, expect to have an EBITDA of around 30 percent, or earn about a 30 percent operating margin before deducting interest, taxes and depreciation.

The three biggest costs for a DCS typically include staffing costs (about 20 percent to 30 percent of revenue), supply costs (about 20 percent of revenue) and facility costs (about 10 percent of revenue).

With staffing costs making up the majority of the expenses, it is critical to benchmark the hours per case to those at other similar centers to ensure your staff is working efficiently.

To control staffing costs, it is imperative to use staff efficiently by cross-training where appropriate, being open only as many hours as cases require and, if possible, by sending staff home when they are not needed. This works more on a model where the staff is paid on an hourly basis or on a per case basis.

Supply costs, to a degree, may be reduced by use of a group purchasing organization or, in some cases, a hospital or management company partner that is able to aggregate expenses over a number of facilities and, as a result, benefit from volume pricing with vendors. Another common way to reduce supply costs is to implement standardization of certain common surgical supplies and reduce the use of nonessential supplies.

While staffing and supply costs can be modified over time, facility costs, once a lease has been signed or construction has commenced, are much more difficult to change.

It is very important to obtain expert advice relative to these three cost items early and often.

As a general rule, in a reasonable market, a center focusing on higher revenue procedures can be profitable with as little as 2,000 procedures per year.

With lower revenue cases, this number can jump to 3,000 to 3,500 procedures

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INNOVATE

Next Step for Ocular Surface Disorders Moshe Rogosnitzky, CEO of Ocular Discovery and co-researcher of the AIIMS collaboration shares with Divya Ramaswamy Ocular Discovery’s work and research perspective ISRAEL BASED Ocular Discovery and All India Institute of Medical Sciences (AIIMS) New Delhi, announced the launch of a novel research partnership investigating the mechanism of action of DCGI approved Dipyridamole, for optimized delivery and therapeutic treatment of various Ocular Surface Disorders (OSD). While the term OSD encompasses several conditions, all of which affect the Ocular Surface, an estimated 344 million people worldwide suffer from Dry Eye Disease (DED) alone. India reports higher levels of DED than that of Western countries, with 54% of India’s population suffering from the condition.

Factors such as increased longevity and growing geriatric population, as well as environment, increased pollution, and lifestyle disorders such as obesity and diabetes, are believed to be increasing global market size; which is anticipated to reach $4.9B by 2024.

Ocular Surface Disorders (OSD) have serious and long-lasting consequences. In addition to the social and psychological burden; physical side effects include severe discomfort, changes to vision, and in some cases – blindness. While the symptoms of some forms of OSD are treatable with topical steroids and anti-inflammatories, for others, surgical intervention remains the only option; signaling the necessity of additional therapies for those with unmet medical needs.

Globally prescribed Dipyridamole, used for the treatment of cardiovascular conditions for over 50 years ; is already approved and available in Israel for the relief of various ocular conditions and disorders. The drug has shown marked symptomatic benefit in patients with pterygium and related dry eye symptoms, as well as offers accessible and efficient delivery of the medication.

Pls Tell us about Ocular Discovery’s previous work and its impact on healthcare?

Ocular Discovery is a new company currently dedicated to creating impactful therapy solutions for common eye disorders that will affect millions in their lifetime. Ocular Discovery is the sole developers of dipyridamole for the signs and symptoms of Ocular Surface Disorders such as dry eye, pterygium and pinguecula, melanocytic nevus, and corneal neovascularization. While the use of dipyridamole in eye disorders is our sole current focus, as the company grows, so too will our treatment profile.

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May 2019

What do you think the previous clinical trials on Dipyridamole have missed and what different aspects will your collaborative research aims to cover?

The primary focus of previous trials has been on posterior segment eye disorders using systemic administration, or topical administration for viral conjunctivitis. The discovery of dipyridamole’s potential for ocular surface disorders is relatively fresh – with the case report and ISVER presentation, and more work ongoing.

The collaborative research with AIIMS seeks to understand mechanism of action, optimal dosing regimens, and to undertake the initial measures necessary for the new use and delivery route to gain approval by DCGI in India.

What about the Bleeding risk with Dipyridamole?

The bleeding risk of Dipyridamole is very low, even at very high doses of up to 400mg/day. The topical doses used in our research, are substantially lower, and bleeding has not been observed nor is it expected at these low doses.

Does your research cover the possible adverse effects and drug interactions (interaction propensity of topically administered dipyridamole with other common eye drops) associated with Dipyridamole?

We anticipate the eventual use of dipyridamole will be as a monotherapy, nonetheless an ongoing clinical trial is currently exploring any and all potential adverse effects; which we are glad to report have not been significant. Dipyridamole is an established drug and potential interactions with commonly used eye drugs have not been shown, however we will continue to study this in the future.

One case study (Pterygium: Nonsurgical Treatment Using Topical Dipyridamole – A Case Report) has reported the recurrence of the condition after temporarily discontinuing

Dipyridamole. Will your research address the recurrence issue?

As stated in the case study,the symptoms recurred within a few weeks during her intermittent breaks from the therapy. In all cases of pterygium there is an underlying dry eye disease of inflammatory nature. No pharmacological therapy cure dry eye disease (unless its allergy related), rather it treats the underlying inflammation which relieves the condition; so ongoing therapy is normal and expected for dry eye disease.

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INTERVIEW

555 Manish Technique Dr Manish Kumar Gupta speaks to Divya Ramaswamy about his innovative surgical technique

DR MANISH KUMAR GUPTA, laparoscopic surgeon, Sir Ganga Ram Hospital, Delhi, has developed an innovative procedure for groin hernia repair in the year 2014. With this innovative and less invasive technique he has successfully operated more than Two hundred and fifty groin hernias till now.

Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. However, Dr

Gupta has developed an alternate optiview “555 Manish Technique”, which is a feasible option without compromising the principles of TEP repair for inguinal hernia. In this technique only 5mm cut is made below the naval for 5mm trocar which avoids the dependence on bigger and costly Hasson Trocar. A simple “Manish Retractor” is devised to make extra-peritoneal space with 5 mm trocar. The surgery is less painful and the patient can easily go back to work.

He is a well-known name in the field of surgery and he is getting immense recognition world-wide, for his efforts. The video of this surgery was also accepted and published by Journal of Laparoendoscopic and Advanced Surgical Technique, Videoscopy Part B, New York, USA. Q: How is the 555 Manish techniques superior to the highly recommended total extraperitoneal patch plasty method?

Laparoscopic surgery is all about minimally invasive surgery which means minimal tissue damage of abdominal wall keeping rest of the internal surgical steps and principles same.

The lesser the invasive procedure lesser would be the pain with shorter hospital stay, early discharge, quick recovery and better cosmesis.

In my innovative technique the TEP repair of inguinal hernia is done by all 5 mm ports only and doesn’t need a 2.5 to 3 cm wound below the umbilicus as in older technique.

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Dr Manish Kumar Gupta, Laparoscopic Surgeon,

Q: What is the rate of recurrence when one is operated using 555 Manish Technique?

We have not encountered any recurrence in any of the patient on six- months follow up. The difference from older technique is of smallest possible access to the operative field. The internal steps of surgery and mesh placement are the same.

Sir Ganga Ram Hospital, Delhi

Q: What is the rate of intraoperative complications while using this technique?

It is rather a safer technique because of 5mm optiview trocar insertion as it prevents any inadvertent injury to peritoneum at the time of 1st trocar placement which leads to difficult dissection and prolong surgery.

Q: What is the most challenging part of this technique?

I must say that it rather abolishes the challenging step of previous technique of Hasson trocar placement by doing that step in lesser time (average 2 minutes) and under complete vision with smaller 5 mm incision only without any assistance. We have also introduced “Tail Pull Technique” to introduce light weight synthetic mesh through which even a mesh of size 15 x 15 cm can be introduced.

Q: Tell us about the ‘Manish Retractor’ and how it is better than the Hasson trocar.

Manish retractor is actually not a replacement of trocar rather it’s a facilitator to introduce a 5mm trocar precisely in between the two layers of rectus sheath through a smaller 5mm skin incision only.

Q: Has this technique been adopted by other surgeons and how successful has it been?

We have done more than 220 inguinal hernia repairs by this technique consecutively till now successfully. Young budding surgeons are getting trained at our institutions.

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SPECIAL FEATURE

Smart Healthcare Facility – A personalised experience IOT ENABLED healthcare facility of the future can provide a smart personalised experience for the patient – an experience that is no longer intimidating and traumatic for the individuals and their families.

Ajit Ashok, Director, Marketing Solutions, Big Data & Analytics, Philips Innovation Campus and Member Healthcare WG, IET IoT Panel

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A brief peek into the future  An Individual visits a “Smart” Healthcare facility  Healthcare Facility recognizes the individual and automatically registers him/her into the Hospital Information system (HIS) using a smart card  Appointment is already pre-scheduled with the appropriate doctor based on the complaints  The individual’s information and the relevant data are synced up in the system and available for the doctor as reference  Doctors updates the details in individual records and orders for an exam or scan as needed  The details get into the Radiology Information System (RIS) and appointment options are provided for the examination. User selects on and the scan get scheduled  On the scheduled day, the patient walks in the facility and is directed to the depart-

ment through an App is done and results are stored in Picture archival and communication systems (PACS) and shared with referring physician  The physician consults another expert over an audio-video, etc. and suggest the next course of treatment plan for the patient  Patient gets admitted to the hospital for a procedure - zero waiting time, all details are entered into the system and the bed is as Scan

signed while the patient is on the way to the hospital  Surgery/procedure is performed by robots controlled remotely and cameras record movement monitored by experts across the globe  After surgery the patient is moved to a room which is personalised with family pictures on the walls, color/hue/light settings etc. for faster recovery

 IoT sensors connected to the patient meas-

ures post-operative vitals. AI algorithms determine early warning symptoms and alert the physician/nurse in case of anomalies  AI systems also determine discharge readiness and likely discharge day  On day of discharge, bill is directly settled with insurance provider. Post discharge care plan and medication is determined and is uploaded to the Home Care App on patient/

caregiver’s App  Post discharge tracking is done for a speci-

fied period. Automatic reminders trigger the patient for medicines, exercises and measurement of vitals. Medicine dispensation systems ensure the correct and adequate quantum of medicines to avoid errors. Vitals are read by doctors remotely who can suggest change in treatment etc.

Welcome to the future!

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SPECIAL FEATURE

5 TIPS

for Healthy Financial Planning

Deepak Bagati, Executive Vice President and Group Business Head–SME Business Bajaj Finance Limited

THE LACK of healthcare penetration in the country offers a great opportunity for medical practitioners looking to expand their patient reach. Moreover, the healthcare sector in India is likely to experience a CAGR of 22.87% by 2020, reaching the INR 28 crore mark. To ensure that you are able to capitalise on this growth and run a profitable medical practice, here are five financial lessons to abide by.

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May 2019

1

Manage your loans before tackling everything else To ensure that you maximise profits, focus on repaying your outstanding debts. It is important to choose a loan which will allow you to settle all existing dues in one go and leave you to manage only one EMI each month. There are many lenders who offer personal loans for doctors up to INR 35 lakh at nominal interest rates. These loans are tailor-made for medical professionals and come with added benefits and facilities. This allows you to address frequent or unexpected needs for finance by allowing you to borrow as you need, multiple times and pay interest only on the used sum. You can also opt for interestonly EMIs and repay the principal sum at the end of your tenor to manage your cash flow better.

2

4

3

5

Invest in indemnity cover Every doctor who embarks on a practice must invest in an indemnity cover. Day by day, the number of law suits against doctors claiming malpractice and negligence are growing and you can be sued for an exorbitant amount.

Having an indemnity plan covers you against legal and financial risks in case any legal suit is filed.

Have sufficient working capital To ensure smooth running of your practice it is important to have enough working capital. An affordable business loan for doctors will help you boost your practice’s working capital. You can avail thisas a flexi loan so that you can borrow and prepay funds as and when there is a need. Another special featureis that you need to pay interest only on what you use and repay your EMI in advance, at no extra cost.

This facility helps lower your interest by up to 45 per cent.

Invest steadily and grow your practice Simply saving is not enough. It is important to develop a three, five and 10-year business plan, and devise an investment strategy to finance each stage. To meet your financial goals and to earn higher returns, it is important to maintain a balanced portfolio. Invest in stable instruments such as fixed deposits or recurring deposits.

However, at the same time it is vital to invest in market-linked, high-risk instruments such as mutual funds and shares as they offer better returns.

Contribute towards a retirement corpus While you work towards your practice’s goals and other aspirations, you should also regularly save for post-retirement alongside.

While building a retirement corpus, ensure that you invest in a mix of high-risk and low risk instruments to create a balanced portfolio.

Investments should be made with a long-term perspective to ensure that you reap lucrative returns.

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SPECIAL FEATURE

7 Effective Strategies for Purchasing Equipment Parvathi Radhakrishnan, Co-Founder and Marketing Strategist, Zepnur Health

Optimising available resources is perhaps the best scope for equipment procurement for small health facility to be adequate. Further, going from an empty facility, to well-equipped and ready to provide dependable health care, rather hi-tech advanced health care facility also requires adding good amount of coherence and value to the procurement procedure.

The drafting of requirements is certainly the first thing to do in the procurement process, however, understanding the patient care intended and clinical set-up needed to facilitate

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A HEALTH facility is all about precision, not just in their functionality in delivering proficient patient care but also in planning its equipment procurement to aid in the process. Though all preplanning demands some meticulous perusal and assessment of requirements, effective equipment procurement in limited resources is definitely the trickiest of the lot.

it is where the procurement process begins.

The insight from fully-functional healthcare institutions serves the basis for refining the requisition process for better opportunities tending to cost-cutting, elevate efficiency and maximise patient health outcomes The process of equipment procurement for small health facility is seldom repetitive within a short span of time unlike in large-capacity healthcare institutions, and requires balancing sticking to the protocol and implementing smart apprises in the procurement process

itself; the assessment for required equipment runs simultaneously, and proceeds with leveraging on technology for information flow according to immediate and on-going requisition. The electronic requisition process (ERP) has been able to simplify and expedite the procurement process. Nonetheless, a more streamlined selection of appropriate and preferably multi-purpose equipment manually thereafter is desirable to suit the small-medium size healthcare, especially if it’s an upcoming healthcare set-up.

Ways to improve effective equipment procurement in limited resources

1

Lever aging electronic process of assessment for requisition saves time and the approval process moved online prevents lagging of the process which might interrupt the patient care activities. This can be facilitated by implementing ERP for procurement list, removing multi-point approval and reducing huge volume of paperwork to bare minimum; when any department raises the requirement the department head or person responsible for approval get notified immediately, who can shortly access and approve it on system.

2

Budgeting alone is insufficient in equipment procurement for small health facility to fight the pecuniary constraints; smart financing options can help optimise the buying power. Loans though

incurs interest, it does not exhaust the whole working capital, which is imperative in an organisation’s proper functioning. Also, several intermediate collaborator services like ZEPNUR health increase cumulative buying power of small to medium size healthcare institutions.

3

Refine section of equipment by opting for multipurpose variety wherever possible, as it ensures that competent health care is achieved. It’s relevant to both upcoming new setups as well as existing ones; while the benefits for the former is mostly cost-effectiveness, the multipurpose functioning enables use of the equipment for much longer when upgraded models are available, by serving any of its functions which perhaps doesn’t have an upgrade yet… thereby optimising the utility of the resources.

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SPECIAL FEATURE

4

A working demo before buying any band new equipment which has not been used before in the institute is worthwhile, especially in case of multipurpose big equipment. Also, considering the complex process of operation of health care equipment the demo provides a basis for insight into its operation and surely, some arrangements for training in troubleshooting along with is also necessary means to ensure smooth functioning for the tech-aided equipment.

5

Equipment with warranty and good maintenance services definitely adds value to the effective equipment procurement in limited resources.

In fact, it’s even prudent to extend

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May 2019

the warranty with a nominal pay after the initial warranty period if that can be arranged.

Maintenance option comes handy as the equipment sets in a healthcare facility need to be periodically assessed and kept up-to-date in terms of their functioning.

6

Shortlisting suppliers/vendors not just based on pricing but also market reputation and feedback from other clients is a real life-saver; both literally and metaphorically. The loss in terms of efficiency of a health care set-up when there’s much wait-it-out period for the tenders from several as well as the chances of being supplied with second-rate equipment within the lot is eliminated if only a copious amount of market research

precedes the actual shortlisting.

7

Collaboration with an equipment procurement planner is one stop solution, it helps reduce process drag, which otherwise makes it almost impossible to keep up with timelines and cause repetitive work-flow interruptions; which is collateral damage in terms of reputation and value for any healthcare institution. It’s a smart move towards effective equipment procurement in limited resources as even with ERP the manual work background research, corresponding with variety of vendors, sync up different delivery schedules etc. are pretty cumbersome for a small-mid size facility with limited workforce.

POST EVENT

Successful Hospital Strategic Management Summit INDIA’S HEALTHCARE sector stands at a crucial inflection point and poised for take-off.

A burgeoning population, a booming economy, rapid urbanization and a growing awareness and appetite for pursuing healthcare; these are the ingredients going into the formula that has spurred the growth of the Healthcare industry.

However, every rose has its thorn. Indian healthcare expenditure is still amongst the lowest globally and a significant challenge exists in terms of accessibility of healthcare service and quality of patient care, what with a majority of healthcare focused in India’s urban areas.

In an effort to give a fillip to the ecosystem, the second edition of The Economic Times Hospital Strategic Management Summit 2019 held at The Hyatt Regency brought together government officials, healthcare industry leaders, analysts & service providers under one roof to focus on delivering innovative and world-class hospital planning. While healthcare systems and hospitals are faced with increasing pressure to find operating efficiencies in a time where traditional cost-cutting methodologies are producing diminishing returns, it is imperative to create sustainable healthcare funding mechanism.

The conference convened with a noteworthy Keynote Address on Patientcentric healthcare system and profitability by Rajit Mehta, CEO and MD, Max Healthcare, who stated that, “To give the best care to a patient, a hospital’s DNA needs to be right, and all the DNA needs to come together i.e. doctors, nurses and administration.

Unless you don’t get your DNA right, you can’t give the best to the patient”.

In apanel discussion focusing on Ensuring Profitability through Optimum Patient Care, Dr K Ravindranath, Founder & Chairman, Global Hospitals opined that, “Our doctors, staff and everybody needs to be educated in such a way that they become involved partners in patient

Rajit Mehta, CEO and MD, Max Healthcare

care. From the beginning, our organization has always focused on delivering patient-centric doctor driven care”.

Dr Tarang Gianchandani, CEO, Sir HN Reliance Foundation Hospital added, “Clinical outcomes are the key and it’s the future, so not only will it improve patient satisfaction, but it will also help the hospital to ensure that costs are taken care of. We always say; what we don’t measure, you can’t improve. In the same way, if you don’t measure your clinical outcomes how will you improve, and if you don’t improve your clinical outcomes, what satisfaction will you give to the patient? ” Dr BK Rao, Chairman, National Accreditation Board for Hospitals and Healthcare Providers (NABH) made a succinct point when he explained, “Accreditation is a holistic kind of thing, it’s a process, it’s not an event and if you really look at what we are talking about, we are talking of quality and safety of the patient and

we agree whatever you may do in the hospital or in the healthcare industry, quality and safety is an integral part of every activity”.

Addressing the topic of Futuristic Models in Home Health Care, Meena Ganesh, Co-Founder, MD & CEO, Portea Medical said,“The movement towards setting up of quality standards is a very important move that’s happening in the whole hospital care space.”

Ram Natesan, Group COO, SRM Institute of Medical Health Sciences & Research also aired his views, stating that,“Blockchain is going to impact the healthcare sector in a very big way, starting from patient data management, patient medical records, insurance claim process management and publishing of research papers. Blockchain is going to impact healthcare in every stream of clinical excellence, because this is one technology which can not be erased or duplicated, and this will help long way for maintaining the patient data medical records.”

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POST EVENT

SYMHEALTH 2019 SYMHEALTH 2019, a National Conference on Interdisciplinary Approach to Healthcare, organized by the Symbiosis School for Open and Distance Learning (SSODL), Symbiosis International (Deemed University), SIU was held on April 19-20, 2019 at Pune.

The inaugural ceremony was graced by Prabal Chakraborty, Vice President & Managing Director, Boston Scientific India, Dr Vidya Yeravdekar, Pro Chancellor, SIU and Dr Rajani Gupte, Vice Chancellor, SIU. Dr Rajiv Yeravdekar, Dean, Faculty of Health & Biological Sciences, SIU was also present.

Dr Sanjay Zodpey, Vice President, Public Health Foundation of India in his address spoke about challenges in healthcare in India and the need to have a healthy population.

He also spoke about the challenges associated with the low expenditure on healthcare, the shortage of clinical and non-clinical staff.

He also touched upon the topic of Universal Health Coverage and the point to be focused upon: affordability of healthcare, quality health service and financial protection to the public.

Bhaskar Nerurkar, Head, Health Bajaj Allianz ltd and GayatriIyer, Regional Manager, NIC spoke about health insurance and schemes like RSBY, NHPS. The other speakers for the day emphasized on enhancing different aspects of healthcare delivery. Rohit Sathe, President, Health Systems, Philips; Vidhi Prasad K V, Head, Wipro GE South Asia; Surendra Deodhar, VP, Reliance Life Sciences and Simmardeep Singh Gill, COO CK Birla Group Kolkata were also present.

The day concluded with sessions on Emerging roles & Opportunities for Healthcare management professionals by Dr Dinesh Pashankar, Associate Professor, Yale University, USA. He spoke about equitable distribution of medical equipment’s devices & pharma products.

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Inaugural ceremony

Day two of SYMHEALTH 2019 opened up with paper presentations by delegates.

There were four candidates who presented on various topics.

Dr Sitarama Budaraju, Consultant, Healthcare Projects, Tata Trust spoke about supply side constraints namely Human resource for health infrastructure, Health financing, Pharmaceutical and supply chain and Technology. Dr Anirudha Malpani, Director & Founder, Malpani Ventures discussed patient as partner approach and how communication is the key. The session was full of jocular remarks that made the session very interesting. Col Ajay Gangoli, Group Medical Director, Apollo Health & Lifestyle chaired a panel discussion with Nishi Saini, Head- North, Clove Dental Clinics, George Chemban, Business Head, Suburban Diagnostics and Anand Mote, COO, Aster Hospital.

The valedictory ceremony on May 20, 2019 was graced by Surg. Vice Admiral Ravi Kalra, NM,VSM, Director and Commandant, Armed Forces Medical College, Pune; Dr Sanjeev Kumar, IAS Divisional Commissioner, Nagpur along with dignitaries from SIU. Around 1000 to 1200 healthcare professionals, from across the country comprising of professionals from diverse verticals of the healthcare sector including domains of hospital & healthcare management, medico legal systems, medical insurance, clinical research, healthcare IT professionals, general practitioners, specialists & doctors from allied health sciences, policy makers & administrators, representatives of the pharma sector, representatives of civil society organizations and representatives of private and public healthcare sector organizations participated in this event.

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