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MEDICAL DEVICE MARKET IN INDIA Is the medical devices Regulatory environment in India Conducive for business?

WHAT IT MEANS TO BE A CARDIOLOGIST IN INDIA TODAY?

IS HEART FAILURE A PUBLIC HEALTH PRIORITY IN INDIA? SMALL HOSPITALS AND NURSING HOMES BUILD TRUST, REPUTATION

MAY 2018

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Medical Device Market Regulation THE DREAM of universal healthcare delivery cannot see full implementation without timely diagnosis. And here medical devices will play a criticalrole in improving healthcare access. However, the medical device ecosystem in India is not conducive for the sector to driveaccessibility and affordability. Manufacturing of medical devices is limited in India due to high costs of investments. India, largely relies on imports to fulfill demand and a complex regulatoryenvironment for medical devices further limits entrepreneurs from investing in this industry. There are a number of factors contributing to disproportionate dependency on imports. Firstly, a look at the duty structure, which is historically favoring import of finished goods rather than raw materials /components for medical devices manufacturing contributes to this high import dependency. Secondly, continued absence of a concrete regulatory framework specificto medical devices has resulted in constraining investments in themarket. Besides, lack of a component manufacturingecosystem and skills base to support domestic manufacturing of medical devices further deepens the import-export divide.

Medical devices market is expected to be a USD 25-30 billion industry in India by 2025

OFFICE 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 www.indiamedtoday.com IndiaMedToday expressly disclaims liability for errors and omissions in this publication. While we try to keep the information timely and accurate, we make no guarantees. The views and opinions expressed in the magazine do not necessarily reflect the official policy or position of IndiaMedToday or the publication. Information on IndiaMedToday should not be used as a substitute for professional healthcare advice. Readers are advised to always seek specialist advice before acting on information contained in this publication. Never disregard professional medical advice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. Printed and published by M Neelam Kachhap, 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Supriya Print Art 143, Pragati Industrial Estate, N M Joshi Marg, Lower Parel West, Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

The Indian medical devices industry comprises four segments â&#x20AC;&#x201C; consumables and implants, diagnostic imaging, instruments & appliances and patient aids and,others. There is ample opportunity in this market and most recent studies indicate that medical devices expected to be a USD25-30 billion industry in India by 2025. In fact, the Indian market is currently growing at a healthy CAGR of around 15%, significantly higher than global industry growth of 4-6%. But the absence of robust regulatory framework for medical devices, and lack of pathways for uptake of innovations in supply chain; subsidies and incentives appropriate to the levels of providing a bolus to the industry, are the major challenges faced by the sector today. Our cover story in May issue explores these and other market landscapes for medical device market in India. Hope you enjoy reading the issue. Do send in your views and suggestions to the Editor. Write to mneelam.kachhap@indiamedtoday.com

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UPFRONT

APPROACH

What should healthcare providers know about consumer centric healthcare delivery?

COVER STORY

15 24

Medical Device Market Regulations

Is the medical devices Regulatory environment in India Conducive for business?

OPINION

What it means to be a Cardiologist in India today? Dr Harminder Singh, Senior Consultant, Cardiology, Mumbai

Is heart failure a public health priority in India? Dr. K. Sarat Chandra, Consultant Cardiologist, Indo US Superspeciality Hospital, President â&#x20AC;&#x201C; CSI

12 4

May 2018

Innovations in healthcare delivery opportunities and challenges

INTERVIEW

Improving Emergency care through Quality Interventions

Dr S Saravana Kumar, Head , Clinical Operations & Accident and Emergency Medicine department, Dr Mehta Hospitals, Chennai

PULSE

INNOVATE

03 Editorial 05 Letters 06 News roundup 33 Events Event report 34 Cahocon 38 Himss 2018 41 Ask the expert

The challenge for healthcare delivery innovators is to ensure that their innovations are successfully and widely adopted

Small Hospitals And Nursing Homes Build Trust, Reputation Dr. Anuradha Pichumani, Executive Director, SreeRenga Hospital, Chengalpattu

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NEWS ROUNDUP SMT AND CARDINAL HEALTH ENTER INTO STRATEGIC PARTNERSHIP SMT (Sahajanand Medical Technologies), the leading manufacturer of cardiac stents in India, announces a strategic partnership with Cordis, Cardinal Health’s interventional vascular business. The new partnership with SMT in India will provide Cardinal Health access to the fastgrowing Indian cardiology market, as the latter marks its entry into the Indian market. SMT has a strong and established sales and direct distribution network across India including Tier II & III cities. Through this partnership, the Cordis range of products would be made available to patients across the country. According to the Global Burden of Disease study, nearly a quarter (24.8%) of all deaths in India is attributable to cardiovascular diseases (CVDs). The age-standardized CVD death rate of 272 per 100 000 population in India is higher than the global average of 235 per 100 000 population. Collaboration between a leading global manufacturer, Cardinal Health, and one of the largest in-bred Indian manufacturers, SMT, will address the high disease burden of cardiac mortality and hospitalizations in India, by providing global quality cardiology and endovascular solutions to hospitals and patients. The new partnership with Cardinal Health will

provide best in class products in cardio access, endo-access, cardiac guide catheter and PTCA balloons segment. SMT will take up this basket of quality products to the fast-growing Indian cardiology market with a strong and established sales and direct distribution network across India including Tier II & III cities. This will help Indian patients to have access to world-class products in the cardiovascular segment. Through this partnership, Cardinal Health will be able to build reliable and efficient channels to reach deep into the Indian market for Cordis products. Speaking on this synergistic relationship, Ganesh Sabat, CEO, SMT, remarked, “SMT is successful in establishing first of its kind medical device supply chain in India, ensuring a direct supply of life-saving devices to 80% of cath labs in India. Our partnership with Cardinal Health will further strengthen our core mission of saving millions of lives even in remote areas of India.” Commenting on the partnership, AmodBhave, VP, Business Development, SMT said, “Our strategic partnership with Cordis (Cardinal Health) enables us to complete our offerings in the Medical Devices market. Patients in India, including those getting treated in Tier II & III cities, will gain access to high-quality products. The partnership also encourages product innovations and will help SMT further cement itself as the leading name in medical devices in India.”

INDU BHUSHAN APPOINTED CEO OF ‘AYUSHMAN BHARAT’ MISSION Indu Bhushan appointed as the Chief Executive Officer (CEO) of the Centre’s ambitious Ayushman Bharat National Health Protection Mission (ABNHPM). According to PTI, Bhushan, the Director General of East Asia Department, Asian Development Bank (ADB) in Manila, Philippines, has been appointed to the post for a period of two years, an order issued by the personnel ministry said. The Union cabinet chaired by Prime Minister NarendraModirecently approved the launch of the Ayushman Bharat mission.The scheme has the benefits cover of Rs 5 lakh per family per year.The target beneficiaries of the proposed scheme will be more than 10 crore families belonging to poor and vulnerable section. Bhushan was in October 2017 appointed as the Director General for East Asia Department in the ADB, according to the bank’s website. Prior to his appointment to EARD, Bhushan was Director General of the Strategy and Policy Department, which leads the preparation and coordination of ADB’s corporate strategy and policies, resource mobilization, and allocation, and results from management, the website said.He has been with the ADB since 1997.Bhushan holds a Ph.D. in Economics and Master of Health Sciences from Johns Hopkins University in Baltimore, it said.

HEALTHIUMMEDTECH ACQUIRED BY QUINAG ACQUISITION (FDI) LIMITED

Quinag Acquisition (FDI) Limited, a company backed by funds advised by Apax Partners recently announced that it has entered into a definitive agreement to acquire a controlling stake in HealthiumMedTech Private Limited, previously known as “Sutures India”, the leading independent medical devices player in India. The controlling stake was acquired from existing shareholders including TPG Growth, CX Partners,

May 2018

and founding shareholders. The transaction is subject to customary approvals. The financial terms of the transaction are not being disclosed. Founded in 1992, Healthium manufactures and sells a broad range of medical devices and consumable products including wound closure products, minimally invasive products including endo surgery and arthroscopy consumables, and urology products. The Company’s key brands include Trusynth, Truglyde, Trubond, and Sironix, amongst others. Through its strong pan‐India distribution presence under the Sutures India division, Healthium sells its products across large and corporate hospitals, nursing homes, and government hospitals and institutions, and services over 10,000 hospitals across the country. Backed by the ApaxFunds, Healthium plans to further deepen its presence in the Indian market and broaden its portfolio of specialty medtech products. Healthium has a significant and growing international business with exports to over 50 countries. With an already strong presence in the urology market in the UK, under the Clinisupplies division, Healthium has also recently and successfully launched a portfolio of wound closure products under the Q‐Close brand. Shashank Singh, Partner at Apax Partners and Head of Apax’s India office, said: “Healthcare is a key focus area for Apax in India given secular tailwinds around healthcare spend and government initiatives focused on affordable and universal healthcare. Healthium, with its strong IP and domestic manufacturing base, is well positioned to improve healthcare access and drive excellence in local manufacturing under the Make in India programme. The opportunity is to create a medtech platform of scale to deliver a broad portfolio of products in the Indian market, and we are excited to partner with the management team of Healthium to deliver this vision.”

NEW BLOOD TEST TO ESTIMATE THE RISK OF DEVELOPING ACTIVE TUBERCULOSIS

An international team of researchers, includ-

ing scientists from the Max Planck Institute for Infection Biology in Berlin, has now developed a simple blood test to enable them to estimate the risk of developing active tuberculosis. Using the new test, the researchers can predict who is likely to come down with the disease. The test measures the activity of pairs of genes involved in the inflammatory response. This should in future enable doctors to offer prophylactic antibiotic treatment to people at high risk of going on to develop active disease, and conversely to avoid unnecessarily treating people who are at low risk. In a new study, researchers analyzed the health status of around 4,500 people from South Africa, the Gambia and Ethiopia living with a tuberculosis patient. The researchers measured the amount of various RNA molecules – and thus the activity of the corresponding genes – in blood cells. Using sophisticated software, they identified genes which are more active or less active in individuals who subsequently go on to develop active tuberculosis than in people who remain healthy. They then paired up sets of one up-regulated and one down-regulated gene and calculated the predictive power of these pairs. Risk gene for active tuberculosis They then looked at household contacts of people with tuberculosis and compared 79 people who developed active tuberculo-

sis within the following two years with 328 healthy people who did not go on to develop the active disease. They found differences in activity of two gene pairs between the two groups. Importantly, these differences were not dependent on where they were from. “Using the pattern of activity of these ‘risk 4’ genes, we were able to determine the tuberculosis risk of infected individuals. That means we can say one year earlier who is likely to develop active tuberculosis,” explains Kaufmann. Because the study focussed on individuals from various regions across Africa, the test should be applicable across the whole of the continent. The results show that certain gene pairs can predict tuberculosis risk. With just a single pair, the researchers were able to identify most of those who would go on to develop active tuberculosis. By adding in a second gene pair, the predictive power of the gene analysis was improved further. “These results are the most significant findings so far in our ten-year Grand Challenges project,” says Stefan Kaufmann from the Max Planck Institute for Infection Biology. The Grand Challenges project, which was supported by the Bill & Melinda Gates Foundation, involved close collaboration between seven research groups from Africa, Europe and the USA. Kaufmann was responsible for coordinating the project. “This study

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NEWS ROUNDUP proves, not only that a partnership between North and South can work, but that such a partnership can also make a significant contribution to controlling one of the most terrible diseases on the planet,” says Kaufmann. Based on these results, there are now plans to develop, in conjunction with a commercial partner, a test suitable for practical use on the ground. This could provide much more accurate results than the diagnostic tests currently available, and also enable doctors to select and offer prophylactic antibiotics to those patients most likely to develop active tuberculosis. At the same time, it could help doctors to avoid subjecting individuals who would not go on to develop the disease to the risks associated with several weeks of antibiotic prophylaxis.

SUCCESSFULLY LIVER TRANSPLANT ON 6.5 KGS BABY Apollo Hospitals Navi Mumbai, Advanced Multi-Speciality Tertiary Care, successfully performed a liver transplant on a critically ill one-year-old baby in February. He is the the smallest baby at 6.5 kgs to have undergone a liver transplant in Maharashtra. The baby’s aunt Divya, donated a part of her liver. Master Ram Mistry was diagnosed with end stage liver disease due to a rare congenital condition called Biliary Atresia, which progressed to advanced liver cirrhosis within months of his birth. The parents of the baby, IshaniMistry, mother and PriteshMistry, father are based in Gujarat. Finding a team familiar with transplanting small babies and managing the cost of treatment were the biggest concerns for the Mistrys. This is when an NGO called ‘Transplants – Help the Poor’ Foundation stepped in. A combination of charitable donations from the above NGO, some funding arranged by the family and crowd funding through Ketto.com, contributed the bulk of the transplant costs. Contributions from Tata Foundation Trust and a grant from the Apollo Hospitals, Navi Mumbai CSR unit made up the difference, allowing baby Ram to have his life saving transplant.

May 2018

Divya (donor), Dr Darius Mirza, Head, Liver Transplant, Apollo Hospitals, IshaniMistry with Master Ram Mistry (1 year old liver recipient)

Talking about the case, Dr Darius F Mirza, Head, Liver Transplant, Apollo Hospitals, Navi Mumbai said, “Biliary atresia is a rare disease in newborns where the liver’s bile ducts are absent and requires early surgical correction, which only works in 40% of cases. In this case, the transplant was needed very early in life. Thanks to the initiative shown by the family and the co-operation between NGOs and funding partners, we were able to successfully perform this life saving surgery. We are happy that baby Ram and his aunt who stepped forward to donate part of her liver are recovering well. Transplantation is all about teamwork and the above example of co-operation of multiple partners can help deliver this essential treatment for our affected children. Our goal is to provide life-saving liver transplantation to all such children, regardless of their family’s ability to afford this treatment.” Apollo Hospitals Navi Mumbai has performed 6 liver transplants in children (of which four received financial help) since the inception of the transplant program in 2017, and is the first hospital in the city to offer this service for very small children.

INDIA FACES ANTIBIOTIC RESISTANCE CRISIS India is amongst the world’s largest consumers of antibiotics for human health. A recent white paper by Aetna International titled ‘Antibiotic resistance: Toward better stewardship of a precious medical resource’ highlights the need for immediate action to contain the situation. Multiple factors, such as high burden of disease, poor public health infrastructure, rising incomes and the unregulated sale of cheap antibiotics have amplified the crisis of antibiotics resistance in India. Addressing the growing concerns around the Antibiotic Resistance worldwide, one of the contributors to the whitepaper, Dr. Prashant Kr Dash, Chief Medical Officer, vHealth by Aetna said, “The majority of Indians think antibiotics can cure illnesses such as common cold and gastroenteritis, which is a wrong perception. The majority of these infections are caused by viruses and antibiotics have no role in their treatment. This problem of inappropriate antibiotic use is compounded by their easy availability at pharmacies. In many cases, patients

experience unwanted serious side effects of antibiotics like an allergic reaction, diarrhea, vomiting, kidney failure, changes in blood sugar levels and toxic effects on the heart and liver. This persuaded us to collate this study which will create awareness on the issue and draw attention to the alarming health crisis being faced globally.” On Aetna International’s plan tocombat antibiotic resistance in India, Mr. ManasijeMishra, Managing Director, India Health Organisation& Aetna India said, “Antibiotic resistance is a crisis that effects everyone globally. We need to address this issue now with a global, multifaceted strategic solution. In India, with our vHealth by Aetna teleconsultation service, Aetna is taking a three-stage approach that emphasizes antimicrobial stewardship in clinical training audit medical consultations, the identification incorrect antibiotic usage in patients and offers counseling on appropriate usage, dosage, duration and rationale of using antibiotics. By these means, we are initiating steps to help combat the growing threat of AMR in the country.”

and Family Welfare, inaugurated NarayanaSuperspeciality Hospital, Gurugram, in the presence of Dr Devi Prasad Shetty, Chairman, Executive Director, Narayana Health, Dr AshutoshRaghuvanshi, Vice Chairman, MD and Group CEO, Narayana Health, along with other esteemed dignitaries including, ShriRaoNarbir Singh, Hon’ble Minister PWD, Govt. of Haryana. Dr AshutoshRaghuvanshi, Vice Chairman, MD and Group CEO, Narayana Health, said, “This is a very proud moment for Narayana Health to launch our first superspeciality hospital in Gurugram. The launch of this hospital

HEALTH MINISTER INAUGURATES NARAYANA HOSPITAL AT GURUGRAM Shri J P Nadda, Hon. Union Minister of Health

in Gurugram is in line with our group’s vision to strengthen our regional presence in Northern India. We have enabled and incorporated every possible stream of clinical speciality here at the heart of Delhi-Gurugram region. Since the hospital is on the national highway, it will also cater to emergency cases 24 X 7. Featuring experienced medical professionals and the latest in medical infrastructure, the hospital represents Narayana Health’s commitment to quality medical care and patient service.” NarayanaSuperspeciality Hospital, Guru-

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NEWS ROUNDUP gram, has been built from the ground-up to be a state-of-the-art facility; with expertly planned and well-equipped sections, including spacious OPD areas and comfortable patient rooms which allows the hospital to cater to both In-Patients and Out-Patients in equal measure. The world-class medical equipment and infrastructure at the hospital ensures that it can provide a wide range of treatments; from complex to routine, and from paediatric to adult, ably supported by a state of art radiology unit with MRI, CT scan and Ultrasound services.

maintenance of health, specifically in critically ill neuro-patients. The absence of correct feeding practices in ICU patients often leads to increased mortality rate and increases hospital, which in turn raises the chance of infection. This has been proved by several studies. To highlight the importance of neuro-nutrition, the Indian Association for Parenteral and Enteral Nutrition (IAPEN) and the Bangalorebased Brains Neuro Spine Centre today organised a national conference on neuro-nutrition. Delivering his inaugural speech Dr. NK Venkataramana, Founder & Chief Neurosurgeon

correct nutritional intake affects the white matter of the brain. This in turn can lead to delay in brain development, brain damage and cause serious neuro related problem like epilepsy.” “Nutrition plays an important role in nervous disorders and in neuro and trauma critical care. Establishing nutrition support teams and protocols in hospitals and effective team work is the right approach for addressing malnutrition among hospitalised patients. The importance of nutrition and its role as part of medical treatment and enhanced recovery has been

BANGALORE-BASED BRAINS HOSPITAL ORGANISED NATIONAL CONFERENCE ON NEURONUTRITION

enlightened the audience on how important is nutrition for the brain right from the foetus to geriatrics. Dr Venkataramana said, “Brain is the first organ to develop in human. Right from the pre-conception stage, neo-natal, childhood, right through adult and old age, consumption of right nutrition is very important. Lack of

well established through several studies,” said, Dr SreemathyVenkatraman, Chief Dietician & Nutritionist at Brains. The conference was aimed at educating dieticians and nutritionists about the importance of medical nutritional therapies in various neurological disorders and feeding practices in neuro and trauma critical care.

Nutrition is an integral part of healing and

April 2018

NAYATI HEALTHCARE ACQUIRES 2 HOSPITALS IN DELHI NCR Nayati Healthcare has acquired majority stake in two hospitals — PrimaMed Super Speciality in Gurugram and VimhansPrimaMed in South Delhi according to PTI news. Nayati Healthcare Chairperson and Promoter NiiraRadia said: “The addition of PrimaMed will help us consolidate our position in North India and act as a strategic centre for the group.” The acquisition of majority stake in these two hospitals will help optimise clinical and service excellence, said NiiraRadia. While the soon-to-be-launched hospital in Gurugram has 600 beds, Vimhans is a 75 bed facility, PTI said.When asked about the stake the company has acquired and the funding details, Nayati Healthcare Co-Promoter Rajesh Chaturvedi said: “We have acquired 51 per cent shareholding in OSL Healthcare which owns these two hospital facilities – one functional, one to be operational soon.” PrimaMed founder and now Vice Chairman of NayatiPrimaMed Hospitals Rajiv K Sharma said: “The new association will give us access to newer markets taking boon of medical science to communities which need it the most within the country as well as international medical tourism.

CHANGE OF GUARD AT PARKWAY PANTAI INDIA Ramesh Krishnan, Chief Executive Officer, India Operations Division, Parkway Pantai will step down on May1, 2018 and Dr Ajay Bakshi, former CEO, Manipal Hospitals will take over as CEO. Parkway Pantai is one of Asia’s largest integrated private healthcare groups operating in Singapore, Malaysia, India, China, Brunei and United Arab Emirates. For over 40 years, its Mount Elizabeth, Gleneagles, Pantai and Parkway brands have established themselves as the region’s best known brands in private healthcare, synonymous with best – in – class patient experience and outcomes. It is part of IHH Healthcare, the world’s

to lead Parkway Pantai’s India Operations. I thank Ramesh for laying the groundwork so that I have a good foundation to build on our future developments in India. It’s an exciting journey ahead because of the tremendous growth potential for healthcare in India. We hope to serve and delight more patients through innovation for best clinical outcomes as well as safety, service and quality excellence.”

TARANG GIANCHANDANI NEW CEO SIR H.N. R LIANCE FOUNDATION HOSPITAL

Dr Ajay Bakshi

second largest healthcare group by market capitalisation. IHH operates more than 10,000 licensed beds across 50 hospitals in 10 countries worldwide, offering the full spectrum of integrated healthcare services from clinics to hospitals to Quaternary are and a wide range of ancillary services including medical education. Ramesh Krishnan, current Chief Executive Officer, India Operations Division, Parkway Pantai says, “Personally it has been a very fulfilling five years for me at Parkway Pantai in building the franchise across India. Today, India is one of our home markets, alongside Malaysia and Singapore. I am proud to hand over the baton to a highly qualified and passionate professional of Ajay’s calibre. He can steer the India operations through its next phase of growth and consolidation, and continue leading an excellent team which I have had the good fortune to put together.” Dr Ajay Bakshi, Chief Executive OfficerDesignate, India Operations Division, Parkway Pantai, says, “I am privileged to be invited

Reliance Foundation recently announced the appointment of TarangGianchandani as the Chief Executive Officer of the Sir H.N. Reliance Foundation Hospital at Girgaum, Mumbai. According to the statement Gianchandani who was earlier with Jaslok Hospital & Research Centre, Mumbai, will take up the new role shortly. Gianchandani did her Masters of Business Administration in 2007 from Singapore, with specialisation in Healthcare Management from the National University of Singapore, Business School. She has also worked with the Ministry of Health, Hospital Services in Singapore, where she managed strategic development and promotion of integrated and holistic healthcare. She has also worked at Alexandra Hospital, Singapore, as a Fellow in the Department of Orthopaedics, and was also the head of Clinical Quality, Changi General Hospital, Singapore. A recipient of RashtraVibhushan and Rashtriya Rattan Awards, Dr Gianchandani has worked as a member of a task force set up by the Maharashtra government on Organ Transplant and turn the state into a hub for medical tourism.

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OPINION

What it Means to be a Cardiologist in India Today? A relevant question in today’s time

Dr Harminder Singh, Senior Consultant, Cardiology, Mumbai

THE IMAGE of a doctor has undergone transformation in the eyes of the patients and doctors themselves in last one decade. Therefore what it means to be a cardiologist is a very relevant question. Our generation has witnessed this change very well and we have participated in it. I have been practising doctor for 34 years and Cardiologist for 18 years, long enough to see 3 generations of doctors- our teachers, ourselves and our students. The change is visible and palpable. Why Choose Cardiology? There were many reasons to choose Cardiology. There is a wide gap between the capability of an MD and a cardiologist. Cardiology is a hands on speciality with so much skilful work to do which also gives the thrill of rescuing a patient out of high mortality situations on day-to-day basis. It also was the highest paying branch with glamour attached to it. Before joining AIIMS as student, I worked briefly as observer at AIIMS and Escorts Heart Institute. Stalwarts like Prof SC Manchanda, Prof KK Talwar, Prof VK Bahl and Dr Ashok Seth were my role models. I saw their knowledge, mannerism, attitude and skills which made me decide that it‘s going to be Cardiology only. It used to be and still is very tough to get into cardiology at an institutes of repute. There were less than 200 seats in the 90’s (now there are 334 DM cardiology seats) and additional 133 DNB seats at large number

May 2018

of private institutes have made it relatively easy of late. As a result cardiologists are being produced in much larger numbers as compared to other super-specialities. Advancements in the field Practice of cardiology has witnessed a sea change. In olden days we used to be more conservative and utilised lots of clinical acumen based treatments with only ECG, X-Ray and echocardiography at most hospitals. Our professors taught us lot of bedside cardiology. For example common emergency like heart attack was treated with simple blood thinners and beta blockers and nitrates. We used to insist on prolonged bedrest and gradual mobilisation. The mortality from heart attack used to be higher. But in the last 2 decades primary angioplasty has become available widely and emergency treatment of heart attack is done within first few hours and patient is ambulated the next day, if stable. This has significantly reduced the death rate. In the last decade cardiology has also become technology based speciality with less emphasis on clinical bedside assessment. Newer generation echocardiography, CT scan, cardiac MRI, PET scan, state of the art cath-labs, cardiac biomarkers, event recorders and electrophysiological studies are now routinely available even in tier two cities. These investigations hardly leave anything to imagination and provide precise disease stag-

Practice of cardiology has witnessed a sea change. In olden days we used to be more conservative and utilised lots of clinical acumen based treatments with only ECG, X-Ray and echocardiography at most hospitals www.indiamedtoday.com

OPINION

The Road Ahead I still perceive cardiology as the best branch which is action oriented, hands on speciality with widest gap above physician level and it gives us the satisfaction of saving lives in most dreaded emergency situations. It is a branch where our colleagues also look unto us in emergency situations. It is still highest paying branch. I am very satisfied being a Cardiologist. My advice to younger doctors who are looking for a career in cardiology is that despite the changing scenario in medical profession Cardiology still remains a very coveted branch. Get training from premier institutes, get good indemnity insurance, train well and treat patients with utmost empathy and care. Never force a decision on a patient, just educate them for pros and cons of a treatment and help them get to the right decision. In non-emergency situations give them time to think, take second opinion and explore other options. Educate yourself on medicolegal aspects of medical practice. Work hard but be safe.

May 2018

COVER STORY

MEDICAL DEVICE MARKET IN INDIA Is the medical devices Regulatory environment in India Conducive for business?

Author: (L to R) Bhavik Narsana, Partner and Minhaz Lokhandwala, Senior Associate, Khaitan & Co

May 2018

COVER STORY

ealthcare is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. This has led to significant demand for medical devices. Interestingly, the medical device market in India was valued at US$3.5 billion in 2015 and expected to grow to approximately US $4.8 billion by 2019 according to industry reports. This looks like a promising opportunity for any device manufacturer, more so because this sector is import dependent. However, week rupee and low-cost Chinese imports make it difficult for manufacturers to gain grounds in this market. Added to that is the underdeveloped regulatory framework and price-capping will further challenge the market players. Foreign investments In fact, 100 per cent foreign direct investment under the automatic route is allowed in the medical devices sector in India. As per data available with the Indian Government, the medical and surgical equipment sector received approximately USD 1,570 Million between 2000 and 2017. In 2013 alone, the FDI inflow was approximately USD 138 Million and in 2015, FDI inflow was approximately USD 153 Million.

May 2018

Dominated by imports A large portion of the demand for medical devices in India is met through imports. India has always been an attractive market for global manufacturers. However, despite being one of the largest medical device markets in the world, it has not been able to tap its domestic manufacturing potential. About 70 per cent of the demand for medical devices in India are met through imports. Public Procurement With a view to encourage an increase in domestic medical device manufacturing, the Department of Pharmaceuticals, on 15 March 2018, published draft guidelines on public procurement of medical devices (“Draft Procurement Guidelines”). These draft guidelines have been published with a view to implement the Public Procurement (Preference to Make in India) Order, 2017 (“2017 Procurement Order“) issued by the Department of Policy and Promotion. Under the Draft Procurement Guidelines, medical devices have been categorized into 4 categories for the purposes of public procurement. Depending on the category of the medical device, the Draft Procurement Guidelines prescribe the minimum local content (i.e. the minimum domestic component cost incurred

The medical device market in India was valued at US$3.5 billion in 2015 and expected to grow to approximately US $4.8 billion by 2019

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COVER STORY

As per data available with the Indian Government, the medical and surgical equipment sector received approximately USD 1,570 Million between 2000 and 2017.

May 2018

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On 31 January 2017, the Medical Devices Rules, 2017 (“MedicalRules”) were notified in India under the Drugs and Cosmetics Act, 1940 (“Act”) which came into effect from 1 January 2018.

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COVER STORY

Under the Drugs Rules, all imported devices should have had a minimum shelf life of 60 per cent from the date of import.

May 2018

What Should Healthcare Providers Know About Consumer Centric Healthcare Delivery? Consumer-Centric Healthcare Delivery can be a boon or a bane or both

Dr. Vidur Mahajan, Associate Director, Mahajan Imaging, New Delhi

I AM going to make a confession about Mahajan Imaging, the chain of radiology centres that I run – we track several metrics as part of our quality program, but one metric that always stands out negatively, is waiting time. The waiting time issue, if I can call it that, is one that is generally restricted to MRI scanning and ultrasound scanning. There are two perspectives of viewing this parameter, the consumer’s and the patient’s.

Different Perspective From a “consumer” standpoint, making someone wait is probably the worst thing one can do to a consumer. It might indicate that a service provider does not value its customer’s time, and hence does not value the customer themselves. Conversely, if we view this parameter from a “patient” and “clinical” standpoint, we realise that the reason most patients face the waiting time issue is because some other patient needed some more time to, in our particular case, build a better and more accurate diagnosis. What this should indicate to a patient is that the service provider would similarly give extra “time” to him/her as well, hence arriving at a proper, more accurate diagnosis. In fact, we have had patients say “time management needs to improve” and “please adhere to appointment timings”, but in the same breath say “report is very detailed” and “doctor explained the report very well”. Healthcare today lives somewhere between these two extremes, and I believe that is where it should stay.

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APPROACH

Consumer Centric Healthcare Delivery To talk about “consumer-centric” healthcare delivery, we would first need to define what it means. Consumerism is typically defined as a movement towards protection of the rights of the consumer, eventually leading to an increase in consumption of the service in question by increasing demand for the same. Consumercentric healthcare, in turn, refers to a trend of empowering patients to make their own healthcare decisions, akin to how consumers make a choice about buying – evaluate quality and cost, and take a decision. Roadblocks The problem with consumer-centric healthcare is three-fold. First, indicators of quality do not necessarily indicate true quality. For example, a consumer (or shopper/buyer) might consider long waiting time to be an indicator of poor quality of service – “how can they cure me, when they can’t even stick to an appointment?” – where waiting time has no real connection

May 2018

with the outcome, whether it is a diagnosis, a treatment procedure, or just a follow-up consultation with a doctor. Second, while the traditional information gap that existed between the patient and the doctor is being bridged by “Dr. Google”, unfortunately the bridge leads to more distrust and hence problems that were before. Just today I was given the example of a patient who was having pain in the hips and subsequently advised an X-Ray by his physician. The patient searched the internet and found that an X-Ray might not be required in his case and consulted his physician, who explained to the patient that he is taking a drug that can lead to osteoporosis and even fractures, hence the X-Ray. Eventually, the patient was diagnosed to have an even worse condition (bilateral AVN of the femur) for which he needed two hip replacements. It seems appropriate to summarize this second issue with the age old dictum – a little knowledge is a dangerous thing. Finally, there are issues related to direct marketing of healthcare services to patients. Not only is this dangerous since it leads to price-undercutting

Consumer-centric healthcare, in turn, refers to a trend of empowering patients to make their own healthcare decisions, akin to how consumers make a choice about buying – evaluate quality and cost, and take a decision

between healthcare firms, but it also leads to confusion in the patients’ mind. It gives the patient the impression that their trusted neighbourhood hospital is now “commercial” where in their heart of hearts, the hospital wants to stay exactly the same. Benefits That said, there is no denying that adding a consumer angle to the healthcare industry helps improve quality in the industry across the board. Again, there are three ways in which “consumerisation” of healthcare is helpful. First, and maybe most importantly, it drives transparency - all said and done, with price and information no longer being “hidden” and patients having access to both at the click of a button, healthcare providers are forced to make decisions that are optimized for each individual patient. While this may sound contrary to what was written earlier in the article, it is important to realise that cost-optimisation is important for patients in India since not only do they pay out of pocket, but they also often compromise on other aspects of their lives – savings of a few thousand rupees can mean that a child’s school fee can be paid by the patient – such is the world we live in. Second, related to the first, consumerisation of healthcare will definitely lead to improvement in quality of services provided. A study done by Wes Yin et Al at UCLA, California studied the impact of introduction of consumer-centric, quality conscious pharmacies in south India and its concomitant

impact on the quality of the other pharmacies in the area. The results were astounding – not only did pharmacies try to improve their look and feel, but there was also real improvement in the quality of drugs sold! Such is the power of a demanding consumer! Thirdly, consumerisation leads to awareness about healthcare, and hopefully will lead to a shift in patients’ currently prevailing “curative health” mindset, to a “preventive health” mindset. Once people know that a certain disease can be prevented or detected early, they will hopefully start acting on the same.

I truly believe that the way forward for healthcare providers lies in having frank conversations with patients

In the end So is consumer-centric healthcare delivery a boon or a bane – well the answer clearly lies somewhere in between. I truly believe that the way forward for healthcare providers lies in having frank conversations with patients. While I realise that this is easier said than done when one is dealing with a country with one of the worst doctor-patient ratios on the planet – but still, what doctors need to gain is patients’ trust, and that is something that does not come easy. So, if there is one thing I would request you, the healthcare provider, take away from this article, is to lay emphasis on communication with the patient. If the patient understands the thought-process behind a decision that a doctor has taken, there is a chance that Dr. Human trumps Dr. Google and leads to not only lesser confusion and misinformation, but also to improved clinical outcomes and hence, better healthcare overall.

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PULSE

Is Heart Failure a Public Health Priority in India?

Dr. K. Sarat Chandra, Consultant Cardiologist, Indo US Superspeciality Hospital, President â&#x20AC;&#x201C; CSI speaks to IndiaMedToday about the status of Heart Failure management in India

What are the significant advances in the management of heart failure? Like other areas of cardiology, heart failure also has seen great strides in management. We have a number of evidence based medications like ace inhibitors/arbs, betablockers, aldosterone antagonists and lately ARNI therapy which have shown further reduction of mortality in heart failure patients. We have today devices like CRT which can improve the ejection fraction and outcomes in patients with left bundle branch block. The patients can also go for a LV assist device if they choose it. Of course we have cardiac transplantation for the relatively younger patients with severe symptoms. All these management and interventions are available in India. Pls could you tell us about burden of heart failure? The burden of heart failure is huge with 26 million people all over the world suffering from heart failure. Pls could you tell us about the reason for the rising prevalence of HF in India?

May 2018

Heart failure is a disease of advancing age. Like the rest of the world India also is witnessing a longer lifespan of its population. Incidentally, diabetes mellitus, hypertensionand coronary artery disease are increasing in incidence and prevalence. Additionally, with established therapies like thrombolytic therapy andprimary angioplasty more and more patients survive the initial heart attack; but the flip side is that there are more patients who have partially damaged hearts. It is no wonder then that for all these multiple reasons we see more patients of heart failure now-a-days than ever before. Is there a difference between the presentations of the disease in the Indian population as compared to the Caucasian population? The reasons for heart failure seem to be nearly similar in India and west with coronary artery disease being the dominant cause. Rheumatic heart disease obviously makes a significant contribution in India. Further, it is observed that Indian patients are 10 years younger than their western counterparts. In fact, what is striking in India is the much worse outcomes during initial hospital admission and during

ck is the cost involved and social barriers for donating the heart by a brain dead persons relatives. At the same time states in the south have demonstrated considerable public awareness and increasing numbers of donations. Is heart failure a public health priority in India? It should be; given the rising numbers which will be of epidemic proportions. Heart failure should be given great importance in our public health propgrammes, and govt policies. The cardiologists, ,physicians, professional societies like Cardiological Society of India and Association of Physicians of India and govt should together with media highlight this dreaded problem and bring about public awareness about the disease and also about the various new therapies available. The patients of heart failure can look forward to better outcomes in future

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INTERVIEW

Improving Emergency Care Through Quality Interventions

Dr S Saravana Kumar, Head ,Clinical Operations & Accident and Emergency Medicine department, Dr Mehta Hospitals, Chennai talks to Indiamedtoday about the new quality interventions in emergency care

May 2018

Pls can you share the present scenario of quality and performance improvement in Emergency Care in India? Health care errors are high and areas like Emergency department are more prone for such errors for the very nature of its functioning as emergency departments. Emergency departments are an open area, difficult to limit or control the number of by standers, over crowded with patients, many category of patients at the same time, poor triaging, high expectations from the patients, limited resources including manpower. Today various steps have been taken by the professional societies like Society for Emergency Medicine,India to work along with Indian Space Research Organisation (ISRO) and AHPI to come up with quality standards and check lists for emergency departments which can be easily adaptable across any emergency unit. Understanding the importance,NABH has

come up with separate emergency department accreditation standards - First of its kind, department specific standards for improving quality and patient safety in emergency units. What are the new developments in this area? Many institutions now recognise the importance of emergency units and its services and good emergency care and resuscitation can bring better outcomes eventually when the care is transferred to other specialities or units like ICU. Also the emergency doctorsâ&#x20AC;&#x2122; team are expected to manage many internal disasters within the institution like mass casualty incidences, cardiac arrest or close blue scenarios etc& handle many medico legal issues directly linked to the reputation of the whole institution,making it much more important for the emergency medical teams to follow clinical protocols,check lists and adhere to quality standards and monitor to improve them.

How can hospitals better their quality and outcomes in Emergency and Critical care? Hospitals should focus on adequately educating and creating awareness among their staff in emergency and critical areas on importance of quality and how it can improve outcomes.Need to identify and promote quality leadership in the unit level. Focus on outcome based metrics than volume based for incentives.Adherence to protocols and checklists and evidence based ethical practice.

Many institutions now recognise the importance of emergency units and its services and good emergency care and resuscitation can bring better outcomes eventually when the care is transferred to other specialities or units like ICU

Anything else you would like to add. One simple tool which can be easily adapted by any emergency department in India is the Health QUEST recommendations by ISRO which on pilot study done at Dr Mehta Hospitals Chennai - showed promising improvements in many quality parameters including a reduction in mortality rate at emergency units.A multi centric study is underway on the same.

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INTERVIEW

Small Hospitals and Nursing Homes Build Trust, Reputation

Dr. Anuradha Pichumani, Executive Director, Sree Renga Hospital, Chengalpattu & Director, Narbhavi Multispeciality Hospitals, Kancheepuram talks to IndiaMedToday about the current healthcare scenario in South India

28 â&#x20AC;&#x2026;â&#x20AC;&#x2026; â&#x20AC;&#x2026;May 2018

Pls tell us about the healthcare delivery market and the contribution of small hospitals and nursing homes? Fifty years ago, the predominant provider of healthcare to the population was public healthcare facilities. Today, that equation has changed with the private sector being the very dominant player. In this changed scenario, being a local organisation, small hospitals and Nursing homes build trust and reputation with its patient-base in a better way and, understand and sync with the culture of its people. By default, they become the first port of call for the healthcare needs of its people. Why is healthcare delivery in South India better than rest of India? Particularly in the recent past, the state governments in the Southern states have been very focused in making healthcare equitable and accessible by the bulk of its citizens. And,

South India has traditionally had a predominant culture that valued academic accomplishments and talents in its people, engendering the institution of colleges and universities for learning and practicing medicine. Increased competition between and amongst the public and private providers, coupled with the higher literacy and awareness levels of its population has led to the demand for better quality of services. A rising tide lifts all boats, after all making healthcare delivery mechanisms stronger and efficient. What factors have been instrumental in making healthcare affordable in South India? The proliferation of medical colleges in the southern part of the country has generated a higher number of doctors in the region. The resulting increase in the supply of medicos and the availability of suitable opportunities right in their native habitats is helping many graduates from the South resist the urge to move to

the metro cities, making their services affordable. The higher -- and rising -- median income levels of the population is another factor contributing to the affordability of healthcare by the population in the South. The historically higher value placed on education by the citizens has probably contributed to their higher income levels, leading to improved affordability of services including healthcare. Could you share some achievements of Tamil Nadu state in healthcare delivery? Effectiveness in the implementation of Universal Immunization Programme, constitution of Tamil Nadu Medical Services Corporation for overseeing the drug procurement processes and promotion of generic drugs, efficient implementation of The Tamil Nadu Health Systems Project (TNHSP), and formulation of a health policy in 2003 with special focus on low-income, disadvantaged communities come to the top of the mind, as significant achieve-

ments. Despite the political vagaries during election times, the government has been steadfast in its commitment to the effective implementation of state-sponsored insurance schemes for illnesses -- another success story that has since been replicated in other parts of the country. Anything else you would like to add. Bodies like CAHO help feed this zest and demand for infusing quality into the fabric of healthcare delivery. Through structured, targeted training programmes such as the CPQIH, CPQIL, CPHIC etc, through the institution of Centre for Quality Promotion patient care is getting safer and better. It is regrettable though that the energy spent by the healthcare providers, by way of quality initiatives such as the NABH certification and accreditation is not adequately acknowledged by the payors, by way of reimbursements for the Cashless treatment services.

In this changed scenario, being a local organisation, small hospitals and Nursing homes build trust and reputation with its patientbase in a better way and, understand and sync with the culture of its people

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INNOVATE

Innovations in Healthcare Delivery – Opportunities and Challenges The challenge for healthcare delivery innovators is to ensure that their innovations are successfully and widely adopted

Dr Srivats Bharadwaj Founder, CEO and Chairman, Vatsalya – Centre for Oral Health, Bengaluru

WHEN WE think of innovation in healthcare, most of us tend to look for the ‘Eureka’ moments. The wonder drug that can cure cancer, the surgical procedure that can revive a brain dead patient, the hi-tech diagnostic tool that can predict cardiac adversities. But these innovations – no matter how spectacular are of little value without the right healthcare delivery processes. A very interesting article that appeared in the November 2013 issue of Harvard Business Review looked at how some Indian hospitals are able to provide world-class healthcare at as much as 95 per cent lower costs than those at US hospitals. The answers, the authors argue, don’t always lie in grand designs, but in smart delivery systems. Addressing the Issue In a recent interview, US-based surgeon and

May 2017

best selling author Atul Gawande called India’s public health system one of the “most complex things” in the world. And that’s true, given the sheer magnitude of the burden of infectious diseases as well as non-communicable diseases that the country has to tackle. Unfortunately, in our prevalent war against diabetes, cardiac issues, HIV/AIDS, et al, we ignore the seemingly less-important battles – like oral health, for instance – that can actually strengthen our chances of success.According to the WHO, the risk factors for oral diseases include an unhealthy diet, tobacco use and harmful alcohol use. These risk factors are the same for the major chronic diseases – cardiovascular ailments, cancer, respiratory diseases and diabetes. Studies have shown that periodontal diseases (also known as gum diseases) pose a risk to general health, especially for patients

The innovation that India needs today is an integration of public health solutions for oral diseases with those for chronic diseases and with the national public health programmes www.indiamedtoday.com

INNOVATE oral disease as a “silent epidemic”, wherein a significant amount of money is spent on expensive, invasive treatments that could have been either avoided with simple preventive measures, or at least treated at a lower cost and lower risk, if identified earlier.

About 72.6 per cent of the rural population, says the data from Dental Council of India, do not have access to basic oral health

May 2017

Reality Check The biggest challenge in implementing an integrative approach vis-a-vis oral health and other diseases is the dismal dentist: population ratio (1:8,000 in urban areas and 1:50,000 in rural areas). About 72.6 per cent of the rural population, saysthe data from Dental Council of India, do not have access to basic oral health. Enhancing access to affordable dental care is important in its own right, but is unlikely to be a sufficient strategy for reducing the burden of disease, states a white paper on Oral Health commissioned by the National Interprofessional Initiative (Oral Health: An Essential Component of Primary Care). Sometimes, we just need to go back to the basics. Prevention is still better than cure. Primary care providers, such as general physicians, nurses and midwives, need to be trained to expand the disease prevention workforce. Children, pregnant women, diabetes and other patients who visit the hospital regularly are ideal candidates for

preventive healthcare. There are several examples of promising healthcare delivery innovations. The challenge is to ensure that they are successfully and widely adopted. And this calls for a change in the attitudes of medical practices, healthcare organisations and policymakers. We need to move away from the traditional doctorcentric healthcare setup and make it patientcentric. Thanks to the advances in information technology, it’s now possible to deliver medical care to patients at a time and place of their convenience. Telemedicine makes the remote delivery of healthcare over the phone a reality, while electronic health records facilitate easier access to expert medical opinions. Innovations in diagnostic technology, pharmaceuticals, surgical procedures and medical devices are undoubtedly important. But what’s more important is inventive methods to deliver these services in a timely, safe and effective manner to patients.Obviously, this can’t happen overnight. But as Bill Gates so succinctly put it, “We overestimate what we can accomplish in two years, but we underestimate what we can accomplish in 10.”

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EVENT REPORT

CAHOCON 2018 Wrapped Up To Enthusiastic Praise

THE 4TH annual International conference of the Consortium of Accredited Healthcare Organizations (CAHO) was held on April 7-8 at Chennai. CAHOCON 2018, the two- day mega event wrapped up to enthusiastic praise. Over 600 participants, including 80 speakers and moderators, attended the event. CAHOCON brought together leaders from hospital management, and diagnostic laboratory segments as well as leaders and policy makers to discuss the latest trends demonstrating outstanding levels of quality implementation, ensuring superior healthcare services and much needed patient safety. â&#x20AC;&#x153;We are delighted to host CAHOCON 2018 in Chennai this year on World Health day. In this international conference, we join together to intend to introduce fresh and innovative ide-

Prof K Srinath Reddy, President, Public Health Foundation of India (PHFI). Dr Preetha Reddy, Vice Chairperson, Apollo Hospitals Group

May 2018

as to help address various challenges facing the nation’s healthcare industry and build a worldclass healthcare ecosystem,” said Dr Agarwal. CAHOCON is the signature event and annual conference of CAHO to engage with the stakeholders to promote quality in the healthcare delivery. The two-day conference was inaugurated by Prof K Srinath Reddy, President, Public Health Foundation of India (PHFI). Dr Preetha Reddy, Vice Chairperson, Apollo Hospitals Group and Dr Vijay Agarwal, President, Consortium of Accredited Healthcare Organisations (CAHO) and Governing committee members of CAHO were present on the occasion. Speaking on the occasion, ProfReddy said, “I congratulate CAHO for its concrete and progressive efforts in order to bring in the best practices and create benchmarks to raise the bar of healthcare quality. Moreover, I believe that this conference would equip the participants with knowledge that focuses on patient safety and quality of healthcare based upon national and international standards.” Prominent speakers at the conference included, Dr. Dinesh Arora, Director, Ayushman Bharat; AlokSaraogi, Chief Innovation Officer, Ashok Leyland; Dr. GSK Velu, Founder & Chairman, Neuberg Diagnostics; Dr. MuraliSrinivas, Chief – Medical Services, Manipal; Dr. Antony Basile, Medical Director, Star Hospital, Hyderabad; Dr. JV Peter, Director, CMC, Vellore and Dr. Pradeep Kumar Vyas, Principal Secretary – Health Services, Govt. of Maharashtra. The conference had parallel sessions on hospital and laboratory related topics and a scientific exhibition along with an awards ceremony.In addition, the conference was enriched with research presentations, posters, panel discussions as well as pre-event workshops and master-classes. What made the conference interesting was the showcase of an array of projects implemented at various Chennai hospitals on energy efficiency, 5S implementation, lab-on-chip, etc. Key sessions were centered on topics like, healthcare sustainability in the present context; key learning from other industries; marketing ahospital ethical; medical education, handling medical negligence; equity and quality in healthcare; importance of timely

Dr Alexander Thomas receiving the Lifetime Achievement Award

CPHIC Mannul release

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EVENT REPORT

MOU for Fire Safety and Emergency Preparedness

May 2018

intervention, and the costing of procedures. Day one sawsessions by prominent speakers, including, Dr.Preetha Reddy, Vice Chairperson, Apollo Hospitals, who spoke on “Will healthcare sustain its nobility and ethos?” This was followed by Dr. Dinesh Arora, Director, Ayushman Bharat who discussed about the impact of “Modicare on Indian healthcare”. Pre-lunch sessions focused on “Learning from Diagnostics” with Dr Vandana Jain, Director, NABL and Dr. Anil Relia, CEO, NABL who spoke on “Accreditation of Laboratories : Present & Future”. After that Dr. GSK Velu, Founder & Chairman, Neuberg Diagnostics gave his speech on “Next generation diagnostics”.Subsequentlt, Dr MuraliSrinivas, Chief-Medical Services, Manipal and Dr. Antony Basile, Medical Director, Star Hospital, Hyderabad shared their thoughts in “Mann Ki Baat” session with interesting facts and information. Post-Lunch session witnessed a storming debate over Pros and Cons on“Marketing a Hospital – Is it Ethical ?” with Dr Harish Pillai, CEO, Aster Medcity,Dr. S. Manivannan, JMD, Kauvery Hospital, Dr. Sanjeev Singh, MS, AIMS, Kochi as participants. The debate was chaired by J Adel, Head Marketing, Meenakshi Mission Hospital, Madurai. The Second day sessions started with platform presentations, followed by session on “International Accreditation” with presentation by Dr. Clive Fernandes, Medical Director, Wockhardt Group of Hospitals on the topic,“International accreditation bodies: Untold story”, followed by a panel discussion on “Handling Medical Negligence”. Post Lunch activities include sessions on Education: Building Blocks” and Laboratory sessions.The Conference was accredited with 6 CME credit points in Category 1 by the TamilNadu Medical Council. The event also saw some other notable activities. Recently, CAHO and SchülkeIndia , signed an MOU to partner in joint efforts to improve the quality of care at accredited hospitals through training and education.CAHO’s training program to Certify Professionals in Hospital Infection Control (CPHIC) is supported by Schülke and the Training Manual for CPHIC was formally released during the conference.

In addition, CAHO and Cholamandalam MS Risk Services Ltd signed a memorandum of understanding to provide a state of the art certification program on Fire Safety and Emergency Preparedness to health care organizations in India. The program will address much of the lacunae in knowledge and systems that hospitals face today in the areas of fire prevention, protection and preparedness. An official exchange of documents for the same was also done during CAHOCON 2018. The valedictory ceremony was followed by the Awards presentation to recognize excellence in Quality in healthcare. The awards were presented to a gamut of achievers. The Lifetime Achiever Award and â&#x20AC;&#x2DC;Young Quality Achiever Awardâ&#x20AC;&#x2122; were also given out to honour substantial work in the field of healthcare quality. Dr Alexander Thomas, President AHPI received the CAHO Lifetime Achievement Award,

at the International Conference CAHOCON 2018, at Chennai Dr. Thomas was honored for his leadership and commitment in taking quality accreditation to the grass roots and for his outstanding individual contribution for patient safety advocacy in India. The award was given to him for being an innovative and intuitive collaborator in bringing great minds of the country together for improving patient safety and hospital quality in India. For highlighting the need and developing training framework for teaching communication to healthcare workers.For championing the cause of DNB, Nursing empowerment and Pre - Accreditation Entry Level Certification.For being a mentor and inspiration to next generation of young quality leaders.For being the face of healthcare quality in India. The earlier recipients of the award are Dr GirdharGyani and Dr VenkateshThuppil.

Dr GirdharGyani, is an internationally acclaimed expert in the field of quality and is responsible for bringing in quality in healthcare in India through NABH. Dr Gyani is the Former Secretary General, Quality Council of India, an apex national body responsible for establishing and operating national accreditation structure and promoting quality in all walks of life. Dr Gyani was founder CEO of NABH and is fondly known as the Quality man of India. Dr VenkateshThuppil is an internationally renowned expert promoting quality in medical laboratory in India and abroad. He is the Principal Adviser of Quality Council of India and is also the Lead/Principal Assessor for the NABL & NABH. He is also called as the Lead Man of India and was director of project Lead Free of The George Foundation which was instrumental in getting the unleaded petrol to India.

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EVENT REPORT

HIMSS India Concluded on a High Note THE ANNUAL HIMSS India 2018 conferenceconcluded on a high note with a promise to return with an even bigger and better event next year. More than 200 participants, including 20 speakers and moderators, attended the event held at Bangalore. HIMSS India Annual Conference and Exhibition brought together key stakeholders from Government, Statutory Bodies, Healthcare Providers, Payers, Life Sciences, Medical Device, Healthcare IT and solution providers for pathbreaking collaborative discussions on healthcare IT issues, best practices and the latest in

tools & technologies that drive and enhance the new age healthcare delivery and outcomes The theme of the conference discussed various topics related to current scenario in healthIT and outlook for 2018-20; AI, precision medicine and machine learning; advanced and predictive analytics; standards and interoperability; mHealth and Tele Medicine;Innovation and Startups and home healthcare &IT. RajendraPratap Gupta, Advisor Ministry of Health and Family Welfare; HarkeshDabas, Country Director, Clinton Health Access Initiative and William J Clinton Foundation and Dr.

Panel Discussion on Startups

May 2018

Devi Shetty, Chairman and Founder, Narayana Health were the keynote speaker. IshaqQuadri, Secretary HIMSS India delivered the welcome address and set the tone for the event.“HIMSS India will organize a number of events for the other state chapters to explore health IT advances and exchange relevant, tangible ideas in the coming months.” Talking about the policy reforms and its impact on digital health Gupta said that healthcare policy reform goals need to be supported by appropriate digital health technologies. “The goals of improving access, enhancing quality and lowering costs in healthcare cannot be achieved without digital health technologies,” he said. Industry should participate in policy making by sharing inputs analyzing and reporting on public policy documents he said. One of the riveting talks on day one was delivered by K Chandrasekhar, CEO Forus Health who captivated the audience with a talk on AI in eye screening. He said that in their mission to eradicate preventable blindness from India AI has been able to democratize eye imaging. This has resulted in wider access to retinopathy diagnosis. Rajesh Kuppuswamy : Healthcare Industry Lead- SAP India introduced the technologies that are helping hospitals improve care and J.P. Dwivedi, CIO – Rajiv Gandhi Cancer Institute spoke about the dilemmas CIOs and IT Heads face at the hospital and how hospitals can achieve its goals of better patient care through consolidated IT technology platforms. An interesting panel comprising innovators and investors deliberated on startup lifecycle and funding leaning towards smart solutions to perennial problems. The panel included Manish Singhal, Founding Partner, Pi Ventures; VaibhavAgrawal, Partner Lightspeed; Dr. GeethaManjunath, CEO, Niramai and BalajiVishwanathan, CEO Invento. This lively panel was moderated by Dr VivekSahi. According to the panel market size and the team are the two most important considerations while evaluating new start-ups. A driven sense of purpose and unique market insights are also desirable traits in startups. While all panelists agreed that there is potential in the Indian healthcare market for technology play-

Dr. Devi Shetty, Chairman and Founder, Narayana Health

CPHIC Mannul release

Rajendra Pratap Gupta, Advisor Ministry of Health and Family Welfare

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EVENT REPORT ers they also pointed out the difficulty of this market when it came to implementation. Dr Devi Shetty delivering his keynote address talked about the challenge that our leaders will face as demand for healthcare increases. “Is it possible to make healthcare accessible for atleast 40-50% of the population with the current resources and budgetary allocations?” he asked. Sighting examples from his practice Dr Shetty explained how technology can be used to deliver last-mile healthcare. “Online healthcare will dramatically change the way healthcare is delivered in India and globally,” he said. “Anyone with medical history or chronic disease should have their medical history on the mobile phone,” he emphasized. He also said that technology can change the way in which skilled professionals offer healthcare. He also said that the world’s largest healthcare provider will have no beds it will be software. The only

question that remains is who will develop it. The chief guest for the day HarkeshDabas talked about technology as an enabler to bridge the inefficiency gap in healthcare delivery. Healthcare landscape is waiting to be disrupted, he said. He also talked about the failures in public health delivery and the lessons one can learn from them. Technology providers should start with the problem and then work backwards to solve it, he said. He also said that adoption of technology should be easy else great technologies also tend to fail. The other session that were well appreciated were improving clinical outcomes through digital transformation byShireeshSahai, CEO, Wolters Kluwer, India.Following this Dr. VivekSahi, GirishKoppar, and Manoj Paul presented the results of HIMSS survey on Data Capture conducted in India. They also spoke about what steps the association is taking for better

adoption of HIM systems in India and the guidance on adoption model for analytics maturity. The HIMSS Analytics Adoption Model for Analytics Maturity (AMAM) is designed to measure and advance an organisation’sanalyti cscapabilities. The HIMSS AMAM certification which was earlier only available in Singapore is now available in India and CIOs were invited to make use of it. One of thefocused sessions on day two was the CIO Conclave: IT Transformation Challenges and Solutions moderated by Arvind Sivaramakrishnan, CIO Apollo Hospitals. RajendraKshirsagar, CIO Meitra Hospital and Ashokkan S, CIO Columbia Asia Hospital shared their inputs on a variety of topics from Ayushman Bharat to Telemedicine implementation and interaoperability issues. The formal vote of thanks was proposed by Dr. Nitiraj Gandhi, Jt. Secretary HIMSS India.

HIMSS India Board members

May 2018

Q&A

ASK THE EXPERT

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

Today many pharmaceutical companies

If any local patient fails to pay the long

dues of the hospital. What actions hospital

for example: for treatment of osteoarthritis;

can take against patient or attendant?

for eg: Boswelliaserrate;

Dr Sunil Dhingra

for promoting

fracture union; eg: Cissusquadrangularis, etc. As an allopathic doctor (orthopaedic surgeon) are we legally allowed to prescribe these Ayurveda medicines?

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

have come out with Ayurveda medicines,

Dr Manikya R, MS Ortho, Hubli

Ans: Please remember that some of the medicines which are launched as Ayurveda medicines may not have any efficacy as they may be commercial gimmick. If you think they are useful, you can prescribe them. Most of the medicines are in OTC (over the counter) list so not even prescription is required from a medical practitioner to buy these. Q:

Can a rabies patient make a valid will?

Dr. A. K. Gupta , Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Ans: The basic requisites of making will are:ď&#x192;&#x152; The person is of sound mind ď&#x192;&#x152; He should have ability to understand what are his properties and heirs. ď&#x192;&#x152; The will should be of his own free will If a person is suffering from rabies, especially in virulent form in last stages, there may be mental changes and person may not be competent to make will. In all such cases, doctor should certify whether is competent to make will or not.

Ans: It is one of the most difficult tasks to recover dues from local patient who is not interested to pay. Legally speaking, hospital has no way except moving civil court for recovering dues. Seeing the status of civil courts in India, it may take decades to recover it. However, there are some ways which can be beneficial. Ask patient to pay by cheque and ask him to post you post datedcheque which you can present in bank and after it is dishonoured, you can get a criminal case registered against him. I can assure you after this, patient would agree to pay immediately Send legal notice by lawyer and ask for penal interest and threaten to go to court. Offer some discount and try to close the case. If money is less say upto one thousand, it is not worth trying to recover. Take it as business loss or charity Q:

What are two most common mistakes

committed

surgeons

while

taking

consent in India?

Ans: Taking a general consent at the time of admission. Taking consent from parents / spouse / children / relatives of an otherwise competent adult patient. What you should do is take consent from patient if he is competent and ask relatives to sign as witness. General

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consent is not complete consent for surgery. Take specific consent Karnataka Consumer Commission Laxmibai&Ors.v/s Dr. B. B. Kappalguddi, Kappalguddi Nursing Home, Gokak &Anr. The patient underwent surgery, suffered complications, was transferred to another hospital where he died. The surgeon defended the absence of patient’s consent by pointing that the patient was unable to sign due to IV line and hence on the patient’s instructions one of his friends had signed the consent. The court while holding the surgeon negligent for not taking consent further observed that left thumb impression of the patient could have been obtained. Q:

Is it essential to keep record of OPD

prescriptions?

Should

give

new

prescription each time when patient comes for follow up? Dr NisheetaAggarwal

Ans: It is not essential legally to keep record of OPD prescriptions, there is no need also to issue new prescription when patient comes for follow up. You can write on same prescription paper again.But it is always better to keep records. It can be easily done if you issue it from computer. Doctors should be tech friendly now. The following are advantages for keeping records You can write research paper easily.  You can monitor and do clinical trial.  You can verify from your records that patient consulted you.  If patient loses prescription, you have the copy.  If case is made medico-legal late , you have the record.

May 2018

Disclaimer: This material has been prepared for informational purposes only, and is not intended to replace, and should not be conveyed or constitute legal advice. You should consult professional lawyer and legal advisors before engaging in any legal matter.