IndiaMedToday Nov 2020

NOVEMBER 2020, VOLUME 4 ISSUE 11 `200 INDIA MED TODAY

ON THE ROAD TO RECOVERY Encouraging trends ahead for healthcare volumes and margins

NOVEMBER 2020

HEALTH-IT Why IMA Does Not Like the NDHM

APPROACH Decentralised Approach to ‘Chase the Virus’

INNOVATION Top 10 Medical Marvels to Look Out for in 2021

INTERVIEW Devang Mody, CEO, Bajaj Finserv Health

EDIT NOTE www.indiamedtoday.com

November 2020 EDITORIAL Editor Neelam Kachhap

BOARD OF ADVISORS Dr Alexander Thomas

When the Going Gets Tough

Dr Girdhar Gyani

Sub-Editor

Dr Prem Kumar Nair

Sanjiv Das

Dr Bhabatosh Biswas

The second wave of Covid-19 is here. The cases reported per

editorial@

Dr Alok Roy

day are increasing and the questions that we started with in

indiamedtoday.com ART & PRODUCTION WepApp Logic Shylesh

Ramesh Kannan

March 2020 are still hanging thick in the air. Although, we

CONSULTING EDITOR

now understand a bit about managing the outbreak, death toll

Dr Libert Anil Gomes

continues to climb.

Dr Salil Choudhary

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Healthcare delivery is limping back. Analysts foresee better days ahead and hospitals are gearing up to receive patients.

Financial challenges have shadowed the best healthcare delivery efforts and hospitals may see this situation persist little longer.

As the pandemic progressed, all eyes were focused on non-traditional providers to deliver healthcare. It looked like telemedicine was getting the much needed push and it would go all out and conquer the said market opportunity. But as the hospitals and healthcare providers struggled digital giants and digital-first health solution disruptors also struggled. These innovative companies did not provide any disruptive solutions to people’s healthcare woes. Of course, the paying capacity that was once a strong force driving many innovative solutions in the Indian healthcare landscape has been decimated.

It is up to the sector to see how this cost-paying capacity gap can be bridged. Insurance players have to come up with innovative solutions to increase their penetration.

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Welcome to another interesting issue of IndiaMedToday.

Our cover story this month looks at the predictions for healthcare delivery in the next year and trends that will make this happen.

We introduce you to the medical and technological innovations that will affect healthcare delivery in the coming year. We also bring you ground report from Assam on tackling Covid and efforts of various NGOs in this regard.

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

Our next issue focuses on the learnings from this pandemic and ways to get back on our feet. In the next issue we talk to healthcare leaders about what they're doing to not only survive, but thrive, under the new normal.

The going is going to get tough. But we are not going to give-up.

information contained in this publication. Never disregard professional medicaladvice 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,

Editor M Neelam Kachhap

Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

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3

NOVEMBER 2020

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CONTENTS

Facebook

Linkedin

16 18

30

HEALTH-IT

INTERVIEW

INNOVATION

Why IMA Does Not Like the NDHM

Devang Mody, CEO, Bajaj Finserv Health

Top 10 Medical Marvels to Look Out for in 2021

17 28 COVER STORY

On the Road to Recovery

UPFRONT

03 Editorial 06 Letters 07 News roundup

APPROACH

Decentralised Approach to ‘Chase the Virus’

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CHECKIT OUT ONLINE

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5

LETTERS

T

World Mental Health Day

here is no health without mental health, for which sustained and scaled up investments are needed. WHO will continue to provide its full support to countries and partners in the Region to strengthen the provision of needspecific, culturally sensitive mental health care and treatments throughout the COVID-19 response and into the recovery and beyond, in line with its strategic preparedness and response plan, the Region’s Flagship Priorities, WHO’s “triple billion” targets and Sustainable Development Goal 3. With crisis comes opportunity, and we must seize this World Mental Health Day to accelerate progress on ensuring all people in the Region can access the mental health care and effective treatments they require to stay healthy, well and resilient. For a healthier, more sustainable social and economic future, together we must act – and invest – now.

Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia

While we have come a long way in dealing with mental health issues, the stigma still persists and there’s a long way to go. Our objective is to reach out to people who don’t have access to mental health services otherwise. We would like to extend our help to those suffering from mental health issues and provide them with a reassurance that we are here to help them in whatever way we can. We hope that we can create a positive

issue. While in-person counseling sessions might not always be possible during this time, people can consult psychiatrists and psychologists via online platforms. It is important to talk to a mental health professional at the right time so that it can be dealt with at an early stage.

Dr Amrit Pattojoshi, Professor Hi-Tech Medical College and Hospital, Direct Council Member of The Indian Psychiatric Society

difference for everyone going through these challenging times.

Neerja Birla, Founder and Chairperson, Mpower

are new experiences. When coupled with work stress and health

Cancer not only affects the body but also have a profound psychological impact like anxiety and depression throughout the cancer journey and beyond. Cancer care professionals need to address the emotional needs of their patients and refer them to qualified mental health professionals. Early detection of emotional difficulties of patients can lead to a better quality of life and treatment outcomes.

concerns, everyone is suffering from some form of mental health

Dr B S Ajaikumar, Chairman & CEO, HealthCare Global

In the midst of a global pandemic crisis, a lot of people are suffering from mental health problems. It is being reported that services to mental health are getting disrupted globally while the demand has been constantly increasing over the last few months. For a lot of people, things like loneliness and isolation

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6

November 2020

NEWS ROUNDUP Centre asks states to form committees for COVID-19 vaccination drive The Centre has asked states to constitute committees for coordination and overseeing COVID-19 vaccination drive while ensuring minimal disruptions in other routine healthcare services, and stressed early tracking of social media to dispel rumours which could impact the community acceptance of coronavirus inoculation.

Stating that COVID-19 vaccine introduction will span over a year with multiple groups being included “sequentially starting from healthcare workers”, the Health Ministry has sought constitution of committees at state and district levels which will review preparatory activities in terms of cold chain preparedness, operational planning, strategies for state-specific challenges in terms of geographical terrain and hard-toreach areas, etc In a letter to states and union territories, Union Health Secretary Rajesh Bhushan has suggested setting up of a state steering committee (SSC) chaired by the chief secretary, a state task force (STF) led by additional Chief Secretary or principal secretary (health), and a district task force (DTF) to be headed by the district magistrate.

Apollo Hospitals partners with Medtronic

a valid document proof to support the clinician’s decision taken on the course of treatment for a stroke patient.

Apollo Hospitals Group announced a partnership with India Medtronic to integrate artificial intelligence (AI) for advanced stroke management for the first time in India. The US FDA approved AI platform for stroke diagnosis has been validated by clinical trials.

WB to train 17,000 doctors to monitor COVID-19 patients

Through this partnership, Medtronic will help in bringing in stroke technologies, technical expertise, training and comprehensive stroke management with the integration of AI platform at the Apollo Institute of Neurosciences at ten locations in Apollo Hospitals across the country, taking stroke management to the next level by standardising stroke diagnosis and empowering clinicians to make faster, more accurate diagnosis and treatment decisions.

The stroke team will be able to remotely access the brain scans of stroke patients with the AI analysis on the mobile app or email for faster decision making without losing time. Other benefits include physicians being able to evaluate the patients remotely and visit in-person only when the AI analysis of the scans suggest indication for treatment. This will help to reduce unnecessary exposure in a COVID situation. The AI system will also generate

The West Bengal government will employ over 17,000 doctors to monitor the treatment of coronavirus patients in home isolation following reports that some of those affected are ignoring early signs of complications and opting for medical advice only after their health condition worsened, an official said.

At present there at least 97,613 COVID-19 patients in home isolation in the state, the health department official said. It has been found that many patients in home isolation are ignoring the health protocols and are reaching out to the doctors only after their conditions deteriorate. So we have decided to employ more doctors to help patients in home isolation free of cost,” he said.

The decision was taken at a virtual meeting between the state health department, civic administrators and representatives of health departments of Kolkata, Howrah, Hooghly, North and South 24 Parganas districts and the Indian Medical Association (IMA).

L to R ( First Row) : Dr Satishchandra P, Neurology, Apollo Speciality Hospitals, Jayanagar, Bangalore; Dr Prathap C Reddy, Chairman, Apollo Hospitals Group; Dr Madan Krishnan, Vice President, Medtronic Indian Subcontinent; L to R ( second row) : Dr Anupam Sibal, Pediatric Gastroenterology and Hepatology, Indraprastha Apollo Hospitals; Dr K Hariprasad, President, Apollo Hospitals Group

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7

NEWS ROUNDUP The IMA will start training local doctors.

The local civic bodies will prepare a list and assign each doctor one patient or a family in home isolation and continue monitoring them closely, the official said.

FDC launches stronger versions of Favipiravir in India

Drug firm FDC has launched stronger versions of its Favipiravir brands, PiFLU and Favenza, used to treat mild-tomoderate cases of COVID-19, at a price of Rs 160 per tablet in India. These prescription-only drugs will be available at all retail medical outlets and hospital pharmacies across the country, from November 1, 2020, FDC said in a BSE filing.

The 800 mg version of the drugs will help reduce the number of tablets to be taken by any patient by 75 percent, it added.

“After the launch of PiFLU and Favenza in August, we decided to work on reducing the dosage frequency as well as the cost, as a result of which we have introduced this variant,” FDC Business Development and Commercial Excellence GM Mayank Tikkha said.

“PiFLU-800 and Favenza-800 will help patients reduce the cost of therapy by 30 per cent, while strengthening the efficacy of treatment,” he added.

in-line with the evolving educational and professional requirements within India and internationally.

formulations, drug delivery, APIs, business development, corporate strategy and mergers and acquisitions.

VK Singh joins Cadila Pharma as COO of API business

Cipla launches ELIFast for COVID-19 antibody detection

Pharma industry veteran VK Singh has joined Ahmedabad-based Cadila Pharmaceuticals as the chief operating officer (COO) of its chemical strategic business unit, which mainly focuses on active pharma ingredients (APIs) manufactured in India. Singh will be based out of Ahmedabad.

Cipla announced the commercialisation of antibody detection kits for COVID-19 in India. In partnership with KARWA under the technology transfer from the Indian Council of Medical Research (ICMR).

Singh is a chemical engineer from IIT Kanpur, and an MBA from the Indian Institute of Foreign Trade, New Delhi. He has experience of over 20 years in the pharma industry, and the last ten years in leading and transforming organisations.

He was last associated as chief business officer with Strides Pharma Science. Prior to that, he was associated with leading pharma companies such as Emcure Pharmaceuticals, RPG Life Sciences, Ethypharm India, and Ranbaxy in various roles.

Singh performed a general management function leading mid-sized pharma companies over the last decade, and has a wide experience, spanning across

Shiv Nadar University Chennai opens

Shiv Nadar Foundation has announced the launch Shiv Nadar University Chennai.

The university will be housed in a sprawling campus at Kalavakkam. It will be home to facilities including academic and research blocks, state-of-the-art cricket stadium, library, sports centre, hostel facilitates for students and a faculty housing complex, auditorium, guest house and 24/7 Internet access. Dr C Rangarajan, former Governor of Reserve bank of India and Dr Raj Reddy, computer scientist, University Professor at Carnegie Mellon University will be distinguished mentors at the University.

The university will open for admissions in April 2021 with four specialised courses in disciplines of engineering and commerce.

These programmes have been designed

8

November 2020

VK Singh

As part of this collaborative effort, Cipla will be responsible for the marketing and distribution of the SARS CoV-2IgG antibody detection ELISA that will be manufactured by KARWA. ICMR has provided the requisite technological know-how and process for developing the test kits to the approved manufacturers.

The product will be marketed under the brand name ELIFast. Cipla’s expansive distribution network will help in ensuring the seamless supply of kits across the country. Supply will be undertaken through the channels approved by ICMR, to ensure equitable access.

ELIfast has been validated and approved

by ICMR and the National Institute of Virology (NIV), Pune. It is found to have specificity and sensitivity of 99.33 percent and 92 percent respectively. The kit is

user friendly with a simple protocol with ready-to-use reagents and is compatible

efficient diagnosis with low operating costs.

with common ELISA equipment.

The Ultrasound 3300 empowers caregivers to deliver efficient and high-quality care whilst supporting a variety of patients and case types across healthcare institutions.

The system is ergonomically designed to ensure high patient throughput and enhanced user and patient comfort.

Somerset Indus Healthcare India Fund to invest in SME companies

Somerset Indus Healthcare India Fund (Fund II), managed by Somerset Healthcare Investment Advisors (Somerset), an independent India-dedicated fund manager plans to make investments in SME companies in the Indian healthcare sector. Somerset is an upcoming fund manager that has demonstrated the ability to generate commercial returns by backing businesses that provide affordable healthcare solutions.

The government of India-backed National Investment and Infrastructure Fund’s NIIF Fund of Funds has committed to invest Rs 125 crore ($17 million) in Somerset Indus Healthcare India Fund II. Somerset’s second fund is an offshore entity domiciled in Mauritius. The fund is targeting to raise around $80 million. The PE firm is simultaneously raising $20 million for its Somerset Indus Healthcare India Fund, which is registered with the Securities and Exchange Board of India (SEBI).

The NIIF’s commitment is likely to help Somerset mark the final close of its fund by the end of the year, according to a person associated with the deal.

The fund will enable the provision of equity capital into the Indian mid-market segment allowing them to scale-up over a period of time. A large portion of the capital is expected to be channelled into sectors that have the potential for strong returns as well as high direct and indirect development impact.

Philips introduces Ultrasound 3300 system Royal Philips has launched the Ultrasound 3300, a new ultrasound series tailored for Obstetrics and Gynaecology (OBGYN), general imaging and cardiovascular imaging procedures.

Through this breakthrough technology, Philips offers clinicians and doctors in India a powerful combination of performance and workflow optimisation for quick and

The Ultrasound 3300, system delivers path-breaking features including Automatic Follicle Counting on 2D probes, which reduces cost for customers and improves throughput in clinic set-ups. Small private and public hospitals as well as private obstetrics and gynaecology clinics which are often challenged by a lack of funds, high waiting times, and space constraints will benefit from the capabilities of the Ultrasound 3300. The system also comes equipped with Nuchal Translucency (NT) Assist feature, which automatically measures the thickness of the nuchal translucency during first trimester scans.

This feature also helps in streamlining the workflow while helping to increase the reliability of the measurement. The Ultrasound 3300, offers the Auto Ejection Fraction feature, increasing the diagnostic confidence for cardiologists. It also comes equipped with the largest-in class 21.5inch LED.

Gland Pharma to float IPO

Gland Pharma has received capital markets regulator Sebi’s go-ahead to launch an initial public offer that includes a fresh issue of shares worth up to Rs 1,250 crore.

Apart from the fresh issue, there is an offer for sale (OFS) of a little over 3.4 crore shares as part of the initial public offering.

The Hyderabad-based company, backed

by China’s Fosun Pharma, develops, manufactures and markets complex injectables.

The company filed draft papers in July and obtained Sebi’s observation on October 19 to float an IPO. Sebi’s observation is necessary for any company to launch public issues like initial public offer (IPO), follow-on public offer (FPO) and rights issue.

Going by the draft papers, the IPO comprises fresh shares worth up to Rs

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9

NEWS ROUNDUP 1,250 crore and OFS of up to 3,48,63,635

supplements brand focused on vital human

Edappadi K Palaniswami inaugurated the

shares. The latter includes the sale of up

health areas including sleep, mood and

250-bed multi-speciality Fortis Hospital

to 1,93,68,686 shares by Fosun Pharma

stress, brain health, beauty and immunity.

in Vadapalani. This is Fortis Healthcare’s

Industrial, 1,00,47,435 shares by Gland

Founded in 1980, Natrol has grown to

second multi-speciality hospital in Chennai

Celsus Bio Chemicals, 35,73,014 shares

be the #1 natural sleep brand. Natrol is

city. Fortis Hospital in Vadapalani is

by

and

trusted by consumers across the globe and

nine-level building covering an area of

18,74,500 shares by Nilay Discretionary

has an established reputation for scientific

150,000 square feet and is designed to

Trust. According to investment banking

efficacy, high quality and innovation.

provide world-class healthcare services

Empower

Discretionary

Trust

sources, the IPO would be worth over Rs 5,000 crore.

for the highest quality products designed

New Mountain in agreement with Aurobindo Pharma

to drive positive outcomes and enhance quality of life for its users,” said Andre Moura, MD at New Mountain Capital. “We

New Mountain Capital announced that

it has reached a definitive agreement with Aurobindo Pharma to acquire Natrol and combine it with Jarrow Formulas, another New Mountain Capital portfolio company.

The transaction is expected to close by January 2021 subject to customary closing conditions and regulatory approvals.

Headquartered

in

Los

Angeles,

CA,

Natrol is a leading vitamin, minerals and

10

November 2020

“Throughout its history, Natrol has stood

thank Aurobindo for their stewardship of Natrol over the last six years, and we look forward to working closely with the

to the public of India. Dr C Vijaya Bhaskar, State Health Minister, Tamil Nadu was also

present

for

the

occasion.

The

ribbon-cutting ceremony was held in the presence of Fortis Healthcare MD and CEO Dr Ashutosh Raghuvanshi, government officials and Fortis Hospital leadership and staff.

management teams at Natrol and Jarrow

The new hospital features 75 ICU beds,

Formulas to build upon Natrol’s strong

six

momentum and drive continued growth

operation theatres and procedure rooms,

and market-leading innovation.”

along with emergency and casualty beds,

250-bed Fortis Hospital opens in Chennai

a state-of-the-art cath lab and a host of

Chief Minister of Tamil Nadu, Thiru

operation

theatres,

three

minor

other facilities. The radiology department features 3 Tesla MRI and for overweight

patients a wide bore to facilitate the ease

in

of scanning. The 256-slice dual-source CT

helping strengthen core public health

offers stunning scan time, with complete

response measures to contain coronavirus

reconstruction of underlying organs and

pandemic, the global health body said.

bone. The ultrasound machine offers liver elastography. The cath lab features the Azurion 7 M20 with a 20-inch detector suitable for cardiology, neurology and GI Procedures, along with inbuilt IVUS that is attached to a dedicated CCU.

Serum Institute, IAVI, Merck to develop COVID-19 treatment

Non-profit scientific research organisation IAVI, vaccine major Serum Institute of India and global science and technology firm Merck have entered into an agreement to develop monoclonal antibodies to fight COVID-19 and to ensure their prompt and equitable global access.

The agreement is “to develop SARS-CoV-2 neutralising monoclonal antibodies (mAbs) co-invented by IAVI and Scripps Research as innovative interventions to address the Covid-19 pandemic”, the partners said in a statement.

The agreement builds on the advanced antibody discovery and optimisation expertise of International AIDS Vaccine Initiative (IAVI) and Scripps Research, and on Germany’s Merck’s and Serum Institute’s significant capabilities in design and scale-up of accelerated manufacturing processes for mAb production, it added.

If the SARS-CoV-2 neutralising antibody candidates being advanced through this partnership are shown to be efficacious in clinical trials, either as a single antibody or a potential combination of both candidates, Merck will lead commercialisation in developed countries, the statement said.

Serum Institute will lead global manufacturing as well as commercialisation in low- and middle-low-income countries, including India, it added.

Polio networks can be effective in COVID-19 vaccination in SE Asia Region

Applying strategies from the polio eradication programme, polio networks

WHO

South-East

Asia

Region

are

In the coming months, the region’s polio networks

with

their

vast

knowledge

on vaccination and tools and strategies tailored to reach the unreached and the most vulnerable, could play a critical role for COVID-19 vaccination roll-out, Poonam Khetrapal Singh, Regional Director, WHO South-East Asia said in a statement.

Within weeks of the COVID-19 outbreak, the integrated surveillance and immunisation networks in five polio priority countries of the Region were re-purposed to support preparedness and response.

“Working among the most vulnerable population and areas, these networks are helping health authorities to ”detect, test, track, isolate and even prepare hospitals” to provide adequate and timely treatment,” Singh said.

From assisting coordination at the national and sub-national levels, to training and building capacities for laboratory and other health workers for detecting cases, tracing contacts, and assessing public perceptions to hospital readiness and preparedness, the WHO’s polio surveillance networks in Bangladesh, India, Indonesia, Myanmar and Nepal, are supporting with strategies and initiatives.

These initiatives have been refined over the years and helped the Region achieve polio-free certification in March 2014, the statement said.

Using polio micro-plans, the surveillance medical officers’ team in India’s Uttar Pradesh — the most populous state in the country–coordinated with the state government in a massive initiative of house-to-house surveillance to identify people with symptoms of influenza-like illness and co-morbidities, covering 208 million people across all 75 districts in the state.

The exercise conducted twice in the last three months, helped identify over

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11

NEWS ROUNDUP 1,00,000 people with symptoms each

in India and supported by Biotechnology

being at the forefront of the ongoing fight

time, who were then followed up and

ignition grant of Biotechnology Industry

against COVID-19 and prioritising clinical

tested for COVID-19, Singh said citing

Research

trials, generating data for their regulatory

one of the many examples of the polio

INVENT (DST) and Kerala StartUp Mission.

network’s support in India.

Kerala startup develops hand-held oral cancer screening tool

OralScan, an indigenously developed

hand-held imaging device for screening, detection and biopsy guidance of oral

Assistance

Council

(BIRAC),

The company recently received investment from Unicorn India Ventures.

Dr Harsh Vardhan launches clinical trials website ‘CUReD’

Dr Harsh Vardhan, Minister of Science

cancer has been developed by a startup in

& Technology, Health and Family Welfare

Thiruvananthapuram.

and Earth Sciences launched a website that gives comprehensive information about

The

startup,

Sascan

Meditech,

which

was incubated at TiMED, the Technology Business

Incubator

of

the

city-based

Sree Chitra Tirunal Institute for Medical Sciences & Technology, is launching the device, a press release said.

Oral Scan, a Make-in-India initiative with seed funding from the National Initiative for Developing and Harnessing Innovations (NIDHI) scheme of the Department of Science & Technology (DST), Government of India, was designed and developed entirely

12

November 2020

the numerous COVID-19 clinical trials that CSIR is engaged in a partnership with Industry, other government departments and ministries.

Called CuRED or CSIR Ushered Repurposed Drugs, the website provides information about the drugs, diagnostics and devices including the current stage of the trials, partnering institutions and their role in the trials and other details.

The minister lauded the efforts of CSIR for

approval and helping launch drugs and diagnostics in the market. He commended the approach of using repurposed drugs and also, synthesising COVID-19 drugs through new processes and transferring to Industry.

India Netherlands collaborate in e-health initiative

India and the Netherlands discussed

a joint thrust in the e-health sector with the purpose of providing digital health facilities and security to Indians and helping the Netherlands accelerate the digital transformation of health.

Part of India’s ambitious National Digital Health Mission (NDHM), this collaboration will see the two countries work closely to create capacities and put in place the requisite technology backbone to enable this revolutionary initiative, according to a statement.

The NDHM, unveiled by Prime Minister Narendra Modi on Independence Day, aims to create a mechanism to improve

Alembic Pharma arm inks pact with Curon

healthcare significantly and provide better

access to it.

said

The

statement

management Partners

was

consultancy

which

hosted

released firm a

by

Primus

web-based

workshop where the collaboration was discussed at length.

Lav Agarwal, Joint Secretary, Ministry of Health and Family Welfare said the Indian government has already embarked on a journey towards creating a national level

Drug

firm

its

associate

Alembic

Pharmaceuticals,

company,

has

Pharma Rhizen

entered

an

exclusive license agreement with Curon Biopharmaceutical for development and commercialisation of Tenalisib, used in treatment of cancer, in Greater China.

According Rhizen

to

a

regulatory

Pharmaceuticals

Switzerland-based

filing, is

a

privately-held

clinical-stage biopharmaceutical company,

Digital Health Ecosystem integrating into

and Curon Biopharmaceutical is a clinical-

its ambit a multitude of ongoing efforts.

stage

innovative

biopharmaceutical

company with a facility in Shanghai. “The National Digital Health Blueprint provides for the architectural approach

Under the terms of the agreement, Rhizen

towards realising the goal of longitudinal

will

electronic health record. A mission mode

cash payment and is eligible to receive

approach is being followed through the

additional development and commercial

launch of National Digital Health Mission

milestone payments with an overall deal

(NDHM) in that direction. The activities

value of $149.5 million (approx Rs 1,047

have already been embarked in selected

crore) plus double-digit royalties on annual

Union territories under the pilot phase,�

net sales of Tenalisib, Alembic Pharma said

he said.

in the filing.

receive

an

undisclosed

upfront

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13

NEWS ROUNDUP Alembic the

Pharma

exclusive

commercialisation

said

obtains

years in an innovation hub in Bengaluru.

2025, in which India plays an important

and

Currently, the company operates from

role as a growth market, the company said.

Tenalisib

rented space in Bengaluru and employs

Curon

development rights

of

for Greater China across all oncology indications.

around 2400 people at its R&D centre.

Gerd

Hoefner,

Senior

President

square meters of office space for the

and

Managing

enlarged R&D centre and 5,000 square

Development

that territory by leveraging its expertise

Director,

in

clinical

“Bengaluru is an ideal location for an

development and regulatory registration

innovation hub because of its strong

and its extensive research collaboration

innovation and healthcare ecosystems,

experience, to accelerate the development

coupled

of and regulatory approval of this product

institutions. The city offers a large talent

in Greater China, Alembic Pharma added.

pool who embrace digital with an open

Alembic

research,

Pharmaceuticals,

through

its

wholly-owned subsidiary, holds 50 per

Siemens

with

Healthcare

reputed

said,

educational

mindset and readily adapts to new ways of

working

with

of the new campus will include 70,000

Vice

It will lead the clinical development in translational

Center

When completed in 2025, the first phase

new-age

technology

meters of factory space. To create a modern work environment for the employees and to meet the highest standards in sustainability

and

energy

efficiency,

international architectural competition is planned to bring creativity into the design of the new campus.

The new campus at Bengaluru is the 4th

competences.�

innovation hubs of the company, with

Siemens Healthineers to build new innovation hub in Bengaluru

The innovation hub will be housed in a

other hubs located in the United States,

new state-of-the-art campus that will

Germany,

combine the existing R&D centre and an

hub at Bengaluru will include centres of

ultra-modern medical imaging factory. To

competence in digital technologies such

cent ownership in Rhizen.

and

China.

The

innovation

Siemens Healthineers, the German

expand its digital capabilities, the company

as data analytics, artificial intelligence,

medical device manufacturer said that

plans to add up to 1,800 digital talents

immersive technologies like augmented

the company plans to invest Rs 1,300

over the next ten years. The investment

and virtual reality, user experience, and

crore (EUR 160 million) over the next five

is part of Siemens Healthineers’ strategy

cybersecurity.

14

November 2020

Wipro GE Healthcare appoints Dr Shravan Subramanyam

Medical technologies and services

giant Wipro GE Healthcare said that Dr Shravan Subramanyam is its new President & CEO, GE Healthcare India & South Asia and Managing Director, Wipro GE Healthcare. He succeeds Nalinikanth (Nal) Gollagunta who will be taking up a

GE holds 51 per cent stake in Wipro GE Healthcare, while the balance is with Wipro. Wipro GE Healthcare, a distributor of 85 per cent of GE’s various healthcare and medical diagnostic products in India, was merged with GE Healthcare in 2009.

Earlier, Dr Subramanyam was with Roche Diagnostics where he was the Managing Director, India and neighbouring markets,

new role as the Global Chief Operating

responsible for commercial operations,

Officer (COO) of the GE Healthcare Digital

market access, customer experience and

organisation post-transition.

digital transformation efforts.

Dr Shravan Subramanyam

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15

HEALTH-IT

Why IMA Does Not Like the NDHM In this 2-part series IMA tells us why it disagrees with the NDHB document on digital health ecosystem, recommends a slew of measures for the healthcare sector in data privacy, policy changes and personal health record, which can be a key enabler of health information exchange

Dr Rajan Sharma, President IMA National Hony Secretary General IMA

Dr R V Asokan, President IMA National Hony Secretary General IMA

The key principles of citizen centricity, quality of care, better access, universal health coverage and inclusiveness are defined in the National Health Policy 2017 and continuum of care is the concept strongly advised. The National Digital Health Blueprint (NDHB) envisages a holistic, comprehensive and interoperable digital architecture which is drafted and adopted by all the stakeholders. The document also wishes to create a national digital health ecosystem managed by a specialised organisation called the National Digital Health Mission (NDHM). The NDHB document published by the Government of India consists of an ambitious plan to bring a digital ecosystem consisting of a digital health network under NDHM. IMA, however, does not favour the content of the NDHB document, its roll-out plan and the administrative mechanism and the opinion is based on the following contentions.

India still lacks adequate healthcare

16

November 2020

infrastructure and manpower and there is no standardisation of many streams of treatment adopted in our country.

The government is adopting strategies to allow untrained and partially trained individuals to practice medicine to address the manpower shortage.

Infrastructure deficiencies have not been addressed. Strategic purchasing through Ayushman Bharath ( PMJY) has not made any impact due to lack of adequate fund allocation and nonempanelment of tertiary care hospitals due to unrealistic package rates.

Primary care has lost focus and the proclaimed wellness centres are yet to make an impact. Apart from this, there is a skewed distribution of medical training infrastructure.

Primary care, strengthening of public health infrastructure and the HR as well as addressing the social determinants of health are IMA's priority. Funding for such an ambitious plan is not appropriately described and any

diversion of funds from NHM will further jeopardise the public-funded healthcare, especially the primary care.

Hence, there is a possibility of the plan becoming a non-starter if investments in healthcare is not significantly increased. Out-of-pocket expenditure in healthcare will increase further in such a situation. Privacy is of utmost concern as privacy protection laws in India are weak and practically non-existent.

Privacy is being ensured through consent managers in NDHB, where the consent through the digital platform in a country where literacy is low, is a cause of concern and the consent mechanism described in the document is inadequate.

Accessibility of health documents to treating doctors is not well defined and medical records are considered to be a document equally owned by the treating doctor, patient and the institution with right of accessibility to remain with all the three. The concepts of data ownership, erasure etc described in the document violates this principle and is objectionable.

The management of analytical data will be governed by data-protection laws which are practically non-existent at present. The NDHM, stemming from the National Health Policy of 2017, is purported to digitise the entire healthcare ecosystem in India. The selfproclaimed guiding principle of the NDHM is 'Security and Privacy by Design' to protect an individuals’ data privacy. It is paramount to see whether the principle satisfies the test of Right to Privacy of the stakeholders under the Act, including, but not limited to, patients and their family members

Data protection is another area of grave concern. Apart from the issue of privacy, management of analytical data by the agency is poorly defined in the document.

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17

INTERVIEW

Our Approach is to Provide Access to Healthcare Ecosystem Devang Mody, CEO, Bajaj Finserv Health, talks about the new venture by Bajaj Finserv into the health tech biz, its growth prospects and how it will provide a comprehensive solution in the healthcare ecosystem, in an interaction with Sanjiv Das has created an opportunity for a health tech business, for example, telemedicine has

seen

a

massive

growth

and

is

expected to reach $5.5 billion by 2025.

It’s also expected that around 20 percent of the healthcare ecosystem will shift to virtual care, tele consultation, home visits etc. This pandemic has accelerated the adoption rate of technology in healthcare, like what happened to digital payments during demonetisation.

Bajaj Finserv has recently ventured into the health tech biz. Tell us more about the new venture?

The health sector is disaggregated today with service providers – practitioners, diagnostic companies, that

healthcare

the

essentially

living in this new reality of COVID-19, a reality that none of us had prepared for.

The unique challenges unleashed by this pandemic, pushed us to quickly adapt to the ‘new normal’ and transform the way we work, learn and live. This health crisis

18

November 2020

there

We

existing

all

believe

ecosystem

India-centric are

loan

providers,

independently.

While

It has been seven months since we started

pharmacies,

insurance

working an

How has the health tech business evolved in India during the COVID-19 pandemic?

centres,

needs

solution. players

offering solutions in certain parts of the healthcare ecosystem, there is a wide opportunity for a large group like ours who are entering this space and enabling connected healthcare solutions to improve the patient outcomes. Today, access to quality and affordable healthcare is what the consumers are looking for and that’s where we are striving for.

Bajaj Finserv Health is a health management

platform that integrates service providers and enables personalised healthcare solutions to consumers, with the help of technology and data. Our research tells that much of the healthcare expenditure comes out-of-household pockets, which adds to the financial and emotional stress factors. We saw a problem that we could help solve and launched this new venture to improve the health outcomes of consumers by changing their behaviour from being reactive to proactive towards healthcare. Under Bajaj Finserv Health, we have launched ‘Aarogya Care’ an industry-first, one-of-a-kind, personalised, preventive, prepaid healthcare solution.

‘Aarogya’ means ‘good health and wellness’ and ‘Aarogya Care’ is our India-centric holistic approach towards solving the country’s health needs. We believe that attending to healthcare needs goes way beyond just visiting a clinic or getting access to healthcare facilities or having an insurance cover.

How is it going to impact the company's growth prospects?

Today, we stand at the forefront of a technological revolution and the health crisis that we were thrown at, a few months back, created an opportunity to build and live a digital-first environment.

Consumers are looking for preventive healthcare with easy accessibility. With Bajaj Finserv Health, we are focussed on integrating the inter-connected yet disassociated service providers of the health ecosystem all under one roof, so that customers’ pain of accessing their services are taken care of. Because at the end of the day, all these services are complementary to each other. And, that’s where Bajaj Finserv Health is going to operate, to provide a comprehensive solution in the health ecosystem. It will also create a provider network of doctors, diagnostic labs and hospitals.

What are your plans to reach out to the masses? How affordable will be the health packages?

Today, we are living in a connected world, where a digital-first experience in availing primary healthcare services is the need of the hour. Through a consumer

Devang Mody, CEO, Bajaj Finserv Health first, digital approach, Bajaj Finserv has always tried to explore, understand and deliver innovative solutions to serve the unmet financial needs of Consumers in an increasingly ‘phygital’ world.

So, we understand customers and their needs and challenges. Bajaj Finserv Health is into the health-tech space, where, using advanced technological capability and quality provider network, we bring affordable, accessible and personalised healthcare delivery closer to our Indian customers.

With how many hospitals did you tie-up with?

Currently,

Bajaj

Finserv

Health

has

presence in 232 hospitals distribution points with 189 partnerships and 671 lab distribution points with 3 partnerships.

Which technologies have been used for this new venture?

Technology adoption would have been our biggest challenge before COVID-19. Now, in this post COVID world, technology

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19

INTERVIEW adoption has become a must. Government policies and frameworks are also helping in giving this a meaningful direction. Timely issuance of tele-medicine guidelines helped remove ambiguities for what is allowed and not allowed. We are trying to make our solution extremely easy to use and ensure it solves a real problem for our partners and customers. Our technology solution is mostly homegrown with mobilefirst and fully on cloud. Our application development is on MERN stack giving us both performance and agility.

DevOps process is fully followed with all tools from Azure.

For e.g, we use Azure API gateway to secure and manage all APIs, use AKS to deploy, scale and manage docker containers. QA for mobile apps is done on third-party cloud device farms to test compatibility across a variety of devices. Our product and solutions are built to be data-driven from day one. We are investing heavily to use data to personalise our product offerings and app journeys. Just to give e.g. our PHR (Patient Health Record) on app enables text search within prescriptions and lab test reports uploaded as images making it easier for our customers to quickly retrieve the document stored.

20

November 2020

Tell us more about your business model?

Our approach is to provide access to the healthcare ecosystem. We have a trusted network of providers, which includes doctors, diagnostic labs and hospitals.

We will have various products to service consumers, right from covering doctor consultations to yearly preventive health tests to hospitalisation. With the help of data management tools, we intend to offer personalised products to consumers. Our product suite will also include a healthcare management application which will allow consumers to interact with healthcare providers.

Through

our

mobile

app,

customers can maintain health records digitally, which would be integrated with National Health ID.

What are your plans for the next five years?

While the healthcare market is huge, at the same time, it’s extremely complex, primarily because of its fragmented nature.

Long-term opportunities can be sizable, and we are focussed to create seamlessly consumer experiences and develop a meaningful network of providers.

In the next three to five years we would like to create a network of 2,00,000 doctors; 10,000 laboratory points; 4,000 hospitals; cater to more than 2 million consumers digitally and reach cashless healthcare spends of Rs 500 crore

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21

COVERSTORY

On the Road to Recovery

Encouraging trends ahead for healthcare volumes and margins ICRA Report

22

November 2020

T

he first confirmed case of the coronavirus infection in India was recorded on January 30, 2020 in the state of Kerala. In matter of months, the whole country

came under the clutches of COVID-19.

Restriction on movement and the fear of unknown brought life to a grinding halt. What followed next was a fight to survive, not only from a life threatening disease but also from an unknown economic landslide.

The report had looked at private healthcare providers in India.

Interestingly, 74 hospital groups contribute to 20 per cent of sector revenue and 17 diagnostic chains contribute 15 per cent of diagnostic sector revenues

operations and invest in additional materials, equipment and manpower to ensure treatment of COVID patients.

In addition, constantly changing rules for covid-19 patient management drew increasing concern from hospitals.

Occupancy levels were low due to the lockdown. A report published in late June by FICCI said that the occupancy levels at hospitals fall to a mere 40 per cent by late-March as compared to pre-COVID occupancy levels of around 65-70 per cent and expected to reduce

To survive companies took to measures

further. Similarly, the diagnostic labs

that

upon.

saw 80 per cent fall in patient visits

Work-from home became a norm and

and revenue. The report had looked

pay

at

were cuts,

earlier

frowned

cost-cutting

became

the

strategic tool to stay in business. In this environment, hospitals too struggled to stay in the business of serving patients.

Struggling Phase The

healthcare

providers

in

contribute to 20 per cent of sector revenue

and

17

diagnostic

chains

contribute 15 per cent of diagnostic sector revenues.

providers

Research body ICRA has said occupancy

unprecedented

plunged across all the players in the

challenges. While they battled with

sector due to lockdown, restrictions

significant drop in patient footfalls,

on

elective

suspension

in

healthcare

private

India. Interestingly, 74 hospital groups

India

delivery

witnessed

surgeries

and international

patients, they were expected to continue

the

movement of

of

people

international

and

flights.

This was compounded by the cautious

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23

COVERSTORY approach adapted by patients as well as hospitals due to fear of infection. There was a sharp drop in OPD footfalls, and postponement of elective surgeries also led to low occupancy levels.

Recovery Trends Experts predict that healthcare delivery will bounce back with a 20 per cent growth in revenues in the next two years. ICRA Ratings expects the long-

The research body said that the average

term outlook of the healthcare sector to

occupancy

ICRA’s

remain ‘stable’ despite its performance

sample set dropped from 59 per cent in

being recently affected due to COVID-19.

of

companies

in

Q1 FY2020 to 37 per cent in Q1 FY2021 and the average revenue per occupied bed (ARPOB) fell by ~1 per cent in Q1 FY2021.

Revenue and Operating Margins The decline in revenue reflected the same trend. The companies in ICRA’s sample set reported a 39 per cent decline in revenues and posted EBITDA

The occupancy of private hospitals is expected to bounce back substantially, to 60 per cent in FY2022, from the projected occupancy of 52 per cent in FY2021. Due to this the revenue growth is estimated to rise to ~20 per cent in FY2022, against an expected contraction of ~19 per cent in FY2021, aided by a lower base.

loss of Rs 231 crore in Q1 FY2021,

Amongst

against an EBITDA of Rs 620 crore in Q1

critical ailments such as oncology and

FY2020. Similarly, the operating margin

cardiology have seen faster recovery

fell from ~14 per cent to ~ - 9 per cent

from

during this period.

has been lagging during this period.

As a result of this, cost optimization took centre stage. ICRA report said that hospitals cut costs to the extent of 15~ 20 per cent and the largest cost rationalisation happened in doctor and employee expenses, which is the largest cost for hospitals.

November 2020

the

the

lows

various

while

specialties,

orthopaedics

Additionally, emergency and trauma as well as mother and child departments have been relatively resilient although lower traffic flows have impacted even the emergency and trauma revenues to an extent.

In fact, the credit risk profile of most of

Occupancy- Trend and Expectation

24

Experts also say that the healthcare providers have adequate capacities and are expected to go slow on capex to conserve cash and focus on better utilisation of existing facilities.

Source: ICRA Research

Trend in Quarterly Revenue and EBITDA

Source: ICRA Research

the hospitals have been improving over

upgraded two entities and downgraded

the last two years. Experts also say that

one (credit ratio of 2). The credit risk

the healthcare providers have adequate

profile of entities in the sector had

capacities and are expected to go slow

been on improving trajectory over the

on capex to conserve cash and focus on

last two years and notwithstanding the

better utilisation of existing facilities.

near-term disruption, as well as given

Industry watchers believe that there has

been

significant

improvement

in

sequential

occupancy

every

month after the sharp fall in April and majority of the players are expected to back in operating profits, starting from the month of August; after reporting EBIDTA losses in Q1 and July.

the essential nature of the services, the sector will report a speedy recovery.

Future Outlook It is interesting to note that the ARPOB and margins from the treatment of COVID-19

patients

is much lower than that of electives. In

The trend of pent-up demand is seen as

fact, the margins from

a positive and is likely to support the

COVID-19

performance, as elective procedures

were further impacted

cannot

due to the price caps

be

domestic

delayed as

well

indefinitely, as

by

international

patients, experts say.

According significant

to

state

ICRA

capex

placed

research,

in

the

last

patients

by

certain

governments.

the

Nonetheless,

the

five

contribution

margin

years has started contributing to the

from

profitability and the capex as well as

COVID-19

start-up costs of new hospitals are

has been positive and

likely to be much lower going forward,

it has cushioned the

which will also aid profitability and

pressure on profitability during these

debt protection indicators over the

challenging times due to a sharp drop in

medium term.

electives and medical tourism.

In

FY2020,

ICRA

upgraded

seven

The

treatment

ICRA

of

Trend in additions in bed capacity

patients

report

points

Source: ICRA Research

out

that

ratings and downgraded four (credit

the aggregate bed capacity of the

ratio of 1.75) and in FY2021 YTD, it has

companies in the sample set was flat,

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25

COVERSTORY at ~24,600 beds compared to a CAGR bed addition of five per cent (addition of ~4600 beds) over the last four-year period. The trend of slow capex is likely to continue as players have adequate capacity for growth over the medium term and the focus is on conserving cash while also improving utilisation of existing facilities.

The aggregate net debt of companies in sample set reduced from Rs 9362 crore as on March 31, 2019 to Rs 9130 crore as on March 31, 2020 and even in Q1 FY2021, despite the cash losses, the net debt reduced marginally, to Rs 9110 crore as on June 30, 2020, due to healthy collections from the institutional clients and payable management. The Net debt/EBITDA improved from 3.15x as on March 31, 2019 to 2.14x as on March 31, 2020 while the Net cash

26

November 2020

accruals/net debt improved from 19 per cent to 32 per cent during this period.

According

to

ICRA,

over

the

medium to-long run, the demand for healthcare services are expected to continue to rise steadily, given the underlying

fundamentals,

including

a growing population, increasing life expectancy, rising incidence of noncommunicable

lifestyle

diseases,

growing per capita spend, increasing penetration of health insurance and a double-digit rise in medical tourism (excluding the impact of COVID-19).

On the supply side, India currently faces a significant shortage of beds and Government investments towards the hospital bed addition are limited. This provides private sector players with the opportunity to step in to fill the gap.

The Net debt/EBITDA improved from 3.15x as on March 31, 2019 to 2.14x as on March 31, 2020 while the Net cash accruals/net debt improved from 19 per cent to 32 per cent during this period.

APPROACH

Decentralised Approach to ‘Chase the Virus’ Health and Family Welfare, Govt of Assam has taken several proactive measures in recent months to contain the spread of coronavirus, the latest initiative being COVID Screening & Counseling Centre’ (CCC). The article gives an insight on how CCC is a win-win situation for both patients and healthcare workers

Dr Dipjyoti Deka, State Programme Manager National Health Mission, Assam

Post-May 2020, the state of Assam witnessed a surge in the overall number of COVID-19 cases. Many cases were reported where positive patients had limited or no travel history. To curb the spread of the virus, the Health Department of Assam with active community participation decided to decentralise the COVID care management by taking COVID care services at the doorstep. The step ensured that maximum people get the testing facility at their doorstep thus preventing the virus spread from going out of control.

Description of the model Assam has been successfully managing COVID-19 pandemic by adopting multipronged COVID response strategies, namely 3 Ts – Testing, Tracing, Treatment. Various activities ensured the availability of sufficient logistics, gap-filling of different health facilities, the involvement of private hospitals in managing non-COVID cases, training of staff engaged in COVID care. The health ministry also ensured active community and support from frantline workers, providing psychological support to patients, massive IEC campaign, safety

Dr Biraj Kanti Shome, Consultant (Health Systems), WHO-India

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27

APPROACH

net initiatives, implementation of ‘ruthless quarantine with human heart’ and ramping up the testing and support from the development partners.

The concept of ‘Ruthless quarantine with human heart’ ensured that whoever enters the state by any mode of transport (air/railway/road) needs to be quarantined and tested before s/he is allowed to move further. Based on the test report, either s/he is admitted at a hospital (if positive) directly from the quarantine centre or is suggested strict home quarantine for the residual number of days out of the 14 days of the quarantine period.

Under the decentralization process, the health department decided to start a “COVID Screening & Counseling Centre (CCC)”. Accordingly, for all the 31 wards of Guwahati city and other towns (in a phased manner), CCCs started functioning either at existing urban state dispensaries or at a suitable school.

The CCC is led by a medical officer, GNM, ANM, lab technician, pharmacist, DEO

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November 2020

and identified urban ASHAs. Any citizen of the ward (irrespective of the medical condition) can visit the CCC to give swab to know about the COVID status. Once the swab is collected, citizens are told to stay at home until the report comes out. The data entry operator (DEO) at CCC maintains the proper database of individuals providing the swab samples which are then sent to the designated testing centre. The CCC-wise report of samples is sent to the respective CCC in-charge, who in turn informs the family member of anyone being COVID positive. If any member is found positive, the rest of the members are asked to visit the CCC next morning to provide swab samples. If any member of the concerned family is too ill or aged, the lab technician from the CCC visits the household to take a swab of the ill or the aged person. The positive individual is sent to the COVID hospital based on the condition of the patient by an ambulance, attached to the CCC. The CCC works from morning 8 am to afternoon daily. The medical team is led by a medical officer and the medical

team counsels the individual. Based on the symptoms, supportive symptomatic medicines are provided. Each of the CCCs is provided with two ambulances, which are used for smoothly managing activities, including shifting of positive cases to COVID hospitals. Once a patient is taken to the hospital, the medical officer attached to the CCC ensures that the ambulance is properly sanitised, before it goes out for the next trip.

The medical officer with the support of school teachers arranges a swab collection corner. Lab technicians with proper PPE gear ensure that they are not exposed to the virus. The health department has undertaken a wide media campaign to ensure that the initiative reaches to larger masses and common man can avail the services.

Capacity building strategy The orientation of COVID-19 testing and counselling to manage patients visiting CCC is being provided before they are sent to the field. The initiative has been proved to be beneficial, as voluntary testing increased manifold, which helped the health department find many positive cases on time, isolating them for treatment, which otherwise would have led to the spread of the virus leading to many more

getting infected. The initiative has also helped to instil confidence among the community members over the fact that the government is concerned about its citizen’s health and safety.

Earlier, when cases were handled centrally from the district headquarter, various issues cropped up while trying to identify a COVID positive patient.

Also, a host of challenges were faced while shifting a patient to the COVIDdesignated hospital. Things changed as CCC in each ward ensured that the positive patient can be isolated easily and sent to the designated hospital more easily. The general public seems to be satisfied with the government’s initiative as the travel time to go for tests has come down drastically without standing in long queues in COVIDdesignated hospitals.

The health department has invested monetarily to train its staff, supply additional logistics for testing, transporting swab, patients, and other miscellaneous expenditure of managing the CCC. Though this is primarily an initiative of the Government of Assam, partners like the World Health Organization (WHO), Jhpiego, UNICEF, Piramal Swasthya have also supported the government’s initiative.

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INNOVATION

Top 10 Medical Marvels to Look Out for in 2021 The annual round-up of new technology and promising medical innovations that will make healthcare delivery more advanced Team IMT

Innovation in healthcare is enhancing medical care daily. Corona virus pandemic has dramatically changed the overall scenario in healthcare delivery.

To overcome this crisis, healthcare needs new innovations in technology, product and process delivery. The ultimate goal of health innovation is to improve the healthcare needs and demands by optimising the performance of the health system. A unique gene therapy for blood disorders, a new class of medications for cystic fibrosis, increased access to telemedicine and many more such innovations are waiting to be used to enhance patient care.

Cleveland Clinic, a non-profit multispecialty academic medical centre

30

November 2020

that integrates clinical and hospital care with research and education, has unveiled top 10 medical innovations for 2021. A panel of clinicians and researchers from Cleveland Clinic looked a new set of innovations which will enhance new healthcare innovations and change the scenario of treating diseases in a new ways in the coming years. The list of breakthrough technologies were selected by a committee of Cleveland Clinic led by Will Morris, Executive Medical Director, Cleveland Clinic Innovations and Akhil Saklecha, Managing Director, Cleveland Clinic Ventures. Let us take a glance at each of the 10 innovations and how these innovations will have an impact on the overall healthcare delivery.

• Gene Therapy for Hemoglobinopathies • Novel Drug for Primary-Progressive Multiple Sclerosis • Smartphone-Connected Pacemaker Devices • New Medication for Cystic Fibrosis • Universal Hepatitis C Treatment • Bubble CPAP for Increased Lung Function in Premature Babies • Increased Access to Telemedicine through Novel Practice and Policy Changes • Vacuum-Induced Uterine Tamponade Device for Postpartum Haemorrhage • PARP Inhibitors for Prostate Cancer • Immunologics for Migraine Prophylaxis Gene Therapy for Hemoglobinopathies The innovations are in gene therapy for hemoglobinopathies, a novel drug for primary-progressive multiple sclerosis, smartphone-connected pacemaker devices,

medication for cystic fibrosis, universal treatment for hepatitis c, bubble CPAP for increased lung function in premature babies, increased access to telemedicine through a novel practice and policy changes, vacuum induced uterine tamponade device for postpartum haemorrhage, PARP inhibitors for prostate cancer and immunology for migraine prophylaxis.

Hemoglobinopathy, a medical term for a group of blood disorders and diseases that affect red blood cells, can be due to genetic defect that results in abnormal structure of one of the globin chains of the haemoglobin molecule. Haemoglobinopathies are inherited disorders, usually autosomal recessive. Cleveland scientists has selected the latest gene therapy for hemoglobinopathies which has showcased how patients suffering from the genetic disorder have the potential ability to make functional haemoglobin molecules. This will eventually help to reduce the presence of sickled blood cells or ineffective red blood cells in thalassemia to prevent associated complications.

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INNOVATION Novel Drug for Primary-Progressive Multiple Sclerosis The second innovation is a novel drug for primary-progressive multiple sclerosis. In multiple sclerosis, the immune system attacks the protective sheath (myelin) that covers nerve fibres and causes communication problems between the brain and the rest of the body resulting in communication problems between the brain and the rest of the body that can result in permanent damage or deterioration and eventual death. Approximately 15 per cent of people with MS experience a disease subset known as primary progressive, characterised by gradual onset and steady progression of signs and symptoms. The novel FD approved drug, the therapeutic monoclonal antibody with a novel target is the first and only MS treatment for the primaryprogressive population.

Smartphone-Connected Pacemaker Devices Pacemakers are saviours for those who have abnormal heartbeats. It delivers electrical impulses to the heart muscle

32

November 2020

chambers to contract and pump blood to the body and are used to prevent or correct arrhythmias – heartbeats that are uneven, too slow or too fast and remote monitoring of these devices is an essential part of care.

Many patients use pacemakers but are unaware about the basic understanding of the device or how it functions.

Bluetooth-enabled pacemaker devices can remedy these issues of disconnection between patients and their cardiac treatment. Used in conjunction with a mobile app, these connected devices allow patients greater insight into the health data from the pacemakers and transmit the health information to their physicians.

New Medication for Cystic Fibrosis Cystic Fibrosis (CF) is a hereditary condition characterised by thick, sticky mucus that clogs airways and traps germs, leading to infections, inflammation and other complications.

It is also caused by a defective cystic fibrosis transmembrane conductance regulator (CFTR) protein. A new combination FDA-approved drug, provides relief for patients with the

most common CF gene mutation (F508 del) – estimated to represent 90 per cent of individuals living with the disease.

Universal Hepatitis C Treatment Hepatitis C as we all know is a silent killer and has emerged as a major health issue across the world. Infection with the hepatitis C virus can lead to serious, life-threatening health problems like liver failure, cirrhosis and liver cancer.

The fifth in line innovation is a new, approved fixed-dose combination medication that has improved hepatitis C treatment. More than 90 per cent effective for hepatitis C genotypes one through six, the therapy represents an effective option for a wider scope of patients.

Bubble CPAP for Increased Lung Function in Premature Babies Babies born prematurely need special care since birth including ventilation for those with infant respiratory distress syndrome (IRDS). Infants are commonly administered surfactant during mechanical ventilation, a practice that can cause lasting lung

injury in preterm infants and contribute to the development of chronic lung disease. The sixth innovation is b-CPAP, a non-invasive ventilation strategy – delivering continuous positive airway pressure to the newborn to maintain lung volumes during exhalation.

The oscillating, rather than constant pressure, plays a role in its safety and efficacy, minimizing physical trauma and stimulating lung growth when administered over a prolonged period.

Increased Access to Telemedicine Telemedicine has been playing a proactive role and has become a major connection between the doctors and patients. COVID-19 has opened a new door to telemedicine which has seen a jump in online consultations. Since March, state and federal regulators in the US have moved quickly to reduce barriers to telehealth, understanding that these new tools can speed access to care while protecting healthcare workers and community members.

These policy change measures have opened the floodgates for telehealth, allowing for new programmes and the expansion of existing networks.

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INNOVATION

Vacuum-Induced Uterine Tamponade Device

The disease has become the second

Postpartum haemorrhage is a devastating complication of childbirth, affecting from one to five percent of women who give birth. Mothers experiencing postpartum haemorrhage may require blood transfusions, drugs which may cause dangerous side effects, long uncomfortable procedures, and even emergency hysterectomy with loss of fertility. Non-surgical interventions directed at the site of bleeding has been limited to balloon devices that expand the uterus while compressing the site of bleeding. The eighth innovation is on the new advancements in vacuum-induced uterine tamponade – a method that uses negative pressure created inside the uterus to collapse the bleeding cavity causing the muscle to close off the vessels. The vacuum-induced device represents another minimally invasive tool for clinicians as they treat the complication and provides a low-tech solution that is potentially translatable to developing countries with low resource availability.

US. The ninth innovation is in the field

PARP Inhibitors for Prostate Cancer

activity of a molecule called calcitonin

Prostate cancer is common with one in nine men diagnosed with the disease.

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November 2020

leading cause of death for patients in the of PARP inhibitors – pharmacological inhibitors for cancer treatment. It blocks proteins called PARP that helps repair damaged tumour DNA in people with BRCA1 and BRCA2 gene mutations.

Though known for their success in women’s cancers, two PARP inhibitors have

been

demonstrated

to

delay

the progression of prostate cancer in men with refractory cancer and DNA repair pathway mutations. Both were approved for prostate cancer in May 2020.

Immunologics for Migraine Prophylaxis Migraine purpose

affects drugs

medications,

many like

and

blood

multi-

pressure

antidepressants,

anti-

seizure drugs and Botox injections have been used to prevent attacks.

However, the results were mixed. In 2018, new medications were developed to help head off migraine pain. The class of drugs works by blocking the gene-related

peptide

(CGRP),

spikes during a migraine.

which

Actively prescribed in 2020, this new FDA-approved class of medication is the first to be specifically designed for the preventive treatment of migraine, marking a new era of migraine therapeutics

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November 2020