Express Healthcare April, 2014

VOL.8 NO.4 PAGES 102

Cover Story Agenda for the next PM Strategy The future of healthcare: The hospital comes home In Imaging Bridging the gap with MRI & USG

www.expresshealthcare.in APRIL 2014, `50

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CONTENTS Vol 8. No 4, APRIL 2014

Chairman of the Board Viveck Goenka Editor Viveka Roychowdhury* Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale Usha Sharma Raelene Kambli Lakshmipriya Nair Sanjiv Das

Bridging the gap with MRI & USG Innovative fusion, MRI+ultrasound: a new hybrid imaging modality is quickly gaining ground among radiologists.

An analysis about the challenges and prospects of the technology | P54

Delhi

MARKET

16

DRÄGER LAUNCHES EVITA V300 AT CRITICARE 2014

17

MEDICAL ELECTRONICS MARKET IN INDIA TO GROW TO $11.7 BN BY 2017

18

THE MISSION HOSPITAL, DURGAPUR TO SET UP CANCER UNIT

19

ERBA LAUNCHES NEW PRODUCTS AT ARAB HEALTH EXHIBITION

20

SOMAIYA AYURVIHAR-ASIAN INSTITUTE OF ONCOLOGY OPENS IN MUMBAI

Shalini Gupta DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro

21

Chief Designer

SEMINAR @ SYMBIOSIS

Pravin Temble Senior Graphic Designer

22

HEALTHCARE INDUSTRY LEADERS OUTLINE VISION FOR FUTURE OF HEALTHCARE

24

INDUSTRY INTROSPECTS AT HEALTHCARE & PHARMA EXPANSION SUMMIT 2014

25

INTERVIEW: JULIE GRAY

Rushikesh Konka Artist Vivek Chitrakar Photo Editor Sandeep Patil MARKETING Deputy General Manager Harit Mohanty Assistant Manager

STRATEGY

KNOWLEDGE

41

THE FUTURE OF HEALTHCARE: THE HOSPITAL COMES HOME

46

PATIENT-CENTRIC EMERGENCY CARE: NEED OF THE HOUR

42

‘INTERVIEW: DR CAMILLA RODRIGUES

50

INTERVIEW: DR GERALDINE ROEDER

44

NTERVIEW: DR GULLAPALLI N RAO

51

INTERVIEW: DR KOTARO YOSHIMURA

45

‘INTERVIEW: BISWARUP GHOSH

52

INTERVIEW: PATRICK R MURRAY

Kunal Gaurav PRODUCTION General Manager B R Tipnis Manager

IT@HEALTHCARE

74

MAINTAINING ELECTRONIC MEDICAL RECORDS: A MUST FOR HOSPITALS

74

Bhadresh Valia Sr. ExecutiveScheduling & Coordination Rohan Thakkar CIRCULATION Circulation Team Mohan Varadkar

Express Healthcare Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045. Printed for the proprietors, The Indian Express Limited by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright @ 2011 The Indian Express Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITOR’S NOTE

Policy primer for the next PM

A

s the nation gears up to choose

the brain drain to other countries. One of the

the next government and

long term suggestions is that we have to build an

weighs each Prime Ministerial

ecosystem to develop doctors by focussing not

candidate, Express Healthcare

just on clinical care but research and academic

asked key industry stakeholders

work as well.

to make a short-list of healthcare priorities that

These are but a gleaning of some of the thoughts

need urgent attention.

expressed in this issue's cover story. We hope that

The 16th PM will be relieved that India was

most of these find a place in the PM's action plan for the healthcare sector.

recently declared polio free but the latest WHO report of global immunisation data shows just how

Though the sector has never got its due, private

much still needs to be done. India tops the list of the

equity (PE) players have realised it worth. A

12 countries which are home to 70 per cent of the world’s 22.6 million unimmunised children. According to data from WHO and the Global Alliance for Vaccines and Immunisation (GAVI), 6.9 million children in India went unimmunised in 2012, and the numbers are sure to be as shocking today as well.

The healthcare leaders featured in this edition recognise the challenges and offer some very clear solutions. Awarding industry status to healthcare

The government needs to create a policyframework to meet the healthcare needs of every Indian citizen

recent report from research and consulting firm GlobalData points out that though global PE flow into healthcare decreased significantly in the last few years (from $57.7 billion in 2007 to $19.8 billion in 2013), there is growing interest in emerging markets, such as India and China. No doubt this is because of the sluggish economic revival in developed economies as well as budget cuts and healthcare reforms.

has been a long standing demand as has been

But our netas should remember that money goes

the urge to increase fund allocation. Public private

where it can grow. The GlobalData report analyses

partnerships (PPPs) are the way forward but most

that in just two years, from 2011 to 2013, the

in India have been non-starters. There are some

volume of healthcare PE investment in the Asia-Pa-

suggestions on how transparency and trust can be

cific region has increased by a massive 125.8 per

increased on both sides and policy makers should

cent. Most of the high value deals may be driven by

try to weave these into the framework.

the pharma segment but we've seen quite a few in-

Diagnostics and medical devices are a key part of

vestments on the healthcare service provider side

healthcare delivery but the grouse of major players

as well, such as clinics (eye care and dental chains).

is that until now, they have not been part of the

PE investors seem to be going for asset-lite

policy making process. So too the wellness segment

models with clear revenue streams. This is where

and with quite a few leaders asking for a shift in focus

the moolah is but it is but a slice of what the

from curative to preventive healthcare, this aspect

country needs. The Indian Government needs to

too should be a vital part of any health policy.

create a policy framework to meet the healthcare

On the incentives and subsidies side, industry

needs of every Indian citizen. After all, it was Ma-

would like sops like reduction in customs duty on

hatma Gandhi who said, “It is health that is real

medical equipment as well as tax holidays for new

wealth and not pieces of gold and silver.”

hospitals in tier 2 and 3 cities.

14

Almost every leader mentions the sheer lack of

VIVEKA ROYCHOWDHURY Editor

quality manpower, especially paramedical staff and

viveka.r@expressindia.com

EXPRESS HEALTHCARE

April 2014

LETTERS QUOTE UNQUOTE

“The current healthcare systems of countries would become unsustainable soon if they continue to function as they do currently. While healthcare is primarily organised within national boundaries, the issues and challenges involved are truly global. Sustainability and convergence are two major issues to be dealt with across the globe. The solutions and the action agenda that have arisen from this conference would favorably impact healthcare in India, and serve as a unique model for addressing health challenges globally�

MARCH, 2014

INTERESTING READ Enjoyed reading the March edition on women leaders in healthcare - I liked the fact that the questions posed to each leader were varied. It made for good reading!

Dr Prathap C Reddy Chairman of Apollo Hospitals Group

Brian Carvalho Head of PR, Portea Medical

HEAD OFFICE Express Healthcare Kunal Gaurav The Indian Express Ltd, 1st Floor, Express Towers, Nariman Point, Mumbai-400021. India Tel: 67440519/502 Fax: 022-22885831 Mobile: 09821089213 E-mail: kunal.gaurav@expressindia.com kunalexpressindia@gmail.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express Limited, Basement, Express Building, 9 & 10 Bahadur Shah Zafar Marg, New Delhi, 110 002 Direct Line: 011-2346 5727 Board Line: 011-2370 2100-107 Ext-727 Mobile: 09999070900 E-mail: ambuj.kumar@expressindia.com Our Associate: Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com CHENNAI Dr Raghu Pillai

(The Future of Healthcare: A Collective Vision conference held in New Delhi)

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EXPRESS HEALTHCARE

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April 2014

MARKET NEWS

Dräger launches Evita V300 at CRITICARE 2014 Dräger’s booth also showcased their range of medical devices and systems in the Intensive Care Division DRÄGER, successfully launched Evita V300, a new intensive care ventilator for adults, children and premature babies at CRITICARE 2014 in Jaipur.

Evita V300 reportedly offers sophisticated ventilation possibilities and many other options. With the Evita V300, physicians can select the functions required for their therapy from almost all of the Dräger ventilations modes and applications. Dräger’s booth also showcased their range of medical devices and systems in the Intensive Care Division.

Nikhil Rao, Country Manager, Dräger India said, “We are delighted to announce the

launch of Evita V300, a customised product offering from Dräger that will address the overall healthcare industry’s challenges through its cuttingedge technology and versatile design.

With deep

Dr RK Mani Director - Pulmonology, Critical Care and Sleep Medicine, Saket City Hospital

industry expertise and focus technology innovation products like Evita V300 that

also offers foot-care instruments like Tynor Medical Arch Orthosis and Tynor Toe Separator Silicon, at affordable rates. Reportedly, most of these products are available at discounts ranging from 15 per cent to 25 per cent.

MAHARASHTRA EMERGENCY Medical Services (MEMS) a project of Government of Maharashtra along with Bharat Vikas Group (BVG) India was formally launched recently by Prithviraj Chauhan, CM, Maharashtra. The toll free ‘108’ number provides free emergency medical services to the entire population in the state of Maharashtra, through ambulances, capable of providing competent care for the sick or injured in any emergency medical setting.

All ambulances are manned by emergency medical professionals (EMPs) specially trained in emergency care, based on the Anglo-American model of care (Load & Go) and imparted over 18 days. These EMPs are thus trained in detection of any emergency, immediate response, reporting, onscene care, enroute care and transfer to appropriate hospital. Training also includes reassurance to patients, relatives and bystanders prior to and during transportation to hospital casualty room.

A formal MoU has been signed between BVG and Symbiosis International University where by Symbiosis Institute of Health Sciences (SIHS) has been entrusted with the entire academic training, across all districts of Maharashtra. To date, SIHS has trained 3000 doctors as emergency medical professionals. cent to 25 per cent.

EH News Bureau

EH News Bureau

provides ventilation for adults, children and neonates, Dräger plans to revolutionise the ventilation and respiratory industry in 2014.”

During the event, Dr RK Mani, Director – Pulmonology, Critical Care and Sleep Medicine, Saket City Hospital, conducted a session on electrical impedance tomography (EIT) where he elaborated on PulmoVista 500, the first EIT device intended for everyday clinical use by intensivists to view regional distribution of lung ventilation directly at the bedside.

EH News Bureau

Dietkart launches ‘Bharat Chhodo Diabetes’ campaign Costly diabetes medicines will be available at a lower price under this initiative DIETKART, A health and nutrition store online in India, has launched ‘Bharat Chhodo Diabetes’ campaign, an initiative through which costly diabetes medicines will be available at a lower price.

The company offers a range of products, ranging from diabetic care supple-

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Company’s products are available at 15 - 25 per cent discount

ments to oil extracts and foot-care instruments for the diabetics. These include Nutrimed Diabetic and Cholesterol Low Glycemic Diabetic Diet, Mapple Diaba Viyog capsules, Green Coffee Bean Extract, Green Tea, Vitamin C Grapeseed Plus, and many more. The company

Maharashtra govt launches emergency medical services with BVG

Medical electronics market in India to grow to $11.7 bn by 2017 Affordable and preventive healthcare access to boost the medical electronics industry in India ACCORDING TO Frost & Sullivan, the medical electronics market in India was valued at $6.5 billion in 2013 and is likely to grow at a compound annual growth rate of 16 per cent to reach $11.7 billion by 2017. However, indigenous manufacturing in medical electronics is still lacking in India. The Government has aided in the form of tax and duty exemptions to boost local manufacturing of medical electronics. The National Policy on Electronics has medical electronics as one of the thrust areas and provides for financial incentives for medical electronics manufacturing not only for new units but also for units relocating from

The Indian medical electronics industry will shift towards developing miniaturised, multifunctional, ultra-low power, portable, and reduced cost devices outside India. The Drugs and Cosmetics (Amendment) Bill, 2013 is now considering recognising medical devices as separate from pharmaceutical products in the regulatory structure. A strong framework that provides for medical devices standards in India is an imperative to boost do-

mestic manufacturing, bring in reliability, and better time to market new technologies in medical electronics.

According to Niju V, Director, Automation & Electronics Practices, Frost & Sullivan, “In India, medical devices need to be made for Indian operating conditions. Focused policy on

medical devices factoring in all industry stakeholders including technology developers, manufacturers, healthcare providers, insurance providers, and patient groups can give a big boost to the sector.”

According to Frost and Sullivan, for providing healthcare, which is universal, affordable, and preventive in nature, the Indian medical electronics industry will shift towards developing miniaturised, multifunctional, ultra-low power, portable, and reduced cost devices that could be used for patient monitoring, imaging, implantable, therapeutic, and surgical requirements. The wearable devices category, which is still a

developing field in India, can potentially aid physicians to offer extended care outside the clinical environment. This will bring higher efficiency and increased access across Tier II, Tier II cities, and rural India, while providing improved healthcare delivery to urban India.

According to Niju V, “Five aspects including miniaturisation through System on Chip (SoC) designs, wireless integrated circuits, efficient power management, intelligent sensors, and connected IT infrastructure will dominate future technology landscape of the Indian medical electronics industry.”

EH News Bureau

Sankara Eye Care bags IMC Ramkrishna Bajaj National Quality Award The only eye-speciality, healthcare institution to win this award SANKARA EYE Care Institution was recognised for their national excellence in quality healthcare by the IMC Ramkrishna Bajaj National Quality Performance Excellence Trophy 2013 at their recently held award ceremony in Mumbai. Dr RV Ramani, Founder and Managing Trustee of Sankara Eye Care Institutions India received the award on behalf of Team Sankara, which was presented

by Arun Maira, Member, Planning Commission, Govern-

ment of India. Sankara was the only healthcare institution amongst others to win the award.

The IMC Ramkrishna Bajaj National Quality Award 2013 saw the presence of experts from the industry, including Dr Devi Prasad Shetty, Chairman, Narayan Hridayalaya Group of Hospitals; Meenal Kshirsagar, Retired Reader French, University of Mumbai; K Maheshwari, MD, GRASIM; Dr Adi Dastur, Obstetrician and Gynacologist; Dr KB

Sankara Eye Institution was recognised for their national excellence in quality healthcare

Kushal, DAV regional directorate; Prasad Menon, Tata Quality Management services and Sunil Alagh, SKA advisor on the panel of judges.

Expressing his views on the occasion, Dr Ramani said, “One can easily understand the need for quality in a manufacturing or trading industry without which they lose on the competitive advantage. But in a service industry, that too where charity is the mainstay, as in Sankara Eye Care Institutions India, where un-

matched quality with high ethical standards is the very DNA of the organisation, recognising and appreciating the excellence at the right time is of greater significance.”

“Awards and recognitions like this are not only great morale boosters for the organisation concerned, but by projecting the same, we are able to motivate many more to tread a similar path, concluded Dr Ramani.

EH News Bureau

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April 2014

MARKET

The Mission Hospital, Durgapur to set up cancer unit Completes six years of operations THE MISSION Hospital, Durgapur, which started operations six years back is now set to add a dedicated cancer care unit adjacent to its existing facility.

Speaking to Express Healthcare, Dr Satyajit Bose, Chairman, The Mission Hospital said, “Initially, when we set up this 350-bedded multispeciality hospital in a tier-III city like Durgapur, a lot of people were sceptical about the viability of the project.

They were in doubts about the success of a such a project in a place, which is far off from the capital city where most of the other corporate multi-speciality hospitals were located. Proving them wrong was a challenging task.

But, our team of untiring consultants, physicians, paramedical staff, support staff have helped us to establish The Mission Hospital as a leading healthcare institution in this part of the country.”

Buoyed by the success of the hospital and the financial model, the hospital now plans

to scale up their operations.

“We are setting up a dedicated cancer treatment hospital, which will be housed in an adjacent building within the existing campus equipped with state-of-the-art Linear Accelerators, PET CT and manned by renowned oncosurgeons, radiation-oncologists, who will be coming to the hospital from different parts of the globe,” Dr Bose said.

The cost for the project has been pegged at Rs 60 crores and will be set up in two phases. In the first phase, 100 beds will be set up, which will be scaled up to 200 at a later stage. The funds for the project will be sourced from internal accruals and lending from FIs and banks, he added.

The construction of the project has already started and it should be operational by the first quarter of 2015.

Dr Bose said, “The hospital is the first multi-speciality in Eastern India outside Kolkata to be awarded the NABH accreditation.” He

Dr Satyajit Bose

added that the accreditation was given only after the hospital met 102 stringent standards and 636 objective elements that cover all aspects from infrastructure, facilities, services to skills of all the staff.

He also informed that the hospital has been the first to introduce the ‘close ended’ packages, wherein the patients would not spend beyond the decided amount. It has also introduced innovative strategies like ‘treat now and pay later’, wherein patients can treat now and make some part payment and pay off the remaining in equal monthly installments, of even

TISS invites application for EPGDHA programme

less than Rs 1000 per month.

Till now, they have facilitated more than 1000 procedures in this scheme and reportedly there have been no defaulters.

Dr Bose informed, “Besides, the cancer care hospital, we have acquired two acre of land in the upcoming airport city of Andal (Sujalam, The Sky City), near Durgapur wherein the country’s first ‘only transplant’ hospital would be built with an investment of Rs 200 crores, primarily performing heart, kidney, liver, pancreas and bone marrow transplants. It also plans to procure two air ambulances for organ harvesting and patient transfer, based on its proximity to the airport.

Keeping in view the quality improvement plan, the hospital aims to acquire the National Accreditation Board for Testing and Calibrating Laboratories (NABL) and JCI Accreditation soon.

TATA INSTITUTE of Social Sciences (TISS) has invited applications for one year Executive Post Graduate Diploma in Hospital Administration (EPGDHA).

Graduates from all across the country currently working in hospitals with two years of work experience in supervisory/ executive level can apply. The course is offered in dual mode with contact programme in Mumbai and continuous online support. Details can be obtained from www.tiss.edu TISS offers four Masters programmes in Health Administration, Hospital Administration, Public Health in Health Policy, Economics and Finance, and Public Health in Social Epidemiology; and a Diploma in Hospital Administration. The school has four centres and two research facilities.

EH News Bureau

EH News Bureau

GE Healthcare, CTSI in strategic partnership To develop a network of 25 cancer care centres across India at $ 120 million investment GE HEALTHCARE and Cancer Treatment Services International (CTSI) have announced a strategic partnership to develop 25 centres across India to improve access to cancer care. The network will be built at an investment of $120 million (Rs 720 crores) over a period of five years.

The partnership underscores four critical points to elevate the access, affordability and standard of cancer care

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EXPRESS HEALTHCARE

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in India. First, modern management of oncology patients requires a multidisciplinary approach, meaning that delivering cancer care according to top world standards demands interplay between a team of personnel from a wide range of medical specialties. Second, offering world-class cancer care requires adherence to well-defined, evidence-based medical protocols derived from the world’s latest medical re-

search. Third, providing the latest therapeutic options for cancer requires expert use of cutting-edge imaging, treatment and digital record-keeping technologies. Finally, reducing patient effort and spend through a comprehensive and transparent approach in a local, patient friendly environment.

GE and CTSI will configure the network in a hub-andspoke fashion, with all centres

linked by a IT network to a hub. The hub will be a centre of excellence with full diagnostic imaging and treatment capabilities while the spoke will have the ability to deliver a range of screening, staging and treatment options. The first hub centre, American Oncology Institute, CTSI’s international brand, is already operational in Hyderabad, Andhra Pradesh. The first spoke or remote centre is being set up in

Andhra Pradesh.

The partners will provide a comprehensive oncology service line to interested healthcare providers in small and large cities to accelerate and expand the network across India. They will take steps to improve awareness and employ screening programmes through all spoke centres to enable early detection of cancer.

EH News Bureau

MARKET

ERBA launches new products at Arab Health exhibition ERBA's biochemistry analyser XL 180 and diabetes management analyser Hb Vario were launched THE ERBA Group of Companies, of which Transasia BioMedicals is a part, launched and showccased some new and innovative diagnostic products at the Arab Health Exhibition and Congress held at the Dubai International Convention and Exhibition Centre recently.

The Arab Health Exhibition and Congress offers a global platform for the confluence of some of the best names in the industry. This year Arab Health was attended by more than 3900 exhibitors and representatives from over 153 countries to make the convention a grand success.

ERBA has been an active part of the exhibition for ten years. This year too, the ERBA Group showcased some of its latest and best technologies in the field of clinical chemistry, haematology, critical care, diabetes, immunology, urine analysis, haemostasis and microbiology.

The key highlight at the event was the launch of ERBA’s latest biochemistry analyser XL 180 and diabetes management analyser Hb Vario. The ERBA Group was epresented by Suresh Vazirani-CMD and the team from ERBA Group.

Reportedly, more than 1000 people including reputed pathologists, microbiologists, diabetologists and haematologists from all over the world, visited the ERBA stall. Some of the famous names include the Ministry of Health (MOH) teams from UAE, Saudi Arabia, Kuwait and Oman. They highly appreciated ERBA Group’s technical expertise.

The company informs that they managed to grab some on the spot orders as well from reputed organisations across the world.

EH News Bureau

EXPRESS HEALTHCARE

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April 2014

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Somaiya Ayurvihar-Asian Institute of Oncology opens in Mumbai Aims to be a standalone cancer care unit in 36 months SOMAIYA AYURVIHAR Asian Institute of Oncology was recently launched at Somaiya Ayurvihar, Sion, Mumbai. An initiative by Somaiya Ayurvihar (KJ Somaiya Medical Trust), it aims to become the nucleus for cancer care.

Currently, the institute has 80 in-patient beds and has plans within the next 36 months to be a standalone comprehensive cancer care unit with over 200 beds in all sub-specialities.

“This is a great contribution to cancer research and treatment, not only for Mumbai, but for the country. The institute is well equipped and with a highly

Sushil Kumar Shinde inaugurates the institute

efficient team of doctors onboard. The city will benefit from the high standards of medical facilities, especially in the field of cancer,” said Sushil Kumar Shinde, Union Home Minister, who inaugurated the centre.

Elaborating on the benefits of the institute, Dr Ramakant Deshpande said, “Asian Institute of Oncology is, not only an initiative to provide cancer care at an affordable rate, but also contribute to the research, education, prevention and spread awareness about cancer. With country’s top oncologists on board, the insti-

tute will provide high standards of training to both medical and paramedical faculties.”

Speaking on the occasion, Samir Somaiya said, “Somaiya Ayurvihar is sustained by shared values: commitments to provide holistic quality healthcare to those who can least afford it; and an equal commitment to the improvement of wider society, to develop the leaders and knowledge that will transform tomorrow. Asian Institute of Oncology is an endeavour fulfilling this objective.

EH News Bureau

WHO South-East Asia Region certified polio-free 80 per cent of the world’s population is now in polio-free certified regions WHO SOUTH-EAST Asia Region, home to a quarter of the world’s population, was certified polio-free today by an independent commission under the WHO certification process.

This is the fourth of six WHO regions to be certified, marking an important step towards global polio eradication. With this step, 80 per cent of the world’s population now lives in certified polio-free regions.

An independent panel of 11 experts in public health, epidemiology, virology, clinical medicine and related specialities constituting the South-East Asia Regional Certification Commission for Polio Eradication (SEA-RCCPE) met for two days to review evidence from countries before reaching the decision that all 11 countries of the region are now polio-free and have met the requirements for certification.

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Before a region can be certified polio-free, several conditions must be satisfied such as: at least three years of zero confirmed cases due to indigenous wild polio virus; excellent laboratory-based surveillance for polio virus; demonstrated capacity to detect, report, and respond to imported cases of poliomyelitis; and assurance of safe containment of polio viruses in laboratories (introduced since 2000).

“This is a momentous victory for the millions of health workers who have worked with governments, non-governmental organisations, civil society and international partners to eradicate polio from the region.

It is a sign of what we can bequeath our children when we work together,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region. Polio eradication

80 per cent of the world’s population now lives in certified polio-free regions programmes, through their networks and knowledge in reaching the ‘unreached’, have strengthened the delivery of health services to the most vulnerable communities.

“Thanks to polio eradication, we now know where these children are who were difficult to reach with vaccine. Now the polio programme has successfully reached them with polio drops in every round, there is

no excuse not to go back with other critical health services, from how to have a safe birth, to where to get access to tuberculosis treatment and how to prevent HIV infection,” said Dr Singh.

Through the effort to eradicate polio, health personnel and community workers have been trained and provided with critical equipment to improve vaccination and health services for other childhood diseases.

Comprehensive global laboratory and communication networks have been built and are being used for other diseases.

These networks played a critical role in responding to avian influenza.

Certification of the region comes as countries prepare for the introduction of inactivated polio vaccine (IPV) in routine immunisation as part of the eventual phasing out of oral po-

lio vaccines (OPV). More than 120 countries currently use only OPV. These countries will introduce a dose of IPV by the end of 2015 as part of their commitment to the global polio endgame plan which aims to ensure a polio-free world by 2018.

The WHO Regional Director also sounded a word of caution to maintain high vigilance against importation of polio.

“Until polio is globally eradicated, all countries are at risk and the region’s polio-free status remains fragile. High immunisation coverage can prevent an imported virus from finding an under-immunised, susceptible population. A sensitive surveillance system, able to quickly detect and identify any importation and guide a programmatic response, is critical,” she added.

EH News Bureau

MARKET PRE EVENT

Seminar@Symbiosis XVIth National Seminar on Hospital/Healthcare Management, Medico Legal Systems & Clinical Research to be held from May 2-3, 2014 SYMBIOSIS INSTITUTE of Health Sciences, a constituent of Symbiosis International University (SIU), is organising the XVIth National Seminar on Hospital/Healthcare, Medico Legal Systems & Clinical Research to be held from May 2-3, 2014 at Lavale, SIU, Pune.

The event is expected to see over 1,000 delegates from all verticals of healthcare such as doctors, medico legal lawyers, insurance and IT professionals, NGO, hospital administrators and clinical research professionals. The event boasts of stalwart speakers, contemporary topics and provides an opportunity for professional upgradation, liaison and networking. The seminar will be inaugurated by Dr Rajani Gupte, Vice Chancellor, SIU. A pre-conference symposium on ‘Successful Healthcare Models’ will be anchored

by Rajan Padukone, CEO & MD, Manipal Health Enterprises. The session will be crowned by a cohort of stalwarts like Dr Harish Pillai, CEO, Aster Medicity, Dr GSK Velu, Founder & MD, Trivitron Group of Companies and Sadananda Reddy, MD, Goldstar Healthcare.

The pre-conference symposium will be followed by select paper presentation by delegates. A session on ‘The Strategic Management in Healthcare’ guided by Daljit Singh, President, Fortis Healthcare has also been organised. The seminar also comprises four intensive, domain specific master class sessions, wherein delegates will get an opportunity to interact with industry experts on a one-to-one basis for knowledge sharing.

A session, “‘Game Changers in Healthcare: Primary Healthcare,’ will be discussed

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by Dr Gautam Sen and Kaushik Sen, CMD, Wellspring and Dr Om Manchanda, CEO, Dr Lal PathLabs covering the diagnostic sector, hospitals being covered by Zahabiya Khorakiwala, MD, Wockhardt Hospitals and Dr Adheet Gogate, MD, HealthBridge Advisors in entrepreneurship. Dr Azad Moopen, Chairman, Aster DM Healthcare will conduct a session called, ‘Challenges in Workforce Management in Hospitals.’

The final master class session on ‘Special Laws and Legal Framework: Surrogacy, PCPNDT, Clinical Establishment Act, Transplantation of Human Organs Act 1994 (THOA)’ will be presided over

by Dr Sanjay Gupte, Past President, FOGSI. Day two of the XVI th National Seminar would comprise a horde of industry experts talking on several industry-relevant subjects.

Pradeep Thukral, Founder & CEO, SafeMedTrip.com will

The National Seminar would comprise a horde of industry experts talking on several industryrelevant subjects. It aims to provide an ideal platform for the exchange of ideas in the critical healthcare field

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talk on ‘Medical Tourism: Present & Future.’

A session on ‘Franchising in Healthcare,’ comprising CK Kumaravel, Chairman – Indian Franchise Association (IFA) and Dr Sanjay Arora, Director- Suburban Diagnostics is also part of the second day’s agenda.

‘Health InsuranceUniversal Health Insurance: Opportunities and Challenges’ will be discussed by Yegnapriya Bharath, Joint Director, Health Insurance, IRDA. Dr Yash Paul Bhatia, MD, Astron Hospital and Consultants will talk on ‘Quality & Accreditation of Hospitals and Healthcare’ while Dr Chandrashekhar Potkar – Medical Advisor, Pfizer will speak on ‘Pharmacovigilance.’ ‘Legal Aspects of Healthcare’ (Land mark Judgements) will be discussed by Dr Gopinath N Shenoy, Medico Legal Consultant.

‘Regulatory Affairs in Clinical Research’ shall be dealt by Dr Raman Gangakhedkar, Deputy Director, NARI. The Valedictory Ceremony will be graced by Chief Guest, Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare. The Guest of Honour for the ceremony will be Advocate Ram Jethmalani, Former Union Law Minister and Dr Vidya Yeravdekar, Principal Director, Symbiosis. The ceremony will be presided over by Padma Bhushan Dr SB Mujumdar, President & Founder Director, Symbiosis and Chancellor, SIU. The National Seminar aims to provide an ideal platform for the exchange of ideas in the critical healthcare field. It is a must attend event for professionals from all verticals of healthcare.

Contact Dr Rajiv Yeravdekar Dean, Faculty of Health & Biomedical Sciences, SIU Phone: 91-020-25655023, 25667164, 20255051, 08888892258, 9552552009.

Email: info@schcpune.org, dep@schcpune.org, Website: www.schcpune.org

POST EVENT

Healthcare industry leaders outline vision for Future of Healthcare Devi Shetty, Naresh Trehan and Shivinder Mohan Singh predict what healthcare would be at the recently concluded global conference in Delhi CAPTAINS OF India’s healthcare industry, including Dr Devi Shetty, Founder & Chairman, Narayana Health, Dr Naresh Trehan, CMD, Global Health (Medicity), and Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare took part in the global healthcare conference, which was recently held in New Delhi.

With participation from over 15 countries and the presence of more than 500 delegates, the two-day event, ‘The Future of Healthcare: A Collective Vision,’ hosted by The Healthcare Alliance, saw an impressive turnout of thought leaders, policy makers, senior government officials, and business and health leaders from India and across the globe.

They discussed on key issues plaguing India’s healthcare industry, including the lack of manpower and policy and regulatory issues, as well as the need for greater integration of modern and traditional systems of medicine, better use of technology and the need to upgrade skill sets to ensure a better healthcare system for the 21st century.

Calling for major changes in the existing health system, Dr Naresh Trehan, CMD, Global Health (Medicity), said, “Healthcare is basically disease management. We should build our system from the ground up to create a new blue-print of India’s healthcare. We have over 800,000

key issues plaguing India’s healthcare industry, including the lack of manpower and policy and regulatory issues, as well as the need for greater integration of modern and traditional systems of medicine, better use of technology and the need to upgrade skill sets were discussed Accredited Social Healthcare Activists (ASHAs) in India, but they are ill trained and don’t have any medical skills.

Their costs are a huge burden on the exchequer and nothing gets accomplished in return.

All we have to do is to upscale their skills so that they can be the eyes and ears of the healthcare system on the ground. They need to monitor hygiene and find out who in the community needs medical assistance. This will be a big help in ensuring quick diagnosis of diseases and reducing the incidence of NCDs.” Talking about the acute shortage of medical specialists in the country, Dr Devi Shetty, Founder & Chairman, Narayana Health, pointed out that while the US has 19,000

undergraduate medical seats and 32,000 PG seats, in India it is the opposite – the country has close to 50,000 undergraduate medical seats but only 14,000 PG seats. “The low number of PG seats results in a shortage of specialists. This can have terrible consequences on the ground.

For example, India has one of the highest maternal mortality rates in the world and this is unrelated to the amount of money we spend on healthcare. The reason is that we have created a regulatory structure where only a specialist can perform certain tasks, and the country simply doesn’t produce enough of these specialists,” he said.

Dr Shetty suggested that to tide over the problem, the

MARKET country needs medical educational institutions on the line of the College of Physicians and Surgeons (CPS) in Maharashtra which would offer diploma courses in fields like anesthesia, gynaecology, and paediatrics to medical graduates. “This can convert the entire 50,000 medical graduates produced in India every year into specialists who can then help reduce maternal mortality in India,” he added.

“If we want to deliver better healthcare outcomes, India doesn’t require money. We only require policy changes.

This will not happen till the government looks at medical education as integral part of the country’s development.”

Dr Shetty also expressed concern about the nursing profession in India, which he said would die down in a few years if urgent measures are not taken. “There is zero career progression for nurses.

Nursing is now considered a dead-end career. Admissions to nursery colleges in India have come down by 50 per cent. Half of the nursing colleges in Karnataka have shut shop. In the years ahead, there will be an acute shortage of nurses in the country. There is a critical need to empower nurses by offering them a path to upgrade their skills and become specialists. About 67 per cent of anesthesia in the US is given by nurse anesthetists. In India, we don’t allow a nurse who has worked in critical care for 20 years to even prescribe a paracetamol tablet!” he said.

Dr Shetty also highlighted the need to look for alternative ways of funding healthcare, such as by a surcharge on mobile phone bills, bring down the cost of building hospitals, develop patient management software, and establish one or two health cities with 3,000 to 5,000 beds in each metro where cutting-edge work can be done.

Outlining his views on the role of technology in ensuring greater access to quality healthcare, Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare said, “Technology has played a vital role in healthcare in the last 30 to 40 years, whether it is diag-

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nosis or treatment. Going forward it is going to trigger more changes in healthcare than any other factor. Healthcare access will get radically transformed with technology whether it is in terms of proximity through devices planted in our bodies or by low-cost healthcare using innovative technological solutions or the speed with which information is shared.”

Singh added, “A healthcare ecosystem would be created in future where different silos begin to talk to each other about patients and exchange information. Healthcare delivery is going to become more personalised in terms of tailor-made treatments for an individual.”

Talking about the need for better integration of different systems of medicine, Singh

said, “Allopathy has taken a predominant share of the existing market in healthcare, but I think we can’t avoid for too long the benefits that other health sciences bring to the table. Some kind of integration of different health disciplines is bound to happen in future.”

He also emphasised that the onus of taking charge of one’s health has to rest on the indi-

vidual. “We need to be more concerned for what we do to our health rather than what healthcare would do to us. We need to take ownership of our own bodies and mind and not outsource these to healthcare providers. People need to focus more on preventive care rather than just landing in sick care – this is going to the mantra of healthcare in future,” he said.

TATA INSTITUTE OF SOCIAL SCIENCES Deonar, Mumbai-400088

School of Health Systems Studies Admission Open to Executive Post Graduate Diploma in Hospital Administration (EPGDHA) 2014-2015 The School of Health Systems Studies (SHSS) of Tata Institute of Social Sciences in Mumbai, pioneers of Hospital Admnistration education in the country, invites application for their prestigious EPGDHA programme. It is a 12-month (two semesters), dual mode programme consisting of online learning and two weeks of contact programme in each semester. The programme is intended to enhance the knowlege and skills of working personnel in the hospital.

Eligibility: Graduates in any discipline with a minimum of 2 years of experience and currently working in hospital. Candidates sponsored by hospitals will be given due preference.

Total Seats: 50 only.

Application form and admission: Application forms and Challan copy can be downloaded from the Institute website: http://www.tiss.edu OR http://download.tiss.edu/admissions 2014/Short_Term_Programmes_2014-2015 Prospectus_EPGDHA_2014-15.pdf Filled-in application form and necessary documents should be submitted, along with the registration fee of Rs. 1,000/- to be paid through Challan and sent to The Secretariat, School of Health Systems Studies, Tata Institute of Social Sciences, V.N. Purav Marg, Deonar, Mumbai 400088. The last date of receiving application is 30th April 2014. Admission will be based on the interview at TISS, Mumbai.

Programme Fees: The total fees for the programme is Rs. 1,00,000/- (One Lakh only), payable in two installments. The fees include tuition fee, learning resources, library and computer services and other programme related expenses.

CONTACT: Telephone: 022-2552 5527/ 5523 / 5525 or E-mail: epgdha@tiss.edu / avinash.bhagade@tiss.edu

MARKET POST EVENT

Industry introspects at Healthcare & Pharma Expansion Summit 2014 PPPs need to include a fourth P – the patient – if they are to be truly successful Viveka Roychowdhury Mumbai THE 2ND Healthcare & Pharma Expansion Summit 2014, Mumbai took a new look at public private partnerships (PPPs), as well as the role of IT systems in meeting some of the growth challenges of hospitals. In his keynote address in the morning session, as well as while moderating the panel discussion later, TS Jaishankar, MD, Quest Life Sciences, spoke about how regulatory issues are proving to be a challenge in the Indian pharma sector.

In her keynote address in the morning session, Uma Nambiar, Special Advisor to Minister of Health, Dijbouti, Africa spoke about the future of ICT in healthcare. She made the point that digital technology has to be used as an enabler to leapfrog into an era of smarter healthcare models.

“Smart healthcare is the new healthcare market with smarter devices (for example within diagnostics kits, she mentioned point of care testing, PoC imaging devices, smart sensors). She suggested hospitals should take healthcare to the patient rather than the patient coming to the hospital, via medical kiosks in rural areas.

Technology solutions providers like Canon India and CISCO underscored the message. While Surendra Pal Singh, Marketing Manager – Managed Print Services, Canon India spoke on converting existing data into manageable databases, Pravin Srinivasan, Sales Business Development Manager, India & SAARC, Cisco Systems India demonstrated how an all pervasive computing system could

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be leveraged for better healthcare outcomes.

PPPs may be a much discussed topic but the panel members managed to throw new light. Moderated by Dr Ravindra Karanjekar, CEO and Executive Director, Global Hospitals the panel discussed the missing gaps in healthcare PPPs in India. Dr Parag

Rindani, Head, Wockhardt Hospitals South Mumbai reminded the audience that we do have examples of successful PPPs like those between radiology departments in government hospitals in Gujarat.

Dr Tarang Gyan Chandani, CEO, Jaslok Hospital & Research Centre, compared the reality in India with her expe-

rience in Singapore where PPPs are a ‘raging success dues to full commitment.’ She spoke of the ‘vacuum’ between public and private partners and the need for an alignment between the two sides.

Dr Vishal Beri, CEO, Hinduja Healthcare Surgical, opined that the government cannot be both payor and

provider, and needs to retain only the former role. He strongly felt that the government needed to move away from making it an election issue. PPPs should be continued irrespective of the government in power and therefore the framework has to be strong. viveka.r@expressindia.com

MARKET I N T E R V I E W

‘We are releasing our novel adiponectin and fructosamine biomarkers in India’ Julie Gray, Head of Global Sales, Randox Laboratories, who was recently on an official visit to India, talks about the company's expansion plans for the Indian market, new launches, partnerships, projects in the pipeline and more, in an interaction with Lakshmipriya Nair Elaborate on the plans and strategies to strengthen Randox's position in the Indian medical diagnostics market?

Randox has had a significant presence in India for over a decade and, since the opening of our manufacturing facility in Bangalore in 2012, we now employ almost 100 people across the country and have a long term and loyal dedicated customer base.

Randox pride themselves on delivering high quality, innovative products to customers in approximately 145 countries worldwide, while providing impeccable service and support. Our operation in India is certainly no exception to this ethos, with our growing team of well trained and experienced sales and support staff.

While visiting India again recently, I was delighted to hear from so many of our customers across the country, some of who have been working with us for 12 years or more, telling me that they continue to be impressed by the quality of our products coupled with the unrivalled service they receive; and it is because of this strategy that we have such a loyal customer base in India.

Our ability to adapt our core products to suit market needs is also a key strategy in strengthening Randox’s position. Take for example when our multi-analyte revolutionary Biochip Array Technology was launched into the clinical market. Randox recognised possible applications in markets as

diverse as forensics and food production. This has allowed for a significant expansion in our customer base in India, where we supply leading honey producers with the technology to test for pesticides for example.

Why is this the right time to expand in the Indian market? How would it be beneficial to Randox's global strategy?

As one of the world’s major growth economies, the scale of the Indian market means there is always room for new business opportunities. India currently ranks in the top 5 of our largest export markets and the potential for growth is palpable.

Randox have found that the interest in personalised medicine and our ability to search for any disease condition online means that people in India are continuing to be extremely interested in their own health. This means that patients want to be diagnosed and treated with the highest quality, innovative products that the market has to offer. Randox is therefore perfectly placed to provide these services. We reinvest approximately 20 per cent of our turnover annually back in to our research and development activity and with around 30 per cent of our workforce employed in this area, we are always delivering innovative solutions to diagnostics.

Randox is therefore expanding their presence not just in India but globally.

Are there any new tests or

Randox offers the largest cardiac test menu in the world and we will be releasing a number of new arrays into the Indian market this year

kits planned for launch in the Indian market?

As a highly innovative global biotechnology company, Randox is always developing and releasing new products; in fact we currently have 400 new tests in development – more than any other company in the world.

According to recent statistics released by Mumbai’s Asian Heart Institute, heart disease will account for 35.9 per cent deaths in India by the year 2030. Randox offers the largest cardiac test menu in the world and we will be releasing a number of new arrays into the Indian market this year. Heart Fatty Acid Binding Protein (H-FABP), a biomarker of myocardial ischemia, detectable within 15-30 minutes is already gathering immense interest in India, alongside Lp(a), homocysteine and, most recently, TxB Cardio, which measures a patient’s resistance to Aspirin following on from studies showing that 25-30 per cent of all patients using the drug are resistant to it.

There are more diabetics in India than in any other country in the world (30-40 million), and with up to 8.7 per cent of the population thought to be suffering from impaired glucose tolerance, levels look set to rise even further. The need for a comprehensive testing menu is therefore vital.

We are releasing our novel adiponectin and fructosamine biomarkers in India shortly to further complement our extensive menu.

Adiponectin assesses an individual’s risk of developing

diabetes, and allows resources and treatment to be focused on those patients most at risk.

This highly targeted strategy should help to decrease the number of people becoming diabetic in India, while using resources most effectively.

Randox Enzymatic Fructosamine has the ability to test glycaemic control in diabetes patients who also have the haemoglobin-related disease, thalassemia.

Thalassemia is particularly prevalent on the Indian subcontinent, with 10 per cent of sufferers living here.

HbA1c has been found to be quite ineffective in monitoring diabetic control in patients with thalassemia (because it measures haemoglobin), and so fructosamine testing in these diabetes patients is crucial.

We have a number of other tests due to be released this year, including a novel bilirubin, Cystatin C and fifth generation bile-acids. This is all on top of the thousands of tests Randox currently offer, our world-leading series of RX analysers and quality control material, our external quality assessment (EQA) scheme RIQAS and our revolutionary multi-analyte platform, Biochip Array Technology. RIQAS has now grown to be the largest EQA scheme in the world and as the widest reaching programme, demand for this continues to grow in India.

You have been touring India for more strategic partnerships. How effective has the endeavour been, any new deals or partnerships

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Our visit to India in February was incredibly successful, and building relationships with key future customers as well as maintaining those with our existing ones is incredibly important to Randox.

Randox always have new deals in the pipeline. We had a very successful year in terms of sales in 2013 and certainly hope to improve on this further in 2014. Our recently secured contract to provide clinical instruments to the Rajasthan government for their free healthcare initiative, is further evidence that Indian confidence and loyalty in the Randox brand continues to grow. We are very excited for our future here, and for how we can contribute to healthcare in India.

With so many growth plans in the offing, do you intend to scale up in terms of manpower?

As one of the world’s major

India is forced to push diagnostics faster than the steep incline of chronic conditions such as diabetes, cardiovascular disease and cancer. Within the market in India there is a high demand for cost effective, faster and sensitive results, while at the same time producing accurate and efficient outcomes growth economies, the scale of the market in India means that there is always room for new business opportunities, and with that comes new employment opportunities.

Part of the reason for my visit to India in February was to interview for a number of new positions and we continue to always look at ways to expand our workforce here.

How is the diagnostics market in India vis-a-vis

the global market?

Growing!! There are a number of drivers leading to growth in the industry. High population growth rate and increased levels of affluence is a significant factor, and as a result of that comes the need to increase India’s number of hospitals and diagnostic laboratories.

India also places a high regard on innovation, and is a very receptive market to new technologies and products, so

Randox’s commitment to research and development is very much embraced. In today’s society of increased levels of sedentary lifestyles and disease, the market in India is forced to push diagnostics faster than the steep incline of chronic conditions such as diabetes, cardiovascular disease and cancer.

Within the market in India there is a high demand for cost effective, faster and sensitive

results, while at the same time producing accurate and efficient outcomes.

What are the trends reigning in the healthcare diagnostics market in India?

The steadily growing number of medical centres in India, along with the ever increasing patient population has resulted in a growing target base of consumers which in turn will result the market to exhibit steady growth in the future.

Diagnostic laboratories are opening, not just in the metro cities like Mumbai or Delhi but also in smaller cities. As mentioned previously, the Internet acts as an enormous and easily accessible virtual research library for patients, meaning that people globally are demanding a more personalised approach to healthcare, which further opens the need for diagnostic laboratories and clinics. lakshmipriya.nair@expressindia.com

EVENT BRIEF MAY 2014-FEB 2015 05

ABMH QIPS-II, 2014

ABMH QIPS-II, 2014 Dates: April 5-6, 2014 Venue: Aditya Birla Memorial Hospital Auditorium, Pune Summary: Aditya Birla Memorial Hospital is organising a national conference called 'ABMH QIPS-II on quality improvement and patient safety Tthe two-day conference is expected to witness speakers and delegates from all over India. Eminent healthcare executives, mainly the CEOs, COOs, Medical Administrators and Quality Heads from hospitals like Apollo Hospitals, New Delhi; Fortis Hospital, Mumbai; Care Hospital, Hyderabad; SPS Apollo Hospital, Ludhiana; Bombay Hospital, Mumbai; Hinduja Hospital,

02

Mumbai; B J Medical College, Pune; Global Hospital, Mumbai; Seven Hills Hospital, Mumbai; Medishield, Mumbai; NABH, New Delhi; Hospital & Health Systems Administrator, Gurgaon amongst others will discuss various aspects of quality improvement and patients safety Contact Saurav Chatterjee Marketing Head, Aditya Birla Hospital Email: saurav.chatterjee @adityabirla.com Mob: 9881123025

XVITH NATIONAL SEMINAR ON HOSPITAL/ HEALTHCARE MANAGEMENT, MEDICO LEGAL SYSTEMS &

XVIth National Seminar on Hospital/ Healthcare Management, Medico Legal Systems & Clinical Research

CLINICAL RESEARCH Dates: May 2-3, 2014 Venue: Symbiosis International University; Lavale, Pune Summary: Symbiosis Institute of Health Sciences, a constituent of Symbiosis International University th (SIU), is presenting the XVI national seminar on hospital/ healthcare, medico legal systems and clinical research.

It aims to provide an ideal platform for the exchange of ideas in the critical healthcare field. Over 1,000 delegates from all verticals of healthcare such as doctors, medico legal lawyers, insurance and IT professionals, NGO, hospital administrators and clinical research professionals is expected to attend the event. The event

11

boasts of stalwart speakers, contemporary topics and provides an opportunity for professional upgradation, liaison and networking Contact Dr Rajiv Yeravdekar Dean, Faculty of Health & Biomedical Sciences, SIU Phone: 91-020-25655023, 25667164, 20255051, 08888892258, 9552552009.

Email: info@schcpune.org, dep@schcpune.org , manager@schcpune.org Website: www.schcpune.org

14TH WORLD CONGRESS ON PUBLIC HEALTH IN 2015 Dates: February 11-15, 2015 Venue: Science City, Kolkata Summary: The 2015

14th World Congress on Public Health in 2015

Congress will offer unique opportunities to discuss global and national public health issues among the global public health community and other key stakeholders. It will provide a unique opportunity to help catalyse change, bringing together and bridging perspectives from various disciplines of public health to infuence governments, organisations, agencies and institutions around the world to meet the challenge of improving peopleâ&#x20AC;&#x2122;s health Contact IPHA 110, Chittranjan Avenue, Kolkata â&#x20AC;&#x201C; 700073 Phone: + 91 33 32913895 Email: secretarygen@iphaonline.org Website: www.14wcph.org

cover

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)

(

FOCUS: POLICY

DR ALEXANDER THOMAS DR HARISH PILLAI DR SUDARSHAN BALLAL AMEERA SHAH AMIT BACKLIWAL PL MEHTA RAJESH SRIVASTAVA DR RAJEEV BOUDHANKAR DR RAMAKANT PANDA DR SANTANU CHATTOPADHYAY

With the elections looming near, Express Healthcare garners industry experts' views on what should be the next PM's agenda for the healthcare sector of India

REKHA DUBEY DR SUJIT CHATTERJEE SURESH SONI DR NARENDRA VAIDYA ZACHARY JONES

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cover ) DR ALEXANDER THOMAS Director (CEO),Bangalore Baptist Hospital

Review and refine government systems for greater transparency

T

he following measures need to be taken on various fronts to improve healthcare in India: Healthcare spending by the government ◗ Revise health allocations with significant increases ◗ Ensure adequate allocation of resources for health in view of evidence-based research ◗ Review and refine government systems for greater transparency

◗ Establish robust monitoring systems Medical devices and disposables ◗ Facilitate reuse of devices without compromising quality ◗ Regulatory mechanisms for affordable pricing and access of devices ◗ Regulate stringent environmentally friendly mechanisms for disposal of used equipment Taxation policy for hospitals and healthcare

providers ◗ Tax relief for healthcare providers on the use of all resources such as water, electricity etc ◗ Tax relief for healthcare institutions in various policies Insurance ◗ Strengthen structured insurance programmes to benefit insurance provider, service provider and patient ◗ Promote affordable health insurance for the over 65-year old population ◗ Affordable health insurance

for chronic illnesses Public health policies ◗ Promote ‘Universal Health Coverage’ ◗ Mainstream policies for senior citizens welfare in all ministries ◗ Strengthen implementation of programmes for vulnerable sections (widows, disabled, patients with chronic conditions etc) ◗ Policies for affordability of healthcare services ◗ Policies to improve accessibility of healthcare services

◗ Policies to enhance CSR engagement in health services ◗ Promote health research Public private participation ◗ Promote health research ◗ Simplify government processes to increase and improve PPP coordination ◗ More opportunities for PPPs ◗ Improved and simplified monitoring mechanisms to assess outcome of PPPs ◗ Tax benefits for private agencies for association in policy agendas

DR SUDARSHAN BALLAL Medical Director & Chairman, Medical Advisory Board,Manipal Health Enterprises

Major revamping of the healthcare infrastructure is needed

I

feel, over the next five years the healthcare industry should increase to at least five per cent of the GDP. Major revamping of the healthcare infrastructure is needed which includes upgrading the primary healthcare systems (PHC). This should also include preventive health measures, prenatal care, vaccinations and

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counselling on the importance of hygienic practices, sanitation, clean drinking water etc Government should focus actively on promoting PHC at all rural centres and secondary care hospitals at taluka levels and tertiary care establishments in districts hospitals Supporting the primary and secondary care could be

predominantly government’s responsibility while the tertiary could be a PPP initiative Another aspect that should be given its due consideration is lack of nursing, para-medical personnel and doctors, both at MBBS and PG level. We need to have a massive exercise in increasing skilled healthcare workers at all levels to meet the ever growing demand.

There is a vast gap between demand and supply of medical personnel, which stresses on the need for an urgent liberalisation of medical education policy to allow

more doctors especially at postgraduate levels to be trained at corporate/private hospitals.

Opening up a medical

Continued on Page 40

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FOCUS: POLICY

DR HARISH PILLAI CEO,Aster Medcity

There needs to be tax support, subsidies and incentives to support specific device manufacturing areas and creation of SEZs

T

he PM's agenda should focus on several aspects such as:

Medical devices and disposables Medical devices and disposables are critical for any hospital, primarily because of the financials, since medical devices are reflected as assets in the balance sheet and disposables appear as consumables in the income statement.

Medical devices are a Capex item and will undergo depreciation within 6-7 years, after which fresh funds will need to be allocated for replacement. On the other hand, disposables have a direct impact on EBITDA, since they can be as high as 20-25 per cent of the revenue, depending on the type of hospital. For example, in highend orthopaedic or cardiac procedures, the cost of disposables due to prosthesis or drug eluting stents (as a ratio to revenue) can be in range of 20 – 25 per cent, while for a basic secondary hospital, the cost could be low as 15 per cent.

Disposables are one of the areas where import substitution may be worth considering. This will need an ecosystem where private and public hospitals work on the same platform to promote the concept of ‘knowledge exchange.’ Through this, one can expect more interaction between the clinical team end

users and industry that can look into the ways of importing substitutes and reducing costs without compromising on quality.

One of the bigger challenges that Indian manufacturers face in the field is effective marketing budgets. This issue needs to be resolved with innovative strategies and in this regard, there are lessons to be learned from international players in the sector.

India has a strong base in Engineering and R&D across industries, not to mention some of the best atomic and space researches. Under the circumstances, our inability to promote the indigenisation of medical devices is surprising, especially in the capital intensive fields like radiotherapy and medical imaging.

To strengthen the delivery side, what is needed is a consortium of like-minded people - hospital players, insurance players and department of science and technology. The government and some industry organisations should take the initiative to create a series of workshop which could help develop a policy document.

There needs to be tax support, subsidies and incentives to support specific device manufacturing areas and creation of SEZs or in this case, innovation hubs.

One of the most successful transfer of technology to domestic industry in India

was by ISRO, when the first successful satellite launch vehicle- SLV-III was manufactured under Dr Kalam’s leadership at the Vikram Sarabhai Space Center, Thiruvananthapuram.

He had ensured that the component technologies for the following series of satellite launch vehicles were transferred to the industry.

Why can’t the medical device industry follow the example of the nuclear and space sectors?

All it needs is concerted effort from various interested quarters.

Healthcare manpower resource Unfortunately, the pipeline for creating medical manpower, whether it is doctors, paramedical staff or nurses, has not kept pace with the industry requirement and serious challenges are foreseen in this area. As a result, healthcare manpower resource constraint is going to be the biggest challenge in Indian healthcare.

The Medical Council of India has followed the pyramid approach for training doctors in the country. Every year, a large number of under graduates don’t have an access to post graduate training due to shortage of seats and teaching facility.

This has created a large pool of skilled yet underutilised undergrad doctors suffering skill degradation. If we have to utilise precious resources and their talent, this pyramid based structure has to be

reconsidered. There has to be reformation in policies and procedures right from the regulatory requirements for land, bed capacity etc, to build medical colleges for undergraduate and post graduate programmes. For the present, we could utilise the large amount of district hospitals across the country where beds are available. An efficient PPP model, where a private medical college could be associated with a public facility could help resolve this issue thus using innovative ways of utilising our resources.

The other area of concern is the absence of standardised national training system. We need to have a national standard for training doctors to remove the skewed training in sub specialties among medical colleges in India. A national standard in training of doctors, nurses and paramedical staff, is the only way to help overcome this situation.

An interesting observation here is, that doctors of Indian origin who are trained overseas, are not welcome to join as professors or faculties in our medical colleges. This needs to change. If these precious resources are ready to give time, we should welcome them with open arms. These type of myopic approaches need to be removed for us to move forward and be able to utilise our existing advantages to the maximum.

There is also an

opportunity to develop the concept of physician assistants in India. This would be an ideal way of mitigating the challenge of the supply chain of doctors. In countries like the US and China, where these models have worked wonders, we could also train physician assistants to take the place of doctors wherever possible, to reduce costs. This would be a very useful approach for treatment in non-critical areas of medicine and healthcare.

At the end of the day, we need to accept the fact that the so called brain drain from India is only partly for money.

There are enough opportunities for high incomes in India for talented doctors. Why we lose them to foreign practices is the lack of an ecosystem that allows them to engage in a complete practice. Medical profession is not only about clinical practice; research and academic work complete the triad, but most medical colleges in India do not provide this environment, and only a handful of public and private sector institutions do.

We need more colleges, hospitals and institutions that can provide this ecosystem to our doctors. Perhaps that will solve a lot of our problems. At the same time, research and product development in healthcare will also benefit from this initiative.

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cover ) AMEERA SHAH CEO & MD,Metropolis Healthcare

It is important that there are policies that uphold basic minimal quality in lab operations

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he next PM ‘s agenda should take the following factors under consideration:

Quality diagnostics services It is important that in the coming five year plan and budget the government makes provisions for empowering institutions like NABL which can lay the pathway for quality diagnostics. It is important that there are policies that uphold basic minimal quality in lab operations and ensure that people have access to quality diagnostics. The guidelines should also direct

the opening and running of a pathology lab. Today, anyone can open a lab with a simple shop act license. This laxity in policy is almost like equating a lab to any other shop selling confectionaries, or clothes. It is important to recognise the importance of lab testing.

Mandatory accreditation In India, any kind of test can be launched and marketed, whether or not it has proven scientific accuracy.

We have many rapid or card tests, which don’t offer the desired accuracy but definitely are cheaper options. Such tests are also introduced for

diseases like dengue and TB. These tests, with their lack of accuracy cost us both lives and money. In the pharma industry if a company needs to launch a drug there exist extremely stringent procedures. There are no such laws for newer tests, reagents or machines; which can keep inaccurate tests and results at bay.

From the perspective of preventive healthcare a large number of diseases can be prevented only with early detection. Early detection in many cases actually means a lab test, for example PAP smear for cervical cancer, CA 125 for breast and ovarian

cancers, vitamin D and calcium tests for bone health, PSA for prostate cancer; and the list goes on. Unfortunately, when we talk of preventive healthcare, we only say, “Do the test” and not, “Do a quality test.” It is very important that especially in cases of preventive tests which have the potential to save millions of lives; strong quality norms are laid down and accreditations are made compulsory. These tests could be prioritised in accordance to the disease burden. These tests should be able to define the right reagents, methodology, testing platform, QA maintenance and

reporting format. Unless we don’t take these steps, our vision to make preventive healthcare the mainstay for reducing disease burden and mortality would be far from realisation.

If these changes are to be undertaken for India; it is important that healthcare gets a more holistic voice in the policy process and truly represents the voice of the industry.

◗ Health is a fundamental human right ◗ Health is the essence of productive life and not the result of ever increasing expenditure on medical care ◗ Health is intersectoral ◗ Health is an integral part of development

◗ Health is central to the concept of quality of life ◗ Health involves individuals, state and international responsibility ◗ Health and its maintenance is a major social investment ◗ Health is a worldwide social goal

DR RAJEEV BOUDHANKAR Vice President,Kohinoor Hospitals

Healthcare needs to be considered as an Industry Magna Carta for healthcare he benefits of modern medicine has still not penetrated the social periphery of our vast country. The glaring contrasts in the state of health between the rural and urban areas and between the rich and the poor can be labelled as gross social injustice. The new prime minister has to wipe out the inequalities in the distribution

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of health resources and services and aim towards attaining the millennium development goals. Healthcare is to be regarded by the new government as an essential component of socio-economic development. The aim should be to provide a level of health for all Indians that will permit all people to lead a socially and economically productive life.

It must be understood by the new government that that

healthcare is a social science and politics is healthcare on a large scale!! Hence, socialisation of healthcare is the way forward. Health is not mainly an issue of doctors, social services and hospitals; it is an issue of social justice.

The new government should have a new philosophy of health which should be reflected in its healthcare policy, as stated under-

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FOCUS : POLICY

PL MEHTA

Whole-time Director,Neotia Healthcare Initiative

Customs duty on imported medical equipment should be exempted for new hospitals for five years since inception

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he next PM should focus on the following: The healthcare sector need to be considered as an ‘industry’ to ensure faster growth.

Focus should be on developing skilled healthcare professionals by encouraging all private players, in addition to non-profit organisations, to create healthcare institutions following the MCI

guideline. Insurance Regulatory and Development Authority (IRDA) should introduce gradation structure for hospitals, considering their level of services before deciding prices for

different procedures. It is recommended that customs duty on imported medical equipment and duty on electricity consumption should be exempted for new hospitals for five years since inception.

RAJESH SRIVASTAVA Chairman & MD,Rockland Hospitals Group

People of our country need a robust healthcare model that can guarantee access to quality healthcare

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ealthcare delivery up to village levels is the biggest challenge India faces today. This problem can easily be resolved if quality diagnostic facilities are created in remote locations and linked with centres of excellence through an IT and telecom interface. Reports can then be read by specialist doctors and then the patients can be referred to a primary, secondary or tertiary care facility. This will ensure right treatment at the right time and reduce the pressure on the tertiary care hospitals in metros.

The people of our country need a robust health are model that can guarantee access to quality health care till the village level. A glance at the cost involved in creating a health network up to village level will indicate that neither the government nor the private sector will be able to organise such large levels of investments alone.

Government has vast resources at its command which can be leveraged to create a healthcare model that can effectively cover even those who are below the poverty line. Private sector has the entrepreneurial and managerial capability to leverage these resources in

an economically and socially sustainable way. A combo of the two will work, provided there is a shared vision and a clearly defined set of roles, responsibilities and deliverables with a monitoring system.

Government can invest in several ways to make this model feasible for the private players by providing land and ensuring a better payment mechanism for the government employees and beneficiaries of its various schemes. This is possible if the patients are insured with the freedom to choose the hospital. The private partner will bring in entrepreneurship, professional management

systems and resources by raising additional funds and bringing in partners for investment in equipment and additional facilities. For this partnership to be effective, mere investments and core competencies will not be enough. A partnership model will have to be built with the following elements built into the agreement: ◗ A transparent monitoring system with access to the Hospital Information System for the government to monitor the deliverables ◗ Quality certification through NABH and NABL to ensure standardised quality services ◗ Insurance coverage for BPL

patients with a rate agreement similar to the one for the government employees There are already enough regulatory mechanisms in use by organisations like CGHS, ECHS and several state government health schemes for the government employees and welfare schemes for the poor. All that is needed is a minor modification to the government systems to ensure a quick response system to avoid delays in decisions and payment cycles.

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cover ) AMIT BACKLIWAL MD - South Asia,IMS Health

There is a need for active collaboration between government and private sector

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esetting the inequity of healthcare infrastructure to address ‘availability’ will also help take care of ‘affordability’ The issue of physical reach exists but it is not as big as the issue of availability in the public channels.

Inadequate infrastructure, lack of availability of healthcare workers and medicines, quality of facilities and longer waiting time in public sector continue to

push people into seeking private care Affordability is a consequence of the unintended overuse of the private health channel As we improve availability of healthcare services, we also need to augment the governance systems to drive higher performance. There is a need to set up measurable standards of performance, provide necessary training for healthcare workers and create efficient and transparent work and decision-making processes.

This needs to be followed up with creation of monitoring and adjustment systems and providing proper incentives and drive effective enforcement There is a need for active collaboration between government and private sector to improve quality of care and healthcare service.

To effectively address gaps across dimensions of access, the government needs to work together with private players – the key principle being that the government

DR RAMAKANT PANDA VC and MD,Asian Heart Institute and Asian Hospitals

Make the Rajeev Gandhi Jeenvandayi Yojana available throughout the country

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here is huge gap within the Indian healthcare delivery system. The forthcoming government needs to concentrate on building a quality healthcare delivery structure within the country. My recommendations for the new PM include: ◗ Tax rebate of at least 10 per cent for healthcare equipment

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in order to reduce the cost of medical equipment. ◗ Create more PPP that will be profitable for both the government and the private sector ◗ Make the Rajeev Gandhi Jeenvandayi Yojana available throughout the country ◗ The country requires trained medical professionals, especially nurses, doctors and

paramedics. In order to fill this gap the PM needs encourage private sector players to introduce postgraduate courses in areas of emergency care, nursing and other specialised spectrum of medicine. ◗ Also, create medical courses that would train medical professionals in rural healthcare practice

act as the payer while the private sector taking care of delivery. To control costs and ensure standards are maintained, this needs to be accompanied with adequate monitoring /checks Private participation (NGOs, corporations, private providers, equipment manufacturers, etc) across the healthcare chain will be very much required to drive accelerated implementation of reforms.

As we add infrastructure, we will also need to increase

penetration of healthcare insurance at an accelerated pace. Until the usage of public health facilities increases, the poor need to be insulated by providing insurance at a faster rate. To make this more effective for the poor, awareness of the programs and schemes for the poor need to be elevated further.

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FOCUS: POLICY

DR SANTANU CHATTOPADHYAY Founder & CEO,NationWide Primary Healthcare Services

I would recommend increased tax benefits for preventive health checks, OPD services and OPD insurance products

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he next PM agenda should comprise the following issues:

Healthcare spending by the government With respect to healthcare spending by the government, it has been observed that this sector is low priority for policy makers. To begin with, government spending should increase in this area and healthcare should be brought to the forefront with a significant shift from curative to preventive care.

cost. Traditionally, private healthcare players have shied away from the primary healthcare space, as this sector is considered to be a “loss-making sector”.

However, this is changing, and in last couple of years, several start-ups have been launched in this sector in various cities, which has also attracted high quality foreign institutional investors (FII), thus making it a more attractive sector to insurance companies.

Taxation policy for hospitals and other healthcare providers The healthcare sector should receive similar incentives to those provided to companies in an SEZ i.e. benefits such as tax exemption for 10 years and a favorable policy framework for primary healthcare providers (not only to hospitals/secondary or tertiary).

I would also recommend increased tax benefits for preventive health checks, OPD services and OPD insurance products.

Public health policies The government should take steps to promote Universal Health Coverage (UHC) through a primary care set-up. In India, an effective healthcare model to develop is one which is financed by the government, but delivery is through family physicians.

These will not be employed by, but provide contracted services for the government.

More importantly, remuneration and monetary incentives should be based on population level health outcomes, such as vaccination coverage, better control of chronic diseases, patient satisfaction and cost reduction.

Insurance The Union and state governments should encourage initiatives by insurance players which will encourage them to cover primary healthcare, thus reducing traffic to secondary and tertiary healthcare providers, which in turn will reduce their claims ratio and

Public private participation The world’s largest PPP in healthcare is the NHS GP model in the UK and it is one of the best examples of a successful PPP. A similar model should be replicated in India. We in India, currently follow a system which is incentivised towards transactions and volumes. As

a result of this, the doctors and healthcare providers (hospitals and clinics) only focus on a higher volume of consultations and procedures without giving too much attention to quality, clinical outcome or patient satisfaction. In the UK, health authorities outsource the care of a given population to GP clinics (who are private players), but their payment depends on multiple parameters such as patient satisfaction, clinical outcome, achieving public health targets (such as 100 per cent immunisation), standards of care, as well as volume and reduction of cost. We too need follow a similar structure in India, which will result in the provision of high quality care at a lower cost.

Disease focused policies Management of chronic illnesses (diabetes, heart disease, etc) is important for the prevention and delay of

future ill-health through advice, immunisation and screening programmes. A focus on non-communicable diseases can improve overall health outcomes for the population.

These illnesses can be addressed at a primary level, making it imperative to bring primary healthcare to the forefront.

Medical education and training In order to build a healthy medical workforce for the country, it is essential to invest in continued medical training and education. This should not only cater to the secondary and tertiary sectors but the primary healthcare sector as well.

Currently, GPs are at a grave disadvantage due to the lack of options for education and specialisation in family medicine.

Healthcare manpower

resource In medicine, we can consider two types of specialisations. The first is a ‘vertical specialisation’, where the doctor has in-depth knowledge of a particular area and focuses solely on it, such as cardiologists or neurosurgeons. The second is a ‘horizontal specialisation’, where the professionals are generalists, dealing with a broad range of health related issues, such as treating a pneumonia patient, managing a child birth, as well as doing minor surgeries. GPs and General Duty Medical Officers in a rural PHC are good examples of such “Horizontal specialists” In order to make healthcare more accessible and affordable, we need more doctors with a wide base of skills and knowledge rather than specialists in a single field. The government, Medical Council of India and private players must work together to solve this anomaly.

Most medical graduates in India want to move into ‘vertical specialisation’ roles because the Indian healthcare system does not provide any career growth for GPs, making it an unattractive choice. If this problem is addressed, the issue of manpower resources in healthcare will automatically correct itself.

The above recommendations aim at reducing cost, improving quality, and increasing accessibility to healthcare services in the country.

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cover ) REKHA DUBEY COO,Aditya Birla Memorial Hospital

The government should allocate atleast four to five per cent of its GDP to healthcare Healthcare spending by the government

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ast year, the government spent a paltry one per cent of its GDP on healthcare but last year’s budget promised to hike it up.

Various economic surveys claim that India has the lowest health spending as proportion of its GDP. In fact, though the number crunchers say that we spend 4.1 per cent of our GDP on health the fact is that 70 per cent of it is from people’s own pockets or private spending meaning that the government spends barely 1 per cent on health. We propose that it should be increased to substantial amount.

Currently, India falls under countries, which spends the lowest on healthcare in the world – 171 out of 175 countries in terms of public health spend. The Nigerian and South African government also spends more percent of its GDP on healthcare.

Healthcare infrastructure Given the growing population, changing demographics, disease profile and shift from chronic to lifestyle diseases there is a need for an enormous amount of investment in coming years to enhance and expand India’s healthcare infrastructure. In most states the government healthcare infrastructure are not up to the mark. If the government does want to achieve its oft-quoted dream of Universal Health coverage – then granting industry status

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is very important. It would allow hospital groups to expand faster, newer ones to come up, hire more doctors and also allow foreign direct investment (FDI) in healthcare. The industry status would also ease up the process of setting up standard medical educations and increase public-private partnership in the healthcare sector.

Healthcare delivery Influx of investments in the healthcare sector will provide a comprehensive range of state-of-the-art tertiary and quaternary care. It will help offer a broad range of acute care inpatient services and extensive outpatient services along with long-term care facility.

Healthcare manpower resource Presently we believe that there is a huge shortage of trained manpower in healthcare, especially the paramedical staff. There is a need of more number of government medical and nursing institutions from where trained healthcare candidates who want to serve the society are churned out.

Medical education and training Presently there are very few standard medical colleges in India. We need more such government medical institutions, which churn out good doctors and nursing staff. Unfortunately the curriculum in India has not

changed for more than 40 years. Today, medical students across developed world follow problem-based education where in they get hands-on training from the day they join a medical college, unlike India. Also the postgraduation seats are limited, which if increased will help in churning out more medical specialists.

Medical devices and disposables The duty on import of medical devices and disposables should be reduced to encourage the development of quality and affordable healthcare to all. This will help bring down patient costs, particularly those that can’t be manufactured in India.

Lower duty will also allow hospitals and doctors to charge less for expensive procedures.

of universal healthcare coverage, in which not only hospitalisation but medicines and outpatient care are also covered. There are some state health insurance plans in states and one that covers a small portion of the people on a national level. These plans need to serve as the basis for building a vibrant new national health insurance plan

Taxation policy for hospitals and other healthcare providers There should be a tax holiday for at least 10 years for the new private hospitals coming up in the tier II and III cities to cater the semi urban areas with quality healthcare.

This will also encourage advance healthcare facilities in these regions, which will also interest expert doctors to serve these areas.

Public health policies India’s public health infrastructure is in shambles.

Government should spend more on public health services. The government should allocate atleast 4-5 per cent of its GDP to healthcare.

Along with investment, improvement in public health system and management is also required. Also a special public health cadre should be formed to improve the quality of health workers.

Insurance Policies need to be adopted to ensure the larger section of the population is covered at least for the basic healthcare.

India must move to a system

Disease focused policies Public health policy must, in coming years, be directed as much towards noncommunicable diseases as infectious ones. Government

should adopt a far-sighted approach and focus on prevention and management though awareness than just treatment.

Public private participation Government should encourage PPP model.

Healthcare institutions, which are not managed properly in primary, secondary and large hospitals, should be identified and PPP model should be adopted for these. The PPP model can be executed very efficiently if proper infrastructural development is applied upon. Wherein there is proper planning and management is systematically functioned. The government should introduce the concept of mobile clinics, which can go to the remote areas of the cities or reach the people who are unable to reach the facility. For more than 90 per cent of the population in India today, modern healthcare facilities are still unaffordable so there is a need to bring down the cost of providing healthcare and PPP model is one way of doing it.

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FOCUS: POLICY

DR SUJIT CHATTERJEE CEO,Dr LH Hiranandani Hospital,Mumbai

Addressing maternal and neonatal mortality should be one of the foremost healthcare agendas of the government

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efore we even analyse what should be the healthcare agenda for the next Government we must appreciate some of the facts that are not very encouraging.

One third of the countryâ&#x20AC;&#x2122;s population cannot access even primary healthcare. One third of our population in rural areas does not go to hospitals because of the expenses associated.

Making healthcare more accessible Out of pocket payments of patientâ&#x20AC;&#x2122;s healthcare are still the norm with almost 40 per cent of Indians from the rural segment and approximately 30 per cent of Indians from the urban segment. They actually finance the healthcare needs by taking loans or disposing of their most precious assets!

Given the above the first step that the Government has to take is solving the financial burden faced by a large chunk of Indian population, from rural areas as well as urban areas, by creating a method through which healthcare services will be utilised by a prepayment mechanism. This is mind boggling as the task is not easy considering theenormous numbers in India.

In independent India, it is unacceptable that one third of our population cannot access even primary healthcare. This

must be made into an agenda that is taken up by the Government on war-footing.

It is a fundamental right that basic health facilities are accessible and available for all.

The challenge really is on how to ensure that there is adequate staff in the very remote area of India to man the health centreâ&#x20AC;&#x2122;s as well as look after their safety and security. The understanding of local traditions, taboos and such like issues will be a challenge. But if the Government puts its mind to it, is not a challenge that is insurmountable as the Government is ably supported by a very adept administrative service that has produced the best results in the most challenging issues that the country has faced.

Reducing maternal and neonatal mortality India is leading when it comes to maternal and neonatal mortality. This is the gold standard of the quality of healthcare of any country and till this is seriously addressed by the government no amount of the most sophisticated hospitals or the latest technology of medical equipment will improve the healthcare in the country.

This should be one of the foremost healthcare agendas of the government.

Emergency services in obstetrics and gynaecology is woefully inadequate in the rural areas and this is one of

the primary causes of maternal and neonatal mortality. We need the Government to change its approach and ensure that the local people are trained on site, given incentives to remain in that location and refresh their knowledge in periodical manner, at a higher centre.

Proper implementation of healthcare schemes Central and state governments have to continue work in tandem as they have been and ensure that healthcare is made accessible at the rural level. It is not that outstanding schemes have not been set up by the government. The National Rural Health Mission is an excellent initiative by the government as is the Rashtriya Swasthiya Bhima Yojna. Some of the state government funded health insurance schemes have been hugely successful. These have to be expanded and made more effective in the penetration in the rural areas.

Technology for progress The government will require to use technology for the citizens who are located in rural India. Thus apart from investments in the healthcare programme, the Ministry of Information Technology needs to lend the health ministry a helping hand to ensure that technology penetrates hinterland. This

may require some amount of research and innovative models to be put into place.

Insurance is key The government also seriously needs to look at ensuring that insurance based schemes are strengthened.

Health insurance premium should be highest in the younger age groups when they have the capacity to earn and the risk of serious illness is less than in the senior years when the capacity to earn is less and the risk of illness is far greater. In the years when an individual has increased risk should be when he pays the least premium as his capacity to earn has decreased considerably.

This will help reduce the financial burden on the seniors.

There is need also to ensure that recent advances or enhancement of knowledge base of the primary and secondary healthcare workers in the rural areas are upgraded or that may create a mismatch in their understanding of case

management. Again the Department of Information Technology can assist the healthcare ministry so that classroom-based teaching is made available for the primary health worker at the rural level.

Prepayment schemes for metros The government will also have to face challenges in the metros. Herein there has been a paradigm shift in the quality of healthcare. It is second to none in the world.

However there is a real need for standardisation as well as some beneficial prepayment schemes for tertiary and also quaternary level of care.

India has a dynamic potential to lead the world and its population is its strength. However it is essential that its population is healthy so that the country is in a position to utilise this enormous human capital in its progress and march into the future to be recognised as a global super power.

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cover ) SURESH SONI Chairman and CEO,Nova Medical Centers

Affordable universal healthcare is the holy grail that India should urgently seek

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he health of a nation is determined in a large part by the health of its citizens. Access to healthcare is crucial in improving the health status of people, empowering them, raising their productivity and bettering the socio-economic parameters.

The role of government is particularly important in a developing country like India where private infrastructure in healthcare is still developing and a huge part of the population subsists below the poverty line. Despite this, the healthcare spending in India is much below what is needed for optimal outcomes.

Healthcare spends and GDP growths are directly correlated. For our nation to progress at the planned 8-10 per cent growth rate, we will have to continuously invest in healthcare infrastructure, medical training and support services. The Indian government spends barely one per cent of GDP on health, even though the stated aim for many years has been to gradually take this figure to three per cent.

The result is predictable: terrible disparities and inequity in Indian healthcare, with vast areas of the rural hinterland underserved by the healthcare system and an absence of preventive healthcare infrastructure throughout the country.

Low spending on healthcare is one of the major

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causes of high infant and maternal mortality rates.

India is home to the greatest burden of maternal, newborn and child deaths in the world: around 309,000 babies die within 24 hours of birth; 56,000 mothers die every year.

India, in fact, accounts for one out of every three maternal deaths in the world.

The low spending on healthcare by the government has another serious consequence too: a very high out-of-pocket expenditure for the masses. More than 70 per cent of all spend on healthcare in India is funded by the citizens themselves, with the majority of it going to meet the cost of medicines. This is a situation unique to the country and inherently regressive. It imposes a heavy financial burden on people.

About 39 million Indians are forced into poverty each year as they go bankrupt trying to meet medical expenses. There is no social security net and the spread of health insurance is negligible among the population.

Healthcare should be made affordable Affordable universal healthcare is the Holy Grail that India should urgently seek, but going by the current trends, such an arrangement seems decades away from fruition. The National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojna (RSBY) are commendable initiatives by the government, but they do

not have much of an impact in increasing public health expenditure as yet. The central and state governments need to strive towards combining the already existing public health insurance schemes into a proper system of Universal Health Coverage (UHC).

Medical education and training The Indian government also needs to spend much more on healthcare so as to increase the avenues for medical education and training. The number of PG and superspeciality seats is severely low in India compared to the global average. This scarcity of opportunities for higher medical education lies behind the shortage of medical specialists in the country.

This shortage can also be addressed by training and empowering the nursing and paramedical staff in India to be at par with the medical staff at other countries like US and UK. The government also needs to look beyond cure to establish a system of preventive healthcare for citizens. Preventive health programmes for non communicable diseases (NCDs) like diabetes, cancer and cardio-vascular diseases which are driven by ageing, rapid unplanned urbanisation, and the adoption of unhealthy lifestyles, are very cost effective and offers much higher returns. It has also

become absolutely essential in the backdrop of the alarming rise in non-communicable diseases. To tackle NCDs in India, the government should plans to scale up the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) to cover all districts in the country.

Promoting healthy lifestyles It is also imperative that the next government take concrete actions vis-a-vis prevention, awareness, and adoption of healthy lifestyle.

First, the government must identify and implement priority actions in non-health sectors like trade, taxation, education, agriculture, urban development, food and pharma production that can allow for substantial health gains, especially for the poor.

For example, policy instruments designed to encourage health sensitive urban development should be part of the solution.

Public private participation The way forward is to encourage the public-privatepartnership (PPP) model which until now has not been much of a success in India.

According to one estimate, only about 1 per cent of all PPP projects in India relate to healthcare. To give PPPs a boost, the government needs to put in place an enabling policy framework for multiple stakeholder PPPs and bridge the trust deficit between the parties. Tax breaks, reduction in duties and policies should be introduced to encourage expansions in tier II and III cities.

The Indian governmentâ&#x20AC;&#x2122;s decision last year to more than triple the budget outlay for the healthcare sector in the 12th five year plan (2012-17) is therefore welcome. It would help bring down the out-of-pocket healthcare expenditure of people and take the government healthcare spending to 2.5 per cent of the GDP. The government has also announced plans to launch district-wise pilot programs of universal health coverage, set up four more AIIMS-like centres in various parts of the country and provide free medicines through a central procurement agency. Now, it needs to walk the talk so that India can emerge on par with other BRICS countries in terms of health parameters of the society.

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FOCUS: POLICY

DR NARENDRA VAIDYA MD,Chief Joint Replacement & Spine Surgeon,Lokmanya Hospitals

A comprehensive healthcare agenda covering the complete spectrum of rural and urban health is the need of the day

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ealthcare agenda for the next government should be:

Future reforms in the health sector should be based on increasing the allocation to healthcare, focusing on preventive care, targeting greater reach and significantly improving the productivity of private and public healthcare spending.

Every common man should

have access to speciality healthcare, which should not be denied due to high costs.

India witnesses a unique and wide spectrum of disease profile ranging from maternal & child healthcare in the rural areas to lifestyle diseases in the urban areas. A comprehensive healthcare agenda covering this complete spectrum of rural and urban health is the need of the day.

Last year's economic

survey pointed out that India has the lowest health spend 4.1 per cent - as a proportion of its GDP, while the US spends around 15.2 per cent of its GDP on health; France spends 11.2 per cent and Britain 8.4 per cent. Even the private plus government spending is abysmally low compared to other nations.

While healthcare is a major and debatable political issue in the western world, in India it sadly finds just a

passing mention in the election manifestos of various political parties. It is high time that health found a place in the political dialogues of the world's largest democracy. Underfunding and poor governance in healthcare spending seem to be the root cause in our ineffectiveness in delivering optimum healthcare facilities to our citizens.

The government should act as a catalyst by providing

sustainable healthcare delivery business models through private public partnerships (PPPs) thus benefitting all stakeholders including healthcare providers and patients.

Reforms like increased tax exemption on preventive healthcare especially in women and geriatric population shall boost the family spending on health.

ZACHARY JONES Senior VP,Portea Medical

Insurers need to become more focused on the life-time well being of the beneficiary

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n healthcare these days all the chatter is about the increasing use of technology and new â&#x20AC;&#x2DC;internet of thingsâ&#x20AC;&#x2122; gadgets to improve health outcomes and lower costs. While the impact of these innovations is indisputable, in India, something much less exciting would likely create a larger near-term impact on the

health of the average Indian: the reform of and increased support for the health insurance industry.

This is something that the new Indian government can help catalyse without making many of the hard choices that reform measures usually entail. Many of the failings of the Indian healthcare system are due to spending in the

wrong areas and misaligned incentives between payors and beneficiaries: spending needs to be allocated more towards preventative care and insurers need to become more focused on the life-time well being of the beneficiary.

This can be achieved through three policy changes:

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cover ) ZACHARY JONES ◗ Make health insurance truly holistic : Currently, most health insurance policies in India only cover hospital-based care that requires admission. Because most insurers do not cover primary, preventative, or geriatric care, patients tend to consume less of these services, leading to higher costs down the road. India should encourage insurers to provide coverage for all medical procedures with a co-pay to prevent overuse.

More holistic insurance coverage not only leads to better health outcomes for patients but also often lower costs for insurers. ◗ Make insurance less transactional: The turnover on “group” insurance accounts which cater to corporate customers is very high and insurers rarely ‘own’ a patient for an extended period of time. This dynamic makes insurers less interested in the longer term

health outcomes of their beneficiaries and makes offering products such as long-term care much more difficult. Deeper relationships between customers and insurance companies would make it more economical for insurers to focus on improving the health outcomes of their beneficiaries. Mandating longer policy duration is an easy way to fix this issue. ◗ Allow insurers to control

costs: In India insurers are not actively allowed to manage healthcare costs as they are in the West. It is a much more passive system wherein hospitals deliver healthcare and insurers pay (with relatively little input in the process). By moving to more of a managed care model, which would allow insurers to dictate ALOS for procedures and pre-approve healthcare costs, the prevalence of unnecessary hospitalisation, tests, and

procedures will likely fall.

These reforms would not only improve patient health outcomes (and lower costs) but also likely encourage the development of organised primary, home, and geriatric care industries in India. By taking a more proactive role in insurance regulation, the IRDA can do a better job of aligning patient and provider/payor interests all while lowering the cost and improving the quality of healthcare delivery.

rather than be a provider of healthcare. The concept of universal healthcare is encouraging but the cost of care has to be reasonable so that private players will come forward to participate in this.

It is an absolute must in our country where private healthcare accounts for a

large majority of healthcare to have a public private participation.

Unfortunately our country is categorised into two sections -the affordable Indian who can get the best of healthcare and the unaffordable Indian who is relegated to the 19th century healthcare, usually

in semi-urban and rural India.

The greatest challenge for all of us is to bridge these two Indians while we focus on our way forward.

Continued from Page 30

SUDARSHAN BALLAL college at every district and using the district hospital facilities would also benefit if sourced from a PPP. This would increase the supply and reduce the demand, eventually leading to reduced corruption and selling of seats at huge profits.

Affordability of quality healthcare is also another

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factor that plagues India. To make treatments more affordable we need to reduce duty on all life saving and critical medical devices along with encouraging and incentivising local production of these. The government should be more engaged in providing insurance for healthcare

STRATEGY INSIGHT

The future of healthcare: The hospital comes home

ZACHARY JONES Senior VP, Portea Medical

Zachary Jones, Senior VP, Portea Medical, expounds on the future trends and themes in Indian healthcare like personalised and proactive medicine, moving away from hospital care, consumer-focused medicine and more

H

ealthcare in India is at a crossroads. Over the past 15 years, so much has been done so well: corporate hospitals have revolutionised the quality of tertiary care, polio has been defeated, and medical tourists have flocked to India to take advantage of the country’s healthcare system.

However, such progress overshadows a bifurcated system, one in which hospitalbased care is of international standards, but care outside of hospitals is very haphazard.

There are huge opportunities in emergency response services, primary care, telemedicine, compliancefocused models, and home healthcare. What is even more exciting is that these functional areas are themselves very much at the crossroads of three healthcare trends that are rapidly developing in the US; India could potentially even break new ground in these areas due to its more favourable regulatory regime which allows for a shorter time to market for new devices and a greater ability to use healthrelated data. Broadly, these three trends are: ◗ Move from hospital-based care to outpatient, remote, and home healthcare ◗ Move from reactive to proactive medicine ◗ Shift from population-based medicine to personalised medicine Thankfully, these changes are a win-win for both patients and healthcare providers as they lower costs while improving health outcomes:

There are huge opportunities in emergency response services, primary care, telemedicine, compliance-focused models, and home healthcare Move away from hospitalbased care: Hospitals have become victims of their own success; as they have become more popular, space constraints have become more acute. By treating patients

outside of their facilities, hospitals can lower costs and become more efficient; their patients also benefit from better health outcomes because they aren’t exposed to hospital borne infections and

recover more quickly and fully at home. This is already an established model in the West and something that our company, Portea Medical, is pioneering in India. We estimate that roughly 80 per cent

of the care that is currently given in the hospital can be delivered in the home setting with the proper use of technology.

Reactive to proactive medicine: How we consume healthcare today is very inefficient. Patients effectively diagnose themselves and then go to see their doctor for treatment. At this point, issues have often progressed and treatment is more challenging. Re-

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STRATEGY I N T E R V I E W

‘Patient awareness on tuberculosis is a big gap’ Tuberculosis is a focused area of diagnostic research at Mumbai's Hinduja Hospital which performs 30,000 TB culture tests annually. The hospital has been committed to the cause of TB for over two decades, with large investments in state-of-the-art lab equipment. As we mark this year's World TB Day, Dr Camilla Rodrigues, Senior Consultant Microbiologist and the Chair of the Infection Control Committee at the PD Hinduja Hospital and Medical Research Centre, speaks to Viveka Roychowdhury on the recent advances in the diagnosis of TB In December 2012, Dr Zarir Udwadia and team published a report about 12 totally drug resistant (TDR) TB cases. It blew up into a controversy with the Union Ministry later deciding that it was to be called XXDR-TB (extensively drug resistant TB). Today there is some good news that some of those patients have tested negative after salvage treatment. In hindsight, was the controversy a wake up call - for policy makers as well as treating clinicians?

In any eventuality, whatever helps patients is good. Yes the controversy did help drug resistant patients in Mumbai.

What are the trends in TB diagnostics in India?

Lack of diagnostics for TB has been a a crucial barrier in the past. Smear microscopy is rapid and cost effective but requires a sufficient number of TB bacilli to flag as positive.

Much reliance was placed on chest X-ray but now India’s Revised National TB Control Programme: (RNTCP) has moved away from that.

In the last five years, the WHO has given a boost to validating TB diagnostics.

For one, the WHO has issued a negative policy recommendation on the use of serology that was being used rampantly in our country. We live in a TB endemic country

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and most of us are TB IgG positive. A positive serological test was used as a valid reason to prescribe TB drugs for any suspicious lesion on the lung or any patient who had a pyrexia of unknown origin.

The Government of India issued a Gazette notification in mid-2012 which banned the use of serology tests. The Government is vital in such situations because they have the wherewithal to stop the import of such kits. This has been a great step towards getting on the right track to diagnose TB. Secondly, there is another test known as the interferon gamma release assay This is a good test to diagnose latent TB. But again, most Indians are latently infected with TB. The problem with this test is that it can detect latent TB but cannot differentiate it from active TB. WHO has come out with a negative policy recommendation, for the use of these tests in the diagnosis of active TB in endemic countries In 2010, WHO advocated the use of GeneXpert MTB/RIF assay for MDR suspects. This molecular test diagnoses TB as well as accurately detects drugresistance to rifampicin. The test takes two hours to give results and does not require any skilled manpower and is a game changer in TB diagnostics.

In the last five years, the WHO has given a boost to validating TB diagnostics. It has issued a negative policy recommendation on the use of serology that was being used rampantly in our country

Currently in India, the cost of consumables for Xpert is being subsidised by the Foundation of Innovative New Diagnostics (FIND), in the public sector, as well as in the private sector via the Initiative for Promoting and Affordable Quality TB Tests (IPAQT). All accredited labs can become a part of IPAQT. Under this initiative, in the private sector, the effective reduction in cartridge cost is passed on to the consumer.

Two additional tests that WHO has approved are: ◗ MGIT automated liquid culture which allows for much faster detection of TB Liquid culture clearly enhances the rate of recovery and the time to detection. To have a TB culture facility, you require biosafety precautions in place. Expertise is required to avoid contamination issues . ◗ Another molecular test that is called the Hain Line Probe Assay (LPA). The National Programme is training personnel across the country to do these tests. These tests, in the last five years, have completely revolutionised TB diagnosis. In fact, sometimes at a molecular level, TB is detected faster than other routine infections!

We now require noninvasive, point-of-care tests, but we are at least two years away from such immuno-

chromatic tests (ICTs) for detection of TB. What has been the response of policy makers in India and the RNTCP? Laboratory capacity building for TB in the nation will take time. I think the response of the programme has been good because you have public hospitals like JJ Hospital in Mumbai that also perform the LPA tests. The authorities have outlined certain areas in each state for upgradation.

Where are the gaps?

The gaps exist in terms of improving patient awareness about these tests and their availability. Patients still want a blood test done rather than a test based on sputum. To convince patients that these tests are actually better than a blood test needs a lot of awareness.

It is also important to create awareness about the fact that a cough persisting for over two weeks, weight loss, night sweats, low grade fever cannot be ignored and require a consultation. If the person has had TB before, or is in contact with a person with drug resistant TB, then we need to quickly do a test to diagnose resistance. And the earlier testing is done, unnecessary treatment can be avoided. If required, treatment too has to be

STRATEGY rational. So, physicians need to be goaded into that direction. The situation is definitely improving. Role models, perhaps from Bollywood, may help to raise awareness about such issues!

One of the projects you are working on is testing biomarkers for immunity to Mycobaterium tuberculosis in exposed but uninfected healthcare workers, which is a collaborative project

with Imperial College, London, UK. Could you tell us a little about this project?

This project is looking at why some healthcare workers, like nurses, paramedics etc., who though being continuously exposed to TB are not positive for latent TB. We are looking at biomarkers in their immune system that prevents the normal response. We are doing this in collaboration with Dr Ajit Lalwani

in Oxford.

A lot of imaging techniques are been investigated to diagnose TB in cases like bone TB. What are you views on that?

To be very honest, from a microbiology perspective, seeing is believing. I have to see the micro-organism. So, I do not think we can make judgement calls based on radiological examination alone. We need to have a

sample from the patient and test it.

The 16th Annual L’OréalUNESCO for Women in Science Awards awarded five women scientists on International Women’s Day. Do you feel that women scientists in India get their due? What can be done to set this right?

They need better visibility within the scientific community. I also really

believe in the power of the pen. If you publish good work, you get noticed.

What is the future of microbiology?

The sky is the limit as far as microbiology is concerned because everything starts with a diagnosis. There is so much that can be done and you need passionate and motivated people viveka.r@expressindia.com

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The future of healthcare... mote monitoring technologies now allow healthcare providers to continuously monitor healthcare parameters (e.g. flagging a high BP earlier), predict where they are trending, and proactively intervene.

Devices such as FitBit have made self-quantification in the fitness field popular and accessible to the general public; expect a similar focus on quantifying your health in the next few years. According to Dr Eric Topol, a luminary in the nascent field of telemedicine, chronic diseases, the most common causes of hospitalisation, are particularly amendable to technologybased solutions that prevent inpatient care.

Population-based to personalised medicine: Historically, patients have been treated as a group or population when they seek medical attention. When you see the doctor they diagnose and treat you based on what has worked for many millions of people globally. By using data collected by remote monitoring technologies and conclusions drawn from advanced analytics, patients can be treated as individuals, as per a very detailed medical history; this approach makes interventions more effective and negative interactions or incorrect treatments less common. The era of ‘Big Health Data’ is just around the corner in the US and not that

far away in India: according to the Journal of Personalized Medicine, globally the quantum of health-related data is doubling every two years.

Portea Medical, a home healthcare company which I co-founded in 2012, is very much at the focal point of these trends. We have been instrumental in shifting care away from hospitals (with their support) and into people’s homes by providing home visits from doctors, nurses, physiotherapists, and home health aides. Portea is also working to bring truly personalised medicine to India by using some of the latest technologies in combination with our innovative healthcare delivery platform.

The five-year view: A complete shake up of the industry While the three previously mentioned changes will revolutionise healthcare over the next couple of years, they are largely business as usual, because healthcare delivery will remain clinician driven and clinician dependent; however, over the medium term, the face of healthcare will change markedly, because the clinician’s role in the delivery of healthcare, which has been more or less constant for thousands of years, will be reinvented.

Broadly, this will happen in three distinct ways:

Over the next five years, powerful diagnostic tools will be in the hands of individual consumers, giving them the ability to take control of their health Healthcare workers using computers to better diagnose patients: As highlighted by thinkers such as Tyler Cowen, computers are interesting machines; they tend to be exceptionally good at completing ‘rule based’ tasks like playing chess (for example, IBM’s Deep Blue defeated Chess Grand Master Gary Kasparov in 1997) and harnessing enormous amounts of information (for example, IBM’s Watson won the Quiz Show Jeopardy! in 2011). These skill sets are particularly conducive to work in medicine, because diagnosis of illnesses is ‘rule-based’ and requires a clinician to remember and be able to

draw upon large amounts of learned information.

Venture capital investor, Vinod Khosla, has argued that computers will eventually do 80 per cent of the work currently done by doctors, all while heightening their abilities. In fact, one of his portfolio companies, Lifecom demonstrated that medically trained personnel that were not doctors, working in conjunction with a diagnostic engine (computer) were 91 per cent accurate in their diagnoses without using diagnostic tests or advanced exams. In the Indian context this creates a significant opportunity for healthcare to become more accessible to a much larger segment of the population by ‘upskilling’ nurses and paramedics’ skill sets, all while unburdening doctors from many routine tasks.

The anytime consult and the great levelling of quality of care: Soon, patients will no longer have to work around doctors’ schedules. In the US, companies such as Doctor on Demand, already allow you to talk to doctors instantly for up to 15 minutes for $40 (Rs 2,400).

However, these services are moving beyond just your common ‘cough and cold’ type questions; specialists, particularly those that focus on less-interventional specialities (e.g., dermatology) now offer remote consultations. By 2020, expect

‘virtual doctors’ practices to develop. This is important in the Indian context because it will help the highest quality clinicians treat patients in small towns, creating a more uniform quality of care throughout India.

Consumer-focused healthcare: Over the next five years, powerful diagnostic tools will be in the hands of individual consumers, giving them the ability to take control of their health. I believe this to be one of the most important developments in healthcare, because doctors will likely be forced to engage with patients as equal stakeholders. There is really nothing more futuristic sounding than the Qualcomm Tr icorder X-Prize (named after the device on Star Trek that could instantly diagnose a patient). To win the $10 million prize, teams will have to create a device which ‘will be capable of capturing key health metrics and diagnosing a set of 15 diseases.’ The device is intended for individual consumers.

Healthcare innovation in India is in its early innings, however, we believe that India has a real opportunity to build a non-hospital-based healthcare delivery system that incorporates the best of what Western countries have achieved over the past 120 years as well as the most recent advances in remote medical technologies.

These are exciting times for healthcare.

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STRATEGY I N T E R V I E W

‘Government has to show its complete commitment to build a robust international standard eye banking network’ LV Prasad Eye Institute (LVPEI), a leading eye care player in India is celebrating its Silver Jubilee this year. Dr Gullapalli N Rao, Founder, LVPEI talks about eye health in India, LVPEI's role in improving it for the past 25 years, future plans and more, in an interaction with Lakshmipriya Nair LVPEI is celebrating its Silver Jubilee this year.

What have been the most important milestones in the journey so far?

Our major milestones so far have been as follows: ◗ Developing the first integrated model of comprehensive eye care from primary to advanced tertiary levels through our pyramidal model of eye care delivery ◗ An integrated model of community, primary and secondary comprehensive eye care with strong links to tertiary care, training and research providing coverage to around 2000 villages directly with ongoing care though permanent facilities. ◗ Established the dedicated "Children's Eye Care Centre" - the first such in Asia and in any developing country. The Children's Eye Care Centre is one of the (top two or three) busiest centres in the world.

◗ First international standard eye bank in Asia- Received around 45000 donor corneas till date. ◗ First eye institute in the world to integrate ‘rehabilitation of reversible blind and low vision’ as part of an eye institute. ◗ Started the first nationwide contact lens education programme ◗ Education programmes which were designed on the needs of eye care in India and developing countries ◗ World class research centre encompassing basic, clinical, translational, outcomes, psycho-physics and population health ◗ World class eye banking training programmes ◗ Founding of Indian Eye Research group ◗ Pivotal role in advocacy, policy formulation and planning of eye care and prevention of blindness programmes at state, national and global levels.

Where do you envisage the company in the next 25 years?

We have a lot of plans in the coming years. Some of them include: ◗ Expansion and extension of all our activities geographically, physically and activity wise ◗ Creating centres of excellence in many niche areas ◗ Fostering creativity and innovation ◗ Continue to influence global eye health policy

We are the leaders among the developing countries and if all available resources human, technological and financial are used optimally, we can be among the very best

Tell us about eye health in India? How do we fare vis-avis the global scenario?

What should be done to improve the situation? How would LVPEI contribute in doing so?

We are the leaders among the developing countries and if all available resources human, technological and financial are used optimally (which regretfully remains a challenge), we can be among the very best. Another major challenge is the quality of education of eye care professionals which needs complete overhaul, without which we will at best be mediocre in our average standards of care. LVPEI has played its role in improving the situation and will continue to do so at every level.

Tell us about eye banking in India? What is the need of the hour in this sphere?

We are still in infancy

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stage. The road map is clear but it is our reluctance to move forward that is a major hindrance. All the ingredients are available but now the government has to show its complete commitment to build a robust international standard eye banking network for the country. It is eminently possible in a very short period.

By 2020, we can be a country with no waiting lists for corneal transplants and can be a model for the world.

What are LVPEI's plans in the current fiscal?

Our plans for the current fiscal include: ◗ Nearly doubling physical space at the main campus in Hyderabad helping to significantly enhance our patient care, education and research capacity ◗ Building of secondary centres in Andhra Pradesh and Odisha (will be initiating rural eyecare in Odisha) ◗ Adding 30 more ‘Vision centres’ for primary eye care in remote rural areas. ◗ Innovation centre at full speed. ◗ Engaging in tertiary care in two other states ◗ Capacity building of over 20 hospitals in India and other countries. ◗ Increasing involvement in international projects and programmes, both at the institutional level and individual level of many of our colleagues. lakshmipriya.nair@expressindia.com

STRATEGY I N T E R V I E W

‘We would like to emerge as a total gas management solution provider’ Since its inception almost eight decades back, Linde India (formerly BOC India) has been closely associated with the Indian healthcare industry. Express Healthcare spoke to Biswarup Ghosh, Head–Healthcare, Linde India to know more about the company's strategies and future plans in India Linde India recently rebranded itself. How would it position itself in India?

Since its inception almost eight decades back, Linde India (formerly BOC India) has been closely associated with the Indian healthcare industry.

BOC India became a part of Linde Group following the acquisition of the BOC Group Worldwide in 2006.

Linde India – Healthcare is a quality product supplier of medical gases conforming to the Indian Pharmacopeia (IP) standards and employs the best operating practices in manufacturing, safety, storage and distribution.

In the coming years, Linde India – Healthcare would not only provide the healthcare industry with medical gases but also like to emerge as a 'total gas management solution provider' for supplying high-quality medical oxygen and other gases like nitrous oxide, carbon-dioxide and nitrogen, etc. as well as taking care of the intricacies of setting up the medical gas pipeline services (MGPS) to a large number of consumers across India. Our thrust would be to emerge as a 'one-stopsolution' for all medical gases management. Today, we can claim that no other medical gas company in the country provides such comprehensive solutions in terms of total gas management.

What are the key strengths of Linde India?

For nearly the last eight decades that we have been operating in India, Linde India has always had the best manufacturing and operating

practices across the globe in its endeavour to provide the best possible service and products to our consumers.

Linde India owns and operates India’s largest air separation plant in Jamshedpur, runs nine air separation plants and 14 filling stations, located in the important cities across the country. We stay closely aligned with clinical progress and continue to design and redesign solutions that meet the unique needs of healthcare professionals and patients. We support our customers in every aspect of the delivery and use of medical gases, including logistics, safety systems, technical solutions, training and extensive customer service, which acts as our key strength areas.

What are the different types of medical gases produced for Indian consumers?

Our medical gases production portfolio offers medical oxygen, Entonox (required for delivery of gyne patients), medical air, medical carbon dioxide, medical nitrogen. We also provide oxygen concentrators for home oxygen therapy.

Tell us about Linde India’s manufacturing, storing and distribution system.

Our state-of-the-art production sites adhere to stringent norms of quality, thereby delivering and assuring reliability of products. The gas cylinders used by Linde India are of PESO standards while our manufacturing plants are ISO 9001 and ISO 14001 certified.

We are setting up medical gas manufacturing and filling facilities in Jaipur, Chandigarh and Raipur Linde India has invested substantially to create this infrastructure backbone and would invest further, if needed, to maintain the highest quality standards.

Who are the leading healthcare institutions/ companies associated with Linde India?

The response from the healthcare institutions of the country have been very positive. Almost all the big names of the healthcare industry, be it in the government sector or the private sector, are associated

with us. The PGIMER, Chandigarh; CMC, Vellore; SSKM Hospital, Kolkata; CMRI; BM Birla Heart Research Center, Woodlands Hospitals, Tata Medical Center, Rajarhat Fortis Hospital, Kolkata are some of the leading names where we are supplying medical gases and in some we are providing the total gas management solutions to the clients.

Moreover, the clients are extremely positive and encouraging about our new role as a total gas management solution provider. We have already successfully provided total gas management solutions to hospitals in Kolkata like Tata Medical Center -Rajarhat and Woodlands Hospital.

Creation of a robust distribution and delivery system is an important element of your business.

Tell us more about it.

At Linde India we strictly adhere to standard operating procedures (SOPs) in terms of storage, distribution and delivery mechanism. We ensure 'zero per cent error' in the entire process.

To cater to all the innumerable issues of managing medical gases, like supply, monitoring, system maintenance, medical gas compliance standards and regulations, comprehensive solutions like QI medical gas, services encompas specialist support to ensure that medical gas supply systems and routines meet best practice standards for quality, safety, reliability and efficiency.

What are the opportunities in Indian healthcare for Linde India - Healthcare in terms of new business generation?

The Indian healthcare industry is expected to grow at a phenomenal rate in the coming years, which would throw up huge opportunities for companies like us. The action would now move to the Tier-II cities. We continuously strive to innovate for our customers with a passion to excel, empowering them in the process and our global footprint ensures we thrive through diversity. Our product offering of complete hospital care business of medical gases and medical gas pipelines should be the key driver for new business generation.

What are your future plans?

In the coming few years, we want to strengthen our foothold in the tier-II cities of the country. So, we are setting up medical gas manufacturing and filling facilities in Jaipur, Chandigarh and Raipur in this calendar year. These facilities will basically focus on the gas-cylinder business of the company.

We would add few more tier – II cities in the next year.

Another focus area would be to strengthen our marketing network in the homecare segment, basically for serving chronic obstructive pulmonary disease (COPD) and other cardiac-diseases affected patients who need to undergo long term oxygen therapy (LTOT). joy.roychoudhury@expressindia.com

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KNOWLEDGE INSIGHT

Patient-centric emergency care: Need of the hour Dr Anunaya Jain, Group Service Line Manager - Neurosciences & Emergency Medicine Apollo Hospitals Enterprise and Dr Minal Jain, Senior Analyst, Health Economics & Outcomes Research, Novartis Pharmaceuticals give an insight on building patient centred emergency care delivery systems

T

o lay the foundation of this article, it is important to understand some of the similarities and differences between the status of emergency care delivery mechanisms in India and the western developed world. Delivery of responsive and time sensitive care during medical emergencies is an apparent gap in both private and public healthcare systems in India. Facilities such as a rapidly responsive EMS transport service, emergency rooms with qualified professionals and nationally governed training and credentialing criteria which are almost a given in the mature healthcare countries are nearly absent.

ERs in the developed world though continue to grapple with issues of overcrowding, patient dissatisfaction regarding service delivery.

In India, emergency medicine gained the honour of being a speciality in medicine only in 2009. Most emergency rooms (ER) continue to be staffed by untrained physicians and are called ‘casualties’ to date. But amidst this, there is a dichotomy developing with several private and public institutions pushing for responsive and accountable emergency care networks and investing in world class facilities of care. With the emergency care delivery systems still in their nascent stage in India and ER admissions accounting for a grow-

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ing proportion of inpatients in hospitals, there exists a unique opportunity to make these systems patient-centric.

The potential issues of tomorrow can be addressed today!

Patient don't really know what they want - The myth of medicine

An increasing number of patients and their relatives understand healthcare, disease processes, care protocols and are able to discern excellence in care delivery

Complicated medical jargon, squiggly scripts and arcane latin-y phrases - coupled with arrogant smirks, and a conversation that started and ended with ‘I know best’ - that should pretty much sum up at least one of our experiences with physicians and surgeons. Somewhere, somehow, we as healthcare providers have propagated and continue to believe in the ‘myth of medicine’. A myth that empowers us to feel ‘all knowing’, ‘all powerful’ and consider everyone else as ‘the common man’.

The truth is however disparate from this created fantasy of ours. An increasing number of patients and their relatives understand healthcare, disease processes, care protocols and are able to discern excellence in care delivery. Care delivery is no longer a myth, but a care experience that is more than the sum of its parts. It is no longer just about good clinical care, but also about the people (the way they communicate, the empathy they display, and the way they treat each other) and the place

KNOWLEDGE (the look-feel-sound-smell, the privacy and the comfort afforded).

Sombre white walls with green curtains and eerily silent staff are not even found in TV series and movies today (albeit they still continue to be disconnected from the ‘actual’ practice of medicine). More interestingly care experiences are no longer limited to the four walls of treatment areas.

Convenient access to areas that enable visiting friends and worrying families to regain fresh-air, the way hospitals/clinics conduct both clinical and non-clinical business all make a difference to the care experience.!

Patient centred care in the emergency room ...

Life goes on Let’s start with an ER experience example that most of us can potentially relate to.

Consider a patient with a bad lung infection that has presented to the emergency room with falling blood pressure and decreasing urine output. The worried family is asked to step out of the treatment area and find someplace to wait in the emergency room where ‘they don't interfere in the care being delivered, and allow the doctors to do their job’. The patient is rapidly assessed by the treating physician to be in septic shock and as he prepares to initiate appropriate antibiotics and perform procedures to augment the blood pressure of the patient, a nurse quickly comes to the family handing them a sheet to take to the admission desk to admit the patient in the ICU ‘quickly’. The family member most experienced with hospitals finds the admission desk crowded with many other admission applications in an area of the hospital that is accessed by taking the first right and the second left turn out of the ER. A few minutes of wait later he is asked to deposit a certain amount of money to ‘make the admission’ of the patient. A few calls and a short walk to the ATM later the money is deposited and the admission file is created. Meanwhile the physician in the ER quickly

explains to the other family members that the patient has a severe infection and will be monitored in the intensive care unit (ICU) for potential affliction of the kidney function. He counsels them on the potential need for ventilation and is in the midst of explaining the next course of action when suddenly a trauma victim is wheeled into the ER in front of everyone’s eyes.

The physician rushes off to ‘handle’ this critical patient.

As the family tries to discuss their next steps the patient next to them vomits on the floor and a child starts wailing in another treatment area. A security guard walks up to them and telling them to clear the ER as ‘only one attender is allowed per patient’. At the same time two nurses walk into the patient’s area and ask him to change out of his clothes into the mandatory ICU gown. As soon as this is done the radiology technician arrives and helps the patient remove the ICU gown to take an X-ray of his lungs. Within an hour the patient is shifted out of the ER into an ICU where a specialist takes control of his management.

As you read the above, reflect on the quality of care delivered and the satisfaction with the care delivered. Are these two distinct questions?

Does excellence in one guarantee the other? Does failure to deliver one of the two trigger a collapse in the satisfaction level of patients/ family members?

The overwhelming belief that many healthcare planners have is that only the quality of care matters during medical emergencies. There is no denying that there are significant challenges to delivering on patient centred care in the ERs. Overcrowding, lack of a relationship between the ER staff and patient families, the social and cultural pressures of a patient arriving in an ambulance, time sensitive nature of interventions and procedures, triaging etc. each have their own ramification on delivery of patient centred care. At the same time though, it is never impossible to deliver care that is based on common

<5 km during a medical emergency, while only two per cent were willing to travel >10 km. On a scale of 0-100 (0 being no consideration, 100 being very high consideration) surveyed subjects displayed an average score of 28 for cost of care during medical emergencies.

This brief study identifies patient preferences and needs during medical emergencies - and these end up being very similar to the basic tenets of patient centred care.

(Check tables)

What is the recipe for patient centred care in the emergency room?

Care delivery is no longer a myth, but a care experience that is more than the sum of its parts. It is no longer just about good clinical care, but also about the people (the way they communicate, the empathy they display, and the way they treat each other) and the place (the look-feel-sound-smell, the privacy and the comfort afforded) sense and is conducted with respect and empathy. The fundamental premise that a care experience is determined by the people, the place and extends beyond the treatment areas remains true even here, and it all starts with understanding what patients and their families really want!

What are patient expectations during medical emergencies?

To gain some perspective on patient expectations during medical emergencies a sample of 125 individuals was surveyed and asked to remember their healthcare facility visits. Of the surveyed sample, 31 per cent indicated they their last visit to a

hospital was for a medical emergency. An additional 44 per cent of the surveyed population indicated that they had visited an emergency room sometime in the past for an acute condition. Of all the patients who had ever experienced care in emergency rooms, 44 per cent indicated that they were willing to definitely recommend friends and family members to visit the same ER, while 12 per cent indicated that they would definitely not. Only 10 per cent of surveyed subjects indicated that they had been told by someone to go to an ER or callan ambulance. More than half the subjects (53 per cent) indicated that they would only be willing to travel to an emergency room located

Indian cooking often has the phrase ‘add as per taste’ in front of components of a spice mixture. Similarly, there is no absolute recipe to deliver patient centred care during medical emergencies, but highlighted below are the major components that should definitely be assessed and addressed at any institution that is committed to delivering responsive care to patients. (Check Figure 1)

The right people When talking about the people who deliver care during medical emergencies, it’s important to remember that this is not just the physicians and nurses who take care of patients inside the emergency room. Meaningful engagement of patients and family members in care delivery is essential as a first step to treating patients with respect and integrity. A few implementation steps that can move the needle in the correct direction are: No strangers ◗The care team should introduce themselves and their roles in a lucid and memorable way. Putting up a magnetic board with small photographs and names of the care team could possibly help patients remember who is taking care of them in what capacity. ◗In a rapidly changing scenario of medical emergencies, it may be useful to have some constant. A patient care coordinator allocated to a particular

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KNOWLEDGE PATIENTS WHOSE LAST HOSPITAL VISIT WAS TO AN EMERGENCY ROOM family would be a good start to establishing a relationship between the ER staff and the patient family.

Family participation ◗ Allow patients to define who would be part of his/her family - and offer to speak freely to family members who maybe healthcare practitioners themselves if the family should like. ◗ Care team should ask these defined family members at the very outset as to how involved they would like to be in the patient care decisions.

Trust in qualified personnel: ◗ Hire qualified individuals who have the requisite expertise in emergent medical treatment. It is also important to display the same to patients - displaying expertise by demonstrating journal publications, interest profiles etc. of physicians and nurses may be a way of doing this. Excellence and Outcomes are markers of expertise. Public reporting of outcome measures may be a good strategy to enhance trust in care delivered and in the people delivering the care. ◗ Have a hierarchy of staff, to ensure that patients have a way to escalate questions if they should like.!

When did you visit the Emergency Room?

Top three reasons why you chose this hospital

< 1 month

34%

Skill & competence of staff

69%

1-6 months

28%

Technology in hospital

28%

6-12 months

10%

Time it takes to get care

24%

> 12 months

28%

Type of hospital you visited

Time taken to get care was

Corporate

69%

No wait

41%

Government

4%

Shorter than expected

17%

Nursing Home

10%

As expected

28%

Not-For-Profit/Trust

17%

Longer than expected

14%

WHAT PATIENTS LIKE AND WANT IN EMERGENCY ROOMS Top five things that you liked about the ER you visited

Top five things that you would like all ERs in India to have

Promptness in delivering care

44%

Trained physicians and nurses

45%

Attitude and attentiveness of nurses and physicians

40%

Special areas for treating high severity diseases like heart attack, brain stroke, infection etc.

38%

Availability of advanced equipment in ER

37%

Technologicaly advanced equipment

37%

32%

Appropriate communication about possible delays in testing/bed availability etc.

21%

Competence of Physicians

Time taken for administrative procedures

26%

Separate quick treatment areas for minor illnesses

17%

Cleanliness

19%

Cleanliness

14%

Communication

14%

Not-For-Profit/Trust

17%

◗ High severity disease management area (if possible then segregated by disease type) ◗ Fast track/chair disposition area for minor illnesses ◗ Isolation/decontamination area ◗ Procedure room for minor procedures ◗ Staff lounge ◗ Waiting area with access to coffee/snacks, counseling rooms, and a multi-faith chapel/prayerroom. ◗ Adequate patient and staff restrooms at distributed accessible locations ◗ Paediatric emergency area ◗ Observation area for patients staying in the ER > six hours. ◗ Billing and central registration areas ◗ Outpatient pharmacy ◗ The nursing/physician areas should have minimal physical barriers for interaction with other staff and family members. ◗ Regular upgrade/service of equipment and introduction of advanced effective diagnostics such as point of care testing and ultrasound not only help to streamline care delivery and decision making but also help convey to patients the technological superiority of the emergency room!

The right place

The right care and the right way

The structure and plan of the emergency room should ensure privacy and comfort for both patients and their family members. The emergency room should also cater to the satisfaction and comfort of their own staff members. Bed clusters grouped by disease acuity/ patient stay duration with dedicated nursing/physician areas for each have shown to improve nurse-patient interaction, efficiency, safety and quality of care delivered.

A well structured emergency room should incorporate at least the following treatment and nontreatment areas: ◗ Triage ◗ Dedicated high acuitytrauma resuscitation ◗ Intensive care unit

Care during medical emergencies is both medical and psychological, and is both for patients/families and the staff themselves. While clinical care is an essential component of this, more often than not it is the effective communication aspect that gets ignored in busy emergency rooms. Attitude often trumps competence in medical emergencies. Some ways to build trust in the care being delivered include: ◗ Display boards that allows patients to access personalised information on waiting times, care plans, pending and completed diagnostics - referrals etc.

These would aid patientfamily engagement as well, especially during times

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SOME FACTORS THAT DETERMINE BEHAVIOUR OF PATIENTS What is the most important factor in your choice of an ER

Do you use the internet to make decisions about which hospital or physician to visit?

Nearest hospital

36%

Yes

17%

Prior personal experience

30%

Yes but only for second opinions

39%

Reference from family physician

20%

No

43%

Reference from friends

14%

Do you use the internet to read about diseases/treatments?

Do online reviews about hospitals/doctors influence you in your choices?

Yes, always

54%

Yes, strongly influence

16%

Yes, but infrequently

38%

Yes, but weakly influence

41%

No

8%

No

43%

KNOWLEDGE of ED crowding when practitioners may not be able to spend as much time with patients. ◗ Development and deployment of communication plans: Introduction of scripting tools for communication, and Initiatives such as the HEART initiative (Cleveland Clinic) that encourage staff to display sensitivity when patients/ families have complaints have been proven helpful in alleviating concerns and improving satisfaction. ◗ Summarising patient findings to consulting specialists in presence of patients/ family members themselves, so they have the opportunity to add/correct facts when required. This would also prevent the multiple times a patient is required to give a history within the current medical system. ◗ The most commonly ignored care in the ED for patients is ‘food’. Creating a system that responds to patient food requests with extraordinary agility is

The structure and plan of the ER should ensure privacy and comfort for both patients and their family members as well as cater to the satisfaction and comfort of its own staff members likely to improve the care experience significantly. ◗ Assisted navigation through administrative processes by patient care coordinators. ◗ Remembering and addressing patients by their names/a name they would like to be called by. ◗ A continuing review of patient expectations and responding to them. ◗ Most hospitals and healthcare facilities today understand patient outcomes and monitor the clinical quality of care, but forget to measure satisfaction with the care-experience. ◗ Asking the right questions at the right time is essential to conduct these care-experience reviews. While there are several standardised tools available to gauge

patient satisfaction with care levels, often these tools are often applied at the time of discharge only. Taking a leaf from lean-six sigma, every single process of care needs to be reviewed at the time it is performed and not once the process is complete. ◗ Response to issues found in these reviews should never be knee-jerk reactions. They should be structured both in thought and in operational feasibility to ensure that there is a minimal tradeoff between providing comfort to families and delivering quality care.

But...

As you read and start reflecting on the above, some common thoughts that may

come to mind are: “All this sounds great, but have you been inside a busy emergency room? Where is the time?”

“I can’t do this alone without backup of my hospital” “Patients and families always want more” “All this is good for the west, in India whatever the doctor says is the word of God” “We will never have the resources to deliver this type of care in India” “Patients don’t even seek care in time in India, where is the opportunity for patient centered care then?”

“All patients care about is money, if you lower the costs they will be happier than ever” The list can go on and on...

What every healthcare administrator and practitioner needs to accept and acknowledge first and foremost is the fact that ‘delivering patient centred care’ is not ‘rocket science’. In the end patients want what everyone wants, better care, better outcomes and a better experience. We may all practice in a developing part of the world, but that in no way entitles our customers to a sub-par experience.

The patient centred care delivery initiative not only improves patient and staff satisfaction but also translates into improved safety, quality measures and an increased sense of empowerment for both.

An organisation that adopts these principles and works towards them would definitely hold an edge over its competition for patient retention and return. In the end satisfied patients will always continue to be the cheapest and most effective tool for business development and competitive advantage.

KNOWLEDGE I N T E R V I E W

‘We expect careHPV test to be one of our key growth drivers in this market in the foreseeable future’ Recently, QIAGEN launched its molecular diagnostic test for high-risk human papillomavirus (HPV) detection in low resource setting. M Neelam Kachhap spoke to Dr Geraldine Roeder, Associate Director, Women’s Health Market Development, QIAGEN to know more about the product How has cervical cancer screening evolved?

The pap smear was invented by Dr George Papanicolaou in 1943.

Gradually, developed countries began to use the pap opportunistically – only testing women who went to the doctors for other things.

In the 1960s, some of the European countries wanted to reduce the incidence of cervical cancer, so they made the pap smear free of charge and ran public awareness campaigns. This had limited success as the same small group of women got screened repeatedly, but the majority of women still didn’t take up screening, despite not having to pay for it. In the 1990s, a new type of pap test called liquid-based cytology (LBC) was developed. This uses a slightly different technique for preserving the sample, but still requires a highly trained cytoscreener to examine every slide. It is still vulnerable to the same failure rate and false negative rate as conventional pap smears. In the meantime, a test called visual inspection with acetic acid (VIA) was developed.

The only real development has been in the organisation and operational side of screening, until the invention of HPV testing by Digene (part of QIAGEN) in the 1990s. Over the past few years, we have seen organised screening programmes in

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developed countries replace the pap smear with HPV testing and an acceptance that VIA is not the best option for developing countries. The careHPV Test should make HPV testing possible for India too.

What are the challenges in the current cervical screening process?

The limitation of pap testing is that it requires constant repeat training as well as costly and burdensome quality assurance (QA) programmes to deliver good quality cytology. At best, cytology only detects around 70 per cent of cervical cancers. At worst, this can be as low as 30 per cent. So the pap test (conventional and LBC) is a very old technology with obvious disadvantages.

The most recent and reliable data shows that VIA test is extremely inaccurate (lots of false positive and false negative results). Also, experience from screening projects around the world has shown that when it comes to scaling up to screen large numbers of women, VIA is not practical because it requires lots of highly trained healthcare workers. In addition, cost effectiveness data suggests that because VIA has to be performed every year, whereas HPV testing can be performed every 5-10 years, or even once

WHO guidelines recommend HPV testing as the test of choice for cervical screening

in a lifetime in very low resource settings, HPV testing is a more cost effective method than VIA. The result of these recent developments is that the World Health Organization (WHO) has issued its most recent set of guidelines for cervical screening, which recommend HPV testing as the test of choice for cervical screening. Only where HPV testing is not possible (for operational reasons) should VIA be used.

QIAGEN has recently developed a cervical cancer screening product. Could you tell us more about it?

The randomised controlled trial run in India, by Dr Rengaswamy Sankaranarayanan of International Agency for Research on Cancer (IARC) and published in 2009, was the first trial to demonstrate that HPV testing could reduce the incidence and mortality of cervical cancer.

HPV testing detects over 96 per cent of cervical cancers and in the eight-year period of the Indian trial, resulted in over 50 per cent reduction in mortality from cervical cancer. However, the Digene HPV Test which was used in this trial requires a good quality laboratory and so QIAGEN, in partnership with PATH and the Bill and Melinda Gates Foundation adapted the Digene HPV Test for use i n low-infrastructure settings – this became the careHPV test which was launched in India recently.

The careHPV Test is a nucleic acid hybridisation assay with signal amplification that uses microplate chemiluminescence for the qualitative detection of 14 high-risk types of HPV DNA in cervical specimens. The HPV types detected by the assay are the high-risk HPV DNA types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Individual HPV types cannot be determined using this

test. The careHPV Test is CE-marked for use as a diagnostic test.

What are the main benefits of the product?

The careHPV test is designed to screen women in settings with limited healthcare infrastructure, such as areas lacking electricity, water or laboratories. It is for primary, standalone screening in women 30 years and older, to determine high-risk HPV infection, which is a risk factor for developing cervical intraepithelial neoplasia (CIN) 2 or higher. The test may be run by a healthcare worker with basic training — no formal laboratory skills are required. Cervical cells are collected by a healthcare worker using the careBrush and careHPV Collection Medium. The assay may be run on mains electricity or using a battery with an inverter, making it portable and adaptable. The assay can be run in a flexible temperature range, from 15 to 40°C. What are your expectations of this product in terms of units sold/revenue?

Globally speaking, HPV testing is one of the largest segments in molecular diagnostics, with a potential of more than $1 billion.

Continued on Page 52

KNOWLEDGE I N T E R V I E W

â&#x20AC;&#x2DC;Our system is a simpler, safer and cheaper solution for obtaining regenerative cells cocktailâ&#x20AC;&#x2122; Dr Kotaro Yoshimura of Tokyo University in Japan demonstrated early success in reconstructive surgeries using stem cells derived from human fat tissue. Recently, scientific papers by Dr Yoshimura found that adipose-derived stem cells (ADSC) could be selected also in lipoaspirate liquid fraction (LAF). Based on this, a new device to extract stromal vascular fraction (SAF) is ready to be launched in the market. M Neelam Kachhap talks to its manufacturer, Pier Ivona, MD, MyStem, US to know more about SAF extraction and its use What is the potential of ADSC? Adipose tissue is a rich and very convenient source of cells for regenerative medicine therapeutic approaches. Due to their wide availability and ability to differentiate into other tissue types of the mesoderm, including bone, cartilage, muscle, and adipose, ADSCs may serve a wide variety of applications. Adipose stem cells have been utilised in studies addressing osteoarthritis, diabetes mellitus, heart disease and soft tissue regeneration and reconstruction after mastectomy and facial repair.

Various delivery systems and scaffolds to incorporate adipose stem cells have also been established. Adipose stem cells have been studied in vitro and in vivo. Much information in vitro has been obtained on adipose stem cell potency and biology as a function of donor gender, body mass index, and anatomical location. Further in vitro studies have examined the various cell populations amongst the heterogeneous population within the SVF from which ADSCs are obtained.

Tell us about your device that isolates ADSC? MyStem SVF system is a specially designed medical device to isolate ADSCs or SVF. The device is a completely

closed and sterile system for automated adipose tissue processing, in a safe and effective way. The device uses a cell selection technology based on cell-size segregation. This technology allows a quick selection of precursor cells naturally present in lipoaspirate liquid fraction.

Collecting a cocktail of regenerative cells from LAF without expensive machines and potentially harmful enzymes, opens a new range of applications for regenerative surgery, from burns, scars, wounds to orthopaedic diseases both in day-hospitals and operating rooms due to the small amount of harvested tissue needed. This device allows surgeon to get the entire SVF cells cocktail that is proved to be more effective than single lineage-expanded cells in a safe and closed system.

How is your device different from the already existing devices in the market?

All existing devices process adipose tissue using a potentially harmful enzyme and a big and expensive machine. Our system is a simpler, safer and cheaper solution for obtaining regenerative cells cocktail from a small amount of lipoaspirate.

It is the only medical device approved in Europe that offers hospitals and clinics the ability

to extract stem and regenerative cells from lipoaspirate liquid fraction in a sterile, cost-effective manner without time consuming manual processing.

Are there any published studies with your devices for automated adipose tissue processing?

Yes, we are submitting our validation study soon to several high-impact factor scientific journals.

MyStem SVF procedure is not very expensive compared to the existing procedures

What is the regulatory status of the device?

The device has CE Marking, ANVISA (Brazil and South America) and TGA (Australia) approval as a medical device.

Is MyStem easy to use?

Yes, absolutely. From early prototypes to current device being user-friendly was our first objective and commitment. With the most compact size, simplicity that enables all processes to be done with one button, and a closed system that protects from air contamination this device is very user friendly.

Who uses your technology and how much does it cost ($)?

Our customers are in orthopaedics, plastic surgery, dermatology, spine surgery.

Our pricing strategy is to keep our technology affordable for high-quality hospitals and

clinics in countries with low budget. Our efforts to optimise the technology allow us to price our device slightly cheaper than other similar technologies. If the Indian market, will support our efforts with good sales, we are confident to lower our price in the future. According to a research, current global stem cell market size is about $4.2 billion. The MyStem SVF procedure is not very expensive compared to the existing procedures. New costeffective technology does impact cost. The cost of any stem cell therapy is almost the same as any conventional surgical procedure. It would perhaps cost as much as Rs 50,000-75,000 for one course of stem cell therapy and the number of courses and duration would obviously depend on patient improvement. The cost of therapy will depend on procedures involved in procuring the stem cells, harvesting, culturing and characterisation including quality control of all procedures.

Is this device being used in India?

Not yet, we are in the registration phase right now, hoping to serve Indian customers as soon as possible. mneelam.kachhap@expressindia.com

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KNOWLEDGE I N T E R V I E W

‘Hospitals should implement standardised diagnostic and therapeutic approaches for sepsis management’ Severe sepsis is a major cause of morbidity and mortality, claiming lives of patients admitted in ICU department around the world. Patrick R Murray, WW Director Scientific Affairs, BD Diagnostics explains about the causes and ways to reduce the number of sepsis cases within hospitals, in conversation with Raelene Kambli Patients admitted in ICUs are more at risk of contracting sepsis. What are the main causes of this phenomenon?

And which patients are more at risk of contracting sepsis within ICUs? Patients admitted to the ICUs are the most critically ill patients in the hospital. Their ability to fight off infections is commonly compromised either through their underlying disease or through medical treatment that may impair their immune responsiveness. If the patients have infections of the lung, urinary tract, intestinal tract or skin, they frequently display systemic signs as the infecting organisms spread from the site of infection into the blood stream and then to distant organs. These patients also frequently have intravenous catheters which can serve as an entry site for hospital-acquired pathogens.

Additionally, immuno-

compromised patients, patients with intravenous catheters, patients receiving broad spectrum antibiotics, patients on respirators or other inhalation therapy devices are the ones that are at high risk of contracting sepsis within the ICUs. Which are the common sites of infection in patients that result in sepsis?

The common sites for infection in patients that might end up in sepsis include lungs in the form of pneumonia; urinary tract from pyelonephritis and the intestinal tract originating from intraabdominal abscess.

Can you give some statistics on mortality in patients with sepsis on the global front?

The number of deaths as a result of sepsis has been increasing ever since. The four major factors responsible

It is commonly stated that 2 to 30 per cent of patients with severe sepsis will not survive

for this rise in the incidence of sepsis are: ◗ Rise in the number of organ transplants and other surgical procedures that require suppressing the patient’s immune system ◗ Increase in the number of elderly people in the population ◗ Overuse of antibiotics to treat infectious illnesses, resulting in the development of drug-resistant bacteria.

It is commonly stated that two to 30 per cent of patients with severe sepsis will not survive, but this can vary enormously with as many as 70 per cent of patients in resource-limited countries dying.

Can you tell us about your research in sepsis management?

My work and that of BD Diagnostics is involved with improved diagnostics – more rapid detection through

improved blood culture technology of the bacteria and fungi responsible for sepsis, rapid identification of the pathogens with mass spectrometry, and rapid antimicrobial susceptibility test results to guide therapy with automated platforms such as the BD Phoenix system.

How can hospitals help in reduction of sepsis cases within ICUs? And what precautions should hospitals take in this regard?

Hospitals should come up with defined policies to reduce the use of broad spectrum antibiotics; limit the use of intravenous catheters, urinary catheters and inhalation therapy. Also, they should implement standardised diagnostic and therapeutic approaches for the management of patients with suspected sepsis. raelene.kambli@expressindia.com

Continued from Page 50

We expect careHPV test to be...

The potential of HPV testing to prevent cervical cancer through routine screening programmes, in developing and developed countries, has been demonstrated in numerous scientific studies involving more than one million women

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that were screened using QIAGEN technology. As a result, the degree and scope of HPV awareness has increased significantly in recent years, with HPV testing becoming a more routine part of cervical cancer screening. India is the

fastest-growing country within QIAGEN’s Asia Pacific region, especially in the molecular diagnostics area.

There are about 72,000 women who die of cervical cancer each year in this country, more than onefourth of the world’s 270,000

annual deaths. The disease accounts for about 20 per cent of all cancer-related deaths in women and is the number one cause of death in middle-aged Indian women.

Therefore, QIAGEN considers careHPV, the world’s first molecular

diagnostic designed to screen women in low-resource settings, a perfect match with the local market and we expect it to be one of our key growth drivers in this market in the foreseeable future. mneelam.kachhap@expressindia.com

KNOWLEDGE I N T E R V I E W

‘Patients prioritise medical expertise above all other factors’ The Boston Consulting Group (BCG) conducted a research with Indian patients across the country to identify the factors that drive patient satisfaction in healthcare. Priyanka Aggarwal, Partner & Director, BCG shares details of the research, key findings and recommendations for healthcare providers to improve patient care, with Lakshmipriya Nair

What prompted BCG to undertake this study?

What was the rationale behind initiating it?

BCG undertook this research last year in 2013 as a joint initiative of the Healthcare Practice and Center for Consumer and Customer Insight (CCCI ).

There was a need felt to better understand insights from a patient lens. It has become imperative to understand how patients select a hospital for treatment and what drives their satisfaction once they are receiving an OPD or IPD treatment at a hospital.

This is the first-of-its-kind research in India. In our discussions with different hospital chains, they all received this very well and said it really added robustness and nuance to their understanding of drivers of patient satisfaction and will help inform their decisions on where to invest for improving patient experience.

You have identified four broad drivers of patient satisfaction: medical expertise, pricing and process efficiency, care and patient comfort, and facilities. Which of these scored more points with the patients, which factor did they give more precedence to and why?

From the results of the study, medical expertise drives a third (33 per cent) of

the overall satisfaction, pricing and process efficiency drives another 30 per cent of the satisfaction, care and patient comfort drives 25 per cent of the satisfaction and facilities drives 12 per cent.

What are the key learnings from the study for hospital providers?

Implications for providers are clear : (i) They should focus on giving patients tangible experience on medical expertise through efforts like establishing clear metrics and sharing data on outcomes for different conditions (ii) They should build uniform and consistent processes to provide smooth, hassle-free and predictable experience across processes along the patient value care (e.g., uniform expected waiting time, time taken to get admitted etc) (iii) Finally they should enhance their organisational capability to provide good service experience to the patients (e.g., interaction with nurses, doctors, other staff) How predictive were the results of the study? Any surprising outcomes?

We had six sets of insights that we have detailed out in the study: ◗ Medical expertise, more than patient satisfaction, drives hospital selection:

Patients are more likely to come back to the hospital if they are satisfied with overall medical care and nonmedical processes experienced during their treatment

When first selecting a hospital, patients prioritise medical expertise above all other factors. However in the absence of tangible metrics to measure medical quality, patients rely on proxies to judge hospitals on medical quality like quality of interaction with nurses, staff and nonmedical processes like time taken to get admitted etc. ◗ Process excellence is essential: Over the course of care, many non-medical processes determine patient satisfaction significantly – e.g., efficiency of service (not having to wait too long), predictable processes and wait time for different tests that are done. ◗ Pricing transparency rivals price: Patients care about transparency in billing as much as actual price of the treatment.

They do not like to be surprised – this can be a big source of dissatisfaction ◗ Focus on the basics: Luxuries have little impact on patient satisfaction, but they expect basic standards of service – hygiene, clean drinking water and food services. ◗ Institutional quality trumps the reputation of doctors: While doctor reputation is important in attracting first time patients, it is less critical in driving loyalty. Patients are more likely to come back to the hospital if they are

satisfied with overall medical care and nonmedical processes experienced during their treatment. ◗ Personal referrals reign, but the role of Internet is increasing: Referrals and word-of-mouth is the biggest source of information and influence on decision making, but significant proportion of patients (~20 per cent) now use Internet to research/ look for information.

The study covers respondents from cities, do you intend to scale it up in the recent future?

Would these findings corroborate with the views of the patients in rural India?

The focus of the study is urban centres – 1000 patients were surveyed across 19 cities. The interviewees — men and women of all ages with diverse socioeconomic and other demographic profiles— received care from seven of the top private hospital chains.

The drivers of selection and satisfaction would perhaps be very different in rural India – that was not part of the scope of the study.

We undertake research from time to time, to deepen our knowledge base or in response to specific client requirements. lakshmipriya.nair@expressindia.com

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IN IMAGING

Innovative fusion, MRI+ultrasound: a new hybrid imaging modality is quickly gaining ground among radiologists. An analysis about the challenges and prospects of the technology.

BY M NEELAM KACHHAP

A

dvances in the field of radiology have always been revolutionising healthcare. Speak of fusion imaging and one always thinks of PET-CT or PET-MRI. However, a blend of MRI and ultrasound technology is now available and has opened new possibilities in prostate imaging and biopsy targeting. By using this technology, doctors can not only find hidden tumours missed by conventional prostate biopsy but also reduce the number of biopsies performed on the patient. A rare and expensive technology fusion MRI/ultrasound is said to add value to the existing information available to doctors treating prostate cancer patients. This technology has proven to be of great value for detection of tumours in

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men with prior negative biopsies, but persistently elevated PSA levels.

Difficult to diagnose Prostate cancer is difficult to diagnose for a number of reasons. The size of the organ and its location, accessibility for inspection etc., all pose great challenges for doctors. “Assessment of the prostate malignancy is difficult because of the small size of the organ of origin, and delayed presentation of symptoms,” says Dr Venkataraman Bhat, Director, Radiology-Imaging Services, Narayana Health City, Bangalore.

“Prostate cancer does not have specific symptoms in its initial stages, and its symptoms overlap significantly with that of benign

Technology allowing fusion of ultrasound and MR images will certainly enhance the value and accuracy of information. This is a welcome addition to the available technology options Dr Venkataraman Bhat Director, Radiology-Imaging Services, Narayana Health City, Bangalore

As techniques and technologies evolve in the future, it may help in improving detection rates, decreasing costs and morbidity and allow the selective detection of significant prostate cancer

This method increases sensitivity of prostate biopsies, than those performed with single modality imaging Dr Madhavan Unni Sr Consultant Radiodiagnostics, KIMS Hospital, Kochi

Dr Gagan Gautam Head of Urologic Cancer Surgery & Robotic Surgery, Medanta - The Medicity, Gurgaon

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IN IMAGING prostatic hyperplasia,” explains Dr RK Gupta, Director and Head, Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon.

Prostate harbours malignancy in several asymptomatic patients, occasionally found incidentally. “Advanced prostate cancer patients are seen by either neurosurgeons or by orthopaedic surgeons, thus a delay in diagnosis is inadvertently made,” says Dr Kailash Mishra, Consultant, Radiation Oncologist, BNH HCG Cancer Centre, Bangalore. “The nocturia, hematuria and dysuria are confused with urinary tract infection and also with benign prostatic hyperplasia which is very common in elderly population,” he adds.

Cancers in other solid organs are usually detected by imaging and then biopsied for confirmation of diagnosis. “In case of prostate cancer, malignancy is usually suspected by a raised PSA or an abnormal nodule on physical examination and then multiple random biopsies are taken from the prostate to confirm the presence and the grade of tumour.

More often than not, a prostate malignancy is not clearly visible on imaging. Moreover, a suspicious lesion on imaging may not be cancer at all,” explains Dr Gagan Gautam, Head of Urologic Cancer Surgery & Robotic Surgery, Medanta - The Medicity, Gurgaon. Moreover, the clinical course of prostate cancer in general is less stormy and protracted, sparing a small percentage of very aggressive forms. And the regular CT is not effective in detecting prostate cancer.

“Imaging with CT scan takes a back seat in prostate cancer,” says Dr Mishra.

Imaging modality for prostate cancer Since diagnosis of prostate cancer is difficult it requires precise and quick imaging information. Many urologists would prefer an MRI exam but it is expensive and not always available. Hence ultrasound is used more frequently in India.

“Prostate cancer imaging has been traditionally done by two

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LEGEND A. T2-weighted axial MRI demonstrating a lesion in the left peripheral prostate.

B. Diffusion weighted MRI showing restricted diffusion (ADC value of 562) within the lesion.

C. Real-time ultrasound image of the lesion (outlined in blue) deriving from MRI fusion in Artemis device.

D and E. 3D reconstruction of prostate, based on ultrasound scan, showing lesion from MRI fusion (in blue) within the model, D saggital and E transverse views. Tan lines, which are image-captured biopsy sites, show sites of both systematic and targeted biopsy cores.

Targeted biopsies in this patient revealed Gleason 7 prostate cancer.

F. Radical prostatectomy specimen showing tumor (dotted line) in whole mount section. Histologically, tumour was a 2 cm Gleason 7 cancer in the left peripheral zone Work flow of targeted prostate biopsy in 59-year old male with PSA 7.4 ng/ml, no palpable prostate lesion and prior negative biopsy

modalities which have till recently, been independent of each other. For the diagnosis of prostate cancer, multiple biopsies are performed randomly from the prostate under transrectal ultrasound guidance. The objective is to ensure that all the areas of the prostate are adequately sampled in order to decrease the chances of missing a cancerous area,” explains Dr Gautam.

“Over the last few years, multi-parametric MRI (MPMRI) is playing a major role in the diagnosis and staging of prostate cancer. With the help of various sophisticated imaging sequences such as dynamic contrast enhancement, diffusion weighted imaging and magnetic resonance spectroscopy and with the use of higher strength magnetic fields (3T) and endo-rectal coil, it is

now possible to detect small cancerous lesions in the prostate and do an accurate local staging with a greater degree of confidence,” he adds.

“MRI is the modality of choice for imaging prostate cancer,” opines Dr Gupta.

“Ultrasound and CT do not have adequate contrast to reliably diagnose prostate cancer,” he says. “Early prostate cancer is imaged using transrectal ultrasonography and MRI,” says Dr TK Padmanabhan, Senior Consultant, Radiation Oncology, KIMS Pinnacle Comprehensive Cancer Center, Kochi.

“Patients having elevated PSA (more than 4 ngm/ml) or having suspicious hard nodules on digital rectal examination (DRE) are subjected to ultrasonography and MRI,” he adds.

“Prostate cancer is initially

imaged by transabdominal sonography. Additional highquality information can be obtained through the transrectal ultrasound. Much more specific and accurate information is obtained using MRI,” says Dr Bhat.

However there are other methods of imaging that provide more sensitive information. “T2W imaging, dynamic contrast enhanced MRI, diffusion weighted MR imaging and MR-spectroscopy are all used for imaging prostate cancer,” informs Dr Madhavan Unni, Senior Consultant, Radiodiagnostics, KIMS Hospital, Kochi. “Isotope scanning, PET-CT and SPECT are also used for staging prostate cancer. Contrast enhanced ultrasonography and ultrasound elastography are new methods in ultrasonog-

Courtesy: urology.ucla.edu

raphy which are being evaluated for prostate cancer imaging,” he adds.

Image-guided biopsy The small size of the organ and its origin pose a lot of challenges for biopsy. It has to be approached via the rectum, urethra or the penis. “Standard approaches for prostate biopsy are transrectal, trans-urethral and trans-perineal. Of these, ultrasound guided trans-rectal (TRUS) biopsies are most popular and are widely employed,” informs Dr Padmanabhan. But the TRUS-guided standard biopsies are cancer blind, so despite taking 12 biopsies there is always potential risk of missing the cancer.

“One data says that these biopsies can miss up to one third cancers and half of the cancers are given lower grade

IN IMAGING on biopsy than what they turn out to be on surgery,” says Dr Gupta. Agreeing, Dr Mishra says, “Trans-rectal ultrasoundguided biopsy (TRUS) is the standard method of biopsy used for prostate but 12 core detection ratio is only 44.4 per cent and is a blind procedure too. There is a 20-30 per cent miss during first procedure, and with each additional biopsy session the rate of cancer detection decreases.”

Explaining the challenge, Dr Unni says, “Despite multicore biopsies, less than one per cent of total gland volume is sampled. Many times, smaller lesions cannot be seen in ultrasonography and essentially the biopsies are nontargeted. Apex, lateral most and anterior parts of prostate are usually not adequately sampled. As mentioned before, close to 40 per cent of prostate cancers can be missed in biopsies also.”

Commenting on the limitations, Dr Bhat says, “In an ultrasound image normal and abnormal prostate are differentiated by difference in echogenicity. Occasionally contrast enhanced ultrasound augments diagnosis of detection of abnormal areas.

Blind biopsies of prostate have a limitation of improper and non-representative sampling.

Transrectal ultrasound-guided biopsies are more accurate, though technically more demanding. Despite being more accurate than blind biopsy, ultrasound is only able to biopsy basal part of the gland. Sizeable part of the gland remains beyond ultrasound reach.”

Experts believe that combination of two modalities can yield new and useful information. For prostate cancer MRI and ultrasound is considered a safe procedure for prostate biopsy, and is widely being accepted

reviewed separately, and in different contexts. “MRI being a more sensitive imaging technique for prostate cancer, data from MR-images can be extrapolated to a computer generated 3D model of prostate gland. This 3D dataset can be fused with images from specially designed ultrasound

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Fusion MRI/USG is the answer Experts believe that combination of two modalities can yield new and useful information. For prostate cancer MRI and USG is considered a safe procedure for prostate biopsy, and is widely being accepted.

MRI and ultrasound techniques have different ways of unravelling normal and abnormal tissues. Information obtained from both techniques is complementary. Since the information is obtained from different modalities, they are

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IN IMAGING Need of the hour

machines having controlled articulated arms and then used for precise targeted biopsies,” explains Dr Unni. “This method increases the sensitivity of prostate biopsies, than those performed with single modality imaging,” he adds.

“Localised CaP has proven difficulty for imaging,” explains Dr Mishra. “The MRI/US fusion technique distinguishes between small insignificant cancer and a lethal one, the former are more prevalent and need only 'active surveillance,' he adds.

Dr Gautam explains, “In this technique, an MP-MRI is done before the biopsy in a patient suspected to have prostate cancer. Any suspicious areas within the prostate are detected and categorised based on the level of suspicion on imaging criteria. This information is fed into the ultrasound machine, which labels and superimposes these suspicious areas on a transrectal ultrasound image of the prostate thereby targeting them for a biopsy. In recent studies, the detection rate of prostate cancer from these targeted areas has been found to be significantly higher than random biopsies.”

Which modality is better?

We know that MRI/US fusion imaging gives a composite set of information with accurate anatomical correlations for targeted biopsies but how does it compare to single modality imaging? “All modalities have their drawbacks.

TRUS-guided biopsies are cancer blind and MRI-guided biopsies are too cumbersome, time consuming and costly,” opines Dr Gupta.

“On discussing the merits of only ultrasound or only MRI or MRI/ultrasound fusion, the opinion was that ultrasound has poor soft tissue localisation whereas only MRI can serve the purpose but it is always better to choose the best one available,” says Dr Mishra. “US/MRI fusion technique aids in systematic and targeted prostate biopsy to guide and record biopsy locations and to fuse MRI with real time USG,” he adds.

Offering a different view, Dr

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Artemis (Eigen, Grass Valley, CA), is a device which allows biopsy site tracking with 3D ultrasound and fusion of real-time ultrasound with MRI. The device was installed at UCLA in early 2009

Many noted medical institutes in the US and Europe are using this fusion technology for targeted tissue biopsies and for grading of cancer Gautam says, “The same function can also be performed by ‘cognitive’ guidance, which implies studying the MRI films carefully prior to performing the biopsy and targeting the suspected areas with ultrasound without the fusion technology.”

“It is an obvious fact that this ‘non-fusion’ guidance would be extremely prone to error, specially since the distance between normal and abnormal areas in the prostate may just be a few millimetres,” he adds.

Growing concern Prostate cancer is one of the most common causes of cancer in males and its cases have been increasing globally.

Incidence is highest in Scandinavia with 22 per 100,000 population and lowest in Asia at five cases 100,000 population. Yet, in India the incidence of prostate cancer is increasing and about 20,000 cases are detected every year.

According to Indian Council of Medical Research (ICMR), by 2020 about 30,000

new prostate cancers will be detected every year.

The distribution of prostate cancer in India varies. “In Delhi, it's the second most common cancer in males. In Mumbai, it is the third most common cancer. In Bangalore, it is the fourth most common cancer in males. Incidence of prostate cancer is less in North Eastern states of India and it is not in the top 10 cancers in males, whereas in other states it is among the top cancers in males,” explains Dr Padmanabhan.

With the rising number of prostate cancer patients in India, it is important that we find a good detection technique that would help doctors make informed decisions. “Combining information from MRI and ultrasound will add to accuracy of diagnosis. Fused images, when used on ultrasound platform, can also allow more accurate biopsy localisation,” says Dr Bhat. “Technology allowing fusion of ultrasound and MR images will certainly enhance the value and accuracy of information. This is a welcome addition to the available technology options,” he adds.

In spite of this, none of the hospitals in India are using MRI/ultrasound fusion imaging for targeted tissue sampling. “I am not aware of any centre wherein the fusion of MR and ultrasound images is done for prostatic evaluation. There are many vendors providing equipment capable of fusion technology which are routinely used in the West,” opines Dr Bhat. Dr Gautam agrees and says, “To the best of my knowledge, there are no centres in India yet, who are using this.”

However, many noted medical institutes in the US and Europe are using this fusion technology, not only for targeted tissue biopsies but also for grading of cancer. Besides cancer, this fusion imaging is also finding application in imaging rheumatoid arthritis among other diseases. As of now, its use and value in prostate cancer has been established. Vendors are researching and fine-tuning the technology further. New transducers are being designed, new combinations are being tested and results are highly promising.

“As techniques and technologies evolve in the future, it may help in improving detection rates, decreasing costs and morbidity and allow selective detection of significant prostate cancer while avoiding over detection of insignificant tumours which do not warrant treatment,” sums up Dr Gautam. mneelam.kachhap@expressindia.com

IN IMAGING INSIGHT

Advents in breast imaging

DR PRIYA CHUDGAR Consultant Radiologist Kohinoor Hospital

Dr Priya Chudgar, Consultant Radiologist, Kohinoor Hospital expounds on different techniques in breast imaging and their advantages

B

reast cancer is the most common kind of cancer in women all over India. It accounts for 25 per cent to 31 per cent of all reported cases in the country. Earlier, the average age for developing the disease was 50-70 years which now has alarmingly shifted to 30-50 years. Breast cancerâ&#x20AC;&#x2122;s drastic shift to the younger lot has made breast imaging vital.

According to Globocan (WHO), India recorded 70218 deaths due to breast cancer in 2012, more than any other country in the world. Awareness and understanding about this disease is half the battle won already. Early detection and prompt treatment will keep a check on the mortality rate.

General awareness, along with self and clinical examination, would detect palpable abnormality. So far, mammography was the mainstay for treating the occult disease.

Mammography, however, has well-recognised limitations and, thus other imaging modalities including ultrasound and magnetic resonance imaging (MRI) have been used as adjunctive tools, mainly for women who may be at increased risk for the development of breast cancer. In this article, we will briefly review different breast imaging modalities with their advantages and limitations.

Mammography Mammography is the process of using low-energy X-rays to examine the human breast and is used as a diagnostic

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and screening tool. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or micro-calcifications. A mammography unit is a rectangular box that houses the tube in which X-rays are produced. The unit is used exclusively for X-ray exams of the breast, with special accessories that allow only the breast to be exposed to the X-rays. Attached to the unit is a device that holds and compresses the breast and positions it so images can be obtained at different angles.

Mammography is possibly the most intensely scrutinised and debated medical procedure, but there is no other breast cancer screening tool that has a better combination of sensitivity and specificity.

Breast tomosynthesis or 3D mammography Conventional 2D mammography produces a single, flattened image of the breast, making it difficult to detect small cancers. Tomosynthesis minimises the impact of overlapping breast tissue during imaging because the camera moves over the breast taking images from multiple angles. These images are combined to create a three dimensional rendering of the entire breast. Thus, it provides a clearer, more accurate view of the breast and allows radiologists to more effectively pinpoint the size, shape and location of any abnormalities. This can lead to better detection and increased

IN IMAGING Breast MRI

accuracy.

Ultrasound More than 40 per cent of women have dense breast tissue, which makes tumours harder to see with mammography alone. Ultrasound is better than mammography at identifying tumours within dense breast tissue. Studies have shown mammography combined with ultrasound can find more breast cancers than mammography alone in women with dense breasts. Ultrasound uses sound waves to make images of the breast. It is non-invasive and is often used as follow-up test after an abnormal finding on a mammogram. Ultrasound helps to differentiate between different types of lumps, such as liquidfilled cysts and a solid mass. It is also used to find out the size, shape, texture and density of a breast lump.

ABUS reduces the subjectivity of ultrasound and makes it easier to verify results and compare them with mammographic and 3D-MRI findings.

Studies are in progress to prove this as an effective screening tool

A breast MRI uses magnetic fields to create an image of the breast. It can sometimes find cancers in dense breasts that are not seen on mammograms.

Breast MRI is often used with mammography for screening some women at a high risk of breast cancer. However, it can be costly and often finds something

M-power your radiology department

3D automated ultrasound A hand held 2D ultrasound is operator dependent and a lengthy procedure. Hence it is only used as an adjunct to mammography. However, a 3D automated ultrasound device has changed the scenario by reducing operator dependent bias. Pre-programmed trajectories ensure that images of every part of the breast are obtained and ensuing data are evaluated by at a 3D workstation by analysing the images of the breast in any desired direction. Thus, automated breast ultrasound (ABUS) reduces the subjectivity of ultrasound and makes it easier to verify results and compare them with mammographic and 3D-MRI findings. Studies are in progress to prove this as an effective screening tool.

Elastography Breast elastography is a new sonographic technique that provides additional characterisation information on breast lesions over conventional sonography and mammography. This technique provides information on the strain or hardness of a lesion, similar to a clinical palpation examination. Two techniques are now available for clinical use: strain (compressionbased elastography) and shear wave elastography.

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IN IMAGING that looks abnormal, but turns out to be benign (false positive).

Image guided biopsies Advent of newer breastscreening protocols has led to an increase in the detection of small or impalpable breast lesions.

The ability to achieve an accurate histopathologic diagnosis of these lesions is crucial to any screening programme in terms of appropriate treatment planning and patient counselling. This can be performed via ultrasounds, as fine needle aspiration or core biopsy, but lesions better seen on mammography images, particularly microcalcifications, require stereotactic localisation.

Stereotactic breast needle biopsy It refers to the sampling of non-palpable or indistinct breast lesions by using techniques that enable spatial localisation of the lesion within

Continuously emerging advancements in technology present new challenges and possibilities for the field of breast imaging.

Such innovations are helping clinicians detect and diagnose breast cancer in its earliest stage the breast. Compared with open surgical biopsy, needle biopsy causes less trauma and disfigurement and is performed as an outpatient procedure with the patient under local anesthetic.

Vacuum-assisted biopsy This is a type of biopsy in which a vacuum-powered instrument is inserted through the skin to the site of an abnormal growth to collect and remove a sample of cells for analysis. Using vacuum pressure, the abnormal cells

and tissue are removed without having to withdraw the probe after each sampling as in core needle biopsy.

Wire localisation Guided by an imaging modality such as ultrasound or MRI, a wire is inserted through a hollow needle to a lesion or suspicious area of cells and tissue. The wire then guides the surgeon to the area so that the abnormal tissue can be surgically removed for examination.

Breast-specific gamma imaging (BSGI) BSGI is a functional imaging technique designed to assess changes in tissue function rather than in anatomical structure.

It is most commonly used for patients who have equivocal mammography or ultrasound findings. It is also used to help determine the extent of breast cancer involvement and to help clarify lymph-node involvement.

The breast is compressed between two camera heads and a small dose of radioactive material is injected intra-

venously (sestamibi). BSGI can help to differentiate cancer from other structures.

Computer-aided detection Computer-aided detection (CAD) technology uses a computer to provide a second read or assist radiologists in making an accurate diagnosis. CAD systems have been approved by the US FDA for use in mammography, lung computed tomography, virtual colonoscopy, and breast MRI. They help increase sensitivity for detecting small lesions and calcifications in the breast.

To summarise, continuously emerging advancements in technology present new challenges and possibilities for the field of breast imaging.

Such innovations in technology are helping clinicians detect and diagnose breast cancer in its earliest stage, thus saving the lives of countless women yearly.

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IN IMAGING SPOTLIGHT

Dr Mukund Joshi : Father of ultrasound in India Dr Mukund Joshi has been instrumental in the growth of ultrasound imaging in India.

Raelene Kambli catches up with the veteran to get a glance into the life of the great man and development of ultrasound in India

H

e finds his happiness in helping as many people as possible, through his work. He is a deft radiologist and a mentor to many in the field of radiology. He has extensively taught and promoted ultrasound in India and the rest of the world.

Moreover, he is the second Indian in 100 years to get a honorary membership of RSNA in 2012 and the first Indian to receive a fellowship of American College of Radiology in May 2013. He is Dr Mukund Joshi, Consultant Radiologist, Jaslok Hospital, Mumbai, a name synonymous with ultrasound in India. His contributions to the field range from grey scale ultrasound to interventional procedures and 4D ultrasound imaging. With his constant effort in promoting the field of radiology, he has been honoured with the prestigious awards such as Sir JC Bose Memorial Oration Award by IRIA in 1985 and the Lifetime Achievement Award

by ISR in 1998. He was one of the members of the expert working group of the Planning Commission during 1997-2002.

He has held editorial positions in national and international journals including Ultrasound Clinic of North America, Clinical Imaging Science and British Journal of Ultrasound. He is currently on the Board of Directors of Medical Imaging Partnership and a member of International Advisory Committee of the RSNA. He is the recipient of ‘Life Time Achievement Award’ by Association of American Radiology of Indian

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Origin in 2008 and has several other honours to his name.

How the story began...

Dr Joshi was born in a very illustrious family, dedicated to the field of medicine. Seeing his father, one of India’s eminent ENT surgeons achieve excellence in his field, gave him the impetus to take up medicine as his career. He completed his medical education from Seth GS Medical College and KEM Hospital respectively. Further, he pursued his diploma in medical radio-diagnosis at the College of Physicians and Surgeons, Bombay. He completed training in ultrasound at Herlev Hospital, Copenhagen, Denmark, and the Royal Marsden Hospital, UK, and training in breast imaging at Sydney Square Breast Center in Australia. Dr Joshi trained in Doppler ultrasound at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, and the University of California, San Francisco.

Dr Joshi’s association with ultrasound imaging began during the times when medical practitioners and radiology worldwide were sceptical about its clinical applications.

During the initial days of his career, he practised general radiology for a long time but then he got bored. Remembering those days when he shifted focus from general radiology to ultrasound imaging, he recalls, “I was bored doing the usual radiology practice of asking my patients to breathe in breathe out and take general images us-

IN IMAGING ing X-ray and giving out radiation to patients. I wanted to do something more, something indepth. I got into diagnostic imaging which would benefit all kinds of diagnosis in medical practice. I decided to further upgrade myself in the field of sonology and ultrasound imaging. At that time, I read an advertisement that spoke about Danish government giving scholarship to students interested in specialising in ultrasound imaging. I applied for the same and landed up at the Herlev Hospital, Copenhagen, Denmark, one of the most reputed institutes for radiology in the world.”

Thus, began the journey of an ultrasound expert. However, learning at the Herlev hospital was not a cake walk. He confesses, “Doctors at Herlev were just great, even the nurses there were apt in understanding the applications of ultrasound. Initially, I found it very difficult to understand. I even thought that I may not be able to pull it off.” Nevertheless, Dr Joshi put his entire heart and soul in learning the clinical applications of ultrasound.

Thereafter, he went to London to study further and work with Dr David, who was the Head of Department at Royal Marsden Hospital, United Kingdom. Working at the Royal Marsden made him a competent radiologist and from there on, sky was the limit.

So, how did Dr Joshi utilise his skill in India?

Establishing ultrasound in India “In the late 70s, X-rays were the only thing in India and for some reason CT scans were more established as compared to ultrasound. Where ultrasound is concerned there was one group of doctors at the Bombay Port Trust Hospital under the guidance of Dr Pai who was the chief of medicine there had installed an ultrasound machine out of curiosity and started doing ultrasound on his patients. Gradually, he became the first man to start ultrasound in India. Then, Dr Amrish Dalal, returned to India after gaining his education in ultrasound imaging from America around the 80s and started his own private prac-

Ultrasound is used in many interventional procedures making it a boon to medical sciences

Dr Joshi’s association with ultrasound imaging began during the times when medical practitioners and radiology worldwide were sceptical about its clinical applications tice in ultrasound. So, these were the only two established people practising ultrasound in Mumbai. However, a top of the line complete state-of-the-art ultrasound department was established first by Jaslok Hospital in 1983. I was very fortunate that the management of hospital gave me the opportunity to establish this department. They extended their full support to me and allowed me to buy the equipment I needed to establish the ultrasound department here at Jaslok. I would also give credit to Dr GN Mansukhani, who was the head of Gynaecology and Dr Keshav who have been my strongest support in establishing the ultrasound department here at Jaslok. Now at the same time, AIIMS in Delhi had also started an ultrasound unit at the hospital; these were the two major well-established ultrasound units in India during those days. The institutes were trying to propagate the uses of ultrasound in India.” In order to spread awareness about the uses of ultrasound Dr Joshi travel far and wide across the country. Apart from bringing

the latest technology and applications to India he is responsible to introduce techniques like the Acoustic Radiation Force Impulse (ARFI) Imaging - a type of ultrasound imaging used in medicine, particularly for the diagnosis and monitoring of cancers and the Automated Breast Volume Scanner (ABVS) used for complicated breast imaging.

The world scenario When asked about the growth of ultrasound imaging in the rest of the world, he disclosed, “World over, the scenario was different. People around the world were hesitant to use ultrasound. They had queries about how much can sound waves penetrate a human body and how much can they give information etc. Europe has adopted it in clinical practice but the Americans were not ready to accept ultrasound as a useful imaging modality. It took some time for the Americans to bring ultrasound into clinical practice. On the other hand in India, ultrasound was slowly getting noticed.”

So, how did the ultrasound technology develop further?

How did the Indian market respond to this development?

haematoma in the brains. The next development came in the B mode (brightness mode) ultrasound, in which a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen. After the B mode came the real time imaging. Then came the Doppler which was further developed to colour Doppler. And finally, around the 90s came the 3D ultrasound imaging. But, people wanted more. They wanted more real time imaging, so 4D technology was introduced in ultrasound. Also, on the research side, people started working on developments in the transducer technology.”

All the above mentioned advancements, especially the ones in the transducers have completely transformed ultrasound technology. Dr Joshi further mentions, “Today, we have the hand-held ultrasounds with wireless transducers which are extremely useful in emergency medicine.”

Moreover, he informs that with these rapid advancements in ultrasound technology, ultrasound is used in many interventional procedures making it a boon to medical sciences. Although he stresses that it cannot replace CT and MR.

The transformation “The first use of ultrasound came during the Second World War to detect German submarines. They sent sound waves into the sea to observe the returning echoes to characterise submerged objects. The reading of which were then used to prepare a graph that indicated that the object was a submarine. The technology was developed by the navy people. It was also brought into clinical practice by navy doctors,” inform Dr Joshi, when asked about the origins of ultrasound technology.

He furthers talks about the development and technological advances, “Ultrasound began with the A-mode (amplitude mode) which was the simplest type of ultrasound. In this type of ultrasound, a single transducer scans a line through the body with the echoes plotted on screen as a function of depth.

These were used for quiet some time to detect

Vision for India Dr Joshi believes that healthcare in India needs a new direction, especially where medical education is concerned. Talking about the lack of specialised radiologists in India he says that there is a huge shortage of manpower in the field of radiology. “Government needs to allow institutes to generate more seats at the PD level of medical education and introduce new PG courses in radiology.”

Lastly...

Dr Joshi has immense knowledge on ultrasound imaging, which is why people refer to him as the ‘Father of Ultrasound Imaging.’ He says that there is more work to do. In the coming years, we will see a new era of diagnostic imaging, specially in the field of molecular diagnostics. raelene.kambli@expressindia.com

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IN IMAGING I N T E R V I E W

‘The future of molecular imaging will be strongly linked with, for instance, oncology and therapy planning’ Molecular imaging has a huge potential to improve healthcare by way of allowing more directed and personalised therapy. KN Sudhir, Business Head – Molecular Imaging, Siemens Healthcare, India talks to Raelene Kambli about its scope in India and how molecular imaging is impacting radiology world over How has the field of molecular imaging developed so far?

The availability of cuttingedge innovations has led to phenomenal growth and widespread acceptance of molecular imaging over the last few years. For instance, in oncology in nearly four out of ten cases, physicians changed their intended patient management due to molecular imaging. (Source: Hillner BE, Siegel BA, Shields AF, Liu D, Gareen IF, Hanna L, Hartson Stine S, Coleman RE. The Impact of Positron Emission Tomography (PET) on Expected Management during cancer treatment. Findings of the National Oncologic PET Registry. Cancer 2009; 115:410418. PMID: 19016303). This additional diagnostic information has made molecular imaging integral to diagnosis (find disease), staging (characterise disease) and treatment monitoring (follow disease) of cancer.

Moreover, molecular imaging has taken on a similar essential role in cardiology and neurology. The field of molecular imaging has come a long way since its inception— making it, in the last years, one of the fastest growing imaging procedures worldwide.

What are the major operational issues being faced by research organisations in this field?

In researching how to

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diagnose and treat the most challenging diseases, such as cancer, coronary artery disease and dementia, molecular imaging is one of the most important quantitative imaging tests.

With conventional PET/CT technology, quantification of imaging biomarker uptake is already possible, but there can be inaccuracies and significant, unknown variances in image measurements that create an operational issue for longitudinal studies and correspondingly research organisations. With today’s SPECT/CT, inherent limitations in conventional technology have even prevented SPECT from producing quantitative measurements of a tracer’s uptake at all. To help researchers make sound decisions, imaging, therefore, must not only be quantifiable—it must also be accurate, reproducible and consistent.

Two additional challenging operational issues facing research organisations today are the dual requirements to improve patient safety, especially for repeating studies and the increase in productivity when, for instance, the instrumentation is shared with daily clinical use. Unfortunately, conventional PET/CT or SPECT/CT systems often require researchers to choose between protecting patients

through lower dose and enhancing productivity through faster scans.

The ability to find answers sooner than traditional anatomical modalities has made nuclear medicine a cornerstone of diagnostic imaging

How does molecular imaging improve the performance of research organisations?

A primary goal of research organisations is to deliver solutions that will produce definitive and timely answers to clinical questions. And, in today’s increasingly competitive and rapidly changing healthcare environment, these answers must also be provided in the safest and most efficient way possible. The ability to find these answers sooner than traditional anatomical modalities has made nuclear medicine a cornerstone of diagnostic imaging.

Additionally, the ability of both PET and now SPECT to provide quantitative results can provide researchers more confidence in their evaluation of patients.

Which are the areas in healthcare research that can benefit from molecular imaging?

The future of molecular imaging will be strongly linked with, for instance, oncology and therapy planning. As population ages, the frequency of cancers will increase and our ability to image the biology and physiology of a patient is critical to being able to understand, diagnose and stage the disease, but even more critically, to plan and

monitor patient therapy. For neurology, new tracers that allow the visualisation and quantification of amyloid plaque deposition in the brain will support physicians in diagnosing and monitoring neurodegenerative diseases.

And for cardiology, the development of new tracers labelled with 18F will make PET more accessible to assess myocardial perfusion.

How do you see innovation in molecular imaging impacting radiology worldwide and in India?

Innovations in molecular imaging help radiologists see the functional part of the organ rather than the physiology. For example, any change in the tumour that can be seen by a CT or MRI after six months can be seen by the PET/CT much earlier. This enables the physician to detect and diagnose certain diseases earlier. Due to this, we find many radiologists planning to acquire nuclear medicine equipment, especially PET/CT. With the advent of newer imaging biomarkers, the utility of PET/CT is no longer limited to detection and staging of cancer alone; there are newer applications in neurology and cardiology as well. All these developments are seen with a keen interest in India.

Which area of radiology do you see increased scope for

Continued on Page 69

IN IMAGING I N T E R V I E W

‘Myrian adapts itself to the exact needs of each user and hospital’ Jigish B Modi, CEO, Modi Medicare, talks to Express Healthcare on his company offerings, its plans for the coming fiscal and India's imaging market Tell us about Modi Medicare's offerings for the healthcare sector?

Modi Medicare has unique range of radiology workstation products to address the needs of radiologists and surgeons, especially in surgical planning of liver and brain, which has been widely accepted. These products are well renowned Intrasense Myrian range of radiology workstations which are modular and scalable. We also offer Angiodynamics RITA radiofrequency ablation products for addressing the needs of surgical oncologists and interventional radiologists for the last 12 years. We have successfully established a protocol for solitary tumour ablation in liver as well as osteoid osteoma.

Which offerings by Modi Medicare have gained popularity and acceptance in the past few years?

Myrian is the first true multi-modality workstation in the market with the capacity

to combine, compare and process images from several modalities simultaneously.

Myrian also adapts itself to the exact needs of each user and hospital. Liver transplant has been growing in India.

Liver resections are also getting very precise which helps the surgeons to save precious lives. To address such specific needs, we offer Myrian Liver solution which is very popular because of its accuracy and precise volumetric outputs which radiologists and surgeons have well appreciated. Liver surgeons also have the need to know the exact anatomical landmarks for precise surgery.

This has led to increased popularity for our products.

Our Myrian XT-brain which has complete solution for DTI,fMRI and perfusion is also well appreciated. Myrian also has comprehensive disease follow-up programmes in oncology, COPD, etc.... which gives the end-user a complete exhaustive, sophisticated, yet userfriendly solutions which can

be established as a PANHospital solution.

Today, India represents our biggest installed base and market opportunities for South Asia Pacific area

How has the company grown since its inception?

Modi Medicare has been involved in the Indian market for radiology workstations for more than four years. We have implemented Myrian installations in several major tier I and tier II cities (Mumbai, Delhi, Chennai, Ahmedabad, Vadodara, Hyderabad, Lucknow, Kozhikode, and Thiruvananthapuram). Our existing references include leading organisations comprising public hospitals, medical colleges and private institutions and clinics. Today, India represents our biggest installed base and market opportunities for South Asia Pacific area. We now have a dedicated team based at several locations in order to follow the client's needs and timely address their technical, clinical and commercial needs.

What are the company's

plans for this segment in the coming fiscal?

In the next fiscal, we will try to consolidate our strengths and introduce ourselves. Our platform is very well accepted in the global market and regarded as a competitive alternative or complement to modality vendors’ workstations as well as a smart way to enhance existing PACS installations.

With three major product launches every year, we move fast to offer state-of-the-art technology to our users.

Myrian XL-ONCO for cancer therapy evaluation or Myrian XP-LIVER for liver surgery planning are considered as the best solutions in their categories. The company recently launched Myrian XPBREAST, the most advanced breast MRI viewer on the market, and Myian XPProstrate, with outstanding reading performance, smart clinical workflows and postprocessing features.

Combined with high quality

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‘Providing leading edge to radiology professionals and helping them improve patient care have always been a priority’ During a recent India visit, Mirna Bassil, Marketing Manager, Emerging Markets ( Middle East, Africa, Greater Russia, Turkey, India, French Overseas Territories) of Carestream Health provides more insight into company’s various knowledge sharing initiatives and significance of them for the industry with Express Healthcare Carestream has launched various educational initiatives for radiology imaging professionals. What is the rationale behind them?

At Carestream, one of the top priorities has always been to help customers be on the leading edge in their profession. For this, not only we bring them high-end innovative digital X-ray imaging solutions but we also offer them various bestpractice sharing initiatives.

One of such best-practice sharing initiative of Carestream is eRadiograph, which is a bi-yearly clinical publication in an ebook format written by experts, who are a reference in their field.

Another initiative is our CWORI Programme (Carestream Workshop on Radiology and Imaging.) We conduct this programme in cities across India, where we invite experts from the radiology field to talk about current best practices in radiology.

We are also happy to run our CROP programme, or Carestream’s Radiographer Orientation Programme, in which our application specialists provide training to radiographers on digital X-ray imaging.

We are proud to have a panel of more than 20 medical imaging professionals, all veterans in their field, who help us in executing these educational initiatives. I’d like

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to take this opportunity to thank them for their trust and continuous support.

results in drawing more and more of them to login to our website and subscribe online.

Tell us more about eRadiograph?

This is a clinical e-journal written by various renowned practising radiologists on current best practices in medical imaging. For each edition of eRadiograph, we invite a different author to write on a different topic.

It is available free of cost to all medical imaging professionals. They just need to login to our website www.Carestream.in and register for current as well as future issues of eRadiograph.

Elaborate on CWORI programme and its benefits?

Carestream Workshop on Radiology and Imaging is an interactive programme, where we invite expert/s to share best practices in medical imaging with local medical imaging professionals. We started this initiative in the year 2010 and till date have conducted more than 40 such programmes in almost all A, B and C class cities in India.

These programmes have been attended by more than 2000 medical imaging professionals. On an average, we conduct around 10-12 programmes in a year.

We try to customise every CWORI programme by selecting the presentation topic and speaker/s as per the feedback received from the local medical imaging professionals. These two to three hour programmes proved to be a highly interactive platform for local imaging professionals. They actively participate to get detailed insight into a particular topic, as well as get answers to their queries directly from the subject matter’s expert.

How do you create awareness about the new edition of eRadiograph?

We have our own database of practicing radiologists. On the release of every issue we make an email announcement to these medical imaging professionals. We also create awareness about this through CWORI and CROP programmes as well as in various local and national radiology conferences. During these events whoever wants to subscribe to eRadiograph is welcome to simply fill-in the subscription form in order to start receiving eRadiograph.

We are happy to notice that eRadiograph is promoting itself. The quality of the content is generating excellent word-of-mouth among the radiology professionals, which

We bring high-end innovative digital X-ray imaging solutions and also offer customers various best-practice sharing initiatives

What are CROP programmes all about?

What are their benefits?

Carestream Radiographer Orientation Programme is a

two to three hours training session designed specifically for radiographers and conducted by our application specialists. The objective of this programme is to educate radiographers about the basics of X-ray systems and on how to effectively produce better quality X-ray images suiting the preference of practicing radiologists. The programme also covers usage and troubleshooting techniques for CR, DR and Laser imagers that lead to keeping the maximum uptime of the equipment. At the end of these training programmes we provide certificates to the participants. We launched CROP last year and we have already conducted 10 programmes in 10 different cities across India, benefiting more than 1000 radiographers. We intend to organise 10-12 of such programmes every year.

What kind of response have you received so far? Any important feedback from radiology professionals on these programmes?

We are thrilled by all the positive feedback and continuously increasing participation in all of our educational initiatives. The numbers speak for themselves! eRadiograph’s has now a 2000 plus subscriber base, which keeps growing. CWORI programmes have been attended by more than 2000 medical imaging

IN IMAGING professionals while the CROP programmes received over 1000 participants in one year.

Many imaging professionals have written to us to tell us that they preserve copies of our eRadiograph for their future reference. In their feedback, readers also often suggest preferred topics for the coming issues of eRadiograph. On the other hand, imaging professionals proactively ask us to organise

CWORI and CROP programmes in their territory.

Are these initiatives introduced only in India?

The idea of developing eRadiograph and organising CWORI and CROP programmes originated in India. The success of eRadiograph has crossed the borders; we offer it online on our corporate website as well and thus people from all over

the world can subscribe on carestream.com/ eRadiograph. In other parts of the emerging markets region we offer similar educational events to CWORI and CROP tailored to the local needs and socio-cultural specificities of each country. At Carestream, we strive to be a trusted partner for the radiology professionals; therefore, all over our region and the rest of the world, we always look

for initiatives that contribute to improving the radiology skills set.

What are your future plans ?

We intend to continue with and take these educational initiatives to the next level by encouraging more and more participation from medical imaging professionals both as audience as well as key opinion leaders speakers. We will enrich the content of

eRadiograph even further by offering a larger variety of topics and getting them covered from different angles by different experts. We also intend to increase the frequency and reach of CWORI and CROP programmes in order to make them available to the maximum number of medical imaging professionals all over India. raelene.kambli@expressindia.com

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The future of molecular imaging... molecular imaging?

Since the first system was released, PET/CT has played an important role in oncology, and this role will continue to expand in not only detecting the disease, but also in monitoring therapies and treatment. PET imaging is already considered the gold standard for staging and monitoring several cancer types, and the increasing availability of new radiopharmaceuticals will help increase its footprint.

Neurology has also been an area of focus for PET, especially in light of the new PET tracers available to measure amyloid plaque buildup in the brain, providing additional information to

physicians evaluating patients for Alzheimer’s disease and other causes of cognitive decline. In cardiology, PET is already used to evaluate myocardial tissue viability with FDG, and is a very powerful tool to assess myocardial perfusion, although not very common due to the very short half-life of specific isotopes for this application. However, developments on new tracers labelled with 18F- will make the distribution easier and may increase the utilisation of PET in cardiology.

SPECT has long been noted for its high sensitivity, and is regarded as one of the key systems to allow early response assessment, which is of vital importance to radiologists.

Tell us about Siemens' Biograph mCT Flow & Symbia Intevo?

With the new Biograph mCT Flow, Siemens found a way to overcome the limitations of conventional PET/CT. So far, PET exams were done in sequential segments, called bed positions.

With Biograph mCT Flow’s FlowMotion technology, the patient bed moves continuously inside the gantry and allows anatomy-based planning. That means each exam is planned based on that specific patient’s anatomy, so physicians can plan their exams to get more information where it is really important for that patient, for example, scanning for more time on the

head, utilising motion correction in the chest and acquiring the legs at a higher speed, in one single exam protocol.

Now, with Symbia Intevo, the world’s first xSPECT system, physicians have the potential to not only image disease, but also leverage the high resolution to see the unseen and more confidently interpret images. Moreover, Symbia Intevo’s unique quantitative capabilities may provide the ability to monitor and adjust treatments earlier by accurately measuring even small differences. XSPECT hardware and software technology enables higher image contrast, and more precise lesion characterisation

provides physicians additional support in distinguishing between degenerative disease and cancer. This facilitates physician decision making and potentially minimises the need for costly CT, MR or biopsy follow-ups. To supplement this outstanding improvement in image quality, xSPECT reconstruction is also the world’s first quantitative technology.

By offering accurate and reproducible quantification, it may support physicians’ ability to more confidently interpret clinical images, enabling early modification of patient treatment to reduce costs associated with ineffective therapies.

imaging market’s evolution?

The overall response from the Indian market towards Myrian remains very good. At the beginning, this response was more oriented on very specific needs, for example in terms of post-processing diagnosis mainly dedicated to liver surgery (transplant programs, digestive surgery).

Now, it seems that the market demand will also shape up in

the future months and year, with new policies to combat chronic diseases (respiratory diseases, diabetes) and in the field on oncology. Three major characteristics will make Myrian the perfect solution to address all the above needs: comprehensive organ-based applications, vendor-neutral multi-modality platform, disease management and follow up.

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Myrian adapts itself... services, these solutions will drive our domestic growth and market leadership as the most innovative visualisation software in radiology field.

What are the advantages and challenges in India for Modi Medicare?

Insurance companies are playing a major role in the development of healthcare system. This has led to strong

drivers of growth: increase in healthcare spending, changes in demography and lifestyle, and significant increase of medical tourism. We strongly consider India as a high potential market. Indeed, the opportunity perspectives are becoming wider with PACS companies who need advanced visualisation and posttreatment software to replace or upgrade their existing

system, CT and MRI modality vendors who want to complement their own workstation with high-end expert modules (eg: brain and cardiac analysis) or finally refurbishing companies who are looking for a competitive offer to match their requirements.

What has been Modi Medicare's role in Indian

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IN IMAGING

Varian launches PaxScan 4336Wwireless detector The panel is optimised for dose efficiency and very low electronic noise VARIAN IS a premier supplier of X-ray tubes, digital detectors, and image processing workstations for X-ray imaging in medical, scientific and industrial applications and also supplies high-energy Xray devices for cargo screening and non-destructive testing applications. Varian’s flatpanel detectors, X-ray tubes, and the company's Nexus image processing software and workstations, are optimised for fast patient throughput, flexibility and usability.

PaxScan 4336W – Wireless Flat Panel Detector The new PaxScan 4336W wireless detector features Varian's proprietary, advanced wireless technology with state-of-the-art sixth generation architecture incorporating 16-bit data acquisition. The panel is optimised for dose efficiency and very low electronic noise. The new wireless platform is a dual band 2.4/5GHz panel with high speed data transfer rates up to 170Mbps and a 2 – 3.3 second preview time. It also has on-panel diagnostics and a built-in shock sensor. The panel is a lightweight 3.4 kg with battery, and has a removable tether/service cable.

These new innovative technologies allow our customers to take full advantage of superior digital image quality with the capability of higher throughput, significant workflow efficiencies and the potential to enhance patient care and comfort for an improved experience.

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Vivek Phalle Business Manager-SAARC Countries

Contact Varian Medical Systems Unit no. 33, Kalpataru Square, Off Andheri Kurla Road, Andheri (East), Mumbai-400059, India Tel: +91 22 67852200/2210 Cell: +91 9619849787/ 998754090

IN IMAGING

Allengers bags National Award Quality Products Award conferred by Dr Manmohan Singh, Prime Minister, India CHANDIGARH-BASED medical equipment manufacturing company, Allengers has received the 'National AwardQuality Products' on the basis of a set criteria exclusively designed to evaluate quality products of the micro, small and medium enterprises (MSMEs). The criteria included testing of raw materials, manufacturing practices, quality control standards, export performance, growth trends, pollution control, use and choice of technology, services offered to consumers, future plan/vision, strategic initiatives, etc. The Ministry of MSMEs scrutinised national level applications after receiving them from their respective state level committees under the Chairmanship of Secretary, Industries and Technical divisions of DC(MSME) and after an entire stringent evaluation process the final selections were made.

Allengers has an in-house R&D/ QC setups/labs equipped with testing equipment to keep check on raw materials in order to maintain quality of their product range at their biggest manufacturing facilities near Chandigarh.

Allengers has always been encouraging Quality Technology Tools (QTT) to maintain and sustain their quality. The enterprise has a team of skilled and experienced professionals and provide regular trainings to their staff for quality assurance where they practice stage inspection procedures at all the relevant stages for the best quality output of the equipment under dispatch.

Previously, Allengers bagged the Export Excellence Awards for two consecutive years 2010 and 2011 and has also been recently given the status of Star Export House

from the Government of India.

This speaks volumes of their mark in the overseas market which is otherwise dominated by the MNCs. This has been possible only due to their stringent quality control measures which has resulted in their exports spreading to more than 70 countries.

Due to their dedication to deliver value for money equipment, Allengers today has a major share in the domestic market for their vast range of medical diagnostic equipment like: Mobile/Fixed DR systems, X-ray systems, cathlabs, CArms, mammography, DSA systems, lithotripters, remote controlled RF tables, OPG, multipara monitors, TMT, ECG, EMG, PSG, EEG, and

software solutions like HMS and PACS. Being an Indian company and to remain ahead in the market place, they keep on adding innovative and revolutionary products at the regular interval of time. They understand the market better and looking at the market demand they indigenously developed and came out with modern products like: ◗Economical version of mobile digital radiography system. ◗Advanced digital radio and fluoro technology ◗Digital mammography ◗Digital OPG ◗Interventional table ◗Trolley Free C-Arm By virtue of their quality, systems and safety standards

they have certifications like CE, ISO 9001:2008, ISO 13485:2012, AERB and BIS for their largest product range which caters to various medical applications viz: radiology, cardiology, orthopaedics, gastroenterology, urology, neurology, software, etc. As a mark of their customers’ trust in them, Allengers, have entered into the 27th year of their journey to excellence which has enabled them to catapult to the topmost position in India and truly making them into 'An Indian MNC.' Contact Allengers Medical Systems S.C.O 212-213-214, Sector 34-A, Chandigarh – 160 022, U.T. (India) Ph:- + 91 172 – 6451209 (O)

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Philips Anatomical Intelligenceturning images into answers It helps clinicians perform typical and advanced tasks, such as alignment, segmenting, visualising, and quantifying ANATOMICAL INTELLIGENCE applies adaptive system intelligence, and a rich database of 3D models of anatomical structures to a patient’s ultrasound data, with the aim of simplifying investigations and providing more reproducible results.

It helps clinicians perform typical and advanced tasks, such as alignment, segmenting, visualising, and quantifying. Today, even with familiarity and practice, these tasks can take significant time during ultrasound exams, as well as during procedures.

In today’s cardiology practice, assessment of LV function is no longer limited to evaluation of ejection fraction. Speckle strain echocardiography is a novel technique for use in imaging myocardial deformation (strain). For cardiologists to incorporate strain results into their clinical decision-making, currently, the most important practical limitations of routine clinical incorporation of strain imaging include its impact on workflow efficiency, observer variability, and intervendor inconsistency, driven by the fact that different manufacturers may use different tracking algorithms.

As with many other technologies, automation is the key to achieving workflow efficiency and measurement reproducibility of strain echocardiography in a busy clinical practice. Conventional ways to initiate GLS measurement require manual tracing of the endocardial border or at least manual location of anatomic landmarks such as the mitral annulus and LV apex. This inevitably slows workflow and introduces hu-

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man error and observer variability, hence limiting practical use of strain imaging. With the aCMQ Anatomical Intelligence tool of Philips EPIQ, GLS can be obtained with ZeroClick technology within a few seconds after acquisition of 2D images from the three routine apical views (4-chamber, 2-chamber, and long-axis).

Automated 2D Quantification A.I. (a2DQA.I.) is an ideal tool for every echo lab.

Its ZeroClick technology uses Anatomical Intelligence for

rapid access to proven 2D EF and volumes for adult and pediatric patients. Your 2D EF measurements are one click on every patient – no manual tracing. AutoEF is available during the study and so fits in with an everyday echo protocol.

Mitral Valve NavigatorA.I. (MVNA.I.) takes a Live 3D volume of the mitral valve and turns it into an easy-tointerpret model in eight guided steps, providing access to a comprehensive list of MV

measurements and calculations. Compared to previously available tools, MVNA.I. models and measures with 87 per cent fewer clicks, saving steps at each part of the process.

MVNA.I. guides the entire process using simple commands and clear graphics, making this a very easy tool to use. This helps a surgeon to look into the valve before a procedure and to decide whether to go for repair or replacement.

IN IMAGING

Nature’s Global Services: Making radiology service simple The company exports products to countries like China, Taiwan, Europe, the US, Africa and the Middle East NATURE’S GLOBAL Service (NGS), established in 1995 has been growing from strength to strength in the field of radiology equipment.

Tarun Bhateja, CEO, is a pioneer in the radiological equipment market and has constantly introduced latest state-of-the-art technological innovations and at significantly lower prices as compared to his competitors, thus creating a niche for himself and his company.

View Box

Apron back

Apron front

Olympus 110HG R Mitsubishi printer

Focus area NGS is a highly reputed ISO 9001:2008/ ISO 13485, CE certified manufacturer and exporter. The company focuses on radiation protection garments manufacturing under the brand name – X-Shield. The innovations comprises light weight and lead free aprons produced with highest technology. X-ray protection vinyl-based apparels brand name - X-Shield.

Among the newest advancement in radiation shielding, NGS has introduced light weight, trendy in style, flexible vinyl, unbreakable, certified radiation shielding apparels. The speciality is covering radiation shielding for entire cath labs apparels, lead glass, ceiling and table shields.

The company exports products to countries like China, Taiwan, Europe, the US, Africa and the Middle East. It has also introduced manufacturing of X-Shield LED viewers in India. The same was being imported from China and now exported from India. X-Shield – X-Ray film LED viewer -- LED type is 25mm thick with film activation sensor, digital dimmer and energy saver.

Sony thermal paper

Oki—dicom paper printer

Tarun Bhateja Founder & CEO Nature’s Global Services

Contribution to radiology and new launch Newly launched innovation in the field of digital radiography with the use of DR – Retorfit kit system for up grading the existing analog X-ray machines of any make with wireless technology for instant imaging has various benefits over the use of

a CR system.

It consists of DR cassette of 17x17 inches (portable just 3.8 kg in weight) complete with a control box, dicom application software and a dicom compatible mono/ colour printer which can be used for a hard copy to be given to the patients on plain paper, glossy paper or plastic sheet. It is almost as good as an X-ray film or to copy the images with reports, etc., on a CD to save on the cost of costly X-ray films. It can be used in the existing bucky or in wall stand for taking chest X-rays too.

The cost of the same too

DR Cassette

can be recovered within a span of maximum two years by any government/private hospitals and is a boon for the government hospitals if used as filmless/paperless option, which is the purpose of digital radiography i.e. to save on the recurring cost of expensive X-ray films - to recover the cost of DR upgradation kit.

For more information on the same visit www.atlaim.com

Exclusive products and dealers for: ◗ Varian CT scan tubes for all CT scan machines including GE ◗ Mitsubishi thermal paper

and printer ◗ Sony thermal paper and printer stock available ◗ Olympus 110s normal density and high gloss thermal paper ◗ Atlaim DR systems ◗ Oki—dicom printer paper based Contact Tarun Bhateja Address- A-3; New Rajinder Nagar; New Delhi- India Tel: 91-11-28741437; +919810270997; Email: tarun@atsequipments.com Website: www.xrayglobal.com

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IT@HEALTHCARE

Maintaining electronic medical records: A must for hospitals

DR J SIVAKUMARAN, Senior VP, SPS Apollo Hospitals

Dr J Sivakumaran, Senior VP, SPS Apollo Hospitals, Ludhiana elaborates the importance of maintain medical records, the protection it offers and the benefits of EMR THE SINE QUA non for quality health delivery is not merely providing safe and sustainable care to the patients but also proper maintenance of records, accessible in the shortest time. If accurate, legible and updated medical records of the patients are not available, it is very difficult for the care providers to decide on the treatment plan.

It is believed that the patient medical record is the main source of information regarding patient care. The medical record is useful whenever evidences are required to protect the service provider on patient care. The consumer forum is mainly dependent on the medical records, whenever there is a medical negligence case filed. This is the only document for the doctors to prove that the patient care was carried out as per protocol, during such disputes. The insurance companies also need an accurate medical record for settlement of claims.

Improper/incomplete record keeping may lead to serious consequences to the service provider and the patients.

If the records are not maintained, the medical claim could be rejected by insurance companies.

Whenever a patient wants to change the service provider, medical record will be handy and helpful for continuity of care. Any hospital will run successfully, only if it has an efficient medical records system in place.

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Purpose of medical records The first and foremost purpose of maintaining medical records is to clearly lay the road map of treatment in order to facilitate a scientific and â&#x20AC;&#x2DC;on the trackâ&#x20AC;&#x2122; treatment to the patients. As the doctors keep moving from one patient to another, it is not humanly possible to memorise the details of all patients. The latest information, along with the case history of the patient, will enable the service providers to work out midterm changes,

if any, and to continue the already laid out treatment plan. This is a good communication tool for referring, treating, visiting doctors and other care providers. This is the only reliable evidence to prove that a systematic care has been provided by the doctor and hospital, in the court of law. The medical records will be useful for taking many health statistics of the hospital for analysis and improvement. These statistical data are not only useful for hospitals but also to government agencies for

many applications. These records are also useful for patientsâ&#x20AC;&#x2122; reference after discharge and helpful to them as a protective tool, in case of any medical negligence.

Traditionally, the records were maintained physically but now it is getting migrated to electronic systems.

Benefits of EMR There are several advantages in maintaining electronic medical records in a hospital. EMR can save a lot of space. When the physical files are digitised, it will

occupy very less space and the environment is kept clean. Apart from space, since the system is almost paper free, the usage of paper by the hospital, insurance companies and the patients will be negligible, resulting in huge savings on paper. EMR saves lot of time as well. The waiting time for getting a record is totally eliminated. The time taken to retrieve the records in the computer is the only waiting time required. When the clinical data is available for the treating doctors at the click

IT@HEALTHCARE of a button, the decision on treatment could be taken faster. According to a study, one fifth of medical errors are due to the absence of instant access to patient healthcare information. This will be handier, when the patient is sick and not in a position to respond. EMR helps in avoiding contra indicative medicines and repeated tests by different doctors. Every one of the treating team can see the actions and prescriptions of the other by which the communication will be better.

EMR can prevent the consequences of the errors arising out of illegible handwriting of the doctors. When a physical medical record file is repeatedly used by a group of care givers, the life of the file will be limited. The EMR system will not have this problem.

The EMR system is accessible at a remote location.

EMR records could be seen by more than one person at a time. In EMR, the health statistics and other hospital data can be obtained in less time, when compared to the manual system. EMR also improves efficiency and staff productivity. Many quality improvement measures could be taken based on the data captured by this system. This could be used as a managerial tool too.

Concerns of EMR As against the conventional medical record system, EMR will be expensive. The patients will always have concerns on the privacy of the documents. There are chances for misuse, if anybody wants to do it deliberately. Adoption of the new system by the busy doctors is very slow. Due to this, an assistant needs to be employed for updating records. Here again, chances of transcription error exists.

Even if a doctor is familiar with one system, there is no universally accepted system in use. Doctors who visit more than one hospital will find it difficult to adapt to different systems. Now many hospitals are migrating from the physical system to the electronic system. However,

as the volume of old records is very high, it is unclear as to how much time it will take to digitise the old records.

Until then, the physical records need to be preserved.

EMR could be accessed only in electronic environment. Proper storage system is needed for data backup, whose investment cost will be high.

EMR and EHR An EMR is the electronic form of patientsâ&#x20AC;&#x2122; information which contains history, demographic details, diagnostic results, medication, treatment and other clinical details and charts. This cannot be updated or edited by the patients or any unauthorised person. EMR is meant for keeping track of all documentations electronically. This has patient data, recognised as a legal record.

Different hospitals have different set of records pertaining to the transactions of the patient in that hospital.

Electronic health records (EHR) is a new concept catching up in developed countries. EHR will have all the details of EMR as well as additional information. This is a collection of patient data of multiple hospitals. This will give a comprehensive health record of the patient which could be viewed and shared with the authorised patient care team so that better care could be provided. EHR is also an EMR with interoperability. This gives a picture of the total health status of the respective patient. This could be created and established, only if the EMR of various hospitals have technical support for exchange of information. While the ownership of EMR is with the hospitals, the ownership of EHR will be with the patient.

The primary responsibility of generating, updating, preserving and maintaining the medical records rests with the hospitals. But the treating doctor is also equally responsible for the proper documentation and completion of the records in all aspects. Medical record is the only evidence to prove that the doctor and hospital has

Medical record is the only evidence to prove that the doctor and hospital has taken proper care during treatment taken proper care during treatment, in the court of law. Hence in their own interest, doctors need to give importance to medical records. Spending sufficient time in preparing discharge summary and mentioning the steps to be followed in post discharge care is essential. If it is not mentioned, a doctor can be held responsible, in case any complication occurs in the post discharge stage.

Patients who wish to get discharged against medical advice (DAMA) also needs to be provided with discharge summary duly mentioning about the patientâ&#x20AC;&#x2122;s willingness to get under DAMA duly signed by the doctor and the patient or a relative along with the signature of a witness. This will again protect the doctor from future litigation. Doctors normally will have busy schedules and hence may not devote much time for discharge summary. But this is important documents which will safe guard the doctor and the hospital, in case of any litigation. Having centralised medical records system will have better effi-

ciency in traceability and fixing responsibility of the individuals. In decentralised system, chances for loss of information are high.

Retention guidelines There is no single guideline indicating how long a medical record needs to be preserved by hospitals in India. Some states have guidelines, while some of them do not. Every hospital has customised protocols fo retention of medical records.

In general OPD records are kept for three years, while IPD and medico legal records are kept for 10 years in corporate hospitals. This is also in line with Directorate General of Health Services (DGHS) guidelines for Central Government Hospitals vide ref no: 10-3/68MH dated 31-8-68. In case a court case is pending on a record, the above rule does not apply. The records need to be preserved beyond the stipulated time period. To allow the possibilities of any appeal, the records need to be kept at least two years after the latest court decision. The Medical Council

(MCI) of India has given guidelines that individual doctors should maintain the in-patient records for three years from the date of commencement of treatment (1.3.1). It also guides to make documents available to patients or authorised person within 72 hours (1.3.2). The Consumer Protection act 1986 fixes a time limit of two to three years for filing a suit, from the date of treatment.

This period may get relaxed by the court, in an appropriate case. Paediatric patients can file for a medical negligence even after attaining majority. Hence, it is for the hospitals and treating doctors to form a team and take the responsibility of generating, using, maintaining, preserving and disposing of the medical records as per the pre-defined guide lines.

References: 1.Medical records and issues in negligence, Joseph Thomas, Indian J Urol. 2009 Jul-Sep; 25(3): 384â&#x20AC;&#x201C;388.

2.Code of Ethics Regulations, 2002, New Delhi, dated 11th March, 2002, Medical Council of India.

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HOSPITAL INFRA

ASK A QUESTION When, and in which stage, is equipment planning done?

NARESH SHRIVASTAVA, Gurgaon Equipment planning is done early in the design development stage. This planning involves HODs, admin team and other medical staff. A series of meetings with staff members is involved in finalising the list, the number and type of equipment required.

List the depreciable and non depreciable hospital equipment?

REENA SAHAY, Bihar The list is as follows: Depreciable equipment: Surgical apparatuses and lab therapeutic equipment and suction machines. Physiotherapy equipment, refrigerators, general use surgical computers, electronic exchanges, typewriter, intercoms, office equipment, pharmacy equipment.

Non depreciable equipment: Recurring in use five years lamps, waste bins, linen, sheets, blankets, catheters, surgical instruments, tableware, chinaware, kitchen utensils.

These equipment are purchased through other than construction contracts. They are low cost equipment.

What is your opinion on fire management of a hospital?

DR KAPOOR, Lucknow

The design and construction of every building structure should incorporate the following features of prevention of fire and fire loss: Q Considering the type and density of occupancy, lobbies, staircases, aisles etc should be sufficiently wide to ensure easy

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movement of traffic at all times.

Q The design of the building

structure should be so planned that it allows pressurised exclusion of smoke in case of fire or any smoke leak.

Q Ideally a heavy duty elevator, especially for the use of fire fighting personnel and in case of emergency only should be incorporated.

Q Adequate emergency rescue aids and suitable refuge area should be incorporated in the design.

Q Safe and easy means of access should be provided in every place of work/occupancy.

Q The floor should be so designed that they are free from obstructions, slip-resistant and even. Openings in floors should be securely fenced or covered.

Q Staircases, ramps etc should be provided with substantial handrails and other suitable support means wherever necessary to prevent slipping.

Q Easy access for the servicing and maintenance of plant, machinery and buildings should also be incorporated in the design.

What is nurse-patient ratio?

SHANTI, Agra

It denotes the number of patients assigned to each nurse. It is based on the acuity or needs of the patient for nursing care.

In critical care units, the ratio must be 1:1 or 1:2 or 1:3. In general care units, the nurse to patient ratio is higher, for e.g. 1:5 or 1:8 depending on the type of unit and the needs of the patient.

What is the job description of a Nursing Superintendent?

DR PARMAR, Delhi

FAQs ON HOSPITAL PLANNING AND DESIGN | MEDICAL EQUIPMENT PLANNING | MARKETING | HR | FINANCE | QUALITY CONTROL | BEST PRACTICE

Job description of a Nursing Superintendent is as follows: Q Overall in-charge of nursing services in the hospital Q Answerable to the Medical Superintendent or Chief of Centres of the hospital Q Implementing hospital policies amongst various nursing units Q Formulating hospital policy, particularly concerning nursing services Q Recommending personnel and material requirement for nursing service departments Q Assisting Chief of Hospital in recruiting nursing staff Q Carrying out regular rounds of the hospital Q Ensuring safe and efficient care rendered to patients in various wards etc Q Preparing budgets for nursing services Q Member of various condemnation boards for linen and other stores Q Responsible for counselling and guidance of subordinate staff Q Attending hospital/intra hospital meetings and conferences Q Investigating all complaints regarding nursing care and personnel, and take corrective action Q Initiating and encouraging research in nursing services Q Evaluating confidential reports of her subordinate staff and recommending for promotion Q Maintaining cordial relations with patients and medical social workers Q Periodically interact with clinical heads to discuss problems in patient care Q Educating nursing staff of all categories by conducting awareness programme on universal precautions

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

Express Healthcare's interactive FAQ section titled – ‘Ask A Question’ addresses reader queries related to hospital planning and management. Industry expert Tarun Katiyar, Principal Consultant, Hospaccx India Systems, through his sound knowledge and experience, shares his insights and provide practical solutions to questions directed by Express Healthcare readers

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AVITEX® TURBO RF

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AVITEX® TURBO MICROALBUMIN

End Point Assay with 2 minute incubation

End Point Assay with 2 minute incubation

Sensitivity 6 IU/ml & Linearity upto 160 IU/ml

Sensitivity 6 IU/ml & Linearity upto 160 IU/ml

No prozone effect upto 800 IU/ml

No prozone effect upto 800 IU/ml

Calibrator included

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AVITEX® TURBO CRP

AVITEX® TURBO CYSTATIN- C

Two Point Assay with 2 minute incubation

Two Step Assay

Sensitivity 2mg/l & Linearity upto 150 mg/l

Sensitivity 0.1mg/l & Linearity upto 10 mg/l

No prozone effect upto 800 mg/l

No prozone effect upto 60 mg/l

Calibrator included

5x2 ml calibrator set separately available

AVITEX® TURBO ASO Two Point Assay with 2 minute incubation Sensitivity 20 IU/m/l & Linearity upto 800 IU/ml No prozone effect upto 3000 IU/ml Calibrator included

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C - ARM OT TABLE & L 5002 OT LIGHT

C- ARM HYDRAULIC OT TABLE

FIVE BULB OT LIGHT [ L-5002 ]

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Health Care Equipments

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Highlights of Mediequip 2014

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ORGANISERS

Ÿ More than 150+ Exhibitors from all over India & Abroad Ÿ Live Demonstration from Leading Manufacturers Ÿ Updated Medical Equipments Ÿ More than 5,000 visitors witness the Fair Ÿ 90% of Trade visitors

Associate Partners

Ÿ Two days Conference with Eminent Speakers and Topics

Ÿ One day Workshop for Biomedical Engineers,

Association of Medical Device Industry

Medical Equipment and Devices Suppliers and Service Providers Association

Lab Technicians, Physiotherapist etc.

Magazine Partners

Online Media Partners

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Business Avenues Please Contact: ■ Mumbai, Ahmedabad: Rajesh Bhatkal 09821313017 ■ Delhi: Ambuj Kumar 09999070900 ■ Chennai: Johnson Rajkumar 08680002244 ■ Bangalore: Khaja Ali 09741100008 ■ Hyderabad: A K Shukla 09849297724 ■ Kolkata: Ajanta 09831182580

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Capturing physical assessment and vital signs data is routine.

Accessing them should be too.

Connect your patient vitals with Welch Allyn Connex®.

Give clinicians immediate access to accurate patient vital signs with the Welch Allyn Connex Electronic Vitals Documentation System. With Connex EVD, you can capture vital signs with the wall-mounted Connex Integrated Wall System or Connex Vital Signs Monitor and wirelessly transmit patient vitals to your EMR in seconds—all without the paper, mistakes, or delay that come with manual transcription.

Visit www.welchallyn.com/connex to learn more today.

Wirelessly transmit patient vitals to your EMR right from the bedside with Connex® vital signs devices

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LIFE PEOPLE

Ameera Shah bags ‘World Women Leadership Award’ AMEERA SHAH, MD and CEO, Metropolis Healthcare, was awarded the ‘Exemplary Women Leadership Award’ at the World Women Leadership Congress and Awards 2014.

The Exemplary Women Leadership Award recognises and appreciates women power and their work, celebrating their successes and showcasing their excellence in their respective fields. Shah has been presented with this award in recognition of her outstanding contribution in the field of healthcare and diagnostics.

Shah has been instrumental in shaping Metropolis Healthcare as one of the first multinational chain of diagnostic labs in the emerging markets.

The event recently took place in Mumbai and it was graced by eminent personalities like by Dr Massouda Jalal, Former Minister of Women, Founding Chairperson, Jalal Foundation and Dr Indira Parikh, President, FLAME: Foundation for Liberal and Management Education.

The World Women Leadership Awards appreciate the profound role played by women as leaders, executioners and decision makers, in shaping the future of the sector and who embody the qualities of leadership in displaying active, creative and integrative efforts in achieving the best possible results in the national and global development plans.

Speaking on the occasion Shah said, “I am highly privileged to receive the recognition and would like to thank my entire team for their dedication, hard work and continuous support towards making the vision come true. Unlike leadership positions in the organised sector being a woman entrepreneur is a very different and unique journey. Each time I am acknowledged with an award, I recall my modest days as an entrepreneur. Initial days of the enterprise where I did everything myself with little support from the small team I had managed to develop at that time. Getting experienced human resource was not possible for a small growing com-

pany. In the initial period, neither did Metropolis had financial resources nor a brand name to attract talent. However, there are positives to all difficulties! Coming with the background of overcoming the odds of an unorganised sector, team Metropolis is a bunch of

self-starters who believes in knowledge-oriented approach that has enabled our success.

Today we are amongst the largest diagnostic players, we take the onus of progressing at a fast pace and creating many more success stories in the future.”

Becton Dickinson appoints Varun Khanna to spearhead India operations BECTON, DICKINSON and Co (BD), a medical technology company, has announced the appointment of Varun Khanna as the MD in India.

Varun joins BD at a time when the company is strategically focused on driving growth through innovation and customer focus. India is one of the key markets and is

He was worked in various roles of increasing responsibility including sales, marketing as well as P&L leadership central to BD’s growth strategy in Greater Asia.

He joins BD from Fortis

Healthcare, where he played a key role in driving business growth n two of its fastest

growing regions. His most recent role was that of Regional Director – Western and Eastern Region, which he held since 2010. Prior to Fortis, he worked with Etisalat Group, Reliance and Bharti Airtel, in various roles of increasing responsibility including sales, marketing as well as P&L leadership.

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TRADE & TRENDS

Capnography: Getting the full patient picture,everywhere Cap-ONE is the smallest mainstream CO2 sensor technology in the world.

CAPNOGRAPHY CONTINUALLY and instantaneously monitors a patient’s carbon dioxide concentration in respiratory gases and is an indirect monitor of oxygenation that helps in the diagnosis of hypoxia. It can also be used for verification of endotracheal intubation, monitoring CO2 elimination during cardiac arrest and CPR, detecting hypoventilation and hyperventilation, and detecting rebreathing of CO2.

A capnograph uses one of two types of analysers, mainstream or sidestream. Traditionally, mainstream units are used on intubated patients and have an analyser connected to a tracheal tube for real-time monitoring of CO2 concentrations. Sidestream units are used on non-intubated patients using a sampling pump with a line connecting from the patient to the monitor. Now with light weight Cap-ONE, the world’s first mainstream CO2 sensor is specifically designed for both situations intubated and non-intubated patients.

When used in cardiopulmonary resuscitation (CPR) or the management of traumatised patients, the earliest possible detection of the end expiratory CO2 concentration is of great importance.

New lightweight mainstream ETCO2 sensor detects the EtCO2 concentration without delay and immediately alerts the paramedic or the emergency physician - e. g. during a difficult intubation or situations like a possible tube malposition – of the required intervention.

Cap-ONE is the smallest mainstream CO2 sensor technology in the world. Being a highly durable and a washable sensor with distinctive anti-

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Cap-ONE is the world’s first mainstream CO2 sensor specifically designed for both intubated and non-intubated patients

fogging membrane, Nihon Kohden is using advanced miniaturisation and sensor technology; the company has substantially reduced the size of a traditional mainstream sensor. This new sensor is attached to a disposable oral and nasal adaptor and is placed directly at the point of expiration. Therefore, one can achieve the same level of quality and reliability found in traditional mainstream CO2 monitoring and apply these benefits to non-intubated patients without any of the hassles and cross-contamination concerns found in traditional side stream technology.

Contacts Anil Srivastva Mob: 09810699223 Nihon Kohden

REGD. WITH RNI NO.MAHENG/2007/22045. REGD.NO.MH/MR/SOUTH-252/2013-15, PUBLISHED ON 8th EVERY MONTH & POSTED ON 9, 10 & 11 EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE.