Express Healthcare (Vol.12, No. 12) December, 2018

VOL.12 NO 12 PAGES 52

Diagnostics Pushing boundaries in cancer diagnosis

www.expresshealthcare.in DECEMBER 2018, `50

CONTENTS Vol 12. No 12, December 2018

PUSHING BOUNDARIES IN CANCER DIAGNOSIS

COVER STORY

Chairman of the Board Viveck Goenka Sr. Vice President-BPD Neil Viegas Asst. Vice President-BPD Harit Mohanty Editor Viveka Roychowdhury* BUREAUS Mumbai

P12: INTERVIEW

Usha Sharma, Raelene Kambli,

LT GEN BIPIN PURI VSM, PHS Director General Armed Forces Medical Service (DGAFMS)

Lakshmipriya Nair, Sanjiv Das, Swati Rana, Prabhat Prakash

Delhi Prathiba Raju

START UP CORNER

Design Asst. Art Director Pravin Temble Chief Designer Prasad Tate Senior Designer Rekha Bisht Graphics Designer Gauri Deorukhkar Artists Rakesh Sharma Digital Team Viraj Mehta (Head of Internet)

Dr Ravi Gaur,COO,Oncquest Laboratories in a candid conversation with Prathiba Raju talks about how Oncquest lab's advanced diagnosis has brought in precision, affordability in cancer diagnosis in India | P29

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MARKET

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NUTRITION & WELLNESS AWARDS 2018 HELD IN MUMBAI

HOW NIRAMAI’S TEST ADDRESSES THE SOCIOCULTURAL ISSUES IN CANCER SCREENING FOR INDIAN WOMEN

TRADE AND TRENDS

Photo Editor Sandeep Patil MARKETING Douglas Menezes, Sunil kumar Debnarayan Dutta Ajanta Sengupta E Mujahid

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PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Arvind Mane

HINDUSTAN SYRINGES & MEDICAL DEVICES WINS 2018 GOOD DESIGN AWARD IN JAPAN

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2016-18. Printed and Published by Vaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press, Plot No.EL-208, TTC Industrial Area, Mahape, Navi Mumbai-400710 and Published at Express Towers,

CIRCULATION Circulation Team Mohan Varadkar

Nariman Point, Mumbai 400021. Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Express Towers, 1st floor, Nariman Point, Mumbai 400021) * Responsible for selection of news under the PRB Act. Copyright © 2017. The Indian Express (P) 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.

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EDITOR’S NOTE

Regulators scramble to catch up with innovation

A

Chinese researcher He Jiankui's claim to be the creator of the world's first "designer babies" using gene editing tool CRISPR has reignited the debate on ethics of genetic research. It has also shown how ill equipped regulatory agencies are, when faced with the fast pace of scientific research and technology.

Medical researchers and the clinical community believe that their priority is healing their patients. If gene editing can prevent a person from becoming a patient, does it justify the risk of the unknowns in the technique? Let's not forget that CRISPR is still at research stage and researchers are not able to predict or control the gene editing process completely.

The scientific community were not convinced that Dr He's achievement passed muster even after he presented his work at a conference following his announcement. In fact, they pointed out that he had breached protocol on several counts: not completely informing his institution nor his team working on the project. There is also doubt that he got proper informed consent from the subjects of this research project. He has already admitted that CRISPR has not acted uniformly on the twin girl’s DNA. It is now a concern if this will create other problems in the children’s future health.

It is but natural that regulations will always lag research and technology but the sad part is that even when we do have regulations, they are not implemented effectively. Neither do regulators have the capacity to respond fast enough.

For instance, take the ongoing Implant Files investigation.

As I write this, the International Consortium

Be it CRISPR designed babies or new age medical devices,where is the line in the sand? And who will draw it?

of Investigative Journalists (ICIJ) and 59 media houses including The Indian Express, are in the midst of revealing the results of an investigation, called the Implant Files, which detail the lack of effective regulatory systems for most medical devices.

The investigation once again alludes to the alleged links between companies and doctors as well as unprepared regulators unable to keep pace with technology. Medical device manufacturers are in crisis management mode but what about the patients? Will all this attention get them justice and compensation commensurate with their pain and suffering?

As the blame game continues, the larger and longer term question is, will we learn from these reports?

The issue of poorly regulated medical devices is not new, and not restricted to India. Just two days after the Implant Files story broke across the world, the US Food and Drug Administration (FDA) went on record to say that it was planning to update its medical device clearance process to address the complexity of new technologies.

Can we hope for the same review and revamp from our regulators in India?

Thanks to patient groups and select media houses, such incidents will hopefully continue to be highlighted. Because the wheels of justice turn slowly. There is no conclusion yet to the JNJ ASR knee replacement issue, even though months after the news first broke.

Thus as the Express Healthcare team wishes all our readers all the very best for 2019, we also hope for more responsive policy makers as well as a more responsible industry. The patient community in India and across the world, has discovered its voice and will stay silent no longer.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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MARKET POST EVENT

Nutrition & Wellness Awards 2018 held in Mumbai The whole concept behind the Nutrition & Wellness Awards was to discuss the latest updates in the industry

T

he 4th edition of Nutrition & Wellness Awards 2018 on November 24, 2018 felicitated achievers of the industry under various domains including R&D, manufacturing, packaging, distribution and other support services in the areas of active ingredients, procedures, practices, technologies, and finished products including winners and winning companies like GSK, Dabur, Nestle India , Abbott Nutrition, Influx Healthcare, Saffron Formulations, Roseate Medicare, Mits Healthcare, 4care Lifescience, Aimil Pharmaceuticals, Tsar Health,

Danone India, Sanger Genomics, G M Nutrition, AeroChem Neutron, Sundyota Numandis, Nysa Lifesciences, Vrihaan Pharmaceuticals, Deccan Healthcare, Walpar Healthcare, Prabodh Dhavkare - Nitrro Bespoke Fitness, Vinod Channa, Healthyhey Foods,

Brukem Life Care amongst others in the presence of top dieticians, nutritionists, doctors and industry stalwarts. Key dignitaries like Bhai Jagtap (MLA Maharashtra State) Shyna Sunsara (Miss United Nations 2018), actors Harshwardhan Rane, Sandhya Shetty and Anaida

Parvaneh were a part of the event.

Speaking about the nutrition, wellness and nutraceutical industry and the role of media in building health awareness at the conference were Subhasree Ray Corporate Dietician, Milind Doshi Co-Founder Sanger Ge-

nomics, Paavni Jella Director Vie Foods and Dr Priya Karkera Pediatric Nutritionist and at the panel discussion were Arnavaz Kollah Certified Reebok fitness instructor, Dt Kanchan Patwardhan consultant Nutritionist and Dietician, Shweta Bhatia Reg Dietician, panelist Mission Fit India and Alok Shirodkar CEO Krunch Today. Organiser Dr Monica Bhatia said, 'The whole concept behind the Nutrition & Wellness Awards was to discuss the latest updates in the industry, to felicitate achievers in the industry and motivate others to perform better'!

PRE EVENT

Pan-Asian Social Investment Network,AVPN,to host inaugural India Policy Forum aimed at promoting public-private collaboration The half-day convening on 5th December 2018 provides actionable policy opportunities ASIAN VENTURE Philanthropy Network will organise the second edition of the India Summit. The two-day summit, happening on the December 5 and 6 in New Delhi, will kick off with the inaugural India Policy Forum, a closed-door gathering of policymakers and social investors. The India Summit on December 6, themed Facing the Future Together, will host a large group of funders and resource providers coming from a diverse range of sectors.

“With an active impact investing landscape, philanthropists broadening their giving, and corporates providing a strong backing for social impact, India has one of the most advanced social economies in Asia”, says Naina Subberwal Batra, CEO and Chairperson, AVPN. “Indeed, the Indian social economy has benefited from policy initiatives that are increasingly focused on capacity build-

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ing and capital mobilisation.

Nonetheless, there are huge amounts of potential for policy initiatives to create more market opportunities, and AVPN seeks to be the bridge between the public and private sectors.”

The AVPN India Policy Forum — an invitation-only forum and workshop at U-Chicago Center — will bring together diverse players within the policy community, including policymakers, development finance institutions and, academic institutions, and more. Key speakers include representatives from NITI Aayog, the Education Commissioner of Rajasthan, Brookings Institution, and more.

“We believe the India Policy Forum will be a good opportunity for policymakers to share insights into their latest policy initiatives and seek feedback from the social investment community to generate deeper conversations towards cross-sector col-

laboration, says Patsian Low, policy director at AVPN. The India Policy Forum will feature the first and only digital platform for investors to identify collaboration opportunities with the policy community on actionable policy initiatives. Named the Asia Policy Forum Exchange (APFx), the interactive portal allows the thirteen policy fellows to share their policy initiatives, implementation plans and expected outcomes online so that AVPN members and selected partners can find synergies to deepen engagement with policymakers.

The keynote speakers who will take part in the event are TV Mohandas Pai, Chairman, Aarin Capital; LM Singh, Head of Impact Investments, USAID Urban Health PAHAL initiative implemented by IPE Global, Prof SV Subramanian, Harvard TH Chan School of Public Health; Rai Mahimapat Ray, Govern-

ment of India; Anjali Nayyar, Global Health Strategies; Anurag Srivastava, Cisco Systems India; Dr Antaryami Dash, Save The Children; Dr Rajan Sankar, Tata Trusts; Dr Shamika Ravi, Brookings India; Jashodhara Dasgupta, National Foundation of India; Jayanti Rastogi, Magic Bus Foundation.

“One of the biggest challenges that social investors face is the fragmented nature of the social sector ecosystem,” says Binali Suhandani, South Asia Director, AVPN. “As an example to address low enrollment rates in early childhood education, social investors have to not only look at the quality of the education system, but also identify healthcare needs, the family’s access to finances and electricity, and more.

A single provider lacks sufficient capacity to address all these problems. This is where AVPN comes into facilitate effective collaboration across the ecosys-

tem to maximize impact”.

The summit will include sessions such as, Financing the Challenging Segments of Sustainable Livelihoods in India; Rippling Effect of Energy Poverty on Education, Health & Livelihoods; Accelerating Innovation in Education through Technology; and Leveraging Strengths of Players in Nutrition for a Multi-sectoral Alliance in India.

Four non-profits organisations have been selected to pitch in front of more than 250 delegates at the AVPN India Summit 2018. Working in diverse fields from health and nutrition, to jobs and skilling, and education, Global Alliance for Improved Nutrition (GAIN), Agrasar, Sasha, and Action Related to the Organisation of Education, Health and Nutrition (AROEHAN) will have an opportunity to showcase their work while gaining feedback from the audience.

Wockhardt Group Hospitals to organise 6th annual conference in Mumbai The theme for this year's confernce 'Doing It The Right Way' will be held on December 7-8 THE EXPERts likely ot be a part of the conference are Dr Clive Fernandes - Group Clinical Director, Wockhardt Group of Hospitals & Consultant Joint Commission International, Kornelia Fiaush - Joint Commission International, Dr Subramanian Swaminathan Global Hospitals, Dr Swati Rajagopal - Aster Hospital, John Yoo - MD Joint Commission International (Singapore), Dr Nitin Shinde ALEXIS Hospital, Dr Harish Nadkarni - CEO, NABH, Dr Parag Rindani - Wockhardt Hospitals, Dr Girdhar J Gyani - Director AHPI, Dr B K Rana Founding CEO QAI (Quality Accreditation Institute), Dr Mahesh Lakhe - Columbia Asia Hospitals, Dr Sanjeev Singh - Amrita Institute of Medical Sciences, Dr Prakash Jiandani Wockhardt Hospitals, Dr Subrojyoti Bhowmik Peerless Hospital, Dr Alexander Thomas CAHO, Dr Behram Pardiwala - Wockhardt Hospitals, Dr Ashok Shukla IMA, Dr Vipin Checker AMC, Dr Suganthi Iyer PD Hinduja Hospital, Dr Ashwini Tayade - Orange City Hospital, Anil Jauhri CEO, NABCB. Discussions that are likely to be held are as follows: What is a process audit and how it should be done?; How to analyse, interpret and act on collected data?; Medication reconciliation – how to do it the right way?; What is “The Right Process” for High alert medications?; Is there a link between Infection control and construction?; Effective communication – do we ever practice it?; Importance of Pharmacovigilance?

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COVER STORY I N T E R V I E W

'AFMS believes service before self' Lt. Gen Bipin Puri,VSM, PHS Director General Armed Forces Medical Service (DGAFMS) in an exclusive interview with Prathiba Raju shares details about military medicines and the need for research work, its intent behind starting aDNA profiling centre, role of IT in Armed Force Medical Service (AFMS)

What is your vision as DGAFMS? I have tried to bring in the IT imprint in AFMS and sincerely believe in aligning with the Prime Ministers Digital India campaign. In times to come, IT will have a huge impact on healthcare, particularly tele-medicine can help us in a big way to get connected with high altitude areas. Recently, with help of the Indian Space Research Organisation (ISRO) we have established 53 tele-medicine nodes, which will help us to enable medical consultation between soldiers deployed at the Siachen glacier and other forward posts along the borders. Such remote posts are cut off for several months due to extreme weather conditions, now can communicate through satellite-enabled telemedicine nodes with the nearby tertiary hospitals.

Also, Artificial Intelligence (AI) is gradually becoming an integral part of healthcare.

Certain apps based on AI help in the stress-detection system by analysing the heart rate, muscle tension, blood pressure and detect the mind of an individual. We are also looking out for such apps which can be used in AFMS, I believe that it will help in assisting the medical needs. Apart from implementation of technology I also make sure that there is constant training programmes conducted for medical professionals in different locations and terrains

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The initiative of establishing a DNA profiling centre and repository at AFMC, Pune has been undertaken as a pilot project

throughout the year.

Every year, the armed forces organises its annual medical conference where you deliberate on various topics. Can you brief us about it?

The Armed Forces Medical Conference is held every year at Armed Forces Medical College, Pune in the month of February to discuss matters of medical research, technical training and scientific publication. We discuss on various issues that the armed forces is confronted with and also look at the upgradation of skills, competency, infrastructure and facilities for the medical fraternity. The conference conducts the Armed Forces Medical Research Committee Meeting, where we discuss on medical

research in the Armed Forces the discussion is focused towards making the soldier fit in all respects through preventive, curative and rehabilitative services in order to have a healthy force.

The meeting is a conglomeration of medical experts of the three services where they interact and integrate their efforts to further military medical research. Every year we get 200 research projects on military medicine out of which we sanction about 100 projects, as we have a limited budget. Armed Forces Medical Academic Council Meeting is also held as part of the conference to discuss all matters pertaining to UG, PF and super-specialty training. The upcoming conference is scheduled for February 2019 .

pilot project. The process of blood collection of high risk group amongst the Armed Forces is under progress and a large number of blood samples have been collected.

If the bill is passed we will do the profiling of each and every armed force personnel pan India.

What is your take on the Ayushman Bharat – PMJAY scheme?

Ayushman Bharat is a mega healthcare campaign. In regards with the programme we have had a discussion with the Ministry of Defence and Ministry of Health and Family Welfare (MoHFW) on

AFMS can help in implementing the scheme in far-flung border areas where there is no medical infrastructure and how we can support them.

The central government is increasing the count in medical seats for the

Let’s count the reasons...

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What is the need and intent behind starting a DNA profiling centre and repository at AFMC? How many samples have been collected so far?

Establishing the identity of the deceased is not a legal necessity but also a moral responsibility as it has emotional implications from the point of view of the next of kin and other family members. Usually the methods employed for establishing the identity of the deceased are examining the personal belongings on the dead body, studying the identification marks, comparing photographs etc., become futile in circumstances where there is extensive mutilation, disfigurement and decomposition of the body.

DNA profiling of the available body parts is the only fool-proof scientific method of establishing the identity and thus can be done only if blood samples of all personnel are stored or DNA database is created for all.

The bill on this project is tabled in the Parliament and it isn't cleared yet. Hence, this initiative of establishing a DNA profiling centre and repository at AFMC, Pune has been undertaken as a Forr enquirie Fo enquiriess contact contact : sales@schillerindia.com

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December 2018

AFMC, from 130 to 150 seats.

Armed Forces Medical College (AFMC) already had the infrastructure and resources required for 150 UG seats. Increase in seats granted by Ministry of Defence (MoD) will ensure optimal utilisation of

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COVER STORY resources. It would also make available additional well-trained doctors for the armed forces.

Your opinion on introducing robotic surgeries on the battlefield? What is your top-most priority on the battlefield? What kind of injuries are common and how can it be reduced?

Early intervention and damage control to save life and limbs is of prime importance in combat situation battlefield surgery.

Definitive management is deferred till the patient is evacuated to a proper centre.

We do have a Da Vinci Robot surgical instrument which performs surgeries with superior precision and control in the Army Hospital in Delhi, it is used

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extensively. Soon, we will be procuring three more such robot surgical machines in Command Hospital Pune, INH Asvini Mumbai and Command Hospital Bangalore. I believe that robotic surgery is the way forward when it comes to minimal invasive surgery as the quality of surgery is much better and effective than laproscopic surgery.

Robotic surgery requires extensive infrastructure and time to allow for the placement of ports prior to the commencement of surgery. The above is not available on field situations where surgical setups in Forward Surgical centres are not permanent structures and may be required to move depending on combat situations. In addition, the learning curve

is very long and most of the young surgeons deployed on the field are not exposed to it.

Projectile injuries from bullets, splinters to limb and torso are the most frequent injuries encountered.

Injuries to torso can lead to fatality and it can be prevented by suitable body armour, which are strong enough to allow the soldier to perform his role without any hindrance.

What are the measures taken to reduce the stress level among soldiers? How are these projects - Milap, Sahyog and Mansik Sahayata Helpline’ helping you to manage stress?

The army is continuously evolving, measures to improve stress releasing mechanisms are taken. An elaborate mental health

programme has been formulated since 2009. The issues of stress and strain is being addressed by the commanders in a comprehensive manner at various levels. Sessions for stress management are organised by commanders and psychiatrists at all major stations. Counselling is an intrinsic component of 22 psychiatry centres in the army manned wellness centres. Multi-pronged strategy in the form of directives, station lectures, special exam clinics with personal counselling is being adopted to reduce stress related disorders.

Mansik Sahayata Helpline has been established at respective command HQ under the aegis of Comd Headquarters. This helpline is available to provide

counselling services to anyone who wishes to avail them.

Mental health awareness training is conducted during pre-induction training. In areas of Northern Command, psychiatrist trained psychological counsellors conduct talks during preinduction training on stress related issues, early recognition, signs and symptoms and measures to cope.

Studies on cause/issues related to suicide/fratricide are carried out from time to time and suitable educational material including short films are prepared and disseminated for education of troops. Screening tools are being developed to detect stress makers and the same will be validated subsequently.

COVER STORY What is the significant role of regimental medical officers (RMOs)?

RMOs constitute a vital asset of the AFMS. These young medical officers are embedded with troops both on field and peace locations and perform a host of important functions. They are the authorised medical attendants and medical advisers to the unit and formations they stay with. In addition to rendering treatment and advice, RMOs spearhead promotive and preventive healthcare strategies at the furthest echelon of the healthcare delivery system. They undertake training activities for trained and highly qualified psychiatrists and battlefield nursing assistants and help to ensure that every soldier can be provided life and limb saving medical care as quickly, effectively and as far forward as possible.

RMOs presence in the units adds to the confidence of troops and they are often the close confidants, friends, philosophers and guides to the officers they serve. All our AFMS officers believe in service before self.

AFMC was planning for a multi-national disaster management exercise, to face any natural or manmade disaster. Any update on that?

A field training exercise involving ASEAN and ASEAN plus countries as part of the 3rd cycle of expert working Group on Military Medicine is scheduled in Lucknow in March 2019. A mid planning conference for the same is scheduled in December 2018. The filed training exercise will involve about 10 member contingents each from all ASEAN and ASEAN plus countries. The exercise will cover various facets of mass casualty management, aeromedical evacuation, chemical spill and healthcare evacuation camps. The aim of this exercise is to develop synergy, coordination and intra-operability between

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ASEAN and ASEAN plus countries in the event of natural and man made disasters.

How important is regenerative medicine in military medicine and what are the recent developments?

There is a fair amount of research which is going on globally on regenerative medicine. In our tertiary care centres we are looking into reconstructive surgeries and tissue engineering techniques particularly in severe burn wounds. Usually army personnel suffer large

surface burns and loose a lot of skin. One of the research project's in the Army Hospital, Delhi is on regrowth of skin, we are hopeful that this research will help and promote skin healing and reduce scarring. We are also in the process of establishing

a department of genetics in the Army Hospital, Delhi and AFMC, Pune and the latter will also have a exclusive research wing,which will help in medical advancement in military medicine. prathiba.raju@expressindia.com

Indo UK Institute of Health (IUIH) furthers India-UK collaboration on healthcare,helping India achieve Universal Health Care (UHC) objectives The benefits of this collaboration are broad ranging. They will include the provision of international standards of healthcare in India for the exchange of ideas in advanced medical research and development, training and education of doctors and nurses in both countries, state of the art training facilities, extensive technology and innovation knowledge transfer

Theresa May, Prime Minister of the United Kingdom with Narendra Modi, Prime Minister of India

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H

ealthcare enjoys a central position in the bilateral relationship between India and the UK and has been identified as a priority areas for the two countries to collaborate on. The benefits of this collaboration are broad ranging. They will include the provision of international standards of healthcare in India for the exchange of ideas in advanced medical research and development, training and education of doctors and nurses in both countries, state of the art training facilities, extensive technology and innovation knowledge transfer. This multi-million pound collaboration between India and the UK, a world first, is a sign of the huge global export market for the UK healthcare and life sciences sector. As one of the fastest developing economies in the world, with over 1 billion

people, India is fast becoming a key market for UK health services and technology investment and sales.

The Indo UK Institute of Health (IUIH) programme was a priority commercial announcement in the Joint Statement during Honourable Prime Minister of India Shri Narendra Modi’s visit to the UK in November 2015. The announcement included the proposal for 11 new UK Indo Institutes for Health in India accompanied by strategic clinical and training partnerships with the UK’s finest National Health Service (NHS) organisations, universities and private sector industries.

IUIH introduces NHS standard healthcare to India On July 5, 2018, the United Kingdom National Health Service (NHS) celebrated its 70th year of universal healthcare. It

was acclaimed at the time, to be the largest experiment in social service undertaken anywhere in the world, according to its founder, Aneurin Bevan, the former UK Secretary of State for Health. It is a coincidence that India has completed 70 years of its independence too. Seven decades ago when the legislation establishing the NHS was passed in the UK, the Bhore Committee in India was setting up the first national plan for health in India. The main principle of NHS that has stood the test of time successfully is delivering healthcare to all based on their clinical need rather than their ability to pay. It is this very principle that drives Prime Minister Shri Narendra Modi’s ambitious Ayushman Bharat initiative as well.

According to Sir Malcolm Grant, recent Chairman of NHS England, “India’s National Health Policy (NHP) is

arguably the most ambitious reform programme since Bhore Committee. When the Prime Minister of India launched the National Health Policy last year, he described it as ‘a historic moment in our endeavour to create a healthy India where everyone has access to quality healthcare’. As Britain celebrates its own historic landmark of 70 years of the NHS, I look forward to India-UK collaboration on healthcare being stronger than ever.”

There are many examples of impressive collaboration between the health systems of India and the UK. Indo UK Institute of Health (IUIH) that plans to build world-class medicities is one such example. In addition, Health Education England has begun an ambitious new programme to train Indian nurses and doctors in the NHS who will then return to India with enhanced

DR AJAY RAJAN GUPTA, MD and Group CEO, Indo UK Institute of Health (IUIH)

These What’s remarkable for over 400 million Indians who’ll benefit from IUIH bringing in the UK’s NHS standard healthcare is the fact that nothing but the best in the world is coming to them.The NHS has been judged the best, safest and most af fordable health care system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health think tank. It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highestrated health system

Dr Ajay Rajan Gupta, Managing Director and Group CEO, IUIH with Honourable Prime Minister of Republic of India, Narendra Modi

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skills. The UK’s Global Health Alliance is already working in rural India and launched a new fellowship in aviation medicine and a diploma in emergency medicine for nurses. Both India and the UK are evaluating telemedicine to support patients without high financial and time costs associated with face to face clinical interactions. In India, this has the potential to transform the way healthcare is delivered to the two-thirds of the population living in rural areas. Artificial Intelligence (AI) is another area where the NHS has made important progress and is currently testing the deployment of AI for diagnosis of breast cancer, eye disease and kidney disease. India similarly has been conducting trials on the use of AI to diagnose cervical cancers and improve blood test accuracy.

Sir Malcolm Grant is of the view that these examples are only the tip of the iceberg in terms of opportunities that exist. Be it the use of electronic patient records, wearables and self-management apps, or the accelerating adoption of 3D printing, predictive analytics and personalised medicine, there is little doubt that the health systems of India and the UK will be transformed over the next decade. “We can together embark on this transformative journey, learning from each other’s experiences and innovations,” he adds.

According to Dr Ajay Rajan Gupta, MD & Group CEO, Indo UK Institute of Health (IUIH), “What’s remarkable for over 400 million Indians who’ll benefit from IUIH bringing in the UK’s NHS standard healthcare is the fact that nothing but the best in the world is coming to them.

The NHS has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health think tank. It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highest-

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RICHARD MURRAY,

DR RAJDEEP SINGH CHHINA,

SIR MALCOLM GRANT,

DR GAUTAM MARWAH,

Director of Policy, London-based King’s Fund think tank

COO, IUIH

Chairman, NHS England

Group Director, Indo UK Clinics

The UK’s ranking is welcome and reflects the strong fundamentals of the NHS. Universal access to health services, a founding principle of the NHS, is rightly recognised by the Commonwealth Fund ranking

The objective is to make every IUIH Medicity a medical tourism hub and attract the patient traffic from across the globe. NHS standard healthcare at lower price points is our winning formula to tap the medical tourism business potential.This shall not just contribute to the exchequer but lead to overall development of the region too, in line with the government’s Smart Cities initiative

India’s National Health Policy (NHP) is arguably the most ambitious reform programme since Bhore Committee.

When the Prime Minister of India launched the National Health Policy last year, he described it as ‘a historic moment in our endeavour to create a healthy India where everyone has access to quality healthcare’. As Britain celebrates its own historic landmark, I look forward to IndiaUK collaboration on healthcare being stronger than ever

Besides this, IUIH is also exploring how mobile diagnostic units, high penetration of smartphones and other disruptive technologies can be used for extending primary healthcare and treatment of patients.We are also relying heavily on big data analytics. Our eHealth and m-Health platforms will facilitate exchange of patients’ medical records electronically using telemedicine, tele-radiology and tele-pathology for diagnostics etc. It’s all about covering the last mile and taking healthcare services down to patient’s doorstep

rated health system.”

The NHS has been rated better than the health systems of Australia, Netherlands, New Zealand, Norway, Switzerland, Sweden, Germany, Canada, France, and the US. This ranking is even more notable because the think tank found the UK to put the fourth smallest amount of GDP into healthcare among the 11 countries.

Richard Murray, the Director of policy at the Londonbased King’s Fund think tank, said, “The UK’s ranking is welcome and reflects the strong

fundamentals of the NHS. Universal access to health services, a founding principle of the NHS, is rightly recognised by the Commonwealth Fund ranking.”

The need for PPP and how IUIH can help The Indo UK Institute of Health (IUIH) will provide an integrated approach to healthcare across India by partnering with the UK’s best organisations in healthcare delivery, research, education and manufacturing

O

ne of the major challenges for the healthcare ecosystem in India is to raise the service quality and ensure equitable access to the population, whilst addressing the need for increased capacity to deal with changing disease incidence profiles. According to a recent McKinsey report, India will have a total bed density of 1.84 per 1000 people against the global average of 2.9 and WHO guideline of 3.5 by 2022.

As a country, India accounts for 20 per cent of the global disease burden but only 12-15 per cent of the Indian population is under health insurance cover. Private sector providers serve close to 90 per cent of hospitals, 80 per cent of doctors, 80 per cent of outdoor patient and close to 60 per cent of indoor patient care services in India. This overly high dependence on private sector provision has debilitating effects on the poor, leading to liquidation of their assets, indebtedness etc. 40 per cent of those hospitalised in India become categorised as below the poverty line (BPL) every year, owing to out-of-pocket expenses being as high as 80 per cent of the total treatment and rehabilitation costs.

A Public Private Partnership, such as described by Prime Minister, Mr. Narendra Modi in his initiative of September 2018, when launching the world’s largest government funded healthcare scheme (Modicare), can effectively address these issues.

IUIH, one of the largest PPP projects in healthcare across the world, firmly believes that it is an effective way

forward to improve healthcare for all in India. The benefits that IUIH brings include: ◗ Introduction of private sector technology and innovation to provide better public services through improved operational efficiency ◗ Delivery of hospital services

which may not otherwise be affordable ◗ Development of local private sector capabilities through joint ventures with large international firms, as well as subcontracting opportunities for local firms in areas such as civil works, electrical works,

facilities management, security services, cleaning services, maintenance services ◗ Job creation and skills development through education and training ◗ Supplementing limited public sector capacities to meet the growing demand for infra-

structure development ◗ Long term value-for-money through appropriate risk transfer to the private sector over the life of the project ◗ Introduction of a health system (with support from NHS partners) that will benefit the Indian population by provision of serv-

Foundation stone unveiling of IUIH Medicity Nagpur by Devendra Fadnavis, Chief Minister, Maharashtra

Foundation stone unveiling of IUIH Medicity Amaravati by Nara Chandrababu Naidu, Chief Minister, Andhra Pradesh,

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Master plan of the IUIH Medicity Nagpur

ices at a reduced/ lower cost.

The healthcare industry is vast and in addition to conventional medicine and treatment of patients, comprises ancillary and complementary areas such as education and training, clinical support, manufacturing and technology, research and development, mental health, alternative medicine and commercial health. Assembling these services within a specific land area allows for an efficient sharing of ideas and resources and creates invaluable economies of scale and size. The 11 Indo UK Insti-

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tutes of Health across India, designated for the provision of integrated healthcare facilities to over 400 million patients in India, will build a capacity of 11,000 beds, 5,000 doctors, 25,000 nurses and generate direct and indirect employment for over 300,000 Indians.

The Indo UK Institute of Health (IUIH) will provide an integrated approach to healthcare across India by partnering with the UK’s best organisations in healthcare delivery, research, education and manufacturing. Each IUIH Medicity will provide a

medical college, nursing college, Post Graduate academy and a training facility for allied health professionals. It will provide a separate zone for medical equipment and device manufacturing, and pharmaceutical production.

Cutting edge medical research will be carried out at the IUIH Medicities in areas as diverse as genomics & stem cells, translational research and clinical research leveraging on the patient data available. The goal is to bring healthcare to India which is Available, Affordable, Ac-

countable and Appropriate to all.

In terms of affordability, IUIH will ensure: ◗ That no patient is turned away; ◗ That costs across the value chain are minimised to make care more affordable ◗ That a tiered system of charges is introduced ◗ That patients are crosssubsidise In terms of accountability, IUIH will ensure: ◗ Transparency of charges ◗ Transparency of treatments

◗ Transparency of outcomes In terms of ensuring availability of healthcare, IUIH will: ◗ Offer all major specialties, treatments and services ◗ Provide outreach programmes to rural and semi-urban areas ◗ Develop digital health initiatives by providing remote consultations, advice and monitoring ◗ Connect with local doctors and nursing homes ◗ Deliver medical education, training and research to increase the number of skilled

medical professionals Construction of the first IUIH Medicity, a fully integrated facility, is underway already in MIHAN SEZ of Nagpur, Maharashtra.

The foundation stone, for the IUIH Medicity in Amaravati, the new state capital, has also been unveiled by Shri Nara Chandrababu Naidu, Honourable Chief Minister of Andhra Pradesh. Both these IUIH Medicities are being developed in association with King’s College Hospital, London.

The states to benefit from

the IUIH programme include Maharashtra, Andhra Pradesh, Telangana, Punjab, Gujarat, Rajasthan, Karnataka, Uttar Pradesh, Madhya Pradesh and Haryana. In addition, IUIH has recently signed Memorandum of Understanding’s (MoU) with two more Indian states - Assam and Uttarakhand. IUIH will enable the evolution of the states, providing a hub for medical tourism, medical equipment and device manufacturing, pharmaceutical production; and a focal point for

cutting-edge medical research.

“Besides this, IUIH is also exploring how mobile diagnostic units, high penetration of smartphones and other disruptive technologies can be used for extending primary healthcare and treatment of patients. We are also relying heavily on big data analytics. Our e-Health and m-Health platforms will facilitate exchange of patients’ medical records electronically using telemedicine, tele-radiology and telepathology for diagnostics

etc. It’s all about covering the last mile and taking healthcare services down to patient’s doorstep,” informed Dr Gautam Marwah, Group Director, Indo UK Clinics.

IUIH is in a process of contracting with world leading medical device companies, medical equipment companies and healthcare Information Technology companies. Many of them will establish their manufacturing operations in IUIH Medicities, in accordance with Prime Minister Modi’s ‘Make in India’ programme, re-

ducing healthcare costs further for the patients in India.

“The objective is to make every IUIH Medicity a medical tourism hub and attract the patient traffic from across the globe. NHS standard healthcare at lower price points is our winning formula to tap the medical tourism business potential. This shall not just contribute to the exchequer but lead to overall development of the region too, in line with the government’s Smart Cities initiative,” added Dr Rajdeep Singh Chhina, COO, IUIH.

IUIH partnerships with United Kingdom National Health Service - global leaders in health care delivery

F

rom inception, IUIH has partnered with senior, reputed organisations from the United Kingdom’s (UK) National Health Service (NHS) https://www.nhs.uk). IUIH have a UK Government level agreement to provide a best in class service with the backing of the UK Department of Health and Social Care (DHSC), UK Department of International Trade and leading UK NHS providers. Accounting for 80 per cent of all healthcare spending in the UK and as the fifth largest employer in the world, the NHS has 70 years’ unrivalled experience and expertise in planning and delivering healthcare services to meet the needs of a diverse population. It is unique

in both its quality and breadth of running the world’s largest integrated health systems.

The provision of high-quality care is key to IUIH’s vision for developing new systems for meeting the rising demand for healthcare in India and the association with NHS quality care is key to satisfying the demand along with Indian’s expectations of care. The NHS is consistently reported as one of the most cherished and recognised brands in the world. It rightly evokes exceptionally high levels of trust and reassurance. Patients and the public continue to see the NHS as a single, high quality, unified service, delivering safe, secure, healthcare for all.

The brand identifiers and regular reports of medical developments gives reassurance to

patients and their families.

IUIH’s approach is to collaborate with strategically chosen NHS partners to transfer the knowledge and expertise of the NHS as a combined proposition to create a world class healthcare offering.

Delivering a robust Clinical Governance Framework IUIH will establish an independent quality and performance assurance framework to ensure that the delivery of services in IUIH is consistent with the standards of care and quality set out by the NHS. The vision of IUIH to deliver quality driven, affordable healthcare for all will be demonstrated and executed by adopting the NHS evidence-based medicine (EBM)

philosophy of care delivery.

The quality clinical governance programme will be regulated by a transparent performance management system which will use standard and innovative metrics that measure, analyse and report on; operational and clinical activity, process and quality outcomes.

Delivering Standardised, Consistent and Transparent standards of care One of the challenges in India is how to bring a kite mark or a trademark to an institution that indicates to the public the care they are receiving is the same across the whole system. Many professionals in India’s healthcare network are trained through a variety of sources making it difficult to

regulate the standard of care available. The fragmented models of care delivery as often seen in India are becoming increasingly recognised as unsustainable in the face of increasing demand, rising expectations and the growing prevalence of long-term conditions.

In contrast, the brand equity of the NHS, coupled with its clinical governance framework, will ensure that the care delivered in IUIH, will be nationally recognised as standardised and consistent across the organisation. Partnership with the NHS will move IUIH towards healthcare solutions that deliver quality, efficiency and outcomes within the system and address the shortcomings of the current fragmented market in India.

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START UP CORNER

How Niramai’s test addresses the socio-cultural issues in cancer screening for Indian women Bengaluru-based startup Niramai was incorporated in July 2016 by two women founders, Dr Geetha Manjunath and Nidhi Mathur, who wanted to productise and take to market a novel idea that they were developing since 2014 as an exploratory project in a multinational research lab observes, Sandhya Michu Concept and roll out The first big challenge we faced, was the funds needed to own the intellectual property, since the initial IP was developed by us when we were employees of our previous organization. We had to raise a seed round within three months in order to ensure that Niramai could own the IP. We were happy to secure the backing from our investors such as piVentures, Ankur Capital, Axilor Ventures and 500 startups without whom this wouldn’t have been possible.

Challenges The key challenge we are addressing was to enable early screening of breast cancer for

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START UP CORNER

all women. Current technologies for detecting breast cancer do not work on women under 45 years of age, they are not suitable for frequent screening and also not accessible to many women. We have developed a new way of doing breast cancer screening in a privacy aware manner, in women of all age groups, more accurately than standard methods. A key challenge we faced was to prove the clinical validity of the solution and get acceptance from medical community. We worked with major hospitals in India to conduct clinical trials and publish in international journals in order to establish the efficacy of the solution. The results from these trials have helped us gain the trust of expert radiologists and product roll out.

can detect cancer at an early stage. Niramai’s Thermalytix solution uses a high-resolution thermal sensing device and an in-house developed patented software to scan the chest area for any thermal abnormality. The thermal sensing device is placed at 3 feet from the lady and the temperature distribution on the chest is measured in non-contact non-invasive way. Niramai software analyses the thermal images to generate a diagnostic report that gives a breast health score and marks the location of abnormality in the thermal image. “We analyse approx. 400,000 temperature values and look at various clinical parameters to detect abnormality, if any. There is no touch or radiation involved in the process,� says Dr Geetha Manjunath.

Product and solution offerings

Why Niramai?

Niramai provides a novel solution for breast cancer detection that is privacy aware and

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Breast cancer is the largest form of cancer found in women today. Early detection is key to improve survival

rates and reduce treatment cost. Yet, there is no cancer detection test that can safely be used for regular screening.

There is no test that can detect early stage malignancy (cancer) particularly in women under 45 years of age. Niramai breast cancer screening test is radiationfree, non-contact and non-invasive. It has the ability to detect early stage cancer in women of all age groups. The test can be used in hospitals and diagnostic centres for preventive health check.

Apart from being portable and affordable, it is can be used in outreach programmes and corporate camps as well.

Customers name and size/reach Niramai aims to expand the availability of breast health screening solutions to women all over India in the next one year. For that purpose we partner with various stakeholders including hospitals, diagnostic centres, individual

practitioners, NGOs, Government and corporate.

Financial report This start up raised $1 million in seed funding in April 2017.

Our solution in commercially available to hospital, diagnostic centres and NGOs at a fraction of the cost of a Mammography machine. We are in early-revenue stage right now.

Expansion plans Niramai is working with hospitals and diagnostic labs in three states in India and plans to expand this year to other parts of the country. Our plan is to expand beyond India by the middle of next year. Niramai expects their test to be incorporates as a standard preventive screening tool that requires minimal skills to operate into their clinical practice across the country making breast cancer detection accessible to every woman, dramatically change efficiency, and save money into the bargain.

Recent wins Within a year of the launch of the solution, the company has won several national and international accolades. It was one of the only four Indian startups invited to participate in the Google Launchpad Accelerator Class 5 in San Francisco. It was also selected by Philips for their first edition of HealthWorks programme in India.

The company won the Amazon AI Award in healthcare category, BNP Paribas award for Best startup in Preventive Healthcare, and Best Startup in Indian Cancer Congress.

Future plans Presently, the solution is available in 11 hospitals across 3 states in India today. The test has received regulatory clearance from DCGI for breast cancer diagnosis. Being a notouch no-see solution, Niramai test addresses the socio-cultural issues in cancer screening and has now become the most sought out test by Indian women.

OPINION

How investment and acceleration can make Healthtech startups trulyAYUSHMAN? Dr BS Ajai Kumar, Chairman & CEO, HCG Enterprises and Devang Mehta, Partner, Anthill Venturesshares insights on theright strategy for health startups

T

he term Ayushman, with its roots in Sanskrit, is synonymous with longevity. Applied to various contexts, longevity is a state everyone aspires for – be it in personal life or in the context of an organisation. Businesses operate on a 'going concern' basis, a premise that presumes functioning of the business without the threat of closure or failure for the foreseeable future. Over the last few decades, the increasing advent of disruptive forces enabled by rapid innovation, fastreducing barriers to entry across multiple industry verticals, rise of the digital economy, easier access to capital, free markets among others have resulted in numerous survival headaches for established companies. Early stage companies face even more trying circumstances, on a regular basis, to sustain and survive in brutal competitive environments.

Specifically, in the healthcare industry, tech-enabled businesses are redefining solutions to existing and new problems.

The healthcare market in India is expected to grow to nearly US$300 billion by 2020. Specific

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OPINION impact of technology has been witnessed in medical record systems, telemedicine software, connected medical devices and digital therapeutics that enable patients manage chronic conditions at the comfort of their home. There has been a strong focus on Big Data & Analytics, Internet of Things (IoT) and AI in India. According to a NASSCOM report, 37 per cent Indian health-tech startups have built, or are building, IoT-enabled products and over 50 per cent have or are building AI-enabled products. Buoyed by this tremendous business opportunity in a market that is starting to take flight, the health-tech industry has become the cynosure of venture capital in India. With heightened investor interest and increasing transaction values in

this decade, there is a strong confidence with the technologies, business models and the market opportunity. The public markets also echo this trend with successful IPOs of Thyrocare, Narayana Hrudayalaya, Dr Lal PathLabs and Health Care Global (HCG).

Startups that lie between Pre-Series A and Series A rounds of funding often require tremendous knowledge and assistance in multiple areas, in addition to pure money. The founders may be brilliant and innovative; however, they may find themselves with limited experience in growing their business and achieving scale.

Startups will need to create processes that involve both people and business operations that can springboard their scaling ef-

forts. Refining customer acquisition strategies, constantly enhancing engagement models, monitoring feedback and continuous improvement are crucial as startups begin to accelerate. Startups need to carefully assess the market and competition, articulate brand and positioning strategy, undertake changes in their product design and make it ready for scale, develop IP strategy, understanding unit economics, inculcate financial prudence and compliance among other essential aspects core to their business. Often getting access to market opportunities can appear daunting for early stage companies – and a savvy investor can make those connections with potential customers.

Further, the startup leadership

team can benefit with executive coaching from seasoned professionals who can lend advice on scaling up and sustaining larger organisations. Perfecting their investor pitches and developing readiness for future funding rounds is another key area where skills need to get developed or refined.

The guidance provided by state-of-the-art speed scaling ecosystems and corporate partners often is the difference between dazzling success and abject failure in the early stage ecosystem. Mentoring provides the right levers that, when utilised correctly, can guide people and processes in the direction of rapid growth. The right guidance can mean the difference between capturing market share with consummate ease

versus eternal struggle to get POCs and to convert POCs to customers. It can mean the difference between a precise, datadriven pricing policy that perfectly captures customer segments versus leaving money on the table and/or ceding markets to competitors purely on price points.

Startups striving for longevity constantly need to fuel their innovation and growth story with smart capital - capital that catalyses growth both with true value addition. They need to prioritise on securing smart capital that will enable rapid growth through speed scaling. With a good strategy in place, these startups can utilise investments from such value-added investors to rapidly accelerate and become truly Ayushman.

Changing realm of healthcare Dr Sweta Choudhury, Head - Medical Product & Services, Nightingales Home Health Services talks about the growing consumerism in healthcare and how it impacts healthcare services, systems and approaches to care giving A DOCTOR uses his knowledge, experience and judgement to diagnose the patient's condition and prescribes a treatment plan. The patient adheres to the advice given to him. If the condition improves, well and fine, if not the patient reaches out to the doctor again. The doctor evaluates how the disease has responded to the treatment plan and prescribes an alternate plan to treat the condition.

There are two important things to note here – the patient goes to the doctor to avail the ‘service’ and the doctor treats the ‘disease’. These two aspects are undergoing a major change.

Consumerism in Healthcare Historically, the doctor and the patient have communicated unidirectionally wherein the patient is passive and excluded from making choices.

Healthcare is a complex sys-

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tem and patients has often been secluded from information about the disease, treatment options and clinical quality parameters.

Today’s patient is the new healthcare consumer. The patient has a lot of expectations from the doctor other than mere treatment of the disease.

Dr Google has already educated the new consumer on the difference between hemodialysis and peritoneal dialysis. The diabetes patient knows the optimal levels of HbA1c. The healthcare consumer is eager to know more about his condition. Internet has already opened the floodgates of information to him.

Plethora of symptom checkers are helping him play around with the correlation between symptoms and disease. The patient approaches the doctor with a lot of questions and expectations. A patient is eager to know why a particular test was prescribed to him. Why

should he consume less salt if he is hypertensive?

Service on demand The patient does not expect only the service. The consumer also expects timely service, service at his convenience and a good packaging of the service too. Few common examples include birthing suites during pregnancy, refraction test at home, quick laboratory tests with newer PoC diagnostics devices, medical records at his tips with

electronic health records, nurses at home and if required, even the dental clinic can come home.

Healthcare organisations are also studying the consumer behaviour and trying to understand their needs. What is convenient for them? How can healthcare services be made more accessible to them? How can the discharge process be made quicker and smoother in hospitals? How to decrease their wait time at the OPD? Customer feedback is equally important in healthcare. Organisations are investing more and more in getting to know the patient, his family and their preferences. Merely providing healthcare services are not important, quality and convenience are equally important.

With many services and offerings available online, the consumer has full access to information. The consumer has

multiple options for a service.

Online reviews further aid the consumer in making a choice.

Consumerism in the long run…

An educated patient is an empowered patient. The patient is eager to know about his problem and understand it.

The moment a Doctor makes the patient a part of the treatment journey, half the battle is won. Now the patient is incharge of his health. A diabetic patient now knows that he should not be eating more sugary foods because his insulin production is not high enough to combat the sugar. Regular walks will help him in improving his metabolism. A push from the doctor is not required anymore.

Systems approach to chronic disease treatment We have been observing the epidemic of chronic diseases

OPINION taking over a large percentage of the population. Doctors have been treating Diabetes type II, hypertension, etc. It is no longer so. The chronic disease is affected by a multitude of factors. The patient’s genetic makeup, health condition, family history, habits and environmental factors affect its progression. Frequently, there exists many co-morbid conditions in a patient with chronic diseases. This makes every patient unique. A patient with hypertension and diabetes in an affluent family needs to be

tackled differently than a hypertensive patient who is a labourer, both being in overall interests of respective patients.

The focus has shifted from ‘treating the disease’ to ‘treating the person as a system’.

Hence, patient profiling in chronic diseases is very helpful.

Patient profiling and predictive analytics can help in planning better treatment in the future.

As we gather more and more data for the population of a country, we help in fine-tuning the algorithm which is running the analytics on the data.

Technology aiding consumerism IoT has played a major role in the birth of the enlightened patient as a consumer. Wearables and fitness trackers are commonly used. The new consumer knows the importance of exercise, keeps monitoring his daily steps on a pedometer and knows what his optimal blood pressure values are.

Organisations know that they cannot exist in silos. Fitness trackers are being integrated with other systems. A

seamless experience to the consumer is the key. The glucometer must capture the data and show-up in patient’s EHR. The weighing machine is helpful if the weight is captured and BMI trend can be shown on patient’s electronic health records. Medication tracker should throw up reminders for daily consumption and refill. And all of this should be present at one place. Multiple apps and multiple logins for different health data is not acceptable to the new-age consumer.

Patient-centric approach enabled by technology convergence including connected devices and digital health help in early adoption of preventive measures and quicker intervention, as and when required. The patient has taken a new avatar in the form of a healthcare consumer. Demand is for personalised care as per his convenience with high clinical quality and in a holistic way. After all, the doctor’s aim is to see people lead healthier lives and consumerism is aiding it!

Can technology democratise Indian healthcare?

Dr Raj Panda, Additional Professor and Health System Specialist, PHFI believes that AB should support practices to develop IT functionality which responds to the evolving needs of patients and underpins integration across care pathways DIGITAL SYSTEMS are the foundation upon which we will build a modern, efficient and responsive health service as envisaged by the current policy directions provided by Ayushman Bharat (AB). Enabling information to flow between care providers within and beyond organisational boundaries and between care providers and patients, is a key means by which we will achieve a safe, convenient and personalised healthcare service that the current health care system in India does not provide.

In a challenging resource environment such as that of current public health systems in India, technology services must not only improve the quality of care through enhancing the patients’ experience of services, but also enable the practice to realise benefits such as reduced administrative burden and providing key information to all stakeholders. While revitalising and reforming primary care, AB should also support practices to develop IT functionality which responds to the evolving needs of patients and underpins integration across care pathways. At the same time one also has to be

careful of the problems that technology can create as there are many opportunities

where patients’ medical records can be compromised.

Developed on the back of

Aadhaar-based India Stack, the National Health Stack (NHS) is imagined as a nationally shared digital infrastructure backbone. It will be shared and used by both the centre and the state across public and private healthcare institutes across the country.

The stack is expected to boost the creation of healthcare solutions based on technology.

The key components of the stack are national electronic health registries, a coverage and claims platform, personal health records framework, national health analytics platform and Digital ID. This is indeed a welcome move for entrepreneurs to design digital solutions for strengthening the healthcare system of the nation. Potential monetary value of digital health companies is in the development of proprietary algorithms and the datasets that have commercial value. These datasets will be mined from patient's medical records. These may raise concerns about data privacy and the potential for compromise.

Democratising healthcare through technology is a noble goal and AB has the potential to be a game changer if re-

sources are allocated and used appropriately. Using technology to help build a patient centric equitable heath care system should be the goal of disruptive technology.

The technology revolution like the biomedical revolution has the potential to improve the quality and quantity of patients’ lives. Nevertheless it does bring with it issues related to privacy and compromise of patient data and unless we have balance and check in place it can result in compromises which may effect health systems at all levels, thus breaching patients trust in healthcare providers and systems which is already at an all-time low. The ultimate litmus test of this trust is going to be tested through large scale transformative programmes like the Ayushman Bharat where technology will be used for delivery of the health care. AB has the potential to be a game changer in th scale for promoting equitable health care.

How it will use technology to democratise the Indian health system while balancing the promotion of innovation remains to be seen in the coming years.

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OPINION

The Indian Medical Devices Industry – The Year that was in 2018 and outlook for 2019 THE MEDICAL device industry market is very dynamic and the key drivers impacting this sector are healthcare expenditure, technological development, aging population, and chronic diseases. Further emerging trends that impact the medical device industry include the changing medical technology landscape, software as a differentiator in medical devices, as well as design and manufacturing of patient portable or smaller devices. In India, Medical Devices is now considered to play a key role in the delivery of quality health care to the masses. The launch of MDR 2017 was significant milestone in creating a robust platform.

The awareness around the need to have a robust Medical Devices ecosystem in the country is gaining traction resulting in higher growth rates for India as compared to the global industry.

The year 2018 has been noteworthy for this space with the emergence of the new medical device rules which came into force from January 2018. This has finally given the medical devices and in-vitro diagnostic devices (IVD) industry a distinctive regulatory identity. By delinking devices from drugs, the multitudes of devices used in the country today are governed to ensure patient safety, quality and performance parameters of devices sold within the country. Given that 80% of the devices are imported, the legislation has an important role to play in creating a level playing field for domestic and foreign manufacturers. The legislation is hopeful in achieving the main goals of the National Health Policy that calls for addressing the changing priorities in Indian healthcare by mainly bridging the accessibility and affordability gap. On another hand, the industry in India is going through tough times because of anomalies in import-export policy as per the report by ASSOCHAM. This is due to

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the import duties for raw materials being higher than finished goods, making it difficult to compete with manufacturers from some countries on price who also benefit with incentives of setting up a manufacturing facility in this space.

The manufacturing space in the medical devices sector is at a nascent stage and with the government’s encouragement; it will evolve as a sunshine sector.

The “Make in India” charter has motivated medical device manufacturers in India, with promise of the government support in the form of land allocation and subsidies to encourage growth of the domestic medical device industry. However, the slow infrastructure development of these parks is creating obstacles for the domestic industry and thereby resulting in an indirect implication of availability of devices in the country. Hence apart from the cost, the govern-

ment’s move to separate manufacturing of medical devices and drugs from the regulatory perspective could usher in better transparency and a level playing field for medical devices makers. This will go a long way in building robust standards ecosystem for the industry, boost domestic production as well as boost exports, usher in greater foreign investment in the sector and bring in more investments into infrastructure and processes.

Digital’ makes a very compelling entry into the world of healthcare 2018. Similarly, technology will continue to provide a fantastic platform for disruptive innovation, wherein the wearables and diagnostic framework leveraging technology can provide out-of-the box, innovative and cost effective solutions for the masses of the country. Wearable medical devices like glucose monitors and

exercise trackers are projected to experience double the revenue growth of the overall device market. The launch of Apple Watch series 4 with a US FDA approved ECG embedded into the watch. Not that we did not have portable ECGs earlier, but this dawns a new era of a daily use wearable as an FDA approved medical device. This combined with the new age analytics and artificial intelligence, along with Medical Devices in conjunction with IOT and Analytics will transform healthcare in unprecedented ways. While there have been reports that AI has bettered diagnosis, there is scope for tremendous development in this domain. Smart devices that measure other vital signs, like blood pressure and glucose levels, will help doctors to keep an eye on their patients.

It will do all this while also allowing the patient to take an active role in their own healthcare.

The connected health framework combined with large data sets and AI will assist the doctors in accurate diagnosis and timely interventions in the near future.

India is fast growing as a key market for medical devices outsourcing and will continue to consolidate its position in 2019. The Indian Medical Devices industry has an opportunity to leapfrog innovation combining physical devices and integrating digital frameworks for long term innovation. The industry was valued at US$3.5 billion in 2015 and could expand to approximately US $4.8 billion by 2019. According to a Deloitte report, the growth rate of India’s medical-device industry is around 15% which is more than double of the global industry growth rate of 4-6%, and is expected to become a $25-30 billion industry in India by 2025.

DIAGNOSTIC I N T E R V I E W

Pushing boundaries in cancer diagnosis Dr Ravi Gaur, COO, Oncquest Laboratories in a candid conversation with Prathiba Raju talks about how Oncquest lab's advanced diagnosis has brought in precision, affordability in cancer diagnosis in India How is molecular hematology and surgical pathology services is evolving in India.

Oncquest Laboratories has a special focus on molecular oncology, can you tell us how have you evolved and progressed in the field?

Established in 2000, Oncquest Laboratoriesis known for its excellence in molecular diagnosis and its core competence in cancer diagnosis. Its key business areas include molecular diagnosis (oncology and infections ), advanced diagnosis, general pathology and microbiology, hospital lab management, clinical trails, and R&D. With over eighteen years of experience under its belt, Oncquest has established itself among India’s largest cancer diagnostic networks. It is a College of American Pathologists (CAP) and National Accreditation Board for Testing & Calibration Laboratories (NABL) accredited centre, with a core focus in Molecular Pathology and Surgical Pathology Services. The logistic capabilities and Pan-Asia geographical spread, makes Oncquest an ideal associate for all clinical activities in India and neighboring countries.

Oncquest utilises the experience and expertise of trained scientists and pathologist to provide clinicians an incisive diagnosis to identify the disease process at the fine point of differentiation. Recently, it has extended its arms in the areas of Companion Diagnostics and Pharmacogenomics which has encouraged greater penetration of personalised medicine into the Indian healthcare market. This is a way towards the future

epicentre of the much technological advancement in healthcare.

What are the latest trends within the diagnostic market in India, particularly in cancer diagnostics?

Looking at the current data, the combined healthcare spending in the major influential countries across the globe is expected to reach $8.7 trillion until 2020 while in 2015, it was USD $7 trillion. And, the healthcare industry in India is one of the fastest-growing sectors worldwide; in fact, the experts expect it to reach $280 billion by 2020. The expenditure on R&D in the healthcare industry in India is increasing by the passage of time as more and more Indian healthcare companies, especially pharmaceutical, are collaborating with foreign companies. Today, India is able to attract high capital investment in the industry’s advanced diagnostic facilities as it’s the prime choice for highrated diagnostic services and medical equipment.

As the lifestyle-related diseases are increasing at an alarming rate, people are being health-conscious and aware of life-threatening diseases like cancer, for which effective treatment is not guaranteed.

This has led to an increased spending on cancer detection and diagnosis by consumers.

Therefore, the demands for accredited cancer diagnostic centres as well as home-based diagnostic services, as a recent trend, continues to spur.

Secondly, we see a rise in technological investments, which is immensely benefiting hospitals, diagnostic centres as well as R&D facilities and education for improved

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DIAGNOSTIC diagnosis facilities and services.

Oncquest is more like a multi-platform pathology service provider what’s your core focus, how will you expand it further?

We are planning to come up with precision diagnosis, nephelometry, and immunofixation to further broaden our service spectrum.

Though we have strong presence in New Delhi, Bangalore, Chennai, Chandigarh, Coimbatore, Hissar, Mumbai, Hyderabad, Jalandhar, Ludhiana, Indore, Patna, Pune, Panchkula, and Surat, we aim to get Pan-India presence. We are also looking forward to creating a vast and effective network of hospital laboratories management services in international markets, particularly in Bangladesh, Nepal, Sri Lanka, and other adjoining countries.

Oncquest has tied up with almost all leading cancer hospitals pan India. As of now we have 38 independent labs Pan-India and we will be adding 25 more labs within the next two years.

What is your take on PPPs in diagnostics market space?

Public-private partnerships (PPP) have the potential in bringing innovation into the healthcare sector. Both public and private sectors can leverage the strengths of each other in terms of resources, management, expertise, knowledge, and skills that would meet the public needs.

The government can partner with private healthcare service providers for working on specific contractual projects where the responsibilities of designing, construction, financing, and maintenance etc., can be managed by private hospitals using their adequate resources and medical expertise.

Why do you think Indian market is important for cancer diagnostics, what are your plans for the next five years?

We see the rise of technological investments in the healthcare infrastructure, which is immensely benefitting

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hospitals, diagnostic centres as well as R&D facilities and education for improved diagnosis facilities and services.

In fact, the cost-efficient and competent technologies in cancer diagnostics facilitate the creation of new drug testing laboratories and hence, the discovery of breakthrough therapies to treat cancer such as immune-oncology and adoptive cell transfer-based treatment.

In light of the growing importance of preventive healthcare, Oncquest is focused on building exclusive tie-ups with experts in the fields of genetic testing to bring newly specialised as well as general health-related tests to India.

We are also working on bringing the best and most advanced technologies available in oncology, cardiology (cardio genomics), infertility, prenatal, infectious diseases, metagenomics and genetic testing to India.

What are new advanced assays which are being offered and why do you think Oncquest is preferred to when it comes to BCR/ ABL &MRD(minimal residual disease) testing?

BCR/ABL testing with International Scale reporting – helps in the diagnosis and monitoring of Chronic Myelogenous Leukemia (CML) and few, though rare Acute Lymphoblastic Leukemia (ALL). Both these cancers affect the mature blood cells and their precursors in the bone marrow; Chronic Myelogenous Leukemia and certain types of acute lymphoblastic leukemia are caused by the product of abnormal BCR-ABL gene fusions.

We perform over 60 per cent BCR/ABL testings and 70 per cent MRDs testings across India. The reason is Oncquest has a highly skilled team of doctors and scientists, trained in most advanced technology-driven platforms and geared up to deliver with globally accepted quality norms. Team Oncquest is well integrated with clinicians and patients to provide final and correct

diagnosis which can help the clinicians in designing personalised and target based therapy, early diagnosis and its recurrence. Today, Oncquest is well known for providing final opinion for complex medical cases.

What are the latest cuttingedge technologies adopted by Oncquest laboratories?

Oncquest offers one of the largest test portfolios especially molecular oncology, in exploratory and end-point biomarkers, genomic services and surgical pathology. Its specialised services cover over 1500 advanced technology based assays spl based on Next Generation sequencing, Rt_PCR & Multiplex PCR, Digital droplet PCR , ten colored Flowcytometry , Immuno Histochemistry ,Advanced Bone marrow assays, infertility assays ,automated microbiology & ELISA’s ,immunology etc., comprising screening, early and final diagnosis, monitoring and prognosis.

Oncquest is a preferred partner of global pharma companies and CROs (Contract Research Organizations) for clinical trials (Phase I – Phase IV). The lab also provides Patient Support Programme, clinical trials, and validation study on patients to bring down the cost of diagnosis and treatment along with prominent epidemic study.

Acknowledging the pathology space, the centre offers almost entire spectrum of biochemistry, immunology, hematology, clinical pathology and microbiology helping in clinical diagnosis, prevention, prediction, early diagnosis, monitoring and much more. Today, it has a state-of-the-art Molecular and Clinical Diagnostics Referral Laboratory, with a national footprint of over 36 laboratories, 250 collection centers and 1400+ service associates across India and South East Asia.

Oncquest Laboratories has launched many new advanced assays and technology-driven platforms for the first time in India. With rapid advancement

and availability of new technology, many more new assays are now being offered including the NGS-based assays for better and focused tumor profiling, liquid biopsy for very early diagnosis of cancers, and Minimal Residual Disease (MRD) in leukemia.

The recently launched tests include final diagnosis of cancer on tissue, FISH-based assays, Bone marrows for Myeloma and blood cancer – leukemia, and cytogenetic testing for haemat malignancies. . The centre is continuously improving its TAT (Turn Around Time) and technical platform with an aim to transform the healthcare space.

These advanced assays have helped researchers, clinicians and patients to understand molecular basis of cancer and plan more specific and successful target based therapies.

What is your opinion on the Ayushman Bharat programme, which offers free diagnostics facilities?

Ayushman Bharat is a good initiative by the central government, it’s success depends on the implementation of it at the town level, we are sure the policy makers must have thought about it. The new programme will help in the improvement of the healthcare infrastructure in both the urban as well as rural areas.

Diagnostic services should be made accessible to all whereas the investments should be made on health IT systems.

Patient-care, as well as the affordability of good healthcare services, is a challenge for the government today. To deal with this, the focus can be laid on the PPP to speed up the strategic planning towards upgrading healthcare facilities and implementation process at a larger scale.

What are the main challenges in the diagnostic industry ?

The challenge the industry faces are the neighbourhood diagnostic labs, which have opened like barber shops.

There are no regulations or set of guidelines to open a lab. I would not say all

neighbourhood labs are bad certain pathologists owned labs do good work, but there are a lot of labs which are owned by technicians which do not have any adherence to quality. They use Korean and Chinese made test kits which are of cheap quality and offer tests at low cost. For the last three years the diagnostics industry is not able to increase the MRPs and the structured labs suffer. Public should understand that structured labs are giving accurate results and they adhere to strict quality mechanisms.Due to such low cost neighborhood diagnostics in the last three years structured labs have not increased their MRPs. Only about 25 per cent of the diagnostics industry is captured by structured diagnostic labs, which does a business of about Rs 4000 to 5000 crores rest is with the unstructured neighbourhood labs, which also includes hospitals which have their own integral labs but we don't have a data on hospital labs. I hope the neighbourhood labs can be phased out gradually if the policy makers strictly implement the Clinical Establishment Act. How cost effective are your tests and how do you balance quality and affordable price?

Oncquest is a preferred partner of global pharma companies and CROs (Contract Research Organizations) for clinical trials (Phase I – Phase IV). The lab also provides Patient Support Programme, clinical trials, and validation study on patients to bring down the cost of diagnosis and treatment along with prominent epidemic study. We develop the test in-house which are present in the international market so this helps us in cutting the cost of the testing.

For example for a EGFR ( epidermal growth factor receptor ) testing of lung cancer will cost almost ` 20 to ` 18,000 in US but we offer it for ` 6000 in India, it is fully validated. People trust us and most of them approach us for the end diagnosis, as our tests are accurate.

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TRADE AND TRENDS

BPL Medical Technologies: Pioneer in medical ventilators A

conceptual revolution in mechanical ventilator’s over the past decade has made us understand the optimal approach to ventilate patients with acute respiratory failure.

A mechanical ventilator is a machine that provides temporary ventilatory support or respiratory assistance to patients who cannot breathe on their own because of illness, trauma, congenital defects, or drugs (e.g., anaesthetics). Depending on the

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patient’s condition, a ventilator can either partly support a patient’s breathing or breathe entirely for the patient. Ventilation can be administered invasively or noninvasively.

A medical ventilator helps to raise the oxygen level in patients until they can breathe on their own. It is a lifesaving equipment which allows the patient to be in a stable state while medication and treatment is administered. Ventilators consist of a

control system, a monitor and is also equipped with a wide range ventilation modes and safety alarm features.

The gas comprising of blended air and oxygen is delivered using a double-limb breathing circuit. Most ventilators are microprocessor controlled and regulate the pressure, volume, and FiO2.

Ventilator’s are classified based on their usage, transport ventilators, these ventilators are small, specifically designed for ambulance

transportation purpose. intensive-care ventilators, ventilators which provide greater control for a wide variety of ventilation parameters. neonatal ventilators, designed with the preterm neonate in mind, more precise volumes and pressures required to ventilate neonates or infants. Positive airway pressure ventilators (PAP) ventilators specifically designed for non-invasive ventilation for use at home and in chronic conditions.

Among the technology available, Ventilation Integrated Tomography (VIT) is the world’s first fully integrated EIT system in ICU ventilators. The non-invasive pulmonary monitoring of the Elisa 800VIT visualises the first-time ventilation-related complications and allows for direct therapy at the intensive care unit. The introduction of this innovative technology marks a new chapter in intensive care ventilation

DR 600: High-productivity,fully automated direct radiography system with ZeroForce Technology from Agfa HealthCare WHEN DID smartphones change from ‘gadgets’ to ‘necessities’? Over the past decade, innovation has been fast and furious, changing even basic necessities about how we live. What’s next?

Self-driving cars, 3D printers, wearable technology and so much more all are living the realm of spy movies and science fiction, and pushing for a space in our very homes.

In healthcare, too, innovations are making a difference.

But they can’t simply reflect technological evolutions; they have to answer real needs. Like the DR 600 ceiling suspended X-ray room, with its ZeroForce and EasyStitch technologies – innovations that make complex imaging problems simple.

ZeroForce Technology, makes all movements of the tube head, wall stand and table in all

different directions, quick and require almost zero effort. Easier operability means a faster workflow and increased staff comfort. Overall, your imaging workflow is smoother and more efficient. Auto-positioning technology, fully-automated tracking and manual positioning option makes this unit indispensable for your emergency rooms. Controlling and re-

ducing patient radiation exposure during imaging is a priority.

Offering a choice of fixed, tethered and wireless detectors with Cesium Iodide (CsI) or Gadolinium Oxy-Sulphide (GOS) technology, ably supported by leading-edge ‘Automatic Exposure Control’ using high-speed accuracy and collimators with ‘Dose Area Product meter’, the DR 600 optimizes and automatically

reports x-ray doses. ‘Automatic EasyStitch technology’ makes your Full Leg/Full Spine (FLFS) imaging both simpler and more precise. Based on fully automated single focus technology, it minimizes distortions for highprecision FLFS imaging.

Innovative tube head design features a touch screen control panel with image preview, as well as an integrated soft console

on the MUSICATM viewing station. The MUSICATM workflow provides quick previews that reduce time between exposures. We’ve incorporated these new technologies right into our high-productivity DR 600, which offers comfort and speed with precision! This multi-detector, high-throughput DR will streamline your imaging workflow, increase your throughput and enhance the experience of your patients. In fact, everything about the DR 600 takes the newest technologies – robotization, automation and integration – and puts them to practical use of helping you enhance your imaging and delivery of patient care! Agfa HealthCare firmly believes that “The diagnosis is in the details “. After all, what is the point of innovation, if it doesn’t improve our lives?

DR can tip that balance in the right direction,with high quality images and a faster workflow Where does DR fit?

Everywhere.

Performance, mobility, budget, versatility and space.

How can you balance these real challenges with the ongoing demands of patient care quality? DR can tip that balance in the right direction, with higher quality images, a faster workflow, potential dose reduction, chemical-less environment – to name just a few of the advantages.

All these benefits aren’t just for general radiography.

We continue to expand our comprehensive portfolio of DR solutions, to ensure the right fit for you. We can help you take Direct Digital imaging wherever you want – from radiology, to the ICU, to the patient’s bedside – with mobile DR.

DR 100e: Powerful imaging on the move Not all patients who need imaging exams have the mobility to move to the X-ray room or to position themselves

properly for optimum imaging. With the compact, wheeled DR 100e, every hospital, whatever its budget, can take imaging to the patient – instead of other way

around!

DR 100e a mobile X-ray unit, with its powerful generator power and ?exible handling, offers clinics and hospitals a cost-effective, high

quality X-ray solution that maximizes patient comfort and performance. DR 100e comes with a choice of a ?xed or rotating column, offering maximum handling ?exibility.

Convenient handling capabilities reduce patient waiting times and increase diagnostic con?dence.

DR 100e offers you a path to direct radiography (DR), at your own pace by combining it with the Agfa HealthCare’s DR detectors or CR solutions already installed.

This compact unit can be easily navigated through narrow corridors and in small spaces, making it ideal for the ICU or bedside imaging. Finally, you have a solution that help you address your radiology department’s goal to continuously enhance patient care.

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Hindustan Syringes & Medical Devices wins 2018 Good Design Award in Japan Hindustan Syringes & Medical Devices (HMD), one of the largest manufacturers of disposable syringes in the world and the largest for auto disable syringes has been awarded the ‘2018 Good Design Award’ for HMD’s Safety IV Cannula - Cathy Sipclip earning recognition in the category of Medical Care Products at the Good Design Award 2018 hosted by the Japan Institute of Design Promotion in Japan.

Japanese Good Design Award 2018 is an additional feather in the cap to the MDSAP (Medical Device Single Audit Plan) quality assurance certification from UL (Underwriters Laboratories, USA) and ICMED (Indian Certification for Medical Devices) certification HMD received from QCI (Quality Council of India).

ICMED Certification process allowed us to build competencies and confidence needed to strive for MDSAP and winning the Indian Design Award from DIPP helped us in winning the prestigious Japanese Good Design (G-Mark) Award, explained Rajiv Nath, Jt Managing Director of Hindustan Syringes & Medical Devices.

HMD’s Safety IV Cannula - Cathy SiPClip, the most revolutionary technology and patented design greatly minimises the chances of accidental needle stick injury among health workers and nursing staff when they attach IV Catheter and remove the blood infected needle from a patient which results in numerous unfortunate infections and even deaths, particularly in developing countries like India.

The auto protection technology of Safety I V Cannula Cathy SipClip is designed to provide Involuntary Activated Safety due to the presence of a protection device SipClip which encapsulates the tip of

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Takashi Kobayashi from Kobayashi, Japan HMD representative collecting the award on behalf of HMD

the used needle, when the introducer needle is extracted from the Catheter.

In India, around 40 million people are infected with hepatitis B and at least six million people with hepatitis C. About 1,84,000 people die each year of hepatitis B- and C-related complications – two times the estimated annual number of HIV and malaria deaths together.

Nath, a strong advocate for preventive measure of blood borne infections like needle stick injury by SIP (Sharps In-

jury Prevention) and of injection safety is seeking a National Swach Injection Abhiyan. He has urged the government to accelerate a switch to ‘Auto Disable Syringes’ to limit HIV and Hepatitis Epidemic. There are villages with over half the population infected with Hepatitis or HIV due to reuse of syringes by quacks. In order to prevent reuse of syringes and contain the spread of infection, it is advisable and recommended to use AD syringes specifically designed to pre-

vent reuse. This reuse prevention has been strongly advocated by WHO. Similarly the next risk is accidental injury from a needle stick and unsafe blood exposure.

Government of Andhra Pradesh has already taken a lead in this regard and has declared the state of Andhra Pradesh as Safety Injection Use State.

“HMD will continue pursuing excellence in user friendly intuitive innovative design and contribute towards our ongoing commitment of aiding ac-

cess to affordable and safe healthcare for common people in India and other developing countries,” added Nath.

The Good Design Award was founded in 1957 as the Good Design Product Selection System (or G Mark System), by the Ministry of International Trade and Industry (the current Ministry of Economy, Trade and Industry). It is the only system in Japan to comprehensively evaluate and recommend design and the GMark carries substantial international prestige.

TRADE AND TRENDS

Carestream spotlights newest healthcare IT,medical imaging technology at world’s largest radiology conference Specialised software enhances review process for radiology reports to help improve patient care CARESTREAM HEALTH demonstrated its expanding portfolio of sophisticated medical imaging and healthcare IT systems designed to enhance the diagnostic review of X-ray exams and expedite delivery of results to physicians and their patients at the annual Radiological Society of North America conference.

Radiology service providers want to tap into the expertise of subspecialists at multiple locations, as well as optimise the quality and speed of clinical reporting.

Carestream’s Clinical Col-

laboration Platform addresses these needs with Workflow Orchestrator software that supports advanced reading workflow and improves the review process by: simultaneously prioritising urgent medical imaging exams; routing complex cases to subspecialists or radiologists affiliated with the site where the study was performed; and logically distributing the case load among all available radiologists.

One of the largest private radiology groups in the United States has chosen Workflow Orchestrator to manage its

multi-site radiology interpretation workflow. Based on early results, the group’s radiologists expect this versatile platform to produce long-term operational and quality improvements as well as more responsive client service, optimised case assignment and a significant return on investment.

Carestream representatives also showcased the unique benefits of the CARESTREAM OnSight 3D Extremity System that equips hospitals, orthopaedic practices and other imaging services

providers with high-resolution 3D images that offer advanced anatomical detail to help orthopaedic specialists make more accurate diagnostic and treatment decisions.

The OnSight system captures high-quality, weightbearing imaging studies for patients with a wide range of injuries and conditions of the knee, foot, ankle and other extremities.

Unlike traditional CT technology, Carestream’s system has a large detector that easily captures a 3D image of the extremity in a single rotation. A

patient simply places the injured extremity into a donutshaped bore in the system.

Since the patient’s head and body are not confined, patients do not experience the claustrophobia that often occurs with CT systems.

Carestream focuses on delivering innovation that is life-changing—for patients, customers, employees, communities and other stakeholders—while enhancing operations for a broad range of healthcare facilities and helping medical professionals provide quality care.

DiaSys innovation in hematology - introducing gen-next analysers Respons hematology systems are state-of-the-art instruments with an elegant design and smallest footprint DIASYS DIAGNOSTICS India, a subsidiary of DiaSys Germany, ventured into the Indian diagnostic market in the year 2014 by introducing a variety of new and innovative tests and analysers.

With the introduction of respons hematology systems christened as respons 3H and respons 5H – innovative 3part and 5 part differential hematology analysers, DiaSys announces its foray in the field of hematology complementing its vast portfolio in biochemistry, urine analysis, and point-of-care.

With a footprint of an A4 size paper and weighing < 9.5 kgs, these are the new gennext instruments in the field of hematology analysers currently present in the Indian IVD market.

Cutting-edge technology Respons hematology analysers are equipped with many exiting features.

Shear Rotary Valve: respons hematology analysers are one of the very few analysers that use a shear rotary valve (SRV) for sample aspiration. For respons 5H, the sample volume aspirated is 25

μL and processed volume is just 2 x 1 μL. Just one drop of blood required!

Microfluidics: respons hematology analysers utilise microfluidics in a miniaturized module resulting in very

low sample volume and thus very low reagent consumption. 70 per cent less reagent consumption than other analysers. Economical operations!

Teflon tubing’s: Unlike majority of the analysers, respons hematology analysers utilises 100 per cent teflon tubing resulting in very less wear and tear and thus low maintenance.

Elegant design with user friendly software: Very simple and self-instructive software, which helps user navigate easily through the software.

DiaSys connect: DiaSys connect tool gives the engineers an opportunity to connect with the analysers greatly reducing its down time.

Printer server tool: This tool helps connect the analyser to any printer through a personal computer.

Auto loader: Retrofit module having interchangeable,

non-moving tray with up to 50 sample vials including a builtin barcode reader & mixer. A complete walk away system.

Respons hematology systems are state-of-the-art instruments with an elegant design and smallest footprint.

Respons 5H has a measuring principle of laser based flow cytometry and volumetric impedance method along with microfluidics, reporting 26 parameters with two histograms and one scattergram.

Respons hematology analysers utilise only three reagents in the smallest of quantities.

With respons hematology, we also contribute to the “go green initiative” with use of low volume cyanide free reagents, thus generating very less waste, low power consumption and no paper printing.

Harshad Bhanushali Product manager

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Understanding NABH and how Medikabazaar can help hospitals achieve its standards INDIA’S PRESENT population stands at 1.3 billion. By the sheer capacity of that number, one can imagine the pressure faced by the country’s hospitals regarding catering to thousands of patients on a daily basis. According to reports, the waiting time for patients to be admitted in a general bed for medical procedures is one year. World Health Statistics convey that India is one of the lowest ranked nations in the number of hospital beds per 1000 population with 0.9. With a change in lifestyle, India sees a rise in deaths caused by non-communicable diseases. A WHO report said that non-communicable diseases, such as cancer cause 61% of deaths in India. Nowadays, diseases are more complex which requires intricate diagnostic and medical procedures.

Due to the above, it is all the more important for medical establishments to uphold and maintain certain healthcare standards and guidelines aimed at providing quality medical care. More so, medical establishments need to achieve the same cost-effectively especially considering the low reimbursement rates of Ayushman Bharat, GIPSA, etc.

The National Accreditation Board for Hospitals & Healthcare Providers (NABH) is one such institution which provides healthcare facilities in India, a set of carefully formulated standards made to assure that hospitals operate under standard protocols for cost-effective monitoring of resources and timely intervention. NABH standards cover almost all the crucial aspects of medical establishments. The guidelines range from how hospitals should uphold patient rights to effective management of facilities to ensure safety for both staff and patients. Though NABH standards are not mandatory, its significance has been the subject of a huge discussion as the government has made it compulsory to have at least, entry-level NABH standards, to allow cashless insurance facilities to patients, including incentive-based payments to hospitals for a

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volume-driven Ayushman Bharat scheme. A November 2017 news report by The Pioneer stated that only 1% of Indian hospitals had taken sufficient measures for NABH accreditation. The report added that although NABH was in place for more than 10 years, only about 1000 medical establishments (both in public and private sectors) were in the process of working towards NABH standards.

Why are the numbers so low?

One of the primary reasons is that there is a lack of understanding and awareness about the standards. Even if the hospital management team know about NABH standards, lack of indepth knowledge in terms of interpretation of each objective element, its application in various scenarios and type of medical establishment and even its understanding at basic conceptual level adds to the woes of percolating it

Dr Akash Rajpal, Executive Vice President, Marketing and Product Management, and a former NABH assessor

on their Total Cost of Operations (TCO) but also purchase quality supplies, unsurpassed negotiations and provide quality patient care. As mentioned above, patient care takes center stage for the NABH, Medikabazaar through their technology-based supply chain solutions can help

out on innovative equipment which may improve care, and a lack of all these can hurt patient care and also lead to significant revenue loss.

Hospitals have an established and conventional procedure to procure their medical supplies.

The purchase manager searches and reviews potential vendors.

This depends on a lot of factors such as the location of the vendor, certifications and their goodwill in the market. After the vendor is selected, hospitals contact them to inquire about their required supplies, negotiate prices, and then procure them. Such an offline procurement process can be complicated and costly. Typically, vendors approach hospitals themselves. In such cases, at times purchase managers don’t review the vendors thoroughly and select any manufacturer who contacts them. This again results in the problems mentioned above.

One of the primary reasons is that there is a lack of understanding and awareness about the standards.

Even if the hospital management team know about NABH standards,lack of in-depth knowledge in terms of interpretation of each objective element, its application in various scenarios and type of medical establishment and even its understanding at basic conceptual level adds to the woes of percolating it down to the last housekeeping staff essential for appropriate patient care. Not everyone can hire an expensive NABH consultant. down to the last housekeeping staff essential for appropriate patient care. Not everyone can hire an expensive NABH consultant.

How can MedikaBazaar help in achieving NABH standards?

Procurement is essential to the success of an organization and achieving NABH accreditation as without timely and right inventory in place; patient care cannot be effectively achieved. Organisations like Medikabazaar are trying to enable hospitals to achieve operational efficiency by helping them to adopt an online procurement system, harness the shifting culture of offline to online search for knowledge seeking behavior for nurses, doctors, and purchase managers before purchasing any items for the hospitals. With its Artifical Intelligence and Machine Learning softwares, Medikabazaar helps its partner hospitals in not only incurring savings

hospitals achieve certain NABH standards. Let’s go through some of these standards.

Management of Medication (MOM) Standard 13: Documented policies and procedures guide the use of medical supplies ◗ Objective Element A: There is a defined process for acquisition of medical supplies and consumables NABH’s interpretation of the above explains as to how hospitals should review and select their vendors for medical supplies.

Vendor selection is a vital part of operations as supplies procurement constitutes about 1/3rd of their OPEX (the second largest expenditure after staff salaries).

Therefore, if hospitals select the wrong vendors, they might procure above benchmark rates, mediocre supplies & even miss

Ideally, the objective of medical establishments should be to make the procurement process qualitative, cost-effective which can allow them to save on their Total Cost of Operations (TCO) and indirectly result in affordable medical bills for the patients.

It can be clearly understood that to fulfill just one NABH standard, hospitals have to endure a complex and rather time-consuming process, especially if they have to maintain quality patient care and curb revenue loss. Such procurement processes require a lot of time, space, and human resource. Healthcare centers can eliminate all of the above-mentioned procurement issues if they adopt an online system as serviced by organizations such as Medikabazaar who are India’s largest online B2B platform for medical supplies. With services such as product comparison,

quality check of supplies, Medikabazaar enables hospitals to make informed purchase decisions and save up to 30% in their OPEX.

Access Assessment and Continuity of Care (AAC) Standard 1: The organisation defines and displays the healthcare services it provides ◗ Objective Element B: Each defined service should have appropriate diagnostic and treatment facilities with suitably qualified personnel who provide out-patient, in-patient and emergency cover Before establishing any medical establishment, an extensive market research should be conducted which can help the owners of the facility, understand what category of establishment is needed. Such studies can also help the owners understand the type of facility required based on the needs of the people in the region. For example, if research shows that the majority of people in a particular area have cardiac diseases, then a doctor planning to open a medical facility can choose to establish a center dedicated to heart diseases. When this is decided, the doctor will need the relevant equipment for the same. This is where Medikabazaar can help the facility by supplying them with the appropriate equipment and consumables required to establish the medical center.

NABH standards are quite exhaustive as they aim to make hospitals patient-friendly and protocol driven. Therefore, at times, these standards can seem quite intimidating for medical establishments to follow. Hence, Medikabazaar is making an earnest attempt to elaborate and describe NABH standards in a way which can be easily understood by purchase managers and hospitals. This will, in turn, help them to implement processes as per NABH standards.

Medikabazaar welcomes any queries related to NABH.

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