Express Healthcare (Vol. 16, No. 11) December 2023 by Indian Express

VOL.16 NO 11 PAGES 44

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INTERVIEWS Trishneet Arora CEO and founder, TAC Security

PUBLIC HEALTH Challenges in the existing public health system

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CONTENTS PUBLIC HEALTH Chairman of the Board Viveck Goenka Sr. Vice President-BPD Neil Viegas Vice President-BPD Harit Mohanty

Pg 14

Editor Viveka Roychowdhury* Editorial Team

Lakshmipriya Nair Kalyani Sharma

CHALLENGES IN THE EXISTING PUBLIC HEALTH SYSTEM

DESIGN Art Director

HEALTHCARE IT

Pravin Temble

RADIOLOGY

EDUCATION

DIAGNOSTIC

Senior Designer Rekha Bisht Senior Artist Rakesh Sharma Marketing Team Rajesh Bhatkal Ashish Rampure Debnarayan Dutta Production Co-ordinator Dhananjay Nidre

Scheduling & Coordination Pushkar Waralikar

P12: INTERVIEW

P20: INTERVIEW

CIRCULATION

TRISHNEET ARORA CEO and founder, TAC Security

DR BHARAT AGGARWAL Director of Radiology Services at Max Healthcare

Mohan Varadkar

THE SKILL GAP IN INDIA’S NURSING SECTOR

DRIVING INNOVATION: PARTNERSHIPS BETWEEN DIAGNOSTIC LABS AND MEDTECH COMPANIES

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2022 - 24. 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 Mafatlal Centre, 7th floor, Ramnath Goenka Marg, Nariman Point, Mumbai 400021. Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Mafatlal Centre, 7th floor, Ramnath Goenka Marg, 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

COPping out, for the greater good?

he run up to the ongoing Conference of the Parties (COP28) negotiations on climate change in Dubai saw quite a few reports linking climate change to health. For instance, the 8th annual Lancet Countdown on Health and Climate Change report, released on November 15, threw light on the convergence of factors fueling the climate crisis. The report underlines how these factors jeopardise the well-being of individuals, public health, and healthcare systems on a global scale and hence calls for reduction in the use of fossil fuels. The authors point out that as the healthcare sector accounts for an estimated 4.6 per cent of global greenhouse gas (GHG) emissions, it needs to transition to sustainable energy sources and adopt greener practices. Similarly, a Call for Action released by United Nations (UN) agencies before COP28, pointed out that the effects of climate events on maternal and child health have been neglected, underreported and underestimated. Doctors and health care professionals had a ringside view as the climate crisis morphed into a health crisis. Extreme climate related catastrophes like floods and droughts lead to water borne infections and malnutrition in the short term. In the long term, disruptions in health systems mean a further slide in health indicators and a strain on resources. The COVID pandemic and other zoonotic diseases breakouts are clearly linked to shrinking habitats. Increasing incidence of severe COPD, asthma and other pollution related illnesses are other clues to the climate-health nexus. Against this backdrop,COP28 is being billed as a milestone, as it puts health at the centre of climate action. The first ever Health Day and linked activities continue to join the dots between climate change and health catastrophes. Despite these pressing arguments, India’s Health Ministry delegation reportedly did not participate in the Health Day activities. And India chose not to sign the COP28 Health and Climate Declaration, as the draft reportedly included a commitment to reduce GHG emissions from cooling applications within healthcare infrastructure. Officials were concerned that these commitments would not be feasible for most healthcare facilities in India. Thus, given the choice between strengthening and expanding health systems versus diverting resources to GHG reduction efforts, India chose the former. Quite a lot of research has already been done on reducing the carbon footprint of hospitals. For instance, a research paper published in April 2023 in the Journal of the Royal Society of Medicine, analysed the carbon footprint of products used in five common surgical operations, and identified contributing products and processes. The results showed that the mean average carbon footprint of products used for carpal tunnel decompression was 12.0 kg CO2e (carbon dioxide equivalents); 11.7 kg CO2e for inguinal hernia repair; 85.5 kg CO2e for knee arthroplasty; 20.3 kg CO2e for laparoscopic cholecystectomy; and 7.5 kg CO2e for tonsillectomy. Across the five operations, 23 per cent of product types were responsible for ≥80 per cent of the operation carbon footprint. Products with greatest carbon contribution for each operation type were the single-use hand drape (carpal tunnel

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Given the choice between strengthening and expanding health systems versus diverting resources to GHG reduction efforts, India chose the former

decompression), single-use surgical gown (inguinal hernia repair), bone cement mix (knee arthroplasty), single-use clip applier (laparoscopic cholecystectomy) and single-use table drape (tonsillectomy). Mean average contribution from production of single-use items was the highest at 54 per cent, followed by decontamination of reusables (20 per cent), waste disposal of single-use items (8 per cent), while both production of packaging for single-use items and linen laundering accounted for 6 per cent each. The authors concluded that change in practice and policy should be targeted towards those products making greatest contribution, and should include reducing single-use items and switching to reusables, alongside optimising processes for decontamination and waste disposal, modelled to reduce carbon footprint of these operations by 23 per cent – 42 per cent. At the macro level, healthcare facilities could literally be washed away by climate change related catastrophes. The XDI Global Hospital Infrastructure Physical Climate Risk Report unveiled at COP28 cautions that failure to phase out fossil fuels by 2100 could put 1 in 12 global hospitals at high risk of shutdown due to extreme weather events. An analysis of 2 lakh hospitals worldwide, (including 53,473 in India), assessing climate change hazards from 1990 to the end of the century, showed that in India, currently, 2700 hospitals are at high risk. Without a fossil fuel phase-out, the XDI report cautions that this will increase to 5120 hospitals (9.6 per cent) projected to relocate or close by 2100, due to riverine flooding, surface water flooding and coastal inundation. The good news is that hospitals have guidelines to start them on the sustainability path. In February 2023, India’s National Programme on Climate Change and Human Health (NPCCHH), National Centre for Disease Control, released Guidelines for Green and Climate Resilient Healthcare Facilities. The green measures to be implemented at health care facilities may seem very basic (energy audits, installation of LED lighting, installation of solar panels, and water conservation measures, mainly rain water harvesting) but the signalling is crucial. As per the NPCCHH guideline document, 65 per cent of energy consumption in a healthcare facility is due to lighting, water heating, cooling, and ventilation. The bad news is the upfront costs of going green are considerable. The NPCCHH norms apply to public healthcare facilities, which can access some funding under the National Health Mission’s Programme Implementation Planning (PIP) process. Given the PE and VC backed consolidation in India’s private healthcare sector, many corporate hospitals do have the funding to go beyond these norms and adopt higher sustainability targets. Will India’s healthcare sector take the cue from COP28 and renew its commitment to going green?

VIVEKA ROYCHOWDHURY, Editor viveka.r@expressindia.com viveka.roy3@gmail.com

HEALTHCARE IT I N T E R V I E W

Continuous monitoring plays a pivotal role in fortifying cybersecurity within the healthcare sector Trishneet Arora, CEO and founder, TAC Security in an interaction with Kalyani Sharma talks about the critical cybersecurity measures for healthcare sector In light of the recent data breach involving ICMR, what, in your opinion, are the most critical cybersecurity measures that healthcare organisations should prioritise? In light of the recent data breaches like the one at ICMR, healthcare organisations need to prioritise several key cybersecurity measures. These include: ◆ Encrypting sensitive patient data to prevent unauthorised access ◆ Implementing stringent access controls to limit data accessibility to authorised personnel only ◆ Conducting frequent security audits and vulnerability assessments to identify and address potential risks ◆ Providing comprehensive cybersecurity training to staff to recognise and respond to potential threats ◆ Establishing a well-defined incident response plan to address security breaches promptly These measures can significantly enhance healthcare organisations' cybersecurity posture and mitigate the risks associated with potential data breaches. Could you elaborate on the role of cybersecurity experts specialising in enterprise security and how organisations can effectively engage with them? Cybersecurity experts specialising in enterprise security play a crucial role in safeguarding organisations from sophisticated threats. These professionals design, implement, and monitor robust security measures

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enterprise security to benefit from their specialised knowledge and experience.

Data backup and recovery measures significantly mitigate the risk of data breaches in the healthcare sector by ensuring the availability and integrity of critical information tailored to an organisation's infrastructure. Organisations should clearly articulate their security needs and objectives to the experts to ensure alignment with their specific requirements. Fostering collaboration between cybersecurity experts and internal teams to understand the organisation's infrastructure, risk appetite,

and business objectives is important. Also, regularly assess and review the security posture to adapt to evolving threats and technologies, ensuring that cybersecurity measures remain effective and up-to-date. And finally, invest in hiring or partnering with skilled cybersecurity professionals or firms with a proven track record in

How do data backup and recovery measures contribute to minimising the risk of data breaches, especially in the healthcare sector? What best practices should healthcare organisations follow as far data backup and recovery is concerned? Data backup and recovery measures significantly mitigate the risk of data breaches in the healthcare sector by ensuring the availability and integrity of critical information. Best practices for healthcare organisations in this regard include: ◆ Perform regular backups of sensitive patient data to secure locations, both onsite and offsite, ensuring redundancy and quick recovery in case of a breach ◆ Encrypt all backed-up data to protect it from unauthorised access, enhancing security even in the event of a breach ◆ Regularly test the backup systems and validate the recovery process to ensure data integrity and the ability to restore information swiftly ◆ Implement strict access controls to limit and monitor who can retrieve or modify backed-up data, preventing unauthorised changes or leaks ◆ Adhere to industry regulations and standards (like HIPAA in the United States) concerning data backup, retention, and recovery to ensure compliance and data safety Can you provide insights into the specific regulations

relevant to the healthcare sector, and how organisations can ensure compliance? How does maintaining regulatory compliance contribute to overall cybersecurity in the healthcare industry? Regulatory compliance, particularly in the healthcare sector, is paramount for safeguarding sensitive patient information. Specific regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States or the General Data Protection Regulation (GDPR) in Europe, impose stringent guidelines for data protection. To ensure compliance, healthcare organisations must: ◆ Encrypt patient data during transmission and storage to meet security requirements ◆ Implement robust access controls to limit unauthorised access to patient information ◆ Conduct routine audits and risk assessments to identify and address vulnerabilities promptly Compliance not only establishes legal adherence but also fortifies cybersecurity by promoting a culture of data protection, risk mitigation, and fostering trust among patients by assuring the confidentiality and integrity of their information. How does continuous monitoring contribute to the early detection and prevention of cyber threats in the healthcare sector? Continuous monitoring plays a pivotal role in fortifying cybersecurity within the healthcare sector. It involves real-time surveillance and

analysis of network activities, allowing for prompt identification of any irregularities or potential threats. Continuous monitoring enables immediate identification of suspicious activities or anomalies within the network, allowing for proactive threat mitigation. Timely detection leads to faster incident response, reducing the potential damage caused by cyber threats. Also, by maintaining constant vigilance, healthcare organisations can maintain an updated and resilient security posture, adapting to evolving threats efficiently. In the healthcare sector, where data confidentiality is critical,

continuous monitoring ensures rapid response to potential threats, minimises the impact of cyber incidents, and safeguards sensitive patient information. What are some of the major challenges that healthcare organisations face in ensuring the security of digital assets and patient data? Healthcare organisations encounter several challenges in safeguarding digital assets and patient data. Some major hurdles include: ◆ Data volume and diversity: Managing vast amounts of sensitive patient data across various systems and platforms poses a significant

challenge ◆ Evolving threat landscape: The constantly evolving cyber threat landscape demands continuous adaptation to new and sophisticated attack vectors ◆ Resource constraints: Limited budgets and resources often hinder the implementation of robust cybersecurity measures ◆ Complex regulatory compliance: Healthcare entities must comply with stringent regulations, which can be complex and challenging to navigate while maintaining security Addressing these challenges necessitates a holistic approach, combining advanced technologies, staff

training, regular assessments, and a proactive cybersecurity strategy to protect patient data effectively. What are some emerging trends or technologies that healthcare organisations should be aware of to enhance their cybersecurity preparedness? Healthcare organisations should focus on emerging trends and technologies such as: ◆ Implementing a zero trust model to verify each user's identity and device before granting access to sensitive data or systems ◆ Utilising AI and machine learning for anomaly detection, predictive

analytics, and threat intelligence to identify and respond to potential threats proactively ◆ Exploring the use of blockchain for secure patient data management, enabling immutable records and enhanced data integrity ◆ Strengthening cloud security through encryption, access controls, and continuous monitoring, considering the increased use of cloud-based services in healthcare Adopting these innovations can significantly bolster cybersecurity preparedness in the healthcare sector. Kalyani.sharma@expressindia.com journokalyani@gmail.com

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14 EXPRESS HEALTHCARE December 2023

Ultrasound is playing a key role in enhancing patient care and shaping the radiology landscape in the country By Kalyani Sharma

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ltrasound is playing a pivotal role in revolutionising diagnostic imaging, elevating the standard of patient care, and molding the radiological landscape in the country. Its non-invasive nature, realtime imaging capabilities, and versatility have made it a preferred choice for various medical conditions. The increasing availability and affordability of ultrasound technology have played a pivotal role in its widespread adoption, contributing significantly to the growth of radiology services throughout the country. Dr Arvind Gupta Medical Director, Primus Super Speciality Hospital shares, “ultrasound technology has undergone significant evolution in the Indian healthcare system over the years. Initially introduced for obstetric and gynecological purposes, ultrasound quickly expanded to various medical fields. The technology became more widely accessible, leading to increased usage in diagnostics across specialties such as cardiology, radiology, and gastroenterology. The evolution involved the incorporation of advanced imaging modalities, improved resolution, and enhanced portability, making ultrasound a versatile and indispensable tool in healthcare settings.” Stressing on the growing market of ultrasound, Dr Saurav Bhagat, Radiologist, Prayag Hospitals Group said, “The India ultrasound devices market is expected to experience substantial growth, with a projected increase from USD 231.86 million in 2023 to USD 316.18 million by 2028, representing a CAGR of 6.40 per cent. The COVID-19 pandemic has played a role in driving this growth, with increased use of ultrasound for diagnosing and monitoring COVID-19 cases. The rising burden of chronic diseases, particularly tuberculosis, contributes to the growing demand for effective ultrasound diagnosis. Major market players are actively introducing new and advanced ultrasound equipment, further propelling the industry's expansion.”

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Ultrasound technology has undergone significant evolution in the Indian healthcare system over the years. Initially introduced for obstetric and gynecological purposes, ultrasound quickly expanded to various medical fields Dr Arvind Gupta Medical Director, Primus Super Speciality Hospital

The India ultrasound devices market is expected to experience substantial growth, with a projected increase from USD 231.86 million in 2023 to USD 316.18 million by 2028, representing a CAGR of 6.40 per cent Dr Saurav Bhagat Radiologist, Prayag Hospitals Group

In one generation itself we progressed from 2D to 3D and even 4D being quite commonly available. Few of the new machines are able to resolve thinnest of nerve fibers, muscles, tendons & smallest of blood vessels Dr Janardhan Reddy Consultant-Radiology, SRV Hospitals

Shift towards cloud-based systems has further propelled the evolution, providing healthcare facilities with enhanced process efficiency, financial predictability, and long-term cost savings Dr Anita Aggarwal Director & Chief of Radiology, Indian Spinal Injuries Centre, New Delhi

“The portable ultrasounds segment is anticipated to hold a significant share over the forecast period, driven by factors such as advanced technology, a growing geriatric population, and increased awareness. Additionally, the 2D ultrasound devices market is expected to grow due to factors such as increased cancer prevalence, technological advancements, and a rising birth rate. Overall, these trends underscore the pivotal role ultrasound is playing in shaping the future of radiology in India, with a focus on portability, technological innovation, and the diagnosis of various medical conditions”, he added.

Evolution of ultrasound in the Indian healthcare system The evolution of ultrasound technology in India has been marked by continuous innovation and technological advancements. From basic 2D imaging, the introduction of 3D and 4D imaging has allowed for more detailed and accurate visualisation of internal structures. Doppler ultrasound, which assesses blood flow, has become a crucial tool in cardiology, obstetrics, and vascular medicine. Portable and handheld ultrasound devices have also made diagnostic imaging more convenient, especially in remote and underserved areas. Talking about the evolution timeline, Dr Janardhan Reddy, Consultant-Radiology, SRV Hospitals, Mumbai said, “ultrasound as an imaging modality was introduced in India at around in the 1980s, though predominantly in metro cities. Initially, ultrasound as a diagnostic application was limited to only a few due to its cost & availability. The uses of ultra-sound were limited due to poor resolution, bulky & expensive equipment. However, as time went on there was a gradual improvement in overall technology including processing power, transducers architecture and image processing algorithms with resultant reduction in size & cost of ultrasound machines in India. In one generation itself we progressed from

2D to 3D and even 4D being quite commonly available. Few of the new machines are able to resolve thinnest of nerve fibers, muscles, tendons & smallest of blood vessels.” Moreover, the diversification of ultrasound applications has broadened the scope of radiology practice in India. Dr Anita Aggarwal, Director & Chief of Radiology, Indian Spinal Injuries Centre, New Delhi also mentions, “Ultrasound has undergone a significant evolution within the Indian healthcare system, becoming a cornerstone in diagnostic imaging. The integration of wireless technology has played a pivotal role in this evolution, offering a seamless flow of data and eliminating the constraints of physical connections. Modern probes enable radiologists to conduct ultrasound procedures without the discomfort of cords, contributing to increased efficiency. Additionally, the shift towards cloud-based systems has further propelled the evolution, providing healthcare facilities with enhanced process efficiency, financial predictability, and long-term cost savings.”

Technological revolutions and advancements The radiological growth of India has been significantly shaped by technological revolutions in ultrasound. Advancements ranging from high-frequency probes to portable devices and the integration of Artificial Intelligence (AI) have not only enhanced diagnostic capabilities but also broadened accessibility, ultimately reshaping the landscape of patient care. These technological revolutions in ultrasound are emerging as a driving force behind overall transformative journey. On this, Chander Shekhar Sibal, HOD & Vice President of Healthcare Business, FUJIFILM India shares, “Innovations like high-resolution imaging, 3D/4D imaging capabilities, and portable devices have enabled more accurate and detailed diagnoses in India. Moreover, the integrated advanced imaging modes and automated features

Innovations like high-resolution imaging, 3D/4D imaging capabilities, and portable devices have enabled more accurate and detailed diagnoses in India Chander Shekhar Sibal HOD & Vice President of Healthcare Business, FUJIFILM India

Shear wave elastography Shear wave elastography (SWE) is an ultrasound technique that measures tissue stiffness and is used to evaluate liver stiffness caused by liver cirrhosis. Contrastenhanced ultrasound (CEUS) uses an intravenous contrast agent to improve the visualisation of blood vessels and organs Dr Rolly Chowdhri Consultant, Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai

The integration of AI in handheld ultrasound devices addresses the challenges of usability and image optimisation. AI aids in enhancing image quality and guiding probe orientation, thus significantly reducing the learning curve for new users and allowing more focus on patient care Dr Vipula Potdar Consultant-Radiologist, Jupiter Hospital Pune

AI has seamlessly integrated into the realm of ultrasound, optimising diagnostic processes and streamlining workflows Dr Divya Kant Consultant –Radiologist, Asian Hospital Faridabad

of ultrasound technology have enhanced the precision and efficiency of diagnostic procedures.” Dr Gupta explains how technological advancements have improved the accuracy and scope of ultrasound examinations, contributing to better patient outcomes. He mentions, “the technological revolutions in ultrasound in India have been marked by advancements in transducer technology, image processing, and machine learning algorithms. High-frequency transducers with better resolution and 3D/4D imaging capabilities have become commonplace. Doppler ultrasound, once a revolutionary addition, is now standard for assessing blood flow. Moreover, elastography and contrast-enhanced ultrasound have provided additional diagnostic capabilities.” Dr Rolly Chowdhri, Consultant-Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai mentions, “ultrasound technology has seen significant advancement. Today, ultrasound technology enables 3D imaging and includes wireless transducers. Radiologists can use appbased technologies to reach a quick and accurate diagnosis. The output can be integrated with CT/MR outputs with fusion technology, allowing for synchronised imaging and improving the detection of lesions and the performance of minimally invasive procedures. The High spatial resolution of ultrasound machine is aiding in reaching the correct diagnosis.” “There is also laparoscopic ultrasound which allows the surgeon to look into the tissues being operated upon, thereby compensating for the inability to physically palpate the organ or lesion. Shear wave elastography Shear wave elastography (SWE) is an ultrasound technique that measures tissue stiffness and is used to evaluate liver stiffness caused by liver cirrhosis. Contrast-enhanced ultrasound (CEUS) uses an intravenous contrast agent to improve the visualisation of blood vessels and organs”, she added. While technological

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cover ) revolutions in ultrasound have propelled the radiological growth in India, challenges persist. Adequate training of healthcare professionals to harness the full potential of advanced ultrasound technology remains a priority. Addressing these challenges presents opportunities for the development of comprehensive training programs, fostering a skilled workforce capable of maximising the benefits of cutting-edge ultrasound advancements.

The intersection of ultrasound and AI has heralded a revolution in precision medicine. AI algorithms adeptly navigate extensive datasets, recognising patterns and aiding doctors in diagnosing complex conditions Dr Ravi Kapoor Director, Senior Consultant Radiologist, City X-Ray and Scan Clinic

AI integration: Improving diagnostic precision in radiology Incorporation of AI into ultrasound technology is improving diagnostic precision in radiology many folds. Intelligent algorithms also help in analysing the ultrasound images accurately, aiding healthcare professionals in identifying the abnormalities and overcoming the challenges that might not be able to happen via traditional methods. The result is a considerable improvement in diagnostic accuracy, offering radiologists a more reliable foundation for decisionmaking. Dr Vipula Potdar, Consultant-Radiologist, Jupiter Hospital Pune said, “The integration of AI in handheld ultrasound devices addresses the challenges of usability and image optimisation. AI aids in enhancing image quality and guiding probe orientation, thus significantly reducing the learning curve for new users and allowing more focus on patient care. AI-integrated ultrasound systems demonstrate a marked increase in diagnostic accuracy and a reduction in false positives.” The integration of AI is also helping in streamlining radiological workflows by offering advanced tools for image interpretation and analysis and better efficiency of the diagnostic process. This, in turn, allows radiologists to focus their expertise on complex cases, with routine tasks being efficiently managed by AI algorithms. On streamlining radiological workflows, Dr Divya Kant, Consultant –Radiologist, Asian

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We now have portable ultrasounds in the wards where we can assess all critical cases at the bedside, analyse effusions in all critical cases, perform Doppler ultrasounds for DVT, and handle all emergencies at the bedside Dr Somesh Lala Director Radiology & Imaging, Sir H. N. Reliance Foundation Hospital

Ultrasound's transformative role extends beyond individual patient care to have a profound impact on public health Dr Akhilesh Mittal Sr. Consultant & HOD, Radiology & Imaging, Accord Superspeciality Hospital

Hospital Faridabad also shares, “AI has seamlessly integrated into the realm of ultrasound, optimising diagnostic processes and streamlining workflows. Machine learning algorithms aid in image interpretation, offering faster and more accurate diagnostics. However, the influx of data generated by these technologies poses challenges. Striking a balance between harness-

ing the potential of AI and ensuring data privacy remains a key consideration for healthcare providers.” Highlighting the Synergy of AI and data mastery, Dr Ravi Kapoor, Director, Senior Consultant Radiologist, City X-Ray and Scan Clinic explains, “The intersection of ultrasound and AI has heralded a revolution in precision medicine. AI algorithms

adeptly navigate extensive datasets, recognising patterns and aiding doctors in diagnosing complex conditions. From an outsider's perspective, doctors leverage these AI-powered tools to optimise workflows, resulting in swifter and more accurate interpretations of ultrasound images. AI integration goes beyond diagnostics; it introduces predictive analytics, enabling doctors

to anticipate and intervene in potential health issues before they apparent clinically. This proactive approach not only saves valuable time but also contributes to a more personalised and anticipant form of patient care.” AI's role in ultrasound also facilitates the early detection of various pathologies, enabling healthcare providers to intervene at the nascent stages of disease progression. Whether it is identifying anomalies in prenatal scans or detecting subtle changes in organ structures, AI's rapid analysis of extensive imaging data supports timely and proactive medical interventions, fostering improved patient outcomes. While the integration of AI in ultrasound presents promising opportunities, certain challenges such as ensuring data privacy, building trust in AI systems, and providing comprehensive training for healthcare professionals need to be addressed. The ongoing evolution of AI algorithms and continuous research and development efforts are expected to refine and expand applications, optimising the synergy between AI and ultrasound technology. Dr Reddy throws light on some of the obstacles. He highlights, “recent advances in deeplearning technology have brought revolutionary changes to AI research and application across industries, yielding major innovations in radiology, which is based on the interpretation of image data obtained through various methods-and has often been compared with computer vision using pattern analysis. Image information obtained by ultrasonography provides the foundation of input data for the development of a machine learning algorithm, either using traditional handcrafted feature extraction or automated feature extraction via deep learning.” “Despite expectations for increasing research and development of AI-empowered ultrasonography, the clinical implementation of AI in medical ultrasonography faces unique obstacles. It will be necessary to

standardise image acquisition, regulate operator and interpreter qualification and performance, integrate clinical information, and provide performance feedback to maximise benefits for patient care”, he added.

Impact of portable and handheld ultrasound devices One of the most significant contributions of portable and handheld ultrasound devices is the democratisation of diagnostic imaging. These compact devices have broken traditional barriers, enabling healthcare professionals to carry out ultrasound examinations beyond the confines of specialised imaging facilities. Whether in remote rural areas, ambulances, or point-of-care environments, the portability of these devices has dramatically expanded access to critical diagnostic services. Sharing his views, Dr Somesh Lala, Director Radiology & Imaging, Sir H. N. Reliance Foundation Hospital said, “we now have portable ultrasounds in the wards where we can assess all critical cases at the bedside, analyse effusions in all critical cases, perform Doppler ultrasounds for DVT, and handle all emergencies at the bedside. That, then, is one of the revolutions that have occurred. smaller device than the main unit, yet it performs all the functions of a

bedside colour doppler, including abdominal and chest assessments.” Portable ultrasound devices empower healthcare providers with the ability to conduct pointof-care imaging, bringing diagnostics directly to the patient's bedside. In emergency situations, this capability proves invaluable, allowing for rapid assessments and immediate decision-making. This shift towards point-of-care ultrasound (POCUS) is particularly significant in India, where reaching specialised medical facilities may be logistically challenging. Stressing on the advantages of POCUS, Dr Chowdhri shares, “handheld ultrasound devices (POCUS) are increasingly used across healthcare specialities due to their portability and immediate results. These devices have shown similar accuracy to cart-based machines for various applications, including bedside portable procedures and diagnostic evaluations in sick & bed ridden patients. Despite their benefits, experts identify that no single handheld device is perfect. High image quality, ease of use, portability, total costs, and availability of different probes are considered vital characteristics. However, poor image quality and limited patient movements are significant limitations, affecting clinical decision-making and user

satisfaction. However, their use in India is restricted under the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994.”

Widespread adoption of ultrasound technology: Impact on public health The availability of ultrasound technology has broken down geographical barriers, making it available to broader spectrum of the population and enhancing the accessibility to critical diagnostic services. Sibal shares, “the widespread adoption of ultrasound technology has significantly improved healthcare access and positively influenced public health services nationwide. It has contributed to early disease detection, facilitating timely treatment. Additionally, the natural nature of non-ionising ultraviolet rays makes them safer for regular use and reduces radiation exposure compared to other imaging techniques.” There is a positive impact on maternal and child health due to widespread ultrasound adoption by allowing healthcare providers to monitor fetal development and identify potential complications. Dr Chowdhri stresses that the best indicator of a developed country is the NMR (Neonatal mortality rate) and ultrasound is helping us achieve that and take a step from developing nation

towards developed nation. She added, “ultrasound has been a core part of national health programmes like National Rural Health Mission, the Rashtriya Bal Swasthya Karyakram, and the Pradhan Mantri Surakshit Matritva Abhiyan, to improve maternal and neonatal health and decrease mortality. The various camps organised by the government and trust hospitals are doing wonders. Evolution is also tremendous; it is pocket friendly. I am not talking about it being cheaper, I mean you can literally carry it in your pocket, attach to your phone and do ultrasound. Ultrasound is not just a diagnostic modality, it's a screening tool. It's called screening tests when performed on healthy individuals. People get incidental findings when the disease has not progressed to cause discomfort and treated early decreasing morbidity and mortality and ultrasound plays a crucial role in it. The incidental findings are so much increased that we have a word for that "Incidentaloma" Dr Akhilesh Mittal, Sr. Consultant & HOD, Radiology & Imaging, Accord Superspeciality Hospital also shares, “ultrasound's transformative role extends beyond individual patient care to have a profound impact on public health. The accessibility of ultrasound technology has facilitated widespread screening programs, enabling the early

detection of diseases and contributing to preventive healthcare initiatives. This has proven particularly beneficial in addressing health disparities and improving health outcomes across diverse socio-economic strata.” “The evolution of ultrasound in the Indian healthcare system, coupled with technological revolutions, AI integration, and the advent of portable devices, has not only transformed diagnostic imaging but has also elevated the standard of patient care. As ultrasound continues to shape the radiology landscape, its impact on public health underscores its significance as a key player in the ongoing healthcare revolution in the country”, he added.

Way forward As technology continues to advance and healthcare infrastructure develops, ultrasound will play an increasingly crucial role in improving overall radiology landscape. By addressing challenges and embracing opportunities, the Indian healthcare system can ensure that ultrasound remains a cornerstone in providing accessible, affordable, and high-quality diagnostic services to diverse populations across the country. Kalyani.sharma@expressindia.com journokalyani@gmail.com

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December 2023

RADIOLOGY I N T E R V I E W

AI's influence is pervasive in both healthcare and radiology The 8th edition of the ‘Textbook of Radiology & Imaging’, curated by Dr Bharat Aggarwal, Director-Radiology Services, Max Healthcare was recently launched. In an interaction with Kalyani Sharma, Dr Aggarwal talks about various elements of the book and how it documents advancements in the field of radiology, especially in terms of technology and patient care Can you tell us about the journey of launching this new edition of Sutton's Textbook of Radiology? The new edition was conceptualised in late 2019, when Elsevier approached me to edit this edition. The first task was to create a strong structured team, for which I reached out to three young and distinguished radiologists – Dr Amit Sahu from Delhi, Dr Akshay Baheti from Mumbai and Dr Varsha Joshi from Hyderabad, to join as associate editors. Since this book was read by all radiologists of our generation, we then travelled to the US for RSNA, the largest radiology conference globally, to seek the support of top subspeciality radiologists from some of the best academic and clinical radiology departments of the world. This helped build a strong sectional editorial team, from hospitals such as the Harvard medical system. Collectively we then identified the contributors to author the chapters and set the production in motion. The book was put together in the COVID pandemic and all authors diligently stuck to their commitment despite being pulled into the frontlines, and we put together a high quality, up to date book that will lay the foundation for the radiologists of the future. What elements of the previous editions have been preserved in this new edition, and why were they considered relevant even after two decades? General radiology procedures such as chest x-ray

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to do contextual on the job learning on an ongoing case based approach but also understand the spectrum of conditions which are closely inter-related in these subspecialities.

interpretation continue to be extremely relevant in modern medicine. Understanding of basic x-ray and other image guided also lays the foundation of more advances techniques which have evolved in the last two decades. As a result, the book continues to retain most of the material pertaining to chest xrays and basics of other imaging modalities such as CT, ultrasound and MRI. Images of some classical x-ray diagnoses were also retained. You mentioned that new sections have been added, such as radiology physics, pediatric radiology, interventional radiology, and emergency radiology. How do these additions make the textbook more comprehensive for today's radiologists? The first section introduced the audience to research techniques, information technology and artificial

intelligence, along with methods of quality control & assurance in the radiology department – these are relevant to the entire spectrum of staff in radiology departments. The clinical sections of the book are comprehensively written covering all current methods – from basic radiography to advanced procedures, to help the radiologists better understand how to use the available techniques in their ecosystem; to provide the appropriate diagnosis in enabling patient care. The illustrations and images typify different diseases so that the readers can not only learn different patterns of disease, but also use the book as a ready reference in their day to day life. Separate sections on paediatrics, emergency radiology and interventional radiology highlight the importance of these in todays’ radiology practice – the radiologists will not only be able

The field of radiology has seen significant advancements over the years. How does this new edition of the textbook reflect these changes, especially in terms of technology and patient care? The book has been kept updated with all new imaging technique including the role of Artificial Intelligence (AI) in radiology today – this is not only captured within the various chapters, but a separate chapter to make the radiologist understand how artificial intelligence works is included. This will enable the intersection of medicine and engineering to improve enhance the clinical applications of emerging technology. The book also captures the changing lexicons of communication and explains the impact of radiology techniques on treatment strategies. There has been an advancement of surgical techniques and medical management of disease- the role of the radiologist in this new ecosystem is emphasised in the book, enabling them to participate proactively in clinical decision making. The book has new chapters on quality assurance and patient safety – all of which are extremely important contributors to improved patient experience, safety and outcomes. The chapter on research methodologies

introduces the radiologist to a very important aspect of medicine which will contribute to further improvements in radiology technology and medical information. The book addresses the importance of AI in radiology. How critical is AI knowledge for practicing radiologists today, and how does the textbook prepare them in this regard? AI's influence is pervasive in both healthcare and radiology. The majority of radiology equipment now incorporates AI to enhance quality and efficiency. This includes tasks ranging from positioning patients in CT and MRI scanners to optimising radiation dosages through AIdriven reconstruction algorithms, which have become standard features in modern scanners. Automated image reconstruction algorithms, powered by AI, deliver immediate high-resolution 3D and 4D advanced visualisation of organs and diseases, thereby expediting the diagnostic process. AI is being used for pattern identification on imaging techniques and contributes to disease prognostication – this has contributed to improved detection rates and the quality of report generation, pointing out abnormalities that could potentially be missed. Relevant sections of the book incorporate this ubiquitous presence of AI in modern radiology practice. Kalyani.sharma@expressindia.com journokalyani@gmail.com

EDUCATION

The skill gap in India’s nursing sector Dr Judith Angelitta Noronha, Dean, Manipal College of Nursing Manipal, MAHE, Manipal shares that the gap evident in the nursing skill in the present workforce, which is quite alarming, can be addressed through proper education, research, and enhancement of skills among the nurses

ndian health care system is facing a huge challenge in terms of shortage of skilled nursing workforce to meet the growing demands of the inflow of patients either at the primary health care level or at the tertiary level. In today’s world, when we visualise the nursing landscape, I remember this sentence that I learned during my earlier days: the grass is always greener on the other side. Referencing this sentence, the other side is the skill force at the global level. I always wonder what is the reason for such a thought to emerge in my mind. The skill, the education, the changing generation, the practice, the teaching, the teachers, the turnover, the burnout… These words emerge now and then when I carefully ponder the thought of the skill gap in India’s nursing sector. And belonging to the teaching fraternity, how can I change it? Should I answer each of these or combine them into one and see a bigger picture that mimics the galaxy? How to change this? The healthcare system has undergone drastic changes in recent years, and the workforce also needs to change, which is long overdue. Focussing on the sustainable development in Indian health sector, Nursing colleges plays a major role to build the skill gap through high quality education to manage the rising comorbidities and complications. The skill gap can be plugged in through the implementation of Continuing Nursing Education (CNE), seminars and workshops to equip themselves with high technical knowledge. Develop funding strategies that can sustain and scale a system of career pathway. To provide healthcare coverage during their study period to ensure

their safety. The beginning of it starts with the education system. Nursing education acts as a catalyst for future nurses and the healthcare team to work towards a better healthcare ecosystem. The gap evident in the nursing skill in the present workforce, which is quite alarming, can be addressed through proper education, research, and enhancement of skills among the nurses. However, teaching and repetitive enforcement have been practiced in nursing education for a long time. And what is required now is the change that must be

bought in the system from scratch. We can say that what we have been doing till now in the system is the tip of the iceberg, to teach the coming generation, we have to see the depth of the iceberg and dwell more profoundly in the sea of education. The digitalisation of the world has made life easy, a click away. The industrial revolution is the rapid speed at which artificial intelligence and biotechnological advancements are happening. It shows that change is required, and we are still trying to catch up with the new evidence generated. Meth-

ods are many, but what we can use efficiently is a matter of question, and I try to answer the same. Various methods can be utilised to improve the nurses' skill set in India. The technology has reached such heights that we can observe, analyse, and solve a patient's problems without the patient being physically present. Augmented Reality (AR) and Virtual Reality have been practiced internationally to improve the skills of nurses. This technology can help nurses face the different scenarios they can face in the healthcare system, which they would not be a part of during their academic journey. For example, in an emergency area, if a patient has gone into cardiac arrest, the experienced healthcare team will jump right in to save the patient, which is necessary. Still, a novice nurse would be flustered because she has not faced such a situation. This AR or VR technology can expose the novice nurse to different scenarios to better prepare the nurse and improve the skill set. Another method that I feel would be beneficial and would enhance the skills of a nurse is simulation. Having adequate simulation centers with highend mannequins that can respond to the changing situation would be advantageous. A fully equipped simulation lab is vital for nursing students and nurses to practice and keep current with the evidence. Under supervision, the novice or experienced nurse can envisage the scenarios and improve their skills. Other methods have been practiced widely, like discussions and demonstrations, which are also crucial for nurses to understand the importance of the skills they learn. However, the current generation needs something

more, where they can relate and visualise the scenarios to relate to the patient. To make this reality, it is imperative for the experienced workforce, veteran nurses, to train and lead the novice or unskilled nurses to make them efficient. The experienced nurses are now retiring and utilising them in formulating scenarios, having them discuss and demonstrate, and setting the circumstances can make the technology more user-friendly and relatable. An additional aspect is the exchange program of the students to expose them to different nursing perspectives and experience global facets. Give them exposure to patient care and differences in the policies and laws in healthcare and how the professionals work cohesively in a team to improve patient care. The viewpoint of the nurses can change drastically, and the improvement of the nurse’s skill set can happen indirectly, boosting their confidence and making them advocate for patient care. The crux of the skill enhancement of the nurses is to understand and keep up with current evidence and practice the skills under the guidance of veteran nurses and with technological assistance that can improve the skills and make them better at providing patient care. We as nurses, though in clinical settings, as educators or researchers, must remember that practicing the skills again and keeping the knowledge up-to-date with continuous guidance from experienced nurses is vital in reducing the skill gap among the nurses in the Indian sector. Nurses must remember to be skilled and empathetic while caring for the patients and providing healthcare as a team of professionals.

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December 2023

PUBLIC HEALTH

Challenges in the existing public health system Shrirupa Sengupta, Public Health Communications Specialist and Director, Strategic Communications, Swasti, The Health Catalyst stresses that enhanced public health surveillance, community health systems, and political commitment resulted in notable accomplishments like polio eradication, a substantial drop in HIV infections, and effective management of recent outbreaks. However, challenges persist, especially in mental health

hy is “enough” never completely measurable in the context of public health? There is no way to measure when a service is affordable “enough” or accessible “enough” or available “enough”. In an ideal setting, we try to ensure that the public health service reaches the last mile, that terrains are not hurdles, and that no one is left behind. We undertake willingness-to-pay studies, we pour over health data and income data and every other statistic in between to determine affordability - and yet looming shadows of challenges to public health systems remain. Public health is not just a public sector undertaking. It is a whole of societal commitment and has players from every corner of the board - the communities, the private sector, the public sector, individuals of all ages and all walks of life. It is tucked into innocuous moments of an ASHA worker noticing a child walking with a limp to a young person deciding to be a Sexual and Reproductive Health and Rights Policy Champion. It is not just in the parliament arguing bills and budgets or building infrastructure but also in communities discussing among themselves ways to get ahead of seasonal illnesses or sharing preventive methods passed on through generations. So, when challenges show themselves in public health systems - they do so in all the nooks and crannies. Vulnerable populations,

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Public health is not just a public sector undertaking. It is a whole of societal commitment and has players from every corner of the board - the communities, the private sector, the public sector, individuals of all ages and all walks of life constituting 50-80 per cent, often experience undiagnosed illnesses and lack necessary health care, resulting in high mortality rates. The health and poverty gridlock presents multifaceted challenges, with health being a low priority for marginalised communities

due to inaccessibility, inconvenience, and cost. A recent study reveals that the poorest households lose approximately 15 per cent of total spending to illness-related wage losses, three times more than medical expenses. Stigma, discrimination, and

social determinants further hinder healthcare access, leading to delayed treatment and unfavourable health outcomes, especially in disadvantaged communities. In India, two-thirds of mortality cases stem from noncommunicable diseases, posing a significant public health concern amid various challenges. India, amid its diverse geography and population, achieved significant progress in public health during the COVID-19 pandemic. Enhanced public health surveillance, community health systems, and political commitment resulted in notable accomplishments like polio eradication, a substantial drop in HIV infections, and effective management of recent outbreaks. The government's focus on the National Digital Health Mission aims to leverage increased digital penetration for further improvement in public health surveillance, among other things within the One Health framework. This is good news. However, challenges persist, especially in mental health. The National Mental Health Survey reveals that 14 per cent of Indian adults have or will have a mental condition. Despite this, there is a severe shortage of psychiatrists, with only 0.75 psychiatrists per 100,000 people compared to the recommended 3 per 100,000. Emphasising community mental health approaches could improve accessibility to therapy and foster supportive communities. Substance use poses another major public health con-

cern. Limited data on the epidemiology of substance use in India exists, particularly regarding opioids. The National Action Plan for Drug Demand Reduction aims to address this issue, with a focus on awareness and community involvement. A continuing gap in human resources for health is evident, with a significant shortage of doctors and nurses/midwives compared to WHO recommendations. Digital penetration has exacerbated myths, misconceptions, and misinformation about health. A survey indicates that a substantial portion of the population struggles to identify credible health information online, highlighting the need for education on seeking information from reliable sources. Environmental pollution and climate change further challenge public health. India faces air pollution-related premature deaths and rising CO2 emissions. Climate change-induced heat waves pose health risks to urban residents, and the country's rapid urbanisation exacerbates these issues. Severe air pollution, with nine of the world's 10 most polluted cities in India, contributes to respiratory illnesses. Addressing these challenges requires a multifaceted approach, including strengthening healthcare infrastructure, expanding mental health services, combating substance abuse, improving digital health literacy, and implementing measures to mitigate environmental pollution and climate change impacts.

The COVID-19 pandemic emphasised the necessity for a comprehensive transformation in healthcare infrastructure accelerating the adoption of digital tools, shaping the future of public health in India, emphasising a digital agenda to bridge the divide.

Could telecare be the magic bullet? Digital health, particularly telemedicine, holds the potential to revolutionise and decentralise healthcare, ensuring the last-mile delivery of primary healthcare and becoming a one-stop shop - for services ranging from public health communication, mental well-being, health counselling and of course medical consultation and triage. It can also contribute significantly to public health surveillance. Technology enhances effi-

ciency in health systems, improving resource management and communication. However, inefficient infrastructure, patient overload, and socioeconomic factors, coupled with low digital literacy in marginalised communities, contribute to limited healthcare access. Traditional telehealth models relying solely on technology often fail in such communities. Developing health interventions tailored to community needs, holistic, and accessible is crucial for timely prevention, diagnosis, and improved health outcomes. Prioritising marginalised communities' health concerns is essential for achieving Sustainable Development Goals and bolstering India's Universal Health Coverage Initiative. An ideal telehealth model is one that has the potential to

address numerous existing gaps in India’s public healthcare system, from the lack of infrastructure to the scarcity of human resources. Telemedicine makes healthcare accessible and convenient and ‘greens’ the healthcare systems by reducing the need for travel. Imagine a community-led and tech-enabled model to deliver primary healthcare for the most vulnerable population. Its vision is to build resilient communities by ensuring preventive and primary care and creating strong referral networks for further treatment. Traditional digital health models fail in vulnerable populations due to a lack of trust in digital services, high digital divide, and low digital literacy but one of a phygital nature can ensure that digital services are con-

textualised to the vulnerable population. The core of a program of this nature would be twinning with health and wellness centres and their cadre of volunteers, community health workers and champions making an otherwise remote concept tangible, reachable and therefore accessible, affordable and available. The technology required by the patient is minimal, as they only need a basic mobile handset or smartphone with a messaging app that supports multimedia and video calling like say whatsApp. The patient can call the telemedicine number to avail consultations for any health issues based on an UID supported registration that helps with tracking. It is a people-centric technology that eliminates the need for additional digital instances

and enables a continuum of care by telemedicine providers and clinical staff and can be expanded to cover referrals and linkages, social protection and a host of services. Promoting digital health tools, especially telemedicine and other advanced technologies, is crucial for collaborative, responsible, and impactful healthcare data use. Integrating these tools with the extensive network of 150,000 Health & Wellness Centers (HWCs) can revolutionise healthcare delivery, addressing challenges of availability, affordability, and accessibility for marginalised communities. Additionally, the government's emphasis on Public Health Surveillance, Yoga and AYUSH services further contributes to bridging existing healthcare gaps.

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December 2023

DIAGNOSTIC

Driving innovation: Partnerships between diagnostic labs and medtech companies Dipanngshu Sannyal, Chief Business Officer, Oncquest Laboratories emphasises that the partnership between technology companies and diagnostic labs can significantly accelerate healthcare capacity expansion and the adoption of new technologies. Flexible commercial models can reduce fixed costs and improve service levels, while medical technology companies can serve extended patient communities

he COVID-19 pandemic underscored the importance of partnerships and collaborations in achieving healthcare goals through a solution-based approach. Collective effort benefits all stakeholders, including patients, and there is a growing awareness that collaboration among healthcare players is a win-win situation. Healthcare players, including diagnostic labs and medtech players, are collaborating to overcome barriers to access, awareness, and inter-connectivity, aiming to improve public health. Partnerships are crucial for accelerating results, and hospitals and healthcare technology companies are increasingly forming to meet patient needs. The partnership between technology companies and diagnostic labs can significantly accelerate healthcare capacity expansion and the adoption of new technologies. Flexible commercial models can reduce fixed costs and improve service levels, while medical technology companies can serve extended patient communities. Strategic priorities for both stakeholders include operational and clinical care optimisation to reduce procedure costs and improve patient outcomes. These days, India’s diagnostic labs are increasingly partnering with healthcare technology companies to improve patient care through innovative technologies like AI tools for disease prediction, high-precision robotic surgery, 3D-printed anatomical models, and customised im-

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areas like hematology, microbiology, serology, immunology, molecular biology & Next generation sequencing.

Role of MLTs

The partnership between technology companies and diagnostic labs can significantly accelerate healthcare capacity expansion and the adoption of new technologies plants. These partnerships are also raising awareness about non-communicable diseases like stroke, cancer, and Parkinson’s disorder.

Medical Laboratory Technologists (MLT) With steady integration of technology in diagnostic labs, there has been a transformation of the role of lab technicians, who can now be re-

ferred to as MLT. MLT is a healthcare professional who performs complex laboratory tests and analyses on patient samples like blood, urine, and tissue using sophisticated equipment, computerised instruments, and microscopic analysis. They work in various settings, including hospitals, clinics, research laboratories, and private diagnostic laboratories, and may specialise in

An MLT plays a vital role in patient care, as their tests are used to diagnose and treat various medical conditions. They collect and prepare patient samples, such as blood, urine, and tissue, following strict protocols to ensure accuracy. They perform various laboratory tests, ranging from basic blood counts to complex genetic analyses. After the tests are complete, MLTs analyse the results, providing accurate reports to healthcare providers. They maintain and calibrate laboratory equipment, keeping accurate records of all tests and equipment maintenance. They also collaborate with healthcare providers to ensure they understand test results and can make informed treatment decisions. MLTs may also assist in developing new laboratory tests and procedures. Overall, their work is crucial for patient care and the development of effective treatments.

How medtech + diagnostic labs drives innovation Partnerships between diagnostic labs and medtech companies bring about innovative solutions and advancements in healthcare. Medtech companies frequently develop cutting-edge medical devices and technology. Collaborating with diagnostic labs allows them to test, validate, and improve their innovations in

real-world clinical settings. Diagnostic labs possess extensive data and domain expertise. They can offer valuable insights and contribute to the development and validation of new technologies. The medtech-diagnostic lab partnership often leads to the creation of more efficient and accurate diagnostic tools. This could include anything from advanced imaging technologies to new testing methods. Also, collaborations can provide opportunities to reach a broader market. For instance, a diagnostic lab might incorporate a new medtech solution, making it more widely available to healthcare providers and patients. Joint efforts often lead to research and development of new solutions that address unmet needs in healthcare, fostering a cycle of continuous improvement. For instance, a medtech company might develop a new imaging technology, and a diagnostic lab could test its efficacy and accuracy in real clinical settings. Their collaboration could lead to refining the technology for better patient outcomes. By combining resources and expertise, these partnerships can optimise costs associated with research, development, and implementation of new technologies. Such partnerships often pave the way for strategic alliances, potentially leading to further collaborations or joint ventures to explore additional areas of innovation in healthcare. The synergy between medtech companies and diagnostic labs can result in break-

throughs that have the potential to revolutionise the way diseases are diagnosed and treated.

Ways to integrate medtech with diagnostic labs

Establishing protocols that integrate medtech tools with lab processes can ensure smooth and standardised operations, reducing errors and improving overall efficiency

Integrating medtech with diagnostic labs involves merging technology with laboratory processes to enhance diagnostic capabilities. Joint initiatives between medtech companies and diagnostic labs can foster the creation of new tools, devices, and software tailored for diagnostic purposes. Upgrading existing lab equipment with medtech innovations like automated sample processing, AI-based analysis, or IoT-connected devices can streamline and enhance lab operations. Developing systems that enable seamless data sharing be-

tween medtech devices and diagnostic lab systems ensure efficient analysis, interpretation, and reporting of results. Establishing protocols that integrate medtech tools with lab processes can ensure smooth and standardised operations, reducing errors and improving overall efficiency. Also, conducting workshops, training sessions, and educational programs for lab technicians and staff can help them adapt to and effectively use new medtech tools. Incorporating medtech solutions

that allow for remote monitoring and diagnostics can extend the reach of diagnostic labs, especially in telemedicine and remote healthcare settings. Implementing medtech solutions for quality control and assurance processes can enhance accuracy, reliability, and consistency in diagnostic tests. Ensuring that the integration of medtech meets regulatory standards and complies with healthcare regulations is crucial for maintaining quality and legality. Leveraging AI and data analytics tools in

conjunction with medtech devices can help analyse and interpret complex data, aiding in more accurate diagnoses and predictions. Furthermore, establishing ongoing communication and collaboration between medtech companies and diagnostic labs is vital to continually improve and refine integrated solutions based on real-world usage and feedback.

Challenges to integrate medtech with diagnostic labs Collaborations

between

medtech companies and diagnostic labs offer advantages but face challenges such as integration complexity, data standardisation, regulatory compliance, privacy and security concerns, resource and financial constraints, differing objectives and timelines, resistance to change, lack of communication and collaboration, and limited scalability. These challenges require a balanced approach, clear communication, and shared commitment from both parties. Solutions involve technology adaptation, regulatory alignment, effective data management, and cultural changes within the collaborating organisations. Balancing these needs against potential returns can be challenging, especially for smaller labs or medtech startups.

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December 2023

BUSINESS AVENUES

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HEALTHCARE TRACKER I N T E R V I E W

Ultrasound today is the new stethoscope Dr Chander Lulla* has been using Mindray’s revolutionary Ultrasound state-of-the-art system Resona I9 since 2022. He discusses the amazing benefits of Resona I9, the evolution of the Ultrasound field, and much more in his interview with Mindray You have more than 3 decades of experience as a radiologist. Can you please share the technological revolutions in the ultrasound field that you have witnessed? In the last three decades of my experience, I have seen almost amazing changes in Ultrasound. We started to use small and very basic portable ultrasound machines, which I used to carry from one place to the other in the year of 1987. Then, the mainframe machines were launched in the 1990s with Colour Doppler and Spectral Doppler. That was one of the biggest game changers in the Ultrasound field as the blood flow was visible without placing the needle and injecting contrast. When I showed my first image of 2D with Colour Doppler at a conference, people couldn't believe that we could see blood flow without doing an Angiography. That was a revolutionary change in the Ultrasound field however it created lots of questions regarding the efficacy of the technology vis-a-vis angiography and others. Today, we can see that no Ultrasound machine is complete without a stellar Doppler component. Then in the year of 1998, 3D and 4D Ultrasound created another revolution wherein we could see the baby’s face in-utero and the entire foetus in three dimensions. And in 4D we could see the foetus and the foetus’s heart in real-time. Apart from that, we have multi-planar imaging that allows three Orthogonal planes and exact orientation of normal and abnormal anatomy in the foetus or the uterus. This 4D real-time can also be used during interventional

procedures or other procedures in a multi-planar format. Then the other significant development was, of course, elastography, which has been there from time immemorial. But with 2D shear wave elastography, in which Mindray has been one of the pioneers, we could do simultaneous imaging of the pathology and get shear wave measurements. So, this was very targeted, focused, and accurate, and we had a lot of quality checks that were possible. And finally, of course, the newest revolution is Artificial intelligence, where Mindray is way ahead of the other companies.

You have been using Mindray’s Resona I9 ultrasound solution since last year. What is your opinion about it? I'm very proud to have the Resona I9 Ultrasound system from Mindray. It has been my long-cherished dream to have this machine in my clinic, which is a wonderful piece of art. It’s a fusion of art and science that is helping me in the clinical management of my patients. i)Resolution The most important thing for any Ultrasound user is the resolution, and Resona I9 has found its firm place in terms of the resolution. Mindray’s ZST technology is a fast software-based and zone-driven technology. It allows a very smooth and rapid workflow. All updates are quickly incorporated on a regular basis without any hassles. It provides excellent and rapid Spatial and Contrast resolution. It doesn’t require focal zones and grants a complete Harmonic and

uniform image from the skin to a greater depth in the human body. We had a patient with a mass in his tongue and we performed a very highresolution sonogram of the tongue using a 23Mhz transducer with Resona I9. Because of the high resolution of Resona I9, we could see the contents and blood flow and elastography revealed that it could be a cyticercus with a central nodule(scolex), this was a rare diagnosis only possibly due to the high resolution on this probe. Before ResonaI9, the diagnosis was not this easy, patients would need a CT scan or MRI for more clarity. Resona I9 has certainly elevated our diagnostic confidence. ii)Ergonomics Musculoskeletal problems are very common in radiologists due to the high volume of scanning. Resona I9 has been designed keeping ergonomics in mind and has helped me with my high volume of scanning as well as easy-to-perform interventional procedures. It has a full-space floating control panel that can be rotated in 360-degree fashion. The transducer connections are on the posterior side of the panel making it easy to be changed and the gel bottle warmer helps to make the patients feel more comfortable during the scan. iii)Artificial Intelligence (AI) The most exciting part of Resona I9 is the artificial intelligence that has been incorporated into the machine which enhances the workflow to a great extent and allows me to attend to patients faster. Apart from that, it has innovative

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HEALTHCARE TRACKER methods of calculation which is astounding compared to manual calculations which are no longer required. This has decreased my hand movement in selecting keys during my scans. For example, we can acquire the rapid volume of the foetal brain in the foetus with ventriculomegaly anomaly. With just one touch of a button, we can get all the different planes and the measurements appear automatically. The BP, the head circumference around the cerebellar diameter, lateral ventricle diameter, brain volume, etc. can be seen very accurately. This is absolutely astounding. I have not seen any machine with such technology in the last 30 years of my practice and I have gone through all the changes in ultrasound from Basic B mode ultrasound in the 1990s. Then we started doing colour Doppler in 91, 3D technology in 98, and Elastography in 2010. And now we have excellent AIbased technology where I don't have to physically measure so many parameters and even the basic parameters as it is all done by the machine. So, it can be used for follicle monitoring, dynamic endometrial volume monitoring, and prostate monitoring on the volume transducer. We also have the biplane transrectal transducer, which is extremely beneficial for visualising the prostate in two planes and allows me to do a great fusion biopsy. Apart from that, we have something called tissue tracking quantitative analysis for foetal echocardiography, which gives us a functional analysis of the foetal heart in terms of ejection fraction, the fractional lung volume, fractional volumes of the different chambers of the heart, and the cardiac output. Smart Pelvic for pelvic floor imaging give us all the various dimensions of the pelvic floor at rest, and it will tell us to see pelvic floor pathologies. It is also very useful for us for the paediatric hip ultrasound to give us all the angles. So, wherever you need measurements, the machine will do it for you

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automatically. The 3D rendering of this machine has a very advantageous feature like detecting the surface that is being scanned and switched to the appropriate pre-set without the need to change it manually. It saves a lot of time and is clinically beneficial. From the point of view of shear wave elastography, it has the highest frame rates and is much faster than the machines in the market. The quality control features MSTB. Reliability Map & Index has improved accuracy & reliable values which are repeatable has made SWE very useful, especially for liver imaging. All these technological advancements are way ahead of time, and this is just the beginning of the technological revolution. What are your views on the implementation of AI in ultrasonography?

I think AI is the final frontier of all imaging modalities. It is extremely beneficial for all Radiologists, and we welcome it with open arms. The AI-based ultrasound machines can do multiple things with more precision than any human will ever do. The calculations are so accurate that it saves a lot of time. Also, I think AI is very useful in the future by fusing different technologies like CT, MRI and ultrasound because there are times we need all three technologies together, especially when we're doing interventional procedures. What is your message to the upcoming radiologists? Radiology is at the forefront of Clinical Medicine today. As I said earlier, every patient management starts with a radiological scanning procedure, and you need to be extremely proficient in using

these advanced technologies. Ultrasound Imaging is a fastadvancing modality in new specialities such as Fetal Echocardiography, Fetal Neuro-sonography, and inutero fetal procedures. So, the degree of specialisation is very high today as compared to what we had in the earlier days. We need to be very focused and keep learning all the new technologies and keep updating ourselves so that the patients can get extreme benefits. It’s very exciting time for the Radiologist and I think that's why it is the most preferred super speciality today as once the students pass the MBBS, they like to select Radiology as their speciality. Ultrasound has gained recognition as a valuable diagnostic tool in resourcelimited settings like the remote parts of India where

diagnostic tools are limited. Is it a sustainable method for clinical management and patient outcomes in such scenarios? Yeah. So today I think the world over people call ultrasound the new stethoscope. There is no clinical management possible without an ultrasound. In fact, I’m surprised when I receive ultrasound references from doctors referring their patients with abdominal pain or other GI symptoms for an ultrasound even before the blood tests are done. This has been a game changer for trauma patients, patients with acute pain, thrombosis, stroke patients, or patients with embolic phenomenon in the extremities. When a patient comes with acute emergencies like sudden bleeding, ectopic pregnancy, rapid colour Doppler diagnosis is very important. At the other extreme in a full-term fetus with loss of movement, we need to see whether the baby is having good blood supply and does not have any other problems. ULTRASOUND is a complete revolution. Today, ultrasound is the new stethoscope, and no clinician can function without the advanced ultrasound technology. *About author Dr Chander Lulla is one of the most prominent radiologists in Mumbai and has more than 35 years of experience in this field. Dr. Chander Lulla practices at Ria-Clinic in Gamdevi and in Khar Mumbai. He also practices at Jaslok Hospital. He completed his MBBS from the University Of Bombay in 1984 and MD - Radio Diagnosis/Radiology from the University Of Bombay in 1988. He also completed several trainings including Colour Doppler USG from Guys Hospital, UK, Foetal Interventions from Kings College, UK, 3D Ultrasonography in 1999 from Seoul, Korea, 3D VISUS course from Vienna, Austria, and Foetal Medicine Foundation course from Sydney, Australia. As a Professor, he has conducted several academic sessions and steered many educational programs.

HEALTHCARE TRACKER I N T E R V I E W

Mindray's commitment to healthier Bharat: Advancing ultrasound technology in India Ashwani Raina, Director-Ultrasound Imaging Systems, Mindray India in an interaction with Express Healthcare highlights that we are currently at number 2 position in India in the ultrasound modality. We have expanded our product lines and offered integrated solutions that adapt to different departments to help healthcare providers boost efficiency and optimise management Mindray has emerged as one of the top players in the ultrasound industry in India. Could you share the journey and key milestones that have contributed to this success? In the last decade, Mindray has made significant strides in the Indian ultrasound industry, positioning itself as a key player. We are currently at number 2 position in India in the ultrasound modality. We have expanded our product lines and offered integrated solutions that adapt to different departments to help healthcare providers boost efficiency and optimise management. Our commitment to offering cutting-edge and innovative ultrasound solutions, and our extensive distribution network, coupled with an experienced team, have allowed us to effectively reach a diverse clientele, spanning from small clinics to large corporate hospitals and diagnostic centres across India. We are grateful for the huge support and motivation from our privileged customers in India & stakeholders, who have helped us to establish a significant presence in the country over the years. Innovation is a driving force in the field of medical imaging. How has Mindray consistently introduced cutting-edge devices and technologies to stay at the forefront of the ultrasound industry in India? Innovation has been an integral part of Mindray's journey and is deeply embedded in our organisational DNA. We've consistently demonstrated a commitment to pushing

boundaries and achieving breakthroughs. A key aspect of our strategy is building long-term and sustainable relationships with our partners. We believe that understanding their needs is essential to crafting solutions that truly make a difference. This collaborative mindset has ensured that our innovations are not just technologically advanced but also aligned with the practical requirements of healthcare providers in India. In addition to our focus on innovation and collaboration, our 24x7 customer service centre plays a vital role in ensuring customer satisfaction. Through a combination of advanced solutions, collaboration, and robust customer support, we strive to stay at the forefront of the medical imaging landscape in India. Can you highlight any Mindray ultrasound solution that has made a significant impact in India?

Mindray's recent innovation, the Resona series, has made a significant impact in the field of diagnostic imaging. The Resona I9 is equipped with a range of innovative features that address the evolving demands of diagnostic imaging. The customisable control panel, foldable structure and super silent design improve the overall workflow efficiency. The system is powered by Mindray's revolutionary ZST+ platform, delivering exceptional image quality for infinite imaging solutions. This innovative ultrasound system is being actively utilized in an IRIA-initiated study titled “The diagnostic effectiveness of the new generation ZST Technology-based HFR SWE with M-STB & RLB Map on Resona series for liver elastography.” This study aims to transform the diagnosis and treatment for Non-Alcoholic Fatty Liver Disease (NAFLD) and reduce its burden in India. Mindray's commitment to

becoming a trusted partner for a healthier Bharat is commendable. Could you share some insights into the strategies and initiatives that the company has undertaken to achieve this goal, particularly in the Indian healthcare landscape? Mindray's commitment to becoming a trusted partner for a healthier Bharat is deeply ingrained in our strategies and initiatives, reflecting our dedication to transforming the healthcare landscape in India. By constantly pushing the boundaries of innovation through strong Research and Development (R&D), we have been able to provide safe, reliable, and user-centric medical devices that address the evolving needs of healthcare professionals. Our operation, sales, marketing, and service teams are dedicated to offering not just devices but also comprehensive support. We also understand that bringing healthcare within reach involves not only providing cutting-edge technology but also offering training and assistance. To address this, Mindray India provides various levels of training to customers, distributors, and service partners. Looking ahead to 2024, what innovations and developments can we expect from Mindray in the field of ultrasound modality? Are there any exciting products or technologies on the horizon that you can provide a sneak peek into? Looking ahead to 2024, Mindray is poised to focus in

advanced clinical solutions in GI, Women’s Healthcare and POC. In GI, Mindray will lead the industry through the introduction of a “multiparametric solution” dedicated to liver, Breast, Thyroid, Vascular, and Urology to enhance diagnostic confidence resulting in better treatment outcomes. In Women’s Healthcare, Mindray Full Stack Smart Solutions powered by AI & deep learning, expected to enhance diagnostic confidence, efficiency & standardization covering Pre-Pregnancy, Pregnancy, Post -Partum Recovery & Neonates. In Point of Care (POC) Mindray's advanced solutions help clinicians reimagine their clinical practice, in demanding environments of critical care and emergency medicine. With industry Unique Xlink, the ability to integrate vital parameters of patients on ultrasound images allows immediate decision by bedside, supporting rapid clinical decision for better patient outcomes. Most importantly revolutionary Zone Sonography Technology will be migrated across mid-segments through the Consona series. This will benefit the entire imaging fraternity in India including Primary care to enhance diagnostic confidence and precision reporting. By delivering comprehensive solutions and maintaining a broad portfolio, Mindray strives to be a holistic solution provider and a trusted partner in building a healthier Bharat.

EXPRESS HEALTHCARE

December 2023

HEALTHCARE TRACKER

Poly Medicure forges its new brand identity Himanshu Baid, Managing Director, Poly Medicure Ltd while talking about company’s new logo mentions that it is a visual representation of our commitment to advancing healthcare through innovation, quality, and customer satisfaction

ince our establishment in 1997, Polymed has undergone a remarkable transformation, evolving from a niche manufacturer to a comprehensive solution provider in the field of medical devices. Over the past two decades, our journey has been characterised by continuous innovation, an unwavering commitment to quality, and an expansion of our offerings to meet the dynamic needs of healthcare professionals and institutions. Adapting to the evolving healthcare landscape, we have navigated technological advancements and industry demands. Today, we proudly stand as a one-stop solution provider, offering a diverse portfolio of cutting-edge medical devices and integrated solutions to meet the ever-expanding requirements of modern healthcare ecosystems. As we evolve and grow as a company, we believe that our visual identity should also evolve to better represent who we are and where we are headed. The new logo is a visual representation of our commitment to advancing healthcare through innovation, quality, and customer satisfaction. Polymed has established a distinctive and remarkable position in the healthcare industry by prioritising a patientcentred approach. With a substantial emphasis on R&D, we have been granted over 370+ patents across an extensive product portfolio, covering vascular access, renal care, transfusion, and diagnostics. Furthermore, Polymed is poised to enter the fields of critical care and cardiology. Through unwavering commitment to innovation, Polymed has effectively addressed key therapeutic domains, including infusion therapy, dialysis, respiratory care, cardiol-

34 EXPRESS HEALTHCARE December 2023

Today, we proudly stand as a one-stop solution provider, offering a diverse portfolio of cutting-edge medical devices and integrated solutions to meet the ever-expanding requirements of modern healthcare ecosystems

ogy, oncology, urology, gastroenterology, critical care,

blood collection and management, anaesthesia, surgery, and

wound drainage. Today, the company stands as an exemplar in the medical devices industry, holding the distinction of being India's largest exporter of consumable medical devices. Our products reach over 125+ countries, solidifying our well-deserved rep-

utation as a foremost player in the medical device sector. The company’s industry dominance is reinforced by an extensive manufacturing infrastructure, boasting 12 state-ofthe-art facilities spread across the globe. These cutting-edge plants collectively produce over 1 billion medical devices annually, meticulously designed to meet the most stringent global standards of quality and safety. Company recognises the pivotal role healthcare providers play in delivering quality care. We actively engage with them in collaborative efforts to run clinical training programs which are designed to empower healthcare professionals to effectively use Polymed's innovative medical devices. By nurturing their expertise, we ensure that our products are utilized to its fullest potential, ultimately benefiting patient care. At the heart of every healthcare innovation are the clinical specialists. By engaging with them and incorporating their feedback into the development and refinement of medical devices, Polymed ensures that its products align with real-world needs and preferences. Patientfocused approach enhances the overall healthcare experience and contributes to better health outcomes. Along with winning the award for the largest Indian consumable medical device exporter from India by PLEXCONCIL (Plastic Export Promotion Council) for the last ten years, the company was also the recipient of many other prestigious honours including "India Medical Device Leader of the Year 2022" award by the Department of Pharmaceuticals Ministry of Chemicals & Fertilizers - Government of India and one of the top “25 Innovative Companies” by CII in 2019.

HEALTHCARE TRACKER

Sysmex: Advancing coagulation with innovative reagents and instruments Srinivas Naidu, Senior Product Manager-Coagulation, Marketing, Sysmex talks about the trends in Indian coagulation market

n recent years, the Indian coagulation market has been witnessing several growing trends. Here are a few notable ones: ◆ Increasing demand for point-of-care testing: There is a growing need for quick and accurate testing in coagulation disorders. Point-ofcare testing devices, which provide rapid results at the patient's bedside, are becoming more popular in India. ◆ Expansion of hemophilia treatment centers: Hemophilia treatment centers (HTCs) are specialised facilities that provide comprehensive care for individuals with bleeding disorders. These centers are being set up in major cities across India, providing access to advanced treatments and improved patient outcomes. ◆ Adoption of advanced coagulation testing methods: Traditional coagulation tests, such as prothrombin time (PT) and activated partial thromboplastin time (aPTT), are being complemented or replaced by newer assays like chromogenic assays, Automated Platelet aggregometry. These modern methods offer better precision, accuracy,

and monitoring capabilities. ◆ Rise in awareness and screening for thromboembolic conditions: With an increasing awareness about thromboembolic diseases like deep vein thrombosis (DVT)

and pulmonary embolism (PE), more people are undergoing screening tests for early detection and prevention. This has led to a greater demand for coagulation panels and D-dimer tests.

◆ Availability of novel anticoagulant drugs: There has been a significant development in the availability of novel oral anticoagulants (NOACs) in the Indian market. These medications offer

advantages over traditional anticoagulants, such as better safety profiles, convenient dosing, and reduced need for monitoring. These trends reflect a positive growth trajectory for the Indian coagulation market, indicating advancements in diagnostics, treatments, and overall patient care. Sysmex has been at the forefront of innovation in coagulation, revolutionising diagnostics in this field. Their cutting-edge technologies have advanced the accuracy and efficiency of coagulation testing. With Fully automated analysers, Sysmex enables rapid and precise measurement of clotting factors, platelet function, and other coagulation parameters. Their innovative reagents and algorithms enhance the detection of abnormalities, aiding in the diagnosis and monitoring of bleeding disorders and thrombotic conditions. Sysmex's commitment to continuous research and development has paved the way for improved patient care, empowering healthcare professionals with reliable coagulation diagnostic solutions.

EXPRESS HEALTHCARE

December 2023

HEALTHCARE TRACKER

Medikabazaar dental: The online dental superstore Dental professionals can trust the platform's curated selection of genuine products sourced directly from top-tier brands

t the core of Medikabazaar's success lies its assurance of authenticity. Dental professionals can trust the platform's curated selection of genuine products sourced directly from top-tier brands. This guarantee instils confidence, ensuring practitioners receive only the highest quality supplies for their patients' care. Recognising the diverse preferences of its customers, Medikabazaar offers the ease of Cash on Delivery (COD), eliminating payment concerns

36 EXPRESS HEALTHCARE December 2023

Dental professionals seeking an efficient, reliable, and cost-effective means of acquiring authentic supplies need look no further than Medikabazaar's Online Superstor and simplifying the purchasing process. Additionally, the platform is committed to providing the best prices without compromising on quality, making it an ideal destination for cost-effective procurement.

In the ever-evolving landscape of healthcare, Medikabazaar has emerged as a game-changer in the realm of dental supply procurement. With a commitment to convenience, reliability, and accessibility, this online dental

superstore has catered to the needs of over 14,300 dentists, delivering across 19,000+ pincodes nationwide. As a gesture of appreciation, Medikabazaar extends a warm welcome to new registrants. Those who sign

up receive an exclusive 7 per cent discount on their inaugural order, further enhancing the allure of sourcing dental supplies through this user-friendly platform. Dental professionals seeking an efficient, reliable, and cost-effective means of acquiring authentic supplies need look no further than Medikabazaar's Online Superstore. Experience the future of dental procurement by visiting medikabazaar.com/Dental and simplify your supply sourcing today!

Scan smart. Ignite your potential. Remarkably sharp. Amazingly mobile. Pristine images, automated functions, intelligent workflows – Aplio flex is as sharp as it looks. The system excels with unmatched mobility, high efficiency and imaging quality. Loaded with smart imaging and workflow functions, Aplio flex is the ideal system to handle a wide variety of imaging needs in a busy clinic. Its versatile design ensures consistently high performance across the entire imaging portfolio.

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