Express Healthcare (Vol. 15, No. 6) July 2022 by Indian Express

VOL.15 NO 6 PAGES 64

STRATEGY Filling the existing surgical gaps: Need of the hour PUBLIC HEALTH New-born screening for metabolic disorders: The need of the hour JULY 2022, `50

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CONTENTS INTERVIEW Chairman of the Board Viveck Goenka

DR UMANG MATHUR

DR ARPAN GANDHI

Sr. Vice President-BPD Neil Viegas

Executive Director, Dr Shroff Charity Eye Hospital

Director of Ocular and ENT Laboratory Services, Shroff Charity Eye Hospital

Asst. Vice President-BPD Harit Mohanty Editor Viveka Roychowdhury* BUREAUS Mumbai Lakshmipriya Nair, Kalyani Sharma Delhi Akanki Sharma DESIGN Asst. Art Director Pravin Temble

Pg 14

STRATEGY

Digital Team Viraj Mehta (Head of Internet) Marketing Team Rajesh Bhatkal Ambuj Kumar Ashish Rampure Debnarayan Dutta PRODUCTION General Manager BR Tipnis Production Co-ordinator Dhananjay Nidre Scheduling & Coordination Pushkar Waralikar

DIAGNOSTICS

CHRONIC DISEASE MANAGEMENT APPS: FILLING A VOID IN THE INDIAN HEALTHCARE ECOSYSTEM

RAPID GROWTH OF E-DIAGNOSTIC INDUSTRY NECESSITATED THE CREATION OF A SELF-REGULATORY CODE OF CONDUCT

FILLING THE EXISTING SURGICAL GAPS: NEED OF THE HOUR

DRONE TECHNOLOGY'S VIABILITY IN INDIA'S DIAGNOSTIC SECTOR

Senior Designer Rekha Bisht Senior Artist Rakesh Sharma

COVER STORY

P25: INTERVIEW SUNIL KHURANA CEO & MD, BPL Medical Technologies

PUBLIC HEALTH

NEW-BORN SCREENING FOR METABOLIC DISORDERS: THE NEED OF THE HOUR

HEALTHCARE IT

DIGITISATION OF ICUS AND REDUCTION IN MEDICAL ERRORS

WHY CONVERSATIONAL AI AND CHATBOTS ARE PERFECT FOR DIGITAL HEALTH

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)

CIRCULATION Circulation Team Mohan Varadkar

* 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.

EXPRESS HEALTHCARE

July 2022

EDITOR’S NOTE

Healthcare sector ripe for GST rationalisation

he Goods and Services Tax (GST) Council's recommendation on June 28 for a 5 per cent levy without input tax credit on non-ICU hospital rooms above Rs 5,000, marks the first time that healthcare services will be taxed in the country. The GST Council's recommendation, driven by a compulsion to increase collections from direct taxes across sectors, has predictably drawn protests from healthcare providers. The move is due to take effect on July 18 and a consortia of industry associations spanning AHPI, ASSOCHAM, FICCI, IMA and NATHEALTH, has shot off a detailed note to the Finance Minister Nirmala Sitharaman, listing the reasons why the GST Council’s recommendation is "contrary to the very spirit and objectives set by government to provide affordable healthcare services to population at large." The note reasons that since healthcare per se has been kept out of GST purview and the hospital bed is very much an integral part of this CARE, it therefore is reasonable that room charges should not be brought under GST purview. The note also lists recommendations, ranging from no GST being levied across the spectrum of health, to providing a 0 rated or one per cent rate of output GST to all of healthcare so that hospitals can avail input credit and the benefits can be passed on to patients. The note also reminds the Finance Minister not to compare healthcare services to other service sectors, as it saves lives and a “patient who is sick does not come willfully to the hospital.” In a statement, President of NATHEALTH Dr Shravan Subramanyam, Managing Director, Wipro GE Healthcare pointed out that this is an additional GST burden on consumers who seek quality healthcare providers in non-ICU settings. He explains,"By not allowing input credit, government is breaking the chain of credit and not allowing any offset for the near 6 per cent embedded GST burden on healthcare sector which would have allowed quality healthcare footprint to expand." Dr Subramanyam recommended that this issue can only be addressed by putting a nominal output GST on core health services and reduction of GST input slabs on healthcare input items to unlock the large embedded taxes in healthcare delivery making quality healthcare more accessible, safe and affordable across the nation. As the order specifies that there will be no input tax credit, the levy will pass on to to patients and will add to the general inflationary pressure on patients and their caregivers. Unlike opting for higher pricer hotel rooms, a higher priced hospital room is not a luxury but a necessity, dictated by treatment regimes. Thus if the GST Council's aim was to tax a certain section of patients who could afford pricier rooms, the levy is mis-directed. As the note explains, many tertiary/quaternary care treatments like organ transplants, bone marrow procedures, even COVID cases, need isolation for patient safety and therefore, patients will have to be kept in private rooms. Unfortunately, these cases often call for prolonged hospitalisation, adding to the burden on patients. The note also asks whether this levy is applicable for patients in High Dependency Units, which function like step-down ICUs for patients who may recover from the ICU but still require constant monitoring in the ward till complete recovery. Worse, as the note points out, insurance companies can set off the GST against GST collected on the insurance

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July 2022

If the GST Council's aim was to tax a certain section of patients who could afford pricier rooms, the levy is mis-directed

premium, the burden of the 5 per cent tax is going to be borne by cash paying patients who are more likely to be poorer than insured patients. A recent NATHEALTH-EY study on embedded taxes in the healthcare sector mentions that the taxes on healthcare services turn out to be quite substantial and the burden is higher for the bottom 40 per cent, as bulk of healthcare expenditure is on medicines (which are taxed at a higher rate than medical services), and particularly so for the bottom 40 per cent. The NATHEALTH-EY study analyses how many inputs going into the healthcare sector are taxed heavily but remain blocked in the value chain as the sector is exempt at the output end. Therefore, the report posits that the phasing away of exemption and bringing the healthcare sector under the GST ambit with some kind of merit rate at the output healthcare service would help in solving the problem of embedded taxes by allowing pass through of input tax credits in the healthcare value chain and thereby would slash the healthcare cost for end consumers. But to determine the merit rate, it is crucial to first estimate the quantum of embedded taxes in the healthcare sector. Which is what the NATHEALTH-EY study set out to do. Based on the data provided by six hospitals and six testing labs and diagnostic centers in India which were part of the NATHEALTH-EY study, it is clear that the sector has not derived the benefits of GST transition, with increasing rather than decreasing embedded taxes. For hospitals, the embedded taxes rate has increased from 4.3 per cent in 2016-17 to 5.7 per cent in the GST period while for testing labs, the embedded taxes rate has increased from 3.8 per cent to 5.8 per cent. As per the report, the inputs leading to blocked input taxes are different for both these segments. While hospitals incur higher expenditure on medicines (both general and lifesaving) as well as contractual labour for cleaning, maintenance and repair services of hospital facilities, they also on an average hire more contractual labour in comparison to testing labs, on which they incur GST rate of 12-18 per cent depending on the nature of the contractual labour hired. In contrast, testing labs incur high expenditure on chemicals, reagents and kits to cater to the high volume of testing demand emerging in India. Such testing labs also have higher marketing expenditure as compared to hospitals, points out the report. The NATHEALTH-EY study puts up four options for discussion. Either the status quo is maintained, with the healthcare sector continuing to be GST exempt. Option 2 proposes a zero rating on healthcare services, which will cause no change in price to the consumers while also reducing the burden of embedded taxes on healthcare service providers. In the third option, a suitable GST rate may be levied on output services for all private hospitals and an optional dual rate structure may be given for government establishments. The fourth option proposes a combination of these three options. As the government considers a large-scale GST rate rationalisation exercise across sectors, it is imperative that these anomalies are corrected so that healthcare costs are made more, not less, affordable.

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

More Efﬁciency with Fewer Bottles NEW 500 mL Ultravist® bottle

To bring you additional efﬁciencies – especially in busier radiology suites – Ultravist® (lopromide) is now also available in a larger 500 mL bottle, for multi-use injection systems. More Convenience The larger size means that you can conduct more scans per bottle, and need fewer bottle changes.

More Choice Choose the most efﬁcient solution for your suite – now with a wider choice of bottle sizes.

More Sustainability

ULTRAVIST Abridged Prescribing Information : Composition : Ultravist 300, 370 : 1 ml contains 0.623 g (equivalent to 300 mg iodine), 0.769 g (equivalent to 370 mg iodine) iopromide in aqueous solution. For diagnostic use. Indications: Ultravist: This medicinal product is for diagnostic use only. To be used as a contrast medium for Uro-angiography, for intravascular use & use in body cavities for contrast enhancement in Computerized Tomography (CT), arteriography and venography, intravenous/ intraarterial digital subtraction angiography (DSA), intravenous urography, use for ERCP, arthrography and examination of other body cavities. Dosage and method of administration: For intravascular use: Dosage should be adapted to age, weight, clinical question and examination technique. Generally, doses of up to 1.5 g iodine per kg body weight are well tolerated, for use in body cavities: Arthrography: 5 - 15 ml Ultravist 300/370, ERCP: Dosage depends generally on clinical question and size of structure to be imaged. Other: Dosage depends generally on clinical question and size of structure to be imaged. Contraindications: There are no absolute contraindications to the use of Ultravist. Undesirable effects: Immune system disorders: (uncommon)- Hypersensitivity / anaphylactoid reactions such as: anaphylactoid shock, respiratory arrest, bronchospasmlaryngeal / pharyngeal, face edema, tongue edema, laryngeal / pharyngeal spasm, asthma , conjunctivitis, lacrimation, sneezing, cough, mucosal edema, rhinitis, hoarseness, throat irritation, urticaria, pruritus, angioedema; Endocrine disorders: (not known)- Thyrotoxic crisis, Thyroid disorder; Psychiatric disorders: (Rare)- Anxiety; Nervous system disorders: (Common)- Dizziness, Headache, Dysgeusia; (uncommon)- Vasovagal reactions, Confusional state, Restlessness, Paresthesia / hypoesthesia, Somnolence; (not known)- Coma, Cerebral ischemia / infarction, Stroke, Brain edema, Convulsion, Transient cortical blindness, Loss of consciousness, Agitation, Amnesia, Tremor, Speech disorders, Paresis / paralysis; Eye disorders: (Common)- Blurred/ disturbed vision; Ear and labyrinth Disorders: (not known)- Hearing disorders; Cardiac disorders: (common)- Chest pain / discomfort; (uncommon)- Arrhythmia; (rare)- Cardiac arrest, Myocardial ischemia, Palpitations; (not known)Myocardial infarction, Cardiac failure, Bradycardia, Tachycardia, Cyanosis; Vascular disorders: (common)-Hypertension, Vasodilatation; (uncommon)- Hypotension; (not known)- Shock, Thromboembolic events, Vasospasm, Respiratory, thoracic and mediastinal disorders: (uncommon)- Dyspnea; (not known)- Pulmonary edema, Respiratory insufficiency, Aspiration; Gastrointestinal disorders: (common)- Vomiting, Nausea; (uncommon)- Abdominal pain; (not known)- Dysphagia, Salivary gland enlargement, Diarrhea; Skin and subcutaneous tissue disorders: (Not known)- Severe cutaneous reactions: Toxic epidermal reactions: Toxic epidermal necrolysis (TEN)/Lyell syndrome, Stevens-Johnson syndrome (SJS), Drug reaction with eosinophilia and systemic symptoms (DRESS), Acute generalized exanthematous pustulosis (AGEP) Rash, Erythema, Hyperhydrosis; Musculoskeletal, connective tissue and bone disorders: (not known)- Compartment syndrome in case of extravasation; Renal and urinary disorders: (not known)- Renal impairment, Acute renal failure, General disorders and administration site conditions: (common)- Pain, Injection site reactions like pain, warmth, inflammation and soft tissue injury in case of extravasation), Feeling hot; (uncommon)- Edema; (not known)- Malaise, Chills, Pallor; Investigations: (not known)- Body temperature fluctuation. Special warnings and special precautions: Caution is advised in patients with hypersensitivity or a previous reaction, bronchial asthma, thyroid dysfunction, CNS disorders, hydration (Adequate hydration status must be assured in renally impaired patients), anxiety, renal impairment, cardiovascular disease, pheochromocytoma, myasthenia gravis, thromboembolic events. Storage and handing instructions: Ultravist should be warmed to body temperature prior to use. Protect from light and secondary X-rays. Store below 30°C. Keep out of reach of children. Contrast media should be visually inspected prior to use and must not be used, if discolored, nor in the presence of particulate matter (including crystals) or defective containers. For large volume containers: The multiple withdrawal of contrast medium must be done utilizing a device approved for multiple use. The rubber stopper of the bottle should never be pierced more than once to prevent large amounts of microparticles from the stopper getting into the solution. The contrast medium must be administered by means of an automatic injector, or by other approved procedures which ensure sterility of the contrast medium. The tube from the injector to the patient (patient's tube) must be replaced after every patient to avoid cross contamination. The connecting tubes and all disposable parts of the injector system must be discarded when the infusion bottle is empty or ten hours after first opening the container. Instructions of the device manufacturer must be followed. Please refer to full prescribing information before use. Source: PI Version No. UL_2021_02 dated 15 Dec 2021. Based on CCDS version 16 dated May 03, 2021, Date of API update: 10-02-2022.

This poster is for informational purpose and by no means obligates or inﬂuences any medical practitioners to prescribe, recommend or purchase any products from Bayer Pharmaceuticals Private Limited (Bayer) or any of its afﬁliates. Please read full prescribing information before issuing prescription for the product mentioned in this poster. Strictly for the use of registered medical practitioner or hospital or laboratory only.

Bayer Pharmaceuticals Private Limited, Bayer House, Hiranandani Estate, Thane, India. Pin: 400 607 or email - medicalinfo.india@bayerzyduspharma.com

PP-M-CEN-IN-0042-1, Approved Feb 2022

The larger presentation also means less packaging and less waste, together with greater ease of handling.

STRATEGY I N T E R V I E W

The cross-subsidy model definitely works in India and most importantly in eye care Dr Umang Mathur, Executive Director, Dr Shroff Charity Eye Hospital and Dr Arpan Gandhi, Director of Ocular and ENT Laboratory Services, Shroff Charity Eye Hospital in an interaction with Kalyani Sharma talks about eye care in Ayushman Bharat and highlights the role of assistive technology to better the eye care facilities in India What is the need of the hour as far as the role of Ayushman Bharat in eye care is concerned? Dr Mathur: Launched in September 2018, Ayushman Bharat actively aims to achieve universal health care. This initiative stands out as a great contribution toward the eradication of blindness because a large chunk of the population that are blind can now have access to hospitals with dignity. One of the important things is that patients no longer have to be dependent for their daily activities. In addition, it gives dignity to the patient to confidently visit a hospital and get their surgery done. This initiative also supports the hospitals. The hospitals doing eye care services are being paid for the procedures and treatments. The process is so huge and yet works so seamlessly that the money to the hospital is transferred quite conveniently within six weeks of the treatment. This way, the hospitals serving the society are also happy and can effortlessly look after the patients their work and contribution are acknowledged. Overall, it is a well-designed scheme having the potential to develop the healthcare industry, more specifically, the eye care industry and society. In addition, it is very important to create awareness about the project at the grassroots level. All our hospitals in the UP (Mohammadi, Meerut, Saharanpur, Vrindavan) area are working under the

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July 2022

Dr Umang Mathur

Ayushman Bharat project and have successfully treated 5,825. Does assistive technology hold the potential to better the eye care facilities in India? Dr Mathur: Assistive technologies are one big achievement for the eye care industry. These technologies are useful for visually impaired individuals for whom getting their vision back is not possible. In today’s time, there are technologies like –mobile phones, which have different applications to help an

Dr Arpan Gandhi

individual keep a tap on their activities and communicate for their needs. We also have the Smart Vision Glasses these days, an Artificial Intelligence-based wearable device that can help the visually impaired read, navigate, and recognise objects and people. With the intent to make vision care accessible and affordable to all sections of society, especially the lower socioeconomic background, we started the Vision Enhancement Centre (VEC) in 2022. It provides training

in adaptive techniques, counselling support and most importantly fitting and dispensing of appropriate optical and non-optical devices. Leveraging the crosssubsidy model in healthcare institutions, how uncompromised quality care can be provided to all patient segments in India? Dr Mathur: India has shown very good examples of the cross-subsidy model, most importantly in eye care services. The cross-subsidy

model means that the patients, who have the money, do pay for the procedure and from that surplus; we look after people who are unable to afford their treatment and surgery. This helps in creating a financially sustainable model for the hospitals, where 50 per cent or more number of patients are highly subsidised or non-paying. To make this model long-lasting and sustainable, it is always important to provide highquality service to every section of the society, both paying and non-paying,

STRATEGY without any compromise on the hospital standards. The cross-subsidy model definitely works in India and most importantly in eye care because the consumable cost of surgery is very low, as we have locally manufactured high-quality products like intra-ocular lenses in India. Tell us about your company's initiatives and future plans for the Indian market? Dr Mathur: Avoidable blindness is a rising issue now and in North India, there is a lot to do in terms of eye care and blindness. We have been trying to do our best to reduce the rising rate of avoidable blindness by organising camps, screenings and projects. As part of our initiatives, in the next 5 years, we plan to conduct 100,000 sight restoration surgeries of which 50 per cent will be done for the very poor section of the society. We also plan to reach out to the geographic areas where there are no eye care services available.

India has shown very good examples of the cross-subsidy model, most importantly in eye care services.The cross-subsidy model means that the patients, who have the money, do pay for the procedure and from that surplus; we look after people who are unable to afford their treatment and surgery.This helps in creating a financially sustainable model for the hospitals, where 50 per cent or more number of patients are highly subsidised or non-paying For this, we would need to create the right human resources and by training young doctors as well as local young women as eye care paramedics, we will try to have the maximum workforce to reach this challenge. Can you highlight the significance of ocular laboratory services in the field of ophthalmology? Dr Gandhi: It has benefited all branches of ophthalmology and the lab has specialised

skilled manpower and is headed by a trained, experienced ocular laboratory specialist. The importance in identifying the correct organism and the sensitivity pattern is the most important step in starting targeted effective medical and surgical treatment. What is its current status and what more is required in terms of investment, attention and focus from key stakeholders?

Dr Gandhi: The current status is that the Main central Super specialised Ocular Lab is equipped with the latest equipment and also trained and experienced personnel. The area that needs attention is in setting up specialised labs in other locations as well as more focus in digitalisation and advanced microscopy. Also, in getting more people trained and the present lab acting as a training center with more reach throughout North and Central India.

What will be the contribution of ocular lab services to eye care in the coming years? How will it be beneficial for patients from remote parts of India? Dr Gandhi: With the opportunity to spread the network to areas where laboratory services would be so useful, we not only trained the team to do the lab work but also to run the lab services in small units with support from the main branch in Delhi. This translated into the secondary center labs and other consortium eye hospitals to set up labs and be able to diagnose patients with ulcers and other clinical conditions. This way a definite diagnosis can be made and the correct treatment can be started. The laboratory opened a fully equipped and functional laboratory in ShahjahanpurLakhimpur district where it has been able to diagnose 600-800 eyes of framers etc. with a geographical reach of 500 kilometers in rural India. Kalyani.sharma@expressindia.com journokalyani@gmail.com

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Express Healthcare accepts editorial material for the regular columns and from pre-approved contributors/columnists. Express Healthcare has a strict non-tolerance policy towards plagiarism and will blacklist all authors found to have used/referred to previously published material in any form, without giving due credit in the industryaccepted format. As per our organisation’s guidelines, we need to keep on record a signed and dated declaration from the author that the article is authored by him/her/them, that it is his/her/their original work, and that all references have been quoted in full where necessary or due acknowledgement has been given. The declaration also needs to state that the article has not been published before and there exist no impediment to our publication. Without this declaration we cannot proceed. If the article/column is not an original piece of work, the author/s will bear the onus of taking permission for re-publishing in Express Healthcare. The final decision to carry such republished articles rests with the Editor. Express Healthcare’s prime audience is senior

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July 2022

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viveka.r@expressindia.com viveka.roy3@gmail.com Editor, Express Healthcare

STRATEGY

Chronic disease management apps: Filling a void in the Indian healthcare ecosystem Parijat Ghosh and Arunava Saha Dalal, Partners, Bain & Company’s New Delhi office and Sujay Subramnayan, Associate Partner, Bain & Company’s Mumbai office highlights that as digital technologies are transforming healthcare in the country, there is significant untapped potential in the chronic disease management space

hronic diseases in India are becoming more prevalent; the country has over 55 million cardiac patients, over 20 million asthmatics, and more than 74 million diabetics. The incidence of chronic, non-communicable, and lifestyle diseases has increased notably over the past few years. Bain analysis suggests that the number of diabetics alone are expected to increase by almost 30 per cent to reach 100 million by 2030, making India the country with the second-highest diabetes burden in the world. Almost 50 per cent of diabetes cases go undetected in India, an even smaller

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July 2022

CAR RDIOVIIT® AT-102 G22 Easy, Smart and State-of-the-Art Ÿ High resolution 8” colour display Ÿ Touch function keys Ÿ Easy-to-clean sealed alphanumeric keyboard Ÿ More than 8 hours battery capacity with ECG printout Ÿ Resting rhythm up to 10 minutes Ÿ Hook-up adviser with colour-coded waveforms and

anatomical model

STRATEGY percentage of patients seek proper treatment, and barely 10 per cent–30 per cent of patients diligently adhere to the clinical and lifestyle protocols to manage the disease.

Pain points for patients Our research with patients and focus groups showed that multiple challenges exist for patients in their diabetes journeys—from dealing with stress from initial diagnosis, to clinical and lifestyle decision making, and then to ongoing disease management. The pain points at the diagnosis stage include acceptance of the longevity of the diseases and stress due to transitions in everyday habits, like switching to a low-sugar diet, consuming meals frequently to avoid sugar fluctuations, and exercising regularly to ensure physical and mental wellness. The patient also faces dilemmas like having to choose from several doctors or clinics for long-term treatment and making decisions about their diet and exercise regime, which becomes difficult due to lack of comprehensive, personalised advice and absence of a single source of truth for information. The challenges related to ongoing management primarily relate to acclimatisation and adherence to the treatment plan, monitoring and managing health records with limited clarity on interpretations of recorded vitals, and following up with doctors for treatment modifications and ordering medical supplies while dealing with the stress of the disease worsening over time.

Parijat Ghosh

the entire disease management journey—from finding the right doctor for proper diagnosis and suggesting changes in daily routines to setting up a personalised workout, medication, and diet plan and maintaining a tracker for vitals, right down to supporting the patient in stocking medicine supplies and follow-up visits to the doctor. CDM apps not only help to address patient pain points vis-à-vis the current system and fill a critical gap, but they also provide proper ongoing care, support, knowledge, and resources. Moreover, CDM apps strive to address concerns by providing access to health coaches, community support, a repository of verified doctors, personalised plans, reminders, easy tracking, continuous connect with doctors, and quick support in emergency situations, making them invaluable for chronic disease patients.

Addressing patient needs

A proven success

Essentially, the healthcare ecosystem—pharma companies, hospital chains, and doctors—does not currently fully address the major needs of chronic disease patients and a huge gap exists that can be potentially bridged via chronic disease management (CDM) applications. An effective, tech-based solution would be one that guides and enables the patient through

The new wave of tech driven CDM apps are fulfilling all these responsibilities and not only emerging as catalysts of change, but also redefining the healthcare business. For instance, a CDM app can design a personalised diet plan for a patient depending on whether the patient is vegetarian or non-vegetarian; it can also serve as a reliable source of information and

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Arunava Saha Dalal

guidance when the doctor may not be readily available. CDM apps provide personalised exercise planning, motivate users to continue adherence by offering benefits, and allow easy logging and storage of personal health data. They also issue reminders to re-order medicines based on past orders and adherence logs. An efficient CDM app becomes an integral part of the patient’s lifestyle, addressing patient pain points while providing the app’s promoters and partner companies direct access to the patient through their chronic disease journey over time. Globally, companies have used the hook-monetise-differentiate-engage model to make CDM apps a huge success. These apps address critical success factors such as endorsements, effective onboarding, economic benefits for doctors, establishment of payment models, B2B partnerships, and having a robust artificial intelligence (AI)/machine learning platform. CDM apps also rely on gamification of the patient’s experience and integration of “doctor-device-patient” triage to ensure strong engagement with patients. For instance, Livongo, the poster child of CDM apps globally, achieved strong growth through a wide spectrum of initiatives—from partnerships with tech giants and a voice-enabled glucose

Sujay Subramnayan

monitor to integration with digital watches and AIdriven personalisation with real-time health signals. Offering strong, demonstrable clinical outcomes at virtually zero cost to patients, CDM platforms like Livongo that are monetised via the B2B2C model have tremendous potential for growth in the years to come.

The Indian opportunity India is a nascent but emerging market for CDM apps. It is bustling with action, and early entrants are not only enjoying good traction among users, but also interest from investors. Phable provides select rule-based insights, continuous doctor monitoring, and discounted, value-added services and has more than 3 million users with $40 million in funding. BeatO has more than 300,000 users with $9 million in funding, providing a smooth user interface/user experience and personalised plans. International CDM player Wellthy Therapeutics, which provides clinical trialbacked AI recommendations and personalised plans with a counselling and motivationcentric approach, has signed a strategic and commercial partnership with Cipla to expand into hypertension and dyslipidemia. Similarly, Manipal Hospitals and PharmEasy have stakes in Phable and BeatO, respec-

tively. Healthcare players are recognising the importance of CDM apps for engagement with their patients. Leading healthcare companies are entering into strategic partnerships with healthtech companies, offering clinically validated digital disease management platforms to patients in cardio-metabolic health. The aim is to leverage digital technology in a big way and play a significant role in transforming healthcare management. Beyond investing in digital therapeutics and augmenting their analytics abilities to tap new possibilities, these organisations are deploying CDM apps to create and maintain direct connections with consumers. CDM apps are emerging as game changers, and given the sheer number of potential users in the country, the CDM space is set to grow exponentially in the years to come. While first movers will enjoy a distinct advantage in the short-term, customer-centricity and innovation will be decisive factors in picking the leaders of this rewarding sector. For healthcare ecosystem players—including pharma, providers, medtech, and other players—the time is ripe to strike a partnership with CDM apps to enhance the quality of life of their patients while also futureproofing their business.

STRATEGY

Filling the existing surgical gaps: Need of the hour Bidhan Chowdhury, Founder, TaCa Healthcare highlights that surgical care gaps exist worldwide and need immediate attention to lower the global burden of diseases on our planet

hen the pandemic first hit in the early months of 2020, India had to reschedule nearly 5.8 lakh elective surgeries as hospital resources were diverted to COVID management. Even as protocols were in place, the unprecedented pandemic situation required a singular focus on containing infections and preventing casualties. Earlier this year too, the government advised postponing elective surgeries in order to not repeat a shortage of beds as was the case last year. Elective surgeries refer to procedures that can be scheduled in advance but need not be conducted on an urgent basis. But lack of access to these surgeries for any reason can cause a lot of discomfort to the patients and, in some cases, may lead to emergency situations, threatening the life of the patient. In the last few decades, India has set world-class benchmarks in establishing quality healthcare in urban centres, but unfortunately, it is not accessible to a vast section of society because of high out ofpocket cost. However, in smaller cities and rural parts of the country, quality healthcare remains a concern because of the lack of infrastructure and skilled manpower. The cost of quality healthcare is still the most important factor in providing specialty care to the masses. Private healthcare is undoubtedly out of reach to a vast majority of people. In smaller cities, the so-called affordable healthcare system made up of small hospitals and nursing homes is fragmented. This has led to a ‘Crisis of Trust’, creating an opportunity for the emergence of 'Ethical' healthcare brands. Surgical care gaps exist worldwide and need immediate attention to lower the global burden of diseases on our planet. According to a World Bank report, 14.3 crore additional surgical procedures are

The principles of supply and demand suggest that if multiple options for elective surgeries are easily available, costs would likely to come down and more people would be able to access them needed each year to save lives and prevent disability. 11 per cent of the global burden of disease requires surgical care. The Lancet Commission for Global Surgery (LCoGS) estimated that 5000 surgeries are required to meet the surgical burden of disease for 100,000 people in Lower & Middle Income Countries. According to NITI Aayog’s repor, up to 60 per cent of health facilities are concentrated in a handful of large cities across the country, which means access to quality healthcare services is limited to only tier-1 cities. Presently, only 30 per cent-35 per cent patients in

India undergo surgery compared to 60 per cent-65 per cent globally and comparatively, elective surgery numbers are much lower. Elective surgeries accounted for 40 per cent of the estimated two crore surgeries conducted in India in the year before the pandemic. As a country with a high disease burden, India is likely to see an increase in elective surgeries, but somehow, they have never been a priority. In fact, the cancellation of all elective surgeries due to COVID has already created a huge backlog of deferred surgical procedures, bringing the neglected issue to

the fore. How can we deal with the situation? The country needs a multi-pronged approach to make short-stay elective surgeries accessible to the masses. First, these surgeries should be made available to people near their homes. A lot of people, especially in smaller towns, keep avoiding surgeries even after they are prescribed by their doctor because it requires them to travel long distances to avail the treatment. This increases the burden on their pocket and makes post-surgery follow-up with their doctor, a must for proper recovery of the patient, tedious. Second, those who have a choice of surgery facilities nearby often find the cost exorbitant. It is a man-made problem. In urban areas of the country, people feel that for all kinds of surgeries they need tertiary care centres. It is a misconception. Only those requiring critical care should be treated at tertiary care centres. These centres are equipped with high-end equipment needed to diagnose and treat severe diseases. While they are a must for patients suffering from a severe disease, they can cause an unnecessary financial burden on those who can safely be treated at secondary healthcare centres. Segregation of patients on the basis of their health needs is an effective way to bring down the cost of healthcare. Your day-to-day health issues such as cold and cough, pains and aches, fever, etc should be treated at primary healthcare centres –the neighbourhood clinics by general practitioners (GP) can serve this purpose. This GPs, if there is a need, would refer you to secondary or tertiary level care centres. This segregation of patients is a must to avoid overburdening of tertiary care centres, reduce the incidence of burnout among super-specialists, and bring down costs for patients.

The principles of supply and demand suggest that if multiple options for elective surgeries are easily available, costs would likely to come down and more people would be able to access them. But if elective surgeries are only available in tier-1 cities or only in expensive hospitals, the needy patients would remain unserved. Instead, decentralising helps reduce the cost for patients, opens revenue streams for many stakeholders in healthcare and reduces the country’s disease burden. COVID is unlikely to end anytime soon. The pandemic has many stages –extreme spread, plateau, low rate of infections etc and not every stage will require the same set of intensive resources. The way- out is to build healthcare delivery models that are asset-light but can help boost revenues for healthcare providers. One option could be to schedule elective surgeries as daycare procedures as often as possible. Another way would be to build partnerships and collaborations among stakeholders so that underutilised health infrastructure across cities can be optimally used. The most effective solutions are the ones that can be scaled up and replicated even in the most difficult circumstances. So, it is better to focus on innovative, out-of-the-box, peoplefriendly healthcare solutions that can help improve and save millions of lives. Let’s understand the real gaps and challenges in the healthcare system that are preventing us from reducing the cost of elective surgeries. It is possible to fill these gaps and make surgeries accessible to a vast majority of people, irrespective of their social and economic backgrounds and their locations. Together we can and must do it for the sake of the well-being of the millions of people, who continue to suffer for lack of affordable surgical care. Let’s join this mission!

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With the adoption of technologies, India's medtech market has evolved to provide quality medical services to patients. However, there are still some unexplored challenges and areas that need attention By Kalyani Sharma

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he Indian medical devices sector was recognised as a sunrise sector by the Government of India as part of Make in India campaign in 2014. Since then, the industry has evolved in terms of deepening its prowess in the value chain across device-segments ranging from low-tech segment like consumables to the more sophisticated ones like diagnostic devices, high- end surgical equipment, etc. With technological advancements, the role of medical devices is now expanding to improve quality of care across each stage of the healthcare continuum. The healthcare industry in general has witnessed various revolutionary changes like elevated use of technology adoption. At the beginning of the pandemic, India's medtech sector had a bigger responsibility as it was faced with multiple challenges like fast-track availability, manufacturing and access of products, majorly due to dependence on other supply chains and disruption of supply and demand systems. The challenges are still not over but opportunities created in the form of the call for ‘Aatmanirbhar’ or selfreliance’ during the pandemic is the brighter side.

The pandemic has convinced many individuals to track their health, fitness and immunity. This, coupled with the devices’ ease of use, has led to wearables becoming pervasive in people’s lives. Robotics is another space which is rapidly evolving and growing in popularity Vijay Chawla Partner & Head- Risk Advisory and Head -Life Sciences, KPMG in India

Implanted medical devices and wearable external medical devices were the fastest growing segments globally. Improved connectivity, development of smart sensors and materials, and advances in technologies such as additive manufacturing, robotics, and digital imaging are driving the growth in medtech Antony Prashant Partner, Deloitte Touche Tohmatsu India

India climbed to the 63rd rank among 190 countries in the World Bank’s ‘Ease of Doing Business rankings in 2020. The Indian Government has undertaken structural and sustained reforms to strengthen the healthcare sector and has also announced conducive policies for encouraging FDI

Medical technology industry in India: Market scenario The Indian medical devices sector presents an unprecedented growth opportunity backed by inherent growth in demand arising from increasing healthcare needs along with government’s commitment towards providing an enabling policy-environment for domestic manufacturing. The pandemic has forced global companies to explore alternative sourcing to de-risk their supply chains and India has the potential to be a preferred destination for global manufacturing. Talking about the medtech market in India, Vijay Chawla, Partner & Head- Risk

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Falgun Jani Head of Sales, Freudenberg Medical India

Advisory and Head -Life Sciences, KPMG in India said, “InvestIndia estimates the medical technology (medtech) sector in India is currently valued at Rs 11 billion and is estimated to reach Rs 50 billion by 2025, at a CAGR of approximately 37 per cent. With the advent of relevant technologies, the market has evolved to provide top quality medical services to patients at

affordable prices. The ongoing pandemic has fueled demand for high quality, lowcost medical technology, and devices. In addition, a key driver in this sector is the favourable regulatory and policy environment created by the government. With the launch of various PLI-type schemes for medical parks, the government has been proactively taking steps to at-

tract investments from MNCs and private players for setting up innovation and manufacturing base in India.” A recent KPMGAPACMed report highlighted that the Indian medical devices industry is expected to grow at a CAGR of 15 per cent which is 2.5x the global growth rate. India is among the top 20 medical device markets and is the fourth

largest medical device market in Asia after Japan, China, and South Korea. The medical devices sector in India has the potential to grow approximately 4x the current market size by FY30, backed by growing healthcare needs and government’s commitment to facilitate growth. Falgun Jani, Head of Sales, Freudenberg Medical India said, “India climbed to the 63rd rank among 190 countries in the World Bank’s ‘Ease of Doing Business rankings in 2020. The Indian Government has undertaken structural and sustained reforms to strengthen the healthcare sector and has also announced conducive policies for encouraging FDI. The Aatmanirbhar Bharat Abhiyaan packages include several short-term and longerterm measures for the health system, including Production-Linked Incentive (PLI) schemes for boosting domestic manufacturing of pharmaceuticals and medical devices.”

Key segments of medical devices sector in India The Indian medical devices sector is broadly classified into five segments: Electronics equipment, surgical instruments: As per KPMG-APACMed report, these segments together account for the highest imports in the medical devices sector. These include high-end technology devices such as MRI machines, CT scanners, ultrasound machines, X-ray machines, cancer diagnostics, dental drills, minimally invasive surgical devices, Polymerase Chain Reaction (PCR) technologies, etc. Manufacturing of these devices involves complex electro-mechanical assemblies requiring manufacturing technologies like PCBs, controllers, sensors, embedded software, electro- physics, electromagnetics, laser-cutting, etc. Consumables and disposables: Products in this segment include bandages and

dressings, suturing material, syringes, disposable catheter cables, gloves, blood bags, etc. These devices can be manufactured using simpler processes like moulding, extrusion, polishing/coating, simple mechanical assemblies, sterilisation, etc. The market in this segment is highly competitive due to low entry barriers. This segment is a top exporting segment accounting for 51 per cent of the total exports of medical devices from India in FY 2021. Implants: Products in this segment include knee and hip implants, artificial joints, dental fixtures. This segment largely comprises of high-risk devices. Antony Prashant, Partner, Deloitte Touche Tohmatsu India highlights that, “The medical technology market in India is broadly segmented into instruments and appliances, diagnostic imaging, consumables and implants, and patient aids and other technologies. Instruments and appliances segment dominated the medical technology market followed by diagnostic imaging, patient aids and other products, and lastly consumables and implants segment. Of these the patient aids and other products segment and consumables and implants segment are expected to grow the fastest in the coming years. The epidemiological transition from communicable to non-communicable diseases, better affordability, increasing geriatric population, and an overall improvement in healthcare infrastructure are driving the growth of the sector. However, production capabilities are at a very nascent phase, with very little production done within the country - domestic production is limited mostly to consumables. Also, the domestic market is fragmented and has a complex regulatory structure.” IVD: Products in this segment include IVD reagents / chemicals, calibrator, control

One of the fastest-growing segments is the development of artificial intelligence (AI) and machine learning (ML). There are many different types of medical technologies that are benefiting from this growth Vinay K Mayer Director, Market Research & Consulting, Asia Research Partners

The spiralling cost of availing medical care and divergence of outcomes across the health system have made value-based healthcare a pressing need to reform the sector Ashok Patel CEO, Max Ventilator

material kit, etc. Stressing on the IVD market, Jatin Mahajan, MD, J Mitra & Co said, “India's IVD story exemplifies leadership and planning at several diagnostics and policy ecosystem levels. The Indian IVD industry quickly rose to the occasion during the corona pandemic. Driven by our extensive R&D, we were quick to develop highly potent test solutions across numerous technologies. This fast and effective action slowed the spread of COVID-19 in India. The large-scale point-of-care (POC) COVID-19 testing added USD 9,000 million to the IVD market's value. Aspects like syringes, surgical gloves, masks, oxygen concentrators, and ventilators registered a multi-fold growth, decreasing and completely wiping out their dependency on foreign players.” “India holds remarkable

potential in the global IVD market and is considered the international centre for frugal medical device engineering. Moreover, India is among the leading exporters of IVD solutions worldwide. The opportunities, therefore, in this segment are tremendous”, he added. The device market is highly import-dependent. As per EMIS data, imports constitute approximately 70-80 per cent of the market. Import-dependence is higher in high-end sophisticated device-segments. Domestic manufacturing is largely focused on low cost- high volume segment (like consumables and disposables). Big data, wearable devices and robotic surgeries are the fastest growing segments globally. Experts believe that these evolving industry trends will be playing a major role in the overall growth of the

market. Vinay K Mayer, Director, Market Research & Consulting, Asia Research Partners highlights that, “One of the fastest-growing segments is the development of artificial intelligence (AI) and machine learning (ML). There are many different types of medical technologies that are benefiting from this growth, including medical imaging and diagnostic equipment, healthcare software and services, telemedicine and remote patient monitoring, and mobile health applications. These technologies are helping doctors to diagnose and treat patients more accurately and quickly. They are also helping to develop new treatments and cures for diseases. In addition, the growth of healthcare data collection and analytics is another major reason for the success of the medtech industry. By understand-

ing how data can be used to improve patient care, medical professionals can provide better care for their patients.” Chawla explains that, “The wearables space includes devices such as smart watches and trackers that monitor heart rate, oxygen levels, exercise etc. The pandemic has convinced many individuals to track their health, fitness and immunity. This, coupled with the devices’ ease of use, has led to wearables becoming pervasive in people’s lives. Robotics is another space which is rapidly evolving and growing in popularity. Innovations in this space are and will continue to enable an increased adoption of a range of robotics-enabled techniques and devices. These range from robot companions to exoskeletons. Such solutions have the potential to drastically improve accuracy rates, recovery times, and surgery outcomes. Robot companions will also see a rise in popularity in the medical sphere as they can aid in treating mental health issues, alleviating patients’ loneliness and helping children cope with chronic illnesses.” “A shortage of hospital beds and medical devices during the pandemic led to an increase in demand for home healthcare. The home healthcare space is expected to grow to USD 21.3 billion by 2027, at a CAGR of 19.2 per cent as more people try and avail healthcare and medtech services from the comfort of their homes,” he added. Prashant adds, “Implanted medical devices and wearable external medical devices were the fastest growing segments globally. Improved connectivity, development of smart sensors and materials, and advances in technologies such as additive manufacturing, robotics, and digital imaging are driving the growth in medtech.” Medical devices generate huge amounts of essential, timely data that can have significant clinical impact.

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cover ) Predictive analytics models using ‘Big Data’ can improve the quality of care and patient outcomes, as well as help physicians gain useful insights. Wearables such as glucose monitors, exercise trackers, and wearables for mental health becoming popular among consumers in India because of their ease of usage. One of the most exciting and fastest growing fields of healthcare is robotics wherein future developments range from robot companions to exoskeletons. Robot companions also have their place in healthcare to help alleviate loneliness, treat mental health issues or even help children with chronic illness.

Need of the hour As far as overall growth of the medtech sector is concerned, the Government of India’s strategies and policies for business continuity and sectoral revival are already in place. The schemes and regulations allowing 100 per cent FDI aiming at global investors to choose India as their preferred destination for investments are driving the sector. This is also important as there is increased demand for technologically advanced, high-quality, low-cost medical devices that are accessible to the Indian population. These factors are also attracting international companies to set

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Big data,wearable devices and robotic surgeries are the fastest growing segments globally.Experts believe that these evolving industry trends will be playing a major role in the overall growth of the market up production facilities in India. However, there are still some unexplored challenges and areas that need attention. The segment-wise development of the medtech sector also needs adaption of new strategies and measures being drafted and implemented by various stakeholders. Ashok Patel, CEO, Max Ventilator believes valuebased healthcare to be the pressing need to reform the sector. He says that, “The spiralling cost of availing medical care and divergence of outcomes across the health system have made value-based healthcare a pressing need to reform the sector. Under this approach, emphasis is given to measuring the outcome of medical treatment and expenses accrued thereof based on the ailment, risk group and the development of customised interventions. It can be seen as a monetary incentive to drive healthcare professionals to meet certain performance assessments to process quality and efficiency. Also, it chastises healthcare

providers in case of any error.” With this model of healthcare, patients spend less to get better care. It is beneficial for those suffering from chronic diseases such as cancer, hypertension, diabetes or obesity. The patients get better quickly with fewer doctor's visits, medicines, tests or surgeries. For the caregivers too, this approach allows one to concentrate more on developing novel prevention-based services and spend less time on managing chronic diseases or conditions. The quality of services too increases leading to greater patient satisfaction. “Technology plays a significant part in this seismic shift towards value-based care since standardising and reporting patient outcomes and the quality of care needs a huge amount of health data and its analysis, diversely engaging patients. More and more patients now want to book appointments online and access their medical records instantly through the click of a button. In this current sce-

nario, those who provide quality and convenience – the basis of value-based healthcareare poised to succeed more. While many medical technology CEOs have been embracing this model of providing services, many others remain skeptical over the fear of disrupting the conventional way of doing business. But that hesitation must be brought to nought. Companies must exploit the possibilities that this new value-based approach to healthcare provides”, Patel added. Mayer suggest that, “End users, including patients and healthcare providers, need easy access to affordable therapies and devices. They also need reliable information about products and their potential risks. Producers of healthcare products and services must cooperate with scientific societies, research institutions, and other stakeholders to develop knowledge about new therapies and devices. Also, in terms of stakeholder engagement, all stakeholders should

be involved in the development of policies that affect them. This includes engaging with regulators, industry representatives, patient groups, health insurers, doctors, nurses, technicians, etc” Prashant says, “Government of India has already undertaken multiple initiatives to support the sector in terms of 100 per cent FDI for medical devices, PLI scheme, and medical parks. This would need to be sustained, and further encouraged, given that medtech industry is capital intensive with a high gestation period for investment. A supportive regulatory framework and being able to attract foreign investments will help shape the domestic market. Meanwhile med tech companies would need to focus on dimensions such as interoperability, cybersecurity, navigating regulatory changes, and attracting digital talent and building digital capability, and ensuring strong privacy and security arrangement, for the industry to scale-up.” Solving these challenges, aided by PLI schemes, timely policy interventions and industry-government cooperation, will smoothen out the growth path of the Indian medtech sector as it evolves to meet patient needs kalyani.sharma@expressindia.com journokalyani@gmail.com

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Focus on R&D and innovation for medical products to ensure quality affordable healthcare for all needs to be addressed Sunil Khurana, CEO & MD, BPL Medical Technologies in an interaction with Express Healthcare explains about the fastest growing segments in medtech in India and highlights the need of the hour for this sector’s further growth What are the fastest growing segments in medtech and why? Presently, the medtech sector can be classified into: IVD devices, cardiology devices, diagnostic imaging devices, orthopedic devices, ophthalmology devices, endoscopy devices, diabetes care devices, wound management devices, kidney/dialysis devices, and anesthesia & respiratory care devices. IVD segment accounted for the largest share in 2014, which was mainly attributed to the prevalence of various health conditions such as diabetes, cardiovascular diseases, and cancer. Similarly, the rising incidence of respiratory infections, hospital-acquired infections, other infectious diseases, and sexually transmitted diseases are also driving the growth of this market. However, if we talk about the fast-growing segment in the medtech industry considering the onset of the coronavirus and the various issues arising thereafter, the anesthesia and respiratory care devices are looking to be the fastest-growing segment during the forecast period, growing at a CAGR of 8.7 per cent. This is primarily due to an increase in the number of COVID cases especially in 2020-2021 causing various respiratory illnesses.

factors driving the overall growth.

The Indian medtech sector is one of the fastest growing sectors in the world, and our government's support will be the most crucial in this aspect. Measures such as increasing the number of medical institutions and hospitals, ease of access to healthcare providers in urban as well as rural region, etc. is needed According to the report published by MarketsandMarkets, the overall growth in medtech industry is primarily due to a

rise in chronic lifestyle diseases like diabetes, hypertension, cancer, and respiratory problems. However, the growing

acceptance of novel technologies in the healthcare segment along with the growing geriatric population are additional

Where does India stand as far as these segments are concerned? India has progressed significantly especially in the healthcare industry over decades and has been positioning itself as a leading market worldwide. With ground-breaking changes in technology and with the advent of medtech, the healthcare industry has been able to extend better and faster access to affordable, quality care to patients. Presently, the Indian medtech market is at a nascent stage; however, it is expected to expand exponentially in the coming years. This can be majorly attributed to factors such as the growth in geriatric population, the government's focus on improving the country's healthcare infrastructure, increase in health insurance penetration and growing per capita income. The Indian medtech sector comprises large, mid-sized and small businesses - all of which have a wide set of opportunities to not only meet the domestic demands but also to address the demand in global markets. The Indian government's support in Continued on Page 27

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The medtech manufacturing sector must be geared towards becoming more sustainable and efficient Mahesh Kapri, Managing Director, GE BEL and General Manager – ISC, South Asia, GE Healthcare in an interaction with Express Healthcare explains about GE Healthcare’s contributions to India’s healthcare ecosystem through its local manufacturing facilities and joint ventures

Showcasing our commitment to Make in India,‘for India and the world’, we have significantly invested in our four healthcare manufacturing facilities, driven by our successful joint ventures with Wipro and BEL

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What are the fastest growing segments in medtech today and where does India stand as a medical devices market? While India’s medical devices sector is still at a nascent stage, it is poised for growth, currently among the top 20 markets in the space, worldwide. The upward trajectory, also spearheaded by incentives and investment in local manufacturing, India is well on its way to becoming a global manufacturing hub. Now, how do we make it happen is the big question. It’s imperative that we recognise core priority areas within medtech to address the current needs and healthcare trends. We are talking advanced technologypowered solutions including AI, ML and cloud computing, preventive care with enhanced diagnostic capabilities, smarter imaging and patient monitoring solutions, and more accessible solutions across radiology and imaging. One key area that requires critical focus is the need to reduce the nation’s import dependency, which roughly stands at 75-80 per cent, as per the IBEF. To realise this goal, local innovation and production are key. At GE Healthcare, we are building India’s commitment to self-reliance in medical device manufacturing. We are

at an interesting juncture where the industry and the government are coming together through various initiatives to make this happen. India is definitely moving closer to achieving its aim of delivering quality, affordable healthcare for all across critical care pathways including oncology, cardiovascular health, women’s health and more. What is the government doing to help shore up India’s medical device manufacturing ecosystem? With the objective to grow India’s local manufacturing footprint, the government has introduced some powerful initiatives, including ‘Make in India,’ and notably, the Production Linked Incentive (PLI) scheme. The PLI scheme has provided a muchneeded impetus for domestic manufacturing of high-value medical devices, including across in-vitro diagnostics incentivising and attracting significant investment from foreign and local manufacturers. For instance, at GE Healthcare, we also recently inaugurated our ‘Wipro GE Medical Device Manufacturing’ factory in Bengaluru, which is one of the 15 medical device manufacturers approved under the government’s PLI scheme. We will continue supporting the national

agenda of ‘Atmanirbhar Bharat,’ which remains one of our key priorities. With the government enabling 100 per cent FDI under the automatic route for brownfield and greenfield projects to manufacture such devices, we are witnessing a new dawn in the policy ecosystem. Moreover, the initial draft of National Medical Devices Policy 2022 by the Department of Pharmaceuticals lends additional support to India’s medical device manufacturing sector. With R&D and innovation promotion, support for medical parks, manufacturing incentives and an aim to reduce import dependence to below 30 per cent in the next decade, the sector’s growth looks optimistic. Could you discuss GE Healthcare’s contributions to India’s healthcare ecosystem through its local manufacturing facilities and joint ventures? Showcasing our commitment to Make in India, ‘for India and the world’, we have significantly invested in our four healthcare manufacturing facilities, driven by our successful joint ventures with Wipro and BEL. This will help us support the country’s

production of medical devices and components. In fact, with the Joint Venture between General Electric and Wipro, Wipro GE Healthcare has emerged as one of the largest medical technology companies in the region, addressing India’s most pressing healthcare challenges. Accelerating our support for indigenous manufacturing, we have made an investment of a little over Rs 100-crore in the ‘Wipro GE Medical Device Manufacturing’ (MDM) factory in Bengaluru, which is a 100 per cent subsidiary of Wipro GE Healthcare. We introduced this 35,000 sq. ft. facility to spearhead the local high-tech manufacturing of critical devices like CT machines, cath lab equipment, ultrasound scanners, patient monitoring solutions, ECG machines and ventilators. Such endeavours will help us become more competitive on a global scale while driving our agenda for

localisation. We remain committed to expanding India's medtech ecosystem. To further India’s selfreliance in medical device manufacturing, could you discuss some of GE Healthcare’s products or services catering to the country’s local needs? We have a great emphasis on localisation of our medical devices. Of the total sales done in the nation, roughly a third of the manufacturing/assembly is being driven out of India currently. Further, over 30 of our products are made in India and sold in more than 70 countries worldwide. Additionally, a significant portion of diagnostic cardiology products are made in India. All our affordable care products across the maternal and infant care segment are also designed, developed, and made in India. Most recently, Wipro GE Healthcare launched the

Revolution Aspire CT (Computed Tomography) scanner, an important medical device to address local diagnostic demand in regions beyond tier 1 cities where affordability and usability are key factors. This 'Made in India' Revolution Aspire Computed Tomography (CT) scanner has been designed and manufactured end-to-end at our new MDM facility. Revolution Aspire is the culmination of cutting-edge technology, superior engineering and high-end innovation from our engineers and scientists. It will increase operational efficiency, enhance image quality and lead to faster diagnosis. The Aspire CT scanner increases throughput by up to 50 per cent when compared to previous generation CT scanners, and also helps support patient and clinician safety through its ASiR technology, reducing radiation by 40 per cent.

How can the medtech manufacturing sector move forward to ensure sustainability is integrated across more operations? What are GE Healthcare’s contributions and goals in this regard? The medtech manufacturing sector must be geared towards becoming more sustainable and efficient. To do this, it is vital to place sustainability at the core of how a company operates. This transformation is already evident, such as with Crisil’s latest ESG score report card indicating improved scores for the majority of companies, driven by renewable energy consumption, gender diversity, board independence and more. Together, the industry must continue to collectively work towards implementing key sustainable strategies to reduce the carbon footprint and protect environmental resources for future generations. This can help the sector move closer to supporting the United Nation’s

Sustainable Development Goals, so we can address identified challenges facing our society today. This needs to be a critical priority across the board, and we continue to work to support a more holistic and sustainable health ecosystem in India. At GE Healthcare, across our factories, we have been working relentlessly on various high impact ESG initiatives including to address environmental waste. We are on a path to rapidly reduce emissions - we have converted 85 per cent of factory power to green solar energy, which has led to a carbon footprint reduction of 22,000 Tonnes per annum. We are also driving energy conservation efforts by adopting LED lighting, and reducing, recycling, and reusing as well as ensuring in-house composting of food waste and leaves to be used as manure. To ensure water conservation, we are also carrying out rainwater harvesting initiatives.

to COVID, one thing was certain Indian medtech companies like ours were needed more than ever. The COVID-19 pandemic demanded that businesses like ours must adapt to novel ways of finding solutions and reach even greater heights of purpose-driven collaborations through public–private partnerships. It was necessary to be quick to change demands. For instance, by providing our Oxygen Concentrator (OC) technology to the GOI-enterprise Bharat Electronics Ltd (BEL) during the pandemic period, BPL Medical worked closely with them to set up sourcing and manufacturing of OCs, which is effectively done and today we are producing oxygen concentrators on a large scale in India.

Huge scope exists in medtech sector, not only to be self-reliant but also to capture a considerable share of the international market. As various businesses globally are searching for alternative manufacturing hubs, India could be their preferred choice, provided that our country can offer a conducive business climate – with better infrastructure, logistics, simplified land and labour laws, etc. These factors can enable India to develop a robust manufacturing ecosystem. Technological innovation, skill development and increase in the scale of production need to be the primary focus to deliver quality and cost competitive solutions to domestic as well as global customer base.

Focus on R&D and innovation... Continued from Page 25 terms of outlining favorable regulations & schemes has been an important driving force, especially for the medtech sector. The Indian Government is very focused on Atma-Nirbhar (selfreliant) Bharat, which is also applicable to the medical devices industry. As a company, we are committed to the vision of our respected PM by extending our manufacturing capability, thereby focussing our efforts on making in India for our developed products. In the next few quarters, our new manufacturing facility in Bangalore will begin manufacturing of our products in addition to the existing capacity in Palakkad,

Kerala which is already at its peak. This gives us a very clear indication that the medical device industry will witness high double-digit growth over the next one-two decades. What are the measures required from various stakeholders? The Indian medtech sector is one of the fastest growing sectors in the world, and our government's support will be the most crucial in this aspect. Measures such as increasing the number of medical institutions and hospitals, ease of access to healthcare providers in urban as well as rural region, etc. is needed. It is important to develop tertiary care centres, health and wellness centres and raise awareness in the

country. In addition, the focus on R&D and innovation for medical products to ensure quality affordable healthcare for all is to be addressed. The medtech sector is currently import-dependent which presents a perfect opportunity for Indian medtech companies to challenge this arrangement. The focus for businesses in the medtech industry should be to find and adapt to cost-effective ways to develop & manufacture high-quality, technology-enabled healthcare solutions that are relevant to the Indian market. Companies must also be able to adapt to the changing demands quickly and effectively, which was a learning during the COVID-19 pandemic. While addressing the pressing issues arising due

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cover ) The future of Indian medtech industry Jatin Mahajan, MD, J Mitra & Co explains about the ingredients that are catalysing the growth of the Indian medtech market

edical Diagnostics accounts for seventy per cent of all critical medical evaluations and procedures. Consequently, the average life expectancy of an Indian has increased from 52.5 years (1980) to 69.3 years (2020), thanks to accurate diagnostics and cuttingedge medical treatments. Hence, diagnostics has emerged as the first line of defence in healthcare. As a result, the Indian IVD market was estimated at USD 1240 million in 2019 and may record a CAGR of 7.5 per cent to reach USD 2060 million by 2027. India's IVD story exemplifies leadership and planning at several diagnostics and policy ecosystem levels. The Indian IVD industry quickly rose to the occasion during the corona pandemic. Driven by our extensive R&D, we were quick to develop highly potent test solutions across numerous technologies. This fast and effective action slowed the spread of COVID-19 in India. The large-scale point-ofcare (POC) COVID-19 testing added USD 9,000 million to the IVD market's value. Aspects like syringes, surgical gloves, masks, oxygen concentrators, and ventilators registered a multi-fold growth, decreasing and completely wiping out their dependency on foreign players. India holds remarkable potential in the global IVD market and is considered the international centre for frugal medical device engineering. Moreover, India is among the leading exporters of IVD solutions worldwide. The opportunities, therefore, in this segment are tremendous. The focus of the Indian medtech companies has been on creating an innovation-driven ecosystem for resource-poor settings. The industry strives to develop tests and analyser platforms to address the need for precision, reliability, self-re-

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The focus of the Indian medtech companies has been on creating an innovation-driven ecosystem for resource-poor settings.The industry strives to develop tests and analyser platforms to address the need for precision, reliability, self-reliance, domestic production (self-reliant), affordability, and reaching closer to point-of-care liance, domestic production (self-reliant), affordability, and reaching closer to point-of-care. The ingredients that are catalysing the growth of the Indian medtech market are: ◆ An increase in chronic diseases ◆ Focus on point-of-care (POC) diagnostics by consumers ◆ The growing focus on preven-

tive healthcare ◆ The proliferation of the hub and spoke model within diagnostics ensures exceptionally largescale automated regional diagnostic centres services by neighbourhood and mobile collection centres.

The future outlook Diagnostics drive around 70 per

cent of all therapeutic decisions. Yet, the segment was neglected within the overall healthcare industry in the past. Domestic production accounts for only 20 per cent, and there is an 80 per cent dependency on imports. Embracing technology will enable the IVD players to meet the country's future needs. Diagnostic services will become more

personalised because of genomics and genetic testing. Technological advancements and related investments in a digital delivery platform for IVD tests will bridge the distance divide and bring the industry closer to clinicians and patients worldwide. An encouraging regulatory ecosystem with the right incentives will see this space proliferate with faster technology adaptation, leading to lower costs and prices. In addition, incentives like the government's PLI scheme for the medical devices manufacturing sector will boost domestic manufacturing output, improve the cost competitiveness of Indian devices in the global market, and reduce import bills. As diagnostic laboratories embrace increased automation, they will become more time-efficient, reduce batch testing, and thus reduce overall TAT (turnaround time) between test and results. Biomarkers integration and availability of biomolecular tools will catalyse new opportunities for the IVD market by creating condition-specific tests. AI and ML will catalyse higher levels of diagnostic precision. AI will transform and disrupt the current workflow in the laboratory, patient diagnosis and treatment, and the role of the critical stakeholders: Healthcare Professionals, laboratory staff, and IVD manufacturers. These will likely increase India's adoption and influence of the in-vitro diagnostics industry. Moreover, India's demand for IVDs will grow with time because of higher disposable incomes, better access to quality insurance, POC diagnostics, an ageing population due to higher life expectancy, an increase in lifestyle diseases, and most importantly, the growing acceptance of preventive care healthcare and monitoring.

DIAGNOSTICS

Rapid growth of e-diagnostic industry necessitated the creation of a self-regulatory code of conduct On 6th May 2022, FICCI launched the self-regulatory code of conduct for the e-diagnostics sector. Ritu Gupta, COO, Genes2Me explains if this will work to protect consumer/patient interests

n recent times, India has seen consolidation and strengthening of the healthcare network. With government initiatives like Ayushman Bharat Digital Mission (ABDM) and 'Atmanirbhar Bharat Abhiyaan,' encompassing the vision of Digital India, the diagnostic sectors have rapidly expanded and flourished. There has been active participation in driving the e-diagnostic sector by all concerned stakeholders-government, startups, and national diagnostic companies. E-diagnostics is a digital diagnostic company that uses a variety of technologies to acquire, serve, and retain customers. Unlike traditional diagnostic facilities, e-diagnostics companies do not have dedicated collection centers and instead rely on a large number of phlebotomists to collect samples, which saves them a lot of money. The COVID-19 pandemic and increased demand for home-based sample collection have boosted the category significantly in recent years. The rapid growth of the ediagnostic industry necessitated the creation of a selfregulatory code of conduct. The FICCI's e-pharmacy working group developed the code of conduct for e-diagnostics after multiple rounds of industry discussions. It aims to ensure adherence to the highest professional standards while delivering excellent e-diagnostic services till the last mile in a safe and compliant way. This voluntary code of conduct is an industry-led effort to conform to the highest standards of excellence and provide adequate safeguards to ensure that patients' health

into a digitally empowered society.

Benefits of the code of conduct

Unlike traditional diagnostic facilities, e-diagnostics companies do not have dedicated collection centers and instead rely on a large number of phlebotomists to collect samples, which saves them a lot of money and safety are not endangered.

Need for code of conduct According to a recent survey, India had 5,295 healthtech startups at the end of 2020, and the number has risen dramatically since then. Between 2023 and 2027, India's diagnostic labs market is predicted to increase at a CAGR of 11.65 per cent to $25.66 billion. The key problems for lastmile access to the diagnostic sector include accessibility, price, and lack of awareness. Adopting technology, particularly the internet, into the

healthcare system could successfully eliminate these constraints. In recent years, e-diagnostic has emerged as an important conduit for providing last-mile access to laboratories. This will mostly benefit individuals with chronic conditions, the elderly, and sick patients who are unable to travel to get their tests performed. New tech-enabled platforms are helping improve access to high-quality healthcare services, such as diagnostic services, by bringing services to the patient's door, expanding the patient-

cantered approach, and athome care. They also provide tracking and traceability of the services that are supposed to be provided through their platforms. The e-diagnostic model provides sample tracking and traceability, addressing the issue of counterfeit reports, eliminating the need of infrastructure in rural areas, and making use of limited human resources, as well as providing value-added services for consumer empowerment in healthcare, all of which are well aligned with the government's Digital India initiative, which reshapes the country

The e-diagnostic sector has taken a positive step by adhering to the FICCI self-regulatory code of conduct to assure service consistency and quality maintenance. This is a crucial step because if the industry self-regulates, it would be able to accomplish both structured growth and consumer protection. The code of conduct highlights the obligations of technology platforms that list medical laboratories. All member firms will have to ensure that labs are listed in a transparent manner on their platforms. They will also be required to disclose thorough information about laboratories and test results in order to assist clients in making "informed decisions." The standard code of conduct will help deliver quality e-diagnostic services to the last mile safely and promptly. The code also instructs the platforms to create a system for selecting and assessing documented laboratories. In addition, to maintain service standardisation, the members must specify all standard operating procedures (SOPs) surrounding factors such as sample collection, transportation, and storage. The code of conduct attempts to guarantee that the space is self-regulated and that services are uniform across the industry. Furthermore, this will help in standardising quality control across the board for diagnostics companies and startups in the country. Continued on Page 30

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DIAGNOSTICS

Drone technology's viability in India's diagnostic sector Dheeraj Jain, Founder, Redcliffe Labs talks about the drone technology in diagnostics and highlights that in order to eliminate challenges like poor accessibility to locations, drones have an important and rising role

he Indian healthcare sector has a unique landscape. On the one hand, growing digitisation and technological advancements are reshaping the urban healthcare landscape. On the other hand, significant chunk of the rural population lives in inaccessible places with no access to even basic healthcare. According to statistics, 70 per cent of India's population lives in rural areas, where only 3 per cent of the country's doctors reside. These distressing statistics highlight the urgent need to address the country's rural population's healthcare requirements. On this front, unmanned aerial vehicles (UAVs), or drones, are helping to improve access to quality healthcare by ensuring the safe and timely transportation of medical items and test samples in a timely and cost-effective manner. Drones are successful in overcoming connectivity issues as they can easily reach remote places such as mountains, valleys, and forests and carry life-saving drugs, emergency supplies, medications, and so on. Areas that were

Drones can carry a payload of up to 25 kgs in temperaturecontrolled boxes without compromising safety and quality. Due to the long delivery period, it becomes difficult to ensure the safety and sterility of the samples. So, sample collection by drone could provide an effective solution to such problems previously cut off by road and unreachable by large helicopters and aeroplanes can now be accessible, enhancing the country's transportation network and strengthening the country's healthcare scenario.

Diagnostics is one of the most common uses for drones Not every hospital or clinic has the facility for diagnostic tests. Therefore, couriers are frequently dispatched between healthcare system

structures and campuses. Moreover, as some diagnostic procedures are time and temperature sensitive, a sample from a patient must be submitted to the lab and the test must be completed within a certain timeframe, which might be as little as 2 hours. To eliminate challenges like poor accessibility to locations, drones have an important and rising role. Also, drones can carry a payload of up to 25 kgs in temperature-controlled boxes without compromising safety

and quality. Due to the long delivery period, it becomes difficult to ensure the safety and sterility of the samples. So, sample collection by drone could provide an effective solution to such problems. Drone technology is one of the ways that Redcliffe Labs has adopted in its journey of providing affordable diagnostic services to people across the Indian subcontinent. With its recent initiatives like opening the commercial drone corridor in Uttarakhand (Uttarkashi to Dehradun),

Redcliffe Labs is able to gather samples from local clinics that have previously struggled to obtain diagnostic samples. This process will help maximise sample processing capabilities, resulting in a more efficient lab operation while also aiding patients who require faster results. Scaling up the use of drone technology in Uttarakhand, Redcliffe Labs will also target Mandi to Shimla and explorethe North Eastern areas.

ganisations to the highest standards. The guidelines established for the corporations will be crucial in regulating diagnostic company activities and allowing enterprises and infrastructure to be streamlined. This will ensure that the health of the customers is not compromised. Given our many years of ex-

perience, brand trust and recall, global quality standards and accreditations, value-added offerings, wide test menus, extensive patient touchpoints to service patients locally, and ability to grow in new markets sustainably, Genes2Me is optimistic about implementing the code of conduct in our e-diagnostic chains in India.

Rapid growth of e-diagnostic industry... Continued from Page 29

Challenges in implementation The diagnostics sector in India is fiercely competitive, with unorganised firms accounting for roughly 84 per cent of the market. Making the code of conduct for e-diagnostic mandatory will result in the elimination of

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many small players. These modifications, however, necessitate not only considerable capital expenditures but also raise maintenance costs. This is especially important for smaller players that are short on cash. Medical equipment and analysers are continually improving in terms of technology.

Diagnostics facilities are continually enhancing their technologies to keep ahead of the competition. Extra costs to implement the code of conduct will result in a delay in research and development.

The way forward The e-diagnostic sector's code of conduct holds diagnostic or-

PUBLIC HEALTH

New-born screening for metabolic disorders: The need of the hour Dr Sudheer Moorkoth, Professor and Head, Department of Pharmaceutical Quality Assurance Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education & Dr Leslie Edward S Lewis, Professor & Head, Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal explains about new born screening and highlights that studies indicate an urgent need for its implementation What is new-born screening and why is it needed? New-born screening or NBS is a program for new-born babies aimed at detecting rare congenital metabolic disorders in children. These disorders are commonly called as Inborn Errors of Metabolism or IEM. Neonates born with these disorders will have a normal appearance and will have no detectable physical signs and the disease will go unnoticed. By the time symptoms appear, it will be too late to treat or manage the disorder. If not treated, these disorders will lead to mental retardation, disability or death. NBS is the only way to detect these disorders early in the new-born period. There are as many as 500 IEMs which lead to congenital disorders. Vast number of these disorders are genetic in nature due to defects in the gene that codes for enzymes in various metabolic pathways such as carbohydrate metabolism, amino acid metabolism, fatty acid metabolism etc. These defects will lead to accumulation of toxic substances which interfere normal functioning of cells in our body leading to diseases.

How NBS will help in overcoming the challenges Early diagnosis of these disorders is a challenge for paediatricians since they will not present any symptoms in the new-born period. Most of the IEM cases are diagnosed after a few months or even after a few years of birth and by this

that the child can get an early intervention and treatment. NBS is a simple blood test where one drop of blood is collected from the heel of the baby with specially designed device onto a filter paper as a spot, which is tested for the panel of disorders. The test is minimally invasive with little discomfort to the baby. Recognising the benefits of the programme, all the devel-

Early diagnosis of these disorders is a challenge for paediatricians since they will not present any symptoms in the new-born period. Most of the IEM cases are diagnosed after a few months or even after a few years of birth and by this time life threatening irreversible damage to brain or other disability has already been happened time life threatening irreversible damage to brain or other disability has already been happened. Commonly manifested symptoms are unintended weight loss, tiredness, low blood sugar, poor feeding habits, vomiting, high levels of acid or ammonia in blood, mental retardation and convulsions. Currently there are treatments available for many of these disorders. If detected early and started the treatment in the new-born period, the affected child can lead a normal life just like any other child. New-born screening (NBS) is the only way to pick up these disorders early so

oped countries and many developing countries have implemented new-born screening programme for treatable IEM disorders as a national health programme.

Where does India stand? Being a country with the second largest population in the world, it is a sad truth that India has not implemented the NBS as a national health programme. As per the UNICEF data, everyday 67385 babies are born in India, which is one sixth of the world’s childbirth. Major obstacles in implementing the programme are the lack of awareness among its stakeholders, absence of

incidence data on these disorders in the country, insufficient budget allocation for healthcare and lack of government policies Inadequate health education, early hospital discharges, and high number of out of hospital births are the other reasons.

Studies indicate an urgent need for implementation of NBS To study the “need and viability of new-born screening programme in India”, the Centre of Excellence in Inborn Errors of Metabolism, Manipal Academy of Higher Education, Manipal has undertaken a project funded by the VGST,

Government of Karnataka and Grand Challenges Canada, Government of Canada. The study revealed a high incidence of IEM disorders in India for the selected disorders. As per the reports 1: 887 babies in India are born with congenital hypothyroidism (CH), 1: 118 babies with G-6PD deficiency, and 1: 4591 babies with Congenital Adrenal hyperplasia (CAH). Incidence rate for other IEM disorders are not available for India since studies are scarce. High incidence rate of the above three disorders is pointing to the urgent need for implementing the NBS for these disorders as a bare minimum programme in India to start with. Implementing NBS for these three disorders could prevent the probable intellectual disability of 27,740 children yearly in India due to congenital hypothyroidism. Similarly, it would prevent the possibility of life-threatening complications from hemolysis due to G-6PDD deficiency in 2,08,415 babies every year in India. Abnormal sexual development, adrenal crisis, other morbidities and mortality due to congenital adrenal hyperplasia in 5,475 children every year in India could be prevented if we have the screening programme in place.

Takeaways: Ensuring each new-born’s overall well-being by screening for rarely identified metabolic diseases is crucial to secure their health and provide each of them the best possible quality of life.

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HEALTHCARE IT

Digitisation of ICUs and reduction in medical errors Dr Dhruv Joshi, Co-founder & CEO, Cloudphysician Healthcare highlights that new-age technology has provided a silver lining. Virtual hospitals, which combine technology with healthcare, are now allowing intensivists to deliver care to people in far-flung areas of the country

he Indian healthcare system is beset by a slew of issues, including inadequate infrastructure, an overburdening patient load, poor service quality, and insufficient training for hospital workers. One of the most obvious problems is that the vast majority of the population does not have access to high-quality critical care. India has less than 3 ICU beds per 1 lakh people, compared to Germany, which has close to 30 ICU beds per 1 lakh people. As a result, nine out of ten critically ill patients in India are unable to obtain the high-quality care they need, resulting in unnecessary mortality and morbidity. The majority of hospitals, with the exception of a few, are unable to handle the demands of critical care. Inequitable critical care delivery has long been a problem in India and elsewhere. We need to take a completely new approach to handle this problem. Traditional critical care delivery systems have proven to be either inadequate or prohibitively costly. We will need a 21st-century answer for this, one that goes beyond traditional models and even traditional telemedicine as we know it. While the situation may appear to be hopeless, new-age technology has provided a silver lining. Virtual hospitals, which combine technology with healthcare, are now allowing intensivists to deliver care to people in far-flung areas of the country. We may virtualize the care provided to critically sick patients by enabling any bed in any location to be converted into an ICU bed by leveraging technology. When an ICU bed is fully networked

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While providing quality healthcare to patients everywhere and anytime is one concern,reducing pressure on the personnel in the existing infrastructure is another area where digitisation helps and digitised, the patient in that bed, as well as the doctors and nurses caring for him or her, can benefit from a virtual backbone of super specialists, aided by intelligent technology that can support them no matter where they are. Hospitals located anywhere can move to a digitised set up and the ICU in the hospital can then be connected to a central unit with tele-intensivists, nurses, and other healthcare experts who can supervise patients 24 hours a day, seven

days a week and provide support as needed. This is a ground-breaking technology that is bringing critical care to patients who previously did not have it. This form of digital ICU care delivery using virtual hospitals enables timely, standardised care for critically ill patients, as well as expanded access to intensive care and efficient use of limited resources to serve a larger percentage of the population. Simultaneously, this patient data, which is collected and transmitted over

large distances, is safe and secure. This complies with privacy standards and safeguards the patients' interests. This isn't a far-fetched possibility. In many countries of the world, including India, progressive healthcare leaders are putting this into reality and implementing it. Using virtual solutions like this, hospitals in remote regions such as Motihari, Nadiad, and Cachar are now giving care equivalent to huge facilities in metro centres at a fraction of the cost. It is vital

that the rest of the healthcare community aligns with the future and empowers both patients and caregivers to receive and deliver services that will make critical care equitable for all. While providing quality healthcare to patients everywhere and anytime is one concern, reducing pressure on the personnel in the existing infrastructure is another area where digitisation helps. As the adage goes - you cannot improve what you cannot measure. Digitisation and virtualisation of care in addition to enabling access also allows care to become transparent, accountable and measurable. This allows for the reduction of errors and better care provision. Digitising the workflow, and reducing paperwork and human effort, is a major step in this direction. Human error in lab reports is another casualty of the overburdened medical infrastructure. Digitisation or automation of report generation reduces errors and consequences due to the same. This will ensure no data loss and decrease in data entry mistakes. Storing patient history in virtual and automated storage systems aids personnel in retrieving it easily when required. A few clicks can provide access to the data, from any location. Digital storage is equally helpful for storing assigned protocols and any other procedures. Nursing staff or less qualified healthcare personnel can access the same, in the absence of other expertise. Digitisation of storage, procedures and other relevant, helps in reducing pressure on both personnel and infrastructure. This is a sure shot in the arm for critical healthcare.

Why conversational AI and chatbots are perfect for digital health Sujit Patel, CEO/MD, SCS Tech highlights that the integration of tech into public health and wellness is nothing new, but the demands of the connected society have only raised awareness of what is possible but also flagged up the opportunities for engagement in the digital space

ver the last decade, the continued evolution of digital healthcare and the impact that next-generation technology will have on patient wellness and diagnostic outcomes has been a recurring conversation. Providers have been looking to make the most of the tech-centric tools that are increasingly available, while those in need of care or the right advice at the right time now expect the medical sector to be investing in digital solutions to physical problems. The integration of tech into public health and wellness is nothing new, but the demands of the connected society have only raised awareness of what is possible but also flagged up the opportunities for engagement in the digital space. Healthcare has never shied away from technology, albeit some recent improvements can be hit-and-miss – electronic health records are only as useful as the data that has been input, for example. However, there is a consensus among providers and medical professionals that the industry is willing to accept some disruption if it has a positive impact on the overall patient experience. In terms of technology with the power to both disrupt and improve the way that people engage with digital health, there is an argument to be made that conversational AI (which includes Machine Learning) and Natural Language Processing (NLP) can be the missing link. After all, if Alexa et al can answer questions about the weather, start your car in the morning and tell jokes, then there is no reason why virtual assistants can’t provide you with the medical advice that you need, when you need it.

The effective use of chatbots to provide the right medical or clinical information at the right time is not a futuristic concept,these solutions are here now.What matters is how healthcare and life sciences companies choose to use them The chatbot will see you now According to the World Economic Forum, virtual assistants – and, by association, chatbots – are not only being used in a diverse set of industries (healthcare, education, retail, tourism, and more), but also offer opportunities for companies to integrate NLP into routine or mundane activities. For instance, Amazon’s Alexa is the chatbot that the average person associates with the tech, but the key element in every interaction is the ability of NLP to understand what it is being asked and respond with the appropriate information.

The problem, the WEF said in a November 2021 blog post, is that building the chatbot is the easy part. Often, it is the conversational aspect that throws a digital spanner into the works. When you are talking to a finance bot or trying to return a pair of shoes, the stilted nature of these exchanges is rarely an issue. In a sector such as healthcare, it is the conversation and the information that is being dispensed that is a key part of how comfortable an end-user is with knowing that they are not engaged with a human being. In rural parts of the world, the use of so-called health bots

has already helped alleviate some of the pressure on localised health providers. This is not limited to firstworld or so-called developed countries, but their integration takes on a particular resonance in regions where access to tech is not easily available. In Rwanda, for example, there is often only one doctor and six healthcare workers per 10,000 people, with the WEF noting that these tools are allowing patients to have access to doctors, nurses, and relevant healthcare information. The caveat is that there is still some concern that a welldocumented stigma surrounding chatbots in general could prevent people from interacting with them in the first place – for the record, this is also not unique to developing countries, there seems to be a global mistrust of chatbots as an accurate or effective engagement tool! Conversational AI and chatbots are not new per se, but they can suffer from falling under a broad definition of what they actually are. Simply put, a “chatbot” is AI software that simulates a human conversation with end-users – this can be text or voice – with the aim being to leverage machine learning algorithms and NLP to deliver required outcomes. The healthcare sector has been experimenting with these solutions for some time. More recently, the World Health Organization launched a women’s health chatbot dedicated to breast cancer messaging – for context, this new digital experience follows hot on the heels of bots that delivered information on COVID-19, mental health and smoking cessation. So, the bots are already here, but the question that we

need to address is how we can use conversational AI and/or chatbots in addressing not only patient concerns but also alleviate the worry or concerns that a person has. Additionally, we should consider both the challenges to overcome and the advantages of using virtual assistants to deliver care and wellness.

The future is already here We all interact with digital experiences every day of our lives, so it makes perfect sense that the technologies we often use without thinking should be mirrored in the healthcare sector. And while the industry still relies far too much on legacy technology (disparate IT systems, pagers instead of wearables), the integration of digital health solutions is picking up pace. Conversational AI has been part of the digital landscape for at least five years, although the average person is likely to only know these virtual assistants as Alexa, Siri and Google Assistant (useful tool, unimaginative name). Chatbots fit into the same category, but their integration into the connected society is less heralded and, arguably, overlooked in terms of the access to knowledge and the assistance they can provide. However, these tools are here to stay and there is a defined need for them to become not only part of the digital health landscape but also a familiar resource for people to turn to. The effective use of chatbots to provide the right medical or clinical information at the right time is not a futuristic concept, these solutions are here now. What matters is how healthcare and life sciences companies choose to use them.

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HOSPITAL INFRA

Friendly hospital flooring Sujanyanti Dasgupta, Co-Founder and Director of Healthcare, W-ARD FOUR explains that the advent of sustainable flooring products has also piqued interest among healthcare decisionmakers. However, with insufficient know-how about the product, such as factors that make it environmentally friendly along with the maintenance regimen required, makes it more challenging to trade up to these products

ealthcare settings are stressful, and the focus is always primarily on medical outcomes, as it should be. So, while there has been significant innovation in the delivery of medical care, there has been little innovation or even adoption of innovation in other areas like the building itself. In addition to medical outcomes, the other area that continues to remain the top priority in a healthcare setting rightfully is safety, and among other things – the choice of flooring material goes a long way in ensuring that. The advent of sustainable flooring products has also piqued interest among healthcare decision-makers. However, with insufficient know-how about the product, such as factors that make it environmentally friendly along with the maintenance regimen required, makes it more challenging to trade up to these products. ◆ The perception of 'green' products as being less effective than the claims made by the manufacturers ◆ The 24/7 operations of hospital environments and the stresses of it. ◆ There is a lack of education and top-down commitment to cleaning and maintenance protocols for these products. ◆ The healthcare industry's slow-building cycle. ◆ Comfort with materials they are familiar with and trust, as they are concerned that problems with an unfamiliar material could disrupt their critical operations. ◆ The product is new to the market and has not been tested long enough in healthcare settings. Architects, installers, facility managers, and users have recent experiences with alternative, green, resilient flooring

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of the area under consideration to help mitigate wear and tear, hence ensuring the longevity of the same.

Choices for hospital flooring materials

Healthcare flooring serves various purposes, including improving safety, reducing stress, facilitating patient satisfaction, and providing a solid return on investment materials in hospitals. Rubber, linoleum, and polyolefin flooring materials have been increasingly featured in the media and magazines. As per some reports, the most commonly used product is sheet vinyl (73 per cent), followed by VCT (64 per cent), Rubber (57 per cent) and linoleum (52 per cent).

Healthcare flooring requirements There's a reason why hospital flooring requirements are so

stringent. Healthcare flooring serves various purposes, including improving safety, reducing stress, facilitating patient satisfaction, and providing a solid return on investment. When it comes to installing healthcare flooring, the following guidelines should be observed. ◆ It's essential that the flooring be both stable, even and slip-resistant. ◆ Resistance to chemicals used for sanitisation and hygiene is the most vital require-

ment in hospitals. ◆ Sealed flooring is essential to prevent the spread of microbes and germs. Also, the surface must reject moisture, bacteria, and allergens. Minimising the number of joints plays an essential role in maintaining the homogeneity of the flooring. ◆ The flooring should ideally contribute toward the absorption of noise and help maintain the WHO recommended noise levels of 40-45 dB ◆ The flooring installed should also be appropriate for the use

The healthcare industry is spoilt for choice when it comes to flooring options. While vinyl and rubber are two materials commonly used in hospitals nowadays, other more traditional options remain, especially in this part of the globe Stone and tiles being the most common choices. Vinyl is an excellent option for hospital flooring. Vinyl flooring in hospitals is stain-resistant, long-lasting, and easy to clean. Rubber proves to be another suitable option, as the rubber sheet flooring is durable, long-lasting, sanitary, easy to clean, impact and noise-absorbing, and available in various styles. Sheet vinyl flooring: Sheet vinyl flooring is the most commonly used material in hospital areas due to many of its desirable properties. Pros: Sheet vinyl is water-resistant, slip-resistant, stain-resistant, comfortable to walk on them, noise-absorption abilities, durability and homogeneity. The impervious nature of sheet vinyl makes it the obvious choice in places looking for high levels of sterility like Operation Suites and Intensive Care units. Additionally, it can avoid joints in critical areas where dirt typically gathers over time, like the skirting region. The homogenous variety is best suited for healthcare environments instead of the heterogeneous because of its resistance to scratches and long-term durability. Given that vinyl is an engineered product, it comes in many colours and patterns, making it an aesthetic delight.

Cons: Vinyl is made of petroleum. It can give off harmful chemicals known as VOCs – volatile organic compounds. Therefore, when choosing Vinyl, it is essential to pick those that are low VOC and are certified by international bodies like Floorscore, Greenguard and Greenguard Gold (lowest VOC) Rubber flooring: Rubber flooring has seen widespread adoption in the western world. However, the same cannot be said for this part of the globe, primarily due to skepticism about the product's durability. Pros: Rubber flooring has all the desirable properties that Sheet Vinyl flooring does. Additionally, it is resistant to shrinkage over a period, maintaining the integrity of the seams and upholding the homogeneity of the material. It is a natural material, so it does not have concerns around VOC. Cons: Rubber flooring is somewhat limited in the variety of finishes it can mimic the patterns it is available in but only in comparison to vinyl. Considering virgin rubber flooring is hard to procure, most rubber flooring in the market has additives but at far reduced levels compared to Vinyl. Linoleum or Marmoleum: Although this material shares many properties with Vinyl and rubber flooring, it has seen limited success with adoption in healthcare settings. While it may not be the best option for large and busy hospitals, smaller healthcare units like clinics and outpatient centres

may experiment with it because of its beneficial properties. Pros: This green product is allnatural and made mainly with linseed oil, natural pigments, pine rosin and wood flour harvested from pine trees. This is typically homogenous and the greenest flooring option available. The lifespan of this flooring can be four times as much when compared to Vinyl if maintained well. Cons: It requires periodic sealing and has a higher capital cost. Natural Stone: Marble, Granite, and Kota are popular alternatives in India due to their familiarity. However, the two are different and cannot be used interchangeably. To begin with, Marble is a soft and porous material which makes it hard to maintain and protect from wear and tear and spills. Additionally, it is prone to expansion and contraction, leading to cracks. Marble, in a nutshell, is not an appropriate material for hospital usage. On the other hand, Granite is a hardy, solid and impervious material making it a natural choice for healthcare environments. Pros: Granite and Kota are non-porous materials, making them excellent candidates for healthcare settings. It can be polished in various ways, ranging from a high gloss to an antiskid surface. The most commonly used and relevant finishes for Granite in the healthcare sector are honed and leathered. These stones are

also incredibly cost-effective. Cons: Granite and Kota, being natural materials, have limited colours and availability. Even the same type of Granite from two different quarries or at two different points of time might have significant variations in its appearance. Vitrified tiles: Vitrified tiles are non-porous ceramic tiles. These tiles are most commonly used as an alternative to hard natural flooring options in hospitals like Granite and Kota flooring. Given that all VT tiles are not made equal and thereby not suitable for the levels of durability required for the duress that it will be subjected to in a healthcare setting, one needs to have clarity and understanding before choosing for their respective healthcare setting. The most common types of vitrified tiles are as follows:

Full body vitrified tiles In Full body vitrified tiles, the colour is not only on the top but seeps through the whole tile during its designing. Because the tile is homogenous and coloured throughout, the scratches on the tiles become unnoticeable. For high-traffic areas, full-body vitrified tiles are recommended. These are available in both a matte and a polished finish.

Double charged vitrified tiles Two types of colours are fed into the machine in this technique, resulting in a very thick coating of a double-coloured

design on the tiles. This layer of colour and design is around 34mm thick. These tiles are good for high traffic areas. These are available in many finishes as well.

Glazed body vitrified tile Glazed body vitrified tiles have a layer of liquid glass applied to the surface. The glazed body gives the tile a more lustrous appearance and protects it from stains. However, these do not make for durable flooring tiles because of the single layer of finish and will start to look very battered with even the slightest of damage. Pros: Vitrified tiles are available in various colours and styles. A mixture of clay, silica, quartz, and feldspar is hydraulically pressed to create vitrified tiles. Thus, creating a Vitrified tile that is hard with low porosity. They are also available in various sizes, which makes them a very hassle-free material to work with. This material is also cost-effective and not usually held hostage to availability. Cons: Manufacturers often change out designs, so it becomes imperative that project managers procure additional material to account for replacement later on site. Because these are hard surfaces, they do very little to mitigate sound. Additionally, if not maintained or sealed well, they are prone to cracking. Engineered stone: As the name suggests, these are manmade products typically made from a combination of stone

(usually quartz or marble) and a polymer resin. Quartz, sometimes known as engineered stone, can be used in high-traffic areas, including reception areas of healthcare facilities. In the case of engineered stone, the stone elements make up a more significant percentage of the total weight. As a result, the material takes on a stone-like appearance and is incapable of being thermoformed. Pros: A highly durable material that comes in a large variety of colours and finishes make it a desirable choice for healthcare facilities. Engineered stones also do not require sealing, and they are practically non-porous. Cons: Engineered stone would be a luxury choice for a hospital budget. It's essential to establish a high-quality healthcare environment. It is the aspect of the built environment that addresses the safety of its users on numerous levels, including slip-resistance and anti-bacterial properties, along with sound absorption, walkability and durability features. Hospitals will continue to face a distinct and demanding set of flooring issues. With the choices being plenty, it is imperative that decision-makers factor in all long-term qualities like durability, permeability, noise absorption, and rigours of maintenance against one-time capital cost. Flooring that promotes safety and quality while reducing harm to customers and employees will maximise return on investment.

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POLICY

What ails India’s organ transplant story? Dr Kumud Dhital, Program and Surgical Director, Heart & Lung Transplant, SPARSH Hospital highlights that the country requires about 50,000 heart transplants and at least a similar number of lung transplants every year when less than 400 multi-organ deceased donations are available

n estimated 5,00,000 (5 lakh) Indians die each year waiting for organ transplants. A report by NOTTO (National Organ and Tissue Transplant Organisation) suggests that about 1.8 Lakh people need renal transplants in India, only 6000 patients are able to get one. Similarly, about 30,000 patients need liver transplants annually, but we are only able to serve 1500 of them. 90 per cent of kidneys and 84 per cent of livers that are transplanted come from living organ donation. The numbers are much more shocking for heart and lung transplants which have to rely on deceased or cadaveric donation. The country requires about 50,000 heart transplants and at least a similar number of lung transplants every year when less than 400 multi-organ deceased donations are available. In spite of being one of the most populated and fastest developing countries, India has a poor deceased organ donation rate at <1 per million population. This compares to >36 in the US, >20 in Australia, >4 in China and, an average of >16 in Europe with 10 nations at >20 and Spain at almost 50 per million population. What ails the drive and willingness to donate organs after death in India? Refusal to accept ‘brain death’ as irreversible: A brain dead patient can give a new lease of life to about 8 patients. There is a huge misconception about brain death resulting in poor consent rate for organ donation. Families are often unable to come to terms that brain-death is irreversible. In the context of ICU monitors showing normal cardio-respiratory parameters, it is difficult for families to accept that their loved one has passed on. This perception is largely based on the confusion over the purpose of brain death determination.

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Taking the example of heart and lung transplantation, there are about 100 approved heart transplant centres and slightly fewer lung transplant centres in India. However, only a handful of them are regularly undertaking transplant procedures The globally accepted criteria for certification of brain death requires stringent, unbiased and repeated assessment that is multifactorial with about 25 different steps including a thorough neurological examination and a mandatory apnoea test. Unfortunately, the association of brain death with cadaveric organ donation in the Transplantation of Human Organs Act, 1994 has also added to the confusion around brain death determination. It is encouraging to see a number of states in India that have already legislated or are assessing the delinking of brain death from or-

gan donation. Consequently, these assessments are seen by many as a means to determine suitability for organ donation rather than being a necessary part of normal end-of-life care. In its purpose, the brain death determination allows confirmation in regard to the viability of the brain and therefore the individual. Importantly, these tests, if confirmatory, permit a timely closure for the patient and the relatives as opposed to the continuation of prolonged, futile, and expensive continuation of care in the ICU. Certifying and maintaining brain dead patients: In addi-

tion to lack of consent and limited awareness, there are other obstacles for organ donation. Given how busy most ICUs tend to be, there is a shortage of necessary infrastructure and training to allow optimal care for the brain-dead multi-organ donor and have sufficient medical staff who are authorised to undertake the brain-death certification process. Need for transplant coordinators: A designated transplant coordinator who can counsel the family members of donors, alleviate their concerns about organ donation, and walk them through the process can go a long way in improving organ donations in India. There is ample evidence that when the counselling is carried out by formally trained medical staff, then the consent rate is significantly higher. For instance, the MOHAN (Multi Organ Harvesting Aid Network) Foundation, an NGO experienced in creating an ecosystem for brain-death organ donation has demonstrated the positive impact a transplant coordinator can have on the conversion rate of organ donation. Lack of necessary infrastructure for retrieval and transplantation: Organ retrieval and transplantation are complex medical and logistical processes that require multidisciplinary expertise. There are about 301 hospitals that are equipped to handle the full repertoire of processes required for transplantation of which 250 are registered with NOTTO. That’s approximately 1 fully equipped transplant hospital for approximately 55 lakh people and roughly a quarter of the transplant infrastructure in the USA per population. More disconcerting is that many of the registered and licensed transplant centres in India are either inactive or perform very few transplants. This is not simply due to the organ dona-

tion crisis, as many organs sadly do not get utilised because of logistics and the enormous cost of mounting interstate organ retrievals. The additional hurdle is the shortage of surgeons, anaesthetists, intensivists and other critical allied staff that are formally trained in their discipline of transplantation. Health literacy, stigma and superstitions: The resulting misconceptions from cultural and religious beliefs to general stigma from lack of health literacy, necessarily lead to the significant handicap in organ donation. Whilst a few voluntary groups and NGOs are having excellent impact, the sheer demographics of the country demand that greater resources must be focused at the community level from schools through to the workforce to enable the necessary positive influence on increasing deceased or cadaveric organ donation in India.

Trust and transparency Taking the example of heart and lung transplantation, there are about 100 approved heart transplant centres and slightly fewer lung transplant centres in India. However, only a handful of them are regularly undertaking transplant procedures. The fact that some centres show no activity over a considerable time leads to criticism that the transplant license merely serves as an emblem for marketing purposes. In reality, the problem requires a deeper appreciation of the complex interplay of multiple factors. Transplantation is not just a surgical exercise, and requires a multidisciplinary team of transplant-trained experts to work in unison to ensure successful outcomes beyond a mere discharge from hospital to meaningful survivorship into the medium and long-term. Most hospitals do not have the necessary infrastructure and

necessary human resources for such activity, and there are few centres that are able to offer an active comprehensive multi-organ transplant service. The other issue is that of transparency and the lack of mandated submission of outcome data or for this to be linked to continued reaccreditation. The absence of such data being available to the public means that patients and referring doctors are unable to make informed decisions on where to seek an opinion for their end-stage organ failure, and furthermore, only serves to compound the misconceptions mentioned earlier. The need for a National or State level transplant registry is appreciated by all but to date, there is lack of consensus on the metrics that should be recorded by any such registry. There is no need to reinvent the wheel as there are plenty of well-functioning transplant registries around the world. Approved transplant centres could even be grand-fathered in to ignore past activity and start afresh with prospective data collection and mandatory submission. This would bring about much accountability and transparency to the whole discipline of organ transplantation. On the background of the majority of transplant centres being in the corporate sector, such a registry would also help establish greater trust amongst our patients, referring doctors and communities at large.

Training and mentorship There is an urgent need of funded transplant fellowships to upskill medical staff from the multi-disciplinary specialties pertinent to transplantation. The COVID pandemic has created a significant backlog for those who wish to go abroad for such training programs. There are sufficient number of good-volume transplant programs for all solid organs in India that could accommodate the Fellowships and serve as the crucial hubs for regional training. The same centres can also serve mentoring programs to upskill smaller facilities to independent practice. In order to maximise the potential for higher volume of clinical work, for gaining necessary experience, for delivering better outcomes, and to be able to train, there needs to be some rationalising of the number of licensed transplant centres on a demographic basis. This is highlighted by the simple statistics around heart and lung transplantation, where the limiting number of deceased organ donations would in many Indian States, equate to less than 1 heart or lung transplant per centre per annum if we assume that all approved centres are clinically active. Low volume translates to the clinical necessity to be more cautious, and cherry-picking recipients for good outcomes means that a large cohort of would-be recipients are marginalised and may never be fully assessed. Some

of these more complex patients may even get to the waitlist but with little chance of actually being transplanted. To be fair, established transplant units are making inroads into such mentorship programs, but the effort needs to be acknowledged and encouraged with provision of coordinated training facilities and human resources to make any significant impact.

We need transplant role models Despite the increased awareness about organ transplantation, referring physicians and citizens alike still do not see enough role models amongst our transplant recipients to act as the ambassadors to communicate the benefits of organ transplantation, of symptomatic relief, of the relevance to family life, of a second chance of life, and the overall positive impact on society at large. Many patients have a misconception that they may live only 1-2 years post-transplant and are rightfully unable to reconcile this outcome with the significant out of pocket expenses involved in organ transplantation. We need to showcase stories of successful transplants and stories of survivorship where transplant recipients are living a fulfilling life posttransplant.

Push from state governments The state of Tamil Nadu has an organ donation rate of 1.8 per

million population, significantly higher than the national average, and has been able to enact legislation and several initiatives to promote and reap the benefits of organ donation. These range from: the establishment of ‘green corridors’ which are facilitated by collaboration between transport and traffic management authorities to the ambulance services and the police force; mandatory brain death certification as part of standard end-of-life care in government and public hospitals; and the provision of some state funding towards the cost of undergoing transplantation for all its citizens. Additionally, NGOs such as the MOHAN Foundation have done tremendous groundwork to improve the numbers of organ donations. For example, in 1999, the foundation started a program ‘Initiative for Organ Sharing (INOS)’ in TN with a mission statement ‘Let No Organ be wasted’. The pilot project began with 5 hospitals and then grew to become an organ donation movement. Other state governments are slowly following suit. Karnataka’s ‘Jeevasarthakathe’ initiative is a step in the right direction. A recent High Court order directed the Govt of Karnataka to build an organ transplant institute to cater to the increasing number of patients in the state who need an organ transplant. We need more initiatives from state governments to build proper infra-

structure, undertake awareness programs, partner with NGOs and create a transparent system to encourage more organ donations and transplant volume. At the same time, we desperately need financial resources equitable available in every state to support all citizens in the event they require a transplant procedure, and not leave this assistance to be seen by the public as an unfair advantage based on their pincode. Organ donation and transplantation requires a grassroots approach. We need to address the misconceptions and taboo associated with organ donation. We need to sensitise our physicians to address concerns around transplantation and encourage organ transplant for those who are truly in need of and likely to benefit from it. Finally, we need to create health schemes and supportive financial programs to ensure that organ transplantation is a reality for those from rural areas and difficult economic conditions. Without this assistance, encouragement to seek transplant opinion can be misplaced and be seen by patients in their plight or endstage organ failure as the unjust raising of false hope. All the more reason for early referrals to ensure best management of organ failure, sufficient time to explore all avenues of raising funds, and for a smooth transplant process with less risk.

EXPRESS HEALTHCARE

July 2022

POLICY

Universal healthcare and the moonshot mindset Swami Subramaniam, CEO, Ignite Life Science Foundation and Aparajithan Srivathsan, CEO, Intent Health Technologies emphasis that any exercise that plots a course towards UHC should start by outlining a set of principles

veryone agrees that Universal Healthcare (UHC) is a necessary good. But detail is lacking on how to get there. Vijay Chandru and Sharad Sharma, in a newspaper piece, have called for a “Moonshot” in healthcare, and have projected a monthly expenditure of Rs 1250 per Indian to achieve Universal Healthcare by 2030 (or 22-lakh crore rupees for the projected 2030 population of 150 crores). Let us examine the 22-lakh crore rupee figure a little closely. If we are to achieve anything like the UK-NHS standard of UHC where the current annual per capita spend is GBP 3227, then after correcting for purchasing power, the per capita figure for healthcare spend per annum would be closer to rupees 1 lakh today. At a country level, this would be 152 lakh crores or 20 per cent of India’s GDP in 2030. We have to ask ourselves if the Indian economy can bear this cost. Is Rs 1250 per month per Indian sufficient to deliver UHC, and if not what will have to give, to support the much higher figure that we estimate. It is one thing to extrapolate a number from the present into the future, but a much more complex exercise to enumerate the actions that will make our UHC aspiration come true. We need a detailed roadmap that will realistically take us towards UHC from where we are today. This roadmap has to accommodate the realities of the healthcare marketplace in India. Any exercise that plots a course towards UHC should start by outlining a set of principles. The reason for this is simple: when we tinker with something as complex and rooted in legacy as healthcare, every change will bring about roll-on effects on other parts of the value chain that can negate the intended positive impact of the intervention. We need to think

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July 2022

Swami Subramaniam

this through carefully and start with a set of simple principles that can guide our decisions and choices. As part of research for an upcoming book, we have been considering these issues, and what follows is our take on what some of these guiding principles might be. We should not consider these as either comprehensive or sacred, but simply as ideas that merit discussion of the kind required when dealing with something as complex as Universal Healthcare. Make volume an advantage: If there is one key and distinguishing characteristic of the Indian healthcare marketplace, it is volume. We have the largest concentrated volumes of patients in many diseases (including diseases thought of as afflicting the Western world, like diabetes and cancer). Our healthcare delivery system should respond by creating large focused care facilities that can take advantage of economies of scale while leveraging volumes to improve quality of care and clinical outcomes (higher volume medical facilities produce better outcomes for patients). High-volume care also promotes efficient use of scarce resources

such as specialists and costly medical equipment. Thus, superior clinical outcomes can be achieved at a lower unit cost. The Arvind Eyecare factory (an example of a focused factory) demonstrates how this works, and in a similar way, we have seen this in cardiac care (Narayana Health) and diabetes care (Dr Mohan’s Diabetes Specialities). Government provided backbone: We cannot build UHC without the government acting as the orchestrator. The Government has to play its role in establishing the rules for fair competition, and set standards for quality while also operating gatekeeper functions (e.g., primary care) and emergency services. Hybrid business models and new business models: India has a rich legacy of privately owned healthcare facilities that must be marshalled and incorporated into the UHC ecosystem, going beyond mere fund transfers for procedures done. Both for-profit and not-for-profit organisations must operate side by side and compete. Newer business models, e.g., physician-run cooperatives, must be seeded and encouraged, given that experience has shown in other countries that physicianowned and managed enterprises perform better than pure corporate models in healthcare delivery. Transparency: Healthcare generates enormous amounts of data that can help understand trends, set pricing, monitor compliance and assist consumers shop for the best care at the best price. While the individual patient's data will be owned by the patient and shared with explicit consent, both aggregate data, and data stripped of identifiers should be part of a vast and growing pool of data that can be used for research. Transparency will also go a long way toward re-

Aparajithan Srivathsan

ducing waste, fraud and error in medical care. Task shifting: We already have a severe shortage of doctors that is not going away anytime soon. Any roadmap towards UHC that is expected to increase the consumption of healthcare has to take this fact into account and institutionalise and facilitate the shifting of common medical tasks and even basic primary care to trained medical personnel who are not necessarily physicians. Liberating the time of highly trained physicians will allow them to perform higher-order tasks that are matched to their training, thus reducing the overall need for doctors. Governance: The management of UHC will need the able administration of a cadre of medically trained administrators and business leaders. An Indian Medical Service, corresponding to the Indian Administrative Service, should be in place to train doctors to perform nonmedical roles with high efficiency. One standard of care for everyone with rationing when required: UHC has to assure that the same standard of care applies across the board regardless of the socioeconomic

status of the patient. There will be limitations to this principle due to the finite nature of resources. But when expensive or difficult to get treatments are rationed, such rationing should not discriminate between individuals based on factors irrelevant to the medical context. Payer models: A monolithic NHS like model will take decades to create and may not even be the best option. It would be better to allow those who can afford it, to pay for their healthcare through insurance (private or public), thus reducing the expenditure burden on the Government. These principles should not be written in stone. They should evolve and change as more data becomes available for analysis. But having such principles as a guidepost allows safe and ethical experimentation. The experiments we do should not simply be a test and fail model, but an iterative process that drives the evolution of ideas about what works best in healthcare. Universal healthcare is doable, but en route to that goal many complex issues will need solutions. Finding these solutions will require deep thinking, analysis and experimentation. We have to stop thinking simply in terms of how much we will need to spend on healthcare. We need to think deeply about the important and hard to measure clinical outcomes that the expenditure is expected to deliver. A term like “Moonshot”, is helpful in achieving big and audacious short-term goals where resources are plentiful, such as the situation when the USA put a man on the moon. But the “Moonshot” mindset does not help in plotting a multi-decadal journey through the complex thicket of problems that healthcare poses. We need to keep this in mind as we begin the journey.

RADIOLOGY

Radiology has seen the advent of AI and Machine learning in a major way Adith Chinnaswami, Co-Founder, MediSim VR highlights that while various medical fields will see great changes in the way we use technology to improve patient care overall. It should come as no surprise that one of the early adopters will be radiology

he 4th industrial revolution has crept up on us and its no surprise that our healthcare fraternity is increasingly seeing newer technologies being foisted upon us. We will have to not just familiarise ourselves with the various terms being bandied about, from Artificial Intelligence to Virtual and Augmented Reality, but also have a good understanding of where they can fit into the medical world. While various medical fields will see great changes in the way we use technology to improve patient care overall. It should come as no surprise that one of the early adopters will be radiology. I think a vast majority of recently passed out radiologists would agree that there exists a major gap between the training period to when one starts practising in the field. The current curriculum chooses to continue focussing on the same principles upon which radiology was practised a few decades ago. This will not serve to better prepare radiologists. The dynamic quality of radiology necessitates medicos being tech compatible. Radiology has always been one of the most dynamic healthcare fields, especially given the intimacy of their work with the machines. All the technological advances have directly rendered a multitude of timetested procedures unsavoury when newer technology is available. None more so in the way dynamic imaging has increased its capacity in terms of endoscopic ultrasounds and nuclear medicine providing pinpoint accuracy in the oncologic practice. Simulators are bringing training standards remarkably close to on-field experience. It has been interesting to

More time ought to be dedicated to sensitising the future radiologist to the use of breakthrough technology. Not only is a working knowledge of all these advancements an advantage, it will soon become a requirement see medicos and the med-tech community warming up to the necessity of training solutions. The development of simulators and the accuracy they can provide in training post graduates has been proven through a multitude of studies. The rise of indigenous players developing healthcare solutions is on the rise. This will give way to cost effective solutions, which can be used to train radiologists in various dynamic imaging procedures such as Ultra SonoGraphy, Fluoroscopy and Endoscopic procedures.

Radiology has seen the advent of Artificial Intelligence and Machine learning in a major way and will perhaps be one of the frontrunners, alongside pathology, in the use of AI for diagnostics. While this has been mooted for a long period of time, we are finally seeing working solutions being slowly presented at various forums. Across the globe, certain companies claim to have achieved 97 per cent accuracy in interpreting X-rays, which is very impressive, even in comparison to human standards. While these claims can still be

debated, it is becoming apparent to all that the day where AI will become the preferred mode of diagnosis is imminent. A huge amount of funding has been channelled into exploring the use of Artificial Intelligence and Machine learning in the field of radiology and we are now at the phase where the gains are becoming apparent. The birth of the metaverse. While there has been a lot of noise around the use of Virtual and Augmented reality, do not make the mistake of assuming it’s a passing fad. Virtual Reality as a technology was envisioned as far back as the eighties and for the tech savvy, this term may not be anything new. It might also lead to some of us assuming it’s old wine in a new bottle. However, there is a reason why all the major tech companies in the world are hedging their bets on developing hardware for the next generation of Virtual and Augmented Reality Headsets. Virtual reality will be an immense aid in visualisation and better understanding anatomy, which is foundation for all radiological work. Usage of Augmented reality during real-time procedures will play a prominent part in interventional radiology as we move ahead. While remote working capabilities is already a major part of a radiologist’s world, Virtual reality along with the advent of haptics and robotics will even bring to life the possibilities of performing ultrasonograms from a remote location. With all of the above possibilities, the question in front of us poses food for thought. How do we take advantage of this? In conversation with a recently passed out radiologist, you can hear his

passion on the subject of sensitisation to newer technologies during the training period itself. It remains a, if not ‘the’, crucial period for such attempts. It is a fairly accepted notion that a radiologist needs a working knowledge of the physics behind the machinery they rely on for their livelihood. However, gone are the days when a radiologist himself needed to run the machinery to get the required output. We have established a separate workforce of trained technicians who are more than capable of ensuring that our infrastructure works seamlessly. More time ought to be dedicated to sensitising the future radiologist to the use of breakthrough technology. Not only is a working knowledge of all these advancements an advantage, it will soon become a requirement. This can be achieved via numerous means, from allotting course credits (however small the number) to conducting workshops and seminars on the same. Finding space and time in the curriculum becomes imperative as it falls on all universities to make sure their students are sufficiently equipped for the future. Why ignore the larger picture? It requires an incredible amount of knowledge of the medical field to understand the problems it faces. So, it should not be surprising that solutions for the same have to come from within. This will allow us to start ideating and come up with the right use case for all the technological advancements that are sure to happen around us. This dream can be made a reality only if we doctors have a grasp on both, the technology and the medicine and the best time to start is now.

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July 2022

START-UPS

The role of health tech start-ups in transforming the dynamics of industry Shanay Shah, President, Shalby Hospital highlights that the healthcare industry has evolved in unusual ways as a result of the integration of digitisation and the need to meet the demands of basic and advanced healthcare across the country Data aggregation

n the past few years, numerous technological advancements have been made in the realms of healthcare and wellness. The healthcare industry has undergone a significant transformation, particularly in the wake of the COVID-19 pandemic. The healthcare industry has evolved in unusual ways as a result of the integration of digitisation and the need to meet the demands of basic and advanced healthcare across the country. Start-ups have played a major role to play in improving healthcare delivery of services as well as products, in technological advancements and for the digitisation of healthcare industry. They saw this as an opportunity for development and in order to keep up with the high demand for healthcare, introduced innovative products and services that are necessary for the operation of contemporary medical facilities. They experimented with the older systems and provided upgradation. The digitisation of health data and information paved the way for the application of analytics and helped recognise the demands and needs of the public. The priority for the healthcare technology start-ups was to improve services, performance, productivity, and efficiency, without sacrificing the dependability or accessibility of the system.

Homecare and blood tests & medicines at home Health tech start-ups have played a big role in home delivery of medicines, blood tests at home and home care services. They have implemented digitalisation, today an online pharmacy offers streamlined shopping for medicines and other healthcare products through its 24x7 online portal and mobile app. Medicines are delivered to

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July 2022

your doorstep; many apps also allow you to directly contact the doctors, making it easier for patients to consult whenever necessary. Start-ups have improved healthcare delivery by creating applications that remind users to take their prescriptions, book appointments, and provide information on the finest doctors, clinics, hospitals, and diagnostic centers. Many start-ups have played a key role in providing home care services. They experimented with the older systems and provided up-gradation. The digitisation of health data and information paved the way for the application of analytics and helped recognise the demands and needs of the public. The priority for the healthcare technology start-ups was to improve facilities, performance, productivity, and efficiency, without sacrificing the dependability or accessibility of the system.

Health apps Since the COVID-19 pandemic, one of the most rapidly growing trends in healthcare has been the use of healthcare apps. These apps, allow patients to interact with doctors via video calls, eliminating the need for patients to visit doctors in person at their clinics. Connecting doctors and clinics to medical experts via these apps is made possible by the use of software solutions. Among its most important products and services are managing health records for patients, online solutions for scheduling and managing appointments for patients, invoices and prescriptions, and diagnostic solutions for clinics. It also gives access to patient profiles and teleconsultations. Patients save time because they do not have to wait in clinics or hospitals and the doctors are able to care for the patient effectively.

Online platforms allow patients to access their health records, schedule appointments, chat with doctors, etc. This trend promotes transparency and convenience, and it improves care and cuts costs. With such online portals, a patient’s information is recorded, and they can check their medical care history, prescriptions, and test results online and share this information with multiple healthcare providers. This eliminates the need to manually transfer or share medical records, which saves a lot of time and is more efficient. These platforms let users track general medicines and specialist visits. They can even message the doctors on the platform and the doctors can access a patient's medical history. When data comes from multiple sources, important patient data can be missed. Data aggregation helps hospitals make quick, insightful patient-care decisions without missing important data.

Artificial Intelligence screening AI screening is another emerging trend in healthcare digital transformation that utilises artificial intelligence technology. Healthcare is one of the most vital fields of AI applications and is used for a variety of reasons like improved information processing and decision-making efficiency. A significant number of medical facilities all over the world have successfully implemented AI-powered chatbots and voice systems for patient consultation and engagement. Radiology images, including chest X-rays, head CT scans, and more can be interpreted within a few seconds using deep learning algorithms. There are many AI-based start-ups that provide automated digital microscopes

to automate the manual review of medical data– blood samples, urine and semen microscopy, and retinal image analysis.

Impact of these services These services have had a significant impact, particularly on inhome healthcare. Many people in urban India have taken advantage of this, for a variety of reasons, including convenience, speed of service, and the ability to compare and select the service according to their needs. Digital healthcare allows patients to schedule appointments at their convenience. Health technology can help deal with medical staff shortages, improve access to medical services and information, and help doctors understand medical issues better. The implementation of digital transformation in healthcare benefit doctors to make more precise diagnoses and provide patients with treatment that is not only better but also more effective and more specialised. Health Wearables allow patients to track their vitals in realtime. Digital transformation enables process automation, which lets healthcare organisations offer cost-effective services and eliminate unnecessary spending on traditional healthcare. The use of digital records can eliminate the need for paper records, speed up patient examinations, and make patient health records more readily available. It can improve and increase the effectiveness of online interactions with patients via video calls and chats and allow the medical industry to create a secure database for encrypting, storing, and accessing the private medical records of patients. Promoting these startups will increase resource efficiency by improving the medical industry.

HEALTHCARE TRENDS

Transasia-Erba group wins three awards at the prestigious Golden Globe Tigers Awards 2022 Transasia was conferred the title of the ‘Best Medical Devices Company 2022’. Suresh Vazirani, Founder Chairman, Transasia-Erba group was recognised as the ‘Best Healthcare Entrepreneur’ and Nikhil Vazirani, Managing Director, and the group’s next-gen leader was entitled ‘Young Entrepreneur of the Year’

t the recently concluded 9th edition of the Golden Globe Tigers Awards 2022 in Malaysia, Transasia and its leaders, were declared undisputed winners in three prestigious categories. Transasia was conferred the title of the ‘Best Medical Devices Company 2022’. Suresh Vazirani, Founder Chairman, TransasiaErba group was recognised as the ‘Best Healthcare Entrepreneur’ for being a forerunner in the industry for over four decades. Nikhil Vazirani, Managing Director, and the group’s next-gen leader was entitled ‘Young Entrepreneur of the Year’. On receiving the award, Vazirani cited, “It’s a matter of great pride for all of us at Erba Transasia that our efforts are being recognized, globally. The Transasia-Erba group remains committed to reducing the global disease burden, by partnering with the pathology community worldwide. Through our journey of over four

decades, we have endeavoured to ensure equitable access and production of diagnostic testing services. We will continue our legacy by offering products with the latest technological

advancements.” A well accepted fact is that early diagnosis plays a crucial role in disease prevention. Adoption of the latest technologies, affordability and timely ac-

cessibility to testing products remains the biggest challenge for India and the emerging markets. The Transasia-Erba group addresses these challenges by adopting the latest

technologies from its European subsidiaries and manufacturing in India to meet the needs of the emerging markets. A deeprooted collaboration of the R&D, manufacturing and sales teams helps early product launch offering customer solutions that are easily adoptable by labs, big and small, easily available in every region and affordable to all. Through its 12 subsidiaries, five R&D centres of excellence and seven modern manufacturing facilities, the group reaches out to millions in over 100 countries and strives to remain committed to a healthier and happier World. The group offers a wide portfolio of sophisticated analyzers and test kits for varied lifestyle-related and infectious diseases. Over the past several years, the Transasia-Erba group has been recognised for its immense contribution to the industry, through several prestigious national and international honours of repute.

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HEALTHCARE TRACKER

Agappe launches new 240 test clinical chemistry analyser Mispa CXL Pro Plus Mispa CXL PRO Plus is 240 test/hour fully automated biochemistry analyser which can perform all the routine tests required in a mid-sized hospital or lab. The technological advancement of the instrument is the Grating Photometry

gappe Diagnostics Ltd launched its third new product in the PLUS (enhanced) series- the fully automated biochemistry analyser Mispa CXL PRO Plus on 10th June 2022, in a hybrid event on virtual as well as physical launch at Hotel Lalit, Kolkata. The mega event was attended by over 80 bandhan partners from West Bengal. Around 1100 attended the launch event over virtual media. Thomas John, Managing Director. Agappe speaking on the occasion emphasised on the need for higher throughput biochemistry analysers as per the current trends of the increased number of tests per sample, covid-related secondary management of ailments, and increased awareness. So, the need for speed with accuracy has become pivotal for standalone labs, corporate labs and hospital labs. Agappe over 25 years has demonstrated commitment to maintaining the highest quality of products and is sensitive to the growing needs of the market. The company is pleased to fill this need gap via the launch of 240 tests per hour, mid-sized, fully automatic biochemistry analyser. John said, “Agappe and biochemistry are like blood and vein”, expressing the company’s strong commitment to biochemistry. Meena Thomas, COO & Director, Agappe unveiled the new product during the occasion. She elaborated on combining the forces from R&D, operations and commercial wings to find pragmatic solutions for our patrons. Binu Matthew, Head Equipment Manufacturing,

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The degassing feature of the instrument ensures perfect pipetting even in case of a minimum sample requirement of 2UL. It dissolves all the air inside the pipes and tubing of the instrument and removes it from the system ensuring perfect pipetting Agappe shared his insights on the technical aspects of the newly launched Mispa CXL Pro Plus and how it is technologically advanced compared to many existing biochemistry analysers in terms of operational efficiency. He showcased the world class shop floor to manufacture the diagnostic equipments and specifically drew attention to the Grating Photometer.

Vincent Ronald Miranda, Business Head, Agappe spoke about need gaps in the market and how Agappe is best suited to fulfill the same. Agappe’s growing footprint and expansion in sales and service teams will enhance customer satisfaction. Sudipta Acharjee, Product Manager detailed the features and benefits of CXL Pro Plus in his comprehensive

presentation. Mispa CXL PRO Plus is 240 test/hour fully automated biochemistry analyser which can perform all the routine tests required in a mid-sized hospital or lab. The technological advancement of the instrument is the Grating Photometry. It is advanced compared to most analysers sold which are based on Interference filter photometry. This advanced Grating Photometry ensures accuracy of the specific wavelengths which is required for the special parameters which is normally the pain point in other conventional methods. The grating photometry requires minimum maintenance and a longer life span, avoiding the cost of frequent filter replacements. The calibration stability ensures accuracy of results and optimum usage of reagents for patient testing rather than the cost involved in frequent calibration. The triple-speed mixing mechanism is another highlight. It ensures mixing at varying speeds for dedicated chemistry. Every chemistry demands different speed of mixing and CXL PRO Plus offers 3 types of mixing – high, medium, and low. The design of the stirrer is paddle-type which results in homogeneous mixing. The Degassing feature of the instrument ensures perfect pipetting even in case of a minimum sample requirement of 2UL. It dissolves all the air inside the pipes and tubing of the instrument and removes it from the system ensuring perfect pipetting. Direct HbA1c is a major differentiator Mispa CXL Pro Plus offers in this segment,

which eliminates the manual error associated with lysing and gives the full walkaway system as the whole blood can be loaded into the instrument for this particular testing. Digital Liquid Level detection ensures optimum usage of the reagents by detecting the accurate stages of volumes. Low water consumption – 4 lt/hour only makes the cost of operation economical as there is no investment in water plants and maintenance costs and frequent testing of input water TDS. The ready-to-use Alkaline Washing Solution ensures convenience and lower operating costs. There is no need for manual dilution of washing solution and the pack size is small which fits inside the instrument. The cost of this washing solution saves the exorbitant hidden costs of operation compared to other available fully automated biochemistry analysers in this segment. Thus, CXL Pro Plus is the ultimate automation for the mid-size workload of 240T/H. The economy of operation with the advanced Grating Photometry makes it the perfect choice in current situations where the specific protein estimation is increasing day by day along with the normal routine profiles. Agappe Diagnostics Ltd has offered many options and offerings for the existing fully automation to upgrade to the advance Mispa CXL Pro Plus. Agappe, best partner in diagnostics, is constantly upgrading the range of innovative, high-quality, affordable, and highly useful types of equipment and reagents, irrespective of the size of the lab.

Economical and value driven solution for neonatal critical care Aditya Kohli, CFO & Director-Sales, Allied Medical Limited (AML) highlights that with most diversified portfolio of anaesthesia and critical care equipment, AML makes it easier for the doctors & technicians to have better access to the healthcare facilities in the tier 2, tier 3 and remotest of locations across India and globally

ith continuous expansion, growth, and innovation as vision, Allied Medical Limited (AML) served the country during and post pandemic times by delivering healthcare solutions whether it is related to critical care, emergency division or operation theatres. Dr Vinod Kohli formulated the company in the year 1982 having an ideology of ‘Make in India’ which coincides with Atmanirbhar Bharat vision of PM Modi. Mechanical ventilators highly contribute to the effectiveness of healthcare services quality in the critical care setups. Generally, healthcare institutions experience malfunctioning and unavailability of mechanical ventilators that affects the efficient treatment of the people in ICUs. The growing sophistication and innovation of ventilators has significantly improved the medical staff and society's health. The advancement has improved survivability in the face of disease or injury and greatly enhanced patients' life quality through an improved diagnosis and therapeutic results. Managing ventilator is one of the significant features in ensuring the continuous business activities in healthcare services. Being a medical equipment manufacturing company, AML was running in full capacity during pandemic and populated most of the ICU setups with ventilators which was the need of the hour for saving lives. AML sold close to 5000 ventilators during pandemic times, thanks to the support from the Indian Government and the team that was working round the clock to cater to demand of the critical care.

AML offers arrays of ventilator that suits to all type of setup in the healthcare facility be it is emergency room, mobile ambulance, or any kind of ICU (NICUs, MICUs or SICUs). With most diversified portfolio of anaesthesia and critical care equipment, AML makes it easier for the doctors & technicians to have better access to the healthcare facilities in the tier 2, tier 3 and remotest of locations across India and globally. Currently, the demand for neonatal ventilators is abounding in post pandemic era. Since its inception, the neonatal mechanical ventilator has been considered an essential tool for

managing premature neonates with respiratory distress syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Prior to the early 1970s, neonates either died without access to appropriate ventilators, or they were supported in the first days of life with paediatric volume ventilators with a large pre-set tidal volume. Fast set respiratory rates and PEEP were believed to increase barotrauma and thus were not used. Infant mortality caused by RDS in the United States decreased from approximately 268 in 100,000 live births in 1971 to 98 in 100,000 live births

in 1985 to 17 in 100,000 live births in 2007. The mortality decreased from 1971 to 1985 was no doubt multi-factorial, but improvements in ventilator technology and the trainings certainly played an important role. In the last decade the role of mechanical ventilation in the neonatal intensive care unit (NICU) has been evolving. Invasive mechanical ventilation, although often necessary for supporting neonates with lung disease, has been implicated as a major cause of lung injury and inflammation, and is now considered a primary risk factor for neonates developing bronchopulmonary dysplasia (BPD). Conventional ventilation combined with the High frequency ventilation technique is the new way of treating the neonatal babies in the critical care division. AML Meditec Vista ventilator is a microprocessor-controlled ventilator with an intelligent and universal effective solution for neonatal to adult patients. Intuitive and simple user interface with quick operational readiness and automatic device check provides confidence in use and reduces training time. It offers wide range of ventilation modes, which makes it suitable for various clinical requirement in NICUs. Simple user interface and effortless operation makes AML Meditec Vista to be innate and require minimum amount of training for the medical and nursing staff. The trend in the neonatal intensive care unit is to use non-invasive ventilation whenever possible, invasive ventilation is still often necessary for supporting preterm neonates with lung disease so as an advantage AML

Meditec Vista provides Non-invasive and Invasive ventilation compatibility in all the modes of ventilation as a standard feature. AML Meditec Vista also offer some dedicated modes for neonates like TCPL and High Frequency ventilation (HFV). Mechanical ventilation at supraphysiologic rates and low Vt, known as high-frequency ventilation (HFV), improves gas exchange in a select group of patients who show no response to traditional ventilatory modalities. The mechanism of alveolar ventilation in HFV is very different from that in conventional ventilation, in that HFV is less dependent on Vt and more dependent on asymmetric velocities and convective dispersion of inspired gas. Patients with severe persistent hypoxic failure are most likely to benefit from HFV. HFV is also helpful in patients with bronchopleural fistula and persistent air leaks. The main tenet of HFV is to recruit lung volume with a high MAP and produce smaller fluctuations in alveolar pressure during inspiration and expiration, thus maintaining a satisfactory FRC and reducing alveolar stretch. AML high-frequency ventilation (HFV) is based on a very reliable and cost-effective principle providing an additional feature of single and dual HFV. Dual HFV facilitates the measurement of end-tidal Carbon dioxide, and the therapist can check the response of the patient without any interventions. If the entire spectrum of critical care, verticals are coming together to deliver better and faster care. It is going to be an inevitably easy path for the companies to have a phenomenal growth in the coming years!

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July 2022

HEALTHCARE TRACKER

Hybase V8/V8 Classic OTtable: Versatility beyond expectation Mindray Intelligent Collision Protection System ICPSTM technology uses the module recognition to find the different plates e.g. head plate, leg plate.This system contains more senses and controls the sensors through trajectory planning system to monitor motion

n operation theatre, the OT table is an important tool for surgeons to achieve best surgical position for intended surgery. Now a days more complex surgeries are being executed in many hospitals, so expected outcome form operation theatre table is also changed like stability of table while performing specialised surgeries like robotic or neuro surgery and smoothness in height adjustment or longitudinal shift of table or may be required position for shoulder surgery and very importantly the ease and safety in conducting C arm, as more and more use of C arm is taking place while conducting surgery. The operating table needs to be adjusted before and during operation to meet the exposure of the operating field. When the bed lowers and encounters an external object, the bed base is gradually lifted because it cannot be recognised (No collision protection system). After laying the sterile sheets, the medical staff is worried that sterile sheets would be installed on the ground or base during table adjustment, so they could squat to see the position of the operating table. How to remind the doctor of patient’s physical state on the table and find it in time? Mindray Intelligent Collision Protection System ICPSTM technology uses the module recognition to find the different plates e.g. head plate, leg plate. This system contains more senses and controls the sensors through trajectory planning system to monitor motion. The intelligent collision protection system monitors the positions of the table & components dur-

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July 2022

ing movement to avoid collision to the floor, table base or table column. Real-time 3D display of table setup information, useful information such as movements, battery, brake, anti-collision information, will be shown on the display. As in recent years, with the continuous update of medical equipment, the Carm X-ray machine has been widely used in trauma surgery, joints surgery, spine surgery, urinary surgery and other surgical operations, which has played a role in improving the operation time and quality. However, the space under the surface of the operating table is insufficient, which is a blind spot for fluoroscopy. The patient needs to be constantly moved to meet the needs of fluoroscopy image acquisition. Mindray offers ultra-thin base, thin frame, and 500mm lifting height allow 100 per cent access for more than 90 per cent of the C-arm X-ray

machines on the market, ensuring that the C-arm will not interfere with the operating table. The head-end and legend perspective distances are 1700mm and 1500mm respectively. The alternative carbon fiber operating platform provides an excellent perspective area, which fully meets the size standards of human organs and tissues, and perfectly meets the perspective requirements of various departments. MIS and robot-assisted operation demand accurate adjustment of surgical position, and flexible angle achievement of surgery process, so as to expose tissue and increase stereo scope of robot arm. Regarded as the base of setting position, the adjustment of operation table makes sure dynamic field exposure of organ and tissue by the help of gravity, reaching ideal operation vision of surgeon. By virtue of the multi-dimension angle adjustment,

HyBase V8 command position behavior by means of wireless transmission, and keep Trendelenburg position range from +36 degrees to -36 degrees. Rapid response help surgeon master real-time position data and judge confidently. And the table can accommodate highest stability and safety even for Bariatric patient because V8 series comes with 450Kg load capacity. Hospital operating table consist of thin mattress over a flat rigid table. If the mattress is unsuitable there is a risk that the patient anaesthetised for a few hours will develop pressure sores. Mindray offers with the Special Foam Core pad and multilayer design, HyBase V8 provides excellent pressure distribution to prevent decubitus ulcers, reduce postoperative health risk, and speed up patient recovery. In current era, the load of operation theatre is increasing and sometimes one

specialised OT is being utilised for other specialised surgeries. To cater such needs without compromising the quality delivered, the table should be modular which makes it flexible to opt such demands and compatible to various accessories with available functions. These modular tables make such tasks easier to execute. We look at more complex surgeries where specific positions with set angles are required which takes time to adjust by user every time, these small but important functions if memorised by tables can save a lot of time which exactly is being done by Hybase V8 /V8 classic tables. The ideal operation theatre table require the combination of intelligence and ease of usage, so that the focus remains on the patient and the best results are achieved without spending time on table adjustment and avoiding human errors.

HEALTHCARE TRACKER

Sequoia Healthcare launches Precision 32 Slice Spectral CTScanner with Dual EnergyApplications Precision 32 comes with mega pixel HRCT lung imaging against the conventional HRCT which are of 512 matrix which significantly improves the diagnosis of lungs angalore-headquartered Sequoia Healthcare has launched a 32 Slice CT Scanner with Dual Energy – Low Dose CT Scanner. The company said that the

HRCT lung imaging against the conventional HRCT which are of 512 matrix which significantly improves the diagnosis of lungs. Talking about the CT Scanner With Dual Energy

of skull beam hardening artifact removal and others to come in future are going to help radiologists in the diagnosis of the diseases,” he further explained. Talking about the feature,

fective healthcare. “In short, we want to bring diagnostic reach for all. With high-tech services accompanied with new world Artificial Intelligence, Robotics, etc, Sequoia aims to become the #1 Imaging

dures), 205 kg weight bearing capacity and 165cm scan ◆ Comes with physical gantry tilt against digital tilt to avoid unnecessary radiation to patient doing spiral scans when a simple sequential scan will suffice ◆ Combination of 42 KW, 350 mA, X Ray generator and 3.5 MHU 735 KHU/min metal tube you can have good images with obese patients as well as higher throughput without waiting for tube cooling ◆ Fast rotation time of 0.72 sec for quick spiral coverage with lesser breath hold times for patient comfort ◆ Patented P Axial technology to get acquisition slice of 0.275 mm thickness for crisper inner ear imaging

Precision 32 Dual Energy CT scanner produces good quality diagnostic images with stable performance and high throughput. That can help radiologist to achieve persistent diagnosis. It will redefine the new standards of 32-slice CT imaging. CT is a critical tool for Covid-19 diagnosis. Precision 32 comes with mega pixel

Applications, S Viswanathan, Chief Executive Officer, Sequoia Healthcare said that the dual-energy applications that were available only with highend CT scanners are now available at entry-level scanners. “Dual-energy applications like urological calculi analysis, fatty liver analysis, metal artifact removal, virtual non-contrast scans, the base

Viswanathan, said, “In order to minimise the radiation dose to patients, Precision 32 adopts a unique low dose technique.” We thrive to bring in advanced and affordable international technology, which ultimately serves in Cost-Effective Healthcare. Sequoia believes in delivering radiology equipment accessibility for cost-ef-

Devices Manufacturer globally,” Viswanathan concluded.

◆ Ultra-low dose algorithm from 60KV, dose modulation and dual domain iterative reconstruction technique ◆ 71.5 cm gantry opening for patient comfort and 50 cm Field of View. Intelligent console with all post processing software’s; dual energy applications, Virtual endoscopy, 3D, Auto bone removal and more features

FEATURES ◆ With mega pixel reconstruction for lung imaging to give sharper HRCT images compared to the convention 512 matrix images in other CT scanners ◆ Full functional couch with up/down (easier biopsy proce-

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Trivitron’s Wisonic Navi: Apremium POC ultrasound dedicated to anaesthesia & pain management Trivitron’s Wisonic Navi can play a major role in the field of critical care, pain anaesthesiology and performing with precision and reducing complications

n recent years, with the expansion of ultrasound applications, the demand for Point-of-Care Ultrasound (POCUS) has dramatically increased in specialities such as anaesthesia, ICU, Emergency, Pain Management, and various others. However, traditional ultrasound is not designed for Point-of-Care applications. Since Point of- Care physicians usually have nominal ultrasound knowledge, they potentially face a steep learning curve; they also have high disinfection requirements and prefer an ultrasound system with intelligent controls. Trivitron Healthcare offers a premium point-of-care ultrasound solution with cuttingedge technology for precise navigation improving quality of care and patient safety during

Focusing on every detail,Trivitron’s Wisonic Navi is designed to be indispensable as previously difficult tasks become routine with sight. It is simple to use and durable with best-in-class image quality critical care procedures. Focusing on every detail, Trivitron’s Wisonic Navi is designed to be indispensable as previously difficult tasks become routine with sight. It is simple to use and durable with best-in-class image quality. With its vision for precise navigation and conceptual design, it is setting up a new standard for anaesthesia ultrasound. Part of its innovative functions, this high-end ultrasound platform and LED POCUS into

its new era includes HoloBeam, wiNeedle, wiLearn, wiGuide, wiCloud Telemedicine, and many other user-friendly physical unique designs such as the largest in industry touchscreen display, probe with control buttons, motorised height adjustments, maximum in industry 7 hours battery backup.

Trivitron’s Wisonic Navi functions HoloBeam: HoloBeam is a wideband beam technology

that can use sound field information as much as possible. It helps in focusing the entire image, improving the image quality and frame rate increase. WiNeedle: WiNeedle intelligent needle visualisation technology, automatically recognize needle steering angle and enhance needle display. WiGuide: WiGuide intelligent needle tracking technology, both out of the plane and in the plane. WiCloud: Helps in remote di-

agnosis by real-time teleconsultation face to face in wiCloud. service or application engineers can adjust image parameters and check the malfunction by phone. WiLearn: WiLearn Education Center provides comprehensive learning materials regarding regional anaesthesia and pain management Trivitron Healthcare believes that ultrasound can provide a new perspective to anaesthesiologists by helping in the performance of previously blind procedures and allowing the discovery of many hidden spaces to uncover their mysteries. Trivitron’s Wisonic Navi can play a major role in the field of critical care, pain anaesthesiology and performing with precision and reducing complications.

Medikabazaar launches Nexage - India’s first trendy & stylish medical wear brand NexAge is curated by ace fashion designers to provide a mix of elegance and comfort to brave healthcare workers

ndia's leading B2B healthcare procurement platform Medikabazaar has announced its ambitious plans to foray into medical wear segment. NexAge is for the modern healthcare professionals who want the perfect balance between performance, safety, and personality. Medikabazaar have revolutionised the scrubs with compelling options of fit, fabric, function, fashion, and feel in line with the latest international trends in scrubs. Medikabazaar did an extensive re-

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search and found that the market is open for different materials, fits, and designs that are comfortable to wear, trendy, and at the same time functional. The scrub clothing needs to go through a complete makeover when it comes to the choice of cloth, the color, and the fit. NexAge is curated by ace fashion designers to provide a mix of elegance and comfort to brave healthcare workers. The scrubs are available in varied color & fabric range like or-

ange, maroon, mauve teal blue denim doctor blue sky grey, leaf green, hot pink, candy green, purple cotton, woven poly-cotton, poly-cotton, knit, denim, stretch Nexage will not only offer option of personalisation for individual but will also offer a flexible bulk purchase options to hospitals to customise scrubs as per choice of fabric, color, sizes & styles according to their preferences and transform the look of the hospital workforce which will result in

boosted team's confidence and patient perspective of the hospital service quality. Vivek Tiwari, CEO & Founder, Medikabazaar, stated during the NexAge launch at Medical Fair India, "We are excited with the launch of India's first premium scrub, Healthcare workers have been limited to lose fitted scrubs, now with the launch of NexAge we have added many important aspects like Comfort, Fit, Trendy, Contemporary breathable yet safe apparel line for them. We have

got a positive reaction from hospitals and healthcare personnel not only from India, but also from Japan, China, the Middle East, and other countries. " With our new offering Nexage, Medikabazaar's mission is to transform the medical wear by introducing trendy, aspirational, comfortable, safe and supremely functional worldclass apparels for medical professionals. Be Bold, Be Confident, Be Stylish, Be NexAge!

HEALTHCARE TRACKER

Impact of poor menstrual hygiene on health Chanchal Jangid, Officer-Sales & Marketing, Ami Polymer talks about menstrual hygiene and explains its impact on health

very women go through the natural physiological process of menstruation in her life. However, although they experience this, not everyone is aware of how to ensure hygiene. During, the time of menstruation the women risk of being infected and the potential of life-threating ailments are increased. If women have poor menstrual hygiene it can lead to many issues on health such as bacterial and fungal infection, irritations etc. to the vaginal and urinary area. We should take care of ourself during the menstruation not only because it is important but also it is required to have a healthy and happy life. Ultimately, bad or poor menstrual

to feel confident and happy to live her life peacefully.

What can cause a poor menstrual hygiene practices? ◆ Bacteria into vaginal can cause to Urinary Tract Infection (UTI) ◆ Cervical cancer has been increased due to the UTI infections. It occurs in the mouth of uterus are which happens due to the Human Papillomavirus (HPV). ◆ Due to unhygienic practices a women can also become infertile. ◆ Unbalanced PH level which can cause an unhealthy bacteria ◆ Growth of bacterial infections can damage the vagina.

get pregnant.

TIPS FOR GOOD MENSTRUAL HYGIENE ◆ Change the Sanitary Napkins/Tampons/menstrual cup while periods frequently to avoid any contamination of the blood with the vagina area and also the skin irritation ◆ Avoid scented products made for intimate hygiene, which can effect vagina area and can disturb by having irritation and heavy white discharge. ◆ Avoid tight clothes while period to have a breath which help to stay fresh and dry ◆ Wash your vagina area especially while changing the sanitary napkins/Tampons/Menstrual cup.

During, the time of menstruation the women risk of being infected and the potential of life-threating ailments are increased. If women have poor menstrual hygiene it can lead to many issues on health such as bacterial and fungal infection, irritations etc. to the vaginal and urinary area hygiene can let us feel less confidant and unhappy. Therefore, each women out there deserves

◆ Good or bad menstrual hygiene also affect women who are pregnant or are trying to

◆ Do not use the sanitary napkins/Tampons/Menstrual cup more than 4-6 hours or as

recommended by the product, which can affect vagina area.

Author: Chanchal Jangid Officer - Sales & Marketing Support2@amipolymer.com Ami Polymer Pvt Ltd.

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How to control water activity in pharmaceutical packaging In the terms of the pharmaceutical industry, water activity is an important metric as it tells about how much moisture is available in a pharmaceutical product for reacting with other substances

umerous studies are carried out at CILICANT to understand the processes behind the challenges faced by formulators and manufacturers when it comes to pharmaceutical packaging. It's only by doing so that we can develop products that tackle issues that cause the degradation of pharmaceutical products successfully. One area in which we have invested considerably is in studies related to water activity, or equilibrium relative humidity (ERH), as it is more commonly known. As a result, we have discovered that the use of relative humidity regulators is the best desiccant choice where water activity must be maintained within a narrow range. To understand why, we need to look at the science behind it.

Defining and determining water activity Water activity is defined as the ratio of the vapour pressure of water in a given sample (P) to the vapour pressure of pure water (P0) at the same temperature. The formula used is: Pure water has a water activity of 1.0, while other substances fall along a sliding scale from this upper limit towards a water activity value of 0.0, indicating complete dryness. When it comes to packaged pharmaceuticals, it's more convenient to express water activity in terms of the equilibrium relative humidity (ERH) of the sealed system. The equilibrium relative humidity expresses the water activity as a function of the packaging environment and the relationship between the two is represented by the following equation: ERH(%)= aw×100 Next it's important to understand the difference between 'water activity' and 'water content', as they are different concepts. Water (or moisture) content of a pharmaceutical is typically used to refer to percentage of water molecules in a product, while water activity is a measure of how reactive those

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water molecules are. Although there is no direct formulaic approach to plotting the relationship between water content and water activity, the changes in the relationship between water content and water activity is known as a 'moisture sorption isotherm' and can be determined for each pharmaceutical product. As the composition of the product changes so too will the moisture sorption isotherm. There are several ways to determine the water activity of pharmaceuticals. The dew point or chilled mirror method is the gold standard. Here, specialised instruments measure the temperature at which air (at moisture equilibrium) condenses on a polished, chilled mirror exposed to a test sample of the product. This temperature is referred to as the dew point and determines the estimated relative humidity of the sample. Other approaches involve the use of capacitance hygrometer sensors or resistance hygrometer sensors.

Water activity and protecting pharmaceuticals In the terms of the pharmaceutical industry, water activity is an important metric as it tells us how much moisture is available in a pharmaceutical product for reacting with other substances. Unlike moisture content, water activity accounts for the energy levels of this water, which will impact on the shelf-life of pharmaceutical products. Since pharmaceuticals have different water activity values, by measuring water activity we can evaluate how resistant a pharma-

ceutical product will be to microbial contaminants. After that, we can assess the best ways to package product in order to maintain a water activity range that is optimal against microbial growth. Of course, pharmaceuticals come in a combination of formats, such as gel capsules and powder, depending on the most effective delivery mechanism to induce the effects of the medication on the human body. The key is the difference in water activity between the two materials. As moisture moves from a region of high-water activity towards one of low water activity, the disparity can lead to issues, such as the cracking of gel capsules or an increase of water activity in the powder. Many pharmaceutical packaging solutions incorporate the use of one or more desiccants to regulate moisture levels. Together, these aim to bring about low water activity to protect products against microbial proliferation and other degradation issues due to moisture build-up. However, where the ERH of the packaging environment must be maintained within a specific range, these 'standard' desiccants may cause over-desiccation.

Introducing ACCUFLIP: a better way to regulate water activity CILICANT has addressed this issue by creating a new range of products - ACCUFLIP. These moisture-regulating sorbents, or humidity regulators, are a new type of desiccant designed to maintain a stable ERH within packaging. Unlike traditional

standard desiccants that can be too aggressive when reducing moisture, moisture-regulating sorbents maintain the ERH of the packaging at an optimum level, allowing for an optimal shelf-life. Furthermore, these moisture-regulating sorbents can be adjusted to meet the requirements of specified ERH levels, making them highly versatile and ideal for a wide range of pharmaceutical packaging scenarios.

ACCUFLIP applications Since humidity regulators can regulate water activity in all forms of pharmaceuticals, the application potential is huge. For instance, in gel capsules, the water activity of the exterior coating needs to be maintained at a level that prevents the coating becoming brittle as a result of very low ERH, or becoming sticky as a result of high ERH. As moisture-regulating sorbents take up and release moisture as required to maintain a constant ERH, the gel capsules are protected from both high and low ERHs. A standard desiccant would be ineffective in this instance as it would aggressively remove moisture from the environment, potentially leading to a very low ERH and low water activity, resulting in capsule brittleness. Another application can be seen with dry powder inhalers, widely used for delivering of drug doses to the lungs. It's essential that these devices are packed in an environment with a stable ERH as moisture fluctuations have negative effects on the stability of the product, detrimentally impacting efficacy for end-users. A high ERH here would result in powder particles clumping together making efficient drug delivery to the lungs problematic. Here, moistureregulating sorbents prevent moisture levels becoming too high or too low, where standard desiccants would over-desiccate and create electrostatic charges, potentially lowering the dose available to lung tissue.

ACCUFLIP - a new tool in pharmaceutical packaging Clearly, the importance of a wellregulated water activity in the stability of many pharmaceutical dosage forms cannot be overemphasised. While traditional, standard desiccants can lower water activity in packaging environments and extend the shelflife of pharmaceuticals, they can also lead to over-desiccation. In these scenarios, moisture-regulating sorbents, such as ACCUFLIP, provide an effective alternative that helps to keep the ERH of packaged pharmaceuticals at an optimal level for longer shelf stability. CILICANT always looks at new and innovative ways of solving problems for our clients in the pharmaceutical industries and believe that these desiccants will play a vital role in the pharmaceutical packaging industry as more products requiring strict ERH levels come to market. To see the full white paper related to this article, visit www.cilicant.com Disclaimer: "The information provided by Cilicant Chem Private Limited in this paper is for general informational purposes only and shall not be relied upon by anyone for any other purpose. We make no representation or warranty of any kind, express or implied, regarding the accuracy, adequacy, validity, reliability or completeness of any information provided in this paper. Cilicant Chem Private Limited owns all the intellectual property rights in the contents of this paper. The contents of this paper shall not be replicated or reproduced in any manner whatsoever without the prior written permission of Cilicant Chem Private Limited. Cilicant Chem Private Limited shall not be liable for any direct, indirect, incidental, consequential or punitive damages or losses resulting from your reliance on the data provided in this paper."

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Express Healthcare (Vol. 15, No. 6) July 2022

Articles inside

DIGITISATION OF ICUS AND REDUCTION IN MEDICALERRORS

NEW-BORN SCREENING FOR METABOLIC DISOR- DERS: THE NEED OFTHE HOUR

CHRONIC DISEASE MANAGEMENT APPS: FILLING A VOID IN THE INDIAN HEALTHCARE ECOSYSTEM

RAPID GROWTH OF E-DIAGNOSTIC INDUSTRY NECESSITATED THE CREATION OFA SELF-REGULATORY CODE OFCONDUCT

DRONE TECHNOLOGY'S VIABILITYIN INDIA'S DIAGNOSTIC SECTOR