Express Healthcare (Vol. 15, No. 5) June 2022

VOL.15 NO 5 PAGES 48

INTERVIEWS Dr Anna Van Poucke Global Head of Healthcare, KPMG International Umakant Soni Co-founder & CEO, ARTPARK

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CONTENTS INTERVIEW

Sr. Vice President-BPD Neil Viegas

Environmental surveillance has proven to be a powerful public health surveillance tool

Asst. Vice President-BPD Harit Mohanty

DR ANGELA CHAUDHURI

Editor Viveka Roychowdhury*

Health Lead COVIDActionCollab

Chairman of the Board Viveck Goenka

BUREAUS Mumbai Lakshmipriya Nair, Kalyani Sharma Delhi Akanki Sharma

Pg 8

POLICY

HEALTHCARE IT

START-UPS

RADIOLOGY

P18: INTERVIEW

P22: INTERVIEW P28: INTERVIEW P29: INTERVIEW

DR ANNA VAN POUCKE Global Head of Healthcare, KPMG International

DR VIKRAM VENKATESWARAN Member-Healthcare Working Group, IET Future Tech Panel

DESIGN Asst. Art Director Pravin Temble Senior Designer Rekha Bisht Senior Artist Rakesh Sharma 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 Arvind Mane

CECILIA OSKARSSON Trade Commissioner of Sweden to India for Business Sweden

SRIKANT SRINIVASAN Head of Services, GE Healthcare South Asia

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

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EDITOR’S NOTE

Making India's death data really count

D

ata is the new oil, but unfortunately, the recently released report on Medical Certification of Cause of Death (MCCD)-2020 reveals that India still cannot tap fully into its health data.

This is a waste of resources, akin to an oil well spewing precious oil, with future generations unable to benefit from the epidemiological insights that could have been gleaned.

MCCD-2020 shows that medically certified deaths account for a mere 22.5 per cent of total registered deaths at the national level (including figures of 34 States/UTs). This is a slight improvement (1.8 percentage point) from the previous year's 20.7 per cent so there is obviously a lot of room for improvement. Especially with COVID-19 cases slowing rising, thanks to various variants. Add in the approaching monsoons and reports of monkey pox, and you have the makings of a perfect storm.

Of the 36 states/UTs represented in the MCCD2020 report, almost half (17) fall below the national average of 22.5 percent of medically certified deaths to total registered deaths for 2020.

Though the MCCD-2020 report is the 47th in the series, it unfortunately remains a work in progress. It cautions that there are 'varying levels of efficiency' of data reporting across the country, with reporting limited to selected hospitals, from mostly urban areas, so 'the profile presented may not yield the reliable pattern of cause specific mortality prevalent in the states/country'.

It is unfortunate that these data gaps exist even though this is the 47th such report on cause of death statistics. Thus the government needs to urgently step up efforts to get more states/UTs and the medical facilities within them to report in the format required. These gaps in data could prove very expensive for public health authorities and will have tragic consequences for patients as accurate health data is essential for health planners and epidemiologists to track effective allocation of resources and monitoring the implementation of a nation's public health policy.

But even with these gaps, some data points indicate trends which bear further investigation, where the states with positive indicators can be taken as examples to be followed.

Manipur's performance bears special mention: it went from 51.4 per cent in 2018, 67.3 percent in 2019 to cent per cent in 2020. Goa has in fact reported cent per cent medically certified deaths from 2018. Even though these are smaller states, with significantly lower mortality numbers than the larger states, they are definitely doing something right which can be replicated and scale up in larger states.

Jharkhand is another example where medically certified deaths is slowly inching up from 4.6

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The MCCD-2020 report gives a tantalising glimpse of epidemiological gems that can be gleaned. But given the data gaps, would it be wise to act on these insights?

percent (2018), to 5.8 (2019) to 6.1 percent in 2020.They are proof that where there is a will, ways can be found.

Goa had 14601 registered deaths, whereas Bihar had 425047 registered deaths, of which just 3.4 per cent (14591) were medically certified deaths.

Reflecting the complexity of all larger states, Bihar shows the most drastic decrease in percentage of medically certified deaths to total registered deaths during 2018-2020. The state went from 13.6 per cent in 2018 to 5.1 per cent in 2019 and a worrying 3.4 per cent in 2020.

Madhya Pradesh is in the same bracket as Bihar: (10.5 per cent to 9.1 per cent to 6.7 per cent) Bihar and Madhya Pradesh are part of the cohort of 11 states/UTs which have reported a decline in absolute number of medically certified deaths in 2020 over the previous year.

Just a cursory look at the data gives a tantalising glimpse of the epidemiological gems that can be gleaned. For example, of the nine leading cause-groups of deaths which make up around 88.7 per cent of total medically certified cause of deaths, diseases of the circulatory system leads with 32.1 per cent. Within this group, the diseases of pulmonary circulation and other forms of heart diseases and Ischemic Heart Diseases (IHD) account for 47.7 and 23.3 per cent deaths respectively.

In fact, the share of these two groups is 22.8 per cent of total medically certified deaths (15.3 & 7.5 per cent). The second cause of deaths is diseases of the respiratory system (10.0 per cent), followed by COVID-19 related deaths (8.9 per cent).

An inter-state comparative analysis shows that more than 30 per cent of total medically certified deaths under the diseases of the circulatory system category are from 14 states/UTs with Jharkhand, Andhra Pradesh and Lakshadweep reporting as high as 61.3, 60.6 and 57.8 per cent of deaths (more than half of the deaths), under this category, compared to Uttar Pradesh which reported just 13.5 per cent in this category. The corresponding figure at the national level for all reporting states taken together is 32.1 per cent.

But given the data gaps, would it be wise to act on these insights? Let us not forget that these data points represent real patients, beloved to their families. Strengthening health data reporting systems is the best way to create better health policies and coverage for the loved ones they leave behind and society at large. This is a legacy worth working for.

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

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, bronchospasm- laryngeal / 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.

GADOVIST® Abridged Prescribing Information Composition: Each ml contains 1.0 mmol Gadobutrol (equivalent to 604.72 mg Gadobutrol) as active ingredient. Indications: In adults, adolescence and children aged 2 years and older for: 1. Contrast enhancement in cranial and spinal magnetic resonance imaging (MRI). 2. Contrast enhancement MRI of other body regions: liver, kidneys. 3. Contrast enhancement in Magnetic Resonance Angiography (MRA). 4. For MRI of the breast to assess the presence and extent of malignant breast disease. Dosage and Method of Administration: This medicinal product is for intravenous administration only. For Adults: a) For Contrast enhancement in cranial and spinal magnetic resonance imaging (MRI); Contrast enhancement MRI of other body regions: liver, kidneys & For MRI of the breast to assess the presence and extent of malignant breast disease: administration of 0.1 ml Gadovist per kg body weight is sufficient to answer the clinical question. b) Contrast enhancement in Magnetic Resonance Angiography (CE-MRA): i) imaging of one field of view: 7.5 ml for body weight less than 75 kg, 10 ml for body weight of 75 kg or more; ii) imaging of more than one field of view: 15 ml for body weight less than 75 kg, 20 ml for body weight of 75 kg or more. For children aged 2 years and older: recommended dose is 0.1 mmol Gadobutrol per kg body weight for all indications. Contraindications: None. Undesirable effects: Reported undesirable adverse events in clinical studies were: Hypersensitivity/ anaphylactoid reactions including anaphylactoid shock, circulatory collapse, respiratory arrest, pulmonary edema, bronchospasm, cyanosis, oropharyngeal swelling, laryngeal edema, hypotension, urticarial, angioedema, etc; Nervous system disorders including dizziness, dysgeusia, parasthesias, etc; Cardiac disorders like tachycardia, palpitations, cardiac arrest; Gastrointestinal disorders like nausea, vomiting, dry mouth; Skin and subcutaneous tissue disorders like erythema, pruritus, rash, Nephrogenic Systemic Fibrosis (NSF) (Not known); general disorders and administration site conditions like injection site reactions, feeling hot/ cold, malaise.

Special warnings and precautions for use: Caution is advised in patients with: Hypersensitivity, previous reaction to contrast media, history of bronchial asthma, history of allergic disorders, cardiovascular disease, receiving haemodialysis, acute or chronic severe renal impairment, acute renal insufficiency, with a low threshold for seizures. Instructions for use / handling: Keep out of reach of children. Warning: To be sold by retail on prescription by Radiologist and Oncologist for diagnostic use only. This medicinal product should be visually inspected before use and should not be used in case of severe discoloration, the occurrence of particulate matter or a defective container. Please refer full prescribing information before use. Source: CCDS version 19 dated 13 May 2014, Revised 13 Oct 2015. Date of revision of Text: 19 Feb 2016 MAGNEVIST Abridged Prescribing Information Composition: Each ml contains 0.5 mmol (equivalent to 469.01 mg) gadopentetate dimeglumine solution for injection. Indications: 1. For Cranial and spinal magnetic resonance tomography. 2. For use in MRI in adults patients to facilitate visualization of lesions with abnormal vascularity in the body (excluding heart). Dosage and method of administration: For intravenous administration, only. For Cranial and spinal MRI in adults: 0.2 ml Magnevist per kg body weight (equivalent to 0.1 mmol gadopentetate dimeglumine per kg body weight), Maximum single dose: 0.6 ml Magnevist per kg body weight. For MRI to facilitate visualization of lesions with abnormal vascularity in the body (excluding Heart): 0.2 ml Magnevist per kg body weight, Maximum single dose: 0.6 ml Magnevist per kg body weight. Pediatric population: Maximum single dose: 0.4 ml Magnevist per kg body weight. Contraindications: None. Undesirable effects: Reported undesirable adverse events in clinical studies were hypersensitivity/anaphylactoid reaction including shock, hypotension, urticaria, pruritus, rash, bronchospasm, laryngospasm, etc, Nervous system disorder incluing dizziness, headache, convulsion, etc, Cardiac disorders like tachycardia, cardiac arrest, gastrointestinal disorders like vomiting, abdominal pain, Pain and Injection site reactions. For a full listing of undesirable effects, please refer to the full prescribing information. Special warnings and special precautions: Caution is advised in patients with: Hypersensitivity, previous reaction to contrast media, history of bronchial asthma or allergic disorders, cardiovascular disease, receiving haemodialysis, acute or chronic severe renal impairment or insufficiency, seizure disorders or intracranial lesions. Instructions for use / handling: This medicinal product should be visually inspected before use. Please refer full prescribing information before use. Source: CCDS version 09, Mar 08 2011, Last Updated: 23-Dec-2011.

PUBLIC HEALTH I N T E R V I E W

Environmental surveillance has proven to be a powerful public health surveillance tool Dr Angela Chaudhuri, Health Lead, COVIDActionCollab in an interaction with Viveka Roychowdhury talks about wastewater surveillance program for COVID-19 initiated by the COVIDActionCollab in Karnataka and highlights its role in the management of infectious diseases Wastewater surveillance programs have been used to detect polio, based on which countries are declared poliofree. Given its benefits, are such programs being used regularly in India?

Polio surveillance has been one of the earliest use cases for environmental surveillance. It has been carried out extensively in many parts of the world, including India. In India, wastewater surveillance was first initiated in Mumbai in 2001, followed by other cities in later years. It played a vital role in the eradication of polio in 2011. India continues wastewater surveillance at 52 wastewater treatment plants and unregulated catchment areas where sewage is drained in nine states and one Union territory.

As per the Ministry of Health & Family Welfare, Government of India environmental surveillance has been established to detect poliovirus transmission and as a surrogate indicator of the progress of any programmatic interventions strategically in Mumbai, Delhi, Patna, Kolkata, Punjab, and Gujarat.

The learnings and experience from the WBEbased polio surveillance have supported the government in taking control measures and expediting the polio eradication program in India, thus making the country poliofree in 2014.

What are the challenges to making them a regular part of disease surveillance programs in countries like India?

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among the public health community and policymakers in India Lack of capacities for regular testing, sense-making platforms, and communication: There are minimal capacities for planning, implementation, and usage of insights for public health actions. Hence, communication holds the key to delivering the message interpreted from the ES data.

Risk of misinterpretation of data and panic spread in the public: A slight miscommunication on data interpretation can lead to unwanted panic in the community and can pressurise the local govt to discontinue environmental surveillance due to apprehension.

Despite significant progress and potential for an expanded and enhanced public health surveillance system in India, there are a number of challenges that need to be addressed in the short term including: Lack of awareness of the relevance and effectiveness of WBE: Although environmental/wastewater surveillance has been used in polio eradication programs in India, there is still minimal knowledge and understanding of its use and effectiveness as a

public health tool. However, this scenario is changing rapidly as more and more cities set up ES platforms for disease surveillance.

Lack of national and state policies on WBE: As there are not many references to environmental/wastewater surveillance in public health discourses and research over a long time, it is not a part of public policies that provide essential space for its resource allocation and use. However, recent developments in this field have indicated an interest

What inspired the wastewater surveillance program for COVID-19 initiated by the COVIDActionCollab in Karnataka?

The concept of wastewaterbased epidemiology existed since the 1930s and 1940s, when it was first used for poliovirus detection in the US. Since then, it has been used as a disease surveillance tool to some extent in different parts of the world. However, it reemerged as a powerful surveillance tool during the COVID pandemic.

A study posted on March 30th, 2020 on MedRxiv reported that a sample collected from Amersfoort, the Netherlands, tested positive for the virus six days before the first COVID-19 case was diagnosed in the city, indicating

that wastewater surveillance can serve as an early warning system. This publication triggered the public health communities and governments in different parts of the world for testing and experiment with ES for SARS-CoV-2 virus in different settings and populations.

In the same year, COVIDActionCollab also conceptualised the process and launched a pilot study in Bangalore with various partners having relevant domain expertise. The pilot study proved to be successful and provided evidence of the detection of RNA copies of SARS-CoV-2 virus from the open drain wastewater prevalent in the city. This prompted CAC to present a proposal that was accepted by Skoll Foundation which provided the grant in April 2021. We officially launched the Precision Health platform, an initiative in Bangalore on 27th May 2021 in collaboration with different partners to set up an Early Warning System through Wastewater Surveillance.

How did the CAC collect and analyse the data?

In our Bangalore initiative, we had been testing wastewater samples collected from 46 open drain sites in the city to detect traces of SARS-CoV-2 virus.

A sample collection plan was developed based on the predefined conditions (grab sampling, one sample per site per week). CAC has two local implementation partners with substantial experience in wastewater management.

The collection team collects samples from open drain sites as per the sample collection plan and delivers those to the assigned laboratory for processing them for RNA extraction.

The extracted RNA samples are tested with a qPCR kit to obtain RNA concentration (RNA copies/ml) for the sample. The RNA concentration is expressed as “Viral Load” and presented in a time series trend graph for any increase or decrease.

We have been reporting three findings from this initiative: Weekly site positivity: Percentage of samples from sites where the samples are positive out of the total samples tested in a week.

Cumulative viral load trend: A trend graph of cumulative Exponential Weighted Moving Average of viral load of all 46 sites. The trend shows whether the city-wide viral load is increasing or decreasing with time.

Variant testing: The positive samples are selected on the basis of Ct values, Viral load and the Sigmoidal curve after RT PCR tests for Genome Sequencing and lineages (variants) are determined.

How did the insights from the data collected from this project help the Karnataka government respond more proactively to the COVID-19 pandemic? (Kindly give as specific examples as possible, compare to states where such programs were not running to show the impact) The data and insights obtained from the precision health program should not be used exclusively to derive actions. The wastewater surveillance only provides an early warning signal in case the samples are tested positive. Hence, it supports the surveillance teams in the local government in the first level screening of the city by providing supplementary information. Thereafter, other surveillance data should also be used to gather additional insights and then derive any action.

The BBMP has set up a

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COVID war room in which all the surveillance data is reviewed by the team of professionals and officials to understand the current scenario and thereby, plan for the actions. One official from the team, who is the nodal person for the Precision Health program, reviews the PPHS

data and discusses how this data could be added with other surveillance data for better planning of action. The PPHS data provides an Early Warning to the city in case the site positivity and viral load increase in the city.

The precision health team has developed a sense-making

platform to help local governments interpret the data and insights in a better way so that necessary actions can be taken.

From the graphs below: In the implementation phase since April 2021, the team obtained three early warning signals from ES in the

months of October, November, and December 2021. An Early Warning Signal was reported on 26th December 2021, and a week later the Total Positivity Rate from the individual samples also started increasing, commencing the third wave in the early January 2022.

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PUBLIC HEALTH Can you give a cost breakdown of the expenses involved and, therefore, the feasibility of scaling it up from Bangalore to the rest of India?

The implementation cost of the initiative depends on the number of sampling sites and the frequency of sample collection the city should have.

As the resources are required primarily in the implementation (sample collection and testing), the highest percentage of expense goes into it. A typical annual implementation cost for ES in a city like Bangalore, with 45 sites with a sample collection frequency of weekly twice per site is mentioned in table 1.

In addition to this, other resources such as program manager, public health professional/epidemiologist, communication professional, data analyst, and stakeholder manager can be resourced separately for a successful project.

For scaling this initiative in other cities, a unit cost for sample collection and testing can be calculated taking all relevant costs into consideration. Based on the number of sites in the city and the total samples to be collected, one can estimate the overall cost of the project. As the Bangalore initiative proved the effectiveness of the ES in case of open drains, it is practically feasible to implement in any city in India.

What is the roadmap for expanding this project, the sewage surveillance system for COVID-19, beyond Karnataka into a pan India program?

The precision health platform was launched for COVID surveillance as an entry point.

As the wastewater surveillance has shown potential for early warning for other infectious diseases, the precision health team has visions of utilising the platform for other disease surveillance. In addition to this, the platform is being tested in drug level testing and study on Antimicrobial Resistance (also known as a slow pandemic).

We are also looking at setting up an alliance as a pan

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India program. The National Alliance for Environmental Surveillance (NAES) shall be a sector-shaper for Environmental Surveillance to prove and be acknowledged as a key public health tool by harmonising academic and private sector efforts. The alliance is envisioned to be India’s first holistic platform focused on environmental surveillance by offering a unique multi-sectoral collaboration with different resource partners sharing knowledge and learnings, further disseminating information for evidence-based decision making.

In addition to this, the team is planning to scale up the COVID surveillance in seven other cities, while continuing

the Bangalore Initiative. In the scale-up initiatives, Precision Health will be supporting the planning and implementation of ES in the city by providing technical support to the city leads and providing data analytics and communication support to the city teams. The proposal for all the above plans has been submitted for further review.

How will this expansion be funded?

This Alliance shall be funded by donors whose role is viewed as a prime mover in supporting through investments, sharing social capital, overseeing governance, and achieving sustainability. They will be supporting the Precision Health team in the mobilisation

of partners through their social capital.

What are the long-term benefits of such sewage surveillance systems? What are the other disease conditions that can be mapped? How is this system better than community screening/testing etc.?

The presence of the virus in wastewater is a surrogate indicator of the disease being prevalent among the community living in that area.

It is not based on assumptions or modeling but on actual findings of the presence of viral remnants in wastewater. The pathogens can be shed in the feces of individuals with symptomatic or asymptomatic infection; therefore,

wastewater surveillance can capture data and information on both types of infection and send powerful early warning signals up to 6 days in advance of preparation.

This platform helps in identifying areas and regions where infection can be spread in the coming days or weeks, by testing the traces of the virus from the community wastewater. Hence, it provides an early warning to the government with evidence from the sample test findings, for necessary actions and steps to prevent the spread of the infection. The program can be replicable in most resourceconstrained urban settlements and serve as a strong example for cities to invest in such surveillance systems.

As a long-term impact, it is expected that the city administration will get better visibility and better decisionmaking tools which can support taking proactive measures in disease control and management.

As the source of samples is community sewage, most enteric pathogens can be detected through Environmental Surveillance.

Some examples can be Rotavirus, HIV, hepatitis A, influenza, and Salmonella typhi. All of these pathogens cause high mortality and a high disease burden in India. As the platform uses pooled samples from the community wastewater drains, which represent a large number of households, the cost of surveillance is significantly less compared to community testing.

What has been the impact of such systems /programs in India and globally, from a public health provider perspective and for communities and individual citizens?

Particulars

Includes

Programme Costs

Supplies for sample collection and testing

37,66,014

Amount in INR

Program Equipment and Assets

One-time cost for equipment, such as centrifuge machine, PCR machine

9,00,000

Program Administration Cost (Salaries)

HR cost

37,72,881

Total

Table 1

84,38,895

PUBLIC HEALTH Environmental surveillance has proven to be a powerful public health surveillance tool.

The COVID surveillance is a case in point. It has provided public health providers with an additional layer of useful information about the infection rate in the city as a whole. As it uses samples from the community wastewater, it is independent of the population's health-seeking behavior. This provides a holistic view of population health status, covering all sections of the population, including asymptomatic and untested individuals.

Governments across Europe and the USA have been very active in expanding environmental surveillance in different cities and towns.

A public health provider has benefitted the most from this platform as it helps him in better resource allocation and targeting actions to control disease spread through evidence-based decision making. Hence, it supports him in taking proactive measures in disease management.

If the insights from environmental surveillance are publicly available and are shared with the community with an appropriate communication for its interpretation, the community is likely to benefit, it can support public health providers by taking unanimous decisions on containment measures. Individuals too can make informed decisions based on the insights from Environmental Surveillance. In the case of infectious diseases, each individual plays a vital role in the disease spread containment. Hence, if prior information is available as an early warning signal, he/she can take also support disease spread control.

After the COVID-19 pandemic, are such systems being made part of India's Smart Cities roadmap to create more resilient cities?

What are COVIDActionCollab's future plans on this front?

A group of interns working in the NIUA’s Smart Cities Initiative under the Ministry of

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Urban Development, while exploring new and innovative ideas for Smart Cities, identified the Precision Health platform as a potential and viable system for future Smart Cities. The Precision Health team had introductory sessions with the group on the matters of navigating and promoting

the ideas in higher public health discourses. Communication is still underway.

The National Institute of Urban Affairs (NIUA), a think tank for research, training, and information dissemination in urban development and management in New Delhi, India, is also supporting and

funding a pilot initiative in Surat, Gujarat. They have set up a national working group consisting of scientists who provide necessary directions in its planning and implementation.

COVIDActionCollab would like to collaborate and engage champions like NIUA in scaling

the initiative in more cities in the future. Also, the team will be working on advocacy for environmental surveillance and capacity building both at the state and national levels around it. viveka.r@expressindia.com viveka.roy3@gmail.com

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Incorporating emerging technologies as part of radiology training is need of the hour

By Kalyani Sharma

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cover ) T

oday, radiology is one of the most sought-after branches and specialties of medicine. It is continuously evolving and becoming competitive, driven by availability of advanced medical imaging modalities like CT, MRI and increased level of acceptance and utility of new technologies like teleradiology accompanied by artificial intelligence (AI) and machine learning (ML). This is in turn fast tracking the journey of radiology becoming a key specialty not only for diagnosis but also in guiding and monitoring the treatments that the patient receives.

However, it is now important for the future radiology workforce to expand and strengthen their skills in line with the need and upgradation of the technology in this sector.

Sharing her views on this, Dr Meinal Chaudhry, Director, Radiodiagnosis and Intervention Radiology, Aakash Healthcare said, “Given the importance of medical imaging in effective clinical practice, radiology education and training are of paramount clinical importance. Basic radiology has continued to evolve in the medical curriculum, with a focus on teaching image interpretation skills, appropriate radiological investigation ordering, judicious use of ionising radiation, and exposure to interventional radiology. The digital revolution has fuelled advancements in radiology, which has had a positive impact on education and training.”

Dr (Col) M.L.Bera, Consultant & HOD-Radiology, HCMCT Manipal Hospital, “The practice of radiological services is undergoing rapid change in recent years due to technological advancement, workload escalation, workforce shortage, privatisation, corporatisation and globalisation of healthcare facilities. Simultaneously with more and more advanced cutting-edge technologies, the radiological services have transformed into multiple sub-specialities.

This sudden proliferation of

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Industry-academia collaboration is paramount for training. Various possibilities include a module on medical imaging with hands on experience that can be introduced in final years of radiology education Nikhel Goel Country General Manager-India Cluster, Carestream

Allocating adequate teaching time, educational budgetary constraints, framing educational needs, professional development for facilitating radiology teaching-learning sessions, and difficulties in developing instruments to assess teaching quality are all challenges that radiology educators face today Dr Meinal Chaudhry Director, Radiodiagnosis and Intervention Radiology, Aakash Healthcare

The practice of radiological services is undergoing rapid change in recent years due to technological advancement, workload escalation, workforce shortage, privatisation, corporatisation and globalisation of healthcare facilities Dr (Col) M.L.Bera Consultant & HOD Radiology, HCMCT Manipal Hospital

The scope and importance of radiology has increased exponentially with invention of latest imaging technologies.

There is increase in demand for radiologists and the placements are relatively easily available Dr Vimal Someshwar Head, Radiology & Head, Interventional Radiology, Kokilaben Dhirubhai Ambani Hospital

radiological services into multiple sub-specialities has adversely affected the quality of patient care and patient safety due to shortage of skill manpower.”

Dr Vimal Someshwar, Head, Radiology & Head, Interventional Radiology, Kokilaben Dhirubhai Ambani Hospital believes that, “The scope and importance of radiology has increased exponentially with invention of latest imaging technologies. There is increase in demand for radiologists and the placements are relatively easily available. Subspecialisation has become the norm and the trainee should focus on the subject of his / her interest.

Continuous learning, attending clinical meetings and conferences would help remain well versed with the subject. The future depends on how the AI impacts the practice of radiology.”

Incorporating emerging technologies as part of radiology training An international survey on AI in radiology published in the September 2021 edition of European Radiology, involving 1041 radiologists showed that a large proportion of radiologists consider the lack of emerging tech knowledge as a major hurdle to their work. The survey highlights that 48 per cent of radiologists and residents surveyed, who were from 54 mostly European countries, have an open and proactive attitude towards AI, while 38 per cent of them fear replacement

by AI. This survey suggests that intermediate and advanced AI-specific knowledge levels may enhance adoption of AI in clinical practice, while rudimentary knowledge levels appear to be inhibitive, an observation which would probably be true of their peers from India as well.

Although the current curriculum on radiology is upgrading with some changes, it is still not in complete sync with what the actual practice is and that is why strengthening the uniformity of the curriculum accompanied with more

incorporation of practical training is the need of the hour.

With technology on the rise in the field of radiology, streamlining the young workforce of radiology with focus on sub-specialisations is very important.

Highlighting the initiatives to train radiologists on AIbased subjects, Vikram Thaploo, CEO, Apollo TeleHealth added, “Even though training on innovative technologies is not part of the radiologist training curriculum, several initiatives have been taken to train radiologists on AI-based subjects. For instance, The European Society of Radiology (ESR) offers an online radiology training curriculum which includes learning the application and function of AI tools to

gain better knowledge of various technical options to implement deep learning and AI applications in the radiology workflow. The EuSoMII or the European Society of Medical Imaging Informatics has even supported the adoption and promotion of this curriculum for the integration of both ethical and technical aspects of AI into the radiology curriculum.”

“Another initiative worth mentioning is the NIIC (National Imaging Informatics Course) co-organised by the SIIM (Society for Imaging Informatics in Medicine) and RSNA (Radiological Society of North America). It includes using AI algorithms for medical imaging and the foundations of deep learning. This programme is not only offered to radiology

residents but even caters to PACS managers and various professionals in the medical imaging domain. Additionally, the American College of Radiology has also been active in offering training programs based on the foundations of artificial intelligence and itspossibilities in radiology practice,” he added.

Stressing on the importance of technology knowledge, Meenakshi Singh, Co-founder and CEO, Synapsica said, “Advanced technologies like AI can improve radiologist efficiency and thereby patient care. But it is only possible when radiologists become comfortable with these tools, so they can use them to their maximum benefit. And to use a product efficiently, one needs to have basic, if not detailed knowledge

about it.”

Dr H.K. Mahajan, Additional Chief of Medical Administration, Indian Spinal Injuries Centre added, “It becomes paramount to adapt radiology training programmes, so that the students are well-versed with the use of AI in imaging.

Radiology training programmes should aim to give residents an understanding of the fundamentals of type of AI in radiology and how to access AI applications in radiology.

The training should also be aimed at building resources that can enhance or build their knowledge in AI applications in radiology. Today, there are many AI training programmes offered to radiologists, but most of them are short and stand-alone sessions that are

not part of a longer-term learning trajectory. The training programmes mainly focus on the basic concepts of AI and are offered in passive mode.

While professional institutions and commercial companies are active in offering the programmes, academic institutes are limitedly involved.”

Dr Vipin Kumar Pathak, HOD & Senior Consultant, Radiology, Apollo Hospitals highlighted that, “The duration of the training and the protocols should be predefined with necessary changes and amendments as per the need. Each hospital should have the facility of training in these subspecialties with adequate facilities. We should also encourage conferences and workshops involving groups of hospitals to spread

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cover ) the knowledge of recent advancements. Involving the international faculties in these conferences would also help us in keeping pace with new advancements at the international level. Along with the radiologists’ training, the training of radiographers is of immense importance considering their role in handling the equipment.”

Only a handful of programmes practically engage radiologists in hands-on training of working with some tech-based tools Vikram Thaploo CEO, Apollo TeleHealth

Role of industry in training the next generation of radiologists In order to achieve the right balance of theory and practical, greater involvement of the industry is very critical. While the academic institutes are already focusing on imparting the theoretical knowledge to the students, industry can prepare them on the advancements and use of the technology, considering the fact that they are the ones manufacturing it. An enhanced focus on industry-academia collaboration accompanied by formation of Centre of Excellence can be one important step in this direction.

Explaining the role of industry in training, Nikhel Goel, Country General Manager-India Cluster, Carestream said, “The medtech industry has an important role to play in training radiologists. Given the advanced nature of X Ray, CT & MRI equipment being manufactured, the training has centered around learning the advanced technology involved for getting the best out of these advances for medical imaging output.

Mostly this involves work flow management, understanding how various software can help understand detailing of anomalies for critical ailments such as breast imaging, musculo-skeletal imaging and learning how AI features and applications can help them make predictable analysis for clinicians to diagnose faster. Beyond this, I believe there can be peer to peer learning modules, experiential sharing with Centre of Excellence and skills to manage large volumes such as in the recent pandemic that can be facilitated

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through industry organised programmes.”

“Industry-academia collaboration is paramount for training. Various possibilities include a module on medical imaging with hands on experience that can be introduced in final years of radiology education to having formal MOUs with leading hospitals by industry players to impart advanced training on medical imaging,” he added.

Current challenges

To successfully incorporate emerging technology in the radiology space, healthcare providers should start by interviewing their radiology staff.

Engaging professionals from the medical imaging division helps in better understanding their needs and challenges in technology adoption Meenakshi Singh Co-founder and CEO, Synapsica

It becomes paramount to adapt radiology training programmes, so that the students are well-versed with the use of AI in imaging Dr H K Mahajan Additional Chief of Medical Administration, Indian Spinal Injuries Centre

The duration of the training and the protocols should be predefined with necessary changes and amendments as per the need Dr Vipin Kumar Pathak HOD & Senior Consultant, Radiology, Apollo Hospitals

Academic institutes should understand that it is essential for young radiologists to have at least the basics of the fast-advancing technologies for better results and less diagnostic errors.

Talking about the challenges, Dr Bera said, “With technological advancement patients now enjoy the benefit of early diagnosis and less invasive treatment alternatives with less cost and lower morbidity and mortality. However, due to sudden technological outburst with increasing volume and complexity of work, there is acute shortage of skilled workforce to meet the growing demand on a day-today basis. This may lead to workload/ workforce imbalance and may adversely affect the quality of patient care and patient safety in the coming days. To overcome these problems, conventional training programmes of technical manpower need to be replaced with more specific and focussed training programmes to face the challenging tasks in the near future.”

Dr Chaudhry explains that, “Allocating adequate teaching time, educational budgetary constraints, framing educational needs, professional development for facilitating radiology teaching-learning sessions, and difficulties in developing instruments to assess teaching quality are all challenges that radiology educators face today.

Non-subject experts frequently lead radiology teaching-learning sessions in most institutions, despite the fact that

radiologists teach diagnostic imaging better than any other specialty.”

Talking about the issues with AI training programmes for radiologists, Thaploo said, “Most of the training programmes concentrate on the conceptual aspects of emerging technologies like the basics of AI, machine learning, etc. and its potential for medical practice in general which is not necessarily related to radiology.

Only a handful of programmes practically engage radiologists in hands-on training of working with some tech-based tools.

Another significant problem with the training programmes is that a majority of them are targeted toward other medical professionals like medical researchers, GPs and other specialisations. In fact, a lot of the programmes are quite generic.

The training instructors of the programmes are observed to be from diverse backgrounds like “founders of tech companies,” “radiology professors” and “researchers” from research and development departments. Half of the programmes are jointly offered by instructors with medical and technical backgrounds. Only a handful of the programmes are offered by radiologists”

Way forward Government and other stakeholders should work in a collaborative mode to strenghthen the current radiology training ecosystem in India for young radiologists via initiatives like increase in investments and developing more Centre of Excellence along with pushing the PPP model which can play a major role as far as

incorporating the practical skills is concerned.

Talking about the way forward, Singh said, “The benefits of any technology can be realised only when they are successfully incorporated into the workflow. To successfully incorporate emerging technology in the radiology space, healthcare providers should start by interviewing their radiology staff. Engaging professionals from the medical imaging division helps in better understanding their needs and challenges in technology adoption. Consulting radiologists from the start also encourages them to share their opinions and ideas during the transition process, which will make technology implementation a much easier task."

“Essentially product vendors provide technical support

to help users while facing challenges with their applications.

But some technical glitches can be easily solved with the help of tech-savvies in the room. Some healthcare professionals have an innate ability to learn new technologies quickly. Identifying these tech savvies can be advantageous as they can provide timely help to their less-trained coworkers when things go south and also help them improve their tech knowledge, eliminating the need to wait for vendor-provided technical support to resolve the issue”, she added.

Dr Bera highlights that, “Due to exponential growth and recent technological advancements in imaging services, now it is becoming necessary to change the training programme on modality-based

training schedule for better understanding of technological advancement and effective implementation of various imaging protocols for better diagnostic yield” Stressing on developing a systemic training programs, Dr Mahajan said, "There is a need to further develop systematic training programs that can help with introducing as well as incorporating emerging technologies in radiology practices. There training programs need to be pedagogically integrated into radiology curriculum. The training need to further focus on learning how to work with AI, ML, AR & VR and be further specialised and customised to the context of radiology work."

Kalyani.sharma@expressindia.com journokalyani@gmail.com

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POLICY I N T E R V I E W

Patients are more informed, conscious, demand privacy and security and custodian of their personal data As India advances towards Rs 5 trillion dollar economy by 2024–25, KPMG in India has come out with a report titled ‘15 top priorities for transforming Indian healthcare: The 2024 agenda’ that highlights the certain priority areas needed for transforming the Indian healthcare industry.

Dr Anna Van Poucke, Global Head of Healthcare, KPMG International in an interaction with Kalyani Sharma elaborate on the key recommendations mentioned in the report Can you throw some light on the role of Indian healthcare sector in achieving India's target of achieving the 5 trillion economy by 2025? What parameters from the international healthcare models can be incorporated in the Indian healthcare system for achieving the same?

India’s healthcare industry has been growing at a CAGR of around 22 per cent since 2016 (As per NITI Aayog’s report on investment opportunities in India’s healthcare sector published in 2021) and has a huge potential in being a key pillar for India’s US$5 trillion economy target by 2024. The Indian Government is undertaking deep structural and sustained reforms to strengthen the healthcare sector. This involves 100 per cent FDI being permitted in various sectors including hospital, manufacturing of medical devices as well as AYUSH. India’s health tech sector currently holds the fourth position in attracting VC funding with investments of US$4.4 billion between 2016 and 2021, with US$ 1.9 billion invested in 2021 alone (as per IBEF report on healthcare industry in India).

India’s healthcare sector also has vast opportunities for R&D as well as medical tourism in wellness and traditional medicine which is

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efficient as well as cost effective.

As per SDGs Report 2020, It is estimated that it will cost USD 3.9 trillion a year to achieve the Sustainable Development Goals (SDGs) in developing countries alone. Current levels of both public and private funding cover only USD1.4 trillion,

leaving an estimated USD 2.5 trillion annual gap. Filling this gap will require tapping new and greater sources of capital from the public and private sectors, including more than US$200 trillion in the capital markets, and effectively deploying these funds towards development efforts (as per the world

investment report, 2020).

There is however not only costs related to building up the Indian Healthcare sector.

A healthcare sector that provides accessible and good quality healthcare to all involved, can help in increasing the available workforce in India. A seminal review in 2013 by a Lancet

commission showed that between 2000 and 2011, about 24 percent of growth in full income in low- and middle income countries resulted from the value of additional life years gained.

One element in that equation is improved labor productivity due to better health. In that sense my statement would be that ‘Health creates Wealth’.

International models such as innovative and blended financing can play an instrumental role in the way we solve society’s greatest health challenges. The healthcare sector has plentiful, immediate prospects to leverage innovative financing to bridge the financing needs for building a resilient health system. India is yet to fully explore and leverage innovative financing models.

Innovative finance can be done through partnerships to pool resources from a range of public and private sources to solve problems faster, more effectively, and at a larger scale. A systematic effort led by the government along with private and other potential financing sources will be critical in creating and adopting innovative financing models in the coming times.

How crucial is the role of public-private partnerships in achieving

sustainability in the Indian healthcare system?

India is taking major steps for the overall strengthening of the Indian healthcare system, however, to increase the resilience and sustainability of the system and to ensure preparedness against future pandemics, new healthcare models or ecosystem of solutions are being envisioned and implemented in India. These are increasing the accessibility of healthcare services for the citizens, allow providers to be more effective in care delivery, helping patients to take control of their health by using their data, and forcing healthcare organisations to use this data to deliver more personalised treatments.

The government and the private players have taken initial steps in the right direction and they should focus on expanding the financing for ‘Healthy India’, promoting it as a mass movement, launching a healthcare sector promotion programme similar to the of Production linked incentive (PLI) scheme, bridging the last gaps in universal health coverage and strengthening the primary care system.

This will help in redefining and reviving public-private partnerships and as well as prove beneficial for driving schemes like Ayushman Bharat Digital Mission (ABDM) till the last mile.

At this juncture, it’s feasible that the government explores collaboration/ partnership with private healthcare players and the investment community to take up the opportunities for much-needed augmentation of healthcare infrastructure.

The need for public-private partnerships (PPPs) is further underlined considering the layout of medical infrastructure in India. According to a report

by NITI Aayog, 60 percent of medical infrastructure is densely populated across metropolitan cities.

Addressing this, private hospital chains are increasingly expanding

beyond the metros to tier-2 and -3 cities. Private players are also seeking accreditation and developing new healthcare models at an increasing rate. PPPs will also help address the shortage of skilled workers by establishing programmes to upskill the health workforce with the ability to adapt to technological advancements.

Further, there is enormous scope to leverage ‘strategic purchasing’ as an integral approach to fasttrack the achievement of larger health goals. Apart from its program to strengthen the public sector, the government can enter strategic purchasing

health data interoperability and unique identification of the patient. Health UID issued as virtual health cards could act like an ATM card preloaded with healthcare benefits like entitlement to health schemes, health coverage for any medical emergency, primary care benefits, certain free ‘JanAushadhi’ pharmacy coupons, health checkups and other such benefits that can be availed at any public or private health facilities.

To strengthen this initiative the most significant aspect is enhancing digital literacy in the country, unless a well thoughtout roadmap is articulated for ABDM to provide technical and

healthcare services across the value chain. Can you elaborate on this? Do you think scalability could be a challenge as far as the nationwide roll-out of such digital health initiatives is concerned?

The Indian health system, plagued by fragmentation across rural and urban areas, often limits the accessibility to healthcare services for citizens. Thus, there is an immediate need to have a one-stop gateway in the form of a ‘National Health App’ for citizens of India to understand and manage their health requirements in an automated way. A National Health application will connect all required

The Indian health system, plagued by fragmentation across rural and urban areas, often limits the accessibility to healthcare services for citizens.Thus, there is an immediate need to have a one-stop gateway in the form of a ‘National Health App’for citizens of India to understand and manage their health requirements in an automated way contracts with the private sector to build primary care services, district hospitals, clinical management services and augmenting of healthcare workforce skilling.

Ayushman Bharat Digital Mission (ABDM) has been playing an important role in making healthcare accessible. What else can be done to strengthen this initiative further?

The Indian Government has always had a firm belief in the use of technology and Digital Health as a great enabler in the delivery of healthcare services and strengthening the healthcare infrastructure. Government has introduced a Unique Health ID to address the issue of patient identification. This health ID will act as a link between all the UIDs locally stored at health facilities enabling

financial incentivisation to small and larger providers, the mission is unlikely to achieve great success. The capital and operational expenses could be factored in as a subsidy and/or indirect tax incentives for the providers leveraging the transformation journey. The success of this initiative will also depend on the ability to onboard a vast number of public and private health providers to adopt digital health solutions and standards to build a digital health ecosystem. Ensuring safety and security of health data effective implementation and monitoring of privacy policies like Health Data Management Policy will build trust amongst the users.

The recently launched report by KPMG talks about ‘National Health App’ for aggregating

services offered by public and private health providers in India with a single window to navigate healthcare needs required by every citizen.

The ‘National Health App’ will complement the existing applications and integrate them to improve access to quality healthcare services and enhance citizen experiences.

The increasing adoption of personal technologies has opened the gateway to the convergence of patient’s medical data with a deluge of non-medical, lifestyle-related data, much of which is generated by the patient.

Patients are more informed, conscious, demand privacy and security and custodian of their personal data.

Self-care will be key to Indian health system in the coming decade and increasing healthcare cost, constraints of healthcare resources and changing

consumer healthcare behaviour will drive most fundamental restructuring of healthcare in India. Amidst increasing awareness on health-related issues and healthcare needs in general, the ‘National health app’ will help patients to take an active part in decisionmaking regarding their health management, treatment regimes and outcomes, and support patients in managing their own health. Patients, governments and healthcare providers would push for self-care with electronic health records, personal health tracking devices and health applications for a remote support.

NITI Aayog's proposed ‘Vision 2035 - Public Health Surveillance in India’ is important in the management of future pandemics. The report talks about stepping up the national surveillance system and the need for institutional strengthening. Can you elaborate on the same?

Surveillance is an important public health function which is important for disease detection, prevention, and control. The NITI Aayog’s document envisions a citizenfriendly public health system integrated with India’s threetiered health system which is responsive and predictive.

To further step up the surveillance system in the country, different methodologies can be adopted which are further elaborated in the document.

Institutional strengthening needs to be done including key Institutes such as ICMR, NCDC and private sector labs to augment human resources, leverage digital technology and advanced data analytics, establish a one-health platform. Interlinking of such institutes needs to be done for timely and seamless integration of disease surveillance and research data.

Continued on Page 21

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Do we need more doctors?

Dr Swami Subramaniam, CEO, Ignite Life Science Foundation and Srivathsan Aparajithan, Managing Director, Intent Health Technologies highlights that doctors are a key ingredient in healthcare delivery. However, increasing the number of doctors will make a difference only if there is a shortage of doctors to start with

D

espite progress on several fronts, India continues to do poorly on measures of population health. One thing is abundantly clear - Indians need ‘more’ and ‘better’ healthcare.

The call for ‘more’ healthcare is often translated by policymakers as a need for more doctors. Doctors are a key ingredient in healthcare delivery. However, increasing the number of doctors will make a difference only if there is a shortage of doctors to start with.

Does India have a shortage of doctors? It depends on which part of the country you are in. Doctors are distributed unevenly, with some parts of the country having extreme surpluses and some parts having extreme scarcity. This skew is prominent when comparing the availability of doctors in urban versus rural districts (the urban to rural doctor density ratio is 3.8:1).

Seen in aggregate, however, the number of doctors per 1000 population is 1.34, which exceeds the number prescribed by the WHO. So, the shortage is not one of numbers, it is one of distribution.

An absolute shortage of doctors, if it exists, is restricted to medical super specialities like neurosurgery.

Since most Indians cannot afford high-end super-specialist care and therefore do not seek such care, the shortage is not evident. It is a latent shortage that will become evident once the government keeps its promise to provide free healthcare to all those who cannot afford it, whether under a system of universal healthcare or something similar. Furthermore, high-end care is even more unevenly distributed, being concentrated mostly in rich metro re-

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Dr Swami Subramaniam

gions. As a result, even the rural rich have to travel great distances to access the super speciality care they need.

The government has made efforts to push medical care out into the rural hinterland in the form of primary health centres. However, these outposts are under-equipped, understaffed, and unable to deliver anything more than the most rudimentary form of care. In the meantime, the doctors who staff these medical outposts are limited to performing routine tasks, referring anything complex to colleagues in nearby towns.

Over time, there is a downward spiral in their skill levels leaving them unprepared to respond to medical emergencies needing immediate intervention. Even in the major metros, many general practitioners struggle to build their clientele in the face competition from super specialist colleagues, and suffer the same fate of skill obsolescence.

Over time many of them are limited to generating income from kickbacks and referrals.

If we have fewer doctors in rural areas, will producing more doctors fix the problem?

The assumption is that if we produced more doctors, some of them will spill over from the metro areas where there is a glut, into smaller towns where there is a shortage. This assumption is a fallacy driven by the belief that healthcare, like any other economic activity, is bound by the same market forces. Economic theory would state that as competition between doctors for the same patient pool grows, some of them will be driven to move to other areas which may be less attractive to their peers from a quality of living point of view. This ignores the reality of healthcare, in which information asymmetry between doctor and patient means that doctors have almost unlimited power to induce an increase in consumption. So, a doctor who sees fewer patients can compensate for a decline in income by prescribing an extra test, an extra medicine or an extra

Srivathsan Aparajithan

procedure. This being the case, the production of additional doctors simply increases healthcare costs with marginal utility or even a negative impact on the health of the population in areas already oversupplied with doctors. Therefore, the quality-oflife difference between rural and urban environments is a gap that cannot be bridged simply by creating more doctors.

While it is be questionable if we have a deficit of doctors, it is a fact that healthcare delivery to large segments of the population is insufficient both in quantity and quality. So, if we do not train more doctors, what can we do to solve this issue.

There are at least 3 things we ought to look at doing before we expand capacity in medical colleges and train

more doctors.

First, much of what frontline doctors do today as part of their medical duties can easily be performed by nurse practitioners (nurses who have received specific supplemental training to perform this role). This includes everything from doing a clinical exam to treating minor conditions. We can deploy such nurse practitioners in rural areas. They can be tethered via telemedicine linkages to doctor colleagues who can back them up when necessary.

It is workable to have such nurse practitioners located even in remote regions, providing care that is lacking today. A cadre of trained community health workers deployed in Chhattisgarh and Assam has shown that this system works very well and can replace doctors for many

POLICY of the tasks that doctors currently perform.

Second, we should broaden the skills of existing doctors to include a wider range of procedures so that they can take on higher-value care. Again, frontline doctors can be supported by experts using telemedicine bridges to the nearest large medical centre.

Continuing medical education and short-term certification courses can be a means to upgrade the skill levels of frontline doctors so that they deliver high-value care.

Besides promoting the skill sets of these doctors, we must devise mechanisms for existing pools of doctors concentrated in large cities to move to tier 2 and 3 towns. The socioeconomic factors underlying the attraction of large metros are hard to match.

However, solo practitioners in big cities who are being muscled out by organised players may find it attractive to move to smaller towns if we give them the option to work in group practices. Community health centre units where

It is a latent shortage that will become evident once the government keeps its promise to provide free healthcare to all those who cannot afford it, whether under a system of universal healthcare they have access to a wider and deeper range of resources, including diagnostic equipment and specialist colleagues on whom they can rely for supplemental expertise and a collegial and satisfying work environment can be a magnet to attract solo practitioners in large cities to move to smaller towns.

These suggestions do not call for training more doctors, but they certainly call for training a cadre of healthcare workers - nurse practitioners or community health workers who are deployed on the front lines of healthcare and who can take up a substantial part of the workload of frontline doctors. That will free up doctors and allow them to focus on the more complex pieces of

healthcare commensurate with the cost incurred in training them. The challenge that remains, therefore, will be the problem of training nurse practitioners in large numbers. This problem can be solved easily and cost-effectively compared to training doctors. More importantly the cadre of nurse practitioners can be sourced from the talent pool in villages ensuring that they are acclimatised to serving near their homes.

This could also have the spinoff benefit from creating large scale skilled employment opportunities for the rural poor.

What can we do with the doctors who are currently performing the low-value frontline tasks? They can be upskilled to become super-

specialists; especially in specialities where there are looming shortages that will only worsen as more patients find such care affordable through schemes like Ayushman Bharat.

The pandemic has brought to public attention the inadequacies in Indian public health care. The government’s placating knee-jerk response is to build more medical colleges and turn out more doctors. The plight of Indian medical students returning from Ukraine has played into the myth that we have too few doctors and inadequate capacity to train the numbers we need. While the stark numbers reported in our public health scorecard are an objective reality the

projected assumption that training more doctors will solve the issue is a fantasy.

We do not need more doctors.

We need well-trained doctors doing higher-value work. In select super specialities, we may need to train more specialists to handle the consequences of emerging epidemics of lifestyle disease.

But mostly what we need is a well-integrated system of health care where telemedicine enabled frontline healthcare workers and nurse practitioners can satisfy the demand for low-value healthcare closer to where the patients live, thus stopping the large-scale migration of the sick to the cities which adds to the burden of our already out of shape public health infrastructure. This model has worked in some Indian states and needs to be rolled out nationally before we build more medical colleges that turn out mediocre doctors who then resort to predatory practices to generate the income needed to pay off their medical education debt.

Patients are more informed...

Continued from Page 19 An integrated national surveillance and pandemic management system encompassing various verticals of public health and health emergencies and other critical aspects of disease surveillance and pandemic management can be developed.

At present, Ministry of Health and Family Welfare (MoHFW) is in the process of establishing a National Public Health Observatory (NPHO) and a network of Health Emergency Operation Centres (HEOCs) across India for coordinated and cohesive public health management. The network of such NPHOs and HEOCs will form the backbone of a robust monitoring system for Indian public health.

Population health information system (PHIS)

could be developed with realtime dashboards to merge geography, demographics and clinical characteristics of patients vulnerable to health crisis to better understand disease incidence, drive service delivery decisions and identify ‘hot spots’ among vulnerable communities.

What are your views on the reliability and costeffectiveness of using technology in the healthcare system?

Although the uptake and utilisation of technology in the system is on a rise, do you think there are gaps that still need to be filled?

The challenges of increasing cost of services, shortage of skilled healthcare professionals, etc. are pushing healthcare providers towards the use of new healthcare models based on innovative and cutting-edge

information and communication technology (ICT) utilisation.

The COVID-19 pandemic has highlighted a huge opportunity to bridge existing gaps in our healthcare system using emerging technologies to provide on-demand virtual and adequate care to the masses. There has been 3 times increase in the number of people using Telemedicine (online health consultations) between March 2020 and November 2020 (as per Practo-TSI report). Nonmetros witnessed a 7 times growth in online consultations compared to 2019, while physical health appointments went down by 32 percent (As per Rise of Telemedicine report 2020).

The National Telemedicine Service of MoHFW, eSanjeevani, has completed 90 lakh teleconsultations in

the country.

The use of the Metaverse in healthcare can be revolutionary which can help remotely located patients get the right care, right diagnosis, receive medical treatment, or assistance in medical procedures from experts sitting in different geographies in real-time.

Some key aspects where metaverse can improve the future of the healthcare system include: ◆ Solve problems more efficiently by remote assisting using virtual and augmented reality by collaborating from different locations providing treatment to the patient. ◆ Leveraging Gestures Controlled Diagnostics to scan through the patients’ medical records during midsurgery by using hand gestures ◆ Visualising 3D medical

images in real 3D using augmented realities instead of getting different views on flat screens. ◆ Using virtual reality, movement-based interaction and mixed reality and its usage with metaverse can help trainees learn from experts while sitting at home and performing assignments and learning.

Although technology has the potential of lowering treatment delivery costs and significantly improving patient outcomes, gaps which need to be addressed include accessibility of health records which can be hacked.

Digital divide – the gap between those who have full access to digital technologies and those who don’t – presents a barrier towards usage of technology in India.

Kalyani.sharma@expressindia.com journokalyani@gmail.com

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HEALTHCARE IT I N T E R V I E W

Data is the key to success of disease surveillance programs Dr Vikram Venkateswaran, Member-Healthcare Working Group, IET Future Tech Panel in an interaction with Viveka Roychowdhury talks about his company's disease surveillance project and highlights that the project looks at disease surveillance from the view of unstructured data What difference has the COVID pandemic made to the practice of disease surveillance in India? What has been the quantum of investment in such activities?

COVID-19 has been a big driver for the growth of digital health in India. Initiatives like telemedicine have received a big boost and this has enabled the growth of digital platforms for consultation and growth.

Disease surveillance has also seen a big boost, with the tracking of COVID infections, hospitalisation, RTPCR tests and serological studies during this period. Also, the vaccination program along with the digital certificates have also shown how preventive surveillance can be tracked nationally. The government had earlier earmarked almost 35,000 crores for the programs including surveillance and vaccination. It has spent almost 20,000 crores so far on these activities. Similarly, the investments in the telemedicine platforms have increased significantly and today the telemedicine market stands at almost USD 1.3 billion.

How effective have surveillance programmes for diseases like TB, malaria, polio, etc been in India? What have been the gaps and learnings that can be adopted to prevent future outbreaks?

India started the IDSP, Integrated Disease Surveillance Program with funding from the World Bank in 2004. This was a 10-year program to track 33 disease conditions in India. The key drivers for this program were the Cholera outbreak in Delhi in

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1988 and the Plague outbreak in Surat in 1994. Now this program has really scaled over the years and today is run nation wide under the National Center for Disease Control in Delhi. While the program is remarkable in many ways and has helped identify and control many conditions in various parts of the country, including tackling the Nipah Virus outbreak in Kerala some years ago there are certain gaps that are yet to be filled. We have been very successful in managing Polio, and before that we eradicated Small Pox, moderately successful in managing conditions like TB, but a lot more needs to be done to manage conditions like Malaria which are cyclical and

have been affecting us for years.

Even during COVID the IDSP managed to track and stop the spread of Acute Diarrheal Infection in Sangrur in Punjab in September 2021, which shows the program is effective but definitely needs an upgrade. Here are some key points to consider: ◆ The program is not real-time and there is a lag between collecting the information and the actions taken ◆ These are mainly due to the manual entry that is done at Primary Health Centres, Labs, District Hospitals and other sources. Forms like P Forms, L Forms Admissions Forms are manually field scanned and then sent to Delhi for analysis ◆ Leveraging smartphones the

program did create a mobile application for tracking the disease condition, but the implementation has not gone according to plan and leaves a lot to be desired What are the benefits of a predictive and scalable planning model for healthcare infrastructure?

What would be the scale of funding required and what are the models to create in infrastructure?

A country like India cannot afford to deliver care uniformly across the entire length and breadth of the country. Our best strategy is to be proactive and determine where disease conditions are developing, so that we can move the entire

infrastructure human capital, technology and supply chains to the affected area. Hence in this context the disease surveillance programs are very important. That way both the government and private organisations can proactively tackle emerging conditions.

This would require the following: ◆ Real-time integration of hospital data- admissions and prescriptions with other sources like lab data ◆ Leveraging the telemedicine platforms to get a real time view of the consultations for a particular local area ◆ Coordination with local block officers to effective tackling of the situation on the ground, similar to the COVID-19 committees made by various state and local administrations ◆ Implementation of the national health stack for authorities to integrate all these data sources ◆ Merging of unstructured data from digital media with structured data to get a 360degree view of the disease conditions NITI Ayog has been working on a vision 2035 document incorporating many of these into a strategy that would be an upgrade to the IDSP and move us in the direction of an integrated disease surveillance program.

A program of this size would require a budget upwards of USD 500 million. The US for example has allocated a budget of $200 million to tackle disease surveillance. India today spends close to 1.2 per cent of the GDP on health.

Continued on Page 24

I N T E R V I E W

COVID-19 catalysed drone usage in healthcare Umakant Soni, Co-founder & CEO, ARTPARK explains Kalyani Sharma about drone technology and highlights that during COVID-19, the use of medical drones grew considerably to avoid the spread of infection. Drones were utilised to carry contactless personal protective equipment (PPE), gather laboratory samples, and distribute vaccines during the pandemic Why does India need an advanced technology infrastructure to address healthcare emergencies and greater accessibility?

Healthcare services are primarily focused in urban areas due to a lack of suitable infrastructure and manpower, making providing healthcare in rural areas a major challenge.

For some patients, the nearest doctor is a half-day drive away.

Doctors in primary care and even community health centres may discover that there is no suitable specialist within 100 kilometres. Furthermore, vast distances can obstruct the distribution of best practices and care coordination. In such situations, an array of technological innovations and deployments can significantly impact India’s rural population.

This is where an electronic health record (EHR) is crucial to population health management and enables healthcare practitioners to examine a patient’s medical history irrespective of their location. Patients can receive more immediate and more accurate care by sharing information electronically rather than travelling long distances. Clinicians can review and analyse previous visits, tests, diagnoses, and correspondence with other professionals, resulting in more precise and personalised care.

Also, telehealth systems can make remote consultations and diagnostics easier and more convenient for both patients and clinicians when professional help is needed.

Thus, a fully comprehensive EHR would be extremely useful for rural patients.

The other major stumbling blocks to patient care are medication prescription and

When it comes to innovative and new technology, we need a set of standards that everyone can rely on and precise and correct regulatory mechanisms. Despite its unique potential, air mobility is currently only available for a limited percentage of the most severe medical cases

dispensation; this can also be done remotely. Medication’ ATMs,’ which are already being used in rural areas of South Africa and India, ensure that patients get the medication they need without relying on pharmacists, doctors, or other difficult-to-find experts and are clinically safe. Furthermore, these ‘ATMs’ could find their capabilities increased in the future, allowing them to function as an information kiosk and patient portal, supporting diagnosis, testing, and medication prescription, reducing the burden on community health centres and hospitals.

Apart from that, rural communities face a shortage of healthcare expertise. It is difficult for them to obtain specialised training,, recruit existing skilled medical staff, and retain them for longer periods once they are there. As a result, providing specialised training to the existing population is one option to address this problem. It will solve the expertise problem and ensure that locals have appropriate job opportunities to progress.

Besides this, virtual reality can be used in rural areas to assist health professionals with training and knowledge by using training simulations with a headset that immerses them in a real healthcare scenario.

With virtual reality, a range of scenarios could be developed that allowed a person living in a rural area to gain practical experience without actually being in the emergency room, adding to the pressure on staff and putting patients at jeopardy. Thus, bringing technology into medicine and healthcare in rural locations can improve healthcare

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HEALTHCARE IT delivery and allow for far more efficient and accurate diagnosis in situations where specialised knowledge is not always available at the time of care.

How do you see the role and adaptation of advanced technologies like drones, and advanced air mobility in India?

A significant amount of the Indian population lives in rural and tribal areas. Apart from that, 40 per cent of villages in India don’t have all-weather connectivity. Thus, many healthcare emergencies are typically home-treated, as the time taken for any ambulance arrival is time-consuming and sometimes impossible.

Moreover, given that India has a diverse landscape, with rural and tribal areas on plains, hills, mountains, and deserts, providing timely medical assistance and reaching these places in cases of natural or man-made calamities often becomes impossible.

In addition, doctors or paramedics must address many other medical emergencies, such as snake and animal bites, burns and scalds, wounds and fractures, or even electrocution within the golden hour. This is where the role and adaptation of advanced technologies like drones and advanced air mobility come into the picture.

Drone technology has started to gain traction in

various sectors, and the COVID-19 catalysed drone usage in health care. During COVID-19, the use of medical drones grew considerably to avoid the spread of infection.

Drones were utilised to carry contactless personal protective equipment (PPE), gather laboratory samples, and distribute vaccines during the pandemic. Besides this, we are all aware that blood transfusions are required in the event of a severe injury or a pregnancy that results in significant blood loss. As a result, drones may be able to assist in ensuring that blood is available when it is required. In addition, several clinically essential transfers, such as ECMO (Extracorporeal Membrane Oxygenation) and organ transport, are not possible with surface ambulances.

Given the need for highquality emergency care and developments in drone technology, it is clear that advanced air mobility systems will begin to impact the future significantly. This will enable emergency medical service (EMS) teams to respond to an emergency in the shortest period of time. In addition, air ambulances with cutting-edge emergency care delivery technologies for patient stabilisation, resuscitation, monitoring, and audio/video telecommunication with a healthcare specialist could play

a key role in providing lifesaving care in a life-threatening situation.

What could be the possible challenges in the implementation of such projects or technologies in India? What is the need of the hour?

When it comes to innovative and new technology, we need a set of standards that everyone can rely on and precise and correct regulatory mechanisms. Despite its unique potential, air mobility is currently only available for a limited percentage of the most severe medical cases. This is due to the high historical costs, which are driven mainly by the high level of availability that these services demand and their low usage. Furthermore, evacuating a patient safely in challenging environmental conditions is a huge task. As a result, cutting-edge AI and robotics technologies will be necessary to enable a safe and effective system that can function in rough terrain and challenging situations.

What are your views on the acceptance of such technologies in the Indian healthcare system?

According to the Healthcare Access and Quality Index (HAQ), India ranks 145th out of 195 countries. Apart from that, the doctor-to-patient ratio is 1:1596, which is alarmingly low

when compared to the WHO standard of 1:1400. Besides this, the disruptions caused by COVID-19 have increased the need for a robust and effective healthcare system. As a result, the quick adoption of innovative healthcare solutions based on knowledge and Artificial Intelligence has the potential to empower doctors to treat proactive disease conditions and scale healthcare across India by providing highquality, low-cost care to the masses. It will help prevent the loss of billions of dollars and millions of lives around the world.

Can you throw some light on the role of partnerships and the PPP model in the successful implementation of such initiatives?

A nation’s real wealth is its healthy citizens. And the COVID-19 pandemic taught the world that a well-functioning healthcare system and a healthy population are vital to a country’s economic and social well-being. Furthermore, it is the responsibility of the government and the healthfocused companies to ensure that people stay healthy and have easy access to quality healthcare. These innovative technologies have the potential to save human lives and reshape the economic and social landscape of a rapidly rising India. Thus, with the convergence of favourable

government policies, industry players, service providers, medical professionals, and cutting-edge technology, can this be made possible.

Please tell us about ARTPARK’s efforts to automate the delivery of essential primary healthcare services in the rural parts of the country.

When it comes to addressing rising healthcare issues, prevention is key, as it is better to deal with manageable problems before they become major issues. On the other hand, the government cannot function and establish public policies in silos and must frequently rely on the subject area expertise of academia and industry. With this goal in mind, we established an organisation like ARTPARK so that the triple helix of academia, industry, and government may collaborate closely to address enormous societal problems using technology and scale them up through spin-offs.

Furthermore, ARTPARK is already working with AI and robotics startups like XraySetu. It is an AI-driven Xray screening and interpretation platform for doctors, and Avtaar Robotics is a virtual healthcare services platform.

Kalyani.sharma@expressindia.com journokalyani@gmail.com

COVID-19 catalysed...

Continued from Page 22 What are the steps in IET's Disease Surveillance Project? What are the objectives, stages and tentative timelines?

IET’s disease surveillance project is a very radical and ambitious approach at looking at disease surveillance from the view of unstructured data.

The project looks at three disease conditions- Malaria, Dengue and Chikungunya, and will track all publicly available data on digital media to track

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their spread and patterns in the growth of the conditions.

The timing of the project is perfect as are in summer now, leading to monsoons. These are the times where these three disease conditions spike.

Based on our initial analysis, we would identify regions, and cities where the diseases are spiking, and correlate them with the on-ground data to build a model that can be scaled and used across the country for all key disease conditions. This is first-of-itskind project and we are

collaborating with our partners like PATH and Siemens Healthineers, along with volunteers from IET who collectively bring together almost 60 years of experience in healthcare.

Right now, we are at the initial analysis stages but in the initial 2 months, we have looked at more than 20,000 data sources of information for these three conditions. In the next stage, we will start triangulating the data with the local on-ground situation.

Finally, in the last stage, we will

bring up a correlation model that can be scaled and used nationally.

Public data can be effectively utilised to prevent disease outbreaks but India's data has been doubted by several international agencies. Like the current controversy about WHO's estimate of deaths due to COVID in India being much more than the estimates of the Indian government. What steps can we take to make our data more robust, given the gaps

in our public health data?

Data is the key to the success of disease surveillance programs.

While I would not like to comment on the WHO controversy, the key is to have a single source of truth, like a golden key in collating data.

Today ,that is possible due to the creation of the Aadhar Card which by itself is the biggest success of the digital transformation program in India. viveka.r@expressindia.com viveka.roy3@gmail.com

POST EVENT

Medical Fair India-27th edition witnesses great momentum with energetic support from industry stakeholders The next MEDICAL FAIR INDIA will be held at the Pragati Maidan in New Delhi from 27-29,April 2023

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he 3-days Medical Fair India (MFI) 2022 from 20th May - 22nd May, 2022 at Jio World Convention Centre (JWCC), Bandra Kurla Complex in Mumbai witnessed participation from 277 exhibitors (including 39 from overseas) along with 12 partners.

The event was organised at an exhibit gross area of 8000 sqm and received 9020 visitors, 155 speakers and 213 conference delegates. Medical Fair India is country’s prominent exhibition and conference for healthcare. A part of the "MEDICAlliance" family of trade fairs, the event is organised by Messe Düsseldorf India and supported by industry forums like Association of Healthcare Providers India (AHPI), Association of Indian Manufacturers of Medical Devices (AIMED), Association of Diagnostic Manufacturers of India (ADMI), Quality and Accreditation Institute (QAI) and Voice of Healthcare (VOH), this edition brought together all the stakeholders from various facets of medical and healthcare industry.

Medical Fair India brought together the community of healthcare and medical industry players showcasing developments, innovations based on current trends, offering a varied program for deepening knowledge and expert dialogues with four parallel conference tracks - Voice of Healthcare Conference, Clin Lab Conference, Future for Health (FTR4H) Conference and Smart Hospitals Conference.

The event’s supporting program contributes to the success of Medical Fair India.

‘The 'Make in India’ pavilion

Ribbon Cutting

formed by Association of Indian Manufacturers of Medical Devices (AIMED) confirms India’s tremendous potential as a centre of the design, innovation, manufacturing and export. In 2022, this was the 5th consecutive year for ‘Make in India’ pavilion with a bigger representation.

On the other hand, the participation from 12 countries further strengthens the initiatives of India as a healthcare hub for business.

In addition to the exhibition, Clin Lab India hosted its 5th conference with the theme “invitro Diagnostics in India: at a point of infection, ParadigmShift, Technologies, Policies.”

The platform was created to promote and highlight the recent developments as well as

market trends in the In-Vitro Diagnostics (IVD) sector.

The Clin Lab Conference is the only dedicated platform for in-vitro diagnostics in the country showcasing the transformations and trends in the Indian diagnostics landscape. The two days conference witnessed discussions on topical subjects such as the paradigm shifts that have occurred during the pandemic along with emerging technologies and enabling policies that could reshape the Indian diagnostics industry. A Poster Presentation Session was also included for the first time this year as a part of the Clin Lab Conference so as to encourage young talent from academia and the healthcare industry.

The Future for Health

(FTR4H) Conference with its theme “Digital Health Takes the Fast Track” had its 5th edition this year at Medical Fair India that focused on how the digital transformation is reconstructing healthcare.

NASSCOM – Center of Excellence – IoT & AI - joined this year as its digital transformation partner.

The key partners at FTR4H were City of Düsseldorf Office of Economic Development, NRW Global Business, Landesentwicklungsgesellschaft Thüringen / State Development Corporation Thuringia, MEDIKABAZAAR, InnovatioCuris, GINSEP, 100 Open startups and The GAIN. The FTR4H Start-up Pavilion was also a centre of attraction and it encouraged the participation from Startups for showcasing their solutions and innovations in the healthcare domain.

Other highlights in the lineup of side events at Medical Fair India included the 6th International Health Conference of Voice of Healthcare (VOH) with the theme for this year titled ‘Digital Healthcare 2022 – TECH ENABLING THE FUTURE OF HEALTHCARE’.

The overarching objective was to focus on digital health and mobilize key stakeholders from both public and private sectors – along with their strengths and innovations – on a networking platform.

Rehaindia Pavilion, powered by REHACARE continued to feature alongside Medical Fair India. This segment was dedicated to the rehabilitation sector in India. The 3-day event attracted all the categories of stakeholders in this segment.

Smart Hospitals Conference, with the theme for this year titled as ‘Smart Hospitals

CREATE Smart Growth Enablers’, was supported by Sukraa as technology partner.

The objective of this platform is to help the small and midsized hospital owners to rethink their business models, how to build future smart hospitals and create new opportunities by evolving novel smart ways of delivering healthcare.

The 2-day business sessions covered multiple themes covering Smart Build, Smart Operate, Smart Quality, Smart Brand, Smart Grow sessions for small healthcare organisation. These sessions were appreciated by the healthcare industry and received commendable response.

MT India Healthcare awards felicitated the top industry players, institutions and doctors for their exemplary work in the field of healthcare and it was also appreciated by the medical and healthcare industry.

The next MEDICAL FAIR INDIA will be held at the Pragati Maidan in New Delhi from 27 – 29, April 2023.

All the details on MEDICAL FAIR INDIA are available online at: http://www.medicalfairindia.com

About MEDICAL FAIR INDIA: MEDICAL FAIR INDIA is a trade fair from the “MEDICAlliance” product family and is conducted by Messe Düsseldorf India, a subsidiary of Messe Düsseldorf, in close cooperation with the team for the world-leading trade fair MEDICA, based in Düsseldorf.

All data, facts and information on the trade fairs of the MEDICAlliance´ are available online at http://www.medicalliance.global.

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HOSPITAL INFRASTRUCTURE

How a hospital can become actually smart?

Dr Raja Dutta, Co-founder & Director, Avisa Smart Hospitals highlights that hospitals that intend to prep for the unforeseen have no option but to evolve into a smart hospital, with meaningfully interconnected systems and devices engineered to deliver optimum patient care while maximising the output

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unning and managing a hospital is nothing quite like holding a corporate office with multiple staff members chasing designated targets.

Even as many would find this juxtaposition of hospital and corporate office out of place, they might want to re-assess the same when it comes to management and operations. Given the criticalities of the healthcare industry, it is inevitable for any hospital or healthcare institution to think and act ahead of time, for you never know when an emergency like the pandemic might rear its head. Hospitals that intend to prep for the unforeseen have no option but to evolve into a smart hospital, with meaningfully interconnected systems and devices engineered to deliver optimum patient care while maximising the output.

Lest we forget, transforming into a smart hospital does not merely entail integration of random tech-powered tools. What really makes a hospital smart is a culmination of several integral elements, from the likes of availability of all relevant information when required and access to internal as well as external expertise when needed, to efficient and effective surgical/diagnosis processes with zero error in a cost-effective manner. The various pain points of all stakeholders – patients, doctors, nursing and other staff, management etc – must be addressed if a hospital envisions itself as a smart hospital.

How do you fancy a hospital where a patient walks in, scans a QR code and without any intermediary human intervention, consults a doctor and walks out of the OPD? If that sounds not doable, how about adding a preconsultation step of an IOT-enabled health monitoring Mini Lab conducting as many as 30 major tests instantly and fur-

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If a hospital is smart, doctors would not need to repeatedly make or receive calls to adjust appointment and other schedules nishing the results for the doctor to decide on the line of treatment? While a few might claim this to be unrealistic, we have worked with hospitals across different parts of India to actually implement these thoughts.

End-to-end automation and digitisation of services in a hospital resolves critical pain points pertaining to patient care such as bed availability during hospi-

tal admission, Insurance/TPA approvals, discharge process, follow up visits etc. With a digital health card, the out patients too would not need to sulk over lack of control on one’s appointment and neither would they need to stand in a queue for long before consulting a physician. In a smart hospital, patients can auto register themselves remotely, book appointments on-

line, live track doctor and OPD appointment status, avail ambulance service, buy discounted medicines, easy diagnosis and access to reports, EMR integration, cashless treatment and 24x7 live support.

While wellbeing of patients is paramount, any hospital, especially the smart ones, can and should never ignore the comfort of doctors on board and medical

staff. If a hospital is smart, doctors would not need to repeatedly make or receive calls to adjust appointment and other schedules. Working with a smart hospital entails a system with digital touch points like mobile phone app to ensure timely notification to doctors about appointments, surgery schedules, thereby helping them with better calendar management. There is an added comfort of digital prescriptions that can be merged with patients’ app, hospital information system, diagnostics as well as pharmacy. As for the staff members, alleviation of queues, frequent queries and thankless coordination allows them to focus on jobs that better leverage their skill sets and acumen.

With all the aforementioned benefitting out of the evolution of hospitals into smart hospitals, the management is bound to be the biggest beneficiary. Models such as Operate and Manage are as a matter of fact designed to ultimately aid the management in plugging revenue leakages and reducing bounce rates while ensuring patient acquisition and retention. In this model, a combination of software, hardware and expert medical teams are deployed to transform the complete operations and management of a hospital that intends to turn smart.

From apps to digital cards linked with EMR and EHR and connected diagnostic services, all the different smart services culminate into a Hospital Information Management System, the access of which is with those who actually hold the stakes.

Hence, a hospital can actually become smart by making a resolve to implement endto-end automation and digitisation, with a smart blend of different elements and subsets of technology along with core expertise.

Augmenting the Indian healthcare infrastructure: One brick at a time Vinit Dungarwal, Director, AMs Project Consultants explains that the real estate companies will have to play a pivotal part in getting the Indian healthcare system up to speed. With the help of new-age innovations, these companies can ensure that the projects are completed in time and within the set budgets

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he Indian healthcare system was already struggling to keep up with the rising population and the growing demands and then came the COVID-19 pandemic that forced everyone to restructure their lives differently. It also did a great job at exposing the need gaps in the healthcare infrastructure. This gap was even more prominently highlighted during the second wave.

Lack of unified protocols along with an inadequate health infrastructure came to the forefront.

Moreover, the Economic Survey, 2020-21 recommended that we need to raise the spend on healthcare services from 1 per cent to 2.5-3 per cent of GDP, to “reduce the out-of-pocket-expenditure (OOPE) from 65 per cent to 35 per cent of the overall healthcare spend".

newer technological innovations to ensure quality healthcare reaches the masses at a cost that can be easily availed and accessed without being a hindrance in progress and economic development.

To boost the health infrastructure at tier 2 and 3 cities across the length and breadth of India, one needs to have unorthodox ideas. One of the ways to achieve this could be to have a ‘Smart Health Cities’ framework in line with the Smart City.

Moreover, the focused promotion of 360’ Health Services should be encouraged. Facilitating Medical Hubs and creating Health Economic Zones like SEZs will attract local and foreign investment in health and bridge gaps in demand and supply of healthcare services.

Bridging the gap The public-private partnership The Indian healthcare system happens to be one of the largest sectors in the country, both in terms of revenue and employment. The entire structure comprises of hospitals, clinical trials, medical devices, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The delivery system of healthcare in India is categorised into two major components - public and private. The government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of Primary Healthcare Centres (PHCs) in rural areas. The private sector provides a majority of secondary, tertiary, and quaternary care institutions with a major concentration in metros and tier I and tier-II cities.

According to reports, India

spent 1.8 per cent of its gross domestic product (GDP) in 202021 on healthcare. Even though health is one of the six pillars of the Union Budget 2021-22, the government has committed approximately 2.5-3 per cent of GDP now. Reports further state that India has 1.4 beds per 1,000 people, 1 doctor per 1,445 people, and 1.7 nurses per 1,000 people.

As per the World Health Organization (WHO), India ranks 184 out of 191 countries in health spending whereas the US spends over 16 per cent of its to-

tal GDP on healthcare, while Japan, Canada, Germany etc. spend over 10 per cent of their GDP on healthcare.

Impact of COVID-19 on healthcare As the second-most populous country in the world, it is now evident that the pandemic has put significant stress on our already limited resources when it comes to healthcare. In addition, due to the infectious nature of the coronavirus, it is very difficult to predict the exact number

of people that will be affected in the future.

It must also be noted that India happens to be a developing nation. With a population of approximately 138 crore, several citizens do not have access to quality healthcare due to poverty-stricken conditions both at a micro and macro level.

A quarter of the country’s population falls below the poverty line whereas about 70 per cent reside in the rural areas due to which it is essential to have a robust medical infrastructure and

The real estate companies will have to play a pivotal part in getting the Indian healthcare system up to speed. With the help of new-age innovations, these companies can ensure that the projects are completed in time and within the set budgets. In certain cases, developers can opt for modular construction as it helps in saving time.

In remote areas where accessibility is a challenge, developers will have to make use of new-age techniques to get the projects off the ground. Another facet that needs to be considered especially in the case of developing healthcare projects is the material that will be deployed. Given the nature of the industry, there are a lot of specific requirements that have to be kept in mind. In today’s time, most projects require green building strategies and the developers need to plan on how these can be implemented while keeping the budget constraints in mind.

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START-UPS I N T E R V I E W

The pandemic has shown that healthcare innovation is critical across the globe Cecilia Oskarsson, Trade Commissioner of Sweden to India for Business Sweden in an interaction with Kalyani Sharma talks about the journey of India Sweden Healthcare Innovation Centre and highlights that start-ups often require good mentoring and funding to reach up to the level of a recognised entity. In this regard, it is important for them to receive all possible support on multiple accounts Walk us through the journey of India Sweden Healthcare Innovation Centre Launched in December 2019, the India-Sweden Healthcare Innovation Centre (ISHIC) is the culmination of the longstanding MoU between the two countries that has taken a shape of a tripartite collaboration between the Swedish Trade Commissioner’s Office, AllMS New Delhi and AIIMS Jodhpur with AstraZeneca as knowledge partner. ISHIC is envisioned to develop an ecosystem of open innovation for start-ups and the healthcare delivery stakeholders to use to collaborate and address current and future challenges in the healthcare sector in India. Through this platform we enable development and scale up of solutions through frugal innovation for affordable and accessible healthcare in line with the objectives of the Government of India. The Centre has the blessings of the Ministry of Health and Family Welfare, Government of India and the Ministry of Health and Social Affairs, Government of Sweden, both of whom are on the Governing Council of the Centre.

Please brief us about the evaluation process carried out by the centre while selecting the start-ups.

The innovation Centre annually invites applications for an Innovation Challenge through a large ecosystem of partners across India and Sweden. A rigorous screening process is carried out with the Advisory board and evaluation

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diagnosis. ◆ Dozee has created a remote monitoring solution through a small sheet that can be inserted beneath the mattress. This solution can convert any bed into a step-down ICU in a matter of few minutes. Their Early Warning system helps save nursing time and assist doctors in analysing records maintained manually by enabling hospitals digitally monitor vitals, critical care automation, improved clinical outcomes as well as patient safety with their step-up ICUs. Manual effort and the time spent by nurses in monitoring the readings are considerably reduced. committee that has representation from all core partners. A total of 24 Startups have been on boarded through our 2 challenges so far, 14 Start-ups identified from 460 applications in the 1st challenge that are currently being mentored and another 10 were handpicked out of 700 applications for our 2nd cohort.

These start-ups are evaluated based on several parameters including, fit within the problem statement, current stage and support required, passion of the founder amongst others.

Which have been the most impactful Indian start-ups providing COVID-19 solutions that India Sweden Healthcare Innovation Centre helped bring to fruition since the pandemic started? ◆ Blackfrog Technologies has developed EMVÓLIO - a

portable, battery-powered refrigeration device. The COVID-19 vaccination program has been disrupted in many states of the country. One of the primary causes of disruption is vaccine wastage. During transportation of vaccines, maintaining an optimal temperature is a challenge which leads to spoilage of vaccines. Unlike a conventional cold box, EMVÓLIO's patented design ensures that the contents in the cold chamber strictly maintain a pre-set temperature for up to 12 hours for last-mile transport of COVID-19 vaccines to remote areas of the country. ◆ Qure.ai works with enhancing imaging accuracy and improving health outcomes with the assistance of Artificial Intelligence. Their technology enables automated interpretation of radiology exams for healthcare professionals, enabling faster

Can you throw some light on achieving a balance between self-reliance and global relevance, given that Indian start-ups could be relevant for other geographies and will need to tap global markets to achieve scale at some point in their life cycle?

While delivering effectively in India and contributing to the healthcare needs of the domestic markets, the startups are in parallel also getting geared up to expand also within the global horizon.

AstraZeneca being the knowledge partner of this initiative enables the onboarded Start-ups get access to international markets and network of Healthcare Innovation Hubs through its Global A-Catalyst Network. We have already seen multiple success stories through this collaboration and expansion into the global network.

How crucial is the role of bilateral initiatives in identifying and facilitating innovative solutions that could help regress critical problems in the healthcare delivery landscape of India?

The pandemic has shown that healthcare innovation is critical across the globe. Through the bilateral collaborations we can exchange the best practices and innovative solutions across boundaries. The cross-country collaboration also helps in enabling the start-ups to grow on an international scale much faster. The support from government from both the countries also helps in clearing many roadblocks and make way for the growth journey to get propelled thus, contributing to the overall good of society and economies as well.

What are the major challenges and need of the hour as far as the start-up ecosystem in India is concerned?

Start-ups often require good mentoring and funding to reach up to the level of a recognised entity. In this regard, it is important for them to receive all possible support on multiple accounts ranging from basics of setting up legal entities to receiving the right know-how of processes and protocols up along the way to the point of funds that help them scale up.

The regulatory approvals and clinical validation also appear to be of prime importance especially in the healthcare space.

Kalyani.sharma@expressindia.com journokalyani@gmail.com

RADIOLOGY I N T E R V I E W

Need for experienced and skilled healthcare professionals is crucial to effective delivery of high-quality care Srikant Srinivasan, Head of Services, GE Healthcare South Asia in an interaction with Express Healthcare talks about radiology training in India and explains how GE Healthcare is incorporating new technologies into radiology training

Give us an overview of the Indian diagnostic imaging market?

The healthcare ecosystem is shifting from curative to preventive. To enable this shift, the subsectors of the healthcare industry are growing exponentially, and radiology is one of them. The world of imaging and technology is evolving, keeping in pace with the emerging healthcare trends. This has opened a whole new world of medtech innovations..

According to the TechSci report, India diagnostic imaging market was valued $1.655 billion. As a result of ongoing technical advancements in digital imaging, it is projected to increase by ~9 per cent in terms of value until 2026. That said, the other side of the coin is the lack of skilled radiologists to perform diagnostic procedures can impede market expansion.

We need to be cognisant of the needs of the industry to ensure that access to technology is not hindered.

What are the current education and training programs for India's next generation of radiologists?

Why is it important to strengthen industryacademic collaboration in radiology training?

Currently, the National Medical Commission of India manages MD/DNB and Diploma radiology courses (NMC). The commission recognises medical qualifications, accredits medical schools, registers doctors, and monitors medical practice. Government and private NMC-accredited

medical colleges offer PG/Diploma seats and a 3-year residency program. Residents learn traditional radiology and modern imaging techniques like Ultrasonography, Color Doppler, CT, and MRI. While NMC is providing courses to train next generation of radiologists, there is a need for the government and paramedical board to form industrial-skilling partnerships to boost employability and close India's healthcare skills gap.

Industry affiliation is a must as it makes the candidate more employable, and we are committed to upskilling and training skilled healthcare professionals to bridge the talent gap by working with governments, ministries, nongovernmental organisations, and industry. Through our collaboration with Tata group, we upskilled over 3800 technicians in 2019, of which 1800 were radiology technicians.

How is India faring in terms of the various challenges when it comes to upskilling radiologists?

The need for experienced and skilled healthcare professionals is crucial to effective delivery of high-quality care. The current need is to develop expertise and experience in one or two subspecialties, this has increased the demand for radiologists to widen their scope of practice and learn the skills needed to work with numerous imaging modalities such as CT scans, MRIs, X-rays, and USG. The availability of such professionals is important for the healthcare industry to function, and demand

continues to grow, hence the need for constantly upskilling the current radiologists. In addition, there is a need for public-private partnership & collaboration to help close the gap between the number of radiologists per patient and the industry's demand for skilled healthcare professionals, as well as to determine what the government can do to improve the regulatory framework as a whole.

We have partnered with leading healthcare and education experts to establish healthcare education and training institutes that will provide accredited skill building programs for students who have completed the 12th standard and upskilling programs for current healthcare professionals

What is GE Healthcare doing to address the shortage of skilled radiologists? How are you incorporating new technologies into radiology training?

To address the growing need for technical skilling in radiology and various other diagnostic practices across the healthcare spectrum, we have embarked on a quest to further accelerate the development of "Yogya Bharat," or "Skilled India," which will increase access to high-quality healthcare across the country.

We have partnered with leading healthcare and education experts to establish healthcare education and training institutes that will provide accredited skill building programs for students who have completed the 12th standard and upskilling programs for current healthcare professionals. Our GE Healthcare institutes have established over 25 programs in radiology, cardiology, critical care, fetal medicine, and leadership training across Africa, India, and South-East Asia in over 10 sites to enhance the skills of healthcare professionals.

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RADIOLOGY

Radiology community must invest in the future through participation and education Dr Sanjay Dhawan, HOD, Radiology, Paras Hospitals stresses that Clinical radiologists need to be aware of ongoing innovations in their profession and get the necessary training and education through various initiatives that must be implemented by the governing authorities ing in India. While the curriculum for radiology studies requires radical reforms over the years to come, knowledge about MRI safety and radiation safety must be an integral part of the learning curriculums. As practice scenarios continue to change and radiologists are exposed to new technologies and vast amounts of information, training of radiologists, nurses and radiographers need further standardization of protocols.

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adiology has emerged as one of the most soughtafter specialities of medicine in India as well as around the world. With advancements in medical imaging capabilities and increasing availability, technologies like MRI and CT scans have become critical to medical practice today. Thus, radiology is fast becoming a much-needed speciality for the diagnosis as well as monitoring and guiding of treatments which patients receive.

With rapid advancements and the inception of new technologies, it is imperative to build a strong foundation for the future of radiology education and train-

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Challenges and areas that require immediate consideration The field of radiology faces many challenges. Present-day radiologists are in a delicate situation to excel in their practice and keep up with the rapidly evolving scenario. In addition, the radiologist also has to watch out for turf wars and fragmentation. These issues will keep recurring and new challenges will emerge every now and then which need to be tackled unitedly. Here are some of the ways through which these issues can be effectively handled:

Invest in the future through participation and education It is the need of the hour for aca-

demic and research institutions to collate knowledge and dedicate resources to the latest emerging fields. The radiology community must invest in the future through participation and education and by developing relevant research facilities.

The IRIA has already taken steps to improve the radiology training of future radiologists as well as updatingthe professional knowledge of working radiologists. It is conducting workshops and academic programs across the length and breadth of India, especially with a focus on specific areas that require urgent attention like foetal radiology. The partnership with subspecialisation associations will provide detailed knowledge, information and training to radiology colleagues to improve sub-speciality reporting.

Standardise and monitor training programs The problem with the majority of programs is that they are based on the requirements of the institution instead of the designated curriculum which mostly stays on paper. Therefore, every institution must adhere to standardised and struc-

tured formats of curriculum training and prepare a schedule of set rotations for every radiology trainee. The regulatory body also needs to periodically monitor and audit the performance of institutes to make sure they are adhering to the defined program. The proficiency in sub-speciality should be ensured by the national-level entry and exit examinations.

Increase investment From rapid innovations, improved capability of equipment’s and known-uniform curriculum of tranining. It is essential for the governing authorities to increase the investment in the sector to create further opportunities for radiology training in the government sector throughout the country. Compared to medicine in general, there is a lack of extramural research money and skilled, educated investigators to perform radiology education research. Except for some central government-funded institutions providing a 1-year fellowship and few offering DM (superspeciality) courses, radiology training in India is curtailed for a maximum of 3 years which is the end point of radiology training.

Certified subspecialists Apart from training subspecialties, there is a growing need for subspecialist faculty. It is crucial that certified subspecialists are involved in the training of subspecialty fellows/trainees. The majority of the courses are run depending on the work experience instead of being trained in a subspecialty. Additionally, we must have quality assurance programs for the teaching faculty as well in the form of exams every few years to make sure that the teaching faculty stays updated.

Final words Clinical radiologists need to be aware of ongoing innovations in their profession and get the necessary training and education through various initiatives that must be implemented by the governing authorities. The next generation of radiologists must also be well versed with ethical and medicolegal issues as well as regulatory compliances. They should also be ready to embrace AI and automation in radiology practice to ensure delivery of best-in-class service to patients and also stay updated to uplift the radiology standards.

HEALTHCARE TRENDS

ADMI announces new leadership team The new leadership was formally handed charge by Veena Kohli, the outgoing President, at the AGM in Mumbai

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ssociation of Diagnostics Manufacturers of India (ADMI) has announced a new leadership team for the period 2022-2025. The new leadership team comprises. ◆ Thomas John – President (also MD, Agappe Diagnostics) ◆ Veeraal Gandhi – Vice President ( also Founder Chairman, Voxtur Bio Ltd) ◆ Jatin Mahajan – Secretary (also Managing Director, J Mitra & Company) ◆ Chirag Joshi – Treasurer (CEO, Beacon Diagnostics) The new leadership was for-

mally handed charge by Veena Kohli, the outgoing President,

at the AGM in Mumbai. Welcoming the leadership team in

their new roles and responsibilities, Veena Kohli said, “ADMI has emerged as a powerful voice of the Indian In-Vitro Diagnostics (IVD) Industry. It has been playing a catalytic role in the transformation that is taking place in the industry. The IVD industry has played a crucial role in the fight against the pandemic. Having proved our mettle, we are working in conjunction with the government to cement India’s position on the IVD map of the world.”

Congratulating the new Team, Kohli said, “the new leadership team comprises dy-

namic business and thought leaders from the IVD industry, who are keen to catapult ADMI and the IVD industry to the next level of growth and in helping achieve its vision.

ADMI is the representative body of the Indian in-vitro diagnostics manufacturing organisations and stakeholders.

It works in conjunction with the government, the policy drivers and other ecosystem stakeholders to drive growth for the industry. ADMI is committed to the overall development of the ecosystem in the country.

BD Life Sciences-Biosciences organises roadshow on ‘Advances in Clinical Flow Cytometry’ BD has been organising the Advances in Clinical Flow Cytometry (ACFC) knowledge sharing sessions for clinicians and hematologists across the country since 2018

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o enable knowledge-sharing of best practices and technological advancement on clinical applications of flow cytometry, BD Life Sciences-Biosciences, a segment of BD (Becton, Dickinson and Company) recently organised the ‘Advances in Clinical Flow Cytometry’ (ACFC) multi-city roadshow for clinicians and physicians. Organised in Bengaluru, Dhaka, Lucknow and Mumbai, each of the ACFC events also enabled discussions by experts from the clinical fraternity on critical aspects of clinical diagnostics including: Standardisation, Performance, Accreditation, Automation and Collaboration.

Commenting on the ACFC initiative, Pavan Mocherla, Managing Director, BD India/South Asia said, “Over the years, flow cytometry has proven to be an invaluable asset in several clinical applica-

tions and plays an important role in clinical diagnostics and research. Cognizant of this and aligned with our purpose of Advancing the World of Health, BD has been organising the Advances in Clinical Flow Cytometry (ACFC) knowledge sharing sessions for clinicians and hematologists across the country since 2018. Our objective is to provide a platform to discuss new processes, and leading technology best practices to enable better patient outcomes

and I am happy to share that we engage with more than 150 leading clinicians and medical professionals annually under this platform."

At this edition of ACFC, several clinical applications and importance of quality were discussed by eminent speakers from the clinical fraternity. Key highlights of the discussions were: ◆ Case studies on Leukemia and Lymphoma as well as Minimal Residual Disease amongst others.

◆ Deliberation on standard operating protocols, accuracy and standardisation of flow cytometry assays. ◆ Importance of quality and standardisation of assays in clinical flow cytometry.

Commending the ACFC initiative, Dr Arun Kumar Arunachalam-MD, PDF, Assistant Professor, Department of Hematology Christian Medical College, Vellore, said, “Advances in clinical flow cytometry is a wonderful initiative

by BD towards bringing together the people who are involved in clinical flow cytometry in the country. The event provided a wonderful platform for discussion and interaction among the participants on various topics that are important and relevant in today's era.”

Present at the event, Dr Ananthvikas Jayaram – Pathologist, Neuberg Anand Refer-

ence Laboratory, Bengaluru said, “The ACFC meet organized by BD brought pathologists who practice flow cytometry together in-person after the last two years of virtual meetings. The lengthy discussions on assay parameters, troubleshooting, utility of different markers and the debate on standardization were all testament to the quality of the program and the interest it generated among attendees. We look forward to many more such meetings in the future. " Flow Cytometry is a process used to sort, separate and examine microscopic particles, such as cells and chromosomes. It plays an important role in clinical diagnostics and research. BD offers a growing portfolio of flow cytometry instruments for Leukemia/Lymphoma phenotyping, stem cell research, immunology, and CD4 testing.

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HEALTHCARE TRENDS

Medikabazaar conducts successful trial of medical supplies through drone delivery Medikabazaar is conducting the pilot project to understand and sort out the issues and challenges of using drones for the ‘last mile’ delivery of medical supplies

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edikabazaar is pioneering the next big thing in healthcare supply chain management by delivering the medical supplies in the B2B space via drones.

In line with Medikabazaar’s mission of transforming healthcare, the company recently launched the pilot drone project in collaboration with Redwing Labs to transport medical supplies and assess the potential of drones as a means of alternative last mile delivery option especially for emergency scenarios. The first scheduled test drone delivery took place successfully in Bengaluru.

In Bengaluru, the trial attempted to deliver medical supplies via drone. The used drone has a maximum range of 35 kilometers and can deliver payload weighing from 1KGupto 10 KGs. The project aims to serve multiple locations across rural, urban and semi urban cities for medical supplies including the geographies where the time to deliver is significantly higher through conventional modes due to tough terrain. The pilot project launched by Medikabazaar aims to create a largescale impact and commitment to transform healthcare by making it accessible even to the remotest area to cater emergent situations.

Speaking about the initiative, Vivek Tiwari, CEO & Founder, Medikabazaar stated “MEDIKABAZAAR is at the forefront of adopting emerging technology to transform healthcare scenario in India, and the ‘Pilot Drone Project’ using drones is in line with commitment to transform healthcare by way use of technology.

Faster delivery of critical and emergency medical supplies, vaccines and lifesaving drugs,

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With this pilot project for deliveries through drone in Bengaluru in the first phase, it will be extended to few more geographies as a part of second phase of trials after collating the learnings and implementing improvisations from the first phase of trials devices and equipment can be a great contributor in saving lives. This project is one of the first such programs in the country where drones are used to delivery medical supplies to hospital centers. The vision is to ensure easy healthcare accessibility throughout the nation, from the most populous to most remote areas in India in the near future” The initiative also seeks to alleviate the burden on frontline health workers and supply chain management. Drones delivering medical supplies directly to healthcare centers saves time and helps healthcare workers in delivering better patient care.

HEALTHCARE TRENDS

Trivitron Healthcare announces the development of real-time PCR based kit for MonkeypoxVirus Trivitron’s Monkeypox real-time PCR Kit is four colour fluorescence based kit, which can differentiate between Smallpox and Monkeypox in one tube single reaction format, with total turnaround time of 1 hour

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edical devices company Trivitron Healthcare announced that it has developed the Real-Time PCR-based kit for the detection of Monkeypox (Orthopoxvirus) virus.

The World Health Organization's Country Office for India recently requested the help of the ICMR-National Institute of Virology in Pune to test suspected cases of Monkeypox for SEAR member-states. Monkeypox has become a disease of global public health importance, as it not only affects countries in West and Central Africa, but is also spreading at a fast pace globally.

For the response measures such as tracing efforts and treatment strategies, the diag-

nostic tools are crucial for responding to control the emerging public health challenges. Research & Development team of Trivitron Healthcare has developed a RT-PCR based kit for the detection of Monkeypox virus.

Trivitron’s Monkeypox realtime PCR Kit is four colour fluorescence based kit, which can differentiate between Smallpox and Monkeypox in a one tube single reaction format, with total turnaround time of 1 hour. In this four gene RTPCR kit, first target detects the viruses in the wider orthopox group, the second and third targets detects and differentiates the Monkeypox & Smallpox virus respectively and the fourth target detects

the internal control corresponding to human cell to address the assay performance and aid in following its epidemic spread. This kit is available as Research-Use only (RUO) and based on literature search and in-silico design.

The World Health Organization (WHO) shares a ‘Nucleic Acid Amplification Testing’ is the preferred research laboratory technique for detection based on its sensitivity and specificity. As Orthopoxviruses are ‘serologically cross-reactive’, and antigen (Ag) and antibody (Ab) detection approaches do not provide Monkeypox - specific detection. Therefore, serology and antigen detection methods are not endorsed for de-

tection or case investigation where resources are limited.

The WHO recommended specimen type for laboratory confirmation of Monkeypox is skin lesion material, including swabs of lesion surface and/or exudate, roofs from more than one lesion, or lesion crusts.

Hence, both dry swabs and swabs placed in VTM can be used.

In the year 2017, Nigeria has experienced a large epidemic, with over 500-suspected cases of Monkeypox, and over 200 confirmed cases and a case fatalness ratio of about 3%. The cases continue to be reported until today. In May 2022, several suspected cases of Monkeypox were identified in quite a few non-endemic nations. Re-

searches are currently underway to further understand the epidemiology, sources of spread, and the patterns of transmission of the virus.

Chandra Ganjoo, Group Chief Executive Officer, Trivitron Healthcare, informed that “Trivitron is committed to contribute cutting edge technologies for better screening of various ailments/ diseases. As a responsible medtech product manufacturer, we feel that the current situation calls for immediate measures to stop the viral spread. India has always been at the forefront of extending help to the world, especially during the COVID-19 pandemic, and this time also the world needs assistance.”

Siemens Healthineers crosses the milestone of producing 500 units of Cios Fit Conceptualised, designed, and manufactured in India for the world, Cios Fit is a mobile C-arm designed for demanding multidisciplinary environments in busy Operating Rooms

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iemens Healthineers achieved yet another milestone in its journey of transforming care delivery in India.

The future-ready medical imaging manufacturing facility at Bengaluru produced 500 units of Cios Fit, a multidisciplinary mobile C-arm, conceptualised, designed, and manufactured in India and exported to over 47 countries across the globe.

Cios Fit, is designed for the tough environment in an OR, where multiple procedures are performed in a day, and keeping in mind the high patient load at the medical institutions. Since the start of manufacturing in 2019, Cios Fit has been helping

healthcare providers deliver high-value care for their patients. Despite the challenges imposed by the pandemic over

the past two years, agile processes and dedicated efforts of the team ensured reaching this benchmark.

Speaking on this milestone, Vivek Kanade, Managing Director, Siemens Healthcare Private Limited said, “This is indeed an

encouraging moment for our entire team. Their dedication ensured we met our commitments despite turbulent times.

Entrusted to transforming care delivery in India, Cios Fit truly resonates with our purpose. We pioneer breakthroughs in healthcare. For Everyone.

Everywhere.”

Siemens Healthineers recently inaugurated the new production line at the Bengaluru facility to manufacture Computed Tomography Scanners under the PLI scheme and launched MAGNETOM Free.Star, a disruptively simple approach to MRI that transforms access to high-value care.

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HEALTHCARE TRENDS

Transasia unveils a range of IVD solutions with enhanced user experience at Medical Fair 2022 Unveils clinical chemistry analyzer XL 640 with conveyor rack system and ESR analyzer ESL 30

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aking its presence felt at Medical Fair India, Transasia BioMedicals Ltd unveiled two new “Made in India” products in its growing portfolio of in vitro diagnostics, Erba XL 640 and ESL 30. The Erba XL 640, a fully automated random access clinical chemistry analyzer with the autoloader is designed to meet the high throughput needs of modern clinical laboratories. By thoughtfully automating the conveyor rack system (CRS), the Erba XL 640 helps establish more efficient workflows: it relieves staff from manual work, eases their burden, and aids in achieving faster TAT. The Erba XL 640 analyzer with CRS was unveiled by Dr Mohan Joshi, Dean in the presence of Dr Pramod Ingale, Vice Dean of Lokmanya Tilak Municipal Medical College and General Hospital (LTMGH), Mumbai. Erba XL 640 has been validated at LTMGH, Mumbai. Once programmed, the analyzer is a walk-away system. Besides, random sample access, innovative robotics

and an advanced user interface using windows embedded operating system optimize time management and streamline the work flow.

In its ESR portfolio,

Transasia announced the launch of ESL 30, a truly automated walkaway ESR system with touchscreen interface that improves workflow, turnaround time, and laboratory

safety. This analyzer was unveiled by N Santhanam, CEO of Breach Candy Hospital in the presence of Dr V P Antia, Head of the Department of Haematological Medicine at

Breach Candy Hospital.

Speaking on the occasion, Suresh Vazirani, Founder Chairman, Transasia-Erba International Group of Companies cited, “Transasia continues to bring in world-class quality products at an affordable cost to Indian patients through Make in India products. With the launch of these “Made in India” auto analyzers, we seek to meet the needs of laboratory professionals for reliable and affordable diagnostic solutions in biochemistry, hematology, immunology as well as inflammatory and autoimmune diseases. This will aid them in providing clinicians with the information they need to make reliable and timely clinical decisions for patients.”

With an over four decade legacy, Transasia Bio-Medicals Ltd., India’s Leading Invitro Diagnostic Company, is at the forefront for providing quality and affordable diagnostic equipment and test kits to pathology laboratories and hospitals even in the remotest areas of the country.

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DIAGNOSTICS

Importance of accurate & affordable diagnostics to improve quality of life in India Sushil Mehta, Chairman, NextGen Invitro Diagnostics highlights that because of lack of access and affordability, diagnostic testing has become one of the weakest links in many prevalent illnesses, including TB, diabetes, and hypertension

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iagnostic is a key element of healthcare, one that helps unlock the true status of a patient’s health.

Through simple tests including blood samples to diagnostic imaging such as X-rays, ultrasound, MRI, CT, they help bridge the gap between problem and solution.

However, even with its undeniable importance, diagnostic is often a neglected aspect of the healthcare system.

Because of lack of access and affordability, diagnostic testing has become one of the weakest links in many prevalent illnesses, including TB, diabetes, and hypertension.

However, as doctors are relying increasingly on evidence and as the COVID-19 outbreak has emphasised, diagnostics are crucial in accurately detecting illness and selecting the best course of therapy. The Indian healthcare industry has a lot to gain from a focus on low-cost, high-precision diagnostics.

Undiagnosed/ misdiagnosed According to a study headed by The Lancet Commission on Diagnostics, about half of the world's population lacks access to basic diagnostics for several prevalent illnesses including diabetes, hypertension, HIV, and TB. The commission recognised that due to the lack of accurate, high-quality, and inexpensive diagnostics, many patients would be overtreated, undertreated, or not treated at all.

This paints a grave picture.

Not having a correct diagnosis can be harmful, even life threatening and even when it’s not, it poses a significant waste of medical resources that could otherwise be deployed to larger problems.

Using up-to date diagnostic equipment will not just offer accurate analysis but also enable patients from rural areas to seek diagnostic services near to them without having to travel to cities and paying a disproportionate amount in the process. It would go a long way toward making diagnostics more inexpensive and providing better healthcare to rural India.

The need for accreditation

Despite being home to more than 70 per cent of Indians, rural and non-metro regions have a substantial dearth of high-quality diagnostic services.This is attributable not only to a paucity of skilled pathologists, technicians, biochemists, and other medical workers, but also to a scarcity of pathology labs and testing facilities Regional discrepancy Despite being home to more than 70 per cent of Indians, rural and non-metro regions have a substantial dearth of highquality diagnostic services.

This is attributable not only to a paucity of skilled pathologists, technicians, biochemists, and other medical workers, but also to a scarcity of pathology labs and testing facilities. As per a

survey, there are only around eight diagnostic labs per 100,000 people in India and diagnostic facilities have a very low reach in small towns and villages.

While government programmes are rapidly working to bridge this gap, there is still a long way to go, and awareness complemented with infrastructure is the need of the hour.

Accreditation of clinical laboratories is an important step in ensuring accurate diagnostic.

Among the many things that make a certified laboratory stand out are the degree of training and understanding of procedures, the participation of lab physicians, and the use of error-detection measures Even with its credibility, accreditation is frequently seen as expensive and time-consuming process with a lot of paperwork.

However, to pave a new world for healthcare, it’s important that we look at accreditation as a must have rather than a nice to have.

Of the nearly 1.1 lakh medical laboratories in the country, whose test reports determine over 70 per cent of medical decisions, there’s only a small percentage that are accredited.

For the new era of accurate diagnostic, this has to change significantly.

Treatment cost Affordable and accurate diagnostics lower costs not just for the patients but also for the healthcare facilities as treatments can be more pinpoint based on the problem.

Analysing diseases at early stages or monitoring health indicators to anticipate future medical problems can drasti-

cally promote the value of prevention.

We all know that prevention is better than cure but not just that prevention also costs much less than the cure and for India whose healthcare sector is still growing, saving that cost can translate into better quality of life for the population.

Diagnostic literacy Additionally, the pandemic has contributed to a rise in "diagnostics literacy" among consumers, meaning that the average patient is now more knowledgeable and careful about his or her health.

This enables them to make better healthcare decision and own their medical journey.

A large number of geriatrics and an increasingly healthaware population are sure to boost the Indian diagnostic industry in the long run. As per IBEF and the Ministry of External Affairs, the Indian diagnostic market is projected to grow more than 20 per cent CAGR for next decade.

Monitoring of chronic diseases Providing affordable mobile diagnostic services for chronic diseases like diabetes, heart disease, respiratory disorders and kidney disease among others, not only helps prevent health emergencies but also allow the patient a much better control of their lives.

Real time diagnosis and mobile diagnostics reduces the mental stress that these chronic diseases can cause, offering the patient a much better quality of life.

Affordable and accurate quality diagnostics for all will therefore increase the quality of life in India and will drive India’s vision of ‘Swasth Bharat, Shrestha Bharat’.

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DIAGNOSTICS

Point of care diagnostics: Post-COVID challenges and scope in India Ranjith K VP, POC Division, Agappe highlights that awareness of point of care testing has increased to unexpected levels among the public. This awareness is both good and bad, good is the awareness about what needs to be monitored and they consult their physicians or clinicians on how to go about it

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oint of care diagnostics or POC diagnostics is nothing but near-patient testing or bedside testing. If you take Asia, India is one of the fastest-growing countries in healthcare and particularly in POC diagnostics or POC testing. Japan is leading the pack in POC revenue from Asia and followed

by China mostly driven by the volume. interestingly, India is growing at a CAGR of more than 15 per cent in both volume and revenue in POC testing.

Post-COVID scenario Awareness of point of care testing has increased to unexpected levels among the public. This awareness is both good and bad, good is the awareness about what needs to be monitored and they consult their physicians or clinicians on how to go about it?

And the worst part is without having proper awareness (Particularly not knowing the authenticity of the messages circulated on social mediachatting sites) taking selftesting and treatment is more harmful to themselves and to their dears. Point of care testing or diagnostics should be strictly followed and used as per the recommendation given by the healthcare professionals only.

The challenge in India is the historical pattern in which testing was wholly or mostly confined to the medical laboratory which entailed sending off samples away from the patient and then waiting for hours or days to get back the results, during which time care must continue without the desired information. In

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Agappe is stepping into POC diagnostics solutions and intends to support healthcare professionals with faster diagnostics tier II, tier III cities, and even in urban metro towns faster diagnostics is a real challenge.

Turnaround time (TAT) is al-

ways referred to as the throughput of the diagnostics instrument, how many tests can be done in an hour or how

much time the instrument works without any intervention, or how fast the laboratory gives the report. Actually, for the intensive care units or Emergency departments, TAT is to be the bad turnaround time, how fast the patient navigated to the right department, or how fast the patient recovers and moves to the general wards and keeps the bed available for the next needy patient. To make faster decisions you really need point of care testing at the near-patient or bedside.

Thus, the scare during COVID-19 has given birth to the point of care devices, where smaller and compact machines can go to the patient/clinician side and deliver test results in a very short time, than visiting big labs and waiting for the results after hours or days. Such POC machines can find a placement in any of the clinicians with a single aid so that they can have the results instantaneously with one or two simple steps with the patient’s whole blood or serum.

Point of care has become established worldwide and the need for the POC concept rapidly increasing in India, In the future, POCT will play a vital role in private and public health care. Point of care diagnostics or testing has potential operational benefits like the number of operational bed requirements, optimal use of professional time, rapid decision making, reducing the high dependency on skilled full technicians, standard care in a disaster situation, and considerable reduction of patient waiting time. A myth in India is POC testing is expen-

sive and premium priced, actually, if you make a value proposition for POC testing with the above-mentioned operational benefits POC testing is highly economical and affordable to all classes of hospitals and clinics in India. After COVID, we all know “TIME IS PRECIOUS” POCT is the tool that supports healthcare professionals for FASTER DIAGNOSTICS, focusing on patient care and saving TIME. It’s important to embrace new and developing technology in POC Diagnostics and Testing, now POC devices are manufactured with high-quality standards and deliver the desired results to the clinicians.

We, Agappe is one of the strong IVD manufacturers in India, focused on clinical chemistry and haematology segment, immuno-chemistry, molecular diagnostics, preanalytics, etc.

Agappe is stepping into POC diagnostics solutions and intends to support healthcare professionals with faster diagnostics. We focus on launching products in the POC segment to address the need of emergency department / intensive care units / stand alone dialysis units / stat lab concepts/ obstetrics & gynae and physician’s office. Under one umbrella we intend to cover most of the POC testing needs in a holistic solution for the hospitals, clinics, and the physician’s offices.

Agappe is your best partner in diagnostics, we are here with our new division, POC DIAGNOSTICS, “SUPPORTING HEALTHCARE PROFESSIONALS FOR FASTER DIAGNOSTICS”.

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STRATEGY

Privacy and data protection in the age of digital health Pankaj Srivastava, Whole Time Director, BSI India highlights the simple measures that organisations can adopt and use to implement privacy by design strategies early in their development lifecycle to ensure protection of patient data and privacy rights

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igitisation of data across sectors is no new feat.

Ever since its introduction, IT has streamlined the healthcare sector by enhancing the quality of patient care, increased patient security and reduced operating and administrative costs for healthcare facilities globally. The pandemic fuelled this digital revolution by serving as the catalyst to deployment of digital health technologies across the world within a very short period. While these advancements have been a boon, it has also exposed healthcare organisations to malicious attacks and threats of data breaches. Pharmaceuticals, hospitals, clinics, healthcare service providers and both public and private sector organisations in healthcare store and process vast amounts of data every second. Most of which is highly sensitive and personal data i.e., health and medical records of patients and staff, their demographics, biometrics, DNA etc.

Simple measures that organisations can adopt and use to implement privacy by design strategies early in their development lifecycle to ensure protection of patient data and privacy rights.

Embed compliance by design: In an ever digitised and evolving world, organisations need to adapt and evolve to stay com-

soon as you become aware of a data leak. ◆ Control: Provide data subjects adequate control over the processing of their personal data by asking the users explicit consent to the processing of their personal data. Offer users a real choice, i.e., basic functionality should be accessible for people who do not consent to the processing of their personal data along with the functionality to review/update/retract or delete their personal data ◆ Enforce: Commit to processing personal data in a privacyfriendly way, and adequately en-

petitive and compliant with the regulatory landscape. The privacy by design approach follows the simple rule of prevention is better than cure. It was published as a framework in 2009 and adopted by the International Assembly of Privacy Commissioners and Data Protection Authorities in 2010. It calls for a proactive approach to anticipate and prevent privacy invasive events before they happen. Embedding privacy measures into the design at the outset, directly improves both financial and operational efficiencies, also known as a 'shift-

Inform data subjects about the processing of their personal data in a timely and adequate manner by supply information of how personal data is processed ing left' approach to privacy and data protection.

Embed privacy culture: Embed a privacy culture within the organisation to use data to its fullest potential. This can be put into action by making privacy a board-level mandate, tailored training for staff, targeted assessments of awareness and awareness campaigns to refresh, reinforce and sustain awareness amongst staff.

Process oriented strategies ◆ Inform data subjects about the processing of their personal data in a timely and adequate manner by supply information of how personal data is processed. Explain which personal data you process, and why, also notify users the moment you process their personal data, share it with third parties, or as

force this. Take responsibility by creating, maintaining and verifying the privacy policy and commit to privacy with all the necessary technical and organisational controls and adjust its implementation whenever necessary. ◆ Demonstrate: Demonstrate you are processing personal data in a privacy-friendly way by documenting all important steps taken and conduct

audits regularly.

Data oriented strategies ◆ Minimise: Limit the processing of personal data by selecting only relevant people and relevant attributes and process only that data. Remove partial data as soon as it is no longer necessary and destroy/or completely remove personal data as soon as they are no longer relevant. ◆ Separate the processing of personal data by collecting and processing personal data in different databases or applications that are either logically separated, or actually run on different (yet still centrally located or controlled) hardware. Using decentralised or even distributed system architectures instead of centralised ones can help preserve data ◆ Abstract: Limit as much as possible the detail in which personal data is processed. By using an approximation of value or adjust the value with some random noise. For example, instead of reporting the exact current location of a person, report the location within some random distance from the real location. ◆ Hide: Protect personal data or make it unlinkable or unobservable. Make sure it does not become public or known by encrypting and restricting access to personal data.

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HEALTHCARE TRACKER

Seize the golden moments after cardiac arrest with technology Dr Ulhas Pandurangi, MD, Chief-Division of Cardiac Electrophysiology & Pacing, Madras Medical Mission explians why golden hour is the most critical and highlights how GE MAC 7 by GE Healthcare aid in delivering cardiac care in the golden hour Comprehensive care for cardiac emergencies-Door to balloon time

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ver the past two decades, advancements in digital technologies and mobile connectivity have led to the development of a variety of novel mobile and implantable devices with wireless capabilities. Many advances have occurred in cardiac telemetry and remote monitoring, and cardiac implantable electronic devices (CIEDs), among others. Widespread adoption of many of these devices and resources has led to improved quality of life and survival in affected patient populations.

Approximately 7 lakh people die each year from sudden cardiac arrest, representing 10 percent of all deaths in India. Every minute, we lose 112 people to cardiac arrest in the country.

The first hour is most crucial and can make all the difference in our effort to save the patient’s life. And yet, due to various circumstances, the treatment of the patient is delayed leading to further complications and death.

The electrocardiogram is the simplest, most cost-effective, and widely available tool which helps in making the vital diagnoses of impending Heart attacks and cardiac arrest. Technology is going to allow the same to be read remotely by an expert.

Why is the first hour (golden hour) the most critical?

The difference between a golden hour and a few golden seconds is similar to suffering from a heart attack and cardiac arrest.

The golden hour is the period, approximately an hour when a patient suffering from a heart attack should be given

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Digital technology has transformed cardiac care and has helped save crores of lives in the past few years. It allows doctors to detect cardiovascular diseases at an earlier, which considerably reduces the risks of cardiac arrest and heart attacks proper medical help to avoid death and irreplaceable damage to organs. So, during a heart attack, the patient should be taken to emergency care within an hour of the inception of the attack.

Heart attack and cardiac arrest are used interchangeably A heart attack occurs when the oxygenated blood fails to reach the heart. With a heart attack, your heart pumps blood with reduced efficiency. So, a heart attack patient can go for minutes to several hours in that condition. However, the person should be taken to the ER instantly to avoid severe damage to the organs with reduced

blood supply.

Cardiac arrest occurs without any warning. The heart stops working because of any reason, disrupting the pumping action. So, there is no blood flow to the brain. Within seconds, a person falls unconscious, and the patient can die within minutes.

So, it is golden seconds for cardiac arrest.

It is essential to acknowledge the symptoms of cardiac arrest and take instant action. Common symptoms of cardiac arrest include: ◆ Chest pain ◆ Shortness of breath ◆ Instant loss of responsiveness ◆ Heart palpitations and unconsciousness

Now, this is where the golden second begins. Effective and appropriate treatment offered during this time can enhance the patient’s survival chance with good results. ◆ Call for medical help as soon as possible. ◆ Check pulse ◆ Position the victim and begin CPR till help arrives. ◆ Offer two breaths of air with 30 compressions. ◆ Call for an Automated External Defibrillator as soon as possible.

During cardiac emergencies, hospitals need to offer expert care to patients and do an instant ECG on the scene. The result is showcased live to the cardiologists at the hospitals and assessed instantly, ensuring no wastage of time and an appropriate treatment plan is immediately delivered.

This is called the Door-toBalloon policy. It plays a significant role in lowering the number of heart attack fatalities.

Heart cells may be irreversibly drying for every second that the person is delayed the treatment.

Hence, healthcare professionals start the treatment in the ambulance itself, and after the patient reaches the hospital, they are taken directly to the cath lab, where primary angioplasty is done.

The door to balloon time is usually the time the person spends before getting major treatment. This is the time that helps him come to the revival stage.

How is digital technology transforming cardiac care?

Digital technology has trans-

formed cardiac care and has helped save crores of lives in the past few years. It allows doctors to detect cardiovascular diseases at an earlier, which considerably reduces the risks of cardiac arrest and heart attacks.

How does GE MAC 7 aid in delivering cardiac care in the golden hour?GE MAC7 is an advanced ECG machine that has an intuitive user interface and improves the ECG signal quality with high resolution. It also allows data exchange in several formats such as DICOM, HL7, XML, and PDF. Most importantly, bidirectional communication is possible with most of the Electronic Medical Record (EMR) systems. This feature allows the physician to read the ECG even when the patient is at a remote place and the ECG is obtained by a paramedic using the GE MAC7 System. The diagnosis of impeding cardiac arrest and heart attacks can be made very rapidly enabling the patient to have the required therapy in the golden hour.

ConclusionWearable gadgets, Remote patient monitoring, mobile apps, and wireless sensors are in relatively early stages of development and adoption. However, the “perfect storm” of rapidly aging populations, unsustainable health care expenditures, and rapid uptake of mobile technologies have created fertile ground for adoption.

During cardiac arrest, every minute matters. The sooner you take action, the better the patient can recover. As such, technology also finds its place in the golden hour in the management of Cardiac arrest, and GE MAC7 is endowed with technical features that make timely diagnosis and delivery of life-saving therapy possible.

Transasia upgrades its fully automated clinical chemistry analyzer Erba XL 640 to include Conveyor Rack System The Erba XL 640, a Made in India, fully automated clinical chemistry analyzer has been a preferred choice for many high throughput labs across the country for its various features that offer seamless workflow

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ith an increase in the number and types of infections and diseases, the need for testing has become even more relevant. Changing lifestyles has led to a greater demand for evaluating parameters such as CRP, LDL, HDL, HbA1c, etc.

This in-turn is creating opportunities for diagnostic manufacturers to provide systems that are highly automated and integrated with the latest technologies.

The focus of all laboratories is now on Turnaround Time (TAT). The last few decades have seen diagnostic manufacturers develop systems that are more efficient to provide results faster and reduce manual intervention. These instruments form a part of the different segments of which clinical chemistry holds a significant share because of the wide range of parameters it entails.

In fact, clinical chemistry has grown from simple blood and urine analysis to today include a whole panel of tests for various clinical profiles.

Transasia’s presence in the clinical chemistry segment Transasia has been at the forefront of endorsing the ‘Vocal for Local’ sentiment. Among the first in the country to introduce Made in India clinical chemistry analyzers, Transasia leads the segment with a wide array of fully and semiautomated analyzers and a large portfolio of reagents for routine and specialised chemistries. In fact, the various auto-analyzers are the

Floor Model

largest selling in the country and are being successfully deployed in large and prestigious government institutes and chain labs. So far, Transasia has installed more than 50,000 units of Erba clinical chemistry analyzers across the country.

Transasia regularly enhances the user-experience of its instruments to meet the needs of the customers.

New Erba XL 640 with autoloader and Conveyor

Rack System for greater convenience The Erba XL 640, a Made in India, fully automated clinical chemistry analyzer has been a preferred choice for many high throughput labs across the country for its various features that offer seamless workflow.

Transasia has now upgraded the analyzer by thoughtfully integrating a Conveyor Rack System (CRS).

The conveyor rack system allows for a continuous flow analysis with automatic load-

ing, mixing, pipetting of sample and reagent. This helps establish more efficient workflows by relieving lab technicians from manual work, easing their burden, and enhancing user safety by reducing exposure to bio-hazardous materials. For labs that run roundthe-clock, it allows for faster TAT and increases walk-away time.

The other key features and benefits of the system include: ◆ The Make in India advantage: Erba XL 640 has been a

result of Transasia’s four decade experience of manufacturing in India to offer the user world-class quality with affordability. ◆ Highly accurate and precise results: Erba XL 640 is based on the principle of photometry. High resolution, optically corrected diffraction grating 12 wavelengths between 340 nm - 750 nm ensures a high degree of accuracy for the entire clinical chemistry range. ◆ Low TAT: With a throughput of 400 tests/hr with photometry and 640 tests/ hr with ISE, Erba XL 640 is best suited for labs with a high workload.

The ISE module allows the determination of sodium, potassium, chloride, and lithium ions in parallel with photometric measurements. ◆ Lower CPT: Erba XL 640 has been designed keeping in mind environmental safety.

The use of permanent hard glass cuvettes eliminates recurring cost of disposable cuvettes, avoiding plastic usage. ◆ Minimum downtime: Erba XL 640 is Integrated with Internet of Things (IoT) a Cloudbased service allows for faster resolution of any technical errors through remote monitoring, thereby reducing downtime. ◆ Smart performance: The tip of the probe is equipped with a Clot Detection sensor, that halts the sampling in case of a clot and performs probe wash. As a result, there is proper dispensing of the samples and sample probe is protected from being clogged.

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Change is the only constant Jigisha Gandhi, Director, Ami Polymer talks about the menstrual cups and how they are extremely environmentally friendly Time is come to accept and adapt change As a menstrual cup user, you are not only choosing an environmentally friendly period care option. But also, they are good for Mother Nature, menstrual cups also give you great freedom and flexibility, especially during your Sports and fitness activities. So let us continue with your environmentally friendly choices, and start to accepting and adopting ways in which you can make.

I used a menstrual cup and found that my whole life turned out easy and comfort! For years we have been told to use napkins - first they were cotton cloth.

Then the attractive napkins and that 'hush.

After using the menstrual cup, I mentally cleared everyone who said that sanitary napkin is the lousy thing to use during periods. Because it has never given me the comfort it boasts of, never ever made me freedom and flexibility.

Menstrual Cup I was apprehensive myself be-

fore using this silicone-based cone shaped cup with a stem at the end, thinking how am I going to push it inside my vagina?

But, guess what? It took me exactly 3 minutes to make the cup into a C shape and set it in. It's really easy, if you can locate the hole. After using it once or twice it didn't take me more than a minute to use it. While changing a pad still takes me about 10 minutes (don't get me into those details) even after years of using them.

It is easier to just pour the collected blood into the toilet pot, gentle wash it with water and push it back in again and you're good to go for no less than 12 hours, even the best of sanitary pads never gave me that much comfort. However, for heavier flow you might want to change it accordingly but that happens with pads and tampons too, no?

Be the Change you want to see in the world Now why I took this step of going the unconventional way was

the concern about my own health and the bigger picture the environment. The toxic chemicals they use in manufacturing pads like dioxins, synthetic fiber and petro chemical additives. The pad blocks the air flow, lock in heat and wetness and produces yeast and bacteria in your vagina! This can cause ovarian cancer and heart diseases.

Coming on the environmental aspect, pads are the worst and most impactful as they have plastic used in making it and we all know that it takes gazillion year to decompose plastic. However, tampons are slightly better since it's mostly cotton. But the

cotton fiber used in the production of tampons contributes 80% of their total impact. One tampon takes about six months to decompose and considering that a study revealed that a woman uses anywhere between 8,000 to 17,000 tampons in her lifetime depending on her cycle it will take a long time to decompose for everyone.

Now coming to menstrual cup, it is sterlisable, so one just needs to keep it in boiling water for five minutes to free it off any bacteria. Then the company claims that one cup can be used for as long as 05 years which means that no throwing of waste every month and no feeling guilty about destroying your own body and the environment.

Every step counts.

While first world countries have been benefiting from Menstrual cups since 1987 when it came the first time around there, India is still kind of getting the hang of it. Reasons can be cultural stigma surrounding menstruation, fear of trying something revolutionary for pe-

riods, so on and so forth. However, now that I have listed down so many advantages of it, all you Indian women and girls must give it a try. Thank me later!

Lastly, the cup I used is made up by a company Ami Polymer Pvt. Ltd. (APPL) - ImasafeTM Reusable Menstrual cup.

ImasafeTM Reusable Menstrual cup saves you from period hassles, rashes, skin infection, leakages and allows physical activity and can last for years together, decreasing waste creation. This translates into improved menstrual health and lowers waste creation. The Unique things about the cup made by APPL is that it is produced in a clean room of class 10000 facility and manufactured with international certified compliance. jigisha@amipolymer.com www.amipolymer.com www.amipolymer.in For buying Menstrual Cup visit: www.imasafe.in

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

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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!

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The system can be scaled for a wide variety of clinical portfolios from shared services to dedicated, specialized applications strengthening your clinical confidence even for the most demanding cases.

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