Express Healthcare (Vol. 16, No. 10) November 2023

VOL.16 NO 10 PAGES 44

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INTERVIEWS Dr Santy Sajan Group Chief Operating Officer, Paras Health

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CONTENTS HEALTHCARE TRACKER

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

Pg 16

Editorial Team

P30: INTERVIEW

Lakshmipriya Nair

RAJAT GHAI Business Head-Government, Wipro GE Healthcare

Kalyani Sharma DESIGN Art Director

GOVERNANCE

Pravin Temble

LEADERSHIP

START-UP

POLICY

23

24

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

P14: INTERVIEW

P22: INTERVIEW

CIRCULATION

SHANNON OLSSON Founder and global Director, echo network

DR SANTY SAJAN Group Chief Operating Officer, Paras Health

Mohan Varadkar

NURTURING HEALTHTECH INNOVATION: GUIDE TO ATTRACTING PATIENT CAPITAL

HEALTH DIPLOMACY: ROLE OF INTERNATIONAL HEALTHCARE PARTNERSHIPS IN GLOBAL RELATIONS

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2022 - 24. Printed and Published by Vaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press, Plot No.EL-208, TTC Industrial Area, Mahape, Navi Mumbai-400710 and Published at Mafatlal Centre, 7th floor, Ramnath Goenka Marg, Nariman Point, Mumbai 400021.

Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Mafatlal Centre, 7th floor, Ramnath Goenka Marg, Nariman Point, Mumbai 400021) * Responsible for selection of news under the PRB Act. Copyright © 2017. The Indian Express (P) Ltd. All rights reserved throughout the world.

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EDITOR’S NOTE

Of threat actors on the dark web and knights in shining armour

P

rotection of health data in India remains a weak link. In what could possibly be the country’s largest health data breach so far, health data of over 81.5 crore Indian citizens, extracted from COVID-19 test details with the Indian Council of Medical Research (ICMR), were offered for sale on the dark web. The previous month, the official website of the Ministry of AYUSH in Jharkhand had reportedly been breached, exposing over 3.2 lakh patient records on the dark web.

While the cyber attacks on ICMR, CoWIN, and AIIMS made news, there could be many more health data breaches that have not been disclosed to the public, or worse, remain undetected by the breached entities.

The private sector too has not been spared. The latest healthcare company to be targeted by threat actors seems to be Redcliffe Labs, though Prabhat Pankaj, CTO, Redcliffe has refuted news around customer data breaches at Redcliffe Labs. He went on to list the measures taken by the company to secure its IT infrastructure, reiterating its dedication to cybersecurity, and emphasised that it would continue to invest in cutting-edge technology to protect customer information.

Industry leaders say that they are taking data breaches very seriously. Commenting on the ICMR data breach, Pavan Choudary, Chairman of the Medical Technology Association of India (MTaI), cautioned that the recent breach of ICMR’s database could trigger identity thefts leading to coercions, extortions, fraud, and doxing.

These massive data breaches only underline the importance of the Digital Personal Data Protection Act, 2023 introduced in August.

The Act seems perfect on paper, seeking to protect individuals' fundamental rights and freedoms, particularly their right to the protection of their personal data. The Act also obligates the data fiduciaries to keep data secure.

However, there is always a gap between intention and implementation. As Choudary points out, “such well-intended legislation needs to be supported with adequate enforcement mechanisms, ring-fencing of all data reservoirs, regular audits, and regular education and awareness programmes."

What's worrying is that 66 per cent of India's healthcare professionals were not confident that their technology infrastructure is sufficient to prevent cyber threats, according to an early 2023 survey of healthcare professionals, conducted by Grant Thornton Bharat and Association of Healthcare Providers (India).

Only 40 per cent felt that their technology infrastructure can ensure patient data privacy. Probably prodded by the increasing number of cyber attacks, a sizable number (84 per cent) of respondents plan to significantly enhance their budget for digital solutions and technology initiatives. Hopefully, these investments in cyber security are implemented with the urgency and utmost care required.

Weak health data security increases mistrust of the healthcare ecosystem and poor implementation could be one of the spoilers of the promising healthcare investment trend panning out. This is why the entry of some of the world's largest PE players into India’s healthcare services market could bring in more effective investments in cyber security, among other infrastructure. However, the razor sharp focus on profits , with the endgame being profitable exits, raises another concern: while access to high-end care will increase, will more patients be able to afford such care?

Global PE fund Blackstone’s first big splash investment in India’s healthcare services sector continues the PE/VC-driven consolidation

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Threat actors chasing India’s health data could be one of the spoilers of the promising healthcare investment trend panning out

wave in India’s healthcare service sector. Blackstone’s acquisition of the CARE Hospitals network, further bolstered by the latter acquiring majority stakes in KIMSHEALTH, creates one of the largest healthcare platforms in the country, with more than 4000 beds, across 23 facilities in 11 cities. That most of these are in under-penetrated, emerging cities signals the intent to focus on new markets.

Many owners of smaller hospitals,still reeling from the impact of COVID-19 on their revenue, are reportedly looking for an exit.

In other cases, founders may be searching for strategic investment partners, to expand their geographic footprint and secure their legacy on a global scale.

Are global investors. like PE firms, the knights in shining armour?

Only time will tell.

According to the Grant Thornton Bharat Pharma and Healthcare Dealtracker Report for Q3 2023, single specialty facilities emerged as a focus segment with increased investor interest in the healthcare sector. Even though there was a decline in M&A values, and deal volumes in healthcare may remain subdued, Bhanu Prakash Kalmath from Grant Thornton Bharat alludes to expectations of sustained momentum, as the sector's growth drivers, such as increasing demand for healthcare services, growing adoption of new technology, digital health and sustained government support, are expected to remain in place.

Highlighting the focus on single speciality hospitals, the report lists PE fund BPEA EQT's investment of USD 657 million in Indira IVF, Quadria Capital's infusion of USD 159 million in Maxivision Super Specialty Eye Hospital, Asian Healthcare investing USD 73 million in Asian Institute of Nephrology and Urology and TPG Growth, and Temasek investing in Dr. Agrawal’s Healthcare, valuing USD 80 million.

Similarly, Manipal Health acquiring a majority stake in AMRI Hospitals and India Resurgence Fund investing in Ivy Health & Life Sciences are examples of continuing consolidation, with bigger national players expanding into regional healthcare markets.

Blackstone Private Equity MD Ganesh Mani’s assurance that they are “committed to being a long-term investor and business builder” and his plan to bring in “global scale and operating expertise” spell out the roadmap ahead for most PE platforms investing in India’s healthcare services sector. As he indicated, the platform will grow both organically and through acquisitions. Thus, it is highly likely that we will hear of more regional hospital networks joining one of the main global investor-driven healthcare platforms jostling for market share in India's healthcare service service.

But for this consolidation wave to be beneficial for patients in the healthcare ecosystem, we need to address the various trust deficits.

This is why legislation like The Digital Personal Data Protection Act, 2023 is important. The Act might assure patients that their digital personal data, including digitised health data, is protected and private. Data breaches of health data from public databases need to be thoroughly investigated, in a transparent manner, with a view to identifying and fixing the weak links and most importantly, preventing future data breaches. It is time we realise that ‘data is the new oil’ is more than just a pithy one-liner.

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

GOVERNANCE I N T E R V I E W

We need to build action-oriented community of diverse players for One Health to be fully implemented echo network, a social innovation network initiated by the Principal Scientific Adviser to the Government of India was founded in December 2019 with the specific focus of increasing scientific awareness, engagement, and insight regarding India’s human and environmental ecosystems. With the Government of India making National One Health Mission as part of its G20 priorities, there will be a lot of focus on how this can be achieved. In the same regard, Shannon Olsson, Founder and global Director, echo network in an interaction with Kalyani Sharma share her insights on One Health mission Can you throw some light on what ‘One Health’ means and why it is important for a country like India to focus on it as part of its G20 priorities?

One Health is an integrative approach to prevent, detect, and respond to human health burdens. This approach acknowledges that human, animal, and environmental health are inextricably linked, and surveillance and reporting of all three aspects and their interactions is required to improve our health security and sustainable development. In this respect, One Health is well-aligned with the “One Earth, One Family, One Future” theme of India’s G20 Presidency and offers a clear strategy to achieve the New Delhi Leaders’ Declaration for sustainable and green development through enhancing human and environmental well-being.

Achieving the goals of such a comprehensive mission can be challenging. What, in your opinion, are some of the major challenges and hurdles that India may face in the process of realising the objectives of the One Health mission?

In governments, businesses, academia, and NGOs across

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the country, the components of One Health are split into tiny facets of expertise and focus. The major challenge lies in integrating the precise details of human, animal, and environmental health into a single system. Most One Health efforts across India still focus on specific aspects of health, such as livestock or zoonotic diseases, where communication channels are already established. True One Health Integration requires us to overcome organisational distrust and information-sharing concerns and simultaneously respect our population’s privacy and equity issues. We need to build an actionoriented community of diverse players for One Health to be fully implemented.

As a foreigner who has worked in India for almost ten years, I firmly believe that this country has all the tools it needs to actualise a One Health strategy at scale

Could you elaborate on how echo network is planning to be a part of India’s National One Health Mission and contribute towards its success? Are there any specific initiatives or collaborations that echo network is currently involved in or planning to initiate to support the One Health mission in India?

The echo network was founded to engage different sectors and communities in

the scientific process and enhance sustainable development. We specialise in building trust, understanding values, and developing a sense of responsibility in individuals to establish action-based communities. Rather than focus on the data alone, we

In governments, businesses, academia,and NGOs across the country,the components of One Health are split into tiny facets of expertise and focus.The major challenge lies in integrating the precise details of human, animal,and environmental health into a single system use specialised methods to help organisations recognise each other’s values and understand how their knowledge integrates with others. With the Bengaluru Science and Technology Cluster (supported by the Office of the Principal Scientific Adviser, GOI), we are working with several organisations to develop a One Health platform for our city. To this end, we ask: What One Health interventions are needed to make a single ward completely Dengue-free?

Using this bottom-up approach, we plan to extract principles that can be

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adopted for other locations and health burdens. If you can’t realise One Health for 50,000 people, how will we realise One Health with 1.4 billion?

Looking ahead, what are your hopes and aspirations for the future of One Health

in India, and what advice would you offer to policymakers, researchers, and organisations aiming to contribute to this mission’s success?

As a foreigner who has worked in India for almost ten years, I firmly believe that this country has all the

tools it needs to actualise a One Health strategy at scale.

We have the aspiration, the technical ability, and the support required. We must develop the patience to listen to each other, the courage to embrace new ideas from different sectors and disciplines, and the humility

to realise that One Health is not a single solution patented by one company or institute.

One Health requires many solutions to work together through bright minds and hearts nationwide.

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

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Healthcare landscape in India is undergoing a substantial transformation with an emphasis on modern hospital design to meet the evolving needs of ecosystem

By Kalyani Sharma

16 EXPRESS HEALTHCARE November 2023

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cover ) T

he healthcare landscape in India is undergoing a significant shift and is in the middle of a transformative evolution. The demand for quality healthcare is on the rise which is directly related to the environments in which healthcare is delivered.

And hence hospital design stands as a critical domain in shaping the overall healthcare experience. Well planned and designed infrastructure hold the power to directly enhance patient outcomes, boost staff contentment, and optimise operational efficiency.

Sharing his views on this, Debasis Kole, GM- Engineering, PSRI Hospital New Delhi said, “In India, the healthcare landscape is undergoing a remarkable transformation, reshaping the way hospitals are designed and structured. As the demand for high-quality healthcare services continues to grow, there is an increasing focus on creating healthcare environments that are not just sterile, but also therapeutic.

Hospital design now plays a pivotal role in shaping the overall healthcare experience, and it's undergoing profound changes to meet the evolving needs of the healthcare sector.”

Current state of hospital design in India With a focus on improving patient outcomes, enhancing efficiency, and promoting sustainability, the current state of hospital design in India looks innovative and experimental in nature.

Modern hospital design principles in India prioritise a variety of factors to ensure that healthcare facilities are equipped to meet the evolving needs of patients, medical professionals, and the healthcare system as a whole.

Kole also shares, “The present state of hospital design in India reflects a departure from traditional norms. Design principles are evolving to create healthcare facilities that prioritise functionality while also providing therapeutic benefits.

Hospitals are moving away

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In this dynamic era of healthcare, hospital architecture plays pivotal role in shaping the entire patient journey Dikshu Kukreja Managing Principal, CPKA Kukreja Architects

Healthcare in India requires a holistic approach that explores new possibilities within architecture and design with government policies and initiatives Alpana Gupta Partner, Vijay Gupta Architects

Sustainability is gaining traction, with green design principles taking center stage. To further encourage this trend, the government should provide incentives such as extra FSI or electricity tariff rebates for achieving green ratings. This will promote more sustainable and equitable healthcare infrastructure in India Nandini Bazaz Director-Architectural Services, HOSMAC

By incorporating nature, flexible spaces, privacy, healing art, technology, accessibility, family-centred care, and proper lighting and acoustics, hospitals can enhance healing, reduce stress, and empower patients Kuntal Vyas Aggarwal Founder and Design Head, Resaiki interiors and architecture design studio

from the traditional centralised nursing stations and shared wards, opting for decentralised models that enhance patient privacy and reduce noise levels.

Furthermore, the integration of biophilic design, emphasising natural light, soothing colours, and elements from the natural world, is gaining momentum. These changes are more than just aesthetic upgrades; they are focused on creating environments that foster healing.”

On current state of hospital design, Dr Aashish Chaudhry, Managing Director, Aakash Healthcare said, “Hospital design in India is undergoing a significant change with a blend of innovative design principles and advanced technologies. Patient centricity is one of the key aspects shaping the contemporary hospital design. The concept is focused on creating spaces that prioritise patient comfort, privacy and emotional well-being. Hospitals are increasingly concentrating on incorporating natural lighting, soothing aesthetics, working to reducing the risk of cross infection and facilitating a nurturing atmosphere for optimal outcomes. Flexibility and adaptability are another key consideration in hospital design that involves adapting hospital infrastructure as per changing healthcare needs. Multi use spaces and modular design usage is gaining momentum, ensuring adaptability to evolving requirements.”

Dikshu Kukreja, Managing Principal, CPKA Kukreja Architects believes that in this dynamic era of healthcare, hospital architecture plays pivotal role in shaping the entire patient journey. It goes beyond bricks and mortar; it's about creating environments that facilitate healing, enhance operational efficiency, and ultimately, elevate the overall patient experience.

Concept of patient-centric hospital design Patient-centricity is the most prominent trend in modern design, prioritising patient

comfort and well-being.

Hospitals are increasingly designed with a focus on enhancing the patient experience.

This includes considerations for patient privacy, comfort, and convenience. Single-patient rooms, soothing aesthetics, and well-designed waiting areas are becoming more prevalent.

“In today's era of healthcare, the paradigm of hospital design has undergone a remarkable transformation, placing patients at the very heart of the architectural narrative.

Gone are the days of stark, clinical spaces; instead, we find a renaissance in the way hospitals are conceived-as sanctuaries of healing. Patient-centricity takes centre stage, with layouts meticulously crafted to prioritise not only medical needs but also the comfort and well-being of those under care.

Within these thoughtfully designed spaces, one finds a symphony of elements working in harmony - from soothing aesthetics to an abundance of natural light, each element weaves into the fabric of hospital architecture”, added Kukreja Nandini Bazaz, Director-Architectural Services, HOSMAC opines that a patient-centric hospital design is all about making patients feel safe, comfortable, and at ease. It helps improve their healing and emotional well-being.

She shares, “Considering the vulnerability of people within its premises, healthcare structures require a lot more caution while designing. Nosocomial infections, also known as Hospital-Acquired Infections, are a significant concern in healthcare facilities worldwide. Even simple changes like elbow-operated taps, waiting areas with proper air circulation, safe exit routes and designing the space in such a way so as to avoid overcrowding, can help to provide a safer space. Indoor air quality also plays a very important role in the overall healing journey of patients. Airborne illnesses may spread quickly putting patients and healthcare

Hospitals form a crucial part of the public health and social welfare system, and the increasing emphasis on sustainable and eco-friendly hospital design is much needed – for our environment and our communities. A comprehensive understanding of sustainability can pave the way forward Sarika Shetty Partner, SJK Architects

By integrating digital health solutions seamlessly into architectural design, hospitals can achieve energy efficiency, reduce their carbon footprint, and provide patients with a healing environment that enhances their overall experience Ravideep Singh Associate Director, Creative Designer Architects

Hospital design now plays a pivotal role in shaping the overall healthcare experience, and it's undergoing profound changes to meet the evolving needs of the healthcare sector Debasis Kole GM- Engineering, PSRI Hospital New Delhi

professionals in danger. And hence comes the idea of making Airborne Infection Isolation (A.I.I) rooms that are kept at negative pressure compared to the surrounding space, preventing the dissemination of potentially infectious airborne particles within the hospital.”

“Furthermore, Neuroaesthetics, which links beauty and brain processing, shows that

hospital design affects emotions and health. Indian hospitals are adopting this approach.

Nature elements like adding greens or ensuing natural light, can help reduce stress and uplift moods”, she added.

Giving his views on patientcentric approach to hospital design, Kuntal Vyas Aggarwal, Founder and Design Head, Resaiki interiors and architecture

design studio said, “Healthcare facilities have long been places associated with illness, stress, and anxiety. However, recent developments in hospital design are changing that perception. A patient-centric approach to hospital design improves the physical environment and fosters a sense of comfort, empowerment, and support for patients.”

“Patient-centric hospital design represents a significant shift in healthcare architecture, focusing on improving patient recovery, experience, and overall well-being. By incorporating nature, flexible spaces, privacy, healing art, technology, accessibility, family-centred care, and proper lighting and acoustics, hospitals can enhance healing, reduce stress, and empower patients. In an era where patient outcomes and experiences are paramount, patient-centric hospital design is a critical step towards improving the quality of healthcare”, she added.

Increasing emphasis on sustainable and ecofriendly hospital design Apart from patient-centricity, modern Indian hospitals are more environmental conscious now and there is an increase as far as embracing sustainability is concerned. There is greater incorporation of eco-friendly practices and materials into designs, reducing the ecological footprint of these healthcare facilities.

Talking about increasing emphasis on sustainable and eco-friendly hospital design, Sarika Shetty, Partner, SJK Architects shares, “Hospitals form a crucial part of the public health and social welfare system, and the increasing emphasis on sustainable and ecofriendly hospital design is much needed – for our environment and our communities. A comprehensive understanding of sustainability can pave the way forward.”

Shetty mentions about some of the ways in which hospitals can be designed sustainably like optimising natural light and ventilation, designing the building envelope for thermal comfort, incorporating nature into the design, reducing operational and embodied energy and designing for environmental, economic, and social sustainability.

To further encourage the green design principles, Bazaz suggests, “Notably, sustainability is gaining traction, with

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cover ) green design principles taking center stage. To further encourage this trend, the government should provide incentives such as extra FSI or electricity tariff rebates for achieving green ratings. This will promote more sustainable and equitable healthcare infrastructure in India.”

The energy requirement of Indian hospitals is diverse since they are marked by distinct heterogeneity. In terms of ownership, there are public or government hospitals, municipal hospitals, railway hospitals, defence hospitals, private hospitals, etc. In terms of size, healthcare facilities range from small clinics to large multi-speciality hospitals with varying air-conditioned areas, medical services, comfort levels, patient privacy, etc. An accurate characterisation of the energy used in different types of hospitals across geographies is a prerequisite for mainstreaming energy efficiency and renewable energy in them. This requires reliable energy consumption and other granular data to help envision a roadmap for lowcarbon interventions. The National Centre for Disease Control (NCDC), Alliance for an Energy Efficient Economy (AEEE), and Centre for Chronic Disease Control (CCDC) released the results of a recently concluded National Hospital Energy Consumption Survey on 24 August 2023, which plugs this data gap.

Talking about this survey, Akash Goenka, Associate Fellow, AEEE and Dr Poornima Prabhakaran, Senior Research Scientist, CCDC shares, “Unprecedented in scale and depth, this survey covered more than 600 public and private hospitals of 10 typologies across 18 states/UTs and all climate zones of India.

The survey results have presented the first-ever baseline of the energy used by hospitals in India based on primary data, estimated their carbon footprint, and helped identify several areas of energy efficiency and renewable energy interventions. For example,

20 EXPRESS HEALTHCARE November 2023

Hospitals are increasingly concentrating on incorporating natural lighting, soothing aesthetics, working to reducing the risk of cross infection and facilitating a nurturing atmosphere for optimal outcomes Dr Aashish Chaudhry Managing Director, Aakash Healthcare

Hospitals and healthcare institutions have undergone a profound transformation, shifting from a traditional approach to one that prioritises the patient. These institutions are now incorporating technology at every level of their infrastructure, addressing India's specific challenges related to healthcare accessibility, affordability, and quality Dr Manisha Karmarkar CEO, DPU Private Super Specialty Hospital, Pune

there is scope to increase the uptake of solar refrigerators in small public hospitals in rural and semi-urban areas where the grid connectivity is unreliable.”

“Similarly, there is considerable potential for adopting solar thermal or electric hybrid water heating systems.

The survey found that 30 per cent of public and 50 per cent of private hospitals had a high penetration of energy-efficient LED lighting. The remaining ones can still benefit from relatively simple and inexpensive lighting retrofits. The survey also provided insights on existing onsite solar PV systems at different levels of the public healthcare system and how they are maintained, indicating that deploying and maintaining solar PV at hospitals need novel governance and financing mechanisms”, they added.

Advanced technologies in hospital design Technology has been playing an important role in healthcare, acting as a catalyst for transformative change. This is also evident in the design and construction of modern hospitals in India. The integration of advanced technologies has become paramount in ensuring that healthcare facilities are equipped to meet the evolving needs of patients, medical professionals, and the healthcare system as a whole.

Ravideep Singh, Associate Director, Creative Designer Architects shares that digital health and technology also offer promising solutions for creating climate-friendly hospital designs prioritising human health and environmental sustainability. By integrating digital health solutions seamlessly into architectural design, hospitals can achieve energy

efficiency, reduce their carbon footprint, and provide patients with a healing environment that enhances their overall experience.

Dr Manisha Karmarkar, CEO, DPU Private Super Specialty Hospital, Pune also said, “The merging of healthcare and technology has created a multitude of opportunities, unlocking new possibilities that were once challenging. Consequently, hospitals and healthcare institutions have undergone a profound transformation, shifting from a traditional approach to one that prioritises the patient. These institutions are now incorporating technology at every level of their infrastructure, addressing India's specific challenges related to healthcare accessibility, affordability, and quality. Although still in its early stages, the adoption of this technological shift is

happening rapidly. Given the immense scope and influence of the healthcare industry, the potential for impact is substantial.”

This visionary fusion of technology with architectural blueprints transcends the realm of mere functionality.

Kukreja mentions, “It is a holistic approach that not only amplifies the efficacy of medical services but also cultivates an environment of perpetual innovation and adaptability. The hospital of tomorrow is not merely a physical structure; it is a dynamic ecosystem where the convergence of technology and design sets the stage for a new era of healthcare excellence.”

The pandemic accelerated the adoption of telemedicine in India, making it a fundamental component of hospital design.

Hospitals are now integrating telehealth facilities seamlessly, enabling remote consultations and monitoring. The Internet of Things (IoT) plays a pivotal role in this integration, connecting medical devices, patient records, and healthcare professionals to create a seamless and data-driven care environment.

Kole highlights that the IoT enables continuous monitoring of equipment and patient health, leading to more efficient resource management and improved patient safety. Additionally, telemedicine is revolutionising the concept of hospital space, as consultations are increasingly conducted remotely, reducing the need for expansive waiting areas and administrative sections. Electronic Health Records (EHRs) are also contributing to the transformation by necessitating the development of secure and accessible data centres within hospitals, influencing the physical layout and infrastructure of healthcare facilities.

Artificial Intelligence (AI) and Virtual Reality (VR) are also some of the most prominent trends in hospital design.

Explaining the role of AI, Singh said, “In an age dominated by the relentless

progression of technology, AI stands at the forefront of transformative change, disrupting industries across the spectrum.

In healthcare design, AI proves to be a transformative force for the better when used as a tool.

The architecture and design industry, including healthcare design, can benefit immensely from streamlining AI and other advanced technologies.”

“AI-driven predictive maintenance leverages data from various sensors, such as occupancy and daylight sensors, integrated with a centralised Building Management System (BMS). This integration enhances energy efficiency and prolongs the lifespan of critical healthcare infrastructure. AI algorithms process vast datasets, providing architects with critical insights into patient needs and preferences.

This intelligence empowers architects to craft spaces that transcend functionality and embrace therapeutic attributes, optimising natural light and privacy. Predictive maintenance improves energy efficiency, reduces costs, and prevents unexpected breakdowns, a critical factor in healthcare where downtime can be lifethreatening. AI's influence extends into the foundations of the hospitals, mitigating potential pitfalls and errors, resulting in more efficient and costeffective construction.”

Advanced technologies are

reshaping hospital design in India, offering patients more comfortable and efficient care environments and providing medical professionals with tools to enhance patient outcomes. As the healthcare sector continues to evolve, the integration of cutting-edge technologies is crucial to meeting the ever-changing needs of the Indian population. The future of healthcare design in India is an exciting journey into innovation and progress.

The future of hospital design Bazaz shares some interesting future projections for hospital architecture.

She said, “Smaller nursing homes might become extinct as larger, comprehensive hospitals gain prominence. Statutory compliance requirements and the pursuit of economies of scale will drive this transition toward hospitals offering "all under one roof" capabilities.”

“Informed and discerning consumers will demand higher standards of hygiene and aesthetics in healthcare facilities.

Hospitals will need to invest in designs that not only ensure clinical excellence but also create a comfortable and visually pleasing environment for patients”, she added.

According to Singh, the future of hospital design can be elevated by using advanced technologies, including AI, IoT,

telemedicine, and EHRs, focusing on efficiency, patient-centricity, and sustainability. Architects, healthcare professionals, and technology experts must work together to create healthcare environments that promote healing and reduce the carbon footprint, ensuring a greener and more patientfriendly future.

Challenges and roadblocks in evolving hospital design in India The healthcare sector in India is currently undergoing a substantial transformation, placing a strong focus on contemporary hospital design to cater to the changing demands of its population. However, the path to creating cutting-edge healthcare facilities is riddled with challenges and roadblocks that require careful consideration and strategic solutions.

Experts scrutinise the challenges that architects, healthcare professionals, and policymakers must overcome to secure a more promising future for healthcare infrastructure.

Alpana Gupta, Partner, Vijay Gupta Architects believes that healthcare in India requires a holistic approach that explores new possibilities within architecture and design with government policies and initiatives. She mentions, “The shift towards private clinics expanding into hospitals, particularly through refurbishment as

brownfield projects, presents an opportunity to efficiently utilise existing resources and infrastructure to bridge the urban-rural healthcare gap. A noteworthy roadblock in evolving hospital design is the concept of integrated campuses.

We must consider having essential facilities like oxygen plants, medical waste disposal units and other critical components on the hospital campus.

The COVID-19 pandemic underscored the importance of preparedness and self-sufficiency within healthcare facilities. Another pressing challenge is the limited availability of funds for greenfield projects, which significantly hampers the development of healthcare infrastructure.”

“To revamp healthcare infrastructure comprehensively, architects and planners must take an active role. Hospital design can significantly impact the efficiency and effectiveness of the healthcare system. Improved natural lighting, indoor air quality and a connection with nature in hospital spaces contribute to patient well-being. The well-being of patients is not just a physical concern; it also extends to mental and social well-being”, she added.

Singh said, “Architects and healthcare planners may face several challenges when designing climate-friendly and technologically advanced facilities.

Limited awareness among

healthcare providers regarding digital health solutions could lead to slow adoption. The scarcity of trained personnel to operate and maintain advanced technologies could hinder their effective implementation. More data and evidence-based design studies may help architects substantiate design decisions and demonstrate potential return on investments linked to patient experience and sustainability.”

Dr Chaudhry considers cost constraints as a significant roadblock, especially for resource-strapped healthcare providers, making it difficult for them to adopt the latest design trends. He added, “the regulatory and bureaucratic processes can slow down the implementation of innovative designs. There is also a shortage of skilled architects and healthcare planners with expertise in hospital design.

Striking a balance between integrating advanced technologies and accommodating the diverse healthcare landscape of India can be a challenging feat.”

The challenges in evolving hospital design in India are complex. But careful planning, collaboration and innovative solutions can help India in building healthcare infrastructure that is affordable, accessible and flexible for the entire ecosystem.

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

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LEADERSHIP I N T E R V I E W

More women in leadership roles serves as an inspiration for future generations Dr Santy Sajan, Group Chief Operating Officer, Paras Health in an interaction with Kalyani Sharma stresses that women leaders bring a valuable perspective to the table. Their strengths in soft skills and emotional intelligence are crucial in a healthcare sector

Why is there a need for gender diversity?

Fostering gender diversity isn't just about meeting quotas; it's about creating an inclusive and productive working environment.

Excellence in healthcare transcends gender boundaries and identifies the unique skills and talents everyone brings to the organisation. We should focus on the quality of an individual’s abilities rather than gender alone and ensure that the team is composed of the best talent available.

Gender diversity allows us to tap into a wider pool of perspectives, ideas, and experiences, ultimately leading to better decisionmaking, enhanced creativity, and improved patient care.

Therefore, the focus should be on the hiring quality of any individual rather than gender specificity.

What is the significance of women's leadership in influencing the future of healthcare?

The healthcare workforce is predominantly comprised of women, yet women remain significantly underrepresented in leadership positions. Women leaders bring a valuable perspective to the table. Their strengths in soft skills and emotional intelligence are crucial in a healthcare sector where compassion, empathy, and effective communication are most essential. As healthcare rapidly evolves with technological advancements, women leaders understand how to navigate this transformation

22 EXPRESS HEALTHCARE November 2023

This inclusive culture fosters innovation, enhances patient care, and strengthens our organisation. To truly bridge the gender gap, we must actively address unconscious bias, provide mentorship opportunities, and promote networking and career development for women in healthcare.

while keeping patient-centred care at the forefront.

Moreover, having more women in leadership roles serves as an inspiration for future generations, ensuring a continuous influx of talented women leaders who can drive innovation and excellence in healthcare.

What is the key role that women leaders contribute to driving progress and innovation in the healthcare sector?

Women leaders in healthcare have a unique perspective as they are often the primary decision-makers and caregivers in their families.

This perspective translates

into innovative approaches to healthcare delivery and patient experience. In an era of rapid technological advancements, women leaders excel in areas critical to the healthcare industry, such as telemedicine, digital health, and patient engagement. Their diverse backgrounds and experiences contribute to a more comprehensive and holistic approach to healthcare innovation, ultimately benefiting patients and organisations alike.

Share your perspective on the essential role of diversity and inclusion in the

healthcare industry, emphasising its significance beyond just numerical representation.

The stark reality in the healthcare sector is that the majority of the workforce is comprised of women, yet there is a glaring underrepresentation of women in leadership roles compared to other industries. True diversity and inclusion go beyond just achieving numerical parity.

It's about creating an environment where every individual, regardless of gender, feels valued, respected, and empowered to contribute their unique perspectives and talents.

What factors contribute to the underrepresentation of women leaders in the healthcare industry, and what strategies can be employed to rectify this imbalance?

The scarcity of women leaders in healthcare can be attributed to various factors, including a lack of mentors and mentorship opportunities, limited networking opportunities, challenges in balancing work and home life, and persistent gender bias. To address this disparity, we must implement proactive measures. Mentorship programs should be established to connect aspiring female leaders with experienced mentors who can provide guidance and support.

Creating a culture of networking and professional development, both within and outside the organisation, can help women build the connections necessary for career advancement.

Additionally, addressing gender bias through awareness campaigns, training, and policy changes is crucial to creating a level playing field for women in healthcare leadership roles.

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

START-UP

Nurturing healthtech innovation: Guide to attracting patient capital Nihar Parikh, Founder, 4point0 Health Ventures share some insights on how healthtech startups can effectively position themselves to attract patient capital

I

n India’s rapidly evolving healthcare technology landscape, we are seeing startups at the forefront of innovation, pioneering solutions to address crucial healthcare challenges and improve accessibility. However, turning an innovation into reality often hinges on securing patient capital - funding that understands and supports the unique journey of healthcare innovation.

The pandemic has improved awareness around the importance of health, resulting in increased utilisation of digital health services and driving the growth of our healthtech sector. In fact, in India, 2022 was the second-highest year of health-tech funding in the past decade, trailing only behind 2021. Let's break down some insights into how healthtech startups can effectively position themselves to attract patient capital.Build strong strategic alliances India’s healthcare landscape is incredibly complex and involves many stakeholders.

Thus, startups need to be able to navigate this intricate ecosystem and engage with all stakeholders involved. You should be able to approach the problems you aim to solve from various perspectives, including those of patients, clinicians, and regulatory authorities. Engaging with these players can provide valuable insights, validation, and potential partnerships that enhance your startup’s appeal. What’s more, understanding India’s healthcare regulations is crucial to develop a comprehensive regulatory strategy and ensure your product aligns with all necessary standards. Embrace the long game Building anything in healthcare takes time and patient capital investors are looking for

India’s healthcare landscape is incredibly complex and involves many stakeholders.Thus, startups need to be able to navigate this intricate ecosystem and engage with all stakeholders involved startups with a long-term vision. Prove that you are committed to solving significant healthcare challenges, not just looking for quick wins. This might involve addressing

chronic conditions, improving healthcare infrastructure, or advancing precision medicine.

Investors also want to see the potential for significant impact so show that your solution is

scalable and has the capability to reach a broad patient population or address multiple healthcare settings. Prove your worth with clinical validation It's important to showcase

evidence that your product works in the real world. Focus on well-conducted clinical trials and real-world data to demonstrate your solution's effectiveness. A great way to do this is to collaborate with healthcare providers and academic institutions to conduct meaningful studies that highlight the impact of your solution on patient outcomes. It will also help you emphasise a more patient-centric approach and highlight how your technology improves the patient experience and overall quality of care.Decode the market Demonstrate a deep understanding of India’s healthcare market and its unique nuances.

This will empower you to explain how your solution addresses unmet needs or improves existing processes within the healthcare ecosystem. It’s also beneficial to keep in mind that investors often look for experienced and capable leadership teams. Highlight the expertise of your founders and key team members, especially if they have a track record of success in healthcare or startups. Data security and privacy Given the sensitivity of healthcare data, prioritise robust data security and privacy measures. These solutions will provide reassurance that patient data is handled with the utmost care and compliance with all relevant regulations.

Securing patient capital is not just about securing funding; it's about finding partners who share your vision for transforming healthcare. By building a solid foundation through clinical validation, regulatory compliance, and strong relationships with stakeholders, you will be better positioned to thrive in the dynamic world of healthtech innovation.

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POLICY

Health diplomacy: Role of international healthcare partnerships in global relations Dr Nitish Shetty, Group Chief Executive Officer, Aster DM Healthcare India emphasises that health diplomacy, an evolving facet of international relations, has been instrumental in cultivating stronger global bonds, addressing the challenges of our time, and creating a robust global healthcare ecosystem

I

n the complex tapestry of international relations, diplomacy has long been a cornerstone of fostering cooperation, respecting economic and cultural nuances, and eventually joining hands for mutual progress. While traditional diplomacy typically revolves around politics, economics, and security, a new paradigm is emerging— one that revolves around healthcare. Health diplomacy, an evolving facet of international relations, has been instrumental in cultivating stronger global bonds, addressing the challenges of our time, and creating a robust global healthcare ecosystem. Although exchanges of health competitiveness have happened before, it was only in 2020-2021 that India with its exemplary gifting of vaccines to countries in need made the world realise the significance of health diplomacy thus reshaping global relations.

The role of healthcare diplomacy in global relations Health diplomacy is an extraordinary tool that transcends borders, as it emphasises international collaborations in the fight against common health issues. One of the most compelling instances of health diplomacy in recent history is the global response to the COVID-19 pandemic. The pandemic thrust the world into uncharted waters, demanding rapid, coordinated action. As nations grappled with the virus's devastating impact, the role of healthcare diplomacy came to the forefront.

24 EXPRESS HEALTHCARE November 2023

India's remarkable contribution: COVID-19 vaccine diplomacy The world looked on as India, known as the "Pharmacy of the World," launched a momentous initiative that would not only shape the global healthcare narrative but also establish an exemplar for health diplomacy.

India embarked on a mission to provide millions of COVID-19 vaccine doses to other countries, not only fulfilling their vaccine requirements but also solidifying diplomatic ties. This initiative was not just about healthcare; it was a gesture of solidarity, trust, and shared responsibility.

In the two years since the initiation of India's COVID-19 vaccination program, more than 220 crore doses of COVID-19 vaccines have been administered domestically, with an additional 29 crore doses exported. This remarkable performance has earned India's vaccination program a triple-A rating in the realm of health diplomacy, akin to the highest credit rating in financial markets. This triple-A rating, underpinned by the Availability, Access, and Affordability of vaccines, symbolises India's exemplary efforts in making vaccines available, accessible, and affordable for its population and beyond.

Through vaccine diplomacy, India distributed COVID-19 vaccines to numerous nations, ensuring that no one was left behind in the fight against the pandemic. This act of benevolence underlined the essence of health diplomacy-utilising medical solutions to foster international relations. As countries around the world raced to inoculate their populations, India's vaccine diplomacy became a

healthcare supply chain.

Championing the fight against Noncommunicable Diseases (NCDs)

symbol of hope and cooperation, setting the tone for future epidemics and international healthcare collaborations.

Empowering domestic medical device manufacturers In the arena of healthcare diplomacy, vaccines are undoubtedly a powerful tool. However, the medical device sector is another burgeoning frontier, with immense potential to transform global relations. India, in particular, has been making significant strides in medical device manufacturing. From advanced robotic machines to cuttingedge equipment, Indian manufacturers are stepping up to challenge global players.

International medical device manufacturers too are eyeing India to set-up plants. Very recently, a south Asian manufacturer announced a substantial investment of $15.5 million to set up a medical device manufacturing plant in Tamil Nadu.

This move signifies the growing confidence in India's manufacturing capabilities and further strengthens healthcare diplomacy. By fostering such investments, India is not only addressing the needs of its domestic healthcare sector but is also contributing to the global

NCDs represent a significant global health challenge, responsible for a staggering 41 million deaths annually. Among these NCDs, cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes stand out as major contributors. As nations grapple with this silent pandemic of NCDs, it becomes evident that tackling these health issues necessitates international collaboration and health diplomacy.

Efforts to combat NCDs are not limited to medical treatments; they encompass the implementation of global health policies that prioritise lifestyle modifications, early detection, and comprehensive healthcare systems. Health diplomacy plays an instrumental role in this process by facilitating the exchange of information, best practices, and resources among nations. It encourages the collective adoption of preventive measures, health promotion, and the development of innovative therapies to mitigate the NCD burden.

Bolstering medical value travel The Indian soft power strategy through health diplomacy received tremendous positive responses world over especially from countries in Africa. With the government launching the ‘Heal in India’ campaign these diplomatic efforts will start paying off rewards through the one-stop website for international patients. That India is as competitive as any developed nation and has an advanced

medical tech power has been proven, now, an active health diplomacy will help India position itself as the leading healthcare destination and a global soft power.

Conclusion: Shaping a global healthcare ecosystem Health diplomacy has emerged as a beacon of hope in the realm of international relations.

COVID-19 vaccine diplomacy, Indian medical device manufacturing, and the fight against NCDs represent critical fronts in this ever-evolving paradigm.

By fostering international collaborations and sharing medical solutions, nations are not only addressing global health challenges but also forging stronger bonds of cooperation and trust.

In the post-pandemic world, the importance of health diplomacy has been firmly established. As nations look to the future, they must recognise the interdependence of healthcare on a global scale. The roadmap for international healthcare partnerships is being redrawn, paving the way for a resilient global healthcare ecosystem, where nations unite, share knowledge, and stand together in the face of adversity.

Health diplomacy is not just a tool; it is a testament to the collective strength of humanity.

It underscores the idea that when nations collaborate on matters of health, they are not merely safeguarding their own interests but the well-being of the entire world. As we look ahead, we can be certain that health diplomacy will continue to play a pivotal role in building a healthier and more interconnected world.

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HEALTHCARE TRACKER I N T E R V I E W

The roadmap to strengthen India’s public healthcare infrastructure Rajat Ghai, Business Head-Government, Wipro GE Healthcare in an interaction with Express Healthcare emphasises that for a country like India, where the demand and supply gap is alarming, PPPs are imperative to address the challenge Public Private Partnerships (PPPs) in healthcare have become an effective model for improving healthcare access.

Could you discuss the critical success factors and challenges in forming and sustaining PPPs, especially in the medtech sector?

The pandemic acted as a catalyst for collaborations in the healthcare sector. For a country like India, where the demand and supply gap is alarming, PPPs are imperative to address the challenge.

According to reports, “Whereas most countries in South Asia Region saw a sharp drop in PPI compared to 2020, India saw a 49 per cent increase in private investment commitments.”1 The collaboration between government bodies and private entities is capable of strengthening public health infrastructure, solving for the diametrically opposite healthcare experience between rural and urban India. Now, let’s understand critical success factors for PPPs. The two most fundamental pillars which stand out are viability of the project and the availability of adequate working capital.

Viability of the project is determined amongst many factors primarily by footfalls of the centre and in turn its ability to generate adequate ROI for an investment. Timely reimbursement is equally critical to ensure adequate working capital in the system.

By virtue of having affordable pricing in and around CGHS rates, PPP centres attract patients from govt. Institutions as well as outside private footfalls, thereby ensuring higher utilisations as compared

30 EXPRESS HEALTHCARE November 2023

financing solutions and affordable healthcare technology options. Our ongoing research and development efforts and localization strategies are aimed at enhancing the affordability and accessibility of our equipment within the PPP framework.

Wipro GE Healthcare has the highest installed base under PPP in India, with ~350 equipment. We have a partnership with more than 30 service providers across 22 states in collaboration with various state governments, spanning different facets of cardiology and oncology. These are partnerships built across multiple tiers of the healthcare system— from creating access at more than 225 district hospitals with 16-slice CT scanners and 1.5T MRI going all up to large medical colleges totaling more than 50 across India, with advanced equipment like 3 Tesla MRIs and 128-slice / 512 slices Spectral CT scanners and also 128 slice Cardiac PET CT. There is also a growing trend of oncology PPPs in states like Tamil Nadu, Odisha, Rajasthan, etc. and cardiology PPP in Haryana. We have collaborated with more than 200 hospitals, handling an impressive average of 10 cases per minute on our PPP installed base.

The Government e-marketplace (GeM) has been a transformative force in public procurement, particularly in healthcare, benefiting both government and private entities to private.

At Wipro GE Healthcare, we

continually support the viability of PPPs through

adequate due diligence prior to investment decision, providing

With many states showing a growing focus on healthcare, how has GE HealthCare adapted to cater to regionspecific needs and preferences in the healthcare sector? What are the notable state-level initiatives that have made a significant impact?

We recognise that healthcare infrastructure comprises a three-tier structure comprising screening centresPHC/ CHC, district hospitals, and medical colleges. Each level has distinct needs, and our collaboration with clinical experts helps us determine the right technology. For instance, research-oriented medical colleges may demand high-end equipment like a 256-slice CT machine or a 3-Tesla MRI. In contrast, screening centres might only require basic diagnostics such as ECGs, Xrays, and pathology tests. We tailor our equipment offerings to suit each level of healthcare delivery.

We have dedicated teams with a state-centric focus.

Each state has its dedicated account manager, showcasing our commitment to catering to the unique needs of that region. We aim to align with the state's requirements, particularly within the realm of diagnostics, our expertise.

Case in point – our collaborated efforts with the Assam government and National Health Mission, with each of the 28 districts equipped with a 16-slice CT machine connected to a hub in Guwahati to ensure best clinical reporting. This is a great example of provision of decentralized healthcare while centralising reporting/ quality via digital solutions to ensure best possible delivery outcomes. Additionally, we introduced South Asia's first Digital PET MRI machine in Assam, signifying our

dedication to advancing healthcare solutions in the region.

Another example would be state of Kerala which is a leading state in terms of healthcare outcomes, health Clinical & nonclinical resources and technology infrastructure which means that even for the large District hospitals state has gone ahead with advanced facilities like Cardiac catheterisation labs and high end 1.5 Tesla MRI to give equitable and distributed high end services to the entire populace of Kerala.

High end diagnostics technology adoption, as mentioned above, augments the in-hospital service delivery technologies like ventilators, anesthesia, C-PAP/ Bi PAP, ECH, monitoring, ultrasounds and color doppler, infant care via warmers, phototherapy units etc. which OEMs like us are partnering with Pan India procurement advisors like HITES in addition to regular state procurement corporations.

The Government emarketplace (GeM) has emerged as a transformative platform for public procurement. How has GE HealthCare leveraged GeM to make its products and services more accessible to government and private entities? What benefits has GeM brought to the healthcare ecosystem in India?

The Government e-marketplace (GeM) has been

a transformative force in public procurement, particularly in healthcare, benefiting both government and private entities. GeM has brought much-needed transparency and speed to the procurement process, significantly improving the acquisition of essential medical equipment.

In the past, the procurement of radiology machines, for instance, could extend over two years. GeM tenders typically come with validity of 180 days, and they are streamlining decision-making process, offering a more efficient and timely procurement experience. Furthermore, GeM's features, such as the introduction of a reverse auction, have been instrumental in simplifying the procurement process, eliminating the need for faceto-face negotiations, further enhancing efficiency, and ensuring a smooth and transparent transaction. In fact, GeM weeded out several sellers after it was established through the scrutiny of shareholding pattern of the entities that they were from China.

In a move signaling widespread adoption, central government entities, including the Armed forces have also transitioned to GeM, moving away from their individual procurement portals. As part of GE HealthCare’s commitment to align with GeM, most of our products are now listed on the platform.

This listing ensures that users from any corner of the country

can easily access the website, review product features, and place orders, creating a seamless procurement experience.

However, there are still areas where improvements can be made. GeM currently exclusively accepts bids in INR, which poses challenges for high-end imported equipment priced in dollars, specifically for multiyear execution of large orders where suppliers are exposed to exchange rate movements. To further enhance GeM's effectiveness, allowing dollar currency bids could be a valuable improvement, particularly in the healthcare sector.

How does GE HealthCare align its strategy to support the vision of Atmanirbhar Bharat? What steps are needed to strengthen the onground delivery of the vision?

Pioneers in localization for decades, Wipro GE Healthcare is the one of the first companies to design and 'Make in India' advanced medical technologies - for India and the world. This initiative benefits India and extends our global reach, with more than 30 products developed in collaboration with our global network and distributed in over 70 countries. We have four manufacturing sites, including joint ventures with Wipro and Bharat Electronics Limited.

Additionally, we have a vast service workforce of over 900 professionals, with 80% of them deployed in Tier 2-3 cities. John F. Welch

Technology Center (JFWTC) in Bengaluru has been at the forefront of healthcare technology R&D in India for over three decades, with more than 1100 patents filed.

Furthermore, we have also launched our first '5G Innovation Lab' in Bengaluru.

We recently introduced our 'Made in India,' AI-powered' Cath lab-Optima IGS 320 to advance cardiac care in the country. This was following introduction of AI based 128 slice Cardiac CT scan, 3 ring Discovery IQ PET CT scanners which were all ‘Local for Global’ products.

We have been a vocal advocator for Make in India and have led the industry in terms of proactive investment followed by further investments in PLI. It is encouraging to see some healthcare procurement being done on MII (Make in India) mode for some categories like 16 slice CT, 64 slice CT scans etc. We are continually nurturing the next wave of localization in high-end technologies across Radiology, Cardiology, Oncology & critical care while doubling down on AI based & Digital offerings.

It would be encouraging to see more such product categories being identified and embarked for preferential buying for, in public procurement across cancer care, radiology, and cardiology.

Reference 1. https://ppi.worldbank.org/ content/dam/PPI/documents/ PPI-2021-Annual-Report.pdf

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HEALTHCARE TRACKER

The DxA5000 Fit workflow automation system: Smaller footprint,big impact Karan Bhatia, Head-Marketing (South West Asia) highlights Beckman Coulter's strong belief that medium-sized labs and hospital labs should be able to leverage the benefits of automation to address their challenges.This is why the company has launched the DxA5000 Fit - the first compact workflow automation solution that's the right fit for mid- volume labs -- because all labs should benefit from automation

D

iagnostics laboratories are living through unprecedented times with a continuous increase in testing and the need to create greater workflow efficiencies.

As expectations on maintaining low turnaround times and error-free reporting increase, labs are also confronted with financial pressures, space constraints and a shortage of laboratory technicians. They also need to make the best use of their lab professionals’ time. To solve for these challenges, lab managers are driven to upgrade their labs with Total Lab Automation (TLA) Systems. While these TLA Systems are needed by labs of different sizes, they are only considered by large labs processing high sample volumes. Often mid-volume labs are unable to take advantage of TLA due to space requirements and infrastructure constraints.

scientific tasks they are trained for. For large laboratories, TLA is a reality today.

However, for medium-volume labs that process fewer than 4,000 tests per day, comprehensive workflow-automation solutions haven't been an option.

Focus on what matters with the DxA 5000 Fit workflow automation system Beckman Coulter’s latest automation solution – the DxA 5000 Fit not only drives lab workflow automation and secures high-quality results through patented innovation, but also offers the flexibility to accommodate growing lab workloads as the lab expands.

Automation for all In a global survey, lab directors and managers were asked to identify the key challenges that hospital labs face. The results found that staffing (26 per cent) and turnaround time (23 per cent) were identified as top priorities1. What they also needed was a compact automation system, balancing between system throughput capacity, test menu and footprint of the system that reduced the number of workflow steps while minimising human intervention.

Their goal was to generate a valid result at first pass so that lab professionals are not moving samples around, but performing the valuable

32 EXPRESS HEALTHCARE November 2023

With the integration of REMISOL Advance and the DxA 5000 Fit, laboratories gain total workflow control, intelligent sample routing, waste prevention and access to future developments in REMISOL middleware technology

With the DxA 5000 Fit, midsized labs can enjoy the same benefits as larger-volume labs: ◆ Comprehensive workflow automation to reduce up to 80 per cent of the manual steps associated with processing a patient sample ◆ When up to 75 per cent of lab errors occur pre-analytically, all laboratories could benefit from comprehensive workflow automation offered by the DxA 5000 Fit ◆ Intelligent routing with dynamically calculated route planning for rapid and consistent TAT, with STAT samples always prioritised to deliver high-priority test results faster ◆ Flexible design that can be customised and adapted to meet a mid-volume lab's space and infrastructure constraints ◆ Increased flexibility with

an integrated input/output module which can be combined with a centrifuge—connected to up to four instruments across Clinical Chemistry, Immunoassay, Hematology and Coagulation.

In fact, these disciplines can be mixed in any type of configurations as long as the total instrument connections does not exceed four

Synchronising middleware with TLA Beckman Coulter’s REMISOL Advance Clinical IT Middleware offers a centralised connection of instruments to the LIS and allows for the continuous exchange of information between the middleware system and instrumentation serving as a hub for results review and data management.

This drives quality in results reporting, as well as operational efficiency and process standardisation across all shifts and sites and helps minimise operational costs. With the integration of REMISOL Advance and the DxA 5000 Fit, laboratories gain total workflow control, intelligent sample routing, waste prevention and access to future developments in REMISOL middleware technology.

The DxA5000 Fit and REMISOL Advance give the lab manager control on the sample flow as well as information flow across the lab.

References: 1. National Health System Crisis Readiness Report 2020 Edition. Accumen. August 27, 2020. https://ACCUMEN.com/crisisreport-2020 [Accessed October 6, 2020]

HEALTHCARE TRACKER

Beyond the microscope: Flow cytometry in clinical settings and addressing hidden challenges for its implementation in hospitals Vikram Patil, Deputy Product Manager-Flow Cytometry, Sysmex explains the role of flow cytometry in modern healthcare and highlights the hidden challenges for its implementation in hospitals

I

n the field of modern healthcare, flow cytometry plays a crucial role in clinical diagnosis. Flow cytometry, at its core, is a technique that allows for the measurement of multiple characteristics of individual cells or particles as they flow through a laser beam. This technology uses the principles of optics, fluid dynamics, and immunology to provide detailed insights into cellular composition.

In hemato-oncology, flow cytometry serves as an irreplaceable tool for the diagnosis and monitoring of blood disorders like leukemia and lymphoma. It enables the classification of hematological malignancies, helping clinicians tailor treatment strategies for patients. Additionally, flow cytometry plays a crucial role in assessing minimal residual disease (MRD), a factor that directly impacts the prognosis and treatment decisions for patients in remission.

Beyond hemato-oncology, flow cytometry is an essential asset in the field of transplantation. It facilitates the crossmatching of donor and recipient tissues, ensuring compatibility and minimising the risk of graft rejection.

CD4 cell counting is another application where flow cytometry is irreplaceable. In patients with HIV/AIDS, monitoring CD4 counts is essential in evaluating the progression of the disease and guiding antiretroviral therapy. Accurate CD4 cell counts are required for assessing immune status and predicting the risk of opportunistic infections, making flow cytometry an essential component of HIV care.

Flow cytometry is essential for quantifying hematopoietic

stem cells, a crucial component in bone marrow and stem cell transplants, which is essential to ensure successful engraftment and reconstitution of the patient's immune system.

Extending even further, it is also used in immunology research, cancer immunotherapy development, and pharmaceutical drug discovery. I Pain points of flow cytometry: ◆ Despite the numerous benefits, this technique is not without its challenges. Firstly, the cost of equipment and reagents can be prohibitive, particularly for smaller healthcare facilities. ◆ Flow cytometers are complex instruments, and their maintenance and operation require specialised training. ◆ Interpretation of flow cytometry data requires skilled professionals who understand immunophenotyping. ◆ Inaccurate sample preparation can lead to misinterpretation of results and unreliable data. Proper handling and labeling of samples are essential to avoid false-positive or falsenegative results.

Factors affecting flow cytometry assays: ◆ Sample quality - contaminated or degraded samples can lead to unreliable results. ◆ Instrument calibration and standardisation are of paramount importance to ensure reproducible results. Variability in instrument performance can lead to reduced reproducibility. ◆ Choice of fluorochromes, antibodies & clones is another critical consideration. Selecting the appropriate combinations that target specific markers of interest while minimising

spectral overlap is essential.

These challenges - high costs, the need for specialised training, experiment designing, sample preparation, instrument maintenance, data interpretation skills cannot be underestimated. It is essential for healthcare institutions and research laboratories to invest in the necessary resources, training, and quality control measures to harness the full potential of this technology. The

significance of flow cytometry continues to grow, and as we address these pain points and optimise its applications.

Sysmex’s XF-1600 Flow cytometer offers a comprehensive package that can address some of the pain points associated with flow cytometry. ◆ Its fluidic system is built on the proven XN series hematology analyzers which provides stability and precise beadles cell counting. This ensures the instrument maintains consistent fluidics performance, reducing the risk of fluctuations in results due to fluidic issues, a common pain point in flow cytometry. ◆ With a maximum acquisition speed of 50,000 cells per second, the XF-1600 stands as the fastest analyser on the market.

This speed is vital, especially when dealing with large sample populations for rare event detections. It addresses the pain point of slow data acquisition. ◆ The instrument's ability to perform an automated background check during start-up, without running any sample or

QC material, reduces the risk of errors in data analysis, which can arise when background noise is not adequately accounted for. ◆ The XF-1600 comes equipped with an in-built autoloader which reduces manual labor and minimises the risk of human error during the loading process. The autoloader addresses one of the pain points in flow cytometry, which is sample handling efficiency. ◆ The Venturi One is a powerful data analysis software package with the ability to merge up to ten FCS files, each containing up to 5,000,000 events, is essential for applications such as minimal residual disease (MRD) detection. This allows clinicians to work with larger data files efficiently without any software lag. This addresses the pain point of investing in expensive third-party software. ◆ XF-1600's can be integrated with Sysmex’s cell washer centrifuge which automates the cell washing steps (centrifugation, decanting & resuspension of cells). This takes care of any manual errors & sample degradation due to incorrect handling.

In summary, the XF-1600 instrument model incorporates a range of features that directly address some of the key pain points associated with flow cytometry. From ensuring stability and precision in fluidics to addressing issues related to data acquisition speed, sample handling, background checks, powerful data analysis, and compatibility with other essential equipment, this instrument is designed to enhance the accuracy, efficiency, and ease of use of flow cytometry in hospitals.

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This comprehensive approach ensures that no aspect of healthcare delivery is compromised due to inadequate or outdated equipment.

With access to cutting-edge equipment, healthcare facilities can offer wider range of services and deliver more ac-

curate diagnoses and treatments. Patients will too benefit from quicker and more precise medical interventions, leading to improved health outcomes & modern medical equipment often comes with advanced features that can streamline clinical workflows.

This not only reduces the time required for various procedures but also minimises the chances of errors, ultimately

leading to greater efficiency and productivity.

Medikabazaar's "Freedom" is more than just a financing product; it's a game-changer for healthcare providers. With its exceptionally low interest rates, the flexibility to secure up to 10 crores, and the inclusivity of all medical equipment, Freedom empowers healthcare facilities to raise the standard of patient care and operational efficiency. In a rapidly evolving healthcare industry, "Freedom" is the catalyst that enables medical institutions to remain at the forefront of medical innovation while safeguarding their financial stability.

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34 EXPRESS HEALTHCARE November 2023

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Simply delivers.

Perform simple, safe, high-quality CT exams with consistent clinical outcomes As radiology departments around the world find themselves increasingly pushed to their limits, they need a CT scanner that delivers low dose, consistent results and fast throughput that leaves more time for patient care.

With workflow features that deliver simplified patient positioning, automatic scan planning and AI-enabled solutions, Aquilion Serve meets these needs.

https://global.medical.canon/

©Canon Medical Systems Corporation 2023. All rights reserved.

Please contact your local sales representative to learn more.

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