VOL.7 NO.7 PAGES 116
Strategy The Great Indian Healthcare Factories: Dr Lal PathLabs IT@Healthcare Deploying digital technology LIFE Conquering the summit
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SHL - The Global Telemedicine Provider Now in India Bringing India to the Heart of Cardiac Care The leading provider of technologically advanced telemedicine services, SHL Telemedicine with over 25 years of international successful services is now making India take a leap in cardiac telemedicine, giving people a brighter chance at life, providing patients the experience and the advantage that over 1,000,000 users across the world have! With operations in Israel, Europe and the USA, SHL is now setting base in Delhi and engaging in strategic collaborations with leading hospitals in major Indian metros. Shortly Indians in Mumbai, Delhi, Bangalore, Kochi and Kolkata, with other cities to follow, will benefit from SHL's advanced telemedicine services. SHL brings a remote cardiac care solution that helps people monitor their condition and receive immediate care when potentially fatal cardiac episodes occur, reducing response time in case of emergency. This subscription-based service stands on the pillars of comfort, peace of mind and security as expert help is a call away, where an ambulance may take over 2 hours to reach. The service is a brainchild of SHL, a 25 year old pioneering Company that has introduced new technological solutions in personal telemedicine systems focusing primarily on cardiac disease management. Successfully deployed across Israeli, European and US markets, the service is reaching wherever the user may be, and its next post is India.
What is the SHL Telemedicine Service all about?
Who is it for?
SHL Telemedicine Serviceis a solution that offers centralised remote monitoring services to subscribers. It merges sophisticated customer care systems, advanced telemedicine consumer devices, and specially designed medical data protocols, into a complete and interconnected service platform that works seamlessly to provide help in the moment of need.
SHL Remote Cardiac Care is for anyone who wants to improve chances of survival from a heart attack, change life habits and gain from a sense of being embraced by a professional medical service anytime, anywhere.
Why is it here in India? It has been proven that the probability of surviving in the first year after a heart attack is more than double for SHL users than for the average person1. SHL is committed to replicate this success story for India, where an increase in life expectancy and lifestyle has brought to an increasing number of people living with chronic heart conditions. There is an increased awareness of the dangers of heart attacks and a demand for solutions that enable better care. CVD is the most significant healthcare problem of 21st century India and this is an evolutionary step to allow people to receive remote medical care and peace of mind that their hearts are always monitored.
How does it work? SHL Telemedicine Service provides immediate real time remote review and evaluation of possible arrhythmia, ischemia, and myocardial infarction conditions to its subscribers and provides immediate and relevant medical attention at any given moment. SHL introduces several advanced components that work in harmony to provide a holistic Remote Cardiac Care solution: Advanced personal 12-lead ECG mobile devices: Proprietary Cellular-digital 12-lead ECG devices for personal use enable the subscriber to transmit a full 12-lead electro cardiogram in less than a minute. Results are analysed in real time, saving critical time during admission and ensuring rapid diagnosis and treatment.
Subscribers to the SHL Remote Cardiac Care worldwide report immediate reduction in their day to day concerns regarding their general health and specific cardiac conditions. They enjoy a better life style knowing that immediate assistance is near, in the case of a suspected cardiac event. Bonded in tough times, subscribers to the service become long term subscribers, enabling the development of a prolonged relationship between the subscriber, SHL and the hospital.
SHL in India True to the tradition of bringing excellence in healthcare across countries, SHL has been studying India for more than one and half years to help define its approach to Indian hospitals and patients. It is now in the process of establishing operations in Delhi, recruiting local medical professionals and key employees. SHL has forged alliances with leading hospitals in major metros, to help provide its novel and state-of-the-art remote monitoring service, and deliver an enhanced cardiac practice offering. By expanding the hospital's basket of services, it aims to add value to their relationships with their cardiac patients and customers outside the hospital. The alliances can also provide a new revenue stream for the partnering hospital.
Give your patients a stronger chance at life Mahatma Gandhi once said, “It is health that is real wealth and not pieces of gold and silver.” Little wonder then, that the critical one-hour from the onset of a heart attack is called the 'golden hour' – a period worth more than its weight in gold. The patient's chances of survival are greatest if given prompt medical treatment during the hour. Hundreds of thousands of SHL subscribers over the years provide solid evidence that SHL's cardiac telemedicine services are saving lives and improving quality of life. Your patients can now be among them too.
Partner us in heralding a reliable and effective way to help your patients lead a better life.
About SHL Medical monitoring centres: At the heart of SHL's service offering, are its medical call centres – operating 24 X 7 X 365, and staffed by medical professionals, trained extensively in telemedicine. They provide SHL subscribers with real time remote evaluation of the transmitted medical data and provide immediate and relevant medical care. Electronic Personal Medical Record: Subscriber's personal data, relevant medical history and real-time information on the current medical condition can be accessed online via secured web access within seconds by the subscriber and every medical professional if authorised.
1
A clinical study (Source: The Israeli Heart Society (ACSIS), April 2007) - published by tmj, VOL 15 No. 1, Jan 2009, 24
Listed on the Swiss Stock Exchange (Zurich), SHL is a market leader in cardiac telemedicine with unique and highly advanced IT platforms. It has provided telemedicine service for over 25 years in three continents to hundreds of thousands of patients; through its 24/7 medical call centres in Düsseldorf and in Tel Aviv. www.shl-telemedicine.com
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INSIGHT INTO THE BUSINESS OF HEALTHCARE
VOL 7. NO 7, JULY 2013
Chairman of the Board Viveck Goenka Editor
Strategy
Market
Viveka Roychowdhury* Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Delhi Shalini Gupta
The Great Indian Healthcare Factories: MARKETING
Dr Lal PathLabs ................................40
Deputy General Manager Harit Mohanty
Knowledge
Assistant Manager Kunal Gaurav
Genetic testing of breast cancer: The
PRODUCTION General Manager
widening horizon ..44
B R Tipnis
‘SPMF therapy has a
Manager
potential to become
Bhadresh Valia
first line of
Asst. Manager - Scheduling &
management for
Coordination
cancer patients’................................46
Arvind Mane Photo Editor
‘We aim to set standards for
Sandeep Patil
infusion care’ ..................................47
Hospital Infra
DESIGN Deputy Art Director
Page 11
Surajit Patro Chief Designer Pravin Temble
Investors conceive winning cycle in IVF market ............................................16
Senior Graphic Designer
Cancer survivor’s 100th birthday ..................................................................18
Rushikesh Konka
Abbott receives Golden Peacock Award ........................................................20
Layout
Axio Biosolutions receives CE mark for emergency haemostat ......................22
Vivek Chitrakar
ILS Hospitals launches its third hospital in Kolkata........................................24
CIRCULATION
‘It is necessary to design each and every system and process keeping the
Circulation Team
customer at the helm’ ..................................................................................24
Paints: Coming of age in
Mohan Varadkar
Does adulteration mean different things in different countries? ......................26
healthcare infra ................................50
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Editorial
Dealing with disaster s the country's armed forces deal with the evacuation of pilgrims and residents of Uttarakhand's flood ravaged districts, their comrades-in-arms from the Armed Forces Medical Services (AFMS) are already seeing the first signs of an impending public health crisis. While the first priority was rightly given to the evacuation of survivors, the delay in clearing bodies of flood victims from water sources has had a devastating consequence: contamination of springs used for drinking water purposes. Medical teams at various sites are already reporting that signs of gastrointestinal infections (fever, diarrhoea, nausea), even among the Indo-Tibetan Border Police (ITBP) personnel were on the rise by June 28. This is but one of the hard lessons we are left with as we grapple with the aftermath of arguably the worst natural disaster of recent times. As teams of doctors, nurses and paramedics help out in the flood-ravaged areas, they are bound to return with suggestions of what public health infrastructure can be put in place in these areas to prevent or at least lessen the toll in future. First on the list will probably be a better communication network between the various groups involved in disaster relief: be it the government, the military or volunteers ranging from hospitals, NGOs, etc. For instance, though hospitals based in the region were only too willing to provide medicines, first aid kits as well as doctors to help out with the relief work, there were media reports that medical personnel were left cooling their heels in Dehradun, far from the affected areas. The flip side of this criticism, of course, is that with limited means of transport, the state government’s strategy was to bring patients to the doctor rather than the reverse. Which makes sense because these cities were anyway better equipped to be the treatment base for the influx of patients. Maybe these reports reflected a temporary impasse and the government, with help from the armed forces, were ultimately able to iron out the logistic kinks. But, delays during disasters of this scale cost lives and on a larger scale, deepen the public health crisis by the day. Both the centre and individual states are reportedly revamping their disaster management plans and one hopes that hospital managements will be consulted for their expertise in emergency medicine and trauma care. Of course, implementing these plans will require intense public scrutiny and media oversight to translate plans from paper to reality faster. The truly sad part of this tragedy is that it is bound to recur; not just in the ecologically fragile Uttarakhand region, but in other regions as well. Disasters come in various shapes: tsunamis, earthquakes, as well as more new age threats like radiation leaks and chemical/biological warfare. Express Healthcare has covered the efforts of some state governments to roll out centralised emergency medical response services, like the Mumbai Emergency Management Exercise (MEMEX) and the Chennai Emergency Management Exercise (CEMEX). These have evolved into good examples of synergies between the state and the corporate sector. (See story: Defence Against Disasters, Express Healthcare, February 2012:
A
What's required is to strengthen the public-private partnership (PPP) efforts on the disaster management front and scale them up to the national level
http://healthcare.financialexpress.com/201202/criticalcare01.shtml)
What's required is to strengthen these public-private partnership (PPP) efforts and scale them up to the national level. Express Healthcare will be collating a detailed analysis of the learnings from this disaster in an forthcoming issue and we invite comments and suggestions from our readers. As the politicians continue to pass the buck, each state is still counting missing victims and so the demand to label it a national calamity is gaining force. But will India's citizenry allow them to get away with it this time? With elections around the corner, it is time for the electorate – both on the individual as well as corporate front – to take an active part in ensuring that the next time Mother Nature vents her fury, we at least have the infrastructure in place to limp back to normal. Viveka Roychowdhury viveka.r@expressindia.com
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Letters QUOTE UNQUOTE
“We have introduced a new scheme for more care and comfort to pregnant women in the country under which the government will take care of her treatment, diagnosis, transport and food at least six to seven months before the delivery and will also cover the new born against all diseases for one year�
Kudos for good work Excellent article. I compliment the author. (MMR and the race against time, Express Healthcare March 2013) Dr Sandhya Joshi sandhya@armman.org
INSIGHT INTO THE BUSINESS OF HEALTHCARE
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JULY 2013
MARKET UPFRONT CIFF invests $787 mn for eradicating under nutrition Touted as largest single investment to eradicate under-nutrition by a private foundatio he Children's Investment Fund Foundation (CIFF), one of the world's largest philanthropic organisations, will invest $787 million that is expected transform the lives of hundreds of millions of children. The investment marks a shift in international development priorities driven by CIFF, the British Government and the Government of Brazil over the last twelve months, which led to donors securing up to $4.15 billion in new commitments to tackle undernutrition up to 2020, at the Nutrition for Growth high level meeting in London. At the meeting, governments, private sector organisations and civil society organisations also endorsed the Global Nutrition for Growth Compact, which commits parties to scale up their political commitment, increase resources and take urgent action on childhood and maternal under-nutrition. CIFF's $787 million investment is being touted as the largest single investment in the eradication of undernutrition by a private foundation in history. Nutrition is one of CIFF's key priority areas, identified as delivering the greatest large-scale, cost-effective benefit for the world's children. Investments in nutrition also provide benefits in two other priority areas, child survival and educational attainment. Jamie Cooper-Hohn, Co-founder and CEO, CIFF said, "We have seen a historic shift with nutrition taking its place at the heart of the health, education and economic development agendas.The investments will transform the lives of millions of children as well as the economic growth and prosperity of nations." EH News Bureau
JUNE 2013
INSIDE
T
Interview Sanjay Datta, Chief – Underwriting & Claims, ICICI Lombard GIC www.expresshealthcare.in
Pg 24
Opinion Does adulteration mean different things in different countries?
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M|A|R|K|E|T
T The demand for invasive and non-invasive cosmetic procedures within the country is on the rise, be it a tummy tuck, a nose job or a face lift. This comes as a surprise as India, once known to be a conservative nation, has broken the realms of all old guards to become one among the top five most popular destinations in the world for cosmetology procedures. The evolution of cosmetic surgery in India is mainly backed by the changing outlook of the country. Gone are the days when they were known to be just a high class hangover- an option only meant for celebrities or for highly beauty conscious men and women of the affluent class. Today, being conscious about one's looks is in vogue even among the lower rungs of the society, especially the middle class. Men, women and even teenagers are opting for these surgeries to get lucrative jobs, best possible marriage partners and primarily to get rid of any deformity that has a negative impact on their self confidence and self-esteem.
Market watch Changing perspectives of people and increasing demand for cosmetic procedures have turned the cos-
DR MUKUND JAGANNATHAN
DR MOHAN THOMAS
DR ABRAHAM ZACHARIAH
Consultant Cosmetologist Kohinoor Hospital Mumbai
Senior Cosmetic Surgeon, Breach Candy Hospital
Seven Hills Hospital
Opportunities are several. The problem is aggressive marketing which is actually banned by the Medical Council. Also, there are misleading ads, and there are many non qualified people who are advertising impossible cures and solutions
The cosmetology segment in India will have to be monitored as there are many new non-proven procedures being brought into the market by companies who have no approvals for these procedures
With Indians becoming increasingly conscious about their appearance, the cosmetic procedures industry is very soon going to see a healthy increase in the number of people who opt for such procedures
metic procedures sector into a full fledged industry that has been witnessing accelerated growth. Currently, the size of the Indian cosmetic surgery industry is approximately $5.7 billion, as per various research reports. The key drivers for growth are rapid urbanisation, rising economic capacity, changing lifestyle of people, growing awareness of cosmetic procedures and availability of better infrastructure. Non-surgical face lifts, botox treatments, derma fillers, instant teeth brightening, ultrasonic lipolysis, chemical peels, body contouring, abdominoplasties, breast surgeries, nose surgeries, body contouring following bariatric surgeries for massive weight loss; laser hair removal, microdermabrasion, sclerotherapy, breast augmentation, liposuction, nose reshaping, eyelid surgery, and tummy tucks are some of the procedures that have huge demand. India is now looking to further its
reputation in the services sector by targeting the $36 billion global market for cosmetic medical services, or cosmetic surgery, which is growing at over five per cent annually, states an industry report released by IBI Partner, an Asia-focused market research agency. “India is viewed as one of the most progressive countries for cosmetic procedures and this trend is expected to continue in the near future. This is mainly due to the fact that cosmetic procedures has evolved beyond the traditional concept of being a ‘risky' or ‘impractical procedure' that was demanded by women who were overly conscious about their appearance. Today, people in India understand that cosmetic procedures are highly specialised and advanced niche of aesthetic procedures which help people attain happiness with fewer risks and greater affordability,” informs Dr Manjiri Patankar Puranik, Founder, InstaSculpt. “Cosmetic surgery market is a burgeoning segment of the healthcare industry in India. With Indians becoming increasingly conscious about their appearance, as is evident from the way the wellness industry is booming, the cosmetic procedures industry too is very soon going to see a healthy increase in the number of people who opt for such procedures – both for medical purposes as well as otherwise,” feels Dr Abraham
Zachariah, a leading cosmetic surgeon from Seven Hills Hospital. “Today, cosmetology has evolved to a great extent in India. I have clients coming from middle class families who are ready to pay even Rs 5000 per session in order to avail these treatments,” chips in Dr Bindu Sthalekar, Consultant Dermatologist and Cosmetologist, Harkisondas Hospital. Observing the upswing within the cosmetic procedure market, Dr Charu Sharma, Head, Aesthetics and Skin Trainings, VLCC Institute points out, “There has been a notable surge in the Indian cosmetic or aesthetic procedures during the past five years, mainly because of the increasing demand for aesthetic procedures from people in the urban cities of Mumbai, Delhi, Kolkata, Chennai, Bangalore, Pune and Chandigarh.” Some major players in this segment are Kaya, VLCC, Yash Birlaowned Evolve Med Spa, Fortis, Apollo, Max Healthcare. Seeing the potential of the sector more and more cosmetic and aesthetic clinics have sprung up within metros and even in tier-II cities and towns. Many leading hospitals in India have also opened their doors to cosmetology within their hospital set-ups by establishing a separate department for such procedures. The market dynamics of this sector has been carefully studied by many ana-
5.7
$
Bil ion
Currently, the size of the Indian cosmetic surgery industry is approximately $5.7 billion, as per various research reports
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lysts and various reports and surveys conducted indicate that the cosmetic surgery market holds immense growth potential in the coming years. A global survey conducted by the International Society of Aesthetic Plastic Surgery (ISAPS) reveals that India was ranked fourth with 894,700 surgical and nonsurgical cosmetic procedures in 2010, thus accounting for 5.2 per cent of all procedures done worldwide. Comparing the Indian market with its immediate competitors, IBI Partners state that the Indian cosmetology and aesthetic surgery market is now 14 times larger than Thailand’s cosmetic surgery market. RNCOS on the hand estimates that the industry is poised to expand at a CAGR of around 17 per cent between 2013-2015. Kuick Research, a market research company based in Delhi, also observes an upsurge of cosmetic procedures in India. According to a report published by Kuick Research, the cosmetics surgery market is witnessing more than 30 per cent annual growth in recent years.
procedure—Dr Gerald Johnson of Houston.
Tapping medical tourists The influx of medical tourists has also helped the cosmetic surgery market to cash in a lot of profits. In line with a report published by Deloitte, as many as 10 million Americans were seeking medical remedies abroad last year despite the economic slowdown faced by them, and India had its eyes trained on them. Explaining how the
WITH SEVERAL FACTORS WORKING IN FAVOUR OF THE COSMETIC SURGERY SECTOR, INDIA CERTAINLY HAS AN ADVANTAGE OVER ITS COMPETITORS growth of the cosmetology and aesthetic procedures market has brought a positive impact on medical
tourism in India, Dr Mohan Thomas, Senior Cosmetic Surgeon, Breach Candy Hospital brings out, “In the
past five years, the number of people travelling from the West or from the Middle East has increased tremendously. This has happened because of the expertise of the Indian doctors, being up to date with recent advances in cosmetology and also because of the procedures being provided at a cheaper cost as compared to their countries. Further on, with increased interest of people in Indian culture and tourism, more and more people are coming
An edge over others With several factors working in favour of the cosmetic surgery sector, India certainly has an advantage over its competitors. Firstly because India has around 2,500 certified plastic surgeons and their number is fast growing. Among these, a sizeable number of these doctors have been trained in the US, the UK and Germany and have been certified by the American Board of Plastic Surgery. Many of these doctors have had long careers in various international cosmetology institutes before returning home to practice. Secondly, India today has the best of medical technology needed to perform complex cosmetic surgeries. Says Dr Sharma,“India is at par with any other part of the globe. We have the best of technology available, almost everything which a doctor uses in the US.” Expertise is another area that has attracted a lot of people to opt for highly advanced cosmetic surgery in India. For example, Dr Zachariah has constantly been in news for performing a successful trans-umbilical breast augmentation (TUBA) method of breast augmentation at Seven Hills, Mumbai. He was personally trained by the American inventor of this JULY 2013
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in as tourists and add on cosmetic procedures to the package. Bringing up the cost factor, Dr Sharma points out, “The cost of the procedures are very competitive in India. Most of the procedures are available in India. The procedure can be done any time without long waits for a consultation appointment as in US or Europe.” Dr Thomas goes on to quote from a report published by the Planning Commission of India that shows the huge cost advantage that India has. The report reveals that in general, a plastic surgery procedure that will cost $20,000 in the US and $10,000 in Britain, will be $3,500 in Thailand will only cost $2,000 in India. Speaking about the advantage of being a hub for alternative medicine, Dr Thomas continues, “Besides costcompetitiveness, India also has a unique advantage that could catapult it ahead of its peers Thailand or Singapore. It has its tradition of Ayurveda and yoga, both Indian-origin practices that are now being perceived the world-over as complementary rehabilitative practices to modern surgical procedures. With increased interest of people in Indian culture and tourism, more and more people are coming in as tourists and add on cosmetic procedures to the package.” Moreover, analysts within the industry also note that there are scores of entrepreneurial plastic surgeons and travel websites in India who are now using the Internet as a tool to tap the cosmetic procedure market. They call it the 'nip and tuck' or 'pop for an op' market in the online space. With their web advertisements they highlight how these prospective medical tourists can avail highly specialised cosmetic services during their travel at best available price.
Going for the gold The growth of the Indian cosmetic surgery sector has also led to a tug-of-war between global and domestic players. Shedding some light on the same, Dr Puranik explains, “Global (cosmetic surgery) brands
THE BIGGEST ISSUE IS LACK OF LEGAL BINDINGS ON THE PRACTICE, ESPECIALLY WHEN IT IS ABOUT THE SAFETY OF PATIENTS SEEKING SUCH TREATMENTS 14
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DR CHARU SHARMA Head, Aesthetics and Skin Trainings, VLCC Institute
DR MANJIRI PATANKAR PURANIK Founder, InstaSculpt
more simplicity and how they can enhance their athome treatments. The increasing acceptance, availability and affordability of many non-invasive cosmetic treatments will be fostering,” reckons Dr Puranik.
Thorns in the rosy picture
The cost of the procedures are very competitive in India. The procedure can be done any time without long waits for a consultation appointment as in US or Europe
Absence of an accreditation body for recognising such courses restricts the development of training institutes and deters prospective students from considering this as a career alternative
are up against tough competition in the Indian market, as domestic players have decades of consumer loyalty and knowledge of the market. There is cut-throat competition due to the presence of large number of domestic players. Moreover, there is a surge in the number of established foreign brands who have already entered or are trying to enter Indian market to tap the immense growth potential.”
and more people wanting changes on the go, undergoing major surgical procedures with an associated downtime would be left to the end. If current growth rates continue into the next decade, the future demand in cosmetic surgery will be driven largely by non-surgical procedures. The growth of surgical procedures will be met by trained surgeons. However, meeting the projected growth in non-surgical procedures could be a potential challenge and a potential area for increased competition.” “Non invasive solutions are a major trend that will continue into the year 2013. Consumers seem to seek innovative products that provide multifunctional benefits. With many people living the fast-paced lifestyle consumers are drawn to
Future growth prospects In the years to come, experts predict that the Indian cosmetic surgery market will continue to grow. Dr Thomas feels, “In the coming five years, the cosmetology market will more than double and the increase primarily would be in the nonsurgical segment. With more
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Although India's thriving cosmetic and aesthetic surgery market has opportunities galore; however, there are many shackles to break. Inspite of having many factors that work in India’s favour, industry experts notice that there are many deterrents as well. The biggest concern is the lack of legal bindings on the practice and lack of regulations, especially when it is about the safety of patients seeking such treatments. Dr Thomas warns us about the legal issues that hospitals and cosmetologists may have to face. He goes on saying, “Unlike mainstream medicine there are no standards of care and the end point is subjective as well as dependent on the expectations of the patient. A great deal of time is required with the patient, which may not be feasible in a hospital setting. Effective communication, assessment of the patient needs, patient selection, psychological evaluation and compliance of the patient contribute to the final outcome as well as acceptance by the patients. Conflicts are bound to occur along with stand-offs which need to be managed quickly, effectively and in a sensitive manner. Globally speaking we live in a litigious society, however, fortunately in this country the legal awakening has been slow. While the
JULY 2013
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reprieve is temporary, one must gear up for it. Legal hassles may also include questions about the area of care and where the doctor and the paramedical staff pick up and leave after the treatment is initiated. There will be several grey areas regarding areas of expertise, onus of responsibility and instructions about discharge. Patient compliance which is essential needs to be assessed and documented and may be the weak link in the chain of care. Comprehensive patient counselling, windows for addressing of complaints or dissatisfaction and binding arbitration may be ways to prevent long and expensive litigation. Medical records become extremely important for any adjudication.” “There is a general feeling amongst medical tourists that the mechanisms in place to address complaints may be non-existent or long drawn out. In their minds patients’ bill of rights is neither well defined nor is there a scope for legal recourse. The legal recourse seems muddled and long drawn out. This now becomes a control issue for people seeking such treatments as mentioned above. The feeling of being helpless or having no rights cannot be accepted by overseas patients,” he adds. Dr Puranik talks about what restricts potential healthcare providers and professional from exploring this sector, “Absence of an accreditation body for recognising wellness courses restricts the development of good quality training institutes. This also deters prospective students from considering such courses as a viable career alternative. There is a clear need to motivate private players to participate in wellness education and training. Lack of sufficient incentives has limited the number of participants in this space,” she says. Highlighting certain illegal practices within the sector, Dr Mukund Jagannathan, Consultant Cosmetologist Kohinoor Hospital Mumbai alludes, “Opportunities are several. The problem is aggressive marketing which is actually banned by the Medical Council. Though quacks and non-qualified people are marketing themselves extensively, making tall claims and promises, it is illegal. The basic problem is too many specialities doing large portions of cross sections of procedures. There are misleading ads, and there JULY 2013
are many non-qualified people who are advertising impossible cures and solutions. Basically more and more people are now aware of these procedures and are looking for solutions, but most of them don't have a clear direction in which to ensure that they are treated by the correct person.” In addition to this, Dr Jagannathan also notes that with the government levying an additional 12.5 per cent service tax for cosmetic pro-
cedures, the overall bill has been pushed up. This has forced several people to hide these procedures or mark it under a different name, which again is an illegal practice. Dr Thomas further urges industry players to keep a close watch on new procedures that are introduced. “This segment will have to be monitored as there are many new non-proven procedures being brought into the market by companies who
have no approvals for these procedures. These have not been studied long term nor have been peer reviewed hence patients should always be wary of new non-surgical techniques, new chemicals or new lasers which have not been studied and compared,” he advises.
In conclusion Well, keeping against all that is according to our legal is a must. There is
guard taboo system a dire
need for market players to strictly follow the law of the land and work towards building strategies that will help augment the growth of cosmetic surgery as a field of expertise in India, as well as the industry at large. Moreover, emphasis needs to be given to education in this field so that with increasing demand India will also have enough experts to cater to the demand. raelene.kambli@expressindia.com
TATA INSTITUTE OF SOCIAL SCIENCES Deonar, Mumbai-400088
School of Health Systems Studies Admission Open to Executive Post Graduate Diploma in Hospital Administration (EPGDHA) The School of Health Systems Studies (SHSS) of Tata Institute of Social Sciences in Mumbai, pioneers of Hospital Admnistration education in the country, invites application for their prestigious EPGDHA programme. It is a 12-month (two semesters), dual mode programme consisting of online learning and two weeks of contact programme in each semester. The programme is intended to enhance the knowlege and skills of working personnel in the hospital. Eligibility: Graduates in any discipline with a minimum of 5 years of experience at the managerial and supervisory level currently working in hospital. Candidates sponsored by hospitals will be given due preference. Total Seats: 50 only. Application form and admission: Application forms can be downloaded from the Institute website: www.tiss.edu. Filled-in application form and necessary documents should be submitted, along with the registration fee of Rs. 1,000 to be paid through DD in favour of Tata Institute of Social Sciences at Mumbai, to The Secretariat, School of Health Systems Studies, Tata Institute of Social Sciences, V.N. Purav Marg, Deonar, Mumbai 400088. The last date of receiving application is 13th September 2013. Admission will be based on the interview at TISS, Mumbai. Programme Fees: The total fees for the programme is Rs. 1,80,000/- (One Lakh Eighty Thousand Only), payable in two installments. The fees include tuition fee, learning resources, boarding and lodging during contact programmes, library and computer services and other programme related expenses.
CONTACT: Telephone: 022-2552 5510/ 5000 /5523 or E-mail: epgdha@tiss.edu www.expresshealthcare.in
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NEWS ANALYSIS
Investors conceive winning cycle in IVF market Three major private players announced their foray into this segment recently
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he optimistic growth in the fertility treatment market has given an unexplored opportunity to Investors. Investment banks, venture capital firms and even parallel healthcare service providers are entering into branded in vitro fertilisation (IVF) clinics through mergers and acquisitions (M&As). Branded IVF clinic will also be in demand once the Assisted Reproductive Technology (Regulation) Bill (ART bill) tabled in the parliament will pass. It aims to regulate and supervise the ART procedure and thereby IVF clinics throughout the country. The bill details procedures for accreditation and supervision of infertility clinics and will prune out the non-clinical and substandard clinics and quacks. Besides insurance coverage for the treatment cost of infertility, it has also given much needed boost to the segment. Recently, three major private players announced their foray into this segment. While Manipal Health Enterprises and HealthCare Global Enterprises have partnered with existing brands in IVF market, TVM Capital MENA has invested in Bourn Hall Clinc India. All of the investments are related to consolidation and expansion of the IVF brand. Manipal Health Enterprises (MHE), one of India’s leading healthcare groups announced that it has invested growth capital in Ankur Healthcare, a speciality centre focussed in delivering comprehensive services in the areas of reproductive medicine -IVF, andrology and men’s health. Manipal – Ankur Andrology & Reproductive Services (MAARS) marks the beginning of Manipal Hospital’s foray into allied healthcare delivery formats in partnership with established players in specified clinical areas. Rajen Padukone, MD & CEO, MHE said that the venture would create a chain of speciality hospitals focusing on andrology, reproductive medicine and men’s health in the country. Dr Vasan SS, CEO, MAARS aims to expand the existing four centres to 12 over the next 18-24
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The MAARS deal
Launching Milann - The Fertility Center months, with new centres located in existing hospitals of MHE, standalone centres in cities like Chennai, Pune, Hyderabad, Indore, Chandigarh etc. as well as setting up such facilities within other hospitals. HealthCare Global Enterprises (HCG) announced that it has made an investment and has acquired a majority stake in Bangalore Assisted Conception Centre (BACC), a leading provider of fertility care owned by Dr Kamini A Rao. Known as Milann – The Fertility Center, the venture aims to make the best practices in fertility care available and accessible across India. “We will build upon BACC's expertise to help establish the nation’s leading fertility care provider,” said Dr BS Ajaikumar, Chairman and CEO, HCG. Last month, private equity www.expresshealthcare.in
and venture capital firm TVM Capital MENA said that alongwith Bourn Hall Clinic UK, it will infuse $100 million (over Rs 540 crore) into Bourn Hall India to fund the opening of 18 new fertility clinics in India by end of FY16. "Our aim is to grow Bourn Hall clinics to be the main player in the in vitro fertilisation (IVF) area in India. We plan to put in $100 million to open 18 Bourn Hall clinics in India by end of three fiscal years," said TVM Capital MENA Partner Youssef Haidar. Talking about branded IVF clinics, Dr Anirudh Malpani, noted IVF specialist said, “Creating a national IVF brand is both a challenge and an opportunity. Anyone who is willing to do it properly is likely to reap rich rewards.” Dr AM Arun, Chairman, Vasan Healthcare Group, in an earlier interview with Express Healthcare had also
expressed interest in launching branded IVF clinics in India. (http://healthcare.financialexpress.com/201204/market10.shtml) In 2012, Nova Medical Centres formed a joint venture with Spain-based reproductive medicine firm, IVI to expand their clinic network in Middle East and India. Goldman Sachs and New Enterprise Associates also invested $54 million in Nova Medical Centres in August 2012. According to a report by market research firm KuicK Research, the IVF market in India was around $ 1 billion in 2011 and is estimated to grow at a CAGR of 25.74 per cent during 2011-2015 to reach $3 billion in 2016. Nearly 30 million couples in the country suffer from infertility, with an incidence rate of 10 per cent. mneelam.kachhap@gmail.com JULY 2013
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Hospi News INVESTMENT
HCG invests in BACC Apollo opens Centre for Liver Disease & Transplantation in Bengaluru
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pollo Hospitals has started a Centre for Liver Disease & Transplantation (CLDT) in Bengaluru to bring advanced liver care closer to home for the patients in the city. CLDT plans to make their services available via multidisciplinary ‘Liver Clinics’ that are aimed to become a one stop solution for patients with liver and hepatobiliary-pancreatic disorders. At Apollo Hospitals in Bengaluru, the services offered will include liver and multivisceral transplantation for all age groups and for the full spectrum of liver ailments. Additionally, patients with various forms of liver, biliary and pancreatic cancers can reportedly avail services related to advanced radiologic and minimally surgical (Laparoscopic Surgery, Radiofrequency Ablations) interventions. Haepatology and interventional gastroenterology services are also offered at CLDT. “Liver disease is a common and serious problem in our country. Liver transplantation is a surgery that is performed to remove a diseased liver in order to replace it with a healthy one. Such surgeries have been done for over 38 years. Several people who have had liver transplants go on to lead perfectly normal lives,” said Dr Anand Khakhar, Senior Consultant, Liver Transplant & Hepatobiliary Surgery, Apollo Hospitals Group. After establishing transplant programmes at Chennai and Hyderabad, these services are now available full time at CLDT in Apollo Hospitals, Bangalore. Apollo Hospitals’ comprehensive liver transplant care programme aims to provide effective healthcare by connecting to people dealing with liver disease.The CLDT, Apollo Hospitals, will reportedly be equipped with the state-of-the-art technology for liver surgery and a multidisciplinary team of eminent doctors trained at the best centres in the world.
Acquires a majority stake in the fertility care provider and will be known as Milann – The Fertility Center
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ealthCare Global Enterprises (HCG) has made an undisclosed investment and has acquired a majority stake in Bangalore Assisted Conception Centre (BACC), a leading provider of fertility care. Founded by Dr Kamini A Rao, BACC, operates four fer-
tility centres across Bengaluru, which will henceforth be known as Milann – The Fertility Center. Dr BS Ajaikumar, Chairman and CEO, HCG said, “We are delighted to partner with one of the country’s most accomplished fertility specialists, who have contributed
immensely in the field of infertility treatment. We will build upon this expertise to help establish the nation’s leading fertility care provider.” Dr Kamini A Rao, Fertility Specialist and Medical Director, Milann said, “HCG has been successful in creating a unique nationwide net-
work of cancer care that makes the latest technology and the best expertise available to all. We look forward to joining hands with HCG to realise our dream of making the best practices in fertility care available and accessible across India.” EH News Bureau
EH News Bureau JULY 2013
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Initiative INITIATIVE
Cancer survivor’s 100th birthday
HP deploys virtual health platform to help deliver psychiatric care in rural India
M Neelam Kachhap EH News Bureau
This initiative is part of HP’s Sustainability and Social Innovation initiatives to improve access, quality and efficiency of global health
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ppaswamy, survived lung cancer to celebrate 100th birthday organised by HealthCare Global Hospital (HCG) in Bangalore. Appaswamy was diagnosed with lung cancer in 1998. Not wanting to give up on life, Appaswamy consulted doctors at HCG, Bangalore, where he was told that he had stage one lung cancer and suggested the cyberknife treatment. Risk of surgery is high in this age group and hencedoctors choose a less invasive treatment process. Dr Kumarswamy, Sr Consultant, Radiation Oncologist, HCG said, “Considering his age, the risk of surgery was high.The tumour was present in the upper part of his left lung and it was about 3.8 cm in size.” Dr Nalini Rao, Consultant, Radiation Oncologist, HCG, said,“With a multi disciplinary team approach, we decided to take a curative approach rather than palliation.” He underwent three sessions of Cyberknife on alternate days from May 2428, 2011. After three months follow up scan showed a scar tissue. Two years post treatment, he is cancer free. “Diagnosis of cancer should not rule out the possibility of treatment in elderly patients. Optimal treatment can be given through accessibility to newer technologies like Cyberknife,” said Dr Rao. “Accessibility to advanced technologies, has improved medical outcomes and quality of life,” said Dr Kumarswamy. His is a case of grit, valor and facing cancer head on to ensure that he leads a qualitative life. Even at the age of 98 he wanted to fight cancer, sought his family support and met the specialist in cancer care. Today, Appaswamy spends time watching cricket, reading novels, newspapers and spending time with his grand children and great grandchildren. His story is one that is emulative for other cancer patient.
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P has deployed a virtual health technology platform that will reportedly enable healthcare professionals to virtually conduct specialist psychiatric consultations with patients. This initiative facilitates psychiatric care without requiring either the doctor or the patient travelling to meet each other. “At HP, social innovation is at the heart of our business, and we are committed to applying our technologies, resources and expertise to address complex world problems and make a positive difference,” said Commander Girish Kumar, Practice Head, India - Healthcare & Life Sciences, HP Enterprise Services. “In India, it is estimated that only 10 per cent of mental health patients
receive active psychiatric assistance or help. The virtual health technology solution aims to improve efficiencies in delivery of quality psychiatric care to under-served rural, semi-urban and remote areas in India,” he added. HP is piloting the platform with MSC Trust, a leading NGO specialised in providing psychiatric solutions to patients in rural Tamil Nadu. HP’s virtual health platform is expected to support MSC Trust’s efforts to extend the reach of psychiatric care in rural India by providing the required information technology infrastructure and improving awareness through continued education of medical personnel onsite. HP will network a central hub with remote smaller cen-
tres as well as provide a specially outfitted virtual health van that will enable delivery of remote consultations in rural towns and villages. The central hubs will be connected via voice, SMS, imaging, and video-conferencing technology to once-a-week clinics in smaller centres that would be temporarily established. The hub will be equipped with an IT platform that will link with medical diagnostic equipment such as digital stethoscopes and digital ECGs to facilitate remote patient diagnosis and medical consultation. A similar set-up is also being deployed in an air-conditioned virtual health van that will serve as a mobile clinic to provide remote consultation through video conferencing and digital diagno-
sis in remote rural parts of Tamil Nadu. A mobile-based application called Medication Alert & Adherence System (MAAS) has also been co-developed by HP’s Enterprise Services team in consultation with HP Labs. It uses mobile phones to monitor a patient’s medicine intake. MAAS issues SMS reminders to the patient or their caregiver, based on the doctor’s prescription which is stored in a central Health Information System. The patient’s affirmative or negative intake response can be recorded and transmitted via SMS and subsequently serves as data that can be used for clinical observations, outcome analysis and to determine drug efficacy. EH News Bureau
RADIOLOGY
Samsung enters Indian medical equipment market Launches digital radiography and in-vitro diagnostics machines into the Indian market which will be marketed under the brand name ‘GEO’
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amsung has forayed into India's health and medical equipment business by launching digital radiology and in-vitro diagnostics equipment and technologies under the GEO brand in the country. The GEO brand includes XGEO for digital radiography, UGEO for ultrasound diagnostic system and LABGEO for invitro diagnostics. “We are leveraging our strengths in technology and R&D to offer medical products that offer fast, easy and accurate diagnosis to both doctors and patients. We are focusing on time engineering that enhances the efficiency of all products being used in hospitals and clinics. By upholding customer values as its top priority, Samsung will continue to develop products which will improve the quality of people's lives through its advanced technologies and contribute to the growth of the global med-
ical equipment industry” said Dinesh Lodha, Vice President, Health & Medical Equipment Business at Samsung Electronics. In the area of digital radiography, Samsung has launched three machines, the XGEO GC80, XGEO GU60 and the XGEO GR40 which cater to requirements across all digital radiography market www.expresshealthcare.in
segments. These are being targetted at large and medium-sized hospitals. Samsung's recently launched in-vitro devices are LABGEO PT10, LABGEO IB10 and LABGEO HC10. These devices reportedly offer fast and accurate diagnostics, portability and other advantageous features. By using the LAN port at the back of
all three in-vitro test units, the user can manage the test results from a PC and update the system software automatically. The products can also be easily connectivity via USB to peripheral devices such as printers, keyboards, barcode scanners and USB drives. EH News Bureau JULY 2013
How to boost your hospital’s revenue. And profits.
Healthcare Marketing MasterClass has been designed for Promoters, CEOs and CMOs to help them fine- tune various elements in their marketing strategy to drive profitable growth. It will focus on ready-to-implement takeaways through real-life hospital examples. It will cover various modules like Product, Branding & Pricing Strategy, Advertising, Digital & Social Media, Sales Force Effectiveness and Public Relations. Ratan Jalan is widely acknowledged as a thought leader in healthcare marketing. An alumnus of IIT and Harvard Business School, he headed strategic marketing initiatives for the Apollo Hospitals group. He also worked with Lowe Lintas, a globally renowned advertising agency for almost a decade. Winner of S P Jain Marketing Impact of the Year Award, he is a frequent columnist and has authored a cover story in Marketing Health Services, a prestigious publication by American Marketing Association. He is a guest speaker and faculty at industry forums and leading institutes like ISB, IIMs, Johns Hopkins and TISS.
Date Friday, July 26, 2013 Venue Hotel Oberoi, M G Road, Bengaluru Programme Fee Rs 9500 per participant (excl tax) Registration write to drvijay.raaghavan@med-ium.com Or call him at + 91 90080 20304
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Company Watch INITIATIVE
Abbott receives Golden Peacock Award Award for Abbott’s management practices and stakeholder engagement
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bbott received the Golden Peacock Global Business Excellence Award for 2013 at the recent Global Convention on Business Excellence in Dubai. The Golden Peacock Global Business Excellence Award was given to Abbott for its strong stakeholder engagement, a commitment to transparency, a good workplace environment, high standards of ethics and compliance for the company and its partners, and the quality of its involvement with communities. It also recognises Abbott’s broader economic, social and environmental performance. “Abbott is committed to advancing healthcare and improving the lives of millions of patients and customers by partnering with healthcare professionals, governments, nongovernmental organisations and other stakeholders,” said Bhaskar Iyer, Divisional Vice President, E s t a b l i s h e d Pharmaceuticals, Abbott in India. “Being a responsible corporate citizen involves more than healthcare innovation and outreach. Good citizenship also extends to the way we run our business in a sustainable manner to benefit our many stakeholders.” The Golden Peacock Global Business Excellence Award was created by the Institute of Directors to encourage Business Excellence achievements in both manufacturing, as well as service organisations globally. This category of award recognises companies in areas such as leadership, vision, financial performance, managing risk and corporate sustainability. EH News Bureau
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WHO launches Global Hepatitis Network Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) pledge their support for this endeavour
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he World Health Organization (WHO) has officially launched the Global Hepatitis Network, a major new international collaboration for the prevention and control of viral hepatitis at a press conference at APASL Liver Week in Singapore. It is an initiative from the WHO’s Global Hepatitis Programme that will build capacity and strengthen national, regional and global action to tackle viral hepatitis. The WHO will provide secretariat support to the Global Hepatitis Network, with a chair and steering committee overseeing a number of regional and technical working groups. A major focus for the Global Hepatitis Network will be to work on activities that strengthen international collaboration around WHO’s Framework for the Prevention and Control of Viral Hepatitis, which is focused on four dis-
tinct axes: ● Axis 1: Raising awareness, promoting partnerships and mobilising resources ● Axis 2: Evidence-based policy and data for action ● Axis 3: Prevention of transmission ● Axis 4: Screening, care and treatment Welcoming the news, the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) pledged their support to the Global Hepatitis Network. A CEVHAP founding member, Professor Seng Gee Lim said, “A systematic and coordinated response across Asia Pacific is essential to combat these diseases. Every day clinicians witness the significant challenges that national health services face in combating viral hepatitis and we hope the Global Hepatitis Network will inject new vigour into the global and regional response.” CEVHAP claims that it is ideally placed to support the
work of the Global Hepatitis Network in Asia Pacific, and is in the process of applying for membership. Professor Ding-Shinn Chen, Chair of CEVHAP commented, “The Global Hepatitis Network represents an excellent opportunity for greater collaboration between governments and expert groups, and we will hope to mobilise resources that are urgently needed. The launch of the Network reflects the growing recognition that viral hepatitis is as serious a global threat as HIV, TB and malaria, something that is crucially important to elevate attention and drive action.” Speaking at the launch of the Global Hepatitis Network, Charles Gore, President of the World Hepatitis Alliance and a founding member of CEVHAP noted, “The greatest challenge for the Global Hepatitis Network will be to access resources that are
urgently needed to tackle viral hepatitis. The major global health funds still exclude hepatitis and despite significant advancements in treatment, the funding situation has led to an era of neglect and a spiral in deaths.” Professor Stephen Locarnini, Joint Secretary of CEVHAP and Director of the WHO Regional Reference Laboratory for Hepatitis B at the Victorian Infectious Diseases Reference Laboratory (VIDRL) welcomed the news saying “We applaud the leadership of WHO’s Global Hepatitis Programme in forming this network. As a WHO Regional Reference Laboratory in the region, VIDRL have already learned the power of international collaboration and this new network demonstrates the important progress and resource commitment being made by WHO.” EH News Bureau
HOSPI NEWS
Max Elite Institute of Orthopaedics & Joint Replacement launched Dr Manuj Wadhwa to head the new centre which will offer pin-less navigation system and digital integrated modular operative suite
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ax Super Speciality Hospital, Mohali launched the Max Elite Institute of Orthopaedics & Joint Replacement under the leadership of the renowned Orthopaedician- Dr Manuj Wadhwa as Director & Head of the Institute. Located at Max Super Speciality Hospital, Mohali it is reportedly the largest and most comprehensive orthopaedics centre in tricity and in the region. The institute is expected to offer a complete range of care to orthopaedic patients under one roof. Spearheaded by Dr Manuj Wadhwa, the institute will comprise 100 beds, integrated modular OTs, digital operating suites to telecast live surgeries, space suits in OTs for minimum infection rates, OPD lounge with video conferencing and
audio video counselling, speciality ICUs for high dependency joint replacement patients, and state-ofthe-art physiotherapy and rehabilitation for ortho and joint replacement patients. Max Elite Institute of Orthopaedics & Joint Replacement also intends to provide pin-less navigation system, a less invasive method of treatment for knee replacement patients. The system uses infrared cameras and tracking soft-
ware to conduct knee replacements surgeries, hence eliminating the use of traditional pins. The institute would also use the Digital Integrated Modular Operation suites, for the first time in the region, as per a press release. Speaking on the occasion, Dr Ajay Bakshi, MD & CEO, Max Healthcare said, “Under the leadership of Dr Wadhwa and his dedicated team, this institute will offer holistic care in the area of
THE INSTITUTE WILL COMPRISE 100 BEDS, INTEGRATED MODULAR OTS, DIGITAL OPERATING SUITES TO TELECAST LIVE SURGERIES, SPACE SUITS IN OTS FOR MINIMUM INFECTION RATES, OPD LOUNGE WITH VIDEO CONFERENCING www.expresshealthcare.in
orthopaedics, supported by the latest technology.” Commenting on the occasion, Dr Manuj Wadhwa, Director & Head, Max Elite Institute of Orthopaedics & Joint Replacement, Max Super Speciality Hospital, Mohali expressed, “At the Max Elite Institute of Orthopaedics and Joint Replacement, our focus will be on providing the highest standards of medical care for orthopaedic problems. Starting from prevention through early diagnosis and intervention, surgical intervention to rehabilitation, the institute through its 360 degree approach will provide a complete solution for orthopaedic care to people suffering from a wide range of musculoskeletal conditions.” EH News Bureau JULY 2013
Partnering with hospitals to improve efficiency and drive growth At IMS Health, our business is to help healthcare providers address their most important business questions:
• • • •
How can hospitals expand their business into new care or access models? How can hospitals grow their patient base? How can hospitals save on costs without compromising operational excellence? How can hospitals make evidence-based, informed decisions based on robust, real-time data?
IMS Health is a leading worldwide provider of information, technology and services dedicated to making healthcare organizations perform better. With a global technology infrastructure and a unique combination of real-world evidence, IMS Health integrates knowledge across all aspects of healthcare to help clients improve patient outcomes and operate more efficiently.
Our tailor-made solutions for providers are:
• Consulting Services From operational model consulting to growth strategies and expansion plans, our experts partner with healthcare providers across multiple areas of engagement:
• Operations Optimization - From a thorough assessment of hospital processes, revenue and cost drivers, to a comprehensive performance improvement program and implementation support • Greenfield Planning - From feasibility analysis to partnership structuring • Business Strategy Support - From business model development and organizational restructuring to forming strategic partnerships and supporting execution • Public Health Strategy & Progam design- From project strategy development and resource planning, to program design and evaluation of systems
Sustained economic growth in India has fuelled a rising demand for quality medical care, driving a rapid expansion of the hospital sector. However, this expansion has increased competitive intensity, impacting both operational and the financial performance of hospitals, and necessitating adoption of innovative business models.
• Analytics & Decision Support System We use our unique evidence-based healthcare management system, ‘IMS Ardentia’, to improve cost and clinical efficiency across hospitals. IMS Ardentia leverages advanced analytics to provide accurate insights into the extent of service variation and the impact of alternative pathways of care on patient experience, costs, and performance drivers.
Connect with IMS Health. Connect with success. IMS HEALTH INDIA Unit No. 302, 3rd floor, Supreme Business Park, Supreme City, Behind Lake Castle & Avalon, Hiranandani Gardens, Powai, Mumbai - 400076 © 2013 IMS Health Incorporated and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
Find out more: Tel: +91 22 3944 2200 info.in@in.imshealth.com www.imshealth.com/india
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Hospi news PARTNERSHIP
Fortis Hospital, Bengaluru on 2013 World’s Best Hospitals list for medical tourists
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ortis Hospital, Bannerghatta Road, Bengaluru has been ranked No 4 on the 2013 World's Best Hospitals list for medical tourists. The hospital has been recognised for the fourth consecutive year by the Medical Travel Quality Alliance (MTQUA). MTQUA is an independent organisation set up in 2009 to promote safety and quality in treatment for medical tourists. The organisation assesses participating hospitals across the globe on a variety of parameters ranging from medical quality and outcomes, communication and care, value for service, safety and security, and attention to the special needs of medical travellers. Complementing the team on receiving the MTQUA award, Aditya Vij, CEO, India, Fortis Healthcare said, “We are proud that we have received the MTQUA award for the fourth year running. The Fortis BG road hospital, along with other Fortis establishments have been instrumental in putting India on the medical tourism map, as a destination for honest, high calibre, complex medical work at a reasonable price point.” Fortis Hospital Bannerghatta reportedly had about 650 patients who travelled from various parts of the world. These patients apparently availed tertiary care treatment in specialities like cardiac surgery, knee replacement, complex urological procedures, and brain and spine surgeries. The hospital is a 400bed multi-speciality tertiary care hospital and has over 150 consultants and 800 paramedical staff.The facility offers services in 40 specialities such as cardiology, cardiac surgery, urology, orthopaedics, neurology, and neurosurgery EH News Bureau
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L&T Insurance & E-Meditek Global join hands for Medicash Card It is a pre-paid card for instant authorisation of claims and immediate payments, configured over Visa Prepaid Card under an exclusive alliance between Ratnakar Bank and Visa
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&T Insurance partners with E-Meditek Global will launch a product called MediCash Card to facilitate instant cashless claim authorisation. The interface of the technology has been configured over Visa Prepaid Card under an exclusive alliance between Ratnakar Bank, Visa and E-Meditek Global. Designed to change the course of health insurance approvals with the option of payment to hospitals, MediCash Card is being tout-
ed as an innovative product which is expected to go a long way in ensuring quality healthcare and adding to customer convenience. This platform reportedly provides instant cashless approval based on the eligibility. The procedure of using this card involves swiping the MediCash Card at the point of sale (POS) terminal, followed by filling of requisite information on the POS machine itself; and then a small wait to get a cashless authorisation
slip. This is followed by a confirmation call to the customer. At the time of discharge, communication regarding the approved amount is shared through SMS and email, with the customer to enable immediate refund of security deposit by the hospital, informed a release. Speaking at the launch, Joydeep Roy, CEO and Wholetime Director, L&T Insurance said, “The MediCash Card allows instant authorisation and on-the-spot
payment, making the crucial period of wait almost negligible. So, help and health are only a swipe away.” Gopal Verma, Chairman, E-Meditek Global said, “The card enables insurers to introduce the out patient insurance plans rather than just the hospitalisation insurance. This will pave the way for launch of genuine OPD or dental insurance plans in the country.” EH News Bureau
TRAINING
TISS launches online programme for hospital administrators It is an Executive Postgraduate Diploma in Hospital Administration (EPGDHA) programme
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ata Institute of Social Sciences (TISS), a pioneer in the field of hospital administration education programme, is offering an online hospital administration education programme using its online courseware, MOODLE. Though it has been offering an education programme for hospital administrators since 1980, so far it was an evening programme which was restricted to working administrators from Mumbai and its surroundings only. School of Health Systems Studies (SHSS) of Tata Institute of Social Sciences in Mumbai, offered this course. However, TISS being a national institute, the Academic Council approved the proposal to go national and even international, resulting in the new
online course. This programme is for those who are currently working in managerial and supervisory positions without any formal qualification in the field of hospital administration and wish to upgrade their knowledge and skills without affecting their current employment. As the working executives need to study along with their existing job, the course is reportedly designed in a way that integrates both study and work. The students shall be meeting most of their academic requirements at their work desk by using the online mode. In order to learning process more rigourous, two mandatory residential contact programmes are being offered in each semester for 15 days.
There are 50 seats available for this course and large number of applications are expected to come in. The candidates have to undergo an interview process in Mumbai and the successful candidates will join the programme in early October, 2013. The fees for the whole programme is Rs 180,000. The fees cover boarding and lodging during the contact programme, course material, library service, computer service and other expenses related to the programme. The Institute will provide an identity card and email with password, which will enable the student to access all the e-resources of the Institute from anywhere in the world. EH News Bureau
COMPANY WATCH
Axio Biosolutions receives CE mark for emergency haemostat Axiostat helps to treat traumatic bleeding within minutes of application to the wound site
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hmedabad-based Axio Biosolutions, a medical device designer, manufacturer company, has obtained the European Union Class III Medical Device CE mark approval for its range of emergency haemostatic dressing - Axiostat. The CE mark designation will allow Axiostat to be sold in the European Union and other countries. www.expresshealthcare.in
It is an advanced class of wound dressing that stops traumatic external bleeding reportedly within few minutes of application by providing an active mechanical barrier to the wound site. The sterile, single use, non-absorbable haemostatic dressing intended to be used for temporary control of bleeding wounds stops moderate to severe bleeding due to
cuts, abrasions, lacerations, venous or arterial bleeding. Axiostat is also approved for use in India and is being used by paramedics, doctors, paramilitary and army soldiers, industry workers etc. With a three-year shelf life it is available in various sizes. This approval represents a significant milestone for Axio. EH News Bureau JULY 2013
LONG-LASTING QUALITY. MINIMISED ERRORS. ELEVATED EFFICIENCY. EXTENDED PATIENT SAFETY. ZEBRA HC100™ DIRECT THERMAL PRINTER — EASY-TO-USE, RELIABLE & HIGHLY COST-EFFICIENT. With Zebra’s new durable, easy-to-scan all-in-one HC100 patient ID solution, now you can enhance critical workflows throughout every department of your government healthcare organisation. Accelerate patient admissions by producing more secure, longer-lasting antimicrobial-coated wristbands on-demand — easily, quickly and conveniently. Enhance productivity and minimise errors in medical record labelling with this reliable and easy-to-use direct thermal printer that automatically detects the wristband size, calibrates — and prints. Ensure your delivery of unrivalled patient safety with Zebra HC100 — the reliable and cost-efficient solution for all your patient ID printing needs. Key Benefits: • Easy-to-use and load for optimum user efficiency • Automatically detects wristband size and calibrates settings for optimal print quality • Lower maintenance costs with longer-lasting wristbands with bar codes and text that remain readable For more information about HC100 printer, please, visit www.zebra.com/hc100 For further enquiries, please email SGMarcom@zebra.com Zebra Technologies India Pvt Ltd Boomerang A202 Near Chandivali Studio Main Chandivali Farm Road Main Andheri E Mumbai 400072 T: 022 67275555 ©2012 ZIH Corp. All rights reserved.
M|A|R|K|E|T HOSPI NEWS
ILS Hospitals launches its third hospital in Kolkata A 130-bed hospital, it will offer tertiary care to the northern fringes of the city
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olkata-based ILS Hospitals launched its third facility at Dum Dum, the northern fringes of the city. ILS Hospitals, promoted by GPT Healthcare, is a multi-speciality hospital chain in the Eastern region with operations in Kolkata's Salt Lake and Agartala in Tripura. The 130-bed, centrally air conditioned multi-speciality hospital, is reportedly the first-of-its-kind in the region providing tertiary level clinical care backed by a multidisciplinary team of doctors. The fully equipped hospital is located very near to the city's airport. Speaking on the occasion, Dr Om Tantia, Managing Director, ILS Hospitals said, “We are happy to launch our third hospital in Dum Dum, as we felt the northern fringes of the city has been deprived of a dedicated multi-speciality hospital till date. ILS Dumdum, with its state-ofthe-art facility, comprises 24X7 emergency and trauma care unit, diagnostics and pharmacy. The hospital has
five highly specialised operation theatres with infection control measures like a pressurised environment and laminar air flow. The clinical care is well supported and complemented by state-ofthe-art diagnostics including a 1.5 Tesla MRI machine and
a high end 128 slice CT scan machine. The entire setup, which includes over 25 critical care beds, is sure to make a profound difference to the population of the area.” Besides, the critical care team and cardiologists, the emergency unit is backed by
a multi-disciplinary trauma care team consisting of orthopaedic surgeons, neurosurgeons, ENT and GI surgeons along with specially trained emergency medicine technicians. The unit, backed by a critical care ambulance with advanced life support systems, is a reportedly one of its kind unit in the city. ILS Hospital offers services in medical specialties like general and laparoscopic surgery, bariatric surgery, gastro intestinal surgery, orthopaedics (spine and joint replacement surgery), gynaecology and obstetrics, neurosurgery, paediatric surgery, uro-surgery, maxillo facial surgery, cancer surgery as well as critical care for adults and newborn. In addition, the hospital is also equipped to address areas such as general medicine, clinical cardiology, diabetology, neurology, nephrology, gastro enterology, chest medicine, oncology, paediatrics and neonatology, ENT, dental surgery, ophthalmology etc. EH News Bureau
30 MINUTES INTERVIEW
‘It is necessary to design each and every system and process keeping the customer at the helm’ Sanjay Datta, CHIEF – UNDERWRITING & CLAIMS, ICICI LOMBARD GIC
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ealth insurance as a mechanism to finance healthcare needs is slowly and steadily gaining acceptability throughout India. This, in turn, gives the insurance sector a greater scope to grow within the healthcare industry. Sanjay Datta, ChiefUnderwriting & Claims, ICICI Lombard GIC talks about the current state of health insurance in India and its scope for growth, in an interaction with Raelene Kambli Give us an overview of the current state of the health insurance sector in India? The health insurance industry is growing at a fast pace with 16 per cent growth and underwriting a total premium of Rs
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153.4 billion in FY 12-13. It alone contributes 22.2 per cent share to the total insurance premium, second largest after the motor insurance business. The sector is poised to grow at a higher rate in the coming years, as low penetration (less than one per cent of GDP) and growing demand opens up a vast potential, which is also evident from the fact that new players are entering the market. How would you broadly characterise the health insurance industry in the last five years? Are there a lot of changes within the sector? In the last five years, the industry has witnessed setting up of market infrastructure, healthcare tie-ups for better network, www.expresshealthcare.in
greater transparency in tariffs and pricing as well as regular focus on the policyholders’ rights. The sector has witnessed optimisation of the sum insured and coverage, along with specialised products as responses to the growing need of the consumers. The health insurance sector has been continuously evolving and is currently going through a phase where it is transforming its treatment-based approach to awareness and preventive care led roadmap. In the coming years, this dynamism is sure to continue. What kind of operating models for health insurance are viable in India? An operating model is viable
only if it brings value to the customer. Therefore, it is necessary to design each and every system and process keeping the customer at the helm.The next step in the health insurance segment is to move from being simply a 'claims settling and process following unit' to simplifying claims and processes. Introduction of network tie-ups and fetching better discounts is such an example. To make an operating model viable for health insurance, technology-enabled solutions would play a pivotal role. What is the impact of the financial crisis on the insurance industry? With robust systems and regulations in place, the industry as a whole has been unaffected by JULY 2013
M|A|R|K|E|T the financial crisis, posting a growth of more than 20 per cent in FY 12-13. As companies are slowing down on hiring and restricting the budget for employee wellness, an indirect pressure on growth of few segments such as group health insurance can be felt. Lack of insurance penetration is one of the biggest challenges that the industry faces. How should insurance companies tackle this industry situation? The insurance penetration has increased significantly since the opening up of the sector for private players. This increase is due to the entry of new players, introduction of new products and channels of distribution along with increasing penetration of the private insurance companies in uncovered markets. The industry as a market is continuously working on reducing the cost, and enhancement of quality of healthcare delivery, by establishing linkages with different stakeholders involved. To improve the overall health insurance penetration, an integrated roadmap by government and private players would speed up the pace further. Recently, Insurance Regulatory Development Authority (IRDA) has taken various steps to ensure increased penetration which includes bringing in more transparency in the industry through monitoring of consumer-related aspects, such as market conduct, consumer education and creation of an integrated platform for redressal of customer grievances.
part of the RSBY Scheme. Recently, the Delhi government has decided to provide cashless health insurance cover to domestic helps, street vendors, railways porters and hawkers in the city. The insurance companies have been working in hand with the government on several new and old initiatives. Recently, ICICI Lombard General Insurance signed an agreement with the Meghalaya government to roll out a comprehensive health insurance scheme in the
state aimed at covering close to three million citizens. ‘Megha Health Insurance Scheme,’ provides all households in the State with a financial cover of upto Rs 1.6 lakh per year to cover inpatient services, irrespective of all income groups. What else needs to be done to address the lack of penetration? What are the pre-requisites to improve the health insurance scenario in India? The industry needs to focus
more on generating high level of awareness amongst consumers to avail insurance products. Even today, consumers typically buy insurance to save tax, as an investment or because it is mandatory. It is extremely critical that these issues are addressed and consumers become aware of the need and importance of health insurance. Though products like micro insurance may be mandated by the IRDA to serve customers, it is imperative to ensure the right mix in terms of prices and serv-
ices of each product to encourage people to avail health insurance. Lack of an integrated health infrastructure poses the biggest challenge in India. With increasing awareness and changing lifestyle, market is currently looking for a more organised provider set-up to impact the complete health spectrum, moving up from insurance. A mechanism to reduce the cost of benefits and to enhance the quality of care is the need of the hour. raelene.kambli@expressindia.com
What are the government’s initiatives in this sphere? Government blames the insurance sector for not doing their part. What is your opinion on the same? The Central Government has given priority to healthcare and is making significant investments to improve infrastructure and delivery mechanism, jointly with state governments through various programmes, particularly in the health insurance domain. They have been contributing through the launch and funding of several central and state level schemes which include the Rashtriya Swasthya Bima Yojna (RSBY) covering around 34.41 million below poverty line (BPL) families and an estimated 170.8 million people through implementation in 445 districts across 28 States and Union Territories. Government, in order to further improve penetration, has also decided to include new groups like workers in the unorganised sectors as a JULY 2013
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M|A|R|K|E|T OPINION
Does adulteration mean different things in different countries? If there is a question mark on the quality of a drug, shouldn't we be worried? Should patients be subjected to drugs which are not manufactured under cGMP guidelines? M Neelam Kachhap gets prominent doctors to air their views
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ast month, the healthcare industry was stunned by the news of settlement between one of the world’s largest generic drug manufacturers, Ranbaxy Laboratories and the US FDA. Pleading guilty to seven federal criminal charges related to faulty drug manufacturing dating back to 2008, Ranbaxy agreed to pay US regulators $500 million as a fine. A lot has been said about the judgment and its repercussion since then. Immediately after the verdict, experts opined that the incident may reflect badly on the generic drugs manufactured in other parts of the country. Some hospitals released advisories against prescribing Ranbaxy drugs. Yet, what has not been commented on is the fact that whether small or big, any fraud is a fraud. All pharma companies are expected to operate under Current Good Manufacturing Practices (cGMP). Violating the trust of patients and not following cGMP is not acceptable. According to a US Department of Justice (US DOJ) press release dated May 13, Ranbaxy admitted to selling certain batches of adulterated drugs that were produced at Paonta Sahib in 2005 and 2006, including sotret, gabapentin, and ciprofloxacin. The company also acknowledged that the FDA’s 2006 and 2008 inspections of the Dewas facility found the same issues with incomplete testing records and an inadequate stability programme, as well as significant cGMP deviations in the manufacture of certain active pharma ingredients and finished products. Secondly, we need to question the quality of drugs the company sold in India at the same time. How can we be sure that the drugs that were sold in India were not adulterated and substandard as in the US? Thirdly, the incident was brought to light by a whistleblower – a former employee. Had he not implicated the company no one would ever
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know of the fraud. Doesn’t that imply that local standards of the drugs may not be up to the mark and local consumers are exposed to sub-standard products? And we have no way of knowing if this was happening. And lastly, the US DOJ release further states that the company has admitted to making false, fictitious, and fraudulent statements to the FDA in Annual Reports filed in 2006 and 2007 regarding the dates of stability tests conducted on certain batches of Cefaclor, Cefadroxil, Amoxicillin, amoxicillin and clavulanate potassium, www.expresshealthcare.in
which were manufactured at the Dewas facility. Regulators as such do not test drugs. They rely on the companies to be ethical and stick to the manufacturing guidelines and make sure that a drug meets the requirements of safety, identity and strength, and meets the quality and purity characteristics, which the drug purports or is represented to possess. How do we know that Ranbaxy has not jeopardised our faith? This incident has raised serious concerns about the quality of the company's other drugs and whether we are safe.
We spoke to a number of eminent doctors in India about their views on the above. Many raised similar concerns but did not want to comment openly. We are publishing a few who did come forward to talk about it. ❚❚ Dr BS Ajaikumar, Founder & Chairman of HCG, Bangalore Menace of spurious/adulterated drug is on increase. When companies sell adulterated drugs, they cause patients to take drugs that are substandard, ineffective, or unsafe and sometimes cause irreversible problems, JULY 2013
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even death. It is very sad that large drug manufacturers are involved in such frauds. We do not use drugs manufactured by the said company. ❚❚ Dr KK Aggarwal, Consultant, Medicine and Cardiology, Moolchand Medcity, New Delhi Indian pharma industry is one of the top three growing industries of the world, it is expected to reach $20 billion by 2015. The domestic industry players have a major role in ensuring safety and quality and providing drugs at affordable prices. 'Counterfeit drug' is one which is deliberately and fraudulently mislabeled with respect to identity and/or source, as per WHO. Counterfeiting can apply to both branded and generic drug products. Counterfeit medicines may include products with the correct therapeutically active ingredients but fake packaging; with the wrong ingredients; without active ingredients or with insufficient active ingredients. In developing countries, drugs used to treat life threatening conditions such as malaria, tuberculosis and HIV/AIDS are generally counterfeited. It is the responsibility of every healthcare provider to ensure that the quality and safety of medicines are not c o m p ro m i s e d . S p u r i o u s drugs can take lives and it is the duty of the enforcing agencies to look into that. Whenever a person is not responding to a drug one should suspect a spurious drug. Stringent prompt time bound action should be taken in this aspect. (When asked about the doubt on the quality of drugs manufactured by Ranbaxy) I think it is a knee jerk reaction by Jaslok Hospital. The advisory should come from the Drug Controller Department or the Medical Council of India. Individual hospitals cannot follow that stand. If that was true the drug controller department by now should have come with their advisory.
ICU patients. Many companies outsource the manufacturer, procure it and then market it. Standards at manufacturing site is questionable. Same might have happened with Ranbaxy. All of us are under Drug Controller of India/regional areas. It is the responsibility of the Drug Controller to check the quality and inform to medical fraternity and withdraw the drug from market. Also the hospitals have to inform the Drug Controller if
they have doubt about the quality. As far as our hospital is concerned, we follow the Drug Controller’s instructions. The incident is an eye opener for the Drug Controller and hospitals to be aware of such a possibility. ❚❚ Dr Prashant Kulshrestha Unit Director, Rockland Hospital, Manesar As of now we are using branded products but we have definite plans to move towards having generic prod-
ucts. This will be of immense importance for Rockland Manesar as cost control and thereby service offering at competitive rates will always remain an area of importance. Instead of trying to reinvent the wheel our simple approach is that we go for compiling the list of generic (unbranded) products of lead manufacturers. In this endeavour we have chosen Dr Reddy’s Pharma Labs (which is among top 10 generic prod-
uct companies of the world). It is an Indian pharma giant and has got fair understanding of the market and its needs. It produces over 400 products covering all major speciality and super specialty in practice at our Rockland Hospital, Manesar. We also look ahead to involve other players like Sanofi (France), Sandoz (Germany) who have prevailing markets in India and are known for their quality.
❚❚ Dr Anil Kumar HOD Surgery, Head-Pharmacy & Therapeutic Committee Bangalore Baptist Hospital Spurious drugs are dangerous to the patients who have a false security of taking drugs and thinking their disease is under control. It can be life threatening in JULY 2013
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EVENTS UPDATE Green lean six sigma certification training for healthcare Date: July 12, 13, 14; July 19, 20, 21; July 26, 27, 28 (9 days program, sessions on weekends ; Fridays, Saturdays and Sundays only ) Location: Ahmedabad, Total seats available: 15 Last date to register: July 2, 2013 Summary: This program module is specially designed for hospital managers and other healthcare professionals and shall focus on Six Sigma methodologies, Lean Concepts in healthcare systems and service delivery. Participant profile: Hospital CEOs /COOs, Management Executives, Hospital Operations Managers, Quality in charge, MHA/PGDHA/MBA (HCM) final year students Organisers: AUM MEDITEC Trainer: Meeta Ruparel, Certified lean six sigma master black belt
pants on the scope of service delivery concepts, strategies and service operations concepts to ensure appropriate CRM and efficient operations management in hospitals. Fees: Rs 3300/- per participant Participant profile: Hospital CEOs/COOs, Management Executives, Hospital Operations Managers, Quality in charge, MHA/PGDHA/MBA (HCM) final year students Organisers: AUM MEDITEC Trainer: Meeta Ruparel, Certified lean six sigma master black belt Contact Meeta Ruparel Email: meeta@meditecindia.com, meetaruparel@hotmail.com Website: www.meditecindia.com
Green lean six sigma certification training for healthcare Date: August 9, 10, 11; August 17, 18; August 24, 25; August 31, September 1 (9 days program, sessions on weekends ; Fridays, Saturdays and Sundays only ) Location: Ahmedabad, Total seats available: 15 Last date to register: July 23, 2013 Summary: This program module is specially designed for hospital managers and other healthcare professionals and shall focus on Six Sigma methodologies, Lean Concepts in healthcare systems and service delivery. Participant profile: Hospital CEOs /COOs, Management Executives, Hospital Operations Managers, Quality in charge, MHA/PGDHA/MBA (HCM) final year students Organisers: AUM MEDITEC Trainer: Meeta Ruparel, Certified lean six sigma master black belt
Date: August 3, 2013 (Saturday) Location: Mumbai, Total seats available: 30 Last date to register: July 19, 2013
Date: November, 22-24, 2013
Summary: Clinical Trials Asia Summit will have a total of six sessions. They are Clinical trials: Current scenario and complexities; The pain points: regulation, ethics and bottom-lines; Quality Control; Emerging trends: vaccines and BA-BE; Quality by design (QbD); The combined learnings. Speakers who will take part in the summit are Dr TS Rao, Adviser, Department of Biotechnology, Ministry of Science & Technology, Govt of India; Dr Shreemanta Parida, CEO, Vaccine Grand Challenges Program, Dept of Biotechnology, Govt of India; Dr Sadhna Joglekar, Area Medical Director- India/Sri Lanka, Executive Vice President- Medical and Clincial Research, GSK Pharmaceuticals; Dr Rajendra H Jani, Senior Vice President -Clinical R&D, Cadila Healthcare; Dr Rajesh Avinash Chavan, Consultant ENT & Principal Investigator, Jehangir Clinical Development Centre; Kapil Maithal, Director, International AIDS Vaccine Initiative; Dr RS
Venue: Jawahar Lal Nehru Auditorium, AIIMS, New Delhi
To tie up with
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Organiser: Department AIIMS, New Delhi
of
Radio-diagnosis,
Summary: The 11th National Conference of IART will bring together experts from the field of radiology to deliberate on topics such as radiography, radiological imaging, radiology equipment, professional issues related to the subject, radiation protection, patient care and many more Contact: Organising Secretary Department of Radio-diagnosis, Ansari Nagar, New Delhi-110029 Tel: 09868398808, 01126546230 Email:ramesh_sh@hotmail.com
AIIMS,
66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA Date: December, 13-14, 2013 Venue: Scudder Auditorium, CMC Campus, Bagayam, Vellore Organiser: Department of Radiology, Christian Medical College, Vellore and the Vellore subchapter of the TN & PY chapter of IRIA
for Media Partnerships Contact kunal.gaurav@expressindia.com
Summary: This programme aims to teach partici-
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Venue: Hyderabad
Contact: Meeta Ruparel Email: meeta@meditecindia.com, meetaruparel@hotmail.com Website: www.meditecindia.com
Service Operations Management in Hospitals (1 day training workshop)
Contact details: Tikenderjit Singh Tel: +91 20 6727 6403/+91 20 6727 6412 Tel: +971 4 609 1570 Email: tikenderjit.singh@fleminggulf.com
Clinical Trials Asia Summit Date: September 26 and 27, 2013
Contact: Meeta Ruparel Email: meeta@meditecindia.com, meetaruparel@hotmail.com Website: www.meditecindia.com
Paranjape, Director, National AIDS Research Institute [NARI]; Dr Siddarth S Chachad, Head Global Clinical Development, Cipla; Dr Prasad Kulkarni, Medical Director, Serum Institute of India; Dr Khalid Saifuddin, Group Head-Central Continuous Remote Monitoring (CCReM), GCOOBD, Novartis Healthcare; Dr Deepa Arora, Global Head, Drug Safety & Risk Management, Lupin; Dr Himanshu Gadgil, Vice President, Intas Biopharmaceuticals; Dr Ranjeet S Ajmani, Chief Executive Officer, PlasmaGen BioScience; Dr Shravanti Bhowmik, General Manager- Clinical Research, Sun Pharma Advanced Research Company.
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Summary: The 66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA will lay emphasis on the ongoing and upcoming trends in the field of radiology and diagnostic imaging. Contact: Department of Radiology, Christian Medical College, Vellore Tel: 0416 228027 Email: registration@iria2013vellore.in; radio@cmcvellore.ac.in
JULY 2013
M|A|R|K|E|T POST EVENT
INS India organises conference for NCR nurses on infusion practices Launches the Delhi forum, the fourth city forum in the country after Chennai, Bangalore and Kolkata
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he Infusion Nurses Society (INS) – India, an international affiliate of the Infusion Nurses Society of the US, launched its Forum at Delhi. This is the fourth INS - city forum in the country after Chennai, Bangalore and Kolkata. To mark the occasion, INS organised a day-long conference at the Max Super Specialty Hospital, in association with 3M & BD, leading global medical technology companies. Built around the theme of ‘Safe Infusion for Safer Healthcare,’ it offered educational sessions, case studies, hands-on simulation labs and a number of presentations from experts. The event was reportedly attended by over a hundred stakeholders representing the Government, clinicians, nurses and other healthcare professionals. Mary Alexander, CEO, Infusion Nurses Society – US, in her video message said, “INS aims to set global standards in infusion nursing. We are committed to bringing innovative new resources and opportunities to healthcare professionals who are involved with the specialty practice of infusion therapy. Infusion is a very common but important nursing procedure, yet it does not receive as much attention in the medical world as it should. We plan to hold a series of conferences and seminars across India to disseminate knowledge about the latest standards and best practices in infusion therapy.” Added Rajnish Rohatgi, Director – Medical Surgical Systems, BD India, “Correct infusion therapy is extremely important for patients and healthcare professionals both. On a daily basis, nurses, clinicians and other healthcare professionals face the risk of injuries from needles and other medical sharps. Nothing much is being done in the country to reduce this risk by imparting proper training and knowledge. As a knowledge partner to this conference, we are pleased to offer the most up-to-date information on infusion therapy practices and technological advances, thus doing our bit to help deliver quality healthcare. Through these conferences and workshops, we seek to protect
JULY 2013
patients, healthcare workers, communities and the environment from the risks associated with unnecessary and unsafe injections practices.” Gautam Khanna, Executive Director, Healthcare
Business-3M India said, “Nursing is an integral component of healthcare. With the poor nurse-to-patient ratio in India, more time is spent in execution than in learning and sharing best practices. We
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have always encouraged empowerment of nurses by providing them access to discussion forums and continuous medical education programmes on best practices. As partners of INS, we provide
training to nurses across the country, and also share best practices to reduce infection and length-of-stay for patients, using advanced techniques.” EH News Bureau
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POST EVENT
CureHealth Diagnostics organises conference on cervical cancer Conference held at Moolchand Hospital had lectures and presentations by specialised doctors
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ureHealth Diagnostics, in joint venture with Moolchand Hospital, organised a conference on cervical cancer. The conference consisted of brief lectures and presentation on cervical cancer, breast cancer, CME on HPV and organ specific squamous cell carcinoma by specialised doctors and educated the delegates about gene expression in women. Lowell Gruman, Scientific Counselor and the Executive Director of IncellDx, California, the Chief Guest for the event, addressed the audience. Dr Prof Sadhana Kala, Sr Consultant, Dept of Obstretrics and Gynecology, Moolchand Hospital hosted the event. Dr Shanti Vardhan and Dr Vandan Sodhi spoke about the advancement of clinical diagnostic technologies in the area of cervical, head, neck and breast cancers. Dr Dinesh Gupta, Laboratory Director of CureHealth Diagnostics, spoke on the topic relating to “Importance and the Need to address Cervical Cancer”. Dr Gupta said, "The conference intends to create more awareness and better understanding about the concept relating to cervical cancer". EH News Bureau
(From L-R) Dr Dinesh Gupta, Dr Sadhana Kala, Lowell Gruman, Dr Vandana Sodhi, and a few others doctors with Dr Shanti Vardhan
Indraprastha Apollo Hospital organises seminar on blood donation Collaborates with State Blood Transfusion Council to observe World Blood Donor Day
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ndraprastha Apollo Hospitals (IAH) organised a national seminar on ‘Promotion of Voluntary Blood Donation’ to commemorate World Blood Donor Day 2013 at India Habitat Centre. The theme of the seminar was ‘Every blood donation is a gift of life’. The seminar was organised in association with State Blood Transfusion Council in NCT Delhi and NGO, Blood
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for All (B4A). The event was attended by Dr Surinder Singh, DirectorNIB and Dr Sunil D Khaparde Director-Blood Safety NACO. Dr RN Makroo, Director Department of Transfusion Medicine Apollo Hospital said, “Blood donation is a noble cause as it saves life, but most often their contribution goes unrecognised. We take this day as an opportunity to facilitate www.expresshealthcare.in
the donors, who are in true sense ‘National Heroes’ for their contribution to the society.” The day was marked by a colourful cultural programme including a skit by staff members of Department of Transfusion Medicine and song performance by thalassemic children. Through their performances the children stressed upon the dire necessity of
donating blood. Dr Makroo also spoke on the need for availability of blood components as opposed to whole blood. He also urged blood banks to improve the blood safety by incorporating latest testing technologies like Nucleic Acid Testing (NAT) besides serological ELISA tests to ensure blood safety and reduce the chances of infection. EH News Bureau JULY 2013
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M|A|R|K|E|T
POST EVENT
ABMH Pune organise National Conference on Infection Prevention The two-day conference reportedly witnessed more than 200 participants including speakers and delegates from renowned hospitals all over India.
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ditya Birla Memorial Hospital, organised a two-day national conference “ABMH IPC 2013” on infection prevention. CEO’s, COO's, Medical Administrators and Quality Heads from hospitals like Apollo Hospital, New Delhi; Narayana Hrudyalaya, Ahmedabad; Max Hospitals, New Delhi; Tata Memorial Hospital, Mumbai; Kokilaben Dhirubhai Ambani Hospital, Mumbai; Max healthcare, New Delhi; Columbia Asia, Pune; Tata Medical Centre, Kolkata; Fortis, Chennai and Breach Candy Hospital from Mumbai amongst others, discussed various factors for prevention and control of infection in the healthcare set-ups. During the conference various approaches, practices and methodologies
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JULY 2013
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were shared to bring about an improvement in infection control practices at hospitals to render quality services for better patient care and safety. The conference also had paper and poster presentation sessions which enabled the participants to showcase various initiatives undertaken by them at their hospitals to bring about an improvement in infection control practices. The topics discussed for prevention and control of infection in the healthcare set-ups were: ● Burden of HAI and effective collaboration and leadership in decreasing HAI ● Evidence-based infection control - how to perform ● Infection control indicators and benchmarking of infection rates ● Cost saving in infection control without compromising quality - various strategies ● Emerging threat of MDRGN - Outline evidence based control strategies ● Areas of research and practical aspects of control of MDRGN ● Implementation of various practices to control MDRGN and choice of antibiotics in MDRGN ● Surveillance data for quality improvement in ICU - How to plan, implement and maintain ● Medication delivery strategies - techniques and technology for patient safety ● Hand hygiene — The ultimate behaviour change strategies to improve compliance ● Re-use of single use devices - safe or unsafe ● Antibiotic stewardship ● Recent advances in microbial resistance – Focus on genetics ● Regulation of disinfection techniques in healthcare setting ● Biomedical waste management and newer disinfectants Active debate sessions on antibiotic use were also held with emphasis on: ● Prophylactic antibiotic use after 2-3 doses ● Restricted antibiotic use – Role of cultures ● Open ICU vs Closed ICU An opinion based discussion was also held on the need for an interdisciplinary meet with nursing/ intensivist/microbiologist/ physician. Different case scenarios like role of foot protection (slippers/foot JULY 2013
cover / no cover at all) were discussed. Sanjay Bhattacharya, Tata Medical Centre, Kolkata said, “Corporate hospital do have good infection control mechanisms in place. However, on the other hand, infection control in rural India is also a big challenge. We normally talk about infection control in corporate hospitals, however, corporate hospitals constitute a very small percentage of total hospitals available in
VARIOUS APPROACHES, PRACTICES AND METHODOLOGIES WERE SHARED TO IMPROVE INFECTION CONTROL PRACTICES
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India. Large chunk of Indian population belongs to rural India. Infection control measures in hospitals serving this population is an issue needed to be sorted out.” “The event was a grand success and also organised as a first of its kind in Pune city. It is a very good platform for all of us from the healthcare sector to review the current status of infection control and prevention in India and identify latest
strategies to improve them effectively. This sort of event also sensitises the policy makers, healthcare professionals for adopting proactive measures to improve the healthcare delivery at hospitals. We plan to come up with various such initiatives in the near future to improve the overall quality of healthcare delivery in India,” said Rekha Dubey, COO, Aditya Birla Memorial Hospital.
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Down the memory lane Medicall has grown from strength to strength since its inception in 2006. With Medicall 2013 in Chennai fast approaching, Express Healthcare recalls the journey traced by the premier event which is attended by crème le crème of the medical fraternity
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edicall—an event which gets top of the mind recall when it comes to naming successful events which bear a tremendous influence on the industry they represent. It is hailed as India’s premier medical equipment expo and the first real “supermarket” for hospital equipment and supplies. Thus, it has undoubtedly traced a success story, yet every story has a beginning.
The beginning Eleven years back, a young man out of medical college and his friends dreamt of starting their own hospital. The dream became a reality and a 30-bed hospital was built, which later went on to become a 400bedded hospital in South India. The ambitious young man who dreamt of establishing his own hospital and managed to do it against all odds was none other that Dr S Manivannan and his hospital is known as Kavery Medical Center and Hospital. However, this path to this achievement was not easy and was strewn with lots of trials and travails. Dr Manivannan and his friends faced many hurdles in the course of their growth and these very hardships and challenges were the seeds from which Medicall emerged. It was born with the idea to share their expertise with the fellow medical fraternity. They realised that many of their problems were a result of limited knowledge about the medical industry and thus, thought of sharing their own experiences and learning with the young and aspiring healthcare professionals of the present day so that their paths to success would be less strenuous and
more accessible. In his own words, Dr Manivannan states, "I am the Promoter-Director of the 400bed hospital group KMC hospital, Trichy, Tamil Nadu. I have undergone the pains of bringing up a hospital in a small Indian town where we rarely get an opportunity to know about latest developments in medical equipment industry. Big companies do not concentrate in such cities due lack of adequate sales force and feel that it is a small market. I wanted to share my experience which I gained over a period of a decade with my fellow colleagues and that prompted me to start Medicall expo."
Medicall – the rise over the years 2006: The first Medicall exhibition was introduced as a small medical equipment expo and was hosted at Chennai. It was very well received by the industry and there were more than 100 exhibitors and 3000 visitors. 2007: Medicall 2007 was bigger and better than its first edition. There were more exhibitors and visitors at the event. 2008: The third edition of Medicall attracted 5,400 visitors from across the country. Apart from hospital owners, hospital administrators, and people from other segments like dealers, architects, hospi-
Dr S Manivannan, CEO, Medexpert
tal consultancy, nurses, and biomedical engineers, exhibitors dealing with hospital flooring, lighting, energy saving equipment, storage solutions, ambulance fabricators, etc., also participated for the first time in this show. 2009: With more than 5700 visitors attending Medicall 2009, the expo bridged the gap between the buyers and users and managed to bring them together on one single platform. In this three-day expo, more than 250 exhibitors from all over India and China displayed their latest equipment. Medicall became a pan-India event than just a regional expo in Chennai. 2010: Availability of unique products, many exhibitors for the same product, international exhibitors were the USPs of Medicall 2010. It was bigger and more
incisive in terms of content and participation. International participation increased and over 400 exhibitors from China, Germany, Taiwan, England and India displayed their latest medical equipment. It grew to become India's largest and Asia's third largest medical equipment expo. 2011: Around 7500 visitors from India and other countries like Sri Lanka, Nigeria, Nepal, and Taiwan visited the three day show. The Healthcare Innovation Awards, instituted for first time in this edition of Medicall, attracted several applications from across the country. More than 430 exhibitors from India, Germany, China, Taiwan, Korea, Japan and Iran participated in the show and displayed A-Z requirement of hospitals. 2012: Medicall 2012 was again an year to remember with huge participation from healthcare industry experts and professionals as well as several new and innovative segments like fashion show on hospital garments and “Hospital Property Mela”. Over 500 companies exhibit ed at Medicall in the year gone by. It also saw an increase in exhibit space. Representatives from Germany, China, Taiwan, South Korea, Pakistan, Malaysia and more participated in Medicall events last year.
The future path With its constant evolution and growth, it is to be expected that Medicall 2013 will continue to provide a big fillip to healthcare sector in general and the medical equipment industry in particular.
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MEDICALL 2013 – Chennai, India's premier medical equipment show This year's edition of MEDICALL will be held in Chennai from August 2-4, 2013
Dr S Manivannan, CEO, Medexpert
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hen it comes to naming successful events which bear a tremendous influence on the industry they represent, MEDICALL gets top of the mind recall. It is touted as India’s premier Medical Equipment Expo and the first real “supermarket” for hospital equipment and supplies. Its huge and comprehensive range of exhibits include Hospital Information System (HIS) and solutions, surgical and examination furniture, rescue and emergency equipment, diagnostic/laboratory, OT equipment, refurbished equipment, hospital linen and laundry, nurse alarm systems, ambulance, hospital floorings, housekeeing equipment, liquid oxygen and central pipeline, physiotherapy equipment, autoclave and steriliser, dental/ophthalmology equipment, medical disposables and cleaning equipment. MEDICALL , undoubtedly the result of the acute vision and acumen of its organisers. As a brand it continues to draw the highest percentage of hospital owners, doctors, medical directors and purchase heads in addition to being a proven and highly successful platform for attracting affluent producers, dealers and suppliers. The fact that its previous hosting attracted exhibitors and quality visitors mostly from the its core target group, speaks volumes about the potential of the event. MEDICALL 2013 too has many interesting segments in store for its visitors and exhibitors. Called the 'Brainstorm MEDICALL' this year's event includes topics such as: ✦ Managing family run hospitals: Family owned hospitals face the twin challenges of managing mission and margin as well as business and family members' aspirations. Chennai business school, a reputed management institution is organising a seminar focusing on these ongoing conflicts. It will cover a wide range of topics including succession
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Medicall team: Yogita Panchal and Sundarajan
trols, functional and space planning, accreditation/ statutory approvals etc. ✦ Essential IT skills for hospital owners and managers: Topics of discussion include 'Importance of investment in Information Technology', 'Customised plans for different types of hospitals', 'Data Security, Accessibility, Availability, Cost Effectiveness' and 'Reduction of Dependency on IT Vendors and IT Professionals'. planning, resource allocation, scaling up and exiting businesses with eminent speakers from the industry sharing their experiences. ✦ Setting standards in sterilisation department: A comprehensive seminar covering design, operations, equipment, standards and quality control, including conformity to NABH. The topics will include 'How to design a sterilisation department', 'Basics of Autoclave', 'EOG & Plasma Sterilisation', 'Ideal Packaging Material', 'NABH Standards for Infection Control'. ✦ Robust medical records for hospitals: A step-by-step approach to initiate, plan and implement an Electronic Medical Records Department for hospitals of various sizes including nursing homes. www.expresshealthcare.in
Special emphasis will be on clinical research and conformity to International standards. The topics will include 'How to Design a MRD', 'Storage Solutions for Medical Records', 'ICD coding of diseases', 'How the data can be used for clinical research', 'NABH standards' etc ✦ Building hospitals, faster, cheaper and better: A detailed overview from feasibility to commissioning. Includes pre-design/strategic review, facility design, air conditioning/electrical/ plumbing requirements overview, project management, construction, medical equipment planning, hospital management systems future trends, master plan , design, elevation, choosing consultants, project execution, timelines, standards, quality con-
✦ Certificate programme in Hospital Management: The programme is being conductedIn association with Great Lakes Institute and Parama Healthcare. Topics covered will be points to consider while planning to start a hospital, project management, HR management, role of IT, audit in hospital, return on investment in quality, funding for hospital projects, front office management, patient feedback analysis, social media in healthcare, materials management, using modern technology etc ✦ Innovations in Health care: Medicall Innovation award winners share their story of rejection and recognition Thus, Medicall 2013, Chennai promises to be a power-packed event with interesting segments galore. EXPRESS HEALTHCARE
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‘MEDICALL 2013 is all set to be the biggest congregation of hospital owners in India’ Dr S Manivannan, CEO, Medxpert gives an overview of MEDICALL's evolution and a preview into this year's event, to Lakshmipriya Nair
How has an event like MEDICALL served the growth of the healthcare industry in the country? MEDICALL was started with the idea of promoting entrepreneurship amongst the medical fraternity. The first MEDICALL expo was held in 2005 with the idea of bringing all the stakeholders of hospital industry under one roof. MEDICALL provides an opportunity for Indian and international hospital needs companies to showcase their products and services. BrainStorm MEDICALL - seminars focusing on hospital management and MEDICALL Healthcare Innovation Awards attract the very best hospitals and medical professionals from all over India. Hospital owners have been depending on speciality conferences to source their equipment. But these conferences cannot satisfy the entire needs of these hospitals; hence
9500 visitors. This year, the show will have over 500 exhibitors, and we are expecting more than 10500 professional visitors. MEDICALL 2013 is all set to be the biggest congregation of hospital owners in India.
we have decided to organise a show which will serve as a hospital needs supermarket. With this vision, MEDICALL was started. So far many successful partnerships have been forged between manufacturers and distributors at MEDICALL events. How is MEDICALL 2013 different from its predecessors? This year we are emphasising on the presence of innovative healthcare solutions and services. BrainStorm MEDICALL will have eight parallel conferences focusing on interesting healthcare management topics. The Innovation awards has additional categories encouraging more innovation from different healthcare segments. What are the segments to look out for in this year's MEDICALL? Apart from the routine
medical equipment, MEDICALL will be focusing on modular OTs, CSSD, IT, fabrics and textiles. We will also be focusing on bringing the best and latest from across the globe. What kind of participation are you expecting at this year's event? Last year, the show had more than 450 national and international exhibitors and
How will the delegates benefit from the event this year? MEDICALL provides a cost effective and accessible opportunity for healthcare entrepreneurs, management professionals and physicians of India. With wider options of medical equipment and technologies, delegates can exercise the right choice in procurement. The BrainStorm MEDICALL – knowledge sharing sessions will help the delegates to take stock of the growth, discuss about the problems they face and identify opportunities for future. lakshmipriya.nair@expressindia.com
Rewarding Innovation An overview on the interesting MEDICALL Innovation Awards to be held this year in Chennai
Objective To recognise, showcase and encourage innovation in the field of healthcare
Number of Awards
✦There may be three winners, in each category, Gold,
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Eligibility
✦ Any organisation from any-
where in the world - commercial, not-for-profit, Government , Quasi – government, public sector undertakings, trusts, Charitable institutions. ✦ Employees and the relatives of the employees of Medexpert, Bio Vedas and
their partners are not eligible to participate ✦ Winners & Participants of Medicall Innovation Awards of earlier years are not eligible to participate with the same innovation. For more details visit www.medicall.in
Category
Description
Healthcare Delivery
Innovations that make healthcare delivery ✦ affordable, accessible and appropriate ✦ enhances the quality of service ✦ increases the patient’s safety ✦ reduces the medical errors ✦ shortens turnaround time ✦ enhances productivity ✦ improves outcomes ✦ increases customer delight
Medical Equipment, DiagnosticsHealthcare IT
Innovations in ✦Medical Equipment ✦Medical Diagnostics Information Technology Product/Services in the field of healthcare resulting in better, smarter, cheaper,safer,faster diagnosis & treatment
Hospitals Entrepreneurship
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Silver and Bronze ✦ The Jury may decide to change the number of winners depending upon the number of applications and quality of innovation
Innovations in ✦Business Models and Marketing
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Exhibitors Speak
ANAND B KOTWAL CEO, Machine Fabrik
Exhibitors at MEDICALL share their views on the event and their expectations from this year's edition
Agenda for MEDICALL 2013 We are planning to launch Plasma Steriliser and ETO Steriliser at MEDICALL.
TORSTEN WAGNER Head - Bavarian Delegation, Bayern International
N MURALI Director & CEO, Shuter Enterprises Expectations from MEDICALL 2013 The Bavarian delegation has been attending Medicall since 2011. To help establish contacts with Bavarian companies and comprehensive information on Bavaria as a business and high-tech location. Agenda for MEDICALL 2013 The nine companies participating in the Bavarian pavilion will showcase a wide range of products and services "made in Germany" which offer high standards in terms of technical innovation and quality. Most of them are seeking for a distributor. Others, such as Medi, already have a distributor in India so they already can push their sales efforts during the show. India is a very interesting market and has vast potential. Bavaria was searching for the right platform to promote products from Bavaria in India. It seems we have found this platform during the last show, because we found Medicall Chennai a professionally organised healthcare exhibition.
A RAJENDRAMANI CEO, Premier Enterprises
Expectations from MEDICALL 2013 We have been participating with Medicall since from year 2009. It was a good platform for us to launch our innovative product and gain customer acceptance. The show was fabulous in attracting the decision makers and their technical team. The Medicall is the prime show for the Hospital products at South India and they have grown in very short span of time. The organisation has become more professional and customer oriented which I feel is the key for their success. Agenda for MEDICALL 2013 We will be launching Emergency and Anesthesia cart at Medicall 2013. We are focused to provide the best in the industry and our this new product will sure to attract good demand. We produced keeping Indian customers in mind and the product will be competitive enough, hence every hospital can afford. The carts comes with host of features keeping utility in mind. We hope to get an opportunity to meet new hospital owners and project managers at Medicall 2013. There has been good developments in the past one year in the hospital industry. Many new projects are coming up in the tier II cities. It is good opportunity for them to visit and get to know the latest development in the industry.
Expectations from MEDICALL 2013 We have been associated with Medicall for more than five years. Overall it has been very good. This year we aim to gather good customer contacts and to develop business contacts and interact with manufacturers and traders Agenda for MEDICALL 2013 We plan to introduce international quality gauze products to all places in India and to launch new products at the event.
ABHAY MUNAGEKAR Director- Operations, InPro Corporation
Expectations from MEDICALL 2013 We have been participating in MEDICALL since 2013, from the Gujarat Exhibition. It was also the first MEDICALL that we attended. Our product was launched into the market about nine months back but we are depending on MEDICALL, Chennai to give us a lot of exposure into the Southern markets of India. Agenda for MEDICALL 2013 Other than the major cities, large areas of South India are still untapped by us and we hope to see a lot of prospective customers from Tier II and Tier III cities. We also hope to get in touch with consultants and architects who are majorly into the healthcare sector. We have attended one Medicall till now but one thing that we like is the diversity of various products exhibited at this event for the healthcare sector. JULY 2013
MANOJ DHARMAN MD, Modular Concepts
Expectations from MEDICALL 2013 We have been participating for MEDICALL for the past three years. The purpose of exhibiting at MEDICALL is an excellent way to grow our business opportunities and the right venue to meet the potential clients, consultants, architects and other healthcare experts. Yes we are going to showcase a new range of customised bed head units for the patient rooms and modular operating theatre (OT) systems. These bed head units can be customised accordingly to suit the patient environment and present a less clinical feel. It Integrates delivery of services like electricity, telephone, nurse call, lighting control , entertainment control, medical gases, support shelves for monitors and medical accessories and OT’s are with wall panels, ceilings and other fixed medical equipment. Agenda for MEDICALL 2013 We will have the opportunity to get information on the current market trends and new projects in the Region. We will meet and interact with potential clients, consultants, contractor’s hospital facility Biomedical engineers to share our information on new innovations and technology for Hospital Design and Engineering systems and help them with Turnkey solution for Hospital Design and Build. MEDICALL is the fastest growing business-to-business platform aimed at bringing together major players in the healthcare industry involved in planning, designing, construction, operating, managing and refurbishment of projects.
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‘This platform gives us an opportunity to reconnect with our users and understand their needs better’ Chandra Shekhar Sibal – Head Of Medical Division, Executive VP, Fujifilm India talks about his experience at MEDICALL, expectations from this year's event and much more
CHANDRA SHEKHAR SIBAL
Head of Medical Division, Executive VP, Fujifilm India
How long have you been associated with MEDICALL, how has it evolved over the years? This is the third year we are participating in MEDICALL. It has shown excellent growth in terms of visitors (including hospital key decision makers, individual customers, dealers etc). The very fact that we have bigger booth shows how MEDICALL had grown in stature as an important exhibition in South India.
opportunity to meet our existing users and get valuable feedback on our support and services. According to you, what sets MEDICALL apart from its counterparts? Today, from the cost point of view, an event has to give excellent returns(by way of new business) against investment which MEDICALL has done effectively over years for Fujifilm!
What is your agenda for MEDICALL 2013, are you launching any new products at the event? We would like to meet both our existing users and new buyers in this event. This platform gives us an opportunity to reconnect with our users and understand their needs better! This year is special as we are launching our new Digital X-ray reader unit Prima T2 which is a Table top high quality and high throughput CR system especially suitable for radiologists, small hospitals, ortho surgeons and small clinics. We are also introducing new generation DR Detectors (wired/wireless) in this event. We are also displaying our Dry Chemistry model FDC 4000. This product has got remarkable appreciation from customers and we hope to grow this market further. What insights do you expect to gather from MEDICALL 2013? This year we want to understand our product perception in the market from new buyers. We strive to give the best products backed with excellent services across India and we want to understand how the new buyers perceive us. Also this event, as mentioned above, gives us an excellent
CERTIFICATE PROGRAMME ON HOSPITAL MANAGEMENT In association with Great Lakes Institute of Management, Chennai, a leading business school India and Parama Health Care, a leading healthcare consulting company in India.Topics covered will be Healthcare marketing, Rule of thumb in hospital management, Finance for non-finance hospital managers, costing of medical procedures and a open house session on project expansion and hospital operations. 3rd August 2013
4th August 2013
Overview of programme An introduction to the program will be given highlighting the practical edge to the programme Patient delight: An internal process not limited to marketing Customer delight in healthcare has many dimensions with customers interacting with various points of service in a hospital. This presentation seeks to capture the essentials of how to delight the patients through a successful program conducted. Group work Participants are encouraged to form in to groups and are requested to discuss and come up with various issues. Tea Break Group presentation Conclusion Lunch Break Operational parameters- industry standards An insight in to what to learn from the past experience of hospital managers. Rule of thumb for managing hospital Hospital industry has over a period of time developed several rules of thumb in managing day to day operations.The importance of such parameters which are not found in text book are shared. Group Work Tea Break Group work presentation Presentation of conclusions/solutions
Importance of costing in hospitals Costing medical procedures- A practical approach Costing in hospital is as complicated as the nature of management of hospital.This lecture captures the objectives, various methods and issues involved. Group work Tea Break Group presentation Reading hospital financials for non finance hospital managers Understanding income statements and statement of position of a hospital has always been a challenge for non finance persons in the industry. A glance at simple methods of understanding is attempted. Lunch Break Open house discussions on project expansion and operational issues. Group wise selection of issues Experts who have worked in projects and management will be available for interactions to answer the practical problems faced by the hospitals Award of certificates and vote of thanks
Fee per Participant : Rs 8000/Group registration for institutions: for three registrations, one registration free
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Glimpses of glory
Pictures depicting some memorable moments of yesteryears’ MEDICALL
Speakers addresing the audience
Honoring the visitors
Visitors checking out the stalls
Awards for innovation
The MEDICALL team
The exhibition area
Delegates attending the Healthcare Innovation awards JULY 2013
Visitors checking out the products www.expresshealthcare.in
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STRATEGY W H AT ’ S INSIDE
ICRI hopes to be a catalyst in the growth of the healthcare sector PG 43
KNOWLEDGE 44 IT@HEALTHCARE 48 HOSPI INFRA 50 LIFE 77
MAIN STORY
The Great Indian Healthcare Factories: Dr Lal PathLabs The fourth in the series of articles on ‘The Great Indian Healthcare Factories’, featuring stories in healthcare that are exemplary and worth emulating, Gp Capt (Dr) Sanjeev Sood, Hospital Administrator and NABH empanelled Assessor, chooses Dr Lal PathLabs and traces the reasons that contributed to its success. The first success story covered was that of Narayana Hrudayalaya, (Express Healthcare, November ‘12), the second was of Aravind Eye Care System (Express Healthcare, February ’13) and the third was of Operation Smile (Express Healthcare, April ’13)
The diagnostic laboratory services are responsible for 70 per cent of all clinical decisions and are critical to delivery of quality and evidence-based modern medical care. Indian diagnostic services market is currently growing at a healthy rate of 20 per cent annually and is pegged at approximately $3.4 billion in size (Source: PwC). However, in a highly fragmented sector, comprising 50,000-100,000 path labs nationwide, one name that stands out as an undisputed leader is that of Dr Lal PathLabs (LPL). Established in 1949, LPL today is the largest and most reputed diagnostic service provider in the country. It has a proven track record of over six decades for strict adherence to international standards and is recognised as a centre of innovation and a premier clinical pathology laboratory in Asia. What makes this story immensely successful and gives it a competitive edge that others can only envy and wish to emulate? To answer this question, one has to examine the visionary leadership, strategic management, professional excellence, unique business model, value for customers and other key attributes of LPL.
A glimpse into the history It was in 1949, when the
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National Reference Laboratory at Rohini, Delhi nation was still recovering from the trauma of partition that the late Dr (Major) SK Lal migrated from Rawalpindi to Delhi and laid the foundation of Dr Lal PathLabs at ‘Eskay House’. Laboratory services as a distinct entity in healthcare ecosystem were unheard of in those days. Trained at the Cook County Hospital, Chicago, US, he was one of a few eminent pathologists of his times, and equipped with great expertise and far sighted vision, Dr Lal sowed the seeds of an organisation that was destined to become Asia’s premier testing labs. www.expresshealthcare.in
The strategy At the core of LPL strategy is its commitment to provide the best professional diagnostic services through a unique network of laboratories and supporting units, integrated supply chain and leveraging cutting-edge technology to seamlessly run its operations with a factory like efficiency and productivity. It has incorporated highest standards of quality, professional ethics and customer centricity as a part of its organisational DNA. LPL is endowed with great strategic vision that thinks innova-
tively and plans smartly for the future in a way that rivals cannot anticipate its adroit moves. Thus, LPL has consistently maintained undisputed leadership in terms of its size, market share and revenues in the diagnostic services arena.
Business model - size does matter Today, LPL has a network of over 150 labs, it has established over 2,000 sample collection centres, have additional 3,000 pickup-points (‘hub and spoke model’) and tests nearly 30,000 patients a day thereJULY 2013
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The author interacting with Dr Arvind Lal by serving 10 million customers annually nationwide. It offers the widest test menu and has a pan-India presence in all important cities and towns in the form of state-of-the-art laboratories and patient service centres. Its employee strength is over 3,000 professionals which include 550 technical and 250 marketing staff. In 1995, LPL got corporatised by creating a private limited company from the earlier partnership. LPL market value has grown nearly 20 times since VC firm West Bridge Capital Partners invested Rs 28 crores ($ 6.5 million) by taking a minority stake in LPL in 2005.
Men leading the organisation
The state–of-the-art data centre at National Reference Laboratory
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In 1977, Brigadier Dr Arvind Lal, took over the reins of LPL and carried forward his late father’s legacy. He received his graduate and post-graduate medical education from the prestigious AFMC, Pune.
Lab technicians working on sophisticated equipment Under his able guidance and dynamic leadership, LPL has become one of the most reputed laboratories in Asia, having many firsts to its credit. He has revolutionised laboratory medicine by introducing the maximum number of new tests, equipment and embracing ICT systems into its operations. Member of many expert and advisory bodies constituted by the central and the state governments, Dr Lal is credited with having forged the first public private partnership (PPP) in the field of laboratory testing with the Government of Tripura since 2004; Gujarat in 2011 and now with Chhattisgarh. Wearing many hats, Dr Lal is also the Chairman of the Healthcare Committee of the PHD Chamber of Commerce and the Founder Treasurer of the newly formed Healthcare Federation of India (NATHEALTH) - an association of eminent Healthcare stakeholders on the lines of NASSCOM. He is also an active member of National Healthcare Committees of CII, FICCI and ASSOCHAM and has played a pivotal role in flying the Indian healthcare flag high internationally. In 2001, Dr Lal was appointed as the Honorary Physician to the President of India. He has also been serving as a pathologist to many present and past senior dignitaries. LPL is the nodal laboratory, testing the largest number of government employees in India from CGHS, ECHS, Ministry of Railways, Delhi Government and many others. Conferred with the Padma Shri, Brig Lal has also been granted an Honorary Brigadier’s rank in the Armed Forces Medical Services by the President of India. For the successful management of www.expresshealthcare.in
LPL, in 2005 he created a team of professionals and administrators led by Dr Om Manchanda, an alumnus of IIM-A.
Rohini - The flagship lab Spread across an area of 85,000 sq ft over six floors, the National Reference Lab at Rohini, Delhi, is equipped with state-of-the-art technology and best professionals in the industry that meet international standards and deliver world class diagnostic services. NRL provides a onestop solution for all routine and sophisticated tests and serves as a scintillating example of India’s growing prowess in launching Indian healthcare industry at a global pedestal. It is the biggest lab in Asia and its histopathology department receives nearly 500 biopsies a day – highest work-load for any Indian Lab. This lab is equipped with a centralised distribution facility to all departments with bar coding, unique ID for each sample and bidirectional instrument interfacing. This ensures error free intra lab tracking system with high throughput by means of an automated pneumatic tube system.
Dr Lal PathLabs –Where quality is the leitmotif, a recurrent theme LPL subscribes to the mantra of 'Total Quality Management' that practices, “get it right, the first time, and always” as an integral part of its organisational philosophy. With strict adherence to international standards, biosafety norms and benchmarks, it is not a surprise that LPL has the distinction of running 12 accredited laboratories and 15 applicant labs in India. It was the first Indian lab to be awarded the
accreditation from National Accreditation Board for Testing and Calibration Laboratories (NABL), Department of Science and Technology, GoI. It is also the first lab to be accredited by the international gold standard accrediting body College of American Pathologists (CAP) which has awarded Dr Vandana Lal, Executive Director, an International Fellowship. LPL has also been awarded the prestigious ISO 9001:2008 from British Standards Institution (BSI) .No wonder that several premier hospitals in smaller towns repose great trust in LPL’s name and prefer to outsource their pathology services to LPL.
Customer-centric services It was in 1980, when Dr Arvind Lal met an elderly diabetic gentleman coming thrice to the lab from a distance– first for fasting glucose, then for post prandial and lastly to collect the report in the evening. Moved by the discomfort caused to such patients, he decided to provide lab services at the door steps of patients by introducing collection centres for the first time in the healthcare industry. Since then, LPL has initiated a slew of customer-centric and patient-friendly initiatives like home collection of samples and delivery of reports at door step, online access of tests and reports. With a view to provide complete diagnostic services, LPL has also added radiology and cardiac evaluation tests to its product portfolio, for early detection of lifestyle diseases.
Leveraging technology and managing supply chain A highly advanced logistics system supports the wide network of labs and collecEXPRESS HEALTHCARE
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Dr A Lal receiving Padma Shri award from Ex-President Pratibha Patil
tion centres. LPL introduced the path breaking laboratory information system that ensures 100 per cent accuracy and use of web-enabled technologies for remote registration and printing of reports. The latest T-3 level Data Centre facility at Rohini is designed and maintained by IBM. Sophisticated softwares like Microsoft Axapta, Abbott StarLims with HL-7 are deployed on a mission critical Application Server that connects the 150 labs spread nationwide. The LIMS SW also enabled interoperability of diagnostic instruments to the central server, thus establishing a bi-directional interface for the first time in an Indian lab in 1999. This SW also planted the seeds of establishing country wide network of satellite labs and collection centres. In addition, the 21 CFR part-II, Compliance Document Management System ensures secrecy and confidentiality of sensitive patient information and audit trail of all transactions. It also facilitates speedy registration of patients and transmission of data at the destination labs much before the sample reaches. LPL’s Kanpur satellite lab was the first lab in the world to use satellitebased communication with VSAT and central server in Delhi for real time and online running of diagnostic machines. LPL has also an effective disaster recovery
Dr A Lal being granted the Hony Brigadier’s rank as Dr Vandana and Dr Archana Lal look on
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Dr (Major) SK Lal with former President Dr S Radhakrishnan mechanism in place.
Research and development-fuelling growth and innovation To fuel its growth and drive its quality services, LPL has a dedicated unit for R&D and allocates two per cent of its overall budget to research activities. The R&D unit reinforces the organisational philosophy by continuously innovating and developing cutting-edge technologies to achieve diagnostic accuracy, particularly in area of molecular diagnostics. LPL also operates a dedicated clinical research services unit servicing several pharmaceutical companies. The organisation’s R&D unit is recognised by the Dept of S&T, GoI with the aim to provide highly specialised tests at an affordable cost to the public at large. Spearheaded by Dr Vandana Lal, this unit has done India proud by developing highly sophisticated tests in molecular diagnostics like the Real Time PCR for HIV Viral Load Studies, Tuberculosis, Genotyping for Hepatitis C Virus, Swine ‘Flu test, BCR ABL, PML RARA, HPV, JAK 2, Chimerism for Bone Marrow Transplants, GenExpert for TB and Resistance and KRAS Mutation CODON 12,13 etc. Sophisticated Chromosome Analysis, Immuno suppressant Drug Monitoring by LC-MS/MS, Leukemia Translocations, HE4 and ROMA (Risk of Ovarian Malignancy Algorithm) have been also introduced by LPL In line with its philosophy of achieving growth through learning and knowledge, LPL www.expresshealthcare.in
plans to set up an integrated pathology institute, awarding DNB degrees, Fellowship in Laboratory Medicine and MLT diploma. The facility already boasts of wellequipped library, eminent faculty, video conferencing facilities and specialised “penta head microscope” – a state-of-the-art tool for histopathology teaching.
Milestones, achievements and awards LPL has a consistent performance track record of pioneering work in the field of diagnostics. It has an impressive list of firsts to its credit since its early days in the field of test introductions, bringing new technologies from the West and use of world class methods for phlebotomy and pioneering the franchisee model for sample collection and report delivery. In recognition of its distinguished service spanning six decades, LPL has been recipient of many awards and accolades. Recently in 2012, it has been conferred with: eIndia award in the category Best Use of Technology by a Diagnostic Service Provider, Franchise India excellence award in hall of fame category, Microsoft Customer Spotlight, Computerworld Honors Laureate Program, Frost and Sullivan 4th Annual India Healthcare Excellence Award, and Diagnostic Service Provider Company of the Year.
Future plans Not to rest on its past laurels, LPL aims to reach out to every nook and corner of India with their world-class diagnostic services. Keeping
sight of its mission, the company has charted a five-year plan which includes continuing to grow at a CAGR of 35 per cent, expanding through organic and inorganic means, and entering new international markets. Key elements of the plan are: ● Expansion into under served markets ● Strategic alliances with acquisition/mergers of existing players and PPPs with State Governments ● Imaging and cardiology centres ● Launch of IPO to finance above projects
Over 60 years of nurturing trust During the last six decades (1949 - 2013) of its operations, Dr Lal PathLabs has become synonymous with trust and reliance in the field of pathology services. LPL has ensured to provide sophisticated lab services of proven clinical value with accuracy, speed to the people in remote areas at an affordable cost. Treasuring this trust, it has emerged as one of the highest accredited laboratories in the country, delighting over 10 million customers per year. Banking on state-of-the-art technology and highly skilled personnel, it shall continue to achieve excellence in diagnostic medicine and services to become India's most valued company to patients, customers, business partners and the communities it serves. Thus, LPL has been able to weave a great success story that is truly Indian and worth emulating and replicating as a benchmark by healthcare organisations JULY 2013
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‘ICRI hopes to be a catalyst in the growth of the healthcare sector’ SR Dugal, Chairman, Institute of Clinical Research (ICRI) gives an insight on the changing landscape of Indian healthcare industry, its future prospects and ICRI’s role in furthering the progress of the sector, in an interaction with Lakshmipriya Nair The Indian healthcare sector is growing at a rapid pace and is expected to reach $ 280 billion by 2020. What kind of opportunities would this growth open up for those seeking to make a career in this sector?
Healthcare is one of the biggest career generators of this century. The healthcare industry will employ more people than the IT industry of this country. The IT industry is worth $100 billion today and could touch $110 billion or so whilst the health industry will be double the size. We would expect that this sector will generate hundreds of thousands of jobs and apart from doctors and nurses, there will be a big requirement for masters in health administration (MHA) graduates to handle business development, health counselling, TPA processing, insurance, operations management, HR, finance maintenance etc. At another level there will be a requirement for caregivers, ward boys, ambulance drivers, assistant pharmacists, pharmacists and people in the health support services. These are going to be the new growth areas for websites catering to health issues, wellness companies, fitness companies, spas, physiotherapists, psychiatrists etc. To give you an idea, in the US close to 15 per cent of the workforce is in the health area, the single biggest employers. The other thing we must all realise is that over 60 per cent of the staffing is non medical. This is a major opportunity for engineers, accountants, economics graduates and life science students as well. What are the steps that need to be taken up on the national front to ensure optimum utilisation of opportunities?
As a nation we have the doctors and there is a huge ongoing expansion capacity taking place for more doctors and nurses, but we also need to recognise the need for MHA graduates to take on the various positions in medical tourism, training of care givers, ward boys, customer relations executives, business development executives, accounts and HR which looks at how to manage highly qualified specialists. New institutions are needed to fill these gaps, we have to borrow this knowledge from UK or US since prior to early 2000 there was no emphasis on management of health as JULY 2013
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it was in the public sector or the charity domain.The corporatisation of healthcare is recent, less than six or seven years. Hence it is necessary to adopt practices which are efficient, effective and health centric for which a number of new institutions catering to this sphere would have to come up, IIM Bangalore has taken some initiatives, so has ICRI but many more such institutions are required.
with in that fashion. What kind of results are you envisaging from plans that ICRI has set in motion?
In the next five years, we expect health to become a major part of our business alongwith clinical research. We aim to pioneer and lead this revolution in India. We are now working with Cranfield University to bring manufacturing techniques in the areas of QC and QA with regards to healthcare. This would lead to not only improvements in productivity but also lead to higher rates of survival due to superior ward management, care management, maintenance etc.
According to you, what are the healthcare verticals which would see maximum progress? Why?
The healthcare areas which will explode are day care centres, superspeciality hospitals, old age and care homes for recovery or for the chronically ill, ambulance services (these are today rudimentary) and health insurance. We can expect a complete revolution in the healthcare sector as 7-star hospitals, 5-star hospitals, budget hospitals and the super low budget hospitals as well as day care centres come up. The central labs and the diagnostic centres will be big chains spread across the country, we should get ready for corporate giants in these fields. The other explosion which will take place is over the Internet, which alongwith mobile telephone will be a major marketing, diagnostic and consultation tool. It would also help reduce patient visits with a large majority of consultation, diagnostics and prescriptions being carried out digitally. Large companies will enter this space, not unlike online retail companies. Thus we may see a huge number of new entrepreneurs being born. What changes are required on the education front to create healthcare professionals who would be equipped to deal with the metamorphosis of Indian healthcare sector?
A complete new set of institutions are required to train managers, marketing professionals and HR personnel in this sector as healthcare has
very different needs from other industries. It is necessary to bring best practices from outside India, particularly from UK and US where the health sector is well developed and has been evolving over time. Our current management schools do not cater to this sector effectively. Allied health is a separate area and there are specialised institutions in both UK and US. It is not part of the medical school or the MBA School and this is what has to happen here. How does ICRI plan to play a role in propelling the growth of the sector?
ICRI is in the area of allied health and has a separate school of health with specialisation in that area. It has brought MHA and a whole host of programmes for different levels of personnel in the allied health area. It has also tied up with one of the best schools in the world i.e. Cranfield University. ICRI has been a pioneer and leader in clinical research and it is now continuing on the same track with health .It has partnered Cranfield University for over seven years in CR and is now partnering it in health. We are following the model that health is a specialised area and must be dealt
What are the pitfalls that could hinder the growth of the sector? How would ICRI’s moves help to tackle these hindrances?
The pitfalls in this area of health will be non availability of sufficient funds. The health sector has to be differently handled by the banking sector and RBI guidelines have to be different for this sector since it has its own problems in terms of high investments. A lack of understanding by the government agencies in insurance legislation and tackling of issues such as current insurance plans will prevent the growth of the day care centres and the pharma industry. Lack of availability of trained manpower is another issue. Another major problem is the failure to develop facilities to deal with various market segments. Ethics again will be an area of great concern What are ICRI’s future plans and how would they be beneficial to Indian healthcare?
ICRI hopes to play a major role in manpower development. It also hopes to be a catalyst in the growth of this sector. It hopes to bring in best practices from the globe to this sector. An example is the application of manufacturing techniques to healthcare. lakshmipriya.nair@expressindia.com
“A COMPLETE NEW SET OF INSTITUTIONS ARE REQUIRED TO TRAIN MANAGERS, MARKETING PROFESSIONALS AND HR PERSONNEL IN THIS SECTOR AS HEALTHCARE HAS VERY DIFFERENT NEEDS FROM OTHER INDUSTRIES” www.expresshealthcare.in
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W H AT ’ S INSIDE
‘SPMF therapy has a potential to become first line of management for cancer patients’ PG 46 'We aim to set standards for infusion care' PG 47
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Genetic testing of breast cancer: The widening horizon A bird’s eye view of breast cancer prevalence, diagnosis and the role of BRCA1 and BRCA2 gene testing, from Dr Faisal Khan, Sr Research Officer-Knowledge Management, R&D, SRL
T This story is of a beautiful girl who has almost everything it takes to make life complete and fulfilling. She is a successful career woman. She has a loving family. She is a doting mother to her kids. She is physically fit and is blessed with good health. But fate wanted to throw an unpleasant surprise at her when she underwent a medical examination, a gene sequencing test. The results of her BRCA1 and BRCA2 gene testing projected an exponentially high risk of developing breast cancer in the near future. This was further complicated by her discouraging family history of breast tumours. Her scenario changed dramatically. She was scared of the impending doom. However, a ray of hope ushered in when she learned that preventive measures can be exercised. But, the choice was tough. She was told that the only panacea to avert her risk of breast cancer was prophylactic surgical removal of the breasts, also known as mastectomy. This presented a huge personal dilemma to her. She had to choose between her own physical appearance and her health, future and family. The benefits certainly outweighed the drawbacks of the procedure; she thought of it pragmatically, futuristically and like a modern woman before she opted to go under the surgeon’s knife for excision of her breasts. She is none other
than the one and only heartthrob of millions and millions of fans across the globe, Angelina Jolie. Jolie’s story speaks volumes about the phenomenal impact of the advancements in medical diagnostics; on the lives of people, all over the world. “Nevertheless, it is ironical that though tremendous progress has been made in the realm of breast cancer diagnostics; direct benefits of these diagnostic advancements have touched the lives of very few women, particularly in developing nations like India,” said Dr BR Das, President, Research and Innovation, SRL. “It is time that we made an effort to reach out to all women with a family history of breast cancer and at least spoke about the availability of such a test,” he added.
Breast cancer epidemiology: Emerging trends Epidemiological data presented in the 2006-2008 report of the Population Based Cancer Registry (PBCR) which is a subset of the National Cancer Registry Program, reveals a dismal picture1. The report shows
Dr Faisal Khan, Sr Research Officer-Knowledge Management, R&D, SRL www.expresshealthcare.in
that almost half of India’s breast cancer cases are below the age of 50 years. The analysis revealed that breast cancer comprised 22 per cent to 32 per cent of all female cancer cases in major Indian cities with the most alarming incidence reported in Mumbai. Globally, breast cancer accounted for 23 per cent (1.38 million) of the total new cancer cases and 14 per cent (458,400) of the total cancer deaths in 2008. About half the breast cancer cases and 60 per cent of related deaths are estimated to occur in economically developing countries like India2. As per recent data published by the WHO, the five-year survival rate of moderately advanced breast cancer cases in India was 48 per cent3. This is notably low as compared to the robust 89 per cent fiveyear survival rate in the US, as revealed by the American Society of Clinical Oncology (ASCO) in 20094. These figures compel us to introspect on the low five-year survival rates of Indian breast cancer patients in comparison to their Western counterparts. The answer lies in the degree of robustness of 'breast cancer awareness campaigns and routine diagnostic surveillance.' The Western world has succeeded in reducing the burden of this disease and in escalating survival rates; primarily due to stringent and meticulous large scale routine screening of breast cancer and huge mass awareness campaigns. This diligent effort seems lacking in the Indian healthcare system. Negligence in routine screening leads to breast cancer being undiagnosed in its initial stages. As a result, most patients are diagnosed only when the aggressive metastatic Stage 3 or 4 cancers develop. In fact, what makes us really uneasy and apprehensive is the PBCR report’s find-
ing that the most aggressive forms of breast cancer, (HER2 positive, ER/PR negative or the worst variety HER2/ER/ PR negative) are much more rampant among the young age group in India1.
Low incidence but high mortality: Indian irony With respect to breast cancer incidence and mortality figures; a comparison of India with other countries of the world, elucidates some interesting facts. The reported incidence of breast cancer is much higher in countries like the US and UK than that in India (101 in the US and 87 in the UK versus 19.1 in India per 100000 women)5. This is primarily because most cases of breast cancer are diagnosed during routine screening, documented and reported while calculating incidence rates, in the Western world. The converse is true for India. Due to relatively less stringent community surveillance of breast cancer, innumerable Indian cases remain undiagnosed and thereby unreported. These cases are missed out while accounting for Indian incidence rates and are identified only when progressive symptomatic disease strikes. Thus, though the incidence rates are lower, India’s breast cancer mortality figures are ironically higher than the western world. The overall percentage of breast cancer deaths at India stood at about 50 per cent a decade ago while similar mortality figures for China and the US were a meagre 30 per cent and 18 per cent respectively5.
The 'Diagnostic Mix' with a special focus on BRCA1/BRCA2 testing To alleviate the burgeoning burden of breast cancer cases, the Indian healthcare system should exercise potent measures to ensure regular screening, early diagnosis JULY 2013
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lifestyle changes are not just recommended but are almost mandatory and warranted. Chemoprophylaxis is yet another potent weapon in the armoury of breast cancer risk reduction. Clinical studies have shown that administering anti-cancer agents like tamoxifen and raloxifene to high risk subgroups of women can significantly reduce the risk of developing breast cancer or its recurrence. These agents have been approved by the US FDA for chemoprevention of breast cancer in known high risk subgroups5.
and risk forecasting for breast cancer. Hence, a 'diagnostic mix' of routine mammograms and clinical examinations; along with gene testing for high risk candidates (testing for BRCA1 and BRCA2 mutations) seems the most pragmatic solution. Within this diagnostic mix, BRCA1 and BRCA2 gene testing for high risk group of women offers clinical advantages which are very distinct from those of routine mammography and clinical examination. BRCA1 and BRCA2 gene testing provides the benefit of forecasting the genetic tendency of a healthy individual to develop breast cancer in the future; an advantage not available through other surveillance methods6.
Cancer genetic testing: A peek into the future
Identifying the right candidates for BRCA1 and BRCA2 gene testing A detailed family and personal history can prove very instrumental in deciding whether a woman is a suitable candidate for BRCA1 and BRCA2 testing. Women with a pronounced family history of breast cancer involving first and second degree relatives, a familial history of ovarian cancer, a family history positive for BRCA1 and BRCA2 mutations or BRCA1 and BRCA2 positive tumours seem to be ideal candidates for BRCA1 and BRCA2 gene testing6. Besides these, certain known high risk subgroups, like women with a history of late pregnancies, those with early menarche and late menopause, those with a history of past long term hormone replacement therapy (HRT) or currently ongoing HRT, obese women with a physically inactive lifestyle and those with a
DR BR DAS President, Research and Innovation, SRL
“It is ironical that though tremendous progress has been made in the realm of breast cancer diagnostics; direct benefits of these diagnostic advancements have touched the lives of very few women, particularly in developing nations like India. It is time that we made an effort to reach out to all women with a family history of breast cancer and at least spoke about the availability of such a test”
References 1.Consolidated report of the Population Based Cancer Registry (PBCR) report (2006-2008). Accessed at http://www.breastcancerindia.net/bc/statistics/trends.htm on 1st June 2013 2.Jamal, B. Freddie, M Melissa, Jacques JULY 2013
F, E Ward and Forman D; GLOBOCAN 2008. Global cancer statistics. Ca Cancer J Clin 2011;61:69–90 3.Cancer Survival in Africa, Asia, the Caribbean and Central America. WHO’s IARC publication number 162. IARCSurvCan, Lyon 2011 4.American Society of Clinical
history of chronic or regular alcohol consumption; can also be considered for BRCA1 and BRCA2 testing5. In case of these high risk subgroups, clinician’s judgement on a case-to-case basis and individual patient choices would drive the decision to undergo the gene test.
Women for whom the BRCA1 and BRCA2 test reveals a positive result, several precautionary and prophylactic measures can be exercised. In cases wherein the percentage of risk projected by the BRCA1 and BRCA2 test is too high, prophylactic mastectomy can be resorted to, after thorough oncological consultation. This procedure involves bilateral surgical removal of the breast tissue. As much of the 'at-risk' breast tissue as is possible is removed during this procedure. This minimises the possibility of developing breast cancer in the future to very negligible levels. Presently, there are no clear cut universally accepted clinical guidelines or recommendation criteria to judge the eligibility of
a woman to undergo prophylactic mastectomy based upon BRCA1 and BRCA2 test results. Therefore, decisions to opt for prophylactic mastectomy post BRCA1 and BRCA2 testing are purely made upon a case-to-case basis6. Risk-mitigation plans would typically involve prophylactic control of factors that are known triggers of breast cancer. This would include a precautionary regimen comprising of reduction of obesity, avoidance of alcohol, indulgence in strenuous physical activity, avoiding the use of hormone replacement therapy, avoiding late pregnancies, breast feeding, using birth control pills for contraception and opting for oophorectomy in consultation with a qualified medical specialist, if needed.6,7 These changes can help women with BRCA1 and BRCA2 mutations to significantly reduce the risk of developing breast cancer. One could counter argue that most of these generic lifestyle changes can be recommended to any woman as a safeguard against breast cancer, regardless of BRCA1 and BRCA2 status. However, for BRCA1 and BRCA2 mutation positive high-risk women, these
Oncology data accessed on 1st June 2013 at http://www.breastcancerindia.net/bc/statistics/stati.htm 5.J. Fertay, F. Bray et al; GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide, IARC Cancer Base No. 5, Version 2.0; IARC Press,
Lyon 2004 6.National Cancer Institute fact sheet on ‘BRCA1 and BRCA2: Cancer Risk and Genetic Testing’. Accessed at http://www.cancer.gov/cancertopics/fact sheet/Risk/BRCA on 1st June 2013 7.Rebbeck T, Levin A, Eisen A, Snyder C, Watson P, Cannon-Albright L et al.
BRCA1/BRCA2 mutation positive cases: Prophylactic and preventive measures
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A market research report by RNCOS revealed that the global genetic testing market which stood at $1.5 billion in 2010 is expected to touch the $4 billion mark by 2015.8 According to this report, the oncology segment will predominate the realm of genetic testing worldwide. However, the realm of genetic testing is faced with multiple ethical concerns. The bioethics of genetic testing revolves around issues like the social stigma attached to an abnormal genetic status, the panic created by abnormal gene test results, the financial and personal implications of gene test results on the lives of patients, the need for precise and sensitive genetic counselling and deciding the therapeutic options to be chosen based on gene test results. These are a few examples of the ethical issues involved which can not be ignored. There are umpteen other ethical dilemmas associated with genetic testing, beyond the scope of this write up, which need to be addressed prior to and after testing. Besides, affordability of genetic testing remains a major concern especially in a country like India; though the costs of several gene tests have now reduced dramatically, making them more affordable to patients. However, in spite of the ethical dilemmas and other obstacles, genetic testing is considered as a promising diagnostic tool. The clinical utility of genetic testing continues to captivate the attention of patients and the healthcare fraternity worldwide.
Breast cancer risk after bilateral prophylactic oophorectomy in brca1 mutation carriers. JNCI J Natl Cancer Inst (1999) 91 (17): 1475-1479 8.RNCOS. Global genetic testing market analysis. Accessed at http://www.rncos.com/Report/IM352 .htm EXPRESS HEALTHCARE
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‘SPMF therapy has a potential to become first line of management for cancer patients’ In order to eliminate the problems associated with the tradition therapy for treating osteoarthritis and cancer, SBF Healthcare has introduced sequentially programmed magnetic field (SPMF), a non-invasive therapy that is reportedly devoid of side effects. Wg Cdr (Dr) VG Vasishta speaks about the technique, its uses and his vision to promote this technique in India, in an interaction with Raelene Kambli
INTERVIEW Tell us about the SPMF Therapy? Sequentially programmed magnetic field (SPMF) therapy is a technology that delivers highly complex SPMF, which can be precisely aligned onto the target tissues inducing cellular regeneration in osteoarthritis or degeneration in cancer. These are nonthermal, non-ionising and have no known side effects.
How is it helpful in treating osteoarthritis and cancer? Osteoarthritis: Osteoarthritis (OA) is the second most common rheumatological problem and is the most frequent joint disease. It is caused by progressive degeneration of articular cartilage.The cartilage has very limited regenerative capacity. Exposure to SPMF can enhance cell regeneration. SPMF therapy sensitises and recreates the missing physiological piezoelectric stimulus necessary for cartilage regeneration. Cancer: Cancer is the uncontrolled growth of abnormal cells in the body. The cell membrane potential of cancer cells are about -15mV to -30mV. SPMF Therapy increases the membrane potential and restores energy production. Exposure of cancer cells to SPMF therapy normalises this potential, thereby halting the process of cell proliferation. The normal cells are not influenced by the SPMF exposure as the Magnetic Field Generators (MFGs) are aimed at the core of the tumour. Studies have demonstrated that electromagnetic fields cause antitumour activity and significant increase in apoptosis in tumours of treated animals.
How is this therapy different from the traditional one; especially in terms of its benefits? This modality of treatment is a unique non-invasive technique, painless, cheaper and scientifically proven. For the time being we are using it to treat OA and cancer, but the potential is enormous. Diseases like tinnitus, diabetes, Alzheimers, degenerative disc disease of the spine can also be addressed in which clinical trials are being initiated. Benefits: The procedure is noninvasive and the treatment is very safe
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rest the rest of the world aware of this technique? How do you plan to promote this technique nationally as well as internationally?
without any side effects. During the treatment, there is no discomfort; dependency on painkillers is vastly reduced. For cancer patients: It halts the progression of the disease and improves quality of life. There is an improvement in survival period and the emotional and psychological wellbeing of the patient. For osteoarthritis patients: It enables natural regeneration of cartilage and significantly decreases pain. This therapy is a cheaper alternative to knee replacement, where both knees can be treated simultaneously. It increases mobility in patients. It improves stability and strength of the knee joints. Patients can carry on their normal activities during the treatment.
There is some awareness worldwide as patients have come to us for treatment from over 33 countries. There is much more we can do to promote awareness and we are taking appropriate steps to do the same. Promotion is mainly done through publishing papers on the technology in research journals, medical journals, newspaper advertisements, lectures, seminars, articles etc.
How many patients have undergone this therapy at your centre? What is the recovery rate? SPMF Therapy has a record of over 5000 successful OA cases from over 33 countries and has aided in treating problems ranging from the knee, lower back, hip and ankles. Several cancer patients have been benefitted from SPMF therapy so far. The success rate in OA is about 85 per cent. In cancer the quality of life and longevity has improved remarkably for those who have undergone the SPMF therapy.
Is it cost effective as compared to the traditional therapies? Yes it is a cost effective treatment when compared to the standard modalities of treatment. On an average total knee replacement (TKR) costs around two to four lakhs; however SPMF therapy costs 70,000 per joint. The traditional treatments of cancer are variable depending on the type, stage and grade of the disease and the cost may run into lakhs. However, SPMF therapy costs Rs 1, 50,000.
When was this technique introduced in India? SBF Healthcare & Research Centre was founded in 2006 by me soon after I took voluntary retirement from the Indian Air Force. I served as the principle investigator in the clinical trials conducted from 2003-2006 where pulsed magnetic fields (PMF) of a certain frequency and amplitude were used to treat osteoarthritis (OA). These PMFs were delivered by a device called AKTIS SOMA invented by me. I have also published patents for the same in India, USA and I also have a worldwide PCT.
How many experts in India practice this therapy? PMF have been used earlier for decades but have not been very effective. SPMF therapy is the world’s first scientifically proven, non-surgical treatment to help regenerate cartilage and restore mobility of arthritic knee
joints. It has also proved to be extremely effective in the treatment of certain types of cancer. SBF Healthcare & Research Centre is the only place in the world, where SPMF therapy is practised.
How long are you practising this therapy at SBF? SBF Healthcare started operations with two centres, one each in Bangalore and Mumbai. In FY11, it opened two franchisee centres in Mumbai. Currently, the company has four clinics, one in Bangalore and three in Mumbai. SPMF therapy is being practised in SBF since 2006. The treatment for osteoarthritis is a 21-day process, which does not require hospitalisation. The total time required for treatment each day is 60 minutes. The treatment for cancer is daily for one hour for 28 consecutive days.
You say that SBF Healthcare is the only place in the world where this technique is practised, so is the
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Are there any challenges associated with this therapy? What precautions need to be taken? There are no challenges associated with this therapy since it is a unique non-invasive technique, painless, cheaper and scientifically proven treatment for osteoarthritis and cancer.
How do you see the progress of this therapy in India? SPMF therapy has a potential to become first line of management for cancer patients, since the standard treatment modalities are fraught with side effects.
What are your plans for SBF? We are planning to put our centres in all major cities and smaller cites of India. We have planned to take this to overseas like USA and Europe. We will be looking at the Far East as well as Singapore, Thailand and Malaysia. raelene.kambli@expressindia.com
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‘We aim to set standards for infusion care’ To promote good and safe practices in the administration of medication and fluids through a needle or catheter, Infusion Nurses Society launched its first-ever forum to improve patient care in North India. Col Saravjeet Kaur, Governing Council member and Head – INS Delhi Forum, shares her views with Shalini Gupta Why has the need for infusion therapy increased in the Indian scenario? More than 90 per cent hospitalised patients receive infusion therapy today. Increased patient flow is the ground reason behind this which in turn is fuelled by patient awareness of getting treated an early stage to prevent further complications, the availability of safe therapy, wider acceptance of infusion therapy for treatment, urge to get well sooner, improvement in the hospital infrastructure and advancement in medical practice, etc.
What are some of the risks associated with unsafe infusion practices? The various risks associated with unsafe infusions include: ■ Infections related to contamination of infusate or contaminated infusion delivery equipments,etc. ■ Allergic reaction ■ Transmission of dreaded infections like HIV,HBV, HCV,etc. to patients as
well as healthcare workers. ■ Needle stick injuries to healthcare workers ■ Exposure to chemotherapeutic medications, etc.
What are the goals and aims that Infusion nurses society(INS) has set for itself? Globally there are various bodies like the INS-US, Association of Perioperative Registered Nurses (AORN). that have contributed greatly in having uniform and right practices. We aim to set standards for infusion care, by developing and disseminating standards of practice, providing professional development opportunities and quality education, advancing the speciality through evidence-based practice and research, supporting professional certification and advocating for the public, all this in alignment with the vision and mission of the Infusion Nurses Society of US.
What is the current awareness level amongst nurses and healthcare pro-
fessionals on infusion therapy?Are nurses trained for such a procedure? Though all the healthcare professionals are aware of Infusion therapy, very few actually are aware of best practices/latest guidelines.The nurses get only basic training in infusion procedures during their training, but majority learn the actual practices in the clinical areas such as handling of central lines, arterial lines, peripherally inserted central catheter (PICC) lines etc.The curriculum needs to be audited in order to make sure that the next generation is equipped with the right education. Hospital and training institutes need to gear up to address this challenge.
How do you plan to train professionals in such techniques? In an ideal scenario we will want all the nurses across the country to have enhanced knowledge and skills, by designing training programs in accordance with standard practices, that will focus on improving practices and better patient outcome. We shall also look at
partnership with hospitals and healthcare industry, who are trying to achieve similar objectives. High attrition in corporate sector is a challenge with nurses moving on every 1.5 years to foreign countries, or government sectors. We are also liaisoning with Indian Nursing Council, to give some recognition to IV nurses so that when they re-register after five years, they get credits and get re-registered with state nursing councils.
What practices in particular do nurses need to be trained in? These include, techniques for intra venous device insertion-which include site selection, securing of IV, right size cannula etc., management of invasive lines like central, arterial, PICC lines, reconstitution and administration of medications like antibiotics, chemotherapy, total parenteral nutrition (TPN), PPN etc., blood and blood product transfusion, infection control practices and preventing and managing complications. shalini.g@expressindia.com
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IT@HEALTHCARE MAIN STORYAIN STORY
Deploying digital technology for progress Rajiv Tewari, Director, Health & Wellness, Rockland Hospitals Delhi, elucidates on healthcare management of patients at home through digital technology
T The story of Jens Danstrup explains the potential of patient care at home through digital technology in India. Jens Danstrup, a 77-year-old retired architect from Denmark had weakened lungs due to smoking which made it difficult for him to even walk to his doctor’s place. Digital technology helped him go to the doctor without leaving home, using easy to use devices with a personal computer and a web camera. He is able to take his weekly medical readings, which are logged into his electronic records. He is also able to sit on his desk and video chat with his nurse who is located several kilometres away. Moreover, Jens can clip an electronic pulse reader in his finger and easily send his readings to his doctor. The doctor then reads the reports and can advice appropriate medication which too can be supplied by a chemist through an online prescription. The Danish information system is certainly one of the most efficient in the world allowing the doctors to save a lot of administrative time. The Danish government is reported to have saved millions of dollars due to the usage of digital technology in healthcare.
Potential for patient care at home There is a growing population now in the Indian metros which in spite of financial prosperity is at risk from isolation, depression, strokes
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and fractures caused by falls in the home due to an increase in the number of nuclear units due to children settling abroad or in other cities within India. This is an opportunity area for the healthcare service providers. Digital assistance in such cases will go a long way and what is more is that the technology is now easily available. Digital patient care at home is being used globally for the geriatric patients, physically challenged and the patients with chronic conditions. This will become a critical tool in the care management models in India too. Home-based care management model will be the key to quality care, as it saves time of the doctors enabling them to see larger number of patients and also help in reducing costs. ABI Research, a market intelligence company specialising in global technology markets, has projected that www.expresshealthcare.in
by 2016, wearable wireless medical device sales will reach more than 100 million devices annually. The market for wearable sports and fitness-related monitoring devices is projected to grow as well, reaching 80 million device sales by 2016. Many segments of patients require regular data recording which can be done with the help of easy to use latest technology tools. These tools can record actionable, real-time care information while the patient is at home. This will lead to better monitoring, diagnosis and timely treatment by the doctors. The new technologies enable the tracking of medication intake and vital signs. The doctors can have access to real-time, round-the-clock care information via an easy-to-use, cloud-based platform. Webbased dashboards can be easily viewed, analysed, and acted upon by the care team in quick time frames. These digital systems can alert the
doctor and family members of events such as a fall. Patients can get also reminders on medication and check ups.
Digital technology for home care in India The digital infrastructure in India as well as the rest of the world has been building for a while. Smart phones, social networks and apps usage is growing simultaneously and becoming a need for many. We are already witnessing the beginning of a digital health management system in operation which can prove to be the best and most efficient way of getting out of our healthcare mess with smart and cost-effective solutions. Home healthcare in India currently includes monitoring devices, therapeutic devices, interventional devices and home services. Interventional devices include drug delivery mechanisms, for example, are used JULY 2013
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by the diabetics. Home services currently include inhouse nurse care and to a limited extent patient monitoring. Companies like Philips and GE are in the market with sleep care and home respiratory care solutions. A variety of home healthcare services are being offered through a wide range of tests at the doorstep- X-rays, ultrasound and ECG besides an array of pathological tests. Apart from a few players like Philips Healthcare, Metropolis Health Services, Religare GE, Medinova, Dr Lal's Pathlabs, the sector is largely unorganised.
Model for India Hospitals in India are yet to offer the home healthcare facility in a significant manner but the trend is expected to grow in the near future. India needs a unique healthcare delivery mechanism to be able to deliver patient care at home. This would need a network of trained healthcare volunteers connected to the doctors in the clinics, nursing homes, small hospitals and tertiary care hospitals. Rockland Hospitals has
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HOME-BASED CARE MANAGEMENT MODEL WILL BE THE KEY TO QUALITY CARE, AS IT SAVES TIME OF THE DOCTORS ENABLING THEM TO SEE LARGER NUMBER OF PATIENTS AND ALSO HELP IN REDUCING COSTS built a medical corridor with a chain of hospitals in the Delhi NCR and is in the process of launching a Health Network with plans for adding digital care at home. Rockland will focus on the special needs of those who suffer from disabilities of various kinds or due to old age. A difficult gynae case, an old or disabled person may need an emergency attention, or there could be a physically challenged person in the house who needs special attention through digital monitoring. A digital monitoring system and connectivity with tertiary care hospitals will help in an immediate response to the patients. Modern day technology can connect the entire network for a seamless flow of communication and clinical
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data for better diagnosis and treatment. The penetration of mobile phones in the country can be easily leveraged for connecting the entire network through mobile apps. The challenge will be in ensuring quality certification and management of the response system which would need a major shift to a mind set. The healthcare service providers need to reach out to the patient instead of the other way around. Hospitals as well as the patients will gain if the hospital stay is reduced by providing home care for post surgery patients and the medicine patients who can be treated at home. This will also increase the availability of beds for other needy patients. It is time for the
healthcare industry to move out of the per bed management systems and shift to a per patient system where the home beds can be used to augment the availability of beds. The potential of this market is bound to energise the old established players in healthcare and at the same time bring new players into the market to respond the needs of the patients. India will witness a big bang in the healthcare services innovation in the next couple of years. Healthcare entrepreneurs, in the near future, will bring disruptive innovation in the delivery of healthcare services due to increased pressure on bottom lines and a huge inflow of investments at the same time. Patient care at home is a big opportunity for the health entrepreneurs to leverage their investments in doctors, infrastructure and technology. India with a well developed IT capacity can do this too. Hospitals with fully equipped with state-ofthe-art IT systems allowing the patients' records to be seamlessly integrated into the system should not be a major challenge in the near future.
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HOSPITAL INFRA MAIN STORYSTORY
Paints: Coming of age in healthcare infra Paints, a long ignored component in healthcare infrastructure, is gradually gaining its importance, thanks to the manifold advantages offered by the range available in the market, growth of informed consumers and the efforts of the players in the paint industry, finds Lakshmipriya Nair
H Healthcare designs have undergone a sea change in India. The emphasis is on creating healing environments than just functional and stark set ups to dispense treatment. Today, be it an Apollo, a Fortis, a Seven Hills, a Hinduja Surgicals, a Medanta Medicity or Global Hospital, lot of thought and effort have been put into determining the look and feel of these healthcare facilities. So, while due importance is being given to lighting, flooring, layout, ambience and multitude of other factors while designing a healthcare facility, can paints be ignored? A rhetorical question with an obvious answer. NO! Painting walls and surfaces are nothing new; paints have always been an integral part of décor. But, to believe that they have no other purpose apart from acting as a decorative agent would be a mistake. If chosen with care and consideration, paints seek to serve several purposes of which the two most important are:
Acquiring the right aesthetics and ambiance In a world where impressions are everything, hospitals can no more afford to be the depressing places that they used to be, with their gloomy interiors and peeling walls. Moreover studies have proved that the design and look of a place have a very
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fundamental role to play as far as a person’s psychological well being is concerned. Hence, it has become imperative to create an atmosphere which is bright yet relaxing and comfortable to put the patients at ease. One of the easiest ways of brightening up a room is to paint its walls and surfaces, provided that the right colours and finishes are chosen. As Percy Jijina, Sales Director-Decorative Jotun India says, “Choosing the right colour and product is very essential. Especially when it comes to healthcare or hospitals, experts have become extremely careful to make the right choice.” Giving an insight into making the ‘right’ choice, Jijina guides, “The colours that are used inside a hospital vary from area to area. For example, the paint that would be used in an ICU or in an operation theatre will be different from the one used in a nurse station or a maternity ward. The difference in the kind of exterior and interior paint is also planned by the experts.” “When it comes to the choice of the right colour for a hospital, it should be a nice balance of both warm and cool colours. Cool colours tend to be more calming, so shades of blues and the blue-greens put people at ease and a balance of these colours with some warm colours like neutrals, beautiful beiges and wood tones give a nice sense of tranquillity,” he further elaborates. Sukhpreet Singh, Vice President of Marketing & Sales (Decorative), Kansai Nerolac reiterates the same view and says, “A well thought out colour palette can work wonders for a hospital. Colours should be chosen with plenty of deliberation, www.expresshealthcare.in
keeping in mind not only the type of facility, but also the individuals who will be using it.” “A healthcare institute is a place where patients come for treatment and are already facing illness. Bright and lively colours should be used in hospital rooms in order to avoid looking dull, and help reduce the depression of the patients,” he adds. Similarly, the right paint finish can also determine the look, durability, and ambiance of a room. Some of the common interior paint finishes (paint sheen) are flat, eggshell, satin, semi-gloss, and high-gloss. Each of these finishes serves different purposes. Some of them even help in sound absorption and thus reduce noise levels which help to create a peaceful environment for the patients. Thus, the role of paints in getting the right look and feel in healthcare set ups is very crucial. They can help create the right ambiance and do their bit in making the healing process faster.
Healing with hygiene The importance of hygiene and sanitation in healthcare set ups cannot be over emphasised. Yet preserving sanitation and cleaning these places is a herculean task. A lot of effort and resources are needed to keep a hospital spick and span. However, now at least the walls can be easily kept clean and uncontaminated by choosing the right paints. “Paints must enhance the feeling of well-being and safety”, says Manish Bhatia, General Manager, Marketing, Decorative Paints, Akzo Nobel India. “Paints used in this industry need to be ecofriendly, durable and must possess attributes of hygiene and cleanliness,” advises Jijina. Singh counsels, “It is imperative that healthcare set-ups use paints that have low-VOC content. Paints with high Volatile Organic Compound (VOC) content can impact the hospital’s indoor air quality and produce tangible health concerns JULY 2013
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MANISH BHATIA
BRIG JOE CURIAN
PERCY JIJINA
SUKHPREET SINGH
General Manager, Marketing, Decorative Paints, Akzo Nobel India
Chief Executive Officer, Seven Hills Hospital
Sales Director - Decorative Jotun India
Vice President, Marketing & Sales (Decorative), Kansai Nerolac
Paints must enhance the feeling of well-being and safety. Paints used in this industry need to be eco-friendly, durable and must possess attributes of hygiene and cleanliness
Paints can contribute immensely to build a healing environment if proper selection of the paint is made with the patients’ psyche in mind
Choosing the right colour and product is very essential. Especially when it comes to healthcare or hospitals, experts have become extremely careful to make the right choice
More and more hospitals are getting increasingly aware of the benefits of use of healthy paints. But, awareness in the Tier 2/3 markets is still low
like – headaches, throat irritation, sneezing and eye irritation.” Bhatia also reiterates this view and states, “The paint should be environment friendly and low on VOC. Also, factors such as Optimum Open Time (time taken by the paint to dry), and whether the paint contains toxic material are some of the factors hospital authorities need to keep in mind before selecting paint for their institution.” Similarly paints with features like washability, stain resistance, high water repellence, dust resistance, anti peel formula etc. are also available in the market. “The property of superior stain resistance and washability keeps the walls hygienic, dirt free and beautiful-looking for longer,” informs Bhatia. Using them in healthcare set ups would ensure that hygiene and sanitation on the walls are maintained without fuss and too much trouble. Thanks to the evolution of the industry, now paints do not just preserve walls but also actively protect. There are antimicrobial and anti fungal paints available which can supposedly tackle several kinds of bacteria and fungi like MRSA, E.coli and Salmonella, that can cause health problems such as blood poisoning, respiratory and intestinal infections. Choosing these paints for healthcare set ups can be instrumental in tackling a major challenge— hospital acquired infections (HAI). Features like high crack tolerance, good anti-flame spread, larger wall-coverage, low odour, heat guard, ecofriendly properties etc., are some of the other protective qualities to look for while
selecting paints for hospitals and healthcare facilities.
Express Healthcare1, Anirban Das, Chief Architect - Projects & Consultancy Division, Medica Synergie informs, “Colour is typically the first thing we notice when we enter a space. Colour can alter the apparent size and warmth of a space, evoke memories and associations, encourage introversion or extroversion, induce anger or peacefulness, and influence our physiological functioning.” Thus, the going is good and hence the paint industry sees a lot of growth potential in this sphere. Thus, in a bid to woo the industry and exploit its latent potential each of them have drawn out their own strategies. Singh informs that Kansai Nerolac has a special team that takes care of the hospital and healthcare vertical. He says, “There is still a general lack of awareness about the ill effects of unhealthy and unsafe paints. Building awareness and showcasing the unique benefits of the product is a key task. Demos, presentation tools and international certifications play a key part in marketing a new concept like this.” While Jotun doesn't have a separate team it offers a service wherein its team not only provides guidance on which type of paint to use but also advice on the colour schemes and themes to be used in various places. The efforts seem to have paid off and more and more healthcare players are giving more attention to the paints they choose for their hospitals. Agreeing that the healthcare industry has become much more conscientious, Bhatia from Azko Nobel says, “Consumers are becoming
more empowered and they want to understand the preventive measures for an improved life. Unhealthy work-life environment, pollution, epidemic, natural disasters, ethical considerations are all increasing the demand for healthcare services. This has led to mushrooming of highquality health institutions or hospitals with better facilities and an increased awareness about products that enhance the feeling of well-being and safety.” Similar views are expressed by Kansai Nerolac's Singh, “More and more hospitals are getting increasingly aware of the benefits of use of healthy paints. But, awareness in the Tier II-III markets is still low.” Jotun's Jijina also informs, “Of late the hospitals and diagnostic centres have also shown interest in procuring the right colour and right kind of paint.” Thus, despite the various challenges and obstacles that remain, paints have gradually begun to get their due importance in the healthcare infrastructure. The paints industry, expected to touch Rs 50,000 crore2, too has a chance to grow even more by tapping the potential available in this direction and thereby create a win-win situation for both the industries concerned, finally benefitting the most important stakeholder—the end consumer.
Filling the gaps Thus paints can play a major role in delivering effective healthcare and is a vital component of healthcare infrastructure. But, are the healthcare players aware of this? Does the industry understand and give paints the due importance that it deserves while planning healthcare set ups? The answer would be that while paints still rank below technology, lighting etc., gradually the industry is waking up to the advantages of choosing the right paints. Brig Joe Curian, CEO, Seven Hills says, “Paints can contribute immensely to build a healing environment if proper selection of the paint is made with the patients psyche in mind.” He further informs, “The quality and durability of the paint, especially in areas of frequent usage as well as wear and tear is very important. The environment created in the hospital must contribute to a general feeling of well-being and optimism. Hence, colours for different rooms have been chosen taking into account the types of patients who are expected in such areas. Calm and soothing colours are chosen for the interiors of Operation Theatre, Cath Lab, ICU etc. In the wards, the colours chosen were to give a feeling of being energetic, and are relatively brighter. Kid’s areas are a combination of colours of the outdoor, play rooms, birds and animals.” Architects and designers creating healthcare designs have also become conscientious about choosing the right paints. In an article written for www.expresshealthcare.in
References: 1. http://healthcare.financialexpress.com/201109/hospitalinfra04.shtml 2.http://www.indianexpress.co m/news/indian-paint-industry-to-touch-rs-50000-cr-markby-fy16-ipa/1061405/0 lakshmipriya.nair@expressindia.com
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RADIOLOGY INTERVIEW
‘Radiation studies suggest that up to 10 per cent of invasive cancers are related to radiation exposure’ Various new studies validate the growing body of evidence of the risk that radiation exposure poses. There is an increasing awareness amongst clinicians to use different forms of imaging that can cut back even further on radiation exposure. Even equipment manufacturers are gearing up to ensure the same. Raveendran Gandhi, Senior Director, Radiology at Philips, gives Shalini Gupta a low-down What are the international guidelines around radiation exposure? What is the situation in India? The guidelines established for radiation exposure have had two principle objectives: 1) to prevent acute exposure; and 2) to limit chronic exposure to acceptable" levels. Exposure limits are defined by The International Commission on Radiological Protection (ICRP) and other such groups and regulators worldwide maintain that they should be at "as low as reasonable achievable" (ALARA) especially for diagnostic and radiation medicine. The guidelines for US and other countries established by competent government regulatory authorities are based on the ALARA principle and are thoroughly followed and implemented in routine clinical practice. For example, the radiation dose limits associated with any diagnostic examinations are specified with declared upper limits and often known to the dose recipient. Atomic Energy Regulatory Board (AERB), being the apex regulatory control body of all X-ray emitting equipment and its operational facilities in India has laid down clear guidelines for radiation safety. Individual guidelines for radiation medicines include definitions of radiation production, storage, transportation, operation and use and finally the disposal of radiation wastes. For diagnostic devices, it covers the operational facility, exposure measurements and monitoring features for safety of patient, equipment operators, employees and the public. Though there are clear guidelines, ensuring adherence to these guidelines is often a challenge in India. AERB has taken some very proactive steps recently, including decentralising its regulation to the state governments and union territories to set up its own Directorate of Radiation Safety (DRS) as well as sign MoUs with Maharashtra, Odisha and other states to ensure its clear implementation.
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INTERVIEW
What devices usually expose patients to radiation in order of high to low exposure? How can this be avoided? What inbuilt mechanisms in the device can prevent this? We are aware that medical devices ranging from X-ray machines, CT scans, cathlabs, bone mineral density scans, OPGs, etc. are all using ionising radiation for diagnosing diseases. Usually a plain X-ray examination or BMD test uses low dose of radiation as compared to a CT scanner or a cathlab machine. The amount of radiation exposed to patient from equipment varies depending on several factors such as the type of investigation, age, sex and number of examination etc. A plain X-ray without a dye injection may not generate significant radiation dose (approximately 0.02 millisievert (mSv) to a patient.When compared that with natural background radiation dose of 1-3 mSv per year ,this dose is surely insignificant, however when we compare it with a coloured X-ray, such as Barium enema, the dose may go up significantly higher up in the range of 5-7 mSv. Similarly, the amount of dose delivered in CT examinations also varies.
imaging contributes almost as much radiation dose to the public as natural radiation. Radiation can also cause changes in DNA and patients receiving radiation treatment experience acute effects of nausea, vomiting or even burns. Pregnant women are specifically told not to get themselves exposed to radiation as it may harm the foetus and may lead to congenital problems.
Is there a permissible level of radiation exposure? What can be some of the risks of radiation exposure? Are women at a higher risk as compared to men?
What is the awareness level in India amongst physicians about radiation exposure?
The Atomic Energy (Radiation Protection) Rules have prescribed the dose limits for exposures from ionising radiations for workers and the members of the public, which shall be adhered to range from 1mSv a year for the normal public to 20 mSv a year for workers and 6 mSv for apprentices and trainees. Inferences from radiation studies suggest that up to 10 per cent of invasive cancers are related to radiation exposure, including both ionising and non-ionising radiations. Exposure is known to increase the future incidence of cancer, particularly leukaemia. In developed countries, medical
There is a varied knowledge on radiation exposure but overall the awareness is perceived as low, across the globe and specifically in India. This can be attributed to lack of adequate training given to the staff, specialists and physicians. It is generally perceived that many doctors across the world underestimate the lifetime risk of fatal cancer and many of them have never had the opportunities for any formal training on risks to patients from radiation exposure. However, there are several recent clinical studies on radiation effects, (especially on children) pointing out the increasing the risk of cancer. This has created lot
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How are equipment suppliers such as yourself working to lower the radiation exposure through improved software programmes and better devices? Every radiation emitting device contains dose limiting and dose optimisation features. In an X-ray machine it may be filters which eliminate unwanted soft X-rays, radiation field limiting diaphragms or a collimator. CT scanners have highly evolved dose optimisation features ranging from filters, collimators, cone-beam diaphragms, highly sensitive detectors and iterative reconstruction features. At Philips, we have imbibed the ALARA principle in its true spirit while designing our low dose diagnostic machines designed with extensive research. Our product iDose4 was recognised as the ‘Best New Radiology Software’ during RSNA 2012. It is an iterative based reconstruction technology recently introduced with Philips CT scanners that helps reduce radiation dose up to 80 per cent without compromising on the quality of images delivered. We have shipped a thousand of these within a short span of their inception in the market. In addition to this, for each diagnostic test, a patient undergoes in a Philips CT scanner, it automatically generates a report of the radiation he/she receives for the test.The cumulative summary of such results are useful while prescribing patients who require multiple follow up CT scans. “Dose-Aware” is a radiation exposure monitoring device we developed for cathlab operators that provides live feed about total exposure the operator received during a cathlab procedure and helps avoid unnecessary exposure to radiation. Our unique Time of Flight (TOF) technology available with PET/CT scanners reduces radiation dose to less than 50 per cent using less than 5 mSV FDG (Radioisotopes injected to a patient prior to a PET/CT scan) where as a conventional PET/CT might require around 10mSV of FDG injection.
standard for CT image reconstruction for decades. While it is a very fast and fairly robust method, FBP is a sub-optimal algorithm choice for poorly sampled data or for cases where noise overwhelms the image signal. Such situations may occur in low dose or tube power limited acquisitions (Scans of morbidly obese individuals). Noise in CT projection data is dominated by photon count statistics. As the dose is lowered, the variance in the photon count statistics increases disproportionately. When these very high levels of noise are propagated through the reconstruction algorithm, the result is an image with
significant artefacts and high quantum mottle noise. Our new technology, iDose4, uses iterative processing in both the projection and image domains. The reconstruction algorithm starts with projection data where it identifies and corrects the noisiest CT measurements (those with very poor signal- to- noise ratio, or very low photon counts). Each projection is examined for points that have likely resulted from very noisy measurements using a model that includes the true photons statistics. Through an iterative diffusion process, the noisy data is penalised and edges pre-
served while ensuring that the gradients of underlying structures are retained, thus preserving spatial resolution while allowing a significant noise reduction. The noise that remains after this stage of algorithm is propagated to the Image Space, however the propagated noise is now highly localised and can be effectively removed to support desired level of dose reduction. Then the iDose4 algorithm deals with subtraction of the image noise while preserving the underlying edges associated with true anatomy or pathology. shalini.g@expressindia.com
How do you ensure that reducing radiation exposure in the CT scanner does not affect its image quality? How can it be retained? Filtered back projection (FBP) has been the industry JULY 2013
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