Express Healthcare September, 2013 Part 2 by Indian Express

TECHNOLOGY FOR HEALTHIER LIVES EXPRESS HEALTHCARE USER CONNECT INITIATIVE

IDEAL IQ: Non invasive, radiation free liver evaluation IDEAL IQ MRI system, finds favour with Dr Vijaya Bhaskar Nori, Vista Imaging â&#x20AC;&#x201C; Hyderabad, who finds it useful as a non-invasive tool for all types of fatty liver diseases

IDEAL IQ is a promising MR-based tool for non-invasive assessment of fatty liver disease

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SEPTEMBER 2013

TECHNOLOGY FOR HEALTHIER LIVES

1 OUT OF 4 NORMAL INDIAN ADULTS AND 9 OUT OF 10 OBESE PEOPLE SUFFER FROM FATTY LIVER AND CARRY THE RISK OF PROGRESSION TO SEVERE LIVER DISEASE INCLUDING CIRRHOSIS AND LIVER CANCER

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atty liver disease has captured the attention of specialists recently as it has a high risk of progressing to liver cirrhosis or hepatocellular carcinoma (HCC). In the past, alcohol was the most common cause for accumulation of fat in the liver, now diabetes and obesity are the major concerns as they cause non-alcoholic fatty liver disease (NAFLD) which is emerging as an important cause of liver disease in India. Epidemiological studies suggest prevalence of NAFLD in around 9 per cent to 32 per cent of the general population in India with higher prevalence in those who are overweight or obese and those who are diabetic or pre-diabetic. 1 out of 4 normal Indian adults and 9 out of 10 obese people suffer from fatty liver and carries the risk of progression to severe liver disease including cirrhosis and liver cancer. NAFLD is also rising in children and adolescents because of these risk factors. Indians are more prone to develop insulin resistance and NAFLD in comparison to other races and this proneness in Indians may have a genetic basis. Indian adults with NAFLD have higher visceral adipose issue responsible for increased abdominal obesity in these patients. A fraction of the patients affected by NAFLD steatosis progresses to inflammation and fibrosis, a condition known as non-alcoholic steatohepatitis (NASH). Since liver cirrhosis and HCC are difficult to treat it is of great importance to identify NAFLD early so that lifestyle interventions and risk factor treatments can slow down the progression of the disease.

GE'S IDEAL IQ IS A NON-INVASIVE METHOD TO QUANTIFY LIVER FAT CONTENT IN 15-20 SECONDS BREATH HOLD MR EXAM Since the disease does not manifest any distinguishing signs or symptoms it is difficult to diagnose. However, blood investigations like liver enzyme and routine ultrasound investigations may reveal NAFLD. A confirmed diagnosis of NAFLD can only be made after a biopsy using the histopathologic technique. Incidentally, many researchers believe that MRI is capable of separating water and fat signals in order to quantify fatty infiltration of the liver (hepatic steatosis). Keeping that in mind, GE launched IDEAL IQ. It provides a non-invasive, quantitative assessment of triglyceride fat content in the liver that can aid in diagnosing steatosis through a 15-20 secondsâ&#x20AC;&#x2122; breath hold MR exam. Dr Vijaya Bhaskar Nori, Director & Chief Radiologist, Vista Imaging & Medical Center, Hyderabad, has been using this MRI for the past two months and is very satisfied with its results. Dr Bhaskar says that IDEAL IQ is a promising MR-based technique that provides volumetric, whole-liver coverage in a single breath-hold and generates estimated T2* and triglyceride fat fraction maps in a non-invasive manner. Dr Bhaskar further states

Dr Vijaya Bhaskar Nori Director & Chief Radiologist, Vista Imaging â&#x20AC;&#x201C; Hyderabad that he has used the IDEAL IQ MRI system to scan about four to five patients everyday and the scans correlate with histopathological findings in his patients. He feels that the technique is excellent as a tool for screening patients with fatty liver disease and for accessing the progress of treatment but also insists that biopsy is a must for liver donors. IDEAL IQ is a breakthrough MRI pulse sequence application offered as an option for GE MR scanners. The IDEAL IQ imaging technique (IDEAL:Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation) is a triglyceride fat and water separation technique that acquires multiple images of the anatomy at separate echo times to calculate the phase differences and deter-

mine triglyceride fat and water content per pixel. It exploits the resonance frequency differences between triglyceride fat and water, measured as phase differences in multiple echoes, to resolve triglyceride, fat and water.

Biopsy vs imaging Dr Bhaskar further says that a quantitative assessment of liver fat with the help of non-invasive technique is highly desirable for diagnosis and evaluation of fatty liver disease. Pointing out that liver biopsy is a fairly risky procedure, he says that the main contention with biopsy is that it's an invasive procedure with a risk of morbidity or mortality. He says that fat deposits in cell could also be very heterogeneous and may result in the variation of sample. Besides it is expensive, takes longer time and has to be performed under expert guidance and in a hospital set-up whereas an MRI is widely available and can be used to scan patients with minimal discomfort.

Last word Although Dr Bhaskar is very happy with his MRI and is using it successfully, he says he will wait for another two to three months to gather sufficient data to be able to publish. He also says that IDEAL IQ is a new breakthrough and promising technology and in time it may turn out to be the tool to detect fatty liver diseases. SEPTEMBER 2013

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W H AT ’ S INSIDE

‘SHL adopts the strictest rules and standards regarding patient confidentiality’ PG 65

IT@HEALTHCARE Risk management in hospitals with CoBIT 5

‘Increasing automation in the healthcare environment and broader access to patient information are expanding the risk of data breaches’ PG 66 ‘A very efficient and simple EMR is an extremely integral part of the hospital infrastructure’ PG 67

Madhav Chablani, Member – External Advocacy Board & Indian Growth Task force – ISACA HQ, talks about the business risks associated with the use, ownership, operation, involvement, influence and adoption of IT within an enterprise

MARKET 11 STRATEGY 29 KNOWLEDGE 36 HOSPI INFRA 43 RADIOLOGY 56 NORTH INDIA SPECIAL 68 LIFE 88

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Information is a key resource for all enterprises, and from the time that information is created to the moment that it is destroyed, technology plays a significant role. Information technology is increasingly advanced, has become pervasive and is at the forefront of technology adoption for providing highest level of patient care and safety, for healthcare delivery - seamless information flow to patients and all connected external partners or internal players. Today, more than ever, in healthcare organisations, information is in silos and making they are striving to: ● Maintain high-quality information to support

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business decisions. Generate healthcare delivery value from IT-enabled investments, i.e., achieve strategic goals and realise healthcare delivery benefits through effective and innovative use of IT ● Achieve operational excellence through the reliable and efficient application of technology. ● Maintain IT-related risk at an acceptable level. ● Optimise the cost of IT services and technology. ● Comply with ever increasing relevant laws, regulations, contractual agreements and policies IT risk is a component of the healthcare organisation’s overall risk universe. Information technologies and systems are a major part of the healthcare organisation’s infrastructure. Integration and alignment of IT risk and enterprise or business risk is a necessity. IT risk is business risk—specifically, the business risk associated with the use, ownership, oper●

ation, involvement, influence and adoption of IT within an enterprise. It consists of IT-related events and conditions that could potentially impact the healthcare delivery functioning. The primary view of IT is that it supports healthcare delivery operations or service delivery organisation. In this capacity, IT risk addresses the ability to deliver IT services that enable the enterprise to perform day-to-day operational processes. However, IT risk also addresses system development, acquisition and maintenance processes. This relates to ensuring the selection, development and maintenance of healthcare delivery processes that facilitate revenue generation and fulfillment of the organisation, and address healthcare delivery needs in a cost-effective manner. Finally, IT risk addresses the ability for IT to provide value and/or benefit to the enterprise through automation. Of course, IT can mitigate

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risks, such as interdependency check of diseases, contraindication of medicines, customer/patient satisfaction, medical mistakes, and tracking of wrong medicines and operating costs. The Institute of Medicine (IOM) released its report titled 'To Err Is Human: Building a Safer Health Care System,' which cited some startling data regarding the number of preventable medical errors that occur within the US healthcare system every year. The report cited many reasons for this, which included a punitive culture that punishes individuals when they are involved in mistakes, a level of complexity (regarding the patients receiving care and the environment in which care is provided) that is now the norm in healthcare and which make errors more likely to occur, and the fact that we fail to learn from our errors or to openly discuss the systemic vulnerabilities that manifest every day and predispose individuals to err. For me as a risk manager, the points raised in the report was not a surprise, but it was, in my mind, an accurate statement about the lack of sustainable success that we have been able to achieve as healthcare risk managers, clinicians, and healthcare administrators. Much has changed since the release of the IOM report. Many risk managers have Risk scenario that is relevant and inherently likely…

..under given negative examples...

been courageous enough to acknowledge specific aspects of the traditional risk management approach that were flawed and not yielding the desired results, and to embrace a new way of thinking about risk, error, transparency, and safety. The most successful risk managers realise that incorporating patient safety principles into risk management is about more than just changing the name of the department or adding an additional job responsibility to their business card. In fact, in many cases, it requires a reassessment of the long-held practices. Risk managers often find it difficult to reconcile traditional principles of risk management which frequently focused on protecting the financial assets of the organisation through vigorous defense of all claims asserted against it and limiting the sharing of information so that it could be shielded from discovery. The traditional principles also focused more on the aftermath of a claim than on the development of why the claim occurred in the first place and, more importantly, how it might have been prevented. There was lack of synergy between departments that often resulted in duplicate or fragmented work, or work that never achieved its potential. In addition, even when results seemed positive, they

Madhav Chablani Member, External Advocacy Board & Indian Growth Task force – ISACA HQ were often isolated to the area where the problem arose and not applied across the organisation. Healthcare risk management professionals are now witnessing a revolution in health information technology that is expected to transform the delivery of healthcare and the work processes of healthcare risk management professionals. Risk management programmes today require more data more frequently and from more sources than ever before. The core need of the risk management professional is to review the right informa-

…how Cobit 5 guidance helps in improvement of process capabilities Note: In this column, next to each process number is an example from the process to consider. These are not the process names

Architectural agility and flexibility

Complex and inflexible IT architecture obstructing further evolution and expansion

APO01 Efficient and defined business and IT-related processes EDM04 Governance over resource optimisation APO02 Responsive strategic planning APO03 Maintenance of enterprise architecture APO04 Innovation and initiation of change APO05 Portfolio management decision taking BAI02,03 Agile development life cycle methods APO13 Maintaining security in an agile and flexible environment

Integration of IT within business processes

Extensive dependency and use of end-user computing and ad hoc solutions for important information needs Separate and nonintegrated IT solutions to support business processes

EDM01 GEIT policies, organisation structures and roles APO01 Business and IT-related roles and responsibilities APO02 Alignment of business and IT strategies APO03 Architectural designs and decisions APO08 Business and IT relations BAI02 Definition and understanding of business requirements BAI03 Adaptation of business processes to new IT solutions BAI05 Managing organisational changes with regards to IT

Software implementation

Operational glitches when new software is made operational Users not prepared to use and exploit new application software

APO11 Consistent and effective quality management activities BAI01 Project management BAI02 Requirements definitions BAI03 Solution development BAI05 Managing organisational changes with regards to software implementation BAI06 Change management BAI07 Extensive solution testing BAI08 Knowledge support.

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tion at the right time to make the best decision. The risk management professionals need tools to automate common processes, a established framework and knowledge bank of credible information on which sound risk reduction strategies can be based, and ways to automate the gathering of intelligence, for in – depth analysis in real time. Many health information systems have demonstrated that they can reduce errors and thereby have a positive effect on the quality of care, patient safety initiatives, and medical professional liability. IT risk management is responsible for the implementation of a risk management process that is in alignment with and supports the healthcare delivery risk model. Failure to design and manage effective IT risk management function could result in: ● Failure to identify material risk or low probability risk with catastrophic impact (black swan) ● Excessive costs by using IT resources on mitigating less strategic risks ● Business exposure to losses due to unidentified or improperly classified risk/s ● Identified risk not remediated due to lack of follow-up and/or lack of monitoring of mitigation projects ● Misaligned risk efforts due to use of differing metrics for probability, cost and impact by different healthcare delivery groups ● Unavailable healthcare delivery functions or processes dependent on IT

Can patient safety, clinical and IT risk management functions be operated singularly? Many departments and individuals in healthcare organisations have tried to claim patient safety as their singular responsibility, artificially segmenting the activities in ways that make little sense and yielding diminished results. It is obvious that risk management ends and patient safety begins, even more so if decentralisation of risk management and patient safety is attempted, and while nondissociating IT risks from mainstream healthcare delivery risks. When this happens, the role of the risk manager is not diminished, but certainly it does change. Healthcare organisations need to clearly distinguish patient safety, clinical and IT risk management subjects/ objectives, define appropriate EXPRESS HEALTHCARE

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system requirements and new healthcare delivery processes, clearly identify performance indices, and establish appropriate new healthcare delivery and IT management/control processes. Risk management subjects (e.g., doctors, nurses, medical staff, IT department staff) responsible for risk management at the point where their roles come into play (e.g., planning phase, design phase, development phase, implementation phase, operation phase) need to be identified. In order to illustrate, let’s walk-through an example on selection of framework, which is derived from actual situations, it is not a reflection of a specific existing healthcare organisation or hospital.

Why was COBIT used?

COBIT 5 PROVIDED A COMPREHESIVE FRAMEWORK THAT ASSISTED THE HOSPITAL TO ACHIEVE ITS GOALS AND DELIVER VALUE THROUGH EFFECTIVE GOVERNANCE AND MANAGEMENT OF ENTERPRISE IT 64

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The hospital’s risk management maturity was at level 1, ad hoc. In almost all cases, the hospital and its staff reacted to incidents in firefighting risk-response manner. While they realised the importance of IT risk management, their management style was not planned. Establishment of appropriate, well-organised, effective and efficient risk management was a critical issue for the hospital, because its information systems were very complicated and critical to its operation. The hospital staff was short on time and lacked knowledge of risk management; therefore, it needed to quickly understand the esentials for establishing IT risk management. In a quest to have a single comprehensive framework that assists healthcare delivery organisation in achieving their objectives for governance and management of enterprise IT which could align with healthcare delivery business processes, COBIT 5 was chosen and proved to be very useful when considering which IT-related risk management /controls to establish for this hospital within a limited time span. The hospital’s team examined COBIT carefully to identify steps to establish appropriate IT-related risk management. - it helped the hospital create optimal value from IT by maintaining a balance between realising benefits and optimising risk levels and resource use. COBIT 5 enabled IT is to be governed and managed in a holistic manner for the entire hospital, taking in the full end-to-end business and IT functional areas of responsibility, and considering the IT-related interests of internal and external stakeholders as delivering

enterprise stakeholder value requires good governance and management of IT assets. Enterprise boards, executives and management have to embrace IT like any other significant part of the business. External legal, regulatory and contractual compliance requirements related to enterprise use of information and technology are increasing, threatening value if breached. COBIT 5 provided a comprehensive framework that assisted the hospital to achieve its goals and deliver value through effective governance and management of enterprise IT: ● Governance - ensures that enterprise objectives are achieved by evaluating stakeholder needs, conditions and options; setting direction through prioritisation and decision making; and monitoring performance, compliance and progress against agreed-on direction and objectives (EDM). ● Management - plans, builds, runs and monitors activities in alignment with the direction set by the governance body to achieve the enterprise’s objectives (PBRM). COBIT 5 brought together the five principles (meeting stakeholder needs, covering the enterprise end-to-end, applying a single, integrated framework, enabling a holistic approach, separating governance from management) that allow the enterprise to build an effective governance and management framework based on a holistic set of seven enablers (principles, policies and frameworks; processes; organisational structures; culture, ethics and behaviour; information; services, infrastructure and applications; people, skills and competencies) optimises IT investment and use it for the benefit of stakeholders. It focuses on risk optimisation, addressing the business risk associated with the use, ownership, operation, involvement, influence and adoption of IT within an enterprise. IT-related business risk consists of IT-related events that could potentially impact the business. While value delivery focuses on creation of value, risk management focuses on the preservation of value. The management of IT-related risk should be integrated within the enterprise’s risk management approach to ensure a focus on IT and be measured in a way that transparently shows the impacts and contribution of www.expresshealthcare.in

IT-related business’s risk optimisation in preserving value. From governance point of view - EDM02 Ensure Risk Optimization process ensures that IT-related enterprise risk does not exceed risk appetite and risk tolerance, impact of IT risk to enterprise value is identified and managed, and the potential for compliance failures is minimised. It ensures that: ● Risk thresholds are defined and communicated and key IT-related risk is known. ● The enterprise is managing critical IT-related enterprise risk effectively and efficiently ● IT-related enterprise risk does not exceed risk appetite and the impact of IT risk to enterprise value is identified and managed. From management point of view - APO12 Manage Risk process integrates management of IT-related enterprise risk with overall ERM, and balance the costs and benefits of managing IT-related enterprise risk. It ensures that: ● IT-related risk is identified, analysed, managed and reported ● A current and complete risk profile exists ● All significant risk management actions are managed and under control ● Risk management actions are implemented effectively The table above demonstrates how Cobit 5 guidance helps in improvement of process capabilities Detailed process-related content for the COBIT 5 governance and management processes, can be referred to in the guide, “Cobit 5 – Enabling Processes”.

Where to start? Work with the board to define the enterprise’s appetite for IT risk, obtain assurance that IT risk management practices are appropriate and to ensure that the actual IT risk does not exceed the board’s risk appetite. Embed risk management responsibilities into the organisation to ensure that the business and IT regularly assess and report IT-related risks and their impact. Ensure that the enterprise’s IT risk position is transparent to stakeholders. Understand value drivers: ● Risks identified before they materialise ● Increased awareness of risk exposures ● Clear accountability and responsibility for managing critical risks ● Effective approach for managing IT risks ● IT risk profile aligned with

management’s expectations Minimised potential for compliance failures Understand risk drivers: ● Risks identified or managed ineffectively ● Increased expenses and costs incurred to manage unanticipated risks ● Critical IT applications and services failure ● Lack of ownership of IT risks Establish control practices: ● Provide the board with information on IT risk exposures and the measures in place dealing with risk containment and associated costs. Confirm the appropriateness of the risk management plan and its alignment with the appetite for risk. ● Monitor risk management practices to ensure that risk management is operating as required, responsibilities for risk management are appropriately and unambiguously assigned, and management has resources in place to ensure proper management of IT risks. ● Evaluate the effectiveness of management’s monitoring of IT risks. ● Review the outcome of management’s evaluation of the risk of IT activities. Confirm that the total risk exposure does not exceed the defined risk appetite, considering mitigating controls in place. ● Oversee the implementation of additional mitigating controls to reduce the overall risk exposure as needed. ●

Conclusion In healthcare organisations, IT can be a doubleedged sword: it can mitigate risks and yet be a big risk factor. Without appropriate risk management, it will fail. Ensure that adequate governance structures are in place and to increase the level of capability and adequacy of the relevant IT processes, with the expectation that as the capability of an IT process increases, the associated risk will proportionally decrease and efficiencies and quality will increase. If a sound risk management environment is established, value will be created. Separating risk and value is impossible. Creation of value and its preservation also has to go in tandem hence risk optimisation and its management is need of the hour and it means addressing the business risk associated with the use, ownership, operation, involvement, influence and adoption of IT within an enterprise. SEPTEMBER 2013

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‘SHL adopts the strictest rules and standards regarding patient confidentiality’ Yariv Alroy, Co-CEO, SHL Telemedicine and Yossi Vadnagra, VP Operations India talk about the advance of telemedicine, SHL’s offerings in this sphere and their advantages, in an interaction with Express Healthcare SHL Telemedicine has been associated with telemedicine for more than a quarter of a century. What have been the major drivers of the uptake of telemedicine globally? The major drivers of the uptake in our opinion are: the ageing of population, the rise in economic healthcare burden, the adoption of new technologies and increasing awareness of consumers who want to take more control on their condition. Those drivers helped the market to understand that, by using advanced telemedicine technology and services people can dramatically improve their condition. Our subscription-based service stands on the pillars of comfort, peace of mind and security as professional help is a call away, when it might take an ambulance over an hour to reach the patient.

How has the company dealt with some of the perceived drawbacks of telemedicine solutions? For instance, since SHL’s products are self-use products for monitoring heart beat, ECG etc., is there a chance that the doctor-patient relationship will suffer over a period of time? According to our experience doctor – patient relationship does not suffer at all. On the contrary, the doctors get better information for managing their patients. Also, patients feel that their doctors are in line with the newest technology. Patient's real-time information on the current medical condition can be accessed online via secured web access within seconds by the subscriber and his medical professional if authorised.

Another fear is of confidentiality of patient information when telemedicine solutions are used for patient records, etc. How does SHL take care of this aspect?

SHL ADOPTS THE STRICTEST RULES AND STANDARDS REGARDING PATIENT CONFIDENTIALITY AND HAS PASSED INSPECTIONS IN STRICT MARKETS LIKE GERMANY AND ISRAEL SEPTEMBER 2013

INTERVIEW

SHL adopts the strictest rules and standards regarding patient confidentiality and has passed inspections in strict markets like Germany and Israel.

How do the medical teams of SHL ensure consistency and relevance of health information across geographies? Our medical management and advisory board is responsible of being up to date and assuring that all SHL teams globally will be updated on the advanced protocols. Our qualified and experienced teams at the international telemedicine centre in Tel Aviv will be training the Indian medical professionals that will provide the services to our Indian subscribers.

Since SHL’s products require some familiarity with medical devices and technology, do the technology teams at SHL factor this into the design of the products? Sure! Our products have been designed in a way that elderly subscribers do not really need to be tech savvy to operate them. The 12 lead ECG devices are very easy to strap on, since most of the leads are actually on a single strap that can be easily strapped around the subscriber’s chest. On the user interface they are simple and friendly and any person can easily use them without any assistance or consumables,which pours a lot of confidence to our subscribers.

What has been the revenue growth of the company over these years? SHL is in continuous growth and expanding activities to other territories as we are doing in India. In second quarter of 2013 we had a ~10 per cent growth compared to second quarter of 2012.

What are the major products and services of SHL? Our main products enable monitoring and transmission of top quality ECG and other vital signs parameter related to cardiac and pulmonary conditions to a highly qualified and technologically advanced medical monitoring centre. SHL monitors Congestive Heart Failure (CHF) for thousands of patients, the largest CHF monitoring programme in the world. We also have the most advanced monitoring programme for COPD patients with numbers that run into thousands. Each of the above, the CHF and COPD programmes stabilises patients while improving their quality of life. SHL remotely monitors Arrhythmia using most advanced cellular devices, the

Yossi Vadnagra

Yariv Alroy

only service in the world that allows the patient to send written messages of his symptoms.

What kind of strategic partnerships has the company set up over the years? (hospitals, insurers, doctors)

In terms of disease areas served, SHL has chosen heart health and COPD. Any plans to expand this to other high burden areas?

We are trying to work closely with all the relevant strategic stake holders in the medical market. We believe that they are all very much important and they all get a lot of value, having the relevant patients that can benefit from our professional telemedicine services.

Yes, we believe that in the visible future many conditions will be monitored through usage of telemedicine technology and services and SHL plans to take a leading role.

What is the cost:benefit ratio of SHL’s products and services compared to existing/competing brands and services? What is the USP of these products and services? In Europe and Israel we have proven to save around 50 per cent of the cost related to admission of CHF and COPD patients. This works out to significant cost saving of millions of euros for the insurers ,which proves to be very economical for the insurance providers especially in a time when all are struggling to justify their premiums while providing good services to their insured patients.

Which countries is the company active in? Since when and who are the partners? We are active in Israel for 25 years and in Germany for several years and starting activities in the UK and again in the US after the termination of the non-compete agreement that we signed five years ago.

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Are there any organisational or bureaucratic difficulties encountered during the roll out of SHL’s services to these partners? In every market there are different bureaucratic difficulties, but that is part of doing business in foreign markets. We do our best to deal with those issues in a professional and ethical manner.

Given that you have been very familiar with India’s healthcare market since over six years, what business potential do you see in the India market for SHL’s telemedicine services and products? Along the years, we have seen how healthcare is developing and significantly improving in India. India has been making a big leap in the healthcare and medical space. We know for a fact that CVD patterns in India are sadly more and worse than in other countries we operate in. The increase in life expectancy and lifestyle changes has brought about an increase in the number of people living with chronic heart conditions in India. We notice an EXPRESS HEALTHCARE

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increasing awareness of patients and a growing demand for solutions that enable better care. CVD is the most significant healthcare problem of 21st century India and our service will allow people to receive remote medical care and peace of mindthat they are always monitored by a high end professional service. We believe that private healthcare in India will continue to grow at a similar pace and with the continuous improving of awareness the Indian market embeds a promising potential for services.

SHL signed their first India deal in March this year with Kolkata-based speciality hospital Belle Vue Clinic, part of MP Birla hospital chain group. Could you give us more details of this agreement and will this be the blueprint for the company’s future strategy for the India market?

Since then we have signed a couple of more agreements and expect a few more in the near future. We believe this model of agreement serves well both parties and will help a fast penetration of the telemedicine technology and services to the patients who need it. And yes, it can serve as a blueprint for future agreements in India.

What has been the response from other potential partners so far? Any entry barriers? (in terms of cost of product/services, competition) Response has been very positive and we have a very attractive pipeline of agreements for the near future. We have analysed the Indian market very carefully and identified some of our barriers like prices, network coverage, level of awareness etc. All of these have been addressed in our go to market strategy and mitigated when we designed our concept for the

Indian market.

What are the targeted revenues/milestones in SHL’s India foray? Sorry, I cannot comment on this, but we see a serious potential in India, otherwise we wouldn’t be here.

What are the further innovations in telemedicine we can expect from SHL’s technology and medical teams in the near future? The nearest innovation is the Smartheart which transforms every Smartphone to a state-of-the-art full 12 lead ECG for personal use. It is our proprietary personal digital 12-lead ECG device, which enables the subscriber to transmit a full 12-lead electro cardiogram in less than a minute. Results are analysed in real time, saving critical time and ensuring rapid decision making.

‘Increasing automation in the healthcare environment and broader access to patient information are expanding the risk of data breaches’ Though digitalisation is making data storage easy in healthcare organisation, they also carry the threat of getting hacked. The data that is stored by the healthcare institutes are extremely valuable as they carry personnel information of an individual and their medical history. There are very few healthcare institutes which has a sound system in place to protect the data from cloud computing, mobiles phone and social websites. M Neelam Kachhap speaks to Srinivasa Boggaram,Team Lead PreSales - India and SAARC, McAfee India Sales to find out more about threat to intellectual property and customer data of healthcare organisation

INTERVIEW

What is the relevance of Intellectual Property (IP) and customer data of healthcare organisation in the Indian context? Like in any other country, IP and customer data in a healthcare organisation is treated with utmost importance as far as critical data security is concerned in India too. Healthcare organisations with IP related to their drugs or research is of paramount importance and it is this factor that makes them a key differentiator in the market. Many healthcare companies are expense conscious with regard to security tools; however, there are a few healthcare organisations who have adopted best and leading security solutions in the industry. Customer data is equally important and organisations are facing more security threats that increase the risks of inappropriate access to patient information and impaired integrity of the information. New security and privacy laws and stiffer penalties have increased the urgency of addressing security risks.

What are the threats to the data from cloud computing, mobile phones and social websites? Looking at the benefits of new technology that brings to the business like many organisations’, healthcare segment too is highly impelled to adapt such technology. Needless to say

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associated risk in such new technologies like cloud computing or BYOD or social websites pose massive risk to IP and customer information. Critical data hosted on cloud services may not get the required attention, however, they carry the risk of losing critical data in the wrong hands. As we all agree, BYOD needs to be imbibed in the right way considering security risk and user work culture so that critical data is not at risk. With improper data protection tools, social websites can help users post critical information with or without right intentions. Increasing automation in the healthcare environment and broader access to patient information are expanding the risk of data breaches. Avoiding these data breaches without disrupting work-flow or limiting rapid access for authorised users can be challenging. Unfortunately, data breaches are not rare events. According to the Privacy Rights Clearinghouse, more than 260 million “records” of all types have been breached. Organisations should look security in a holistic view and not just in silos. McAfee being the largest security vendor in the industry, we offer the widest range of tools that help in providing comprehensive and complete control to secure data/handling information for a successful and profitable business.

What are the laws related to data security in India?

and the (Indian) Contract Act, 1872, which is the cyber law of India, also incorporate few provisions regarding data protection in India. However, till now we have no dedicated statutory and constitutional data privacy laws in India. Having said this, many of our healthcare organisations who are serving Indian clients are mandated to follow their client specific regulations like HIPPA, HITECH, FTC etc.

What is the framework under which hospitals work to keep patient data secure?

We have no dedicated data protection laws in India. Data of individuals and companies require both constitutional as well as statutory protection. The constitutional analysis of data protection in India has still not attracted the attention of either individuals/companies nor of Indian government. The statutory aspects of data protection in India are scattered under various enactments. The Information Technology Act 2000 (IT Act 2000)

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Some of the best practices that many hospitals and healthcare organisations follow to keep their patients data secure are listed below. ● Secure channel to connect back to their data centre ● A very secure host level protection on the end points at hospitals and branches ● A matured and advanced DLP solution both on host level and network level ● A good identity management and access control mechanism ● A good data management mechanism ● Advanced security tools to give them good visibility and control of the entire infrastructure so that they have good ‘situational awareness’ and proactive control. mneelam.kachhap@expressindia.com SEPTEMBER 2013

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‘A very efficient and simple EMR is an extremely integral part of the hospital infrastructure’ The advent of electronic medical recording (EMR) systems was instrumental in enhancing healthcare delivery by making data more storable, accurate and healthcare operations more efficient and effective. Jay Mehta, Founder and CEO, ViDoc elaborates on the evolution of EMR, its myriad benefits, parameters to look for while choosing an EMR and ViDoc's offerings, in an interaction with INTERVIEW Lakshmipriya Nair How have Electronic Medical Record (EMR) systems evolved and revolutionised healthcare? A medical record is the most important account of information regarding the health and medical treatment of a patient – this is a wellknown fact. How can we further utilise a medical record? This progressive thought has substantially evolved over the last few years, inspiring the medical fraternity to work on e-enablement in patient care - hence the emphasis on EMR. Digitisation of medical records through EMR has been further fuelled due to advances in research and technology: ● Hospitals use non-private information for a lot of research work ● Technology enables extraction and analysis of clinical information from medical records to further improve the quality of patient care ● Ability to forecast epidemic and take preventive measures ● Ability to refer to cases treated in the past and extract specific learnings from that ● Codification of diseases and diagnosis codes enables universal treatments of patients ● Promote the practice of evidencebased medicine All of these are distinctly increasing the life span, and ability to treat diseases and medical conditions considered difficult earlier.

Please elucidate on the importance of EMR in healthcare? What are the benefits accrued from it? A very efficient and simple EMR is an extremely integral part of the hospital infrastructure. Given the government regulations on retention period of medical records, increasing medicolegal cases, precious time of doctors, space crunch in hospitals, the need to refer case histories quickly and many more such critical needs – it is

In one of the cases: One senior doctor was on a vacation outside of Mumbai. While on vacation there was an urgent need to provide medical insight in to a medico-legal case that was being discussed in the court. Our online EMR application enabled the doctor on vacation to refer to the patients’ medical records, understand the case and provide an immediate input for the hospital to clarify their line of treatment.

What should hospitals look for while choosing an EMR? The criteria and the parameters While choosing an EMR, hospital should look at four ‘A’spects carefully ❖ Aggregation, ❖ Archival, ❖ Access and ❖ Analytics Aggregation refers to collecting and assembling all required patient data. While scanning the paper records is an essential activity, capturing the right information from relevant source points in an easily accessible electronic format is very important. By ‘information’ here I mean, all data pertaining to the patient’s stay in the hospital – registration / visit details, diagnosis, treatment, test reports, etc. All patient information should be available under one umbrella. Archival is about how you are going to store this aggregated information. Q's about the security and disaster management come into picture here. Medical records and information must be absolutely secure! Access determines the retrieval of all these records and information. MRD personnel, doctors and nurses may need to view the EMR for different purposes. Some hospitals also favour e-sharing of records with patients. The EMR must have the flexibility to quickly deliver selective information to the users, ‘securely’ as per their preferences. Records must be available quickly

ONE OF OUR MOST IMPORTANT USPS IS THAT OUR SOLUTIONS ARE INSPIRED BY THE SUGGESTIONS CONTRIBUTED BY OUR CUSTOMERS, THAT IS — HOSPITALS , DOCTORS AND PATIENTS. SO IN ESSENCE, IT IS TAILOR MADE SEPTEMBER 2013

(clients and case studies)

absolutely essential to have a good EMR in the hospital. The key benefits hospitals can accrue are: ● Saving of space to preserve records ● Ease in maintaining health information of patients for longer durations ● Faster search of records for quick reference ● Reduced healthcare costs ● Practically paperless medical history ● Ease to distribute specific records to patient

How big is the market for EMR in India? How does it fare vis-a-vis the global markets?

when required only to the entitled persons. And, analytics gives EMR a 360 degree closure. After assembling all the medical records and information, you must be able to generate Audit Trails and MIS Reports which give insights in your key functional areas – as in, which department has higher turnover of patients, which records have completed the retention period, etc.

Tell us about your offerings in this sphere and their USPs in comparison to the other similar offerings in the market? We offer an end-to-end solution to hospitals. Hardware, software, manpower and storage space – all under one roof. Moreover, our solution fits easily in the hospital environment, with setup ready in two to three days. Our proprietary work-flows allow hospitals to move from paper records to EMR, in an incredibly simple yet fast manner. This has helped our customers save some valuable time and costs. One of our most important USPs is that our solutions are inspired by the suggestions contributed by our customers, that is — hospitals , doctors and patients. So in essence, it is tailor made. This also helps us to continuously enhance our service offerings.

Any examples elaborating the use of your product/s and the advantages availed?

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North America is the world’s largest market at about $9 billion and Europe, Latin America and Africa (together) are sized at around $6 billion. The Asia-Pacific market is estimated over $2 billion, and expected to grow at 7-8 per cent annually, with high dependence on China and India markets. Traditionally healthcare across the world, and especially in India, has been traditionally conservative in including Information Technology (IT) in normal routine. This mindset is going through a change. We can see growing enthusiasm from healthcare administrators and doctors to know how IT can assist them in their work. We can also see them now being able to identify merits of working with a specialist in Health IT to handle their medical records, rather than employing a neighbourhood scanning operator.

What are the challenges in this sphere that need to be overcome to propel growth? One of the biggest challenge facing the medical world today is – time of treating doctors. This time crunch could be addressed by an effective EMR through use of technology (24x7 availability of records online) and tools (access on mobile devices). The other key challenge is – acceptance of electronic records for the purpose of insurance, medico-legal cases. Government departments such as income tax and registrar of companies are widely using digital signatures and e-filing. Governmental guidelines around acceptability of EMR for health insurance and litigation will prove as a shot in the arm for EMR. lakshmipriya.nair@expressindia.com EXPRESS HEALTHCARE

A MARKETING INITIATIVE

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Rockland Hospitals Now & The Road Ahead...

Rajesh Srivastava

Prabhat Srivastava

Rishi Srivastava

Aditya Bhandari

Sanya Srivastava

Pranav Srivastava

Somya Srivastava

Entrepreneurial Team at Rockland he Rockland entrepreneurial team after successfully launching a chain of tertiary care hospitals in the Delhi NCR, is getting ready to move to the next level of healthcare service delivery system by creating a five layered network of health volunteers, clinics, nursing homes and small hospitals finally connected with the group’s tertiary care hospital. The five layered network model has been developed after years of research and development in all the key areas of healthcare management covering major challenge areas like cost management without compromising on the quality of treatment, delivery mechanism for a patient oriented model, value added services in diagnostics services, technology solutions for connectivity, management processes and systems. Rajesh Srivastava, Chairman, Rockland Hospitals, during the inaugural ceremony of the group’s first hospital, had announced that the group will have five hospitals by 2020 which became a mission for his team. The Rockland team has already launched three hospitals by 2013 and is about to complete the fourth hospital by doubling the bed capacity of its first unit. Land has already been acquired in Noida for the fifth hospital and the teams are ready with

the construction plans. Since the very beginning the Rockland team was focused on quality. It started as a teaching hospital with DNB programmes and took an early lead in setting standards of quality by organising a thought leaders’ conclave. Roclave was attended by the who is who of the healthcare industry. The outcome of this small initiative became one of the starting points for NABH which today sets the quality standards of the healthcare industry in India. Another encouragement came in 2009 when in a survey conducted bya leading publication; Rockland Hospital was ranked among the top five hospitals in India. Rockland has been able to attract some of the most respected names on the clinical as well as management side and has generated a lot of interest among the GPs

Roclave 2005 SEPTEMBER 2013

and small hospitals who wish to be a part of the Rockland Network. The goals are larger now and so is the team. Rockland has taken a big leap forward from a single unit with 100 operational beds in one location to 800 beds in three locations. With the

CSSR and South Asian countries. International patients have begun to come to our hospitals from diverse geographies. The domestic marketing team has organised several successful CMEs and Health Camps across the Delhi NCR. It has initiated an aggressive awareness campaign among the patients and doctors. The healthcare needs of these countries are similar to India and therefore the Rockland group has plans of replicating its model of healthcare delivery in several developing countries. India became an IT destination on the strength of its human resources and today the Indian IT professionals are respected and recognized around the world. Healthcare has an even bigger potential

recognised for their commitment and capabilities. The Rockland entrepreneurial

Rockland Dwarka team is gearing up to tap this huge potential of earning foreign exchange for India while reaching out to the remotest village within the country

Dr Sameer A Khan, CEO addition of Noida the group will have over 1300 beds in the near future. The operational charge of all the hospitals has been handed over to Dr Sameer Khan, Group CEO with hands on experience of launching and operationalising hospitals. Under Dr Sameer’s leadership, the group is moving forward at a faster pace to meet the vision and mission objectives. The Rockland International team has organised several successful OPDs abroad and has entered into alliances with select partners in the Middle East, Africa, www.expresshealthcare.in

Rockland Qutab as Indian doctors and nurses are highly respected and

through its innovate model of healthcare delivery.

Rockland Manesar EXPRESS HEALTHCARE

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Fortis Escorts Heart Institute Engagement is one of Fortis Escorts Heart Institute's core values and engaging clinicians is a critical element to building a quality and safety culture within the organisation ortis Escorts Heart Institute (FEHI) was incorporated in 1988 and today is recognised as the ultimate cardiac care destination in the Asia Pacific region. The institute has been setting benchmarks in cardiac care with its path-breaking work for over two decades. FEHI boasts of a vast pool of renowned doctors who are acknowledged leaders in their respective areas within the discipline of cardiology.

Vision “To create a world-class integrated healthcare delivery system in India, entailing the finest medical skills combined with compassionate patient care” based on foundations of efficient systems and trust. The 310-bedded hospital offers a spectrum of offerings including cardiac bypass surgery, minimally invasive surgery, interventional cardiology, non-invasive cardiology, pediatric cardiology and pediatric cardiac surgery. Talking about the hospital's growth, Raajiv Singhal, Vice President, FEHI, says, “ Yearon-year, FEHI has continuously shown improvement in all areas of operations - financial growth, expansion, upgradation, new medical programmes and quality patient care.” FEHI is equipped with the best infrastructure and the latest technology required for cardiac bypass surgery, minimally invasive surgery (robotics), interventional cardiology, non-invasive cardiology, paediatric cardiology and paediatric cardiac surgery. The hospital is backed by the most advanced laboratories performing complete range of investigative tests in the field of nuclear medicine,

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radiology, biochemistry, haematology, transfusion medicine and microbiology. It has a state- of-the-art Nuclear Medicine Department, Cardiac MRI including five Cath Labs equipped with OCT and FFR technology and nine operation theatres. FEHI offers several firsts in areas of clinician engagement, specialty clinics, medical programmes and the latest technology. Engagement is one of Fortis Escorts Heart Institute's core values and engaging clinicians is a critical element to building a quality and safety culture in the organisation. Clinical engagement empowers clinicians to improve collaboration to improve patient outcomes. In addition, the hospital runs several medical programmes and new clinical technologies. The hospital’s quality standards are at par with best in the world. Its hospital, CABG and paediatric congenital cardiac surgery mortality rates are among the lowest in the industry. FY2012-13 saw FEHI perform India’s first TAVI procedure, a remote patient monitoring system aided by real time two way audio-visuals. It is an ideal blend of medicine with technology to improve critical care delivery. It is also a clinically proven programme that has resulted in delivering quality patient care with reduced mortality and infection rates along with decrease in ALOS. Chest Pain Pathway (CPP) initiative was developed in collaboration with 'The Medicines Company', one of the global leaders in acute and intensive care in the world. Clinical pathways have been shown to have significant impact on quality

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and economics of healthcare worldwide. The chest pain pathway enable evidencebased medicine at the point where it matters the most: at the patient bedside. It works as a guidance for clinical care of patients presenting with acute chest pain right from admission till discharge and follow up. It helps standardise clinical care based on international consensus guidelines customised by Fortis Escorts. It also augments efforts to establish benchmarks in cardiac care by enabling measurement of quality parameters in real time and take necessary actions. Critinext – electronic ICU A remote patient monitoring system, aided by real time two-way audio-visuals. It is an ideal blend of medicine with technology to improve critical care delivery. It is also a clinically proven programme and results in delivering quality patient care with reduced the mortality and infection rates along with decrease in ALOS. FEHI currently supports several CritiNext sites and 25 HCCs across 10 states and four countries. FEHI also uses Electronic Anesthesia Charting, a device which captures anesthesia records electronically as well as Massimo – Intra-operative Fluid Management Technologies in the operating room that enables monitoring and management of patients’s hydration status during major and high-risk surgery. FEHI performed the first cardiac patient in Asia with coronary artery disease, successfully treated by using a Bioresorable Vascular Scaffold (BVS). It is the first hospital in Asia, to enroll a patient into the ABSORB EXTEND trial, a worldwide trial of up to 1,000 patients at 100 centres in Europe, Asia Pacific, Canada and Latin America. In a first-of-its-kind procedure conducted in India in FY13, two patients successfully underwent heart valve replacement without anaesthesia. Further, the drug-eluting bioreabsorbable vascular scaffold (BVS) was launched. FEHI also created Fortis’s first team of Infusion Nurses to build capacity in this spe-

Dr Raajiv Singhal, Vice President , Fortis Escorts Heart Institute cialised area, and disseminate knowledge and best practices to other group hospitals. The Fortis Acute Stroke Treatment (FAST) was launched in May 2012. On the preventive side, considering that diabetes puts individuals to greater heart-related risks, an exclusive helpline for diabetics and their caregivers commenced operations in September 2012. The helpline provides access to information on diabetes, its treatment and containment protocols. Fortis Organ Retrieval & Transportation (FORT), an initiative aimed at helping save lives, was also launched in FY13. During the year FY13, FEHI set a “Guinness World Record” for conducting 14,161 preventive cholesterol tests in a single day, the highest number achieved by any hospital in the world. The institute aims to establish a heart failure clinic to give consultation and treatment to heart failure patients, as well as an arrhythmia Clinic, a 24*7 ECG service, where ECG reports can be sent to experts who can see and revert with the line of treatment immediately. A 24X7 free emergency ambulance service upto 10 km is also in the offing alongwith plans to provide comprehensive electrophysiological cardiology to the paediatric patients and launch hybrid cath labs to provide advanced imaging and at the same time fulfill the requirements for treating complex cases like high risk patients and structural heart disease. Strengthening TAVI with e-ICU beyond borders at new locations in India and overseas is also planned SEPTEMBER 2013

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PSRI Hospital, New Delhi With the endoscopy unit of gastroenterology department and haemodialysis unit of nephrology department being the premier and highest patient processing units of Delhi, PSRI promotes world class clinical work by nationally and internationally acclaimed faculty members SRI was established in 1996 with a unique concept of putting together two specialities together viz. nehphrology and gastroenterology including liver disease. Chronic liver disease very often ends up with renal failure (the so called hepatorenal syndrome) and advanced chronic kidney disease patients on dialysis get often infected with hepatitis B or hepatitis C requiring specialised care from liver specialists. Promoted and managed by the Singhania family who own JK Industries, medical care decisions pertaining to patients are made by a group of doctors headed by the medical director. Such an arrangement ensures perfectly ethical practice of medicine done in the best interest of their patients without any bias to benefit the hospital owners or administrators. JK family has a legacy of establishing non-profit social organisations in different parts of our country and to continue this corporate social responsibility forward, they wanted to create a super speciality healthcare facility which fills the gap felt in the healthcare system of our country. It was then that they decided to establish a gastroenterology, nephrology tertiary care institute which was not present in this fashion and combination, at that point of time, in the health sector of our country. Late Shri Hari Shankar Singhania along with the immediate family members

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were the main pioneers to envisage the idea of PSRI. Their vision was to create a world class tertiary care centre for gastroenterology and nephrology for the specific care and management of these diseases, through well known experts in the country as well as develop it into a knowledge centre through clinical research and seat of teaching and training to help medical experts of these specialities to cater more centres for such specialities. The first and foremost challenge was to develop an identity of chosen combination of healthcare facilities which did not exist in this form in the entire country with stand-alone super speciality tertiary care centres being rare. The next challenge was to grow the size of the institute so that a large number of patients could be catered for comprehensive care in the chosen specialities. Still another was to establish the institute as the super speciality referral centre for different states of our country and for foreign patients also. PSRI was able to overcome all these challenges through excellent team work, and setting mile stones of success through the world class clinical work by the nationally and internationally acclaimed faculty members, as well as consistent guidance and encouragement by the managing committee and inputs from eminent national and international medical experts. The hospital started out with 37 beds including a seven-bed ICU and just one operation theatre with a very basic endoscopy unit and a dialysis unit having four machines. Today, it is a 106bed facility with three critical care areas (medical ICU, surgical ICU and post transplant ICU) manned by well qualified staff with rich experience in all the departments. Endoscopy unit of gastroenterology department and hemodialysis unit of nephrology department are one of the premier and highest patient processing units of Delhi. Surgical facilities have grown substantially creating many national and international records, for difficult and unique surgeries. www.expresshealthcare.in

Dr Rakesh Kumar Tandon (Medical Director & Head, Dept of Gastroenterology

Dr Dipak Shukla, DirectorOperations

The hospital has since grown into a well known centre of clinical research recognised by ICMR and Director of Science and Technology. The comprehensive diabetes centre and gamut of regular support specialities eg. chest, psychology, gynaecology, neurology, medical oncology, dietetics, pain management, orthopedics and ENT provides comprehensive patient care. The surgical counterparts of both the specialities ie Urology and gastrointestinal (GI) surgery at PSRI have excelled in their own rights. GI surgeons are most proficient in doing minimally invasive surgery e.g. laparoscopic cholecystectomy and laparoscopic thoracotomy. Similarly, the urologists are capable of doing most procedures through minimally invasive approach performing about six to eight kidney transplants per month with 90 per cent success. Supporting specialities include paediatric gastroenterology, diabetes and endocrinology, general medicine, gynaecology, psychiatry, clinical nutrition, cardiology, respiratory diseases etc. Doctors from certain other specialities like haematology, oncology, dermatology, neurology, ophthalmology, orthopaedics and ENT services are available for consultations and referrals. The ICU has two sections, one for medical and another for surgical patients. Other essential services include a full range

of laboratory and radiology services that work round the clock and provide a full range of tests at reasonable price. A hospital ambulance is available 24 hours for transporting critically ill patients on vital support. The hospital also has an active DNB teaching programme and research cell, with regular updating of its clinical services. A well equipped library with Internet facility helps greatly too. NABH and ISO accreditation gives it the stamp and confidence of high quality. The hospital has all the equipment and technology to address the full spectrum of medical and surgical solutions for the patients which has made it one of the premier referral centre for the chosen specialities. Telemedicine is an area where the doctors constantly work with several African countries. The hospital plans for expansion including adding facilities for liver transplant, cath lab and cardiology services. All these will be housed in a new building, which is coming on the same premises along side. This is to be completed within two years time. With this expansion the number of patient beds will be doubled. Bed numbers will also increase in the critical care units, dialysis stations and endoscopy facilities. Apart from these several allied support services will be added.

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Living with arthritis Not all arthritis are disabling and deforming, hence understanding one’s arthritis is important. Timely and proper treatment prevent irreversible damage and disability with current non-operative and operative treatments being very effective in restoring function effectively, says Dr Vivek Mittal, Senior Orthopaedic Surgeon rthritis is the world’s leading cause of disability. It refers to more than 100 different diseases, many of them self limiting. Early recognition and appropriate treatment goes a long way in preventing the severity of disease. The word arthritis literally means inflammation of joint ("arthr-" means joint; "-itis" means inflammation). In simple terms, it is the condition where cartilage at the joint surface of bone wears away. Conditions range from wear and tear of cartilage (such as Osteoarthritis) to inflammation as a result of an overactive Immune system (such as rheumatoid arthritis). It usually affects the area in or around joints, but sometimes other parts of the body including the muscles, skin and internal organs can also be affected.

What is arthritis? FACTS ● Arthritis is inflammation of one or more joints. ● Symptoms of arthritis include pain and limited function of joints. ● Arthritis sufferers include men and women, children and adults. ● Not all arthritis ends up in deformity and disability, many of them are self limiting ● Earlier and precise diagnosis can help to prevent irreversible damage and disability Arthritis can affect anyone and at any age. Nearly two-thirds of people with arthritis are younger than 65. Arthritis is also more common among adults who are obese. Osteoarthritis (or wear and tear arthritis) is the commonest form of arthritis and usually starts around 60 years of age. There is no data available for India; however, 80 per cent population above 65 years suffers from osteoarthritis. 22 to 39 per cent of Indians are affected by it and is more commonly seen in women as compared to men. Other common forms of arthritis includes rheumatoid arthritis, lupus, fibromyalgia, and gout.

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Rheumatoid arthritis and lupus, not only affects joints but can also affect multiple organs and cause widespread symptoms. Rheumatoid arthritis on the other hand develops at a younger age and in fact if you have arthritis under 45, you are more likely to have rheumatoid arthritis than osteoarthritis.

Who is at risk for arthritis? Certain factors are associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not.

Non-modifiable risk factors Age:The risk of developing most types of arthritis increases with age. Gender: Most types of arthritis are more common in women; 60 per cent of the people with arthritis are women. Gout is more common in men. Genetic: Specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and ankylosing spondylitis.

Modifiable risk factors Overweight and obesity:Excess weight can contribute to both the onset and progression of knee osteoarthritis. Infection:Many microbial agents can infect joints and potentially cause the development of various forms of arthritis. Joint injuries: Damage to a joint can contribute to the development of osteoarthritis in that joint. Occupation:Certain occupations involving repetitive knee bending and squatting are associated with osteoarthritis of the knee. Dietary factors: Elevated uric acid levels cause gout. The risk factors and causes of many of the other forms of arthritis are unknown.

What are the common symptoms of hip or knee arthritis? The first stage of arthritis is usually silent, as mild carwww.expresshealthcare.in

tilage damage typically shows no symptoms. It is only when there is significant cartilage loss that one notices real pain and loss of joint function. Common joints affected by arthritis includes weight-bearing joints including the knees and hips, small joints of hands and wrist, elbow joint, shoulder joints, spine, etc. Warning symptoms of arthritis are pain, swelling and stiffness in the joints. Rheumatoid arthritis initially presented as multiple joints pain and stiffness, which is worse in the morning or after a period of rest, while activities reduces these symptoms. However, as the disease progresses they became constant. On the other hand osteoarthritis present as increase in pain, swelling and stiffness after activities while rest reduces these symptoms. As the disease advances, not only do the symptoms persist all the time but disability, limp and deformity appear. Certain arthritis like gout can present like acute inflammation of toe joints with raised uric acid in blood and gouty crystal in joint fluids. “Many people assume that arthritis pain is just part of getting old and they have to put up with it - it may not be true.” If you have swelling, stiffness, or pain in your joints for more than three weeks, it’s time to take opinion from an expert.

What can people do to prevent and control arthritis? We tend to think of heart health as the main reason to keep physically fit and keep our weight down. But we need to consider another good reason—preventing arthritis. There is no cure for most arthritis. However, prevention is the best bet against all form of arthritis. The three best things are exercises and staying active; maintain appropriate weight; and prevent injuries to your joints. Most types of moderate, low-impact exercise are helpful, but best are strengthening of muscles around the joints, yoga-training, range of motion exercises, and water exercises. The stronger the muscles around your

Dr Vivek Mittal joints, the greater the pressure they take off those joints. These benefits include less pain and better physical function, mental health and quality of life. People can reduce their risk of developing osteoarthritis by controlling their weight and avoiding injuries. Weight loss can also reduce symptoms for people with knee osteoarthritis who are overweight or obese. When we walk, our knees absorb a force equal to about three times our body weight. So losing just 10 pounds actually relieves each knee of about a 30-pound load with every stride we take.

What is the treatment for arthritis? Majority of arthritis can be treated with conservative treatment. Treatment of early arthritis begins with simple things and it does not includes surgical treatment. Rest to the affected part with the use of a splint, ice-pack over the affected joint and range of motion and strengthening exercises, helps. Modification of activities especially, those causing excessive strain on joints should be avoided as much as possible, for example for knee and hip joints squatting (Indian toilet) position, sitting cross-legged, climbing steep steps, high-impact sports activities. Pain-killer medicines or anti-inflammatory tablets help in pain and stiffness by reducing swelling, and inflammation in the joint. Physiotherapy and reduction of weight also helps over a SEPTEMBER 2013

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period of time. Change of diet helps especially, in gouty attacks. Use of a ‘stick’ while walking helps in hip and knee arthritis. Supplements such as Glucosamine and Dycerein also helps in early and moderate arthritis. Specific medicines (disease modifying drugs) are required for diseases such as rheumatoid arthritis, gouty and seronegative spondyloarthropathy like ankylosing spondylitis. Biological injections are also available when disease modifying drugs fail to provide adequate relief. Intra-articular injection with steroids or viscosupplementation is the best alternative if above treatment fails to help.

harm in living with the damaged joints? I understand at times it is a difficult situation them and their family members are placed. However, with increase in the longevity of life facts gives better answer to the above question. a) Joint replacement surgery is considered only for severely damaged knees and when all modes of conservative treatment have been exhausted. b) Joint replacement

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surgery not only changes persons life style for better but also brings independence in your activities, thus making it a wonderful operation. c) However, if you choose to live with your damaged joints: i) Then you will continue to live rest of the life with pain and walk with difficulty due to the deformed joints. ii) If your damaged joint becomes unstable, then incidence of fracture around

your hips or knees increases dramatically. Your osteoporosis will also worsen as a result of inactivity thereby making you furthur prone to fractures. iii) Your deformities and instability will only worsen with your age or passage of time. iv) Also regular consumption of analgesics and anti-inflammatory drugs may damage your kidneys and cause ulcers in stomach. In the end I would say:

one should never ignore arthritis as it can affect us at any age. Not all arthritis are disabling and deforming, hence understanding your arthritis is important. Timely and proper treatment prevent irreversible damage and disability with current nonoperative and operative treatments being very effective in restoring function effectively. You can know more about Dr Mittal on www.drvivekmittal.com

Operative treatment Most of us may get respite from pain and stiffness for a very long time following conservative treatment. In advanced stage of arthritis, the pain becomes so severe that a person avoids using the joint and routine activities are not possible. When one has tried all non-operative measures, then one has to resort to operative treatment. Total joint replacement not only relieves the pain completely, but also allows the person to move pain free and improve the quality of life. Total joint replacement is also called total joint arthroplasty. “Joint replacement surgery not only corrects deformity and mechanically aligns the joint but also gives freedom from pain and movement for life”. Replacement surgery is needed only when conservative management fails despite trying non-operative treatment for a significant period of four to six months (at least). It is not only done for pain but if there is: ● Severe pain in spite of daily analgesics or restricting ordinary activities of daily living and recreations ● Significant instability (constant giving way) of your knee or hip joint ● Significant deformity causing pain and inability to walk. Total joint replacement has come a long way. With advances in technology (Computer Assisted Surgery (CAS)) and materials like Oxinium, artificial implants last longer and restore functions better after surgery. Elderly patients with severe arthritis do come and ask this question: Is there any SEPTEMBER 2013

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Saket City Hospital, New Delhi The hospital plans to develop subspecialities in each clinical speciality while also focussing on clinical trials, research, academic programmes and newer modalities like stem cell therapy and gene therapy aket City Hospital is a new-age multi-super-speciality tertiary care hospital located at Saket, in the heart of New Delhi. Driven by the credo, ‘YOU FIRST’, the fast emerging healthcare centre promises highest level of quality amidst technology that is truly world-class and futuristic. Spread over 12.5 acres, the hospital has 252 beds in the facility with ample parking and open space. Saket City hospital provides a centre of excellence in cardiac sciences, orthopaedics and joint replacement, neurosciences, pulmonology and critical care, and urology sciences alongwith a range of services such as clinical nutrition, cosmetic and reconstructive surgery, dentistry, MAS & bariatric endocrinology, ENT, internal medicine, ophthalmology, psychiatry, obstetrics & gynaecology, physiotherapy and health check.

DR MAHESH INDER VS, CEO, Saket City Hospital

Vision ●

Our commitment to excellence starts with making sure that we deliver exceptional results through technology and expertise. Saket City Hospital offers the best medical expertise and the highest quality of healthcare services. With highly qualified and a dedicated team of doctors onboard, our endeavour is to ensure the best possible medical treatment for all our patients. As we expand our services in a phased manner, we will continue to raise our benchmark of patient experience

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To be a national leader for excellence and innovation in healthcare delivery and patient safety, continually improving the quality of services and patient care experience. ● To set precedents with a superior model of healthcare services. ● To provide exemplary clinical settings to support the education of future health care practitioners, both as individuals and as members of the healthcare delivery team. ● To be the ideal employer, providing a highly rewarding environment for our employees. SCH is accredited by the National Accreditation Board for Hospitals & Healthcare Providers (NABH), accreditation programme for healthcare organisations. It also aims to obtain accreditation from National Accreditation Board for Testing and Calibration Laboratories (NABL) as well as international bodies. The hospital spent close to Rs 220 crores during the first phase of the project out of which 30 per cent has been allocated for procurement of medical equipment. The hospital has partnered breakthrough in the field of Indian

medical science and raised the benchmark by introducing Delhi’s first ever broadband MRI that will help in better diagnosis through better imaging, while ensuring up to 40 per cent more signal to noise ratio. Some of the highend equipment in the radiology department is as under:

MRI Ingenia 3.0T The ultra-high-field strength, magnetic field of the scanner enables faster and higher resolution scans, resulting in superb image quality and potentially more accurate diagnosis. The wide bore opening of the scanner with patient-friendly design, fast scan time and accurate scans make the MRI experience more comfortable for the patient for whole body imaging.

The Philips ICT With a focus on clinical collaboration and integration, patient care, an economic value, the system will provide a high image quality with the outstanding lows that are becoming increasingly important (low energy, low dose and low injected contrast). The ICT TVi is a new approach to total vascular imaging. The unique combination of hardware innovations, state-of-art acquisitioniDose4, and iterative reconstruction technique offers premium result for stroke, cardiovascular, thoracic and run-off imaging. DoseWise philosophy is a comprehensive approach to dose management focused on delivering the right quantity and quality of radiation where and when it is needed.

TURis TURis resectoscope system is a logical step forward in technology. The instrument has converted many of the open and laparoscopic electrosurgical procedures from a monopolar to bipolar technology (in monopolar surgery, the current goes through the patient to complete the current cycle, while in bipolar surgery, the current only goes through the tissue between the two electrodes of the instrument). TURis technology causes minimal effect to the surrounding tissue and avoidance of nerve and muscle irritation. The bloodless www.expresshealthcare.in

nature of TURis surgery makes it one of the safest procedures for prostate gland surgery. Also, the saline usage considerably reduces the risk of TUR syndrome which is an uncommon but serious complication of a specific type prostate surgery.

Allura FD10 XPER The Allura FD10 XPER provides the ultimate experience in cardiovascular X-ray. The machine promises superb image quality with lowest possible doses and is befitted with the most advanced features like Stent Boost and Xper Swing. While Stent Boost improves stent visualisation by manifold, Xper Swing diagnosis coronary artery disease with perfection provides 3D impression based on a 2D acquisition and reduces the procedure time. Spice Global has plans to invest close to Rs 1,400 crores by 2016 with the expansion to 1000 beds. Advanced softwares like Clinical Information System (CIS) or electronic medical charting (EMC) in operation theatres and ICU’s, Hospital Information Systems (HIS) and a seamless Enterprise Resource Planning (ERP) solution implemented by the technology partner IBM are the noteworthy utilities at the hospital. The clinical support at Saket City Hospital is also underlined by installation of equipment like other modules, facility for virtual ICU and Cath Lab. Other equipment at the hospital include Ultrasound iU22, BMD, Echo iE33 with 3D live TEE, Flat Panel C-arm,

world Class Neonatal ICU equipped with closed incubator and best in class warmers, LED phototherapy and electronic medical charting. The state-of-the-art OTs are equipped with pendant mounted anaesthesia machines on motorised pendants and sleekest OT lights along with centralised touch screen panels. Additionally, the two laparoscopy OTs are equipped with the latest high definition Laparoscopy System mounted on motorised pendants with two HD Monitors connected through fibre optic signals gives lot of comfort to surgeons and hence results in efficient workflow management. SCH plans to come up with a medical centre which will offer premium-end medical office space. The experience focuses on comfort, innovation and convenience. It offers best-in-class diagnostic-equipment, IPD facilities and variety of restaurant and café options along with valet parking for customers/patients. With world class infrastructure, excellence in patient care Saket City Hospital is determined to offer best healthcare practices, create centres of excellence and develop subspecialties in each clinical speciality which also focussing on clinical trials, research, academic programmes and newer modalities like stem cell therapy and gene therapy. Rs 1400 crores will be utilised to expand the capacity to 1000 beds in the coming years. SEPTEMBER 2013

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Shri Komal Hospital and Dr Saxena Nursing Home, Rewari (Haryana) From a three-room rented accomodation to a multi-speciality hospital with 50 beds, Dr Saxena's nursing home has come a long way t is the oldest and most reputed hospital of South Haryana comprising Rewari, Mahendergarh, Narnaul, Bawal, Manesar, Gurgaon, Pataudi, Kosli, Dharuhera and most of other important villages around Rewari founded by Dr SN Saxena and Dr Tara Saxena. The duo started their small practice in three-room rented accommodation in the heart of the city of Rewari on first floor of an old building. Rewari was a mofussil town at the time with brackish water and no portable drinking water of its own, most of which was bought over from the railway colony. Both doctors were instrumental in changing the face of the city by not only providing modern medical facility but taking active interest in establishing Public Education Board running five institutions and all other cultural and educational activities. With their earnest desire to uplift the poor and bring modern medical facilities, they organised free eye camps annually in Rewari and villages and educated the people thereby. They also started several social welfare organisations viz. Lions, Lioness clubs and AIWC, Rewari. Gradually they added diagnostic facilities viz. X-ray and computerised lab, ultrasound etc. Their next generation who also took to medical profession joined in the line and now the hospital has grown in infrastructure and facilities. The bed strength is 50 now and in times of rush some 20 more can be accommodated. Dr Saxena's son Dr Lalit Mohan, MD (Paeds.) joined in 1991 and his wife Dr Ruchi Saxena, MS joined in 1995. His daughter Dr Mitra Saxena, MD and her husband Dr Adesh, MS (ENT) joined in 1995. They worked together for 10 years during which a lot of improvement took place in the main hospital. Ultrasonography and computerised lab were added and laparoscopic surgery started. In 2005, Dr Mitra and Adesh opened another branch in new

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upcoming Model Town and both the hospital were given ISO certification. Together they cater to 100 indoor beds. From a small beginning

this hospital has grown to a multi-speciality institution of repute only because of the dedication of its founders, something which has percolated down to the next gen-

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eration. Dr Saxena's eldest daughter Dr Chitra Prasad is working as an Associate Professor of Genetics & Metabolic disorders in London Health Sciences

Centre, Ontario Canada. The hospital has a number of qualified doctors on its panel viz. â&#x2014;? Dr Narender Sharma, MS Laparoscopic & Gen

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Surgeon Dr Chandrakantkar, Urologist Dr Dheeraj Gupta, MS (Ophtho) Phako Srugeon Dr Grover, M Derm, Dermatologist Dr Fateh Singh, MD, Anesthesia Dr Dhananjay Singh, MD Anesthesia

Philanthropic activities :Dr SN. Saxena Founder, Dr Saxena Nursing Home

a. Free ANC clinic every 9th of the month b. Free Spirometry camp every fortnight c. Free ENT camps twice a year d. Infertility treatment at subsidised rates Several reputed multinational hospitals of Gurgaon like ARTEMIS, PARAS, MAX and MEDCITY hold their OPDs on different dates

here. The hospital has a team of dedicated trained staff which can tackle all sorts of emergencies. In 1966, Dr Saxena helped control the epidemic of cholera which is almost unheard of

now and helped railway authorities when a disastrous train accident happened near Bawal. The hospital tackled the emergency when two school buses of Mahendergarh collided and

several children were affected. Even in Uttrakhand, they were the fist to send truck load of relief material alongwith Lions Club, Rewari. This was followed by other charitable organisations and substantial help was sent to the PM and CM's relief funds. The hospital also holds drills for fire fighting regularly and also hold CMEs on Neonatal ICU, Breast feeding, immunisation etc. PPH drill is also done so that the staff remains alert all the time to work in an emergency in a organised manner. Because of continuing medical education and efficient, sincere handling of patients, the hospital has earned a very good name of being most reliable hospital in Southern Haryana.

Indus Hospital, Mohali From a single unit in 2002, to four units, Indus Hospital today offers a wide array of services from primery to tertiary care and cosmetic surgery centre with eight dental chairs, cosmetic lasers and OT for all kind of cosmetic surgeries) The OPDs have increased from 50 per day to an average of 450 per day, with 700 monthly admissions.The total number of beds are 180 Vision: “To be the destination of choice for healthcare.” Mission: "To provide competent, comprehensive, cost effective and environment friendly medical care to all."

ndus healthcare (INDIA) was established in year 2002, with 30 beds. Initially, it was focused on primary and secondary care, like gynaecology, paediatrics, general surgery, dentistry, internal medicines and laboratory medicine. Today, the hospital has four units Indus Super Speciality Hospital (a tertiary care hospital, with more then 100 beds and having facilities like- cardiology, nephrology, comprehensive cancer care including radiotherapy, critical care department) ● Indus Hospital ( a secondary care hospital with IVF, NICU along with other departments) ● Indus Scanlab (a diagnostic centre with CT scan, USG, doppler, digital x-rays, OPG, mammography, EEG) ● Indus Hygiea (a world class dermatology, dental

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Anaesthesia Cardiology Casualty Corporate Services Critical Care Dentistry Endocrinology ENT Gastroenterology Gynaecology Laboratory Medicine Emergency Medicine Nephrology Neurological Neuropsychiatry Neonatal ICU IVF Oncology OT Day Care Treatment Orthopaedic Paediatrics Pharmacy Plastic-Surgery Radiology Surgery SEPTEMBER 2013

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Disaster management ndus Hospital Mohali shall always be prepared for treatment of up to 30 total patients with arrangements for 10 patients in critical condition due to any External Disaster/ Emergency that may take place, as a part of its Corporate Social Responsibility(CSR) At Indus we have an Emergency Operations Plan (EOP) which describes how a facility will respond to and recover from all hazards. It is inclusive of the six critical elements of Emergency Management Standards: ❑ Communications ❑ Resources and assets

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Safety and security Staff responsibilities Utilities and clinical The Hospital Emergency Evacuation Plan(HEEP) is intended to provide instructions, protocols and procedures that should follow in case of any Internal Emergency situation necessitating either a horizontal, vertical, full or partial evacuation of the hospital. The following systems have been provided to enable early warnings and adequate communication network to facilitate safe egress from the building, when necessary. ❑ Automatic Fire Alarm and Smoke / Fire

Detection System. Manual Call Points (MCP). Public address system. Defined exit routes and points of egress put up as large displays in each independent ward / area for all to see. Hence our hospital considers it a primary responsibility for saving lives and provide 24x7 emergency care service. “It is our responsibility to provide health care services to the community in quiet times and disaster time.” ❑ ❑

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SERVICES OFFERED BY TTHE HE DEPAR DEPARTMENT TMENT OF PULMONOL PULMONOLOGY OGY & CRITICAL C CARE ARE • Chest • Asthma • COPD • Sarcoidosis/ILD • TB • Snoring / Sleep Apnea • Shortness of Breath • Paediatric Pulmonology • Respiratory Critical Care Unit • Thoracic (Chest) Surgery

Diagnostics & Therapeutic T herapeutic • Pulmonary Function Test (PFT) Lab • Video Bronchoscopy (Endoscopy of Lungs) • Sleep Study Lab (Polysomnography) • CPAP / BiPAP / NIV Titration Study

Saket City Hospital, Mandir Marg, Press Enclave Road, Saket, New Delhi – 110 017

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Trauma & Joint Replacement ■ Home Care ■ Preventive & Occupational Deptartment ■ Innovative technologies: ■ Multislice CT SCAN. ■ Siemens Linear Acce-lerator Radiotherapy. ■ Baxter dialysis machines. ■ Latest IVF laboratory with heap filters. ■ Modular OTs with heap filters ■ Labomed operating microscopes. ■ Digital radiography. ■ Siemens ventilators. ■ GE Colour Doppler. ■ Lumenis cosmetic laser ■ Vessel sealing system. The hospital aims to provide a wide array of services (from primary care to tertiary care) in a focused and innovative manner and believes that its operating protocols and our selection and retention criteria for employees and doctors is its USP. Indus Hospital is committed to deliver the best possible experience and clinical outcomes for its patients and hence is ISO certified having already applied for NABH. The quality system complies with internationally recognised quality management systems which imply adopting good professional practices. Hence, Indus Hospital is committed to provide excellence in patient care and it is dedicated to meeting changing needs and expectations of the patients and introduce quality in all its services and ensure continuous improvement of quality through national and international accreditations. This is being achieved by quality teams totally committed for effective implementation of quality management systems through continuous review of quality objectives and trained professionals, supported by state-of-the-art equipment. It aims to be the largest healthcare provider in the region beginning the construction of new 350-bedded hospital within this year.

T: + 91 11 7121 2121 | F: +91 11 2696 3801 | E: contactus@saketcityhospital.com www.saketcityhospital.com | EMERGENCY +91-11-4069 9999 | Follow us on

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Academy of Hospital Administration Academy of Hospital Administration (AHA) strives to support the cause of professional governance in public hospitals by helping make high quality healthcare equitable, affordable and accessible to all without any discrimination HA is a pioneer institution known for quality education/ training, planning designing, consultancy and research in the field of hospital and healthcare management. The academy came into being in 1987 at AIIMS, New Delhi and later shifted to AHA House, Noida. AHA prides itself in being a pioneer in development of quality standards for hospitals and healthcare organisations, which were later developed into NABH standards. It also promotes scientific hospital management practices and quality management in healthcare delivery institutions in India. AHA undertook the task of capacity building for trained qualified hospital operations manager in the country, a cadre highly deficient but in great demand, training more than 4000 hospital and health administrators including few from neighbouring countries. Institute of Healthcare Management, Training and Research has

Maj Gen (Retd) M Srivastava, VSM - President, AHA

been established by AHA for conducting various courses and research.

proposal pertaining to hospitals planning and establishment, for completion on turnkey basis.

Mission “To develop and maintain hospital and healthcare planning and designing parameters, quality training, consultancy and research activities in health and hospital system through active involvement of healthcare organisers and providers, in order to attain a leading role in continuously improving the performance of healthcare systems in the country.” AHA has a team of more than 300 expert consultants in various fields of health, hospital and allied sector all over the country. Renowned and well established hospital administrators are on the panel of the academy for undertaking consultancy and short-term assignment for planning/execution of hospital projects and to tackle specific hospital problems. Academy also accepts sound

Training in quality management systems More than 450 healthcare professionals have been trained by Academy of Hospital Administration, through distance learning courses Post Graduate Diploma in Hospital and Health Management ( PGDHHM) course, approved by DGHS, Ministry of Health & Family Welfare, Government of India. AHA successfully conducted Management Development Training Programme (MDP) a World Bank-sponsored Project of UPHSDP, OHSDP, KHSDRP. AHA designed the first unique hospital and health system management training programme 'Post Graduate Diploma in Health Management (PGDHHM)' in collaboration with Indira Gandhi National Open

University (IGNOU) and trained more than 2,000 professionals during 2000 to 2004. AHA faculty has designed an unique job-oriented course called Quality Management & Accreditation of Hospital and Healthcare Organisations Course (QM&AHO) AHA is registered by National Accreditation Board for Education and Training [NABET], QCI Government of India as Consultant Organisation for Quality & Accreditation System. Hospitals desirous of getting accreditation from NABH can seek consultation from AHA. Going forward, AHA strives to support the cause of professional governance in public hospitals by helping make high quality healthcare equitable, affordable and accessible to all without any discrimination. It also hopes to promote scientific hospital management beyond borders and start overseas centres for learning.

SPS Apollo Hospital, Ludhiana Expansion plans include setting up a cancer hospital and a women and children hospital in Ludhiana

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pS Apollo Hospital, Ludhiana is a 282 bedded hospital with a sacalable capacity of 350 inpatient beds facilitates that is established to cater to the healthcare needs of different strata of people in the entire North Indian region (Punjab, Himachal Pradesh, Jammu & Kashmir and parts of Haryana and Rajasthan) by providing the essential tertiary level care. The inception of SPS Apollo Hospitals, Ludhiana was a cherished dream turning into a reality. The idea behind starting of this hospital was to provide a destination of choice of healthcare for people in all demographic and age profiles. The hospital commenced its operations in March 2005 with the expertise of eminent medical professionals and efficient paramedical and nursing professionals. Prime Minister of India, Dr Manmohan Singh inaugarated the hospital with 125 inpatient beds across all major multispeciality medical departments in September 2005.

The vision of Sri Satguru Partap Singh Ji forms the backbone of setting up of SPS Apollo Hospitals which includes setting up a world class healthcare facility providing quality and affordable healthcare to the people of Punjab. The mission of the hospital is, “To bring excellence in healthcare within the reach of every individual. We are committed to the health and well being of humanity.” these words form the spirit and backbone of every associate of SPS Apollo Hospital. Keeping up the promise of maintaining excellence in terms of healthcare for the benefit of humanity, the hospital has been setting standards in the North India. In terms of intangible assets, SPS Apollo Hospitals has built a strong and profound goodwill and an unwavering image in healthcare sector. Also, it has witnessed phenomenal growth year-on-year in terms of patient numbers (both OP and IP) and revenue. The financial performance of the hospital has been extremewww.expresshealthcare.in

ly satisfying, with both revenues and profits showing significant growth YoY. The hospital reached its breakeven in 2007, only two years after its inception and revenues have risen by ~20 per cent every year with both the EBITDA and net profits margins being handsome. Patients volumes has also grown by over 25 per cent each year. Inspired by the dream of being the most comprehensive healthcare provider across all specialities, most of the medical multi and super specialities have existed in the hospital since the beginning. In the recent past, super specialised services like Interventional neuro radiology, renal transplantation, paediatric cardiology, infertility services and urogynaecology, have been added. The radiology department of the hospital offers comprehensive and diagnostic services under one roof including a 1.5 tesla MRI, 128 slice CT scanner, CR system, 500 maX-rays with IITC, mammography, DEXA scan and colour doppler. The set up also boasts of a next generation

Cath Lab and the most advanced endoscopic suites including capsule endoscopy. The stainless steel operation theatres provide an infection free environment ensuring patient safety and superior surgical outcomes. The ambulance network of the hospital has allowed the creation of a seamless emergency management system. The ambulances are equipped with advanced life saving and emergency equipment. The pneumatic shoot system allows on time delivery of samples to the in house laboratories . Information technology has been leveraged through an advanced Hospital Information System(HIS) and Enterprise Resource Planning (ERP) programmes. The 100bedded intensive care unit follows a multi-disciplinary approach with multi-channel monitoring that supports noninvasive and invasive pressure monitoring and high-end ventilators. The competitive advantage of SPS Apollo Hospitals is the quality of healthcare services that it offers at affordable SEPTEMBER 2013

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rates along with an infection free environment. Cost effectiveness always ensures that world class healthcare is assessable to all the people in North India and this is what makes this hospital from going good to great. The 'We Care' programme that aims at generating a confidence among the patients, that the decision to come to SPS Apollo was right, differentiates and sets apart the quality of patient care at the hospital. A focus on the patients and giving them the warm culture of tender loving care has been created through the development of an in house programme that aims to make patients feel comfortable and ensures that their needs are attended to in the best possible way. Clinical excellence through quality care has been a continuous journey at SPS Apollo Hospital with Joint Commission International (JCI) accreditation acquired shortly after inception becoming the first hospital in South East Asia to attain the JCI accreditation within a span of just 18 months. In February 2010 and February 2013 the hospital was successfully reaccredited by the JCI, USA. Quality at SPS Apollo is a way of life and is driven passionately by the top management with 200 quality indicators which are continuously monitored. A reflection of this can be found in its VAP (ventilator associated pneumonia) being zero and catheter related urinary tract infection (CR-UTI) rates being lower than the National Health & Safety Network. Practices like Lean, Six Sigma and Kaizen have been adopted to improve and ensure better processes. The Apollo Clinical Excellence Model has been implemented in the hospital and quality is regularly monitored and benchmarked against the best medical institutions in the world. It was awarded the first prize by the Punjab Energy Development Agency in May 2011 for its efforts towards becoming a green hospital through energy conservation. The good work done at SPS Apollo Hospitals in the area of Medication Safety was published as a case study by the JCI, USA. Its attendance management system was rated as one of the best IT implementations by one of the leading IT magazines in the country. SPS Apollo Hospitals has always prioritised its Emergency Management Plan(EMP) preparedness as a goal, by developing a system SEPTEMBER 2013

to achieve and maintain it with disaster management strategies for both external and internal disasters. The EMP deals with all situations rising from such disasters. A complete analysis of threats is done, and the EMPs made accordingly. These consist of certain SOPs, responsibilities of individuals and departments, functioning and activation of the plan and communication. Disaster Command (Emergency Response Team),

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headed by the Chief Security Officer (CSO), is present who are fully prepared to deal with any kind of an emergency situation. A reserve manpower pool to cater for any additional requirement, is also present. To make sure that the people understand the plan, rehearsals and mock drills are carried out every six months with lectures and trainings on fire safety, emergency codes, record management, lab safety etc. conducted throughout the year for all the employees.

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There is a dedicated fire safety team for four main fire safety systems: Detection, Warning, Suppression and Exit. Adequate number of fire extinguishers and Personal Protective equipment (PPE) are placed throughout the hospital. The security guards on each floor act as the fire marshals, in case of an emergency. To serve humanity and to become a name of distinctive reputation in pan Punjab healthcare network, SPS

Apollo Hospital in collaboration with the Apollo Hospitals Group, aims to reach out to other cities of Punjab and provide them with qualitative healthcare at affordable prices. The expansion plans also include setting up a cancer hospital and a women and children hospital in Ludhiana. Further to develop the centres of excellence, the main hospital in Ludhiana would see addition of critical care beds and liver transplant programme.

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Qualimed Healthcare Medical quality services such as setting up practices, policies and methods in medical administration, medical treatment, patient service, quality assurance, and public relations activities are an absolute necessity in healthcare and Qualimed helps fulfill the gap ualimed started in 2012 with a mission to make an impact in the crucial area of medical quality which impinges on all stakeholdes, the patients, HCO and the community at large by partnering with organisations in enhancing the quality and effectiveness of healthcare. From two employees it has expanded to over ten today providing the whole gamut of medical quality services, ranging from establishing/documenting/ training and implementing the basic quality standards, to providing guidance for accreditation/empanelment of NABH/NABL/JCI /CGHS/ECHS, as well as guidance on business excellence models/lean/Six Sigma Implementation.

Dr Farah Deeba, Senior VP, Qualimed Healthcare

Vision Quality healthcare will always be defined by meeting and exceeding customer expectations. The pursuit for excellence will be an essential component for differentiating the successful healthcare organisations. Sevices provided include:(a) Sharp supervised gap analysis of existing healthcare facilities. (b) Training and implementation(i) NABH JCI ISO standards (ii) Lean / Six Sigma (iii) Documentation (iv) Internal audit (v) Legal/ Statutory compliances (vi) Formulating policies/ procedures (vii) C o m m u n i c a t i o n workshops (c) Implementation (i) Standard Operating Procedures (SOP) (ii) Maintenance of records (iii) Management review (iv) HR Policies (v) Continuous Quality Improvement (CQI) (d) Consultancy (i) Fire safety (ii) Biomedical waste management (iii) Legal and statutory guidance (iv) All other aspects of medical quality as per scope of services The team members have experience in implementing innovative, effective organisational and strategic planning and execution skills with great

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success and attaining organisational economy in terms of cost and efficiency at both, micro and macro level. At the micro level, the team has demonstrated excellence in setting up practices, policies and methods in medical administration, medical treatment, patient service, quality assurance, and public relations activities thereby working towards various accreditation requirements and quality in medicine. True to its tagline ‘Raising the Bar in Medical Quality’ the organisation aims to raise the bar in medical quality thereby providing benefits to patients, healthcare organisations, medical fraternity and the community. It has expansion plans in terms of infrastructure, capacity building, enhancing training programmes, process refinement in multi-departmental level and bringing in innovation and best patient practices.

Medical quality aspects 1. Patient safety is a critical component of quality care, and is one of the most challenging issues in healthcare today. The aim of providing quality medical care, in distressing times of disaster, where saving of life, essential organs and limbs is of prime importance, appears not only daunting and far fetched affair, but also entails a great deal of planning, training and implementation. 2. However, at such very times of disaster management when resouces are stretched and scarce with urgency, the need for effective allocation and measurable outcome is all the more essential. The sound principles of quality management implemented at the various stages of disaster will ensure better outcomes. The Government of India through its manifold contributers in the field of medical quality need to be geared up to these facts to provide better disaster disease outcomes for the benefit of patients. 3. Human error is a fact in healthcare, more so in a scenario of disaster and we all must be educated on what to be watchful of regarding things that might go wrong. Many countries in the world have already recognised process mapping and improvement as an important aspect in www.expresshealthcare.in

disaster management, and are building ways and approaches to improve the outcomes and quality of care. Healthcare professionals also need to be educated on the principles and concepts of patient safety. 4. To illustrate the role that medical quality can play at various stages of disaster scenario, some essential aspects of providing seamless, faster, better and organised care are outlined below:-

Pre disaster planning The paradigm that, “The more you sweat in peace, the less you will bleed in war” is equally applicable to preparing for disasters. The aspects which deserve attention are: (a) Decision making Inclusion of a medical quality professional in areas of decision making in Disaster Management Committee, Medical Council of India and Regional / National Health forums (b) Treatment plans Use of evidence-based medicine and clinical practice guidelines in formulating national disaster management treatment plans and implementation guidelines, based on best practices (c) Planned checklistsDevelopment of user friendly checklists / tools/ scorecards To facilitate quick deployment of resources like man and material (d) Standardised protocols - To develop standardised protocols for treatment applicable as follows; (i) Onsite at the site of location of disaster (ii) During transport of patients (iii) Offsite at the referral hospitals (e) Resource allocation It is essential that man and material is predesignated in order to ensure that a right person is earmarked for the right job and he knows the role to be performed at crucial times and chaos is averted.

Monitoring the disaster Once disaster strikes, whilst provision of prompt and efficient care, is of utmost importance and is handled by the operational team, a medical quality representative would play a very vital role. He would perform the functions of process mapping, filling in various checklists,

deploying of essential toolkit, all providing critical inputs and followup leading to process improvement and delivery of better patient care. It is imperative to identify error pathways in order to ameliorate or circumvent them and this can be achieved by the inputs generated by the Medical Quality Representative, Post disaster Recovering and learning from the disaster. The hospital need to keep patients safe and learn valuable emergency preparedness and management lessons in the process. This goal could be achieved by the following means (a) The process mapping reports are studied in details to detect gaps, differentiate value added steps from non-value added steps and issue process improvement guidelines, (b) Study of the checklists/ toolkits / scorecards, to analyse deviation from protocol, determining root cause analysis and implementing corrective and preventive actions (c) Post disaster audit of care provided against pre decided parameters. All disasters whether manmade or natural lead to human suffering and create needs that the victims cannot alleviate without assistance. Thus, various organisation pitch in help at national/international level. Each of them have different objectives, expertise, and resources to offer, and several hundred may become involved in a single major disaster, hence the need for standardising, seamless delivery of care based on evidence based guidelines, process mapping, process improvement and well coordinated efforts to avoid further chaos and confusion both during and after the disaster and better patient care outcomes. Quality patient care provision and improvement, in a disaster situation, therein forms the key to prompt patient management and better outcomes. Implementation of well established principles of medical quality can vastly aid in the veritable goal of delivering timely effective care under the most demanding of circumstances. Quality is a journey and not a destination, and needs focussed and concerted efforts by one and all. SEPTEMBER 2013

Health and hygiene are a clear priority for the healthcare sector, but it’s also important to create a comfortable environment for patients, and good working conditions for staff. Tarkett has a solution for every area, from brilliant colours for children’s wards to static-control for an operating theatre, from traffic and stain-resistance for reception to slip-resistant and waterproof ﬂoors. Hygienic and ultra-hard, easy to clean and maintain, our ﬂoors offer optimum return on investment while reducing staff workloads and improving patient comfort and care. www.tarkett.com

Flooring solutions for healthcare

Health and hygiene are their priority We provide the solutions they need Tarkett India 132, 1st Floor, Rec.-1, D-4 District Center Saket, New Delhi + 110017, India Tel: 011 435 240 73 Fax: 011 435 240 79 E-mail: thomas.schneider@tarkett.com

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Goldstar Healthcare Goldstar has developed the HIMS solution on MS. Net platform which provides comprehensive application that integrates various functions to enhance the operational efficiency, making it one of the most effective healthcare software developments oldstar Healthcare (an ISO 9001:2008 certified, Microsoft & IBM Partner) was established in 2006 by Sadanand Reddy with a motive to provide healthcare and hospital management consulting and information system solutions. It helps hospitals plan/procure equipment, improve operational performance, develop process and setup systems in place, enhance quality, implement a turnkey, assist in accreditation preparation, outsourcing solutions/guidance, biomedical engineering support and strategic plan for HIMS software solutions. With the vast knowledge and experience in hospital industry, Goldstar has developed the HIMS solution on MS. Net platform to provide end-to-end features to hospital management. It provides comprehensive application that integrates various functions to enhance the operational efficiency, making it one of the most effective healthcare software developments. It is a web-based hospital information system covering clinical, administrative and financial areas of a healthcare set-up. The modules are designed to help healthcare organisations reduce costs, streamline administrative processes, improve quality of care (clinically and administratively), and raise the standard of the hospital at par with the NABH accreditation. The company has successfully accomplished few projects with locations in northern, southern and eastern parts of the nation and few international projects as well. Goldstar provides turnkey solutions for healthcare sector from specialty to tertiary sectors ensuring optimal utilisation of facilities through innovative design, networking various elements of healthcare delivery system and bringing in latest and feasible global technologies in line with the international players by customising the same to the local requirements. Goldstar has well defined and mature application development process, which comprises the complete SLDC from business case analysis to warranty support of the

Sadanand Reddy MD, Goldstar

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application and ultimately leading to ongoing maintenance support. This process supports a distributed delivery environment where in work responsibilities can be effectively divided between the delivery teams spread across the globe. Strict quality assurance methodologies are followed where each stage of the application development process is monitored, reviewed, audited and controlled. This clubbed with benchmarked practices and experienced delivery skills help clients get maximum return on their IT spending. The company also provides end-to-end IT solutions for a typical healthcare industry on – hardware, networking, IT department layout, manpower selection and recruitment including onsite training. We also undertake outsourcing of the IT department.

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Proven credentials in providing complete package of IT solutions and allied services Experience in implementation of HIS in India and overseas Domain expertise across various disciplines of healthcare industry to help ‘clients’ assessment and requirements of hospital IT and management solutions.

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Comprehensive, integrated, web based, multi-location solution Covers all the aspects of hospital management: Patient Management System Clinical Management System PACS and Interface Management Information System Support Services International Standards Compliant: ICD10 ICP-9 HL7 CIMS for Drug Interaction Integration with MS NAV, Tally for financial management Single window concept to Patients for billing and collection Facilities Controlled by user-defined parameters www.expresshealthcare.in

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Multiple tariff lists with very flexible option for rate revision Covers medical insurance companies functional requirements (TPA) Customised preventive health packages for the OPD & IPD Patients On-line clinical management system for all specialties, Pre-defined multiple medical & discharge summary with auto generation Audit trail facility Powerful search engine for locating various information related to patient Comparative performance reports Comprehensive MIS

Turnkey projects Today this is the area where most of the entrepreneurs are interested in. This is financially more viable and ensures one point of contact. The challenging market is now demanding innovative and integrated service delivery. GHPL provides end-toend solutions encompassing: ● Selection of site ● Feasibility study to validate the need for facility ● Identify target market segment ● Finalisation of clinical programme ● Quantification of need ● Preparation of architect’s brief ● Identification and listing of regulatory requirements ● Development of SOPs for functioning of a hospital ● Clinical protocols ● Hospital committees ● Human resource management ● Revenue sharing with consultants ● Outsourcing decisions ● Medical equipment planning and procurement ● Pricing and tariff setting

Process development Service delivery processes typically consist of a complex organisation of technology, people and practices. Developed and operated effectively, they can provide with significant competitive advantage; if poorly conceived and mis-managed, they can saddle an organisation with inefficiencies and performance problems that are difficult to over-come. The team at GHPL helps

design process flows, policies and standard operating procedures for all the departments in the hospital keeping in view efficiency, capacity, quality, throughput time and flexibility.

Equipment planning and procurement Although a great deal of emphasis is placed on meticulously planning healthcare construction and controlling associated costs, the medical equipment piece of the puzzle is often overlooked or grossly underestimated. The end result is unexpected expense and the potential for costly redesign. This is the core area, which needs meticulous planning and experts. Clients receive objective advice and creative solutions ensuring cost effectiveness. Core areas include: ● Budgeting ● Specifications development: ● Procurement Management ● Installation ● Relocation Planning ● Equipment Management Systems and Software ● Department Procedures

Materials management Effective management of materials is crucial to the performance of an organisation. Material costs are usually a firm’s largest expenditure. Operating with fewer inventories offers a firm a competitive advantage. Materials management can have a significant impact on quality, customer satisfaction, profitability and market share. There is a need to ensure availability of right materials at right time in right place. GHPL undertakes planning, reviewing and control of the following core activities: ● Demand forecasting ● Procurement ● Budgeting and material planning ● Receipt, inspection and storage ● Issue and distribution ● Consumption ● Maintenance ● Condemnation and disposal ● Inventory control ● Pilferage control ● Maintenance of records in accordance with statutory obligations

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Pushpanjali Crosslay Hospital Pushpanjali Crosslay Hospital aims to provide quality healthcare at affordable price by incorporating modern technology with a vision to create a three-tier healthcare delivery platform with primary, secondary and tertiary care interwoven into a hub and spoke system ushpanjali Crosslay Hospital is a multi-superspeciality and tertiary care centre that serves to provide the highest quality of healthcare to a broad mix of local and international patients, and is amongst the few hospitals in the region to have accreditation by National Accreditation Board for Hospitals and Healthcare Providers (NABH) & NABL. With passionate, committed and dedicated medical doctors who have given their best to this venture, right from conceptualisation to execution, the hospital provides unmatched range of preventive, diagnostic and alternative treatments with regular follow-ups in all medical specialities. Located on NH-24 along with ultra-modern treatment at affordable cost, it attracts patients not just from DelhiNCR but from other parts of the country and even overseas. The premier facility has 350+ operational beds spread over a built-up area of 4.3 lakh sq feet. Medical facilities are supported by a large group of physicians, nurses, technicians and management professionals in an environment that enables them to deliver the desired patient-centric care. Commitment to patient welfare and delivery of quality healthcare is also reflected in the unique design attributes of the hospital.

nological environment of the highest standard. The state-ofthe-art equipment in all disciplines adds to the efficiency of diagnosis and treatment and provides the highest level of comfort and convenience to

patients including the 1.5 Tesla MRI, 64-Slice CT Scan and advanced Cath Lab. The labs are equipped with modern technologies for biochemistry, haematology, microbiology and histopathology. The

hospital has 11 advance operation theatres where both open surgeries along with complicated advanced laparoscopic surgeries are performed. A pneumatic chute system facilitates the transfer of laboratory

Dr Vijay Agarwal, Executive Director, Pushpanjali Crosslay Hospital

Vision Developing an affordable and efficient healthcare system by balancing preventive and curative measures, establishing an enduring DoctorPatient relationship. ● Centres of Excellence at Pushpanjali Crosslay Hospital● Pushpanjali Institute of Cardiac Sciences (PICS)● Pushpanjali Institute of IVF & Infertility (PIII)● Nephrology and Kidney Transplant ● Paediatrics and neonatology ● Orthopaedics and Joint Replacement ● Galaxy Cancer Institute ● Crosslay Wellness Programs

State-of-the-art equipment Our consultants are supported by a clinical and techSEPTEMBER 2013

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samples, blood samples, consumables and drugs. The hospital has over the years, not just expanded in its services but has also witnessed in increase patient footfall, with excellent outcomes.

Patient growth

Services

Dr Vinay Aggarwal, Chairman & MD, Pushpanjali Crosslay Hospital

In a short span of four years, since its inception in 2009, Pushpanjali Crosslay Hospital has grown from 100 beds to 350+ operational beds. PCH has highly specialised centres of excellence including Pushpanjali Institute of Cardiac Sciences (PICS) – which includes invasive cardiology and cardiac surgeries. The cardiology team at PICS accords utmost importance to proper diagnosis, which helps to decide the most appropriate line of treatment. The other centres of excellence includes Pushpanjali Institute of IVF & Infertility (PIII) working at “enabling the joy of parenthood”. It has been delivering excellent outcomes with an average success rate of >50 per cent with one

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Total

F.Y 2010-11

F.Y 2011-12

F.Y 2012-13

2013-14 (Q1)

IPD

10262

12,092

14,961

3,826

OPD

66558

1,00,863

1,42,074

40700

Emergency

7,417

10,706

12,596

2,972

Surgeries

2,336

3,962

5,145

1,374

Revenue growth- (Rs in crores) Revenue

F.Y 2010-11

F.Y 2011-12

F.Y 2012-13

F.Y. 2013-14 (Q1)

57.22

91.48

134.94

33.55

cycle delivering over 67 per cent success rate. One of the latest centre of excellence is the nephrology and kidney transplant which has 29 dialysis machines as opposed to 13 at its inception performing more than 2,000 dialysis per month. It not only treats patients within India but also overseas patients. The hospital is accredited by National Board of Examination for DNB in five specialities including internal medicine, anesthesia, paediatrics, radiotherapy and family medicine and general surgery.

Other facilities The needs of the attendants and visitors are taken care by the provision of comfortable waiting areas, cafeteria, round-the-clock pharmacy, ample car parking along with ATM facility inside the hospital. The hospital strives to reduce the waiting time for the patients, right from the admission to discharge, by improvising the quality of service. It also has dedicated

ICU lounges for the attendant/s of the patient/s.

Unique model The hospital is managed through well-defined policies, processes and a robust webbased Hospital Information System (HIS) supports this model. Though the primary focus of the hospital is on treatment and cure of diseases and disorders, PCH believes in partnering with the community in its ‘Journey to Good Health’.

Infrastructure and back-end The need for an environmental friendly and clean hospital is imbibed in each and every employee of the hospital and is one of the most important areas in tandem with patient care. The infrastructure of the hospital conforms to its belief in holistic health. The building is eco-friendly with electricity back up from CNG fired generators. The hospital is mercury-free to the maximum extent possible. Inpatient and outpatient serv-

ices are placed on the same floor for each of the major specialties to facilitate speedy and efficient services. In addition, PCH is an equal opportunity employer with a diverse workforce that has on its rolls employees with visual and hearing impairments. PCH has key performance indicators (KPIs) established for each area of its patient care, operations and other activities, which are closely monitored and evaluated monthly. Pushpanjali Crosslay Hospital has a vision to create a three-tier healthcare delivery platform with primary, secondary and tertiary care interwoven into a hub and spoke system. The plan is to create secondary care hospitals in tier-II cities within the radius of 500 kms with some as greenfield and brownfield projects. The aim of Pushpanjali Crosslay Hospital is to provide quality healthcare at affordable price by incorporating modern technology.

Medicmarcomm Kapil Munjal provides a perspective on how to effectively use paid advertising, owned media (website, social media, in-hospital), and earned media (followers of owned media) across all media types here are two critical challenges healthcare marketers face today (a) building patient trust and (b) spreading positive word of mouth about their hospitals service. These twin challenges are accentuated with a shift in the nature of social interactions, and a sudden spurt in the type of media consumed by people, especially new media and its rapidly evolving features. The marketing team can be overwhelmed by its tasks to handle physician referral programmes and marketing activities across wide array of media including print, digital, social, TV, radio et al. An example of this fact is, that understanding and exploiting

Kapil Munjal CEO, Medicmarcomm

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each social channel (Facebook, Youtube, Twitter and others) requires expertise in each one of these. The creative, reach planning, media buying for each media is different, increasing the diverse set of skills required from a small team of inhouse marketers. Integrating these social channels amongst themselves and with print and on ground activities can be a daunting task. The flip side of this challenge is the opportunity, to engage the precise target audience, for each speciality, from defined location(s), for a longer period of time, over highly engaging media, thereby increasing the return of interest (ROI) from the advertising spends. www.expresshealthcare.in

Attracting new and more patients from domestic and international markets had never been possible earlier, in the way, it is now. An intelligent, well integrated content and advertising plan across your website, your Facebook page and your Youtube channel positions your ‘brand’ as a ‘trusted brand’ and attracts domestic and international patients. This also acts as an ongoing medical education and awareness amongst your network of referring physician and your patients.

Social media Conversations and word of mouth have always been instrumental in bringing success to any hospital. Social

Media, now a very powerful tool, takes the patient conversation to a new level, while helping the hospital stay connected with the community. Facebook with over 88 million active users and YouTube extensively used by secondary and tertiary care seekers, together both media platforms top the importance charts for hospital marketing. To begin, ensure that your social media channels integrate with your website and the posts have links to your website. This helps the website get higher ranking in the search engine results. It is important to have a content plan in place before launching the social media platforms. The content that is posted is like a health talk or SEPTEMBER 2013

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CME lecture that is given in a public gathering. It includes patient testimonials, patient and physician information and education. Always encourage the audience to interact on social media platforms and ensure to answer the queries. Excellent creative designs for the posts and videos provide the cutting edge. Fan acquisition should be through paid advertising, as this ensures you are acquiring fans from the desired target group.

introduced; and competitive (often disruptive) pricing for existing treatment methods. Each medium has its own characteristics, and same creative design may not work across all mediums.

Events Experiential marketing is time tested and trusted. The age old health camps still are very relevant in attracting new patients. Preventive, free health checks, top faculty advertised to the desired target

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group gets the desired results. Use of social media helps better engagement of people from surrounding areas, both pre and post event.

Physicianâ&#x20AC;&#x2122;s network Building a network of general practitioners for referrals is the most important piece in the marketing story. Convincing a GP about the level of healthcare service is a continuing task. CMEs and hospital visits to showcase latest techniques of treatment

require time and travel. Virtual walk through videos and online, live video CMEs are the way to go. Recordings of these videos on Youtube are useful for those who could not attend.

word of mouth. Social mediaâ&#x20AC;&#x2122;s impact here continues to grow. Patient testimonials must be allowed and encouraged on all platforms. Handing over patient information brochure to all indoor patients also helps.

Word of mouth Existing patients are your future brand ambassadors. Nothing succeeds like success. Positive brand reinforcement comes from patients with positive prognosis. Use integrated marketing to spread positive

The author runs an independent, healthcare focussed advertising agency, offering integrated marketing solutions. He can be reached at kapil@medimarcom.com

The Internet A recent study by a leading health insurance company in India, showed that over 40 per cent of patients use the web for treatment related information. A hospitalâ&#x20AC;&#x2122;s website is a tool to attract new patients from across the globe, both domestic and international. The number of patient queries that your website generates is a barometer to its success. Important activities include search engine optimisation, pay per click advertising on major search engines, display advertising on health related websites and networks, re-targeting and video ads. Some of the smaller hospitals have been smarter than the larger corporate chains in getting patients from the internet. Quite often people tend to forget yahoo and bing search engines, relying only on google. There are thus, often, available attractive ad inventories on Yahoo and Bing.

PR Press coverage of a rare surgery, an accomplishment, celebrity visit for treatment creates the desired visibility and builds positive image. Knowing what would interest the health journalist and reaching out to him with appropriate information at the right time is both science and art. Benefit of any piece of mainline media coverage is accentuated by social media, both in terms of reach and shelf life. Most PR agencies are yet to come up to speed with social media though.

Advertising An integrated advertising plan across print, digital, social, outdoor and events helps in getting better ROI. It should be ensured that the creative designs are not only visually appealing, but also carry a copy that works, an intelligent media plan which aims to reach the precise target audience and aggressive media buying ensures to get best prices from media owners. It is considered prudent to advertise new treatment technology SEPTEMBER 2013

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ERS’ D ACH AY E T

5t hS

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“Guru Govind dono khade kake lagu paay, Balihari Guru aapki Govind diyo batay” The famous couplet by Saint Kabir aptly projects the reverence and gratitude we feel for our teachers and their place in our life. This Teacher’s Day, M Neelam Kachhap gets the industry to send in their memories of their 'most memorable teachers', as a way of saluting those great figures who make a difference in our lives

DR MI SAHADULLA Chairman and MD, KIMS Healthcare Group

DR RAVIKUMAR HN Director – Operations, RV Metropolis Diagnostic & Health Care Centre Bangalore

Name of the medical college Medical College, Trivandrum Name of the teacher/s Dr Mathew Roy Subject taught Internal Medicine A dynamic teacher, always well dressed, well updated with the subject, friendly and always tried to bring the best out of a student.

DR UMAPATHY PANYALA CEO of Apollo Hospitals, Karnataka Region

Name of the medical college Siddharta Medical College, Vijayawada, Andhra Pradesh Name of the teacher/s Prof Eshwar Subject taught: Internal Medicine A simple humble teacher, with an extraordinary knowledge on the subject, fluent and flowing were the capabilities exhibited. The most difficult subject was explained as if it was a kids knowledge.

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Name of the medical college Bangalore Medical College, Bangalore Name of the teacher/s: Professor DR Krishna Murthy Subject taught: Pathology

I must admit that I was one of those lucky ones who got admitted to Bangalore Medical college for my post graduation,under Prof Krishnamurthy who was then the HOD at Bowring and Lady Curzon Hospital, Bangalore. He taught us basics in pathology and today we feel that this is so useful for our day-to-day application in our laboratory practice. He was very punctual, strict, more practical and was maintaining the TAT (1986) in those days. Unfortunately, today we do not see people talking about basics as they think it is not useful in view of improved technology ,but they forget the fact that the technology is based on basics in pathology. We, at times, see people making blunders due to lack of knowledge about basics. I owe him a lot for teaching me the fundamentals of pathology..

MEMOIRS OF THE GOLDEN DAYS

DR SUSHIL SHAH Chairman, Metropolis Healthcare, Mumbai Name of the medical college Grant Medical College, Mumbai Name of the teacher/s Dr TG Thariya, Dr OP Kapoor, Dr RD Kulkarni Subject taught Gynaecology, Medicine and Pharmacology respectively

I distinctly remember three teachers from my days at Grant Medical College. These three teachers were special because I not only attended their lectures meticulously but paid keen attention to what they taught and spoke. Dr TG Thariya, a very renowned gynaecologist in Mumbai, had an extremely good sense of humour which added to the vitality of his lectures. He was also able to simplify a complex subject like gynaecology and make it understandable. We all used to look forward to his class because they were educative and entertaining. In medical sciences, when the study pressure is so high, such teachers and their lectures are an absolute bliss. Dr OP Kapoor was famous for his marathon classes. A physician by training, his marathon classes meant sitting for seven complete hours of lecture. One would be terrified with the very idea of such long lectures, but Dr Kapoor had a style that made those seven hours pleasant rather than hectic. He had a simple narrative style of lecturing. I recall myself sitting week after week for these seven-hour lectures to learn the subject. Dr RD Kulkarni was a pharmacologist with a lecturing style that I wouldn’t really call entertaining but hugely informative and made easy through simplified language. Pharmacology is generally considered as a very mundane subject, but Dr Kulkarni had his own informative style of lecturing which helped students grasp the topics quickly and effectively.

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DR JATINDER BHATIA Chief of Lab Services & Projects - North India

Name of the medical college Govt Medical College, Amritsar Name of the teacher/s Dr BR Prabhakar Subject taught Pathology He is a highly knowledgeable professional, master of his subject with vast experience. A strict, disciplined and ethical doctor with a golden heart. Yet to see a teacher like him.

DR MAHESH SINGH Consultant Cardio Vascular Thoracic Surgeon, Kohinoor Hospital Name of the medical college St Vincent's Med school, Affiliated to University of New South Wales, Sydney Australia Name of the teacher/s Dr Alan E Farnsworth HOD, CVT Surgery Subject taught: Taught everything related to heart surgery and transplantation A wonderful teacher and a great human being. He always said to offer your patient the honest service that you would want for yourself, because one can’t be more honest than that.

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DR SUNITA DUBE Radiologist, Chairperson, Medscapeindia, Director of Aryan Hospitals, Mumbai

DR SHAILESH RANADE Name of the medical college Jawaharlal Nahru Medical College, KLE Society, Karanatka Name of the teacher/s Dr Kalagatti, HOD of Medicine Department He was very simple and down to earth but a great teacher. Beyond his subject he always appreciated and encouraged me for qualities which I was not aware that I possessed and helped me to believe in my dream which has come true now after so many years. So, a teacher plays a great role in building a personality. As a teacher he explained, demonstrated and inspired me not only in my studies but also to be what I am today. Since I have left my college, every year on Teacher's Day, I have wished him and shown my gratitude. A true teacher's patience is grounded in wisdom and compassion.

Burns, Plastic and Reconstructive Surgeon, Coordinator, Burns Unit, Bhatia Hospital, Mumbai Name of the medical college Lokmanya Tilak Municipal Medical College, Sion Mumbai Name of the teacher/s Dr Ravin Thatte Subject taught Plastic Surgery

Dr Ravin Thatte not only taught me plastic surgery, but also how to live for others! He is a hard working, insistent, intellectual scientist, scholar and philosopher for whom word impossible does not exist in the dictionary. No wonder that all possible awards and trophies, national and International, are on the display in his living room. Just to mention one of many is Honorary F. R.C.S. (ad hominem) degree awarded to him by the Prestigious Royal College of Surgeons, Edinburgh. What I feel great about him as a teacher is that rather than imposing his ideas on our minds by force, he gave all his students a mental freedom to think and think different. He supported and guided each and every student who came to learn from him. Thus, our department at Sion Hospital holds a record for maximum number of articles published in the most reputed British Journal of Plastic Surgery in the stipulated time of a decade. Over years of his practice, he created a brigade of talented enthusiastic and innovative plastic surgeons who have reached all parts of the world. They all are bound by one umbilical cord – Department of Plastic Surgery headed by Dr Ravin Thatte. One should learn how to make the best use of time from him. He is never late! It is said that in the 1980s, sisters used to adjust their watches on arrival of Sir in operation theatre to know the right time. Be it a scientific debate in a plastic surgery conference, fight for a social cause, philosophical discussion, gossip in surgeon’s room over politics, cricket and finance, every listener and participant in discussion or debate is sure that finally ultimate winner will be Sir. He has an excellent command over languages and is a great writer and orator. What is a unique about the man is that he is always calm, composed and balanced, even when he is facing a huge problem. It is surprising that after seeing all possible ups and downs in his personal and public life he has remained the same at the age of 75 years, what he was before 50 years! Of course his yoga, regular exercises and simple lifestyle has kept him physically fitter than all his students! I feel proud to say that I have known and worked with Dr Ravin Thatte. On the occasion of Teacher’s Day, I pray to God that may every student in the field of medicine be as lucky as me to have a teacher, a guru like Dr Ravin Thatte. I wish Sir a long and healthy life.

DR SS SIBIA Sibia Medical Centre, Ludhiana, Punjab

Name of the medical college Government Medical College, Patiala Name of the teacher/s Dr BK Chopra Professor – Department of Medicine Subject taught Internal Medicine A great teacher and a greater person, Dr BK Chopra taught medicine along with technical skills and competency. I learnt that the doctor’s behaviour is at times more important than his incredible technical know-how in their field. It is important for him to be trustworthy, dedicated and a mentor to his patients. Dr Chopra’s mere company taught the ability to remain calm and proficient when under pressure and still make clear and timely decisions.

DR (PROF) HARSH WARDHAN

DR KSHITIZ MURDIA,

DR NAGENDRA SWAMY

DR SUNIL ESHWAR

Chairman, Department of Cardiology, Rockland Group of Hospitals, Delhi

Gynecologist & IVF Specialist

President & Chairman- Quality Council, Manipal Health Enterprises, Bangalore

Obstetrics & Gynecologist, The Cradle

Paediatrician & Neonatologist, Yashoda Hospitals, Sec.bad, Hyderabad

Name of the medical college Kasturba Medical College, Manipal Name of the teacher/s Late Dr Padma Rao Subject taught Obstetrics and Gynaecology

Name of the medical college JIPMER, Pondicherry Name of the teacher/s Prof Dr Soundara Raghavan Subject taught Obstetrics & Gynecology

Name of the medical college: Sri Ramachandra Medical College Name of the teacher/s: Dr Binu Ninan, HOD Dept of Neonatology Subject taught:Medicine

He is my mentor, God and Guru not only in the profession but also in life. He imbibed in me all skills required to do my duty ethically and proficiently. His selfless service to the medical profession has inspired to give my best in the women care.

I am what I am today because of him. I hated him during my post graduation days but I now realise the importance of his teaching and the love behind those harsh words. Thank you is a very small word to appreciate his efforts.

Name of the medical college Maulana Azad Medical College, New Delhi Name of the teacher/s”Dr PS Gupta Subject taught:Medicine A very meticulous teacher with emphasis on basics and importance of thorough clinical examination. My admired teacher is a wonderful human being. With his very systemic clinical approach, he is able to unravel the diagnosis in difficult cases easily. His punctuality and simplicity is what I admire the most.

SEPTEMBER 2013

Name of the medical college Indira Infertility & Test Tube Baby Centre, Udaipur Name of the teacher/s Dr Ajay Murdia Subject taught Infertility His vision gave me the thought to make the costly test tube baby (IVF) treatment economical so that it can be made available to all stratas of the society. This would ensure that more and more people would benefit from this technology which was not possible before due to sky high costs.

Late Dr Padma Rao, our OBG professor is my favourite teacher at KMC Manipal as she taught us with passion and affection. She was strict but at the same time very humane.

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DR TP KARTHIK

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BOOK REVIEW Demystifying HR management Human Resource Management in Hospitals intends to be a resourceful guide on various laws for HR managers within hospitals. Raelene Kambli goes through the book to find out what makes it an interesting read

ospitals these days are gripped with various kinds of litigations; be it compensation claims from patients or any statutory and regulatory issues from the government. D Samuel Abraham's book titled 'Human Resource Management in Hospitals' seeks to provide insights, to newly appointed HR managers, hospital administrators and CEOs of hospitals in India, on various aspects of labour laws applicable to a hospital by highlighting settled law suits which have been pronounced by the judiciary and enforced by the executives in India.

What's inside? The book begins with a foreword written by Dr Sunil Chandy, Director, Christian Medical College, Vellore who says, “This book is very comprehensive on matters of legal jurisprudence. It is well researched and referenced and will therefore be a ready reference guide for students of law and judiciary. The casebased approach makes the book practical and readable.” Dr A Francis Julian, Senior Advocate, Supreme Court of India giving a preface to the contents of the book writes that this book would make the task of management of healthcare institutions and those of the administration easier and legally compliant. This gives the readers an idea of the book's simplified presentation on legal literature. In this book, the author has taken every effort to simplify the Indian law for hospitals with his lucid language. The law cases referred in the book are also well interpreted to give an clear understanding of the issues and how each case was dealt. The book mainly deals with three key areas pertaining to hospital management and administration, namely: basic introduction to hospital law, the legal issues related to HR functions and the relevant statutory provisions which require compliances. For better understanding of these subjects the book is divided in three parts Part one - Introduction to law: In times when hospital administrators, HR managers and CEOs are faced with judicial disputes, due to the lack of understanding about our legal system they find it difficult to justify their conduct. Identifying this need, in the first part of this book, the author mentions that HR managers, CEOs and administrators within hospitals must know a few things about our constitution, rights, privileges, procedures followed in judiciary and certain fundamental principles on which our entire democratic system functions. He has bifurcated the chapter giving us a comprehensive understanding of the Indian legal system; especially laying emphasis on our constitution. It covers topics such as medico-legal cases and medical practitioners, medicolegal aspects of certain crimes, medical professionals and criminal laws and

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Title: Human Resource Management in Hospitals Author: D Samuel Abraham, Senior Law officer, Christian Medical College, Vellore Edited by: C Sampath & Hannah Paul Publisher: Jefflin Rimon Publications Pages: 350 ISBN: 978-81-926834-0-9 Price: ` 500 /-

doctor-patient contracts which medical professionals and hospital administrator need to know. Chapter 9, 10 and 12 are interesting topics discussed in this part where the author in a simple way explains laws related contracts, consumer protection and laws specifically for medical practitioners. Chapter 12 in particular, speaks about laws that protect the conduct of medical professionals which is indeed an important resource for all healthcare providers. Part two - Legal issues in human resource functions: After presenting a broader perspective of how our legal system functions, the author in the second part of the book provides useful information on human resource management. In the introduction to the second part, the author writes, “This part is the heart and soul of this book and unique from other books; while all other books of HR discuss the principles part of it, which discusses mainly the practical part. It also takes the HR manager to the exact scenario to face real life situations.” In this part, the author has concisely put together various kinds of issues

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that HR managers can come across. He has covered important issues such as types of appointments, legal guidance of HR functions, principles of natural justice to be followed while dealing with the HR issues and various procedures followed by the labour court, high court and remedies to be followed by hospitals while taking disciplinary action against employees. The must read topics from this part are: Chapters 2.5, 2.6 and 2.7 which speaks of the right procedures that need to be followed while taking disciplinary actions against an employee, how to deal with cases of sexual harassment and how to deal with challenges that arise while taking disciplinary action. It a bold step by the author to discuss sexual harassment at workplace as this subject is seldom spoken when it come to a healthcare set-up. Many such cases go unnoticed; however, the author has given a bird’s eye view to all important aspects of HR management- which is certainly commendable. The other interesting part is the chapter on 'Settled law in human resources' in which the author has cited various examples of cases that deal with industrial relations. Apart from these significant topics discussed, the author has provided description on 25 cases and their judgement so that readers can utilise them as reference for further reading. Part three - Statutory provisions and its compliance: For those who have read the author's earlier book, 'Laws on Hospital Administration', would easily connect with the third part, as its contents appear to be quiet similar to his previous book on hospital administration. In this part, the author has explained about 18 important laws that are mentioned in the Industrial Disputes Act. Although, the Industrial Disputes Act is common to all industries, HR managers of hospital need to be well versed with these laws mentioned in this act feels, the author. Giving emphasis on the same, Chapter 9 and 10 in this part highlights the application of industrial laws within hospitals. The book gives the look and feel of a text book meant for students, the subject is noteworthy and can serve as a reference guide for hospital HR managers, CEOs and hospital administrators. Apart from the good topics discussed and simple language used, the content of the book is also well edited. The editors of the book, C Sampath and Hannah Paul have also retained the original style of the writer while maintaining consistency and making the tone and language crisp and lucid. Thus, Human Resource Management in Hospitals surely gets a thumbs up for its insightful contents and intelligible approach. raelene.kambli@expressindia.com SEPTEMBER 2013

Express Healthcare Business Avenues

SEPTEMBER 2013

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Express Healthcare Business Avenues ha vi fo Spe ng r c ex CA ial tra T Mo ch H L del am A be B rd ep th

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CARTRIDGE PUNCTURING INSIDE CHAMBER UNDER VACUUM CONDITIONS v External Compressed Air Requirement – Optional v In Built Printer Facility & PC Connectivity v Entire process fully automated – PLC Controlled

v EO Cartridge Puncturing inside the chamber in vacuum conditions (Negative Cycle)

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v In built Printer gives record of entire cycle

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W H AT ’ S INSIDE

Hospital Central: Outsource Medical Record Management PG 109 Role of HMS in Compliance PG 110 Building a better radiation safety culture PG 111 Avantgarde solutions from Asiatic Medical Group PG 112

TRADE & TRENDS Smart solutions from ViDoc ViDoc’s EMR service in India is targeted at improving patient care and increasing efficiency in medical practices iDoc Healthcare Solutions (ViDoc) was formed with the goal to provide innovative technology driven solutions to make healthcare delivery more efficient and economical for all parts of the eco-system – viz. doctors, medical and administrative staff and patients. ViDoc’s vision is to create an environment where patients and doctors are able to seamlessly connect to each other in a hassle free, paperless environment. From the various technological advances that healthcare in India needs, ViDoc decided to begin with patient record management as one of the key focus areas – it has a central belief that efficient practices here (and in ancillary areas) will automatically trigger betterment in other facets of healthcare (for e.g. insurance payments, clinical decision support, operational improvements, etc). Backed by a team of hard working professionals from diverse backgrounds, ViDoc tries to put in a central thought – that there is always a smarter way of doing things. ViDoc’s solutions have been designed based on suggestions from the end users in the medical fraternity – hence the solutions easily fit in the user’s work routine and are very simple to use. ViDoc uses the best in class

technologies for all aspects of software and hardware – understanding the criticality, confidentiality and security of medical records. ViDoc provides a webbased electronic medical records (EMR) service in India, targeted at improving patient care and increasing efficiency in medical practices. ViDoc products are catered to the needs of two main parts in the health ecosystem i.e. care giving entities (hospitals, clinics, medical centres, doctors) and patients. Its services are catered to all scales of hospitals (large >250 bed, mid > 100 bed and small < 50 bed), clinics and diagnostic centres.

Service verticals Hospital Central: Outsource medical record management - ViDoc’s end-to-end proprietary workflows, digitise and classify patient records at the document level and group them category wise --so that an online medical record is exactly like the way you keep it physically in the MRD Clinic Central: Patient record management for clinics and OPDs - Clinic Central enables the user to collect all the patients’ information in one place and access it from anywhere. MyHealth Central: Personal health records (PHR) - All the vital information and

medical records at one place, accessible 24x7. With MyHealth Central, the user’s medical information stays with them, wherever they go, even when travelling. No need to spend time, effort and money to find a record when seeing a new doctor, specialist or to get a second opinion. ReportsDirect: e-Delivery of test reports for diagnostic facilities Catered towards diagnostic facilities, this service enables patients to easily access their reports over the internet. Useful to both, hospitals (having in-house diagnostic facilities) or independent diagnostic /medical centres, ViDoc’s ReportsDirect is the perfect, innovative and low-cost solution. It enables you to provide patient’s diagnostic test results over the Internet, in a simple, quick and efficient manner. Patients simply log on and view/ print their test results. No more worrying about misplaced or lost test results. Analytics: Inferential analysis of clinical and administrative information -Sometimes simple numbers and statistics can prove to be eye-openers. ViDoc’s analytics service has a similar objective - to aggregate information from various data points in the medical establishment, understand correlations and then arrive at results that make sense. Inferences derived from the patients’ hospitalisation/ clinic visit data trends are ought to provide key operational insights to improve

efficiencies. Systematic Physical Storage: Organise and store physical records — onsite or offsite - With increasing patient load, maintaining paper records is becoming a herculean task. Apart from the day-to-day monitoring overhead, hospitals/ clinics face practical constraints of space crunch! Owing to space crunch, records are kept (sometimes even dumped) at different locations. More than often, admin personnel lose track of the file location and are not able to retrieve the file when required. At many instances files are also lost. Via their Systematic Physical Storage (SPS) service, ViDoc provides the hospitals/clinics a complete solution for managing their physical medical records.

Testimonial ❖"ViDoc’s digitisation practice and EMR software are great, but what impressed me the most is the prompt service they provide. Very innovative; Excellent people to work with."

Contact ViDoc Healthcare Solutions B4 Parekh Mahal, V N Road, Churchgate, Mumbai 400 020, INDIA. Tel: +91-80808-30216, +9122-2282-8545 Email: info@vidoc.in Website: www.ViDoc.in

MARKET 11 STRATEGY 29 KNOWLEDGE 36 IT@HEALTHCARE HOSPI INFRA 62 LIFE 88 108

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SEPTEMBER 2013

T|R|A|D|E & T|R|E|N|D|S

Hospital Central : Outsource Medical Record Management A low cost and end-to-end solution for medical records management iDoc’s flagship product ‘Hospital Central’ ( w w w. h o s p i t a l c e n tral.in) is an end-to-end medical records management solution for large, mid size and small hospitals. Hospital Central is an innovative low-cost solution that enables you to keep track of all patient details including medical records, in a simple, quick and efficient manner. These patient records, better known as electronic medical records (EMR), empower you to not only provide better care for your patients but also save costs and time. Using Hospital Central hospitals can centralise all records at a single location; Access patient data securely, anytime, anywhere; Share patient data with patient, other departments, doctors /specialists, TPA etc. Our end-to-end proprietary workflows digitise and classify patient records at the document level and group them category wise --- so that an online medical record is exactly like the way you keep it physically in the MRD.

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Product features ●

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SEPTEMBER 2013

Implementation: Easily fits in current work environment Easy to use: The application is user friendly and is very simple and easy. It does not require in depth knowledge of working with computers. Search: The application provides excellent search facility for searching the patients and records, taking just a few clicks to access the right details. ICD Coding: Patient case history can be codified using ICD-10 coding enabling the hospital to use the data for analytical purposes and medical data

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exchange. Records Access: The patients and doctors can be given access to selected records as per requirement. Reports & Analytics: Excellent in-built reports are readily available in the application. Analytical reports can also be made available on demand. 24x7 Availability: The application can be hosted on the internet /intranet hence available 24x7. Security: Only authorised users can access the application using valid user id and password. The access can be controlled as per need. Integration: The application can be quickly integrated with any HIS/HMS or any other hospital application. Software Installation: The application can be hosted locally on the hospital infrastructure very easily. ViDoc also has a secure data centre which the hospital can leverage for hosting their information.

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Benefits ●

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Organised record keeping: Records keeping becomes simple. All records are classified and organised by patient. Any patient record can be easily accessed using a simple search. Record Centralisation: It involves the task of collecting all records (billing data cards, test results, prescriptions etc.) of the patient at one central location. Physical records will be scanned in order to convert them into electronic format. Physical records from multiple locations such as different clinics/hospitals will be combined to build a central patient record. Records available in electronic format will be appended to the central patient record. Record Classification: ViDoc has proficient solutions to intuitively classify all the records. Depending on your need, the classification can range from macro level categorisation to granular level individual record identifiers. The classification creates an

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efficient index allowing you to quickly search and retrieve the required records. Sharing of records: Patients records can be shared electronically with external parties (insurance, TPA, doctors), patients or for research purposes within the hospital – saving paper and time. The retrieved records can be printed, downloaded, emailed etc. Never lose a record Better employee productivity: Employees can quickly locate records sitting from their desks instead of surfing through heaps of physical records, freeing-up their time to concentrate on other tasks Security of data: Role based access to patient data is provided only to users authorised by the hospital.

Contact: ViDoc Healthcare Solutions B4 Parekh Mahal, V N Road, Churchgate, Mumbai 400 020, INDIA. Cell: 8080830216 Tel.: +91-22-22046792 Website: www.ViDoc.in EXPRESS HEALTHCARE

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Role of HMS in ompliance Kishore Shinde, VP- Healthcare, IndiSoft Consultancy Services talks about Access, Assessment and Continuity of Care (AAC) ospitals today are preparing to improve quality of care, manage cost, while adhering to mandated requirements. To achieve this, processes need to be benchmarked, they have to adhere to certain standards. HMS(Hospital Management Systems) software can help hospitals to automate processes and give consistent output by following the unique processes, irrespective of you does it.

Objective of compliance Kishore Shinde VP- Healthcare, IndiSoft Consultancy Services

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Helps in improving patient care ● Helps in streamlining operations ● Improvement of overall organisational performance ● Provide staff education on better or best practices ● Increase efficiency and reduce cost ● Strengthen patient confidence For the topic of today’s discussion say NABH (National Accreditation Board For Hospitals And Healthcare Providers). NABH is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organisations to achieve compliance. NABH has 10 Chapters. First fivechapters are patient related while the other five chapters are healthcare organisation related. Let us see how HMS covers AAC in detail.

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Functionalities covered in HMS: Registration, admission, transfer, patient assessment, discharge, access

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records. Some of the highlighting features in HMS : Unique patient identification number Patient transfer record between departments/ units Patient assessment (record temperature, pulse, height, weight, BP) Discharge summary (It covers complete stay record along date of admission, date of discharge, investigation results, diet, special precautions, treatment advise, treatment given, condition at discharge, follow up date- auto appointment can take place)

Following are the screens from HMS for reference: Screen 1: Admission/ Registration screen : It has unique registration number (P13-03296) for every patient. Consent can be selected, Medico Legal Case (MLC) details, provisional diagnosis can be entered Screen 2: Patient transfer: It has transfer details like date and time of transfer, current and transfer to bed details. Screen 3 : Vitals: Patient regular assessment entry can be done from this screen. It covers examination date and time, vital parameters like pulse, BP, temperature, weight. Continuous monitoring/ assessment, regular data updation and following defined processes will give relevant and accurate data. It will give alerts to concerned person, will help in proper diagnosis which will ensure patient safety and continuity of care. Below is just an overview of remaining chapters : Care of Patients (COP) – Regular patient Monitoring, periodic re-assessment, pre and post operative plans, informed consent, anesthesia monitoring, equipment check and sterilisation, diet plan. Management of Medication (MOM) - Allergy alerts and symptoms management associated with patient case sheet, www.expresshealthcare.in

availability of emergency drugs, check of expiry dates, medications with clear instruction, legible date, time, name and signature. Patient Rights and Education (PRE) – Information about disease and possible outcome made clear to patient and his family, consents are bi-lingual, cost estimation is given, patient can view online reports – Secured patient portal, can view case records, treatment advise, special precautions, diet advise. patient complaints and feedback is taken. Hospital Infection Control (HIC)- Facility Management (rooms, wards and waste management), pharmacy notifications (expiry), operation theatre and equipment sterilisation. Continuous Quality Improvement (CQI) - HMS is capable of reporting ‘Key Performance Indicators’ that help to monitor the processes and outcomes which are used as tools for continual improvement. Responsibilities of Management(ROM)Role definitions, authentication and authorisation. Facilities Management and Safety (FMS)- Material man-

agement, inventory/equipment management, staff management. Human Resource Management (HRM) – Maintain employee profile, pre-employment medical examination, maintain employee training record, proper duty allocation. Information Management System (IMS) – The aim of information management is to provide right information to right person. HMS makes sure this is achieved. The authentic, secure and accurate information is provided as per the roles and privileges assigned. This is how HMS can help hospitals to achieve compliance by adhering to automated and defined processes. Finally with the growing number of hospitals and patients looking for quality care, adhering to compliance and following processes will help hospitals to improve quality, improve clinical outcomes, improve individual and overall organisation performance. Disclaimer : Few parts in this article has been referenced from NABH Website. The author can be contacted at kishore.shinde@indisoft-cs.com SEPTEMBER 2013

T|R|A|D|E & T|R|E|N|D|S

Building a better radiation safety culture Anna Wanland & Rahul Sanghavi, Raysafe elaborate on building a better radiation safety culture at workplace

SEPTEMBER 2013

hanks to the advancement in the field of Xray technology, it is now possible to diagnose complex medical conditions such as cardiovascular diseases, stroke and cancer at an earlier stage and treat them more effectively. However, ionising radiation such as X-rays can be harmful to both patients and medical staff. If the radiation dose exceeds a critical level, certain injury or even death will follow, the severity depends on the dose. Examples of such deterministic effects include cataract, erythema and infertility. But even smaller doses accumulated over time and across a population may have adverse effects, in that case, the probability is related to the dose. Cancer would be an example of such a stochastic effect. While healthcare and medical technology develops and becomes available to more people, patients and staff are exposed to increasing amounts of X-ray radiation. Considering the fact that there is no known level of safe X-ray dose, it is more important than ever to minimise exposure to unnecessary radiation. But what is unnecessary radiation? For patients in the diagnostic X-ray setting, unjustified X-ray examinations would be one example of unnecessary radiation. Likewise, any radiation that does not contribute to the image quality is also regarded as undesirable, because it causes dose to the patient without any benefit to the process of diagnosis. Such radiation can be from retakes, exposure errors, X-ray machines that are not performing optimally and so on. Medical staff is also exposed to unnecessary radi-

ation, primarily in the form of scattered radiation, during interventional radiology and cardiology procedures. Through building a better radiation safety culture within the diagnostic imaging workflow, dose and image quality can be optimised while minimising unnecessary radiation. Our endeavour to help you build a better radiation safety culture at your workplace includes solutions for:

I) Quality assurance (QA) of X-ray equipment Atomic Energy Regulatory Board (AERB) recommends periodic quality assurance of X-ray equipment. The QA protocols are well defined by the regulatory board. For the actual implementation, accurate and calibrated QA instruments, phantoms and test tools are required. When service engineers install a new X-ray machine or service existing machines, they use QA instruments to check parameters such as dose, kVp and exposure time. The qualification of an X-ray machine depends on several factors, such as reproducibility and linearity of exposures, light and X-ray field alignment, contrast resolution and more. Needless to say, measurement accuracy is critical in order to make the right decision about the X-ray machine. The consequences of even one wrongly calibrated X-ray machine can be grave considering the workload of that particular machine. To secure the highest measurement accuracy – which means an increase in the reliability and credibility of each measurement, it is necessary to calibrate and test the QA instruments annually. It is this accuracy

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that helps the service engineer make a correct judgment whether or not an X-ray machine is safe to use. The type of measuring instrument will have an impact on the QA, because the technology being used influences the measurements in certain situations. Unfors RaySafe’s solutions are primarily based on solid state technology and hence the QA instruments are extremely sensitive to detect lowest possible doses, have high durability and stability while being compact and light-weight.

II) Radiation safety for the patient Several research groups and regulatory bodies in India have done studies and recommendations on dose reference levels for patients.1,2 To bring the numbers from paper to actual practice, our solution RaySafe S1 is ideal for filling the gap. RaySafe S1 is a cloud-based application that will collect, add value and share patient dose information to different individuals in the diagnostic radiology workflow including referring physicians, radiologists, operators, medical physicists and Radiation Safety Officers (RSO).

III) Medical staff In order to be protected from exposure to the scattered radiation present in the X-ray room, medical staff needs to have knowledge about radiation protection devices – and a dedicated practice to use them adequately. However, even with correct use of radiation protection devices their doses are still affected by their behaviour. For example, where someone chooses to stand in the room will influence the amount of scatter radiation they are exposed to and will influence the absorbed dose, even though they may be wearing lead apron. The longer someone stays in the room and the closer they are to the X-ray machine, the higher the dose will be, even though they are standing behind a shield. So, two staff members with the

same amount of radiation protection can still have very different doses! In India, as per the safety code from AERB, all radiation workers should use appropriate personnel monitoring badges (TLD badges). In addition to wearing a legal dosimeter, International Atomic Energy Agency (IAEA) also recommends the use of a real-time dosimetry system.3 A real-time dosimetry system like RaySafe i2 helps medical staff visualise their exposure in real-time, so that they can take immediate action to reduce their dose by changing their behaviour within an X-ray room. Unfors RaySafe provides a comprehensive solution for the X-ray room consisting of products which collect radiation information, add value and share it in an easy-tounderstand way with all relevant stakeholders. User friendliness combined with state-of-the-art technology and maximum accuracy form the backbone of the RaySafe product range, serving the company’s mission to help people avoid unnecessary radiation and to establish a better radiation safety culture wherever people encounter radiation.

References [1] AU Sonawane, VK Shirva and AS Pradhan, "Estimation of skin entrance doses (SEDs) for common medical X-ray diagnostic examinations in India and proposed diagnostic reference levels (DRLs)," Radiat Prot Dosimetry, vol. 138, pp. 12936, Feb 2010. [2] AU Sonawane, JV Sunil Kumar, M Singh, and AS Pradhan, "Suggested diagnostic reference levels for paediatric X-ray examinations in India," Radiat Prot Dosimetry, vol. 147, pp. 4238, Nov 2011. [3] IAEA, 10 Pearls: Radiation Protection of Staff in Fluoroscopy, https://rpop.iaea.org/RPOP/R PoP/Content/Documents/Whi tepapers/poster-staff-radiation-protection.pdf Contact Rahul.Sanghavi@raysafe.com Tel: 91-9819062553

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Avantgarde solutions from Asiatic Medical Group The company boasts of an eclectic offering for healthcare facilities in terms of hospital infrastructure Established in 19992000 by Hemal Joshi, a techno-managerial Founder and CEO in India, Asiatic group has steadily grown over the years in terms of solutions provided, geographical reach, infrastructure and know-how. Today, it combines talents and skills of a number of highly qualified professionals in fields of engineering, management, medicine, finance and architecture not only from India but also from countries like US, Europe and Singapore to form the core of what is Asiatic Group today. It offers a wide range of solutions and possibilities to cater to existing and future needs of a healthcare facility in terms of ‘infrastructure’, in terms of planning, designing, infection control, health

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it, equipment, systems, consumables, spares not only in implementation, but also for maintenance and upgradation. In short, they are always able to provide some sort of solution for a healthcare facility during its entire life cycle starting from planning till execution, operational, expansion and upgradation stages. Organisations typically have a particular set of skills e.g. manufacturing, distributing, maintaining, etc but we are proud to possess skills combining all the above sets thanks to almost 15 years of experience in healthcare industry and combining talent pools possessing above skill sets. Here’s a brief idea of what the company can do……. ❖ “Truly Modular” (customisable, upgradable) Healthcare IT solutions for ● Operation Theatre Complex : (Digitally

Integrated OTs in terms of Video Capture, Streaming, Storing and Broadcasting, PACS II for long term storage, Integration with HIS / CIS / RIS / Radiology PACS, etc. ● Radiology : (Enterprise level PACS, RIS, Teleradiology, 3D Workstations) ● Cardiology : CIS, Cath Lab Hemodynamic Data Monitoring, Capturing, and Storing ERP Solutions, Networking, HIS, Barcoding, RFID, Access control, CCTV Monitoring, etc ❖ “Truly Modular” (flexible, upgradable) operation theatres in terms of infection control, digital integration, interiors, equipment, etc advanced equipment and consumable solutions for operation theatre, radiology ❖ ‘Highly customised’ solutions for medical equipment and systems, speciality consumables relat-

Digitally Modular OT

Digitally Integrated Cath Lab

DIigitally Integrated ICU

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ed to above specialties ❖ “Maintenance” and “post sales service support” (in terms of service contract, spares, accessories) not only of above solutions provided by us but also of third party solutions* for above specialities already existing in hospitals (* select cases) In short, talk to the company about your needs for above departments, and they will find a solution for you within your budget, specifications and expectations…. So, come explore the possibilities and solutions they can offer! Contact Hemal Joshi Founder & CEO Asiatic Medical Group Tel:+91-261-6457323; +91-9825204267 Email: info@asiaticmedical.in; asiaticmedical@hotmail.com Website: asiaticmedical.in

SEPTEMBER 2013

GE Healthcare

NEEDLE FREE THE WAY MR SHOULD BE Needles hurt. They’re scary. And there is also growing awareness that many procedures involving needles such as biopsies, contrast and sedation can have potentially dangerous side effects to patients, add additional cost to procedures and extend patient recovery times. So we asked ourselves, how can we strive to reduce the use of needles in certain exams? Our answer is the Needle-Free Suite of MR applications. Whether it’s assessing whole liver parenchyma non-invasively, capturing arterial and venous flow in fine detail without contrast or correcting for patient motion to potentially reduce the need for sedation, we’re focusing on the way MR should be − obtaining clinical results through non-invasive exams.

GE’s IDEAL IQ MR Technology Biopsies are invasive, painful and may introduce the risk of complications. Liver biopsies also provide information about a very small sample of the tissue. Recognizing a growing need for effective, repeatable, non-invasive tests to accurately assess diffuse liver disease, we’ve introduced IDEAL IQ, an advanced tool that allows you to quantify fat fraction IDEAL IQ Fat Fraction Baseline

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