Express Healthcare October 1-15, 2013 by Indian Express

VOL.7 NO.10 PAGES 106

Market Deal or no deal ? Knowledge The new enactment in 2013: An extra shield for working women

www.expresshealthcare.in OCTOBER 2013, `50

In Imaging Dawn of Green MRIs

GE Healthcare

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INSIGHT INTO THE BUSINESS OF HEALTHCARE

VOL 7. NO 10, OCTOBER 2013

Chairman of the Board

CONTENTS

Viveck Goenka

KNOWLEDGE

Editor Viveka Roychowdhury*

The new enactment in 2013:An extra shield for working women PAGE 32 ‘Absence of a robust and transparent organ donation system in the country tends to promote acts of desperation’ PAGE 34

Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair,

STRATEGY

Sanjiv Das Delhi

Quality function deployment (QFD): A strategic tool for healthcare organisations PAGE 38 ‘We feel everybody should be working on improvement of quality’ PAGE 40

Shalini Gupta MARKETING Deputy General Manager Harit Mohanty Assistant Manager

IT@HEALTHCARE

Kunal Gaurav

Corelation of health information exchange and meaningful use PAGE 41 ‘Since BYOD is already in, I would like to see to that we do not block it but, with the Fortinet Solutions, are able to control it’ PAGE 49 ‘The need of the hour is telemedicine’ PAGE 50

PRODUCTION General Manager B R Tipnis Manager Bhadresh Valia Senior Executive Scheduling & Coordination

HOSPITAL INFRA

Rohan Thakkar

Access automation solutions for healthcare sector PAGE 51 A ruby in the crown of Indian healthcare PAGE 54

Photo Editor Sandeep Patil DESIGN Deputy Art Director

PAGE 11

Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Layout Vivek Chitrakar CIRCULATION Circulation Team Mohan Varadkar Express Healthcare Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045 Printed for the proprietors, The Indian Express Limited by Ms.Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of news under the PRB Act. Copyright @ 2011 The Indian Express Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

OCTOBER 2013

MARKET Narayana Institute of Cardiac Sciences launches ‘Heart Station’PAGE 17 HCIL to provide tele-education network for medical students PAGE17 The National Forum on Tuberculosis release national standards of TB care PAGE 18 Eye-Q launches centres of excellence for glaucoma and retina PAGE 18 Ziqitza Healthcare joins Business Call to Action (BCtA) initiative in India PAGE 19 Countries to adopt 10 targets to combat NCDs PAGE20 Japanese nanotech helps eye stem cell storage, transport PAGE 2O ‘We are interested in developing low-cost solutions that can be used outside hospitals and large clinics’ PAGE 22 ‘We are planing to open 15-18 centres all over India with an invest $100 million by end of FY16’ PAGE 22 ‘The usage of labs is closely linked to usage of healthcare overall’ PAGE 24 ‘Our USP is adding comfort to care in all that we do with the help of the latest and best in terms of medical technology’ PAGE 25 New Delhi to host first Indian Cancer Congress 2013 in November PAGE 26 Dr DY Patil University’s Dept of Business Management to organise HOSPI EXPRESS PAGE 27 CII's 6th Medical Technology Conference held in New Delhi PAGE 27 UK seeks to create healthy business environment with India PAGE 28 MGM hosts seminar on ‘Supply Chain in Healthcare’ PAGE 3O www.expresshealthcare.in

IN IMAGING Dawn of green MRIs PAGE 57 Dr VRK Rao: A true pioneer PAGE 61 ‘Our ambition is to become the leader in advanced medical imaging visualisation and analysis solutions’ PAGE 65 Quality assurance services for radiology PAGE 66 CURA Healthcare launches indigenous manual patient table PAGE 66 Ultrasound technology records tongues in action PAGE 67 Asia’s first Intra Operative 3D Radioguided Surgery System at HCG PAGE 68 Telerad Tech introduces multi-lingual radiology workflow platform PAGE 68

LIFE HR challenges in hospitals PAGE 70 Dr Narendra Dabholkar: Martyr for reason PAGE 72 Dr LH Hiranandani: A life well lived PAGE 72 Dr (Prof) Ranjit Roy Chaudhury receives FICCI's Lifetime Achievement Award 2013 PAGE 73 MED-EL Founder and CEO, Dr Ingeborg Hochmair receives Lasker Award PAGE 74 EXPRESS HEALTHCARE

EDITOR’S NOTE Does the MCI need a ‘medical CBI’?

THE BILL IS CLEAR ON THE FACT THAT THE CENTRAL GOVERNMENT WILL HAVE THE UPPER HAND AND THE FINAL WORD, AND WILL DIRECT THE MCI ON POLICY MATTERS INCLUDING AMENDING AND REVOKING REGULATIONS MADE BY THE COUNCIL

Established almost eight decades back, the Medical Council of India (MCI) is today on the threshold of a major restructuring. Reports suggest that the Indian Medical Council (Amendment) Bill 2013 which was introduced in the Rajya Sabha on August 19 has been referred to the Standing Committee on Health due to lack of consensus between the members of various parties. But the medical community has expressed reservations with what is seen as bureaucratic interference, a reference to the Board of Governors (BoG) which currently conducts the functions of the MCI. The BoG was constituted after the organisation’s Chairman, Dr Ketan Desai was discovered to be at the centre of a major scam, taking bribes to recognise medical colleges. (See June 2011 Express Healthcare edit: 'Will past history bog down the new MCI BOG?' http://healthcare.financialexpress.com/201106/editor ial01.shtml) The current BoG's term has been extended by 180 days and the Central Government will have to reconstitute the MCI by November. An industry source went so far as to compare the Government’s attitude to a modified version of the Central Bureau of Investigation (CBI). But if the MCI can stand up to the scrutiny, would not this add to the credibility and transparency of the process? However, industry experts believe that 100 per cent transparency is not possible and wrongdoers will find loopholes in any system. Secondly, having to wait for the Central Government to scrutinise decisions will only add layers to the decision making process and leave it open to political whims. Indeed, the Central Government's stand to have a single national eligibility cum entrance test (NEET) for medical colleges was ultimately a traumatic experience for millions of students this year. The MCI and the Central Government continue to battle it out in court, but the underlying purpose of having these students take one entrance test was defeated, with many aspirants taking several of them as private medical colleges went ahead and organised their own tests. Possibly the only amendment giving cheer to the medical fraternity is the proposal that doctors of Indian origin who got their qualifications abroad, will be allowed to practice medicine in India; in effect recognising their overseas qualifications and doing away with the need for qualifying exams. It is true that the MCI's image as an institution

has suffered a beating in the last two years. The MCI was envisioned as a watch dog, to monitor the quality of medical education in the country and entrusted with accrediting medical colleges, recognising medical qualifications and granting registration to medical practitioners. Even though a few individuals abused this trust, it is the institution which will have to work doubly hard to rebuild this trust. For its part, the Government seems to be putting in many safeguards to prevent history repeating itself. For instance, the Bill specifies a term of four years for the MCI and a limit of two terms for both the major office bearers, the President and Vice President. The Bill also specifies the conditions under which the Central Government can remove both heads. Abuse of the position while performing the duties specified under the Act; wilfully or without sufficient cause failing to comply with directions issued by the Central Government and in public interest are some of the conditions specified in the Bill. The Bill is thus very clear that the Central Government will have the upper hand and the final word, and will direct the MCI on policy matters including amending and revoking regulations made by the Council. The medical community has objected to these strictures and their stand seems to be supported by the Opposition, who argued that the proposed changes would take away the autonomy of the MCI. However, political parties seem to be divided on this issue. For instance, there have been reports of the CPI(M) proposing a list of amendments as they feel that the Act seeks to go beyond the shores of India and award recognition to overseas branches of Indian medical colleges in neighbouring countries. This, they allege, is designed to benefit a few of the bigger private medical colleges. There is no doubt that the MCI's role as a watchdog is critical to the quality of medical education in India which in turn is pivotal to the massive scaling up of India's healthcare system. While we do need further discussion and debate on the finer points of the Bill, both the Government, political parties and the industry will have to hammer out a consensus asap. With the November deadline looming close, and political parties preoccupied with electoral posturing, this looks like a pipe dream right now. Viveka Roychowdhury viveka.r@expressindia.com

EXPRESS HEALTHCARE

www.expresshealthcare.in

OCTOBER 2013

Letters QUOTE UNQUOTE

Informative article

An insightful read

The article titled,'Recording it right' authored by D Samuel Abraham is very nicely written and is an informative article on maintaining medical records. It is really nice to know the importance of this subject and its preservation periods.

The article titled, 'For internal audit and healthcare: A strategic partnership' is an extremely useful and insight article. Those involved in developing guidelines, regulations and legal provisions should insist on such practice within healthcare industry as this will be a useful source data for futuristic directions.

A Mahalingam The Sankara Nethralaya Academy,Chennai mahali@snmail.org

INSIGHT INTO THE BUSINESS OF HEALTHCARE

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Pranab Mukherjee, The President of India st (At the 31 meeting of Ministers of Health and 66th Session of the WHO Regional Committee for South-East Asia)

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OCTOBER 2013

MARKET UPFRONT Health ministers of 11 SE Asian countries pledge to eliminate measles by 2020

EH News Bureau OCTOBER 2013

INSIDE

ealth Ministers of 11 South-East Asian countries committed to eliminating measles and controlling rubella and congenital syndrome (CRS) by 2020 at WHO’s Sixty-sixth Regional Committee meeting. WHO estimates that $800 million are needed to achieve this goal by 2020. Dr Samlee Plianbangchang, Regional Director for South-East Asia, WHO said, “Measles outbreaks are a major development obstacle. I believe that with political will and by focussing on the vulnerable and hard to reach populations, we can eliminate measles and control rubella in South-East Asia Region by 2020.” In order to reach the goal of measles elimination and rubella control, governments will need to achieve and maintain 95 per cent population immunity against measles and rubella within each district through routine immunization and/or supplementary campaigns. Countries will also need to develop and sustain a sensitive and timely case-based measles and rubella/CRS surveillance system.The regional network of accredited measles and rubella laboratories needs to be expanded and strengthened. Strategic plans are being developed by all countries in the region.These plans will need to be adequately funded and human resources allocated. Significant progress has already been made toward this ambitious goal. Countries of the region have already achieved a 63 per cent decline in the measles incidence rate from 69.9 per million to 25 per million population between 2000 and 2011. Country efforts in the SouthEast Asian Region have led to a 48 per cent decline in measles deaths between 2000 and 2011. Although the current rate of progress in the region may not be fast enough to achieve the World Health Assembly target of reducing measles deaths by 95 per cent by 2015, the stage is now set for acceleration of measles and rubella control strategies. If implemented this would allow the region to achieve the 2020 elimination goal.

‘We are interested in developing low-cost solutions that can be used outside hospitals and large clinics’ Deepam Mishra, CEO, i2iHealth www.expresshealthcare.in

Pg 22

‘The usage of labs is closely linked to usage of healthcare overall’ Dr Adheet Gogate, Founder and MD, HealthBridge Advisors

Pg 24

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H Healthcare – one of the largest sectors in terms of revenue and employment, is growing rapidly. The primary source of healthcare in India is the private medical sector, used by 70 per cent of households in urban areas and 63 per cent of households in rural areas. Most of the medical expenses incurred by Indians are paid from their own pocket. Patients' preference for a particular healthcare provider depends on a lot of factors like, proximity to place of residence, review of services offered, consultants, time, etc. This is where ecommerce finds use in connecting the service provider to the customer. By opening up an additional marketplace for patients to not only gain information on diseases and treatment options, e-commerce connects patients to best possible service providers across the industry. Technically, the term e-commerce refers to the use of electronic information technologies to conduct business transactions among buyers, sellers, and other trading partners. Experts believe that the objective of e-commerce in healthcare is to provide information and generate revenues through sales of products and services.

Small but significant E-commerce is used by

DINESH MADHAVAN

CEO, Groupon India

Director, Healthcare Services, HCG

GM Marketing, Global Hospitals

Groupon thought it might be a good idea to offer a platform for pushing healthcare services; which otherwise people put on the backseat

E-commerce is a sunrise sector in healthcare. The online information gives access to users, be it patients or primary physicians about the services and products of the provider

E-commerce has changed the way healthcare is delivered. With web access they can make an informed decision about their treatment

many hospitals in India to varying degrees. Almost all tertiary care hospitals in the private sector and 70 per cent in public sector have functional websites; providing information on the history of the hospital, doctors/consultants working there and the services provided along with the contact details. Some hospitals conduct dedicated ecommerce activities through their website. “E-commerce is a sunrise sector in healthcare, mostly used by tertiary care providers. The online information gives access to users, be it patients or primary physicians, about the services and products of the provider,” explains Dinesh Madhavan, Director, Healthcare Services, HCG Hospitals. HCG Hospital Group has a huge online presence and generates a fair amount of revenue from its collective e-commerce activities. Rajiv Katoch, GM Marketing, Global Hospitals

Mumbai says, “E-commerce has changed the way healthcare is delivered. Patients today are more active in their treatment-related decision making. With web access they can make an informed decision about their treatment, they understand the ailment better and seek good service providers.” While the flagship hospital under the global banner has more web presence, the newly operational Global Hospital Mumbai is slowly and steadily building its web presence. “E-commerce has definitely added another dimension to marketing hospitals and they are exploring this channel seriously,” says Vinay Kaul, VP-Sales and Marketing, Columbia Asia Hospitals.

cent to reach Rs 62,967 crores by the end of 2013. India has close to 10 million online shoppers and is growing at an estimated CAGR of 30 per cent as compared to a global growth rate of 8–10 per cent. Electronics and apparel are the biggest categories in terms of sales. Popularity of Flipkart, the country's most prominent e-commerce player and other brands like Makemytrip, Jabong, Shaadi.com, Naukri.com, etc,. have reached consumers in non-metros and smaller towns, who have embraced this concept, many on their mobile phones. Healthcare e-commerce is very different from retail, but it holds much promise and is set to grow rapidly. There are no studies looking at the size of e-commerce in healthcare services but experts opine that a 300-bed tertiary care hospital specialising in high-end treatment can generate around Rs 75 lakhs per month from its e-commerce activities.

Currently, India has an Internet user base of about 150 million users.

150Milion 12

EXPRESS HEALTHCARE

RAJIV KATOCH

ANKUR WARIKOO

www.expresshealthcare.in

Current market in India India has a large and rapidly growing middle class, accelerating Internet access and a staggering penetration of mobile phones making it a hot-pot of Internet-based activities. Currently, India has an Internet user base of about 150 million users. However, the penetration of e-commerce is low as compared to developing countries but is increasing at a steady pace. A report released in mid-2013 by the Internet and Mobile Association of India (IAMAI) and IMRB International valued the e-commerce market in India at Rs 47,349 crores in December 2012. The same report predicts that e-commerce market in India is expected to grow by 33 per

Leading the pack Hospitals sound positive. Some of the biggest hospitals in India are now venturing into e-commerce and others are betting big on it too. While TopDoctorsonline, Ask4healthcare, Rx HealthCare Magic are old players, Surgerica, MediAngels and Ehealthaccess are the new players exploring this segment. There are many third party vendors selling healthcare services for these OCTOBER 2013

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hospitals too. Companies like Groupon and SnapDeal are now offering healthcare services among other things. “Around 7 -10 per cent of our merchants are healthcare providers,” reveals Ankur Warikoo, CEO, Groupon India. “Some of the bigger brands who have associated with us are Fortis Hospitals, GenX Diagnostics, Oncquest, Vasan Eye Care, Visual Aids Center, Thyrocare, Manipal Hospital, Medinova Laboratories and more,” he adds.

further adds that e-commerce may benefit preventive service providers but again the industry does not have uniform costs of services. In addition, costs of tests or services are not exhibited online for patients to compare therefore it’s difficult to make an immediate buying decision.” Contrary to this, Madhavan says that the more complicated an ailment the

Healthcare e-commerce is very different from retail but holds much promise and is set to grow rapidly

more information is sought by the patients. If there is stigma related to a disease patients like the anonymity that the Internet provides and thus prefer online information search and consultation. “Patients who seek tertiary care may combine chat and buying activities but in wellness - all categories - people are willing to buy online,” informs Madhavan. “Groupon thought it

Customer behaviour There is a lot of scepticism among marketing managers on how patients behave online. While some experts feel that patients are not interested in buying services online others believe that it will be a better revenue generator in future. “As of today, e-commerce does not have much significant impact on the business of the hospitals,” says Shrikant Soman, CEO, Bhatia Hospital, Mumbai. “It has major impact on the areas of medical tourism. However this is only the beginning. Going forward to the next three years, we expect e-commerce to come into prominence,” he adds. Bourn Hall India’s MD and CEO, Gaurav Malhotra says, “E-commerce may work for a limited number of speciality.” “It is a short-term marketing tool to bring in footfalls but may not guarantee repeat business,” he adds. According to Malhotra only health check-ups, dental services and skin and beauty services can benefit from e-commerce. Concurring to his thoughts Katoch says, “Treatment decisions are not impulsive they are very emotional in nature and include all stakeholders, therefore patient may not be willing to buy it online.” He

THE OBJECTIVE OF E-COMMERCE IN HEALTHCARE IS TO PROVIDE INFORMATION AND GENERATE REVENUES THROUGH SALES OF PRODUCTS AND SERVICES OCTOBER 2013

www.expresshealthcare.in

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might be a good idea to offer a platform for pushing healthcare services; which otherwise people put on the backseat,” says Warikoo. “If a person gets up in the morning and receives an email with a deal on full body check-up at his/her doorstep by a reputed diagnostics brand at an unbeatable price; which includes diabetic screening, cholesterol, liver, renal, thyroid profile, complete haemogram and more, they tend to act on it impulsively,” he explains. “We were ourselves surprised when a lasik eye surgery deal with one of India’s foremost eye care centres sold 150+ Groupons which was priced at Rs 25000 each. 1000s of Groupons for skin care treatments, weight loss deals, dental check-ups and professional dietician services have been sold in the past one and a half years. The best part for the service providers is that instead of paying upfront for advertising, they only have to pay when the customer walks in,” he further adds.

Ever evolving The e-commerce sphere in healthcare is ever evolving. Hospitals have moved from e-brochure format to on-line customer care to web-broadcasting. One of the most

EXPRESS HEALTHCARE

GAURAV MALHOTRA

SHRIKANT SOMAN

VINAY KAUL

CEO, Bhatia Hospital

VP-Sales and Marketing, Columbia Asia Hospitals

MD and CEO, Bourn Hall India

As of today, e-commerce does not have much significant impact on the business of the hospitals. In the next three years, we expect e-commerce to come into prominence

E-commerce has definitely added another dimension to marketing hospitals and they are exploring this channel seriously

E-commerce may work for a limited number of speciality. It is a short-term marketing tool to bring in footfalls but may not guarantee repeat business

distinct feature nowadays is blending of on-line customer service and easily available help on the phone. Voiceover–net protocol gives customers the opportunity to connect with service providers for a more personal feel right over the phone. And this service information can be accessed any time and the service is available 24x7. “Today e-consultations

have become common. We have many features on our website for patients who seek appointments, second opinions, diagnostic appointments etc.,” explains Madhavan. “Most hospitals have chat function on their websites, they have thirdparty payment portals by which patients can pay bills online. Some hospitals have webcasts for live surgeries

and informational videoonline.” he adds. “HCG is developing active pod-casts and live digital radio station to further enhance the user experience on its website,” Madhavan informs. SaaS-based on-site customer engagement tool for online businesses, is also gaining popularity with healthcare providers. These solutions allow online busi-

www.expresshealthcare.in

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INDIAN E-COMMERCE SPACE MAY LOOK VERY APPEALING BUT THERE ARE UBIQUITOUS CONCERNS ABOUT SECURITY, PATIENT CONFIDENTIALITY, AND TECHNOLOGY EXPENDITURES nesses to run promotions and offers on their websites and gather customer insights.

Plus points The foremost advantage of e-commerce is that it breaks the location barrier. “With medical tourism gaining momentum in the country, e-

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commerce has definitely expanded the market for the hospital and the universe for the consumer,” says Malhotra. Besides, there is no limitation of space and abundant information can be packed in the same platform for patients to make informed decisions. “Some healthcare providers use the website to promote brand loyalty by building relationships with patients, developing new web-based markets, and collecting information about consumers’ buying habits,” informs Katoch. Today, hospitals spend a huge portion of their budgets on marketing activities to attract and retain patients. “The role of formulating a proper marketing strategy and its effective implementation is vital for any healthcare facility, be it for-profit, trust or public,” says Madhavan. “Many successful healthcare facilities tend to struggle to maintain constant revenue growth without marketing; apparent long gestation period for a new hospital is often a consequence of inadequate marketing. E-commerce not only offsets rising marketing costs but also delivers higher profitability,” he adds. “Patients buy services through our website, however its magnitude is very small at present,” informs Soman. In addition, there are plenty of third-party companies that are helping promote ecommerce activities in India. “We have partnered with such portals and the response has www.expresshealthcare.in

been encouraging. There are certain healthcare specific portals that have come up over the past few years and these are gaining momentum,” says Kaul. “By working with Groupon, service providers get a free marketing platform to advertise their brand/ business and get new customers from this platform. Customers who are likely to come back if the service they experience the first time is beyond their expectations,” explains Warikoo. “We can market their new services and promote their specific ones and can make city aware of their brand,” he adds. Explaining the working of his company Warikoo says, “Hospitals also need to bear in mind that if a customer has purchased a deal and he/she is not eligible for that particular medical procedure; it needs to inform the customer immediately. Groupon will then refund the amount to the customer. All necessary documents/certification needs to be in place in order to be listed on Groupon.” Talking about Groupon, Kaul says, “If there is a service like this available, there is no harm in promoting healthcare services through them. It adds to the number of channels which are available to the public for buying the product/service. Marketing through these channels also add to awareness generation among the target group.”

Concerns While the Indian e-commerce space may look very appealing with unimaginable potential; it is abound with various issues. There are ubiquitous concerns about security, patient confidentiality, and technology expenditures. There is a need of higher internet penetration and cheaper data plans to boost mobile commerce or m-commerce. “Building customer confidence is the key and the presence of new and more convenient ways to pay will boost e-commerce,” says Malhotra.

The next step Once hospitals get into this e-commerce bandwagon they will be looking for newer avenues to explore. Mobile commerce will become the next big thing in e-commerce. With the staggering number of mobile phone users and ease of mobile money, use of debit and credit cards, this segment sure has the potential to drive growth in the coming years. Social media networks such as Facebook are likely to increasingly become channels for sales and consumer engagement. “HCG is already active on various social networking sites. The group launched a mobile app for breast cancer earlier this year and we are in the process of developing more apps for mobile phones,” reveals Madhavan. mneelam.kachhap@expressindia.com OCTOBER 2013

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Narayana Institute of Cardiac Sciences launches ‘Heart Station’ The heart station boasts of advanced echocardiographic applications such as 3D ECHO, 3D transoesophageal ECHO and contrast ECHO

HCIL to provide tele-education network for medical students

u g h e s C o m m u ni c a t io n s India Ltd (HCIL), a subsidiary of Hughes Network Systems (HUGHES), will provide a managed tele-education network to the Delhi Academy of Medical Sciences for post-graduation medical coaching. The satellitebased, online service is expected to assist medical students in attaining success in NEET/AIIMS/PGI and other post-graduate medical exams. HCIL plans to offer its tele-education solutions to other renowned medical institutes as well. Dr Sumer Sethi, Director, Delhi Academy of Medical Sciences said,“This technology is bound to help medical students, particularly those based in tier IIIII cities. We have the largest face-to-face classroom network in India with 30 classrooms. We are looking to leverage the advantages of satellite technology from Hughes, pioneers in tele-education and e-learning software to reach out to more students. So far, medical students who have participated have really loved the concept.” Shivaji Chatterjee, VP, HCIL commented, “India has the highest number of medical institutes in the world, yet many students around the country are not able to access quality education because of geographical limitations. This initiative represents a paradigm shift in medical education, as it will dramatically increase the accessibility of knowledge to every corner of the country—employing our latest, most cost-effective and user-friendly technology platforms.” Hughes’ advanced teleeducation networks promise to provide a virtual face-toface experience with highquality, high-clarity and direct eye contact, including two-way voice interaction and chat-based queries..

arayana Institute of Cardiac Sciences at NH Health City in Bangalore has launched its first comprehensive cardiac diagnostic centre - 'SN Heart Station' in association with SN Agarwal Foundation. This heart station aims to provide comprehensive heart diagnostic services under

one floor for all patients and to offer diagnosis at a quick pace. The heart station will cater to health scheme and non-scheme patients as well. The heart station, apart from conventional cardiac facilities, boasts of advanced echocardiographic applications such as 3D ECHO, 3D transoesophageal ECHO and

contrast ECHO. The infrastructure of the heart station is expected to improve the accuracy of non-interventional diagnosis. Dr Devi Shetty, Chairman, Narayana Health said, “Approximately 400 ECHO are performed at the hospital everyday and this heart station will improve

the patient satisfaction in terms of reducing the waiting time.” He further added, “Our desire is to create a centre of excellence which can be a model to follow for other hospitals both government and nongovernment.” EH News Bureau

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Agilent Technologies India partners with Trivitron Healthcare To establish a stateof-the-art lab at IIT Chennai Science Park

gilent Technologies India has announced its collaboration with Trivitron Healthcare to establish a world class partner lab situated within the campus of IIT Chennai Science Park. The partner lab is reportedly equipped with some high end technologies like UHPLC, LC MS/MS, qPCR’s from Agilent. Trivitron aims to develop end-to-end solutions using these analytical platforms that are cost effective way, thereby making them accessible and affordable for clinical testing markets in emerging countries like India. Dr Pasupathi Siva Kumar, Country Manager, Life Science Group & Chemical Analysis Group, Agilent Technologies India said, “As a part of the association, Agilent will provide its latest analytical technologies to establish a world class lab within the campus of IIT Chennai Science Park. With this collaboration we hope to ensure better health preparedness for the Indian population” Dr GSK Velu, MD, Trivitron Healthcare, India said, “The partnership with world leader Agilent Technologies for instrument platforms will enable us to offer a wider specialised area of clinical testing. With the benefit of Agilent’s analytical capabilities and expertise, Trivitron will work to innovate and develop diagnostics kits in several areas like carrier screening, pre natal screening, new born screening, drug monitoring, vitamin profiling, biogenic amines, homocysteine, carbohydrate deficient transferrin (CDT) etc.” EH News Bureau

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The National Forum on Tuberculosis release national standards of TB care Standards have been developed to improve engagement with private sector for TB prevention and control

tandards of TB Care in India (STCI) were released at The National Forum on Tuberculosis held in the capital, and presided by the Chief Guest, Dr Shashi Tharoor, Minister of State for Human Resource Development and Dalbir Singh, Convener, National Forum on TB. The release was led by Anshu Prakash, Joint Secretary, Ministry of Health and Family Welfare (MoHFW). The STCI has been developed by the Central TB Division (CTD) as a way to engage with the Indian private sector for effective TB prevention and control. The Standards take into account World Health Organization (WHO) and International Standards for TB Care (ISTC) endorsed regimens

used across the globe. The standards will be updated with the latest evidence and practices for TB control in India and disseminated to all private providers. The members of the forum deliberated upon the increased need to introduce new and more accurate diagnostics for TB to ensure timely and appropriate diagnosis. They also discussed the rise and challenges of drug-resistant TB in India.

Dr Soumya Swaminathan, Director, National Institute for Research in Tuberculosis (NIRT) made a presentation at the meeting on the emergence of drug-resistant TB as well as the challenges of the Indian TB diagnostic landscape. Singh commented, “The Forum is dedicated to fight TB and as a first vital step, this meeting has brought together key stakeholders including parliamentarians,

THE STANDARDS WILL BE UPDATED WITH THE LATEST EVIDENCE AND PRACTICES FOR TB CONTROL IN INDIA AND DISSEMINATED TO ALL PRIVATE PROVIDERS

policymakers, civil society organisations and technical experts, who are committed to the cause. We are resolved to achieve enhanced TB prevention and control in India.” The National Forum on TB is expected to work for raising awareness on the need for improved TB control. The members of the Forum will reportedly meet several times in a year to discuss critical challenges in TB control. Based on these discussions, the members will formulate key recommendations to address these challenges which will then be presented to the MoHFW for further action. EH News Bureau

Eye-Q launches centres of excellence for glaucoma and retina The centres promise to offer super-specialist eye care with the best medical expertise, advanced technology and personal care at reasonable rates

ye Q Super Speciality Eye Hospitals has launched two superspeciality centres of excellence for glaucoma and retina that will bring the latest technology and best of medical skills under one roof to benefit scores of Indians who need super specialist eye care. Eye-Q Institute of Glaucoma will focus on the care and treatment of patients for common types of glaucoma as well as forms of the disease which require treatment not easily available in India. The institute will be led by Dr Devindra Sood, Fellow of the American College of Surgeons, who has been practicing glaucoma exclusively for the last 16 years. Commenting on the launch of the Eye-Q Institute of Glaucoma, Dr Sood emphasised, “Eye Q Institute of Glaucoma will help provide increased awareness about glaucoma, prompt diagnosis and

effective treatment under one roof.” Prof NN Sood, Founder President, Glaucoma Society of India & Formerly, Professor of Ophthalmology & Head, Glaucoma Services, Dr RP Centre for Ophthalmological Sciences, AIIMS said, “The needs of a person with glaucoma are different from those with other eye diseases. I am glad that the initiative to provide wholesome and qualitative glaucoma care under one roof has finally been taken.” Eye-Q’s Institute of Retina will treat complex medical cases as well as common diseases of the retina

including retinal detachment, diabetic retinopathy and macular diseases. Dr Deependra Singh, Director, Retina Services, Eye Q stated, “Treatment of the eye, particularly of retina, requires extreme caution and care. Our Institute with superior technology and team of experts is prepared to deal with complex surgeries and is committed to provide the best patient outcome.” Eye-Q’s centres of excellence for retina and glaucoma is expected to offer expertise, advanced technology and personal care. Medical procedures will be

FROM COMPREHENSIVE SCREENING EXAMINATION, EYE PRESSURE TESTS TO INTRICATE SURGERIES, THE INSTITUTES WILL REPORTEDLY OFFER ONE-STOP SOLUTIONS FOR GLAUCOMA AND RETINA PATIENTS www.expresshealthcare.in

accessible to the people at reasonable prices. From comprehensive screening examination, eye pressure tests to intricate surgeries, the institutes will reportedly offer one-stop solutions for glaucoma and retina patients, not just in Delhi but all over the country. Dr Ajay Sharma, CMD and Founder, Eye Q Hospitals, emphasised, “With the establishment of this facility and the two institutes, we hope to help raise the overall standards of care in these two areas of super speciality. Our institutes are pioneering efforts and we are certain that people will benefit from the wide range of services we are offering.” He further added, “Over time, we hope these institutes will become national centres of referral for glaucoma and retina patients, both through Eye-Q centres and other hospitals.” EH News Bureau OCTOBER 2013

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Ziqitza Healthcare joins Business Call to Action (BCtA) initiative in India To provide ambulance access for all as part of the new initiative

iqitza Health Care Limited (ZHL) has joined the Business Call to Action (BCtA) with a commitment to expand its ambulance services across India, Africa and Latin America, and increase the number of patients served from two million in 2012 to seven million by 2015. ZHL aims to save life by creating a strong network of fully equipped ambulances across the developing world to act as a robust emergency response mechanism. To meet this urgent need, ZHL partners with various state governments under the brand “Dial 108 in Emergency.” This could be either free for emergency victims or on a user fee basis depending on the state. This model is currently operational in Bihar, Thiruvananthapuram, Punjab and Odisha. ZHL also operates a private ambulance service with different prices, where the more affluent pay higher costs, the less affluent pay lesser costs and the very poor emergency victims are treated free of cost. This cross-subsidising model called ‘Dial 1298 for Ambulance’ is operational in Mumbai, Punjab, Bihar and Kerala. In addition, ZHL operates an ‘Ambulance Outsourcing’ model where ZHL provides a fully equipped ambulance with a trained driver and a paramedic to hospitals who outsource this aspect of their business to concentrate on their core specialties of treating patients. “It is very encouraging that ZHL, a pioneer in providing emergency health services will join the BCtA. For too long, the poorest emergency victims have

been overlooked and ZHL’s efforts in the sector are extremely welcome,” Sahba Sobhani, Acting Programme Manager of the BCtA, said,

“We are pleased to continue to reach new patients and serve clients who often have no access to the quality health services or ambulato-

ry services they need. We are confident that the ZHL programme will also allow us to expand our services to much needed clients across the

country,” Sweta CEO, ZHL said.

Mangal,

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ZHL AIMS TO CREATE A STRONG NETWORK OF FULLY EQUIPPED AMBULANCES OCTOBER 2013

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TPG Growth invests Rs 1,450 million in Sutures India

PG Growth, the mid-market and growth equity platform of global investment firm TPG has announced an investment of Rs 1,450 million in Sutures India, a Bangalore-based manufacturer of medical consumables. Through a significant minority stake in Sutures India, TPG Growth will reportedly be actively involved in helping the company to expand its product portfolio as well as drive its M&A initiatives. Vishwarupe Narain, Country Head, TPG Growth India said, “India has one of the world’s lowest penetrated healthcare services industries with only nine hospital beds per 10,000 people as compared to other emerging markets like Thailand, China and Brazil. Given existing gaps in the Indian healthcare delivery services, the medical devices market is poised for growth with a market size of roughly $3 billion. We believe that Sutures India is well positioned to take advantage of the macro drivers and look forward to partnering in the company’s growth to achieve its goals.” LG Chandrasekhar, Chairman, Sutures India said, “We believe that TPG Growth’s investment, combined with the firm’s operational experience and global reach, will stimulate our expansion worldwide.” In India, TPG Growth focuses on growth sectors including healthcare, financial services, industrials and manufacturing, and consumer and retail. TPG Growth has reportedly made 14 significant investments specifically in the healthcare and pharmaceutical industry across North America and Asia, and this transaction is a culmination of an initiative in the healthcare space.. EH News Bureau

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Countries to adopt 10 targets to combat NCDs The action plan is intended to provide a roadmap of actions for developing and implementing policies and programmes leven South-East Asian countries are expected to adopt 10 targets to prevent and control non-communicable diseases (NCD) by 2025. The increase in NCDs is attributed to factors such as population ageing, rapid and unplanned urbanisation, negative effects of globalisation (such as trade and irresponsible marketing of unhealthy products), low literacy, and poverty. “Noncommunicable diseases exact a huge toll on national economies. NCDs disproportionately affect poor, impoverished families and are a growing burden on health systems,” said Dr Samlee Plianbangchang, WHO Regional Director for SouthEast Asia. “These 10 targets are ambitious goals and they

demonstrate that governments are serious about reducing the disease burden from NCDs,” he added. The Regional Committee is expected to adopt a regional action plan for prevention and control of NCDs. The action plan is intended to provide a roadmap of actions for developing and implementing policies and programmes to reduce the burden of NCDs. It also provides a roadmap to achieve a 25 per cent reduction in deaths from cardiovascular diseases, cancers, diabetes, or chronic respiratory diseases by 2025. Implementation of the plan will be monitored through a set of indicators which are consistent with the global monitoring framework. Reports on progress in imple-

menting the action plan will be submitted to the WHO Regional Committee sessions in 2016, 2018 and 2021. The 10 targets to be achieved by 2025 are as follows: ● 25 per cent relative reduction in overall mortality from cardiovascular diseases, cancers, diabetes, or chronic respiratory diseases ● 10 per cent relative reduction in the harmful use of alcohol ● 30 per cent relative reduction in prevalence of current tobacco use in persons aged over 15 years ● 10 per cent relative reduction in prevalence of insufficient physical activity ● 30 per cent relative reduction in mean population intake of salt/sodium.

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25 per cent reduction in prevalence of raised blood pressure. Halting the rise in obesity and diabetes. 50 per cent of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes. 80 per cent availability of affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities. 50 per cent relative reduction in the proportion of households using solid fuels as the primary cooking source. EH News Bureau

Japanese nanotech helps eye stem cell storage, transport World’s reportedly such feat accomplished by Indian doctors jointly with NCRM s a part of an ongoing, Indo-Japanese research initiative, the transport of the endothelial cells at normal temperatures without cool preservation has now been made possible. This feat, which involves viable transportation of corneal endothelial tissue without any cool preservation, has been accomplished jointly by ophthalmologists from all over India, with Nichi-In Centre for Regenerative Medicine (NCRM), an Indo-Japan academic institute based in Chennai. The time from harvesting the corneal endothelial tissue (from cadaver donor-eye) till reaching a central stem cell lab was up to 72 hours, and yet due to a unique nanopolymer cocktail used for the transportation, the cells have survived. This work has been published online in the Indian Journal of Ophthalmology. Cornea, the transparent front portion of the eye which transmits the images into the eye for visual perception, when damaged, may need to

be transplanted with a cornea from a deceased donor. The cadaver cornea when donated should be harvested within six hours from the death of the donor and be preserved in specialised media under cool conditions to be transplanted within two weeks to a needy patient. Cornea has three main layers, the outer epithelium, central stroma and the inner endothelium. In today’s practice, the eyeball is harvested and if the cornea is of usable quality, then it is preserved and transported in cool conditions to the needy patient’s place where the cornea is removed and transplanted. In the present study, the endothelium alone was separated and transported in a nanopolymer cocktail from hospitals in Dharmapuri, Mumbai, Sirsa (Haryana) etc. to the NCRM lab in Chennai and the team at NCRM could successfully isolate viable cells from these otherwise not usable endothelium, which could be further multiplied and be proven as corneal endothelial precursor www.expresshealthcare.in

(stem) cells. It was Dr Shiro Amano of Tokyo University, Japan, who first identified that human cadaver endothelium has precursor cells and guided the NCRM team with the culture technique. However, the major hurdle was the transportation of the cadaver eyederived corneal endothelium from the place of harvesting to the lab in Indian conditions because the corneal endothelial cells are very sensitive and fragile. This is where the nano-polymer based cocktail prepared by NCRM in collaboration with Prof Mori of Waseda University has proven that the corneal stem cells could be transported from even faraway places like Sirsa in Haryana from the Shah Satnamji Hospital without any cold chain preservation in the varying climatic conditions of India between 25 to even 40o Celsius to the Chennai lab of NCRM. “Now that the corneal endothelial stem cells could be transported without any

damage and further could be multiplied, instead of them as a tissue be used in one eye of a patient, they could be used in more than one eye thereby making several patients waiting for corneal transplantation benefitted and see light. This 'An-eye-for-eyes' mission has taken close to eight full years to see the light and this day is very significant to us as eight years ago on the same day NCRM was inaugurated in India,” said Dr Abraham, Director NCRM. Dr Aditya Insaan, Director and consultant ophthalmologist of the Shah Satnamji Hospital said that with this technology we can retrieve the stem cells from corneal endothelium even in the eyes which are otherwise not usable for transplant and help save the vision of patients waiting for transplantation. He recommended that similar studies be done in transporting the full thickness cornea to see if we can prolong its shelf life. EH News Bureau OCTOBER 2013

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‘We are interested in developing low-cost solutions that can be used outside hospitals and large clinics’ i2iHealth has recently announced plans to significantly expand the availability of its lung care device in India. This innovative, FDA-approved medical device provides relief to chronic diseases such as chronic bronchitis, chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis (TB), asthma, fibrosis, pneumonia and other chronic respiratory ailments. It also provides significant relief and quality-of-life benefits to long-term smokers suffering from congestion and has proven very successful across India. This medical device is ideal for Indian patients as it is simple-to-use, low-cost and drug-free (no side effects). Deepam Mishra, CEO, i2iHealth tells M Neelam Kachhap about the device and the company's expansion plans. What is the size of market you are targeting with lung-flute device? While the volume of patients in our target market is very high – about 20 million – the real markets in India are significantly smaller due to widespread distribution and income limitations. Our target market includes patients suffering from compromised secretion clearance and increased secrete production.These also include people having poor secretion mobilisation such as COPD, asthma, cystic fibrosis, bronchiectasis, airways inflammation etc.The impact of TB and COPD is very high in India and the former is now considered of epidemic proportions.

What are your investments in this device so far? We do not share specific investment details in these companies – primarily for strategic reasons and partly because our investments go much beyond financials. We use our global networks for procuring technology, leverage our Clinical Advisory Group for clinical validation, and spend

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Kindly comment on the lung disease in India? In India, the incidence and growth rate of lung disease is very high. Pollution,TB and low-quality-tobacco smoking are some of the greatest challenges. Even by known estimates (which we think are low) the size of the market is over 20 million. What is worse is that COPD has no cure and can only be arrested or slowed down. Improved pulmonary hygiene is a natural and lowcost solution that can help the fight against lung disease. Our products are specifically designed for the same.

a significant amount of our core management time in mentoring and managing these start-ups. We typically invest between $50000 to $500000 per project, often over two rounds.

Would you be launching any new product soon?

What is your target for the sales of the product this year? We do not provide specific numbers of sales. We have sales in over 20 locations so far across the country. We plan to expand our footprint to another 20 odd locations as well as to expand sales in existing territories. We are being approached by distributors of conventional pulmonary-care equipment, for product bundling and collaborative sales.

How are your product different from the current products available in the market? Lungflute is a unique product which works on low frequency sound waves to clear the deep seated sputum. Other products in market are air pressure based products which can clear sputum only from the upper part of the broncotracheal system.These products are

the distributor and sub distributor channels. We also see significant benefits to smokers who have difficulty with sleeping or breathing. We are exploring channels to sell our produc directly to them.

expensive in comparison to Lungflute and require more effort by the patient to operate these devices.

How would you address the price point issue as India is demanding less expensive diagnostics? Lungflute is already in the affordable category of devices. A single device lasts a lifetime and does not include any costly components or maintenance.The price will further reduce as the sales volume increases.

Are you are looking to expand your presence in India. Please elaborate? We have reached almost all the metros in India, and few tier II cities through a wide distribution network. We are planning further business expansion in other tier II cities through

We are developing technologies and business plans in the areas of chronic-disease management and cancer-screening. Both these areas have large unmet need, both in diagnostics and management. In fact, we are looking for interested entrepreneurs with relevant commercial experience to help launch these companies.

What are your future plans? We are interested in developing low-cost solutions that can be used outside hospitals and large clinics – ideally in a primary care facility. We are looking at solutions which can bring a larger population under higher quality care through simple solutions that allow diagnosis and therapeutics at a location closer to the customer. mneelam.kachhap@expressindia.com

‘We are planing to open 15-18 centres all over India with an invest $100 million by end of FY16’ On his recent visit to India, Jay Highman, Strategic Advisor and Global CEO, Bourn Hall Clinic, Kochi spoke to M Neelam Kachhap about the fertility market in India and Bourn Hall's expansion plans. He was here to take the expansion plan forward and get familiar with the Indian market. Would you start off with a brief overview of what you do? I was Chairman, President & CEO at IntegraMed America, Inc before joining Bourn Hall. IntegraMed was founded as a fertility company in the early 90s as a

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result of an international relationship with some of the pioneers of modern fertility treatment. I came to the company when in vitro fertilisation was first emerging in the US as an effective form of therapy for couples with infertility. At that time, it was www.expresshealthcare.in

a very fragmented market and quality was quite variable among hospitals and physicians providing these services. Over almost 20 years, IntegraMed grew to approximately 175 locations across the entire US and today IntegraMed fertility centres account for over 25 per cent of all fertility care in the US. In the process we helped raise the bar of clinical service and saw quality of care improve dramatically.

Comment on the fertility market in India and your interest in Bourn Hall? OCTOBER 2013

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The fertility market in India is huge. Also since it is very unorganised, it gives us the advantage to establish Bourn Hall Clinic as the only corporate in this business. In addition, I see great similarities between the Indian market today and the US market for fertility care in the mid-90s. My expectation is that Bourn Hall International can play a similar role in India by helping bring high quality, modern fertility treatment to the emerging middle class of India.

How will this market change in the future? With the rising middle class comes a demand for high quality medical care including infertility treatment. But consumers need to be educated about what to look for in a high quality fertility centre. For example, with the Indian Council of Medical Research (ICMR) guidelines becoming a reality, there will be an increase in transparency and honesty to be followed by all fertility centres. Bourn Hall already has internal standards that exceed these guidelines

and we expect to continue to raise the bar for the entire fertility market in India.

What are Bourn Hall's expansion plans for the rest of the year? Bourn Hall International currently operates three centres – two in India and one in Dubai. We are in the very early stages of expansion. We’ve succeeded in building three very high quality programmes and expect to build on that success along with the world renowned reputation of Bourn Hall, UK to continue expansion in the region.

From a competitive point of view, what makes you unique? Well there are many things which makes us unique, if I have to highlight some of them, then first would be that we are the pioneers, then the only clean room lab in Asia. As mentioned earlier, we are also the only clinic with ICMR certification in India.

Could you share with us your

I BELIEVE THAT EVERYTHING STARTS BY PROVIDING EXCELLENT CLINICAL CARE TO PATIENTS AND INVESTING IN THE BEST FACILITIES AND PEOPLE

short-term financial outlook as well as your long-term objective? We are a commercial enterprise and expect to provide our shareholders with a good investment. That being said, having run a publicly traded company providing infertility services across the US, I believe that everything starts by providing excellent clinical care to patients and investing in the best facilities and people. Bourn Hall International has made those investments and expects to continue making investments to bring high quality services to the region. With that will come outstanding financial results. We are planing to open 15-18 centres all over India with an invest $100 million by end of FY16. As part of the expansion plans, Bourn Hall International also plans to add 900 people to its employees strength in India by end of FY16. Our long-term objective is to become the largest organised fertility brand in India.

What is the key message that you would wish to convey? When you combine great science with sufficient investment and human talent, extraordinary things are possible. IVF is an exciting field of medicine and we’re fully committed to moving forward with our research, and pursuing the original vision for Bourn Hall Clinic: “Pioneers in treatment, experts in care”. mneelam.kachhap@expressindia.com

OCTOBER 2013

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‘The usage of labs is closely linked to usage of healthcare overall’ Dr Adheet Gogate, Founder and MD, HealthBridge Advisors, talks about the latest trends in the diagnostic lab market and its future path of evolution, in discussion with Sachin Jagdale A recent white paper from Healthbridge on the diagnostics lab market estimates that the lab market in India is worth at least Rs 30000 crores. What were the parameters considered to arrive at this figure (common estimate is about Rs 15000 crore)? There is also a significant presence of clinical laboratories in rural India. How do you divide this market estimate among labs from big and small cities as well as rural India? We sized the market using two distinct methodologies. Through one approach, we sized the market using a ‘bottoms-up’ approach by aggregating city level build-up of players using individual lab data, hospital data and qualitative data such as interviews. We also did a separate top-down population, using disease and utilisation based model to determine the market size. We were surprised to see how different this number was in comparison to the traditional estimates. We were also unable to trace any model, study or survey that was the basis of this Rs 15,000 crore number. Virtually all reports we read referenced it circularly as a given! We decided to not accept it and invested significant effort to validate it and are confident that the market is far bigger than generally imagined. It may be possible that conventional estimates ignored or underestimated segments such as intra-mural lab studies (done by physicians in their own clinics) that are actually quite significant. In our estimates, we believe that the top 60 metros drive 65 per cent of the volume, with about 35 per cent from the rest of India. With reference to market division, we believe about 35 per cent of market revenue comes from metros and other top 60 big cities constituting 20 per cent of population - 12 per cent coming from top three metros alone. Remaining 65 per cent is from rest of India, which constitutes almost 80 per cent of the population.

There are places like Kerala in India where doctor density is one per thousand population. Do you think that such disparity also affects the count of clinical laboratories in that particular region? Lab investigation is integral to diagnosis and the usage of labs is closely linked to usage of healthcare overall. In India, healthcare usage and availability are highly variable and driven by a large number of factors. Patient-side factors include health-seeking behaviour, disease profile, awareness, affordability and others. Similarly, provider

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India has predominantly remained an importer of diagnostic devices. Do you think that self sustainability in this regard will make labs more affordable and in turn more accessible for patients?

side factors such as doctor density, quality of doctors, mix, presence of incentives etc. So, the correlation is quite multivariate.Though we did note that in Kerala logistic and paramedic support (e.g. supply chains) are not that strong, this is not unique to Kerala and is true of other semi-rural states too. What is stark is the difference between rural and urban levels of consumption though.

At present, most equipment and consumables are imported. If India chooses, at a policy level, she can become a net manufacturer and exporter. If she chooses, at a policy level.That is a big 'if'. In automotive, for instance, she has chosen to do so and is a significant player with strong domestic players too. In other sectors, she has chosen to remain a net importer.

What is the average ratio of diagnostic labs per thousand population in India? How does this compare with global ratios, in developed and developing nations? In India, the rate of usage of laboratory services is far lower than in developed markets. This is due to a variety of factors that include lower affordability, no insurance coverage for diagnostics, lower reliance on diagnostics (Indian doctors are generally more comfortable with their clinical judgment), lower retest rates and the nature of disease itself. For example, lifestyle diseases like diabetes have very high per capita lab consumptions. We estimate that the average number of labs per thousand population in India would be about 0.1. However, to compare with global ratios, we believe number of tests per capita per annum is a better indicator. In India, average number of tests performed per capital per annum is about two, which is much lower as compared to 30 in developed countries like the US.

Molecular and genetic testing is slated to play a significant role in the growth of the lab market over the next decade. However, will these tests be available across all laboratories or restricted predominantly to the larger labs? These tests will definitely be more broadly available as they become cheaper, easier to perform and more robust. At present, many sophisticated tests are physically conducted at a smaller subset of labs as their reagents are expensive and the tests have to be run in batches with their own unique economics. But as technologies are evolving, these tests are moving closer to the frontline. Arterial Blood Gas (ABG), for instance, used to require larger labs but new kit-based tests have brought these technologies to the frontline. Spot ELISA is another example. However, it is important to note that even when these fields are growing fast, their market share will remain small as the overall market itself is likely to continue growing rapidly.

market can absorb all sorts of players, though they will have to be realistic about their growth aspirations.

Do you have the approximate figure of qualified pathologists in India? How does this compare with global ratios, in developed and developing nations? We believe there are about 3500045000 qualified pathologists in India. In US this number would stand at about 10000-15000. However, the problem is that ratio of number of pathologists as compared to total number of labs is very low in India. It stands at about 0.35-0.45 in India as compared to almost two in US.

Many new diagnostic tests/lab technologies are built for point-ofcare and are virtually touch-less. Are we going to see technology evolve to a stage where a patient will have his own diagnostic kit/test at home and he would need the pathologist only for interpretation of results? If doctors decide to make such testing services available in house within their clinics, how is it going to shape up the lab market? Absolutely. We have identified this in our paper. More and more tests will not require labs or pathologists at all. Many will be done by individuals at home or in doctor’s OPDs, reducing the need for large labs with complex collection systems. In this space, technology is a powerful democratising force.

As per the Healthbridge white paper, the lab market is going to remain fragmented and unorganised. Will this development impact the entry of new organised players in the market? We believe the market is very large, with strong demographic trends favouring prolonged continued growth.The

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Any lab market stands on three pillars-patient, pathologist and doctor. What kind of symbiotic relationship you would expect among these three key factors in future? Is the government expected to play any role for the same? We have articulated this in the paper. The appropriate role of a healthcare system (and thereby a lab too) is to deliver to the population the highest level of healthcare possible at the lowest total cost of ownership possible. This is a very lofty requirement and requires the creation of a system where both doctors and laboratories are encouraged (through incentives and regulations) to enable rapid, accurate diagnosis and prompt treatment to maximise health at minimal total cost (to the system and patient). The creation of such a system takes decades. Various countries across the world have made significant strides towards this direction. In India, we have a long way to go. The role of government is crucial. It has to play a far more active regulating role than it is currently. In our view, the government’s biggest job is to safeguard patients. Creating mandatory national quality and safety standards, testing standards are key steps. Linking payment to these is another. However the real role of the government is to shape incentives. Doctors and labs are currently subject to powerful conflicts of interest that may stand in the way of ensuring that all providers act in the best interest of all their patients at all times. Incentives need to change from being provider-centric to patient-centric. Regulators have to plan this and shape the industry over time. This is not easy and requires a clear articulation of long-term goals along with the patience and commitment to move (and keep moving) in the direction of this goal. sachin.jagdale@expressindia.com OCTOBER 2013

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‘Our USP is adding comfort to care in all that we do with the help of the latest and best in terms of medical technology’ Ruby Hall, a renowned healthcare player in and around Pune, has recently begun operations at their new boutique hospital based in Wanowarie, Pune. Built around the concept of ‘comfort with care’, the new centre boasts of world class facilities, be it in terms of infrastructure, technology or medical expertise. Bami Bhote, CEO, Ruby Hall Clinic, shares more details about his new hospital, its USPs, further plans and more, in conversation with Lakshmipriya Nair

INTERVIEW

and more effective clinical outcomes, but the operational efficiencies which can be built into such a model also result in lower overheads, more specialised manpower and higher operating margins. We would also be working on a package system for a patient’s billing so that there is more transparency and less errors with better economics.

Are there any expansion plans in the offing? Tell us about the rationale behind setting up this boutique hospital? Today, healthcare delivery within hospitals has gone beyond treating medical conditions. With the growing demand for comfort and exclusivity, hospitals now go out of the way to offer a combination of clinical expertise, personally tailored services and superb hospitality to its niche corporate clientèle and high net worth individuals. With the look and feel of a five star hotel and its focus redefined, boutique hospitals cater to quality conscious affluent patients. There has been a growing need among our corporate customers for an exclusive and comfortable hospital for medical care. Of late, a number of young corporate executives end up with lifestyle diseases and demand five star facilities. We have set up this hospital to fulfil their requirements.

What planning went into designing the new hospital? What are its USPs (in terms of infrastructure, technology, equipment etc.) Barrier free environment and accessibility was taken into consideration while creating the urban design (external environment) as well as the building design (internal environment). The prevalence of green material is maximised and pristine interiors of the building compliment the urban exterior with use of glass and steel. The ambi-

ence created is spiritual and comfortable to elevate the spirit of the patient. The planning, design and final architectural expression in a healthcare project is reflective of the gradual shift in the outlook of healthcare institutions from merely treating the sick to a concerted approach towards healthy living. Our USP is adding comfort to care in all that we do with the help of the latest and best in terms of medical technology like fully digital systems for electronic medical records, real-time access to patient results, radiology imaging systems that provide transcribed reports, monitoring in all patient rooms, easy registration, digital surveillance and many more.

How is the new centre likely to enhance Ruby Hall Clinic’s existing service portfolio? At Ruby Hall Clinic (RHC) the whole philosophy is to offer a comprehensive solution to a patient for his healthcare needs and with this new centre coming up, more focus would be laid on developing niche areas in medicine like obesity surgeries, breast clinic, cosmetic surgeries, robotic surgeries, foetal medicine, etc. Also, since the new centre provides exclusivity, patients have a choice to make keeping in mind their own comfort and convenience.

Are there any plans to enter into

We have already commenced construction of our new hospital at Hinjewadi and are planning to start our next venture at Amanora Park.

How has Ruby Hall hospitals grown from its inception. What have been the major learnings from the journey?

any new spheres of services? This will definitely expand RHCs service portfolio by adding new services like radial lounge for cardiology, breast clinic for oncology, robotic surgery, etc. We are continuously evolving and our development is based on client needs and the shifting trends in the ever expanding healthcare industry. So, new sphere of services focussing more on the wellness components is being looked at and evaluated.

What are the new hospital’s plans and strategies for the next fiscal? The plans and strategies would revolve around building higher throughput in healthcare facilities which focus on a limited number of niche clinical domains. These not only translate to higher patient satisfaction

THE NEW CENTRE WOULD FOCUS ON DEVELOPING NICHE AREAS IN MEDICINE LIKE OBESITY SURGERIES, BREAST CLINIC, COSMETIC SURGERIES, ROBOTIC SURGERIES, FOETAL MEDICINE, ETC OCTOBER 2013

www.expresshealthcare.in

Ruby Hall Clinic was started more than 50 years back at a bungalow by Dr KB Grant, the founder of this institute. Over the years, it has grown to be the largest, most advanced and a highly acclaimed and renowned medical institute in Pune. With this new centre that now come up at Wanowarie, we successfully manage 720 patient beds with a patient base all over Maharashtra and are a tertiary care referral centre. Apart from this, we have satellite diagnostic centres in tier-II and tier-III cities with further plans of expansion. We are the biggest provider of medical services to corporates and run about 20 medical centres in major corporate companies and also at the Pune International Airport. Other than providing medical facilities, we focus a lot on academics and research. We churn out several nursing graduates, medical specialists and super-specialists every year. The major learning, I would say was to build the business foundation on a very high level of patient satisfaction by providing them with the best of clinical expertise along with high-end technology, not to forget, a customerservice approach.

What is the need of the hour in Indian healthcare? How does Ruby Hall intend to provide it? Penetration of health insurance to the grass root level is the need of the hour. We are planning to work out a business model or a system with various health insurance companies, to offer maximum discounts to insurance policy holders based on business volumes. This would also help to contain the escalating medical costs. lakshmipriya.nair@expressindia.com EXPRESS HEALTHCARE

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PRE EVENT New Delhi to host first Indian Cancer Congress 2013 It promises to be a confluence of onco-associations and affiliates to redefine cancer care for the benefit of the medical community and society

he first Indian Cancer Congress (ICC) will be held from November 2124, 2013 at the Kempinski Ambience Hotel in New Delhi. Experts from surgical, medical and radiation oncology are expected to join forces with radiologists, pathologists, scientists, physicists, and ancillary service providers such as oncology nurses, technicians, and paramedics to comprehensively address various facets of cancer care. Additionally, patients, caregivers, advocacy groups, and NGOs are also expected to have an opportunity to share the platform with policy makers. Hosted by the Association of Radio Oncologists of India (AROI), the Indian Association of Surgical Oncology (IASO), the Indian Society of Medical and Pediatric Oncology (ISMPO), the Indian Society of Oncology (ISO), and the Oncology Forum, the Congress reportedly enjoys the support of over 25 professional bodies, 100 cancer institutions, and seven leading international associations

involved in cancer care. With a confirmed faculty of over 250 global thought leaders, ICC has already received 3,000 delegates registration for the conference and 5,000 delegates are expected to attend. This international conference aims to act as a catalyst for further research, treatment and dissemination of knowledge in the field of cancer. Addressing the media, Dr GK Rath, Chairman, Organising Committee, ICC 2013 stated, “We are excited to lay the foundation of one of the most empowering gatherings on cancer in India in the form of Indian Cancer Congress. Slated to be the biggest oncology event ever in India, the Congress will strive collectively to face the daunting challenge of cancer and showcase the lead India has taken in cancer research. It will establish India as an emerging leader in cancer care and will inspire both experts and the new generation to take on cancer with new learnings from their colleagues across the world.” Over 300 leaders from

across the country have worked together to create a very exciting scientific programme. The Congress has received 1,740 abstracts from the scientific community across the world. The ICC will also offer 400 hours of deliberations during the four days of the event, with 10 pre-conference workshops planned in the sidelines. Oncotech, an exhibition of state of art technology, will display a range of equipment required for setting up a fullfledged cancer hospital. This conference is expected to promote and showcase all types of cancer research in India. Highlights of the programme include breast oncology, surgical management of sarcomas, haematology, head and neck oncology, paediatric oncology, thoracic oncology, palliative care, preventive oncology, imaging and radiology, gastrointestinal and HPB cancers, pathology, genitourinary oncology, nuclear medicine, geriatric oncology, gynae oncology, and nursing oncology. Dr Harit K Chaturvedi,

Organising Secretary of the ICC commented, “The scientific deliberations during the Congress and strengthening of collaborations between different arms of oncology are directed towards better patient care, better clinical outcome and most effected treatment. The treatment today is out of the reach of the significant section of our society. We hope this Congress will come out with well-defined strategies.” Four days of programmes as well as a day of pre-conference workshops on November 20 await the delegates. The programmes will apparently consist of a mixture of poster presentations, panel deliberations, round table discussions, and lectures, with an emphasis on discussions and audience participation. The ICC intends to assist care providers implement new ideas and research into their practice as well as further the discussion of best practices to curtail the rapid growth of cancer cases and provide quality care to patients.

IHMR gears up to host PRADANYA 2013 The theme for this year is ‘Healthcare India: Opportunities, Challenges and Innovations’ he 18th annual conference of Institute of Health Management Research (IHMR), Jaipur will be held from October 3-6, 2013 on the theme ‘Healthcare India: Opportunities, Challenges and Innovations’. Healthcare professionals are constantly finding the need to rethink operations management, funding and financing, staffing issues, quality management and assurance. The healthcare industry is also striving to enhance hospital design and integrate technology to improve healthcare service and delivery. Opportunity is being created both by developments in healthcare industry itself as well as increasing awareness amongst the people of their own well-being .The result is rising expenditure on healthcare products and services of all kinds. Entrepreneurs have come up

EXPRESS HEALTHCARE

with and implemented better solutions to old problems and launching new businesses to meet the increasing health-conscious population. Taking into account the opportunities and challenges faced nowadays, the healthcare industry aims at improving the quality of life, diagnostic and treatment options, as well as the efficiency and cost effectiveness of the healthcare through proliferation of innovations. Based on the concept of innovation in healthcare, the 18th Pradanya International Conference aims to try and address questions regarding the process of innovation in healthcare.

the best outcomes ● Gain firsthand informtion

on the healthcare developments of Asia and get insights to effective healthcare management practices of today ● Learn about effective plan designs

● Drivers for pharmaceutical

Major tracks

●

Keeping in mind the theme 'Healthcare India: Opportunities, Challenges and Innovations' the following areas will be considered:

● Will act as a platform for

healthcare leaders and professionals to share best practices, exchange ideas and discuss strategies on how to spend the least resources while achieving

innovation ● Emerging trends for phar●

● ●

maceutical services in hospitals Pharmaceutical opportunities in non-communicable diseases Managing quality and affordable medicines Fostering workforce for 2020 Innovations, IPR and Access to Medicines

Health/Hospital management

Key speakers (health– hospital)

● Drivers for healthcare

● Dr Nittita Prasopa Plaizier,

innovations ● Health technology

assessment

Key takeaways

Pharmaceutical management

● Managing non-communi-

cable diseases ● Aligning quality and cost

in healthcare ● Future hospitals:

Planning, Designing and Management ● Workforce governance www.expresshealthcare.in

Programme Grant Manager, PFPS, WHO, Geneva. ● Dr Chandrakant Leharia, AEFI & New vaccine focal person at WHO, India ● Dr Vivek Desai, CEO, HOSMAC India, Mumbai. ● Dr Chandil Gunashekara, CEO, Rx eHealth Enablers, Bangalore

● Dr Sanjeev Singh, Senior

Medical Superintendent, AIMS, Kochi. ● SV Kiran, Vice president, HR, Sakra World Hospital, Bangalore ● Vasanth Kumar, ACCESS Health International

Key speakers (pharma) ● Sudarshan Jain, Director,

Abbott Healthcare ● Vivek Padgaonkar,

Director, OPPI ● Hemant Dande, President,

Raptakos, Brett & Co

Contact Conference Secretariat, 18th Pradanya, IHMR 1 PD Marg, Near Sanganer Airport Jaipur (302011), Rajasthan, INDIA Ph:+91 141 3924700, 2791431-34 Fax: +91 141 3924738 Email: conference@iihmr.org.in Website: http://jaipur.iihmr.org/Academic /Pradanya/Home.aspx

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Dr DY Patil University’s Dept of Business Management to organise HOSPI EXPRESS P The 5th National Conference on Healthcare & Hospital Management is slated to be held on November 23, 2013

admashree Dr DY Patil University, Department of Business Management, Navi Mumbai is organising the 5th National Conference on Healthcare & Hospital Management on November 23, 2013. Dr R Gopal, Chairman, National Organising Committee says, “Development of healthcare facilities meeting international standards is now a felt need in our country. The Union Budget for 2013-14 reflected this concern through a 21 per cent increase in allocation towards health.” The event would comprise: Session I: 'Issues and Challenges in Healthcare & Hospital Administration' This session aims at highlighting the various issues and challenges faced by healthcare providers in today’s 21st century fly-bynight culture. With smaller hospitals and nursing homes mushrooming every day, it has become increasing difficult to fight the competition.

It is medium sized healthcare settings which suffer the most. The event would be graced by: Anupam Verma, President, Wockhardt Hospitals would be the Chief Guest and Inaugural Speaker; Dr Nandita Palshetkar, Dr Sanjay Oak, Vice Chancellor – Pad. Dr DY Patil University, Navi Mumbai; and Dr Vivek Desai, MD – HOSMAC India amongst others. Dr Nitin Sippy, National Convener opines, “This conference aims to prepare small and medium-sized healthcare providers to brace the various day-to-day issues and challenges of managing healthcare institutions and the second session aims to throw a light on the burning issue of cost vs benefit for quality improvement programmes in these healthcare providers”. Session II: Panel Discussion on 'Quality Initiatives - Cost v/s Benefits for a Healthcare Service Provider'

The panelists at the event are:

● Dr Shirish Patil

● Dr Anupam Karmakar

Panel Head Dean, Pad. Dr.D.Y.Patil Medical College & Hospital ● Viveka Roychowdhury Panel Member Editor - Express Healthcare, Express Pharma & InImaging ● Arun Diaz Panel Member Director – Jeevanti Healhcare ● Dr Atul Adaniya Panel Member Asst Medical Director, Reliance Industries

Panel Member GM-Operations, Jaslok Hospital ● Reny Varghese Panel Member DGM -Project Consulting Wadia Hospital ● Dr Shridhar Thakur Panel Member Director Projects, Vasan Healthcare ● Dr Paresh Khadtale Panel Member ManagerAccrediation & Compliance, Hinduja Hospital

A panel of eminent healthcare experts will discuss the need for good quality of services. Whether it be NABH, ISO, JCI, etc it is important to understand the competency of the cost input against the benefits (outputs). With ever increasing inflation and more than 70 per cent of the population choosing private health

facilities, cost effective –high quality services are the need of the hour. It is expected to be a very pertinent event for hospital promoters, managing/medical directors, hospital administrators/managers/executives, clinicians/consultants/ doctors, other healthcare professionals.

POST EVENT CII's 6th Medical Technology Conference held in New Delhi Focuses on the medical technology and its vital place in India’s healthcare sector

OCTOBER 2013

he Confederation of Indian Industry's (CII) 6th Medical Technology Conference was recently held in New Delhi. The conference focused on the medical technology and its vital place in India's healthcare sector. Present on the occasion were Ajay Shankar, Member Secretary, National M a n u f a c t u r i n g Competitiveness Council; Dr GN Singh, Drug Controller General (India); Dr SE Reddy, Deputy Drug Controller, India; Dr Naresh Trehan, Chairman, CII National Committee on Healthcare and CMD, Medanta – The Medicity along with a large number of participants from the entire healthcare spectrum. Dr Singh said, “The 12th Five-Year plan has envisaged the creation of as many as 1200 technical personnel including 300 medical devices officers for efficient implementation of the new regulatory regime as envisaged in the Medical Devices Bill,

which is now under consideration of the Rajya Sabha.” Shankar emphasised that the Government was cognisant that the industry was poised to grow very rapidly in the next 10 years, possibly at a rate of 10 per cent to 12 per cent creating more than hundred million jobs in the process. He supported the industry's proposal for Government’s interventions in creating an ecosystem for innovation, R&D and provide incubation and funding support to start-ups. He further observed that NMCC was open to the creation of a strategic package for the medical technology industry to support its growth provided the industry could present to the NMCC a unified proposal encompassing different strategic elements. Trehan focused on the need for the medical technology sector to come forward with innovations that could not only meet the high-end requirements, but also able to www.expresshealthcare.in

address the enormous healthcare demand that are emerging in the country at the urban, suburban and rural levels. He urged the industry to come forward with innovations which could meet the requirements of the population in the last mile. In this context, he said that India should learn from the experience of other countries and the sector should work towards a strategic programme for developing into a powerhouse and innovation hub which could not only meet the burgeoning demand for healthcare delivery in the country but also be able to serve the needs of many other countries in the African, Asian and CIS regions etc. Pavan Choudary, Chairman, CII Medical Equipment Division and MD, Vygon India shared, “If India has to achieve universal healthcare for all by 2020, it has to ensure that the four wheels of healthcare viz. the healthcare providers, the

pharma industry, the health insurance sector and the medical technology industry grow in tandem. Though medical technology is vital, it was still the smallest of the wheels. To help it reach its potential it needs smooth flows of FDI, technical and R&D collaborations, a strong incentive to set up manufacturing units in India, a robust technological ecosystem to support this manufacturing activity, and an appropriate regulatory regime.” Himanshu Baid, CoChairman, CII Medical Equipment Division and MD, Poly Medicure while addressing the audience said, “In India about 70 per cent of the population stays in rural areas having limited access to the healthcare facilities in comparison to the urban population. Through CII, we aim to bring innovative technologies, meet the external and internal challenges and eliminate the gap between rural and urban facilities.” EXPRESS HEALTHCARE

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POST EVENT

UK seeks to create healthy business environment with India 13 British pharma, life sciences and research organisations on a business visit to India

K and India’s business ties within the pharmaceutical and healthcare sectors continue to grow, with 13 British pharma, life sciences and research organisations visiting India this September. The delegation's first engagement was in Mumbai on September 2, 2013. As part of their engagement in Mumbai, UK Trade & Investment (UKTI) Mumbai, hosted a panel discussion on ‘International collaboration in drug delivery science' aimed to create an opportunity for Indian and UK business delegates to meet and interact to explore trade links in Western and Southern India. The panel discussion brought together major pharma MNCs, CROs, oncologists, hospitals, scientists, intellectual property experts and other healthcare professionals to provide areas of opportunities for UK companies as well as to deliberate on issues related to drug delivery systems that need urgent attention. Express Pharma and Express Healthcare were the media partners for this discussion. Kumar Iyer, British Deputy High Commissioner, Western India & Director General, UKTI inaugurated the event and explained the reason for their visit to India. It was followed with a small welcome note by Mahesh Zagade, Commissioner Food & Drugs Administration, Commissioner of Food Safety, Maharashtra state who spoke about increasing UK and India business ties within the healthcare sector. He stated, “I believe this kind of interaction will further developments within the Indian pharma and healthcare industry and will also help in research and development (R&D) which will ultimately be beneficial to the end consumer i.e. patients.” He also pointed out the need for an efficient drug delivery system in India, and issues such as over use of antibiotic drugs in India. Raising a valid point, he said that excess prescription of antibiotic drugs leads to drug resistance which is a bigger threat in India. He left it to the audience and the panelists to ponder on these important points. This was followed by the panel discussion. The panelists were Sangeeta Topiwala, Director-Market Access, Sanofi, Nidhi Saxena, CEO, Karmic Life Sciences, Ranga Iyer, Promoter, Salus Lifecare, Dr Tselepi, Founder Director, Cavendish NanoTherapeutics and Inbaraj Baskara, Mirada Medical . The discussion was moderated by Viveka Roychowdhury, Editor, Express Healthcare and Express Pharma, The Indian Express

Speakers at the event

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www.expresshealthcare.in

Dr Tselepi

Ranga Iyer

Nidhi Saxena

Mahesh Zagade

Kumar Iyer

Sangeeta Topiwala

Inbaraj Baskara

John Lownds OCTOBER 2013

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Delegates at the event Group. Topics discussed included opportunities and challenges in Indian pharma and healthcare sector, need for advance drug delivery systems,opportunities in NDDS in India, etc. The discussion started off with Topiwala speaking on the need for advanced drug delivery system for medicine in India. She stress upon topics such as chemotherapy and toxicity which is one of the biggest challenges in today’s time. Additionally, she spoke about the advancements in targeted therapy in the fields of oncology and diabetes. Introducing one of their latest products, AllStar insulin pen, she spoke about how the company as part of their CSR activity contributes Rs 10 from each pen towards creating better healthcare networks. Dr Tselepi spoke about her company which offers advanced medical systems aimed at increasing the efficacy of chemotherapy or radiotherapy by targeting solid cancer tumours. She further drew notice towards the various business opportunities in this segment. Moving on, Ranga Iyer brought in a different perspective on drug delivery. “Any drug delivery system has to be patient centric rather than business,” he stated. Further on, he suggested that India pharma needs to focus on fixed dose combination systems. Pointing out another of India's biggest challenges, he said that the country lacks in logistic and compliance ratio. “Compliance to medicine in India is horrible,” he claimed. Citing an example of the 'goli ke humjoli campaign'an initiative based on providing free oral contraceptives to women in the rural areas of India, he went on to say that inspite of distributing contraceptive pills free of cost, these women skipped their medicine doses. "Drugs should be developed in such a way that the patients would not require to take them on a daily basis. This will make chances of skipping the dose less likely," On these lines, he urged the industry to look at the compliance factor while developing a drug delivery system.“ Drug delivery to patients must be done efficiently without worrying about the compliance factor,” he added. Further, Saxena highlighted the opportunities within the new drug delivery system (NDDS) market in India. “Today 17 per cent of the global NDDS market is present in India which is a $100 billion market”. She emphasised, “Indian companies should join hands with partners from the US, Europe and other developed countries and conduct clinical trials. Through such partnerships they can bring products to market in less than or within 24 months. This kind of synergy will help in bringing new technologies at much affordable costs in India and will be beneficial to the patients.” Despite having one of the largest

SPEAKERS FELT THAT THE GOVERNMENT NEEDS TO PLAY A BIGGER ROLE IN MAKING HEALTHCARE AFFORDABLE AND POINTED OUT THAT INDIA'S HEALTHCARE SPEND AS A PERCENTAGE OF ITS GDP IS VERY LESS OCTOBER 2013

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pharma industries in the world India hasn't yet managed to produced a single new chemical entity (NCE) and Saxena touched resons for this lapse like the lack of proactive support from the government and the huge investment required to develop NCEs, hampering the growth of this area of research. Moreover, there was a common consensus among the speakers over the fact that while developing new NCEs, efforts should be taken to reduce their side effects as well. Baskara also spoke on the role of IT in facilitating efficient drug delivery system. While concluding the panel discussion, speakers also felt that the Government needs to play a bigger role in making healthcare affordable. The speakers pointed out that India’s healthcare spend as a percentage of its GDP is very less. Also Indian pharma companies, namely Cipla, Piramal Enterprises, Ranbaxy Laboratories and Sun Pharma are currently working on various NDDS projects and results are likely to be seen in the near future. The Government of India has started a national immunisation programme but thanks to issues like non-maintenance of cold chain etc, only 65 per cent of babies are benefited from the programme according to Ranga Iyer. “The Government of India has launched the Food Security Bill in the Parliament, it also needs to look into the access of medicines at affordable costs,” he commented. The delegation proceeded to Bangalore where UKTI and the Association of Biotech Led Enterprise (ABLE) signed a MoU to encourage and develop collaborative opportunities between Indian life sciences organisations and the UK. Rounding off the tour, UKTI hosted a two-day Oncology Summit in Chennai. During their Bangalore visit, UKTI and the Association of Biotech Led Enterprise (ABLE) signed a memorandum of understanding (MoU) to encourage and develop collaborative opportunities between Indian life sciences organisations and the UK, on September 4, 2013. The MOU, a milestone for the UK Oncology Mission aimed at combining UK's heritage and leadership in the area of healthcare and life sciences and India's emerging and thriving healthcare ecosystem to promote and develop the life sciences sector in both countries. The partnership includes the participation of life sciences experts of UK and India in the areas of industry, research and trade. It will further promote UK and India as each other's partner of choice in life sciences such as drug discovery, bioinformatics, regenerative medicine, clinical research, agri-bio, oncology and regulation. This will be done through on-going research and discussion, identifying areas of potential business opportunity that can be addressed by Indian and UK firms. At Bangalore, the delegation also visited Health Care Global (HCG) Hospital, Biocon, Mitra Biotech, Mazumdar Shaw Cancer center etc. "Our main aim is to facilitate collaboration between like minded Indian organisations in lifescience and healthcare having common interest in oncology with UK-based organisations to make oncology care more affordable and accessible," said John Lownds, Acting Head of UKTI's Strategic Trade Life Sciences Team. "The MOU would cement relationship we are looking to build in India," he added. EXPRESS HEALTHCARE

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MGM hosts seminar on ‘Supply Chain in Healthcare’ Experts threw light on best practices around the globe and opportunities for improvement which would take the supply chain management in healthcare to attain higher level of excellence

EXPRESS HEALTHCARE

he Second Chapter of SPECTRUM 360o – Supply Chain in Healthcare “Delivering Care in Real Time” which was recently held at MGM Auditorium, MGM Institute of Health Sciences, Kamothe, Navi Mumbai and hosted by MGM School of Health Management Studies witnessed the congregation of key decision makers of the industry who deliberated, discussed and debated on various issues affecting and shaping the supply chain in healthcare industry. Experts threw light on best practices around the globe and opportunities for improvement which would take the supply chain management in healthcare to attain higher level of excellence. The day started with a grand inauguration ceremony by Dr Tarun Gupta, Professor Emeritus, School of Business Management, NMIMS University, Mumbai who was the Chief Guest for the event. Prof Dr CAK Yesudian, Professor & Dean, School of Health System Studies (TISS), the Guest of

Honour, lit the lamp in the presence of Dr Narayan Khedkar (Chancellor), Dr SN Kadam (Vice Chancellor), Dr (Lt Gen) SK Kaul, Pro-Vice Chancellor, MGM Institute of Health Sciences, Kamothe; Dr ZG Badade, Registrar, MGM Institute of Health Sciences, Navi Mumbai; Dr Prakash P Doke, Medical Superintendent, MGM Hospital, Kamothe; Dr Virendra Mahadik, Medical Superintendent, MGM Hospital CBD Belapur and Prof Ashwini Arte, Director, MGM School of Health Management Studies, Kamothe. The session commenced with Dr Gupta setting the stage for supply chain in healthcare. His inputs on the evolution of supply chain and importance of IT sector in supply chain gave great insights and food for thought for the upcoming sessions. This was carried forward by Dr Yesudian who threw light on cost effectiveness while maintaining high quality service; wherein there should be a proper balance of quality and cost. He also opined that in a hospital, administrator and clinician should work together; which laid a strong foundation for the topics to be discussed further. The first speaker of the day, Joy Chakraborty, Senior Director - Operations, Hinduja Hospital, Mumbai; dealt with the topic 'Hospital Inventory Management'. His teachings on hospital inventory management, particularly emphasising on managing working capital, was very insightful. His insights on inventory management in hospitals and critical issues faced in the current supply chain systems followed opened new avenues for thinking in young minds. He also discussed on reorder quantity methods. The next speaker, Dr Akash Rajpal, Founder & Business Leader, Ekohealth Management Consultants, Navi Mumbai; dealt with 'Funding & Working Capital Management in Supply Chain of Healthcare'. His inputs on how to ensure that whatever working capital is available can be optimised for more time, how efficient SCM can www.expresshealthcare.in

reduce cost by 30 per cent and the best practices on SCM was very informative. The pre-lunch session was by NK Phatak, Hospital Administrator, Reliance Dhirubhai Ambani Hospital, Mumbai who discussed real time case studies and guided the students on how to ensure through quality care and less wastage by making a committee inclusive of doctors, pharmacists, administrators and supply chain manager for better and holistic growth of SCM in healthcare. The post-lunch session commenced with Sanjay Goel, Chairman, GTC Group, Mumbai enlightening on 'Supply chain in Healthcare – Managing Expectations'. His views on integrating and automating the supply chain was insightful. He also pointed out the new avenues and opportunities in hospitals to transform supply chains into a vital, collaborative, and strategic function. He also spoke about streamlining the workforce and facilitating a tight inventory; improving the charge-capture process, reducing claim denials and the risk of audits as well as having an integrated IT system. He also recommended collaborative governance and maintenance of common SCM data architecture. The final session was conducted by Rajkamal Bhatia, Director Supply Chain & Distribution, Sanofi Pasteur, Mumbai who spoke on 'Critical Parameters in Demand & Forecasting of Healthcare Supply Chain'. His inputs on types of demands, forecasting, critical parameters and challenges in SC was very informative. This was followed by a panel discussion on 'Strategies and Planning of Supply Chain Management in Healthcare'. It was moderated by Dr Ravindra Pratap Gupta, VP, Micro Technologies, Mumbai; and participated by Prashant Laghate, Associate Director - Head of Commercial Overseas Operations, Business Development, Institutional Business, Merck Serono, Mumbai; Amit K Ghosh, GMWorks, Elder Pharmaceuticals, Patalganga; Dr Doke; Dr Kalyani Sen, Medical Superintendent, MGM New

Bombay Hospital, Vashi; Dr Virendra Mahadik, Medical Superintendent, MGM Hospital, CBD Belapur and Dr Nimain Mohanty, Medical Superintendent, MGM Hospital, Kalamboli. The discussion went to the strategies and challenges faced, understanding pricing and forecasting in SCM. The vital roles of planning and SC Analytics were dealt with. They also threw light on how healthcare is most unpredictable, leading to difficulties in regulations. But, one thing that came out unanimously is that an integrated working model needs to be implemented across various departments. Serious issues like substandard drug supplies, reverse logistics, recall of drugs were also dealt with satisfactory suggestions. All the panelists opined that human life is of the highest importance and hence quality should never be compromised. The importance of quality certifications were highly stressed upon. Many new trends followed by various hospitals globally for holistic improvement in SCM in healthcare. The last, but not the least, were their valuable guidance to future SC managers. Some of their suggestions were, ‘Don’t be confined to one department, embrace rotation across departments and get acquainted with all doctors and staff as well as their jobs in the hospital, evolve each time you work, use data for purpose of development etc.’ The closing ceremony was conducted by Prof Arte who congratulated the student organisers and staff for hosting an influential and successful event and thanked all the speakers, delegates and sponsors and extended her best wishes to all. The event organising committee was lead by students, Rabindranath Biswas (MBA Hospital Management) and Pratima Patil (MBA Pharmaceutical Management), and they were guided by the Organizing Secretary’s team, Prof Arte, Assistant Prof Vibhavari Rane, Assistant Prof Archana Mishra and Assistant Prof Jayalaxmi Shinde.

OCTOBER 2013

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EVENT BRIEF ❖

PRADANYA 2013

❖

Date: October 3-6, 2013

❖

Venue: Institute of Health Management Research, Jaipur Organiser: Institute of Health Management Research, Jaipur Summary: The 18th annual conference of Institute of Health Management Research, Jaipur will be held on the theme 'Healthcare India: Opportunities, Challenges and Innovations'. The following topics would be covered under the conference: Health/Hospital Management ❖ Drivers for Healthcare Innovations ❖ Health Technology Assessment ❖ Managing Non-communicable Diseases ❖ Aligning Quality and Cost in Healthcare ❖ Future Hospitals: Planning, Designing and Management ❖ Workforce Governance Pharmaceutical Management ❖ Drivers for Pharmaceutical Innovation ❖ Emerging Trends for Pharmaceutical services in Hospitals ❖ Pharmaceutical pportunities in Non-Communicable Diseases

Managing Quality and Affordable Medicines Fostering Workforce for 2020 Innovations, IPR and Access to Medicines

Contact: Conference Secretariat, 18th Pradanya (IHMR), 1 PD Marg, Near Sanganer Airport Jaipur (302011), Rajasthan, INDIA Tel: +91 141 3924700, 2791431-34 Fax: +91 141 3924738 Email: conference@iihmr.org.in Website: http://www.jaipur.iihmr.org/A cademic/Pradanya/Home.aspx

HOSPI EXPRESS

Benefits for a Healthcare Service Provider' Participant profile: Hospital Promoters, Managing/Medical Directors, Hospital Administrators/Managers/ Executives, Clinicians/ Consultants/ Doctors, other healthcare professionals, students (MHA / PGDHA), Contact: Dr Heta Mehta Tel: 9819550748| Email: hetamehta62@gmail.com Dr Abdul Shaikh Tel: 9004352693| Email: rashid683@yahoo.co.in Website: www.hospiexpress.in, www.hospiexpress.blogspot.in

11th National Conference of IART

Date: November 23, 2013

Date: November 22-24, 2013

Venue: Padmashree Dr DY Patil University, Department of Business Management, CBD Belapur, Navi Mumbai

Venue: Jawahar Lal Nehru Auditorium, AIIMS, Delhi

Organiser: Padmashree Dr DY Patil University, Navi Mumbai Summary: 5th National Conference on Healthcare & Hospital Management which comprises: Session I: Issues and Challenges in Healthcare & Hospital Administration Session II : Panel Discussion on 'Quality Initiatives - Cost v/s

Organiser: Department of Radio-diagnosis, AIIMS, New Delhi Summary: The 11th National Conference of IART will bring together experts from the field of radiology to deliberate on topics such as radiography, radiological imaging, radiology equipment, professional issues related to the subject, radiation protection, patient care and many more

Contact: Organising Secretary Department of Radio-diagnosis, AIIMS, Ansari Nagar, New Delhi-110029 Tel: 09868398808, 01126546230 Email: ramesh_sh@hotmail.com

66th Anual conference of Tamil Nadu and Pondicherry Chapter of IRIA Date: December 13-14, 2013 Venue: Scudder Auditorium, CMC Campus, Bagayam, Vellore Organiser: Department of Radiology, Christian Medical College, Vellore and the Vellore subchapter of the TN & PY chapter of IRIA Summary: The 66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA will lay emphasis on the ongoing and upcoming trends in the field of radiology and diagnostic imaging. Contact: Department of Radiology, Christian Medical College, Vellore Tel: 0416 228027 Email: registration@iria2013vellore.in; radio@cmcvellore.ac.in

To tie up with

for Media Partnerships Contact kunal.gaurav@expressindia.com

OCTOBER 2013

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W H AT ’ S INSIDE

‘Absence of a robust and transparent organ donation system in the country tends to promote acts of desperation’ PG 34

KNOWLEDGE The new enactment in 2013: An extra shield for working women D Samuel Abraham, Law Officer, CMC, Vellore on behalf of the Directorate gives insights on Sexual Harassment of Women at Work place (Prevention, Prohibition and Redressal) Act, 2013 and elucidates how beneficial it would prove in empowering working women

Definitely, 2013 is a new era for working women! What they have not been able to express so far, has been brought out, well defined, well protected and entered into the statute book this year! Not only that; the executives have been notified of the same so that the provision can be enforceable. Usual restriction to the State of Jammu & Kashmir has also been removed. Now, all the provisions are enforceable to the whole territory of India including Jammu & Kashmir! How was all this bought into effect? Through the ‘Sexual Harassment of Women at Work Place (Prevention, prohibition and redressal) Act, 2013’!

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The Vishaka Case as a model

offenders to book.

Every working woman should feel proud that we have a powerful, dynamic Supreme Court which intervened into a male-dominated, male-oriented official atmosphere and gave revolutionary orders in the Vishaka Case. Detailed guidelines, alongwith with a penalty of fine upto Rs 50,000/- were also provided. This was a grey area, when our parliamentarians in the first instance, failed to understand the mental trauma a woman may have to face at the workplace. It is the Supreme Court which understood the gravity of the situation and bought the

Special features of this new Act The newly enacted, Sexual Harassment of Women at Workplace Act, 2013 has many extra provisions. The following are some of them: ● It covers all the states of India where working women are affected; ● It defines 'working place' to include a house-maid who is working for a household; ● Two adjudication bodies are provided; one for the employer with jurisdiction within his undertaking and the District Complaint Committee www.expresshealthcare.in

●

which shall have jurisdiction to include unorganised sectors The redressal of complaints should be done within one year Compensation can be awarded to the victim by the committee Guidelines were given as how to calculate compensation Funds were provided for awarding compensation by the State to meet the expenses/award to the unorganised sectors, who are sexually affected in the work place The Internal Complaints Committee shall have powers equivalent to the Civil Court under Code of

Civil Procedure 1908 when trying a suit in respect of adjudication procedures

Defining sexual harassment 'Sexual harassment' includes any one of the following unwelcome acts or behaviour (whether directly or by implication) namely ● Physical contact and advances; or ● A demand or request for sexual favours; or ● Making sexually coloured remarks; or ● Showing pornography ● Any other unwelcome physical, verbal or nonverbal conduct of sexual nature OCTOBER 2013

K|N|O|W|L|E|D|G|E Defining work place ● ● ● ●

Any department of the government All private organisations Hospitals and nursing homes Any place visited by the employee arising out of or during the course of employment including transportation provided by the employer for undertaking such journey

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Time limit for adjudication of complaint ●

Behaviour of sexual harassment ●

D Samuel Abraham, Law Officer, CMC, Vellore ●

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Implied or explicit promise of preferential treatment in her employment Implied or explicit threat of detrimental treatment in her employment Implied or explicit threat about her present or future employment status Interference with her work or creating an intimidating or offensive or hostile work environment Humiliating treatment likely to affect her health or safety

Constitution of Internal Committee (ICC) ●

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Senior level woman employee : Chairman one Not less than two members from among the employees: Members – two or more One member from NGO, which is involved in woman welfare - One

Duration of office ●

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The Presiding Officer and Members chosen from employees shall hold office for three years from the date of nomination. Member from NGO may be nominated by employer for specific duration with specific honorarium.

Disqualification of the Presiding Officer and Member of the Committee: ●

●

● OCTOBER 2013

If the member and Presiding Officer reveals the name, address and identity of the complainant or Disseminate any information related to conciliation, enquiry proceedings, recommendations of the internal committee to public for printing, communicate to others including to press and media He/she has been convicted

He/she has been found guilty in any disciplinary action or any disciplinary action is pending against him/her He/she has so abused his/her position, which may be prejudicial to the public interest

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● ● ●

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Any aggrieved woman may make in writing, a complaint of sexual harassment at work place to the ICC, within three months from the date of incident, if it is a continuing offence, three months from the last occurrence The ICC may render all help to a woman who does not know how to write a complaint The ICC may receive a complaint even after three months of occurrence, if it thinks fit If an aggrieved woman is not in a position to make a complaint due to physical, mental incapacity her legal heir or such other person in her place may lodge a complaint ICC may settle the dispute through conciliation No monetary settlement through conciliation The ICC shall complete the inquiry within ninety days from the date of receiving the complaint from the aggrieved person (Section 11 (4)) The employer shall act upon the recommendation within sixty days of its receipt from the ICC

Powers, jurisdiction and status of ICC The ICC may recommend to the employer: ● To transfer the aggrieved woman or the delinquent to any other place ● To grant leave to the aggrieved woman upto a period of three months in addition to the leave she would be otherwise entitled ● To grant such other relief to the aggrieved woman as may be required ● To order deduction of wages from the perpetrator and paid to the aggrieved woman employee on the basis of her condition

ten days from the date of commencement an enquiry and such report made available to the concerned parties. When the ICC, after arriving at the conclusion that the allegation against the delinquent has been proved, it shall recommend: ● To take action against the delinquent as per the Service Rules ● To deduct salary of the delinquent, an appropraite sum to be paid to the aggrieved woman

Calculation of compensation to aggrieved woman While determining the quantum of compensation, the ICC shall take into consideration: ● The mental trauma, pain, suffering and emotional distress caused to the aggrieved woman ● The loss in the career opportunity due to the incident of sexual harassment ● Medical expenses incurred by the victim for physical or psychiatric treatment ● The income and financial status of the respondent (Delinquent) ● Feasibility of such payment in lump sum or installments The ICC shall have the same powers as are vested in a Civil Court under code of Civil Procedure, 1908. It may: ● Summon and enforce the attendance of any person and examine him under oath ● Require the discovery and production of documents ● Require any other matter, which may be prescribed ● Enforce its orders by issuing recovery orders under the provisions of arrears of land revenue to the District Collector.

False complaint ●

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Enquiry and recommendations by ICC On the completion of the enquiry under this Act, the ICC shall provide a report of its findings to the employer within a period of www.expresshealthcare.in

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If the ICC, after enquiry finds that the aggrieved woman has made false complaint, it may send a report accordingly to the employer If any forged document has been produced by the aggrieved woman employee or fake witnesses have been produced, then the same shall be referred to the employer to enable him to take disciplinary action as per existing provisions of Service Rules If the aggrieved woman

is not in a position to prove the contents of the complaint, no action is to be taken against her

Duties of the employer ●

●

Adequate displays should be put up by the employer about the penal consequences and the Constitution of Internal Complaints Committee At regular intervals, organise workshops and awareness programmes for the ICC members and other employees of the organisation Provide facilities to the member of ICC for doing proper enquiry Assist to secure the attendance of the respondent and witnesses Make information available to the ICC for adjudication of such complaints Report to District Officer once in a year.

Third party harassment The employer will take all steps necessary and reasonable to assist the affected person in terms of support and preventive steps.

Penalty for employer Where the employer fails to : ● Constitute Internal Complaints Committee ● Take action under Section 13, 17 and 22 ● Contravenes the provisions of this Act He shall be punished with fine up to Rs 50,000; if repeated Rs 1,00,000 besides cancellation of his license/non renewal or cancellation of registration, which may be required to carry on his business.

Conclusion As per Para 11 and 12 of Vishaka & Ors vs State of Rajasthan & Ors ordered on August 13, 1997, the judgement and order are enforceable until suitable legislation has been enacted to occupy the field. Therefore, as the provisions of new comprehensive law have been enacted and notified, the orders issued in the above case become obsolete. But there are many employees, including states that without knowing the new legislation, continue to issue guidelines and orders under the Vishaka case because in States what one wing enacts the other wing does not know. Hence this write-up. EXPRESS HEALTHCARE

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‘Absence of a robust and transparent organ donation system in the country tends to promote acts of desperation’ In recent times,the healthcare industry on various occasions has been creating awareness on the need for organ donation. On the other hand, media has been constantly reporting on the increasing number of organ trafficking cases in India. Dr Avnish Seth, Head of Fortis Organ Retrieval and Transplant (FORT) programme has been in the forefront to promote organ donation in the country. He expounds on the laws, issues and the role that the industry can play to promote lawful organ donation in India, in conversation with Raelene Kambli What is the procedure for organ donation in India? What are the laws related to organ donation here? The Transplantation of Human Organs Act (THOA) 1994 provides the regulation for removal, storage and transplantation of human organs for therapeutic purposes in India.The Act recognised the concept of brain death and gave legal sanction for deceased organ donation, but failed to provide the much-needed boost to altruistic organ donation.The process of organ donation involves diagnosis of brain death, consent of family, documentation and organ retrieval in a hospital approved for the purpose by the appropriate State authority.

Is the Indian law for organ donation different from the rest of the world? There is a fair amount of uniformity in the laws on organ donation all over the world but THOA 1994 is considered more restrictive. Declaration of brain death and organ retrieval is allowed only from hospitals approved for organ transplantation. Four doctors, including a neurologist, are required to ascertain brain death and the tests have to be repeated after six hours, when already time is at a premium. In most countries, one or two doctors are enough to certify brain death and there is no mandatory time interval between two sets of tests. Some of these issues are

ABSENCE OF A ROBUST AND TRANSPARENT ORGAN DONATION SYSTEM IN THE COUNTRY TENDS TO PROMOTE ACTS OF DESPERATION 34

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INTERVIEW

addressed in The Transplantation of Human Organs (Amendment) Act 2011 which shall be implemented as rules shortly.

Do you feel that the existing law is good enough? I feel that the existing law safeguards the interests of all concerned but tends to slow down the process of organ donation. I am also concerned with an aspect of THOA 2011 which mandates that forensic expert should be present during organ retrieval in medico-legal cases where post-mortem examination is not waived off by concerned authorities. All patients with head injury, which is the most common cause of brain death, are medico-legal. When we are trying to promote organ donation in the country one should avoid changes in the law which make the procedure even more difficult. Currently, we just obtain a no-objection certificate from the forensic authorities and go ahead with organ donation.

In India, does the government provide subsidies for efforts directed towards encouraging organ donation? Increasing awareness on organ donation is the need of the hour.This does not happen overnight but requires years of dedicated effort and money. I am afraid that as a nation we have been found wanting in this aspect.The government does not provide any subsidy on this count.

Deep rooted religious beliefs are one of the causes for hampering organ donation in India. There are many healthcare providers, media personnel and NGOs who struggle to dispel these myths. Tell us how can we break these shackles? Religious beliefs, in my opinion, are a punching bag we tend to use as an excuse for poor organ donation in our country. Lack of awareness on brain death and the process of organ donation amongst medical professionals as well as the public and failure to

put systems in place is the prime reason for lack of organ donation in India. Those of us who have strived to make this work have found an acceptance rate of 40 to 50 per cent, which is comparable to the best in the world. This is true for Fortis Organ Retrieval and Transplant (FORT), Armed Forces Organ Retrieval & Transplant Authority (AORTA) and MOHAN Foundation in the South. It is a myth that any religion prohibits organ donation. It is mentioned in the Bhagwat Gita that one should not grieve for the body and that ‘Daan’ is the act of selfless giving. Similarly, Guru Nanak said, ‘The dead sustain their bond with the living through virtuous deeds.’ The Holy Quran mentions, ‘Whoever saves the life of one person would be as if he has saved the life of all mankind’. ‘Freely as you have received, freely give,’ says the Holy Bible.

Also, illegal organ trade in India is on the rise. Organised gangs are believed to be harvesting organs such as kidneys and livers. What could be the reasons for such a practice? I do not think that is the truth. However, the absence of a robust and transparent organ donation system in the country tends to promote acts of desperation.The families of patients with end stage liver and kidney diseases will do anything to save the life of their loved ones.

How can we curb this practice? How is the healthcare industry working towards this?

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Promoting organ donation and having an effective organ donation programme is the only way to curb illegal activities. Increasing awareness on the concept of brain death and organ donation is the first step. Brain death usually occurs in a setting of head injury, stroke or brain tumour, leading to irreversible loss of consciousness, absence of brainstem reflexes and requirement for ventilatory support.The heart continues to beat for 12 to 48 hours after brain death, thus maintaining blood supply to the vital organs.This is the concept which is difficult to understand by a grieving family ‘How can my loved one be dead when the heart is still beating?’ Education has to start from school level and continued at all levels by involving the media. Organ pledging facility should be made available extensively. We have hundreds of individuals who have pledged to donate their organs through FORT. We make organ donor cards on request at fort@fortishealthcare.com or our helpline number 08447743868 may be contacted. In Bangalore, the option for organ donation in case of brain death is being exercised at the time of making driving licence.The public must know that a single heart beating but braindead donor can save several lives by donating the liver, kidneys, heart, lungs, pancreas and small bowel.

What is the need of the hour? India has the maximum number of road accident related deaths in the world but one of the lowest organ donation rates at 0.18 per million population. There are hundreds of individuals with brain death in ICUs across the country but counselling for organ donation does not happen because of lack of awareness and non-availability of documentation. Declaration of brain death and counselling families for organ donation should be made mandatory. Look at what happened in Croatia. 10 years ago they had the lowest organ donation rate in Europe but today they are second highest in the world. They earmarked a key donation person for every hospital to monitor and promote all organ donation activities and also placed trained transplant coordinators in every hospital. In our setting the medical administration has to consider organ donation as key area and the Medical Superintendent or his team should supervise all activities related to brain death and organ donation in the hospital. The State government should ask for monthly return on the same from each hospital. raelene.kambli@expressindia.com OCTOBER 2013

Medica North Bengal Clinic, Siliguri Providing 'quality patient care'

DR SHAILESH KUMAR JHA Administrator & Medical Superintendent, Medica North Bengal Clinic

edica North Bengal Clinic (MNBC), Siliguri was initiated by people like Prof Mihir Sen, Dr Santanu Kar and Dr Salil Dutta, and never looked back since then. Today, it is an advanced medical unit in the region. This year, the hospital plans to glorify the contributions of their founding fathers by putting thrust on providing 'quality patient care’ to become 'Better than the Best'.

State-of-art infrastructure The hospital has a 24-hour emergency department, a 15bed ICCU, paediatric ICU (PICU), neonatal ICU (NICU) and neurosurgical ICU with all essential life support systems. The fully modernised OT complexes is equipped with latest facilities for GI and colorectal endoscopic examinations, microscopic surgery and sutureless surgery. There are endoscopic suites for performing endoscopies, colonoscopies, ERCP. The

OCTOBER 2013

state-of-the-art lab provides pathological, biochemistry and microbiological investigations. Radiology and diagnostic services are also provided.

Medical facilities MNBC has recently added another feather in its cap. It now manages North Bengal Oncology Centre, the only hospital in North Bengal offering comprehensive cancer treatment. Medical amenities of the newly inaugurated premium ward, renovated ICCU with technically advanced equipment make the hospital a versatile place for

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any kind of treatment. Facilities like CT scan, X-ray, Ultrasound, TMT, Echo provide support to the clinicians. The department carries out all routine examinations of brain, thorax and various 3D examinations with guided FNACs.

Keeping the patients safe The infection control team at MNBC works closely with the infection control norms, managers and healthcare workers to minimise the infection risk to patients. All staffs at the hospital have regular training on infection prevention and control.

Weekly audits are carried out to check that they comply with the hospital’s strict hand hygiene policies, and there are signs at the wards and other clinical areas to remind everyone – patients and visitors as well as staff – to clean their hands. Information is regularly collated for rates of antibiotic-resistant infections in each ward and department, and the hospital staff use this data to help reduce these rates as much as possible.

Costs and services The hospital offers all its services at a reasonable price. They have certain package systems for different health checkups. For in patients free consultation post discharge, discounted medicine from their Medica pharmacy, one time registration fee, lifetime guarantee for medical records file archival and many more cost-effective facilities make MNBC the best in the domain of healthcare.

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Neotia Getwel Healthcare Centre, Siliguri N

A quality healthcare endeavour of Ambuja Neotia Group

P L MEHTA Whole-time Director, Neotia Healthcare Initiative Ltd

eotia Getwel Healthcare Centre (NGHC) at Siliguri is a quality healthcare endeavour of Ambuja Neotia Group. To enhance the experience of ten glorious years of running Bhagirathi Neotia Woman and Child Care Centre in Kolkata, Ambuja Neotia Group decided to bring in world-class medical expertise in the eastern part of the country through this state-of-the-art multi-specialty healthcare facility with the primary objective of quality care, transparency in services and patient safety. Apart from the hospital services, Ambuja Neotia Group has also focused on fertility care, retail chain of pharmacies and diagnostics, which are operated through an independent company named Neotia Healthcare Initiative Ltd under the able leadership of P L Mehta.

Introduction

‘We aim to establish ourselves as a dependable, transparent, quality healthcare institution by creating diversified healthcare delivery models constituting hospital services, fertility care, diagnostic services, retail pharmacy along with other allied services. The primary objective is to bring in 1100 operational hospital beds within the next two to three years by means of greenfield, as well as brownfield projects. Apart from direct service delivery it is also in our focus to train and develop human resources required in the healthcare industry, an effective beginning of which has already been started by establishing a full-fledged nursing academy in Kolkata.’

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NGHC is a 250-bed multispeciality hospital beautifully landscaped and spread over three acres of land dedicated to provide integrated medical care to a wider range of patient population in the northern part of West Bengal, Sikkim, Nepal, Bhutan and pan-North Eastern India with its state-of-the-art infrastructure and unparalleled medical facilities. NGHC has managed to achieve the status of the most preferred healthcare service provider in the region within just a year from its launch.

State-of-art facilities NGHC has more or less than two lakh sq ft closed area with suite, superdeluxe, single and multioccupancy patient rooms, five operating theatres, 30bed intensive care unit, 22bed neonatal intensive care unit, a laboratory where a wide array of tests can be carried out round the clock along with a cutting-edge diagnostic imaging centre and integrated pharmacy outlet. The departments of the facility have been scientifically designed in order to ensure that the turnaround time for internal process flow is minimised significantly, resulting in considerable improvement in effi-

ciency. Since the beginning of designing the facility it has been kept in mind that the facility should have an aesthetic environment where compassion, quality, safety and cost effectiveness are integral to care which indirectly contribute to patients’ well-being such as shorter length of stay, reduced stress, increased patients satisfaction and others.

Systematic approach to quality Quality healthcare for patients in a hospital starts with an integrated team of medical professionals. At NGHC, all the speciality conwww.expresshealthcare.in

sultants have been brought into the system from the premium institutions all over India e.g. PGI Chandigarh, AIMS, CMC Vellore and many more to work together with other medical professionals and medical technicians, who are equally skilled to provide the best possible treatment. NGHC has introduced an academic platter of multi-speciality services through integrated interactive programmes amongst consultants of different specialties which ensure continuous up-gradation of professional skills of the individuals. With expertise and excellence being the cornerstones of NGHC, the hospital not only aims to furnish the best in medical services but also intends to play a significant role in advancing the healthcare infrastructure

and overall socio-economic development of North Bengal and North-East India.

Advanced super-speciality services Being the first explorer in the region as an institutionalised and transparent healthcare service provider, today NGHC is proud to introduce a bunch of super-equipped advanced super speciality services like nephrology, endocrinology, gastroenterology, advanced laparoscopic surgery and neonatology in its service bouquet backed by a professional corporate setup to look into supply chain management, procurement, etc to ensure only the best quality of equipment, medicines and consumables are used for the procedures. In addition to this, the treatment protocols and operational SOPs are designed in such a way so that the hospital can earn accreditation of NABL and NABH. The applications for the accreditation is already in process. OCTOBER 2013

W H AT ’ S INSIDE

‘We feel everybody should be working on improvement of quality’ PG 40

STRATEGY INSIGHT Quality function deployment (QFD):

A strategic tool for healthcare organisations Dr JP Pattanaik, Healthcare Business Analyst, UnitedHealth Group Information Services makes a case for quality function deployment and expounds on the benefits it offers to enhance healthcare delivery

Over the years, healthcare organisations have adopted various quality tools and methods for enhancing efficiency of healthcare service delivery. Identifying the right tool and following the right methodology is essential for sustaining any quality improvement effort. This is true for any kind of organisations, thus; healthcare organisations cannot be an exception. The article comprehends how ‘Quality Function Deployment (QFD) – The House of Quality’, can be adopted to understand customer requirements, prioritise organisational strategic goals and reap optimum benefits from the available resources.

method for developing a design quality aimed at satisfying the consumer and then translating the consumer's demand into design targets and major quality assurance points to be used throughout the production phase. ... QFD is a way to assure the design quality while the product is still in the design stage." The three primary objectives in implementing QFD are: ● Prioritising spoken and unspoken customer wants and needs ● Translating these needs into technical characteristics and specifications ● Building and delivering a quality product or service by collectively aiming towards customer satisfaction The primary areas of QFD application are product planning, part development, process planning, production planning and services planning. Since its origin, many organisations have adopted QFD and have reaped benefits from it. Today, its usage is not

Healthcare organisations such as hospitals have adopted numerous quality improvement tools for efficiency enhancement including those practised in manufacturing and production industries. Studies reveal healthcare organisations have benefitted immensely from adoption of quality practices from other industries.

Benefits of QFD

Dr JP Pattanaik Healthcare Business Analyst, UnitedHealth Group Information Services just limited to production or manufacturing organisations; service industries too have benefitted from this approach. QFD is now an integral part of various quality improvement methodologies such as lean six-sigma to name one.

Evolution of QFD “Time was when a man could order a pair of shoes directly from the cobbler. By measuring the foot himself and personally handling all aspects of manufacturing, the cobbler could assure the customer would be satisfied.” - Dr Yoji Akao, Cofounder of QFD during one of his private lectures

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QFD approach was developed in Japan in 1960s to understand the spoken and unspoken needs of customers and design high quality engineered products aiming at providing high value to customers. By 1970’s Mitsubishi Heavy Industries had demonstrated the positive impacts of the approach to the world. According to Akao, QFD "is a

Improves customer satisfaction

● ● ● ● ●

Creates focus on customer requirements Uses competitive information effectively Prioritises resources Identifies items that can be acted upon Structures resident experiance/information

Reduces implementation time

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Decreases midstream design changes Limits post introduction problems Avoides future development redundancies Identifies future application opportunities Surfaces missing assumptions

Promotes teamwork

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Based on concensus Creates communication at interface Identifies actions at interfaces Creates global view out of details

Provides documentation

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Documents rationale for design Is easy to assimilate Add structure to the information Adapts to changes (a living document Provides framework for sensitivity analysis

Figure-1: Benefits of QFD (Adapted from James L. Brossert, Quality Function Deployment – A Practitioner’s Approach, Milwakaukee, WI: ASQC Quality Press, 1991)

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The QFD approach has been proved to be an effective tool for organisations of various types. QFD follows a methodical and rigorous approach to understand customer requirements and translates into product or service features thereby satisfying the customer needs; thus, providing right direction to the organisation needs. Figure 1 below summarises the benefits of QFD and how organisations can leverage the approach for achieving better efficiency.

Components of QFD : The house of quality The most popular approach for QFD is the ‘house of quality’. As the name suggests the tool resembles shape of a house, thus the tool is been popularly called as ‘the House of Quality.’ It is a matrix that helps in identifying the spoken and unspoken needs, prioritising based on the perceived customer value and matching those against how an organisation will meet those requirements. (Check figure 2) The house of quality consists of following components. ● Voice of the customer VoC (Whats) ● Voice of the business - VoB (Hows) ● Inter relationship matrix ● Technical matrix ● Technical correlations OCTOBER 2013

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Techinical Correlation Voice of Business (VoB)

(HOWS)

3 (Whats)

Voice of Customer (VoC)

Inter Relationship Matrix

Technical Matrix

Figure- 2: The house of quality and its components

60 50 40

33.8

32 26.6

26.6

State-of-the-art technology

Consultation time

Fire safety measure

11.6

Wellknown qualified doctor

Addressal of requirements

13.1 13.1 13.1

Cleanliness of the premises

Quality of F&B services

16.9 14.9

Protected health information

Quality of medical care

Proper escorting, counselling & direction

Weightage

Problem solving/Prompt replies to queries

Amenities

Ambience

Skilled, talented & experienced staff

Proper & well organised waiting area

Courteous and concerned staff

Effectiveness in sample collection

Value for money

Price of the package

All specialities under one roof

Timing of availability of reports

Hygenic toilets

16.9

Quality of non-medical care

16.9

Safety from infection

17.4

Courteous & concerned physian

21.3 20 19.9 19.9 19.9 19.9 19.9 19.9

Figure- 3: Prioritised customer requirements

1200 1134

1000

1005 943 891

800

860

824 811

778

744 678

600

602 594 567

418 391

356 302

200

275 254

Figure -4: Prioritised business requirements www.expresshealthcare.in

Equipment procurement policy

Pricing strategy

Preventive maintenance protocols

Interiors

Patient information on management process

Availability of information on brochures

Recruitment policy

Calibration procedure

Constant upgradation

Effective management of wating time

Functionally defined layout

Infection control protocol

Communication skills of staff

Intra & inter-departmental coordination

Computer-based information system

Availability of consumables

Availability of consultants

Regular 360 degree feedback mechnisim

Weightage

Availability of state-of-the art equipment

136

the total visitors. The customers were asked to rate the various parameters based on their perceived value to them and how they rate the defined service characteristics. The organisation also carried out several brain storming sessions to identify the technical descriptors. Each customer requirement was examined to know how the same has been correlated with the technical descriptor (strong, medium or weak). A target value was set for each customer requirements. Same approach was followed for the technical descriptors. Customer requirements were prioritised based on the target value, scale of factor and sales point. (See figure 3) Similarly, the technical descriptors/business requirements were prioritised based on degree of technical difficulty, target value, absolute weight and relative weight. (See figure 4) The outcome: After a comprehensive analysis of customer requirements and the technical descriptors, the organisation was in a position to prioritise the action items. The organisation implemented the recommendations in the high priority areas. Over next few months, a steady improvement in customer satisfaction index was recorded.

Conclusion Organisations need to prioritise the requirements which can have maximum impact on the outcome. It is essential for managers to identify the right approach to solve a problem keeping a right balance between the resources available and the target requirements to be met. QFD is an effective tool to prioritise decisions. Right quality management practices coupled with a strong leadership direction can yield great results for the organisation.

References

542

400

Stadard operating procedures

The problem: The health checks department of a tertiary care hospital had been receiving several customer complaints, thereby pulling the overall satisfaction index low. Since most visitors were asymptomatic, their needs were quite different from

Trained support staff

QFD healthcare organisation - Lessons from practice

patients who visited to hospital for specific treatments. Though, the organisation had taken a few measures, it had not resulted in any significant improvement. The approach: To understand customer needs who visit the preventive health checks department in a better way, the management decided to carry out a study based on QFD approach. The study was carried over a period of three months. To understand the customer needs better, the organisation followed a number of methods such as reviewing customer feedback, observation of customer behaviour, structured interviews with 50 per cent of

Planning Matrix

Planning matrix Voice of the customer (VoC) – WHATS: The left side of the house represents customer requirements in other words ‘What’ your customers ask for in a product or service. Each of primary customer requirements is supported by secondary requirements to represent the primary needs in greater detail. Voice of the organisation (VoB) – HOWS: The ceiling or the second floor represents the voice of the business or technical descriptors. It represents a tools and methods by which the organisation willing to meet the customer requirements. Further definition of the primary technical descriptors is accomplished by defining a list of secondary technical descriptors which represent the primary technical descriptors in greater detail. Inter relationship matrix: The interior walls of the house represent the relationship between customer requirements and the technical descriptors. The relationship matrix represents graphically the degree of influence between each technical descriptor and each customer requirement. Technical matrix: The foundation of the house represents the prioritised technical descriptors. The prioritisation is based on a number of factors such as benchmarking, degree of technical difficulty and the target value listed. Technical correlations: The roof of the house represents technical correlations i.e. how the technical descriptors influence each other. This helps in identifying similar technical descriptors which have a synergy impact and/or conflicting technical descriptors which might adversely impact the planning process. Planning matrix: It represents prioritised customer requirements. The prioritised customer requirements are based on number of factors such as importance to customer, target value, scale-up factor, sales point and absolute weight.

Minimum process time

●

Total Quality Management’ By Dale H. Besterfield et al, Pearson Education, Inc. (New Delhi -2005) QFD Institute’ – The Official source for QFD (http://www.qfdi.org/what_is_ qfd/what_is_qfd.htm) ‘Quality Function Deployment’ By Creative Industries Research Institute (http://www.ciri.org. nz/downloads/Quality%20Fun ction%20Deployment.pdf) ‘American Society for Quality” (http://asq.org/learn-aboutquality/qfd-quality-functiondeployment/overview/overview. html) EXPRESS HEALTHCARE

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â&#x20AC;&#x2DC;We feel everybody should be working on improvement of qualityâ&#x20AC;&#x2122; John Ledek, WW President, BD Diagnostics-Preanalytical Systems was in India recently to announce BD's alliance with the College of American Pathologists (CAP). Viveka Roychowdhury gets more details of the company's plans for India and the BD-CAP partnership Results of diagnostics tests dictate diagnosis and treatment. What is the level of treatment errors due to poor quality and varying proficiency levels in terms of healthcare outcomes? With the diversity of quality levels among laboratories, not just in India but across the world, we see error rates ranging from near zero to 15-20 per cent. And sometimes that results in patients being called back so that the blood/sample can be retaken for fresh tests. Other times, errors can lead to misdiagnosis where either the patient has the disease but its not diagnosed or in some cases, the patient is told he has a disease when he actually does not. Obviously that is tragic for the patient and the healthcare system. So, we look at what is the error level at a particular facility and how we can help them improve. If employees are constantly challenged to improve, it creates a culture for improvement. Hence, we think itâ&#x20AC;&#x2122;s important for all organisations to have a viewpoint on quality and how they seek to improve it.

How does the alliance between BD and CAP seek to redress this issue? How will this impact patient outcomes? Any data to back this? Most often, it is the patient who bears the cost of low quality.Therefore, if we can eliminate this cost, then it lowers the cost of the healthcare delivery system as a whole. We believe that is going to be the case with all laboratories and hospitals as they improve quality. Patient outcomes have already improved in the 40 odd labs within India which are CAP-accredited. Errors also add to the cost, either to the patient or to the healthcare system. And also misdiagnosis. Upwards of 70 per cent of all decisions are driven by the diagnosis results. If you have 1-15 per cent errors, then you have 70 per cent misdiagnosis rate. Eliminating those errors can help the healthcare system and save the patients considerable amount of money and time.

INTERVIEW

to a better experience. It becomes easier to get access to them. Secondly, many times when hospital labs use these tools, they have queries and need support, sometimes in the local language and in the same time zone. At BD, we can offer that customer support service, to answer all basic queries during the testing process. We expect that to be a big value driver in this relationship.

India already has some 40 CAPaccredited labs, mostly from the larger established players and diagnostic chains like SRL, Metropolis and Dr Lal Pathlabs. But not every player has the resources to be so advanced on this learning curve. So, how will this alliance benefit these smaller players specifically and the industry at large? CAP accreditation is the gold standard when it comes to lab accreditation and everybody is not going to get to the gold standard in the first year.Therefore, part of our mission in this partnership is to define how we can develop those milestones from the very beginning and every step of the journey towards that gold standard. Many players may never get to that gold standard but that does not mean that they cannot improve quality. So, whether we talk about other accreditation standards, ISO 15189 or just some of the audits we do, which we call 'May I help you?' where we come into a lab and make suggestions to improve the quality in the lab, all of these can help a lot of players. We do not see it as a 'CAP or nothing' situation; we feel everybody should be working on improvement of quality. It is a journey towards a quality goal where everybody could have a different goal. Some may want CAP accreditation while others may be fine with other accreditations. Others might want to solve specific problems with specific tests. So any where that customers have challenges, we want to be able

On the revenues front, where do the India operations fit into BD's global revenues? And what are BD's growth plans for India going forward?

to provide support. In a sense, such accreditations are an aspirational goal for players to live up to.

Since the BD-CAP alliance covers China and India, how do the two markets compare in terms of size, challenges, price points, growth potential, etc.? Both are very large markets, with fast growth as more people get access to quality healthcare. As that access improves, so does the demand for quality. Both markets are very different in the way the healthcare systems are structured, the way care is delivered and who pays for the care.The priorities of the two governments are often different as well. But I think, fundamentally both governments seek to cover as many citizens as possibly. Hence, building the infrastructure to deliver this care is a very important priority for both governments.That is why the BD-CAP partnership aligns very well with those goals.

What will be the challenges to BD's growth in India? Looking ahead, the challenge is to expand into the tier II and tier III towns but we see every challenge as an opportunity. Specifically, the challenge about expansion into these tier II and III markets is how do you standardise quality of operations across players in such a fragmented market. As the bigger players consolidate, the challenge for the bigger player is to see that they lift up the standards of the smaller players and

What is BD's role in the roll out of this alliance? Initially, BD will be managing the distribution of CAP's proficiency testing tools and quality improvement tools. Right now, CAP's challenge is to get these tools efficiently through each country's customs to the customers. Hence, as soon as we become the channel of distribution, more labs will get access to these tools and this will lead

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that is where we work very closely with the labs and hospitals to see that this happens. Also, we are creating access to our products and services across tier II and III cities either through our education programmes or dispersion of our sales personnel in order to get closer to the customer (like smaller hospitals, nursing homes, clinics, etc) in these locations.

We have been in India for over 17 years now and we are very proud of the success we have had over these years. We have tremendous talent here in India and we are very fortunate that many of our top performing employees in India have moved on to other locations across BD in other countries. So that is a clear message that if you do well here, we have opportunities all over the world. India is an important market for us and a very important growth driver for our business. Our global revenues last year were $8 billion, 25 per cent of which came from emerging markets (China, India, Brazil, Latin America). Developed markets are growing in the two to three per cent range (US, Europe, Japan) while emerging markets are growing in the 12-14 per cent range. India grew at around 20 per cent over the past few years and we expect to maintain or even exceed this rate over the next few years, Nowhere else in the world, except China, do we see such growth. Partnerships like the one with CAP will help us grow.

Any specific strategies for growth? As we grow our business further, one of the important things is that as more patients get access to care, there will be certain unique needs of the Indian market that we will want to serve better. For example, many of the top tier labs here are fully automated.That is the case in many of the developed markets of the world so products developed for automated labs are universal. But, many of the labs do not have full automation so what is the appropriate product for those labs? And they operate differently for instance, in rural areas, such labs have a lower volume/throughput of patients.Therefore there are opportunities to develop products unique to those labs that may not exist in developed markets. We do think that such products may be suitable for labs in other emerging markets which have similar set-ups in rural areas.Therefore, these are the areas that we are investing in to understand better and to see if we can come up with product solutions to address these challenges. viveka.r@expressindia.com

www.expresshealthcare.in

OCTOBER 2013

W H AT ’ S INSIDE

‘Since BYOD is already in, I would like to see to that we do not block it but, with the Fortinet Solutions, are able to control it’ PG 49

IT@HEALTHCARE Corelation of health information exchange and meaningful use

‘The need of the hour is telemedicine’ PG 50

Navin Chandra Nigam, Software Development Consultant from Dell presents a white paperthat looks at the correlation between health information exchange (HIE) and meaningful use (MU), which will improve many aspects of care for patients, providers, vendors and other healthcare stakeholders

MARKET 11 KNOWLEDGE 32 STRATEGY 38 HOSPITAL INFRA 51 IN IMAGING 57 LIFE 70

OCTOBER 2013

Navin Chandra Nigam Software Development Consultant, Dell India

“Although many consumers access their banking information online daily, fewer than 10 per cent use the web to access their personal health information.”— National Survey, April 2010, California HealthCare Foundation In order to keep up with government-driven healthcare mandates, such as the Stimulus Bill and ICD-10, stakeholders are seeking innovative solutions and adopting new initiatives and technologies. Healthcare providers need to focus on quantifiable deliverables in order to benefit from mandate incentives and funding. If they don’t make efforts to meet the new guidelines, they run the risk of getting penalised for noncompliance. With this in mind, healthcare providers are taking all possible measures to deliver patient-centered care. www.expresshealthcare.in

Health information exchange (HIE) and meaningful use (MU) are two federal initiatives that can help deliver better healthcare. HIE connects doctors, nurses and other healthcare providers electronically, and MU provides context and defines the use of health technology to achieve mandate compliance. Establishing MU also determines federal incentive funding. This white paper discusses the correlation between HIE and MU and provides insight for using this correlation to improve healthcare delivery.

Data-driven healthcare The Health Information Technology for Economic and Clinical Health (HITECH) Act, embedded within the American Recovery and Reinvestment Act (ARRA), is encouraging healthcare providers to share clinical records with other providers, hospitals and clinics to achieve continuity of care. They can accomplish this by using HIE and obtaining certified electronic health records (EHR) — while avoiding financial penalties. With $36 billion in exclusive funding for the HITECH Act, providers will be able to

adopt the MU incentive program in a staged manner. This funding, which originated through the HITECH act in 2006, benefits healthcare providers who adopt certified EHR systems (or MU software). Incentive payments are being distributed from 2011 to 2016, causing providers to adopt EHR systems more quickly than they might usually adopt a new technology. A US Department of Health and Human Services (HHS) news release cites encouraging results for EHR adoption. It says that HHS has met and exceeded its goal for 50 per cent of eligible professionals by the end of April 2013, which was merely 17 per cent in 2008. Also, eligible hospitals EHR adoption jumped from 8 per cent to80 per cent in the same period. Another government budget report for FY 2014 cites that HHS has maintained its focus on adoption of healthcare IT and meaningful use of EHR. CMS and the Office of the National Coordinator for Health IT are working together to improve quality, reduce costs, decrease paperwork, and expand access to care through increased adoption EXPRESS HEALTHCARE

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TO CREATE A UNIQUE PATIENT EXPERIENCE, IT IS ESSENTIAL TO CAPTURE MEDICAL INFORMATION IN A STRUCTURED MANNER FOR UNIFORMITY AND VIRTUAL DATA CONNECTIVITY 42

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and meaningful use of EHRs. HHS aims to increase the number of eligible providers who receive an incentive payment from Medicare and Medicaid EHR Incentive Programs from 230,000 by the end of FY 2013 to 314,000 by the end of FY 2014. Front-end care providers, such as physicians and hospitals, face inevitable changes as they will need to alter their data capture process and assume additional mandatory reporting. Payers will benefit the most in the adoption of the MU program and implementation of HIE, because the cost of healthcare will decrease. The reduction in cost is due to hospitals and physicians opting to adopt guidelines-driven healthcare delivery and leave behind the older system of paper use in daily tasks. This will reduce medical and medicinal errors, making care more effective and accomplishing one of the goals targeted by ARRA. Product vendors will also find easier ways to cope with changes that are being suggested in stage 2 while reducing the cost of building new features in their products.

Patient-centric medical information A number of hospitals in the US still use manual processes for charting, administrating medication and scheduling staff and patients. This paper-based method can create interrupted continuity of information and give rise to confusion and/or incorrect data. These issues can result in low-quality care delivery, missing information, test duplication, wrong clinical decisions and could even put patients at risk. Studies indicate that medical errors cost anywhere

MEANINGFUL USE STAGES AND GOALS 2009

HITECH ● Policies

from $8,000 to $15,000 per bed for a mid-sized hospital. Electronic-based solutions and applications are proven to be substantially helpful in reducing cost of healthcare and improving care delivery. For example, a patient is travelling and in need of critical medical attention. Electronic medical information such as past medical history, family history, current medication and allergy information can be used to diagnose and potentially save this patient. Not only does the electronic availability of patient records bring down the cost of healthcare by avoiding duplication of records, it also saves time and, more importantly, helps make critical medical decisions supported by sound information and hands-on data.

Implications of meaningful use It is vital to capture clinical information in a structured and controlled manner during a patient encounter. This structured data provides a base for uniform vocabulary and semantic interoperability and retains consistency in operations. Strict adherence to clinical guidelines is needed www.expresshealthcare.in

2011

Stage1 ● Capture and share data ● Coded format and digitisation

2013

2015

Stage2 ● Clinical decision support ● Information exchange

for better overall healthcare delivery. Currently, there are vast disparities in data assimilation — from the point of initiation to processes and tools used to capture data. The MU software has allowed healthcare providers to collect data in a precise standard format at the time of a patient encounter, enabling better communication and accessibility in the greater healthcare community. The data collection procedure is changing workflow patterns, business operations, processes and diagnostics templates. At the application level, product vendors have initialised changes to put the end user at ease when adopting certified EMR software.

Improving patient communication One of the goals of health information exchange — and an important part of the meaningful use programme — is patient and family engagement. Standards for patient empowerment are consistent with national health priorities and allow patients to have the information they need in order to make informed choices about their healthcare. Disseminating patient information and making it

Stage3 ● Self-management ● Patient portal access ● Improving health outcome

available online for patients to view, download and transmit is one of the objectives of stage 1. This enables patients to access, review or follow up on their health data (or that of their relatives’) in a secure way. Real-time data is captured by certified EMR software and securely sent to the desired destination. When a patient is well informed and aware of steps taken for his/her betterment, they are provided with a sense of security and empowerment.

MU as stepping stone to attain HIE Healthcare communities come in various forms: large health systems, large and mid-sized hospitals and rural health systems. Fragmentation of health records, legacy systems and an aging population continue to contribute to inconsistent and uneven healthcare delivery across the world. With HIE, the healthcare community can resolve issues, even across borders. By focusing first on data, they are able to collect, clean, store securely, research, analyse and securely send vast amounts of data. The ultimate goal of ARRA, HITECH and the reform bill is to thread all of the data fragmented by manOCTOBER 2013

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Meaningful use

Meaningful requirements summarised

HIE roles & objectives

■ ■

Stage 1

Stage 2

Stage 3*

Electronic copy of health Information

Greater introperability

Increased use of patient health record portal

Discharge Instructions

Analysis of data for decision making

Connectivity between EHR and PHR portal

Structured and controlled data capture

Patient controlled data

Data transmission to primary referral centers or HIE’s

Discharge Instructions

Support transitions to unaffiliated providers

Data submission to public health agencies

Key clinical information exchange

Structured lab results

Self-management health tools and data upload

Testing data for exchange capability Reporting CQMs and PHI

■ ■

Secured exchange capability Data interoperability

■ ■

Patient -centric care HIE following patient information

*In preliminary suggestion stage

ual processing together. This is accomplished by filtering and connecting meaningful information from raw data to help reduce record duplication and medical and medicinal errors. MU is a concrete step towards this objective and the* staged manner in which it is being implemented gives sufficient time for the community to respond and adopt EMR applications, bring internal changes and implement the application. The diagram below represents the high-level strategy proposed by the Health Information Technology (HIT) Policy Committee, an official federal advisory committee to the Office of the National Coordinator (ONC) that makes reports in a content management system (CMS). This strategy is a systematic approach to develop the foundation of technology and processes in order to improve patient outcomes. The HIT Policy Committee has proposed the definition of meaningful use for 2011, 2013 and 2015.

HIE and MU: An intersection of health delivery and patient information To meet the objectives of HIE, healthcare providers will need to implement and use a certified EHR in order

A STRATEGIC APPROACH IS THE ANSWER TO BRINGING ALL THE FRAGMENTED DATA TOGETHER FOR BETTER ANALYSIS AND DECISION MAKING ACROSS HEALTHCARE OCTOBER 2013

to exchange patient information electronically with other healthcare organisations. At first glance it seems that HIE is not explicitly required in the various meaningful use stages. But several of the requirements — such as availability of electronic patient records or discharge information — need HIE as a facilitator. The HITECH Act also includes funding for states to create an HIE infrastructure that helps providers prepare for and meet meaningful use criteria. The final MU guidelines are expected to be written in a way that allows providers other means of meeting the definition of an established HIE. The meaningful use programme is unfolding slowly but consistently. Stage 1 has provided guidelines to capture data in a controlled way, while engaging providers to use certified EMRs. Requirements are heavily centered on health information gathering and clinical decision making. Stage 2 is more focused on requirements and information exchange, where an HIE model will be applied to some of the aspects. A safe and secure HIE will give access of stored data to end users and simultaneously allow patients and physicians to become more involved in health data dissemination, ensuring better communication.

Increasing role of HIE in MU fromstage 1 to stage 2 A major shift of focus occurs when going from stage 1 to stage 2. The requirements of stage 2 need increased interoperability to support the objectives of healthcare reforms. Shifting focus from single patient data collection (in stage 1) to the exchange of medical records within various care delivery organisations allows for www.expresshealthcare.in

faster and more accurate healthcare decision making and results in better quality outcomes. The robust solution to enable interoperability of HIE will give rise to faster accessibility of health data at the national and state level for research, population-based disease management and crisis control. This collection of data will benefit national and individual health greatly; it will also benefit the formulation of healthcare strategies and help monitor resources and infrastructure requirements.

HIE use in meaningful approach HIE is gaining importance in the meaningful use program. The requirements to meet MU span from testing HIE at stage 1 to connecting to at least three external primary care networks (or establishing bi-directional connection to at least one HIE) in stage 2. There are several requirements in stage 2 that support and encourage the use of HIE in data exchange. These include: Electronic prescribing: Eligible hospitals (EH) and eligible physicians (EP) place an electronic prescription order with a pharmacy within 10 miles of their hospital or clinic. Using HIE for electronic prescription transmission reduces medicinal errors and record duplication (such as when a paper-based prescription is lost or misplaced) and increases efficiency in terms of authorisation. Clinical summary of office visits: EPs needs to provide a clinical summary of records for each particular patient visit. While the rule allows for different options for disseminating information, HIE can be very effective here. The online transmission of clinical summaries is more effective than using a CD or USB drive,

which can be less secure and more expensive. Transmission of lab results: One of the most essential aspects of medical information is the secured exchange of lab results. The HIE needs to transmit structured lab results data from EHs to EPs and also facilitate the EH to transmit the data to other hospitals. This reduces the cost incurred when records are duplicated and helps establish online and timely availability of lab results at the point of care. Patient health information transmission: Patients are able to view online health records — from anywhere, at any time — to ensure they are up to date on their health status and aware of any necessary follow-up steps. The availability of complete longitudinal health records increases patient communication and empowers patients to make more informed health decisions. Communication through personal health records (PHRs) can also enhance geriatric and remote care, by avoiding unnecessary hospital visits. Medical reconciliation: Tracking medication and the reconciliation of prescribed medications helps reduce medical errors and drug allergies and incompatibilities. As one of the most important aspects of care delivery, medical reconciliation can be handled through the secure and interoperable exchange of medical data. The cost of medicine also decreases when medicinal history is accurately updated and recorded from visit to visit. Summary care record for each transition of care or referral: Patient records being able to transmit through an HIE to different providers and specialists improves clinical decisions overall. Sending a referral electronically from a primary EXPRESS HEALTHCARE

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HIE INVOLVEMENT IN MU STAGES Stage 3

Stage 1 and 2

Meaningful use

Quality

Privacy and security

● Data

testing and submission to public health agencies HIE for data transmission ● Care coordination processess

● Clear

● Active

● Patient communication ● Self-management tools ● Complete connectivity to

● Structured

clinical result data submission to external entities ● Patient involvement through PHR ● Connectivity with referral centres

● Increased

● Data

● Data submission to PHAs ● PHR use for data and error reporting ● Greater focus on patient education

● Data

● Secured

● Information exchange to healthcare ● Inclusion of encryption and security ● HIPAA security risk analysis

submission to external entities messaging to patients ● CDA and ‘The Direct Project’ defined and initiated ● Connectivity with referral centres

care physician to a hospital for a patient appointment or admission also speeds up the process. Medical imaging sharing: Not yet mandatory in the use of certified EHR technology, however, medical imaging sharing is a great opportunity for the betterment of healthcare delivery. Uploaded images with relevant information help care providers make timely decisions and can also reduce the cost of diagnosis duplication.

Rising role of HIE in Stage 3 Stage 3 of MU is expected to take effect in 2016 for select healthcare providers. On November 16, 2012, the ONC released a request for comment regarding stage 3 meaningful use measures, which represent the preliminary thinking of the HIT Policy Committee. The public is being asked to give their views on the readiness and feasibility of new objectives and measures in the following areas: meaningful use, quality and privacy and security. The comment period ends mid-January 2014,

SEAMLESS INTEROPERABILITY ACROSS THE REGION AMONG VARIOUS SYSTEMS AND HIEWILL HELP PROVIDERS AND PAYERS SHARE CLINICAL DATA IN A SAFE AND SECURE WAY AND REDUCE COST AND ERRORS 48

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following additional public meetings in 2013. The stage 3 MU requirements will create a mature and robust collaborative healthcare delivery model meeting objectives set at the initiation of healthcare reforms. At the broader level, preliminary stage 3 requirements fall under the continuation of requirements from the previous stages and those newly introduced in Stage 3. “While the committee appreciates and recognises today’s challenges in setting up data exchanges, it is the committee’s recommendation that stage 3 is the time to begin to transition from a setting-specific focus to a collaborative, patient- and family-centric approach,” stated a report from the HIT Policy Committee. HIE is expected to facilitate the connection of multiple care settings and accessibility of medical records. For example, in the absence of HIE, it is necessary to connect with 30 per cent of the primary referral network; and if HIE is available, a connection is mandatory as per stage 3 recommendations. While Stage 1 set the ground for EHR utilisation to capture data, Stage 2 initiates secure access to patients via PHR and other mediums. Stage 2 requires providers to transmit care summaries to referral centres and other EHR-technology-enabled care providers. It is also required to enable patients to view, download and update their historical and critical information by using web-based technology. By 2015 or 2016, the meaningful use standards are expected to include and address the following outcome objectives: ● Offer patient-specific educational resources online ● Allow all patients access www.expresshealthcare.in

focus on patient-centric data

HIE

focus CQMs

data upload to EHR

to their medical records — using PHR population in real time with data from EHR ● Enable the use of self-management tools to outpatients ● Make online web-based patient experience reporting and analysis available ● Offer ability to upload and incorporate patient-generated data (e.g., electronically collected patient survey data, biometric home monitoring data and patient suggestions of corrections to errors in the record) into EHRs and clinician workflow A more in-depth look at the stage 3 requirements shows a large focus on data connectivity, online medical information availability, clinical data accessibility to patients and transmission of clinical and public health information using different mediums. The requirements also show more and more involvement of patients via different channels such as self-management tools. Stage 2 and stage 3 have shown that the value of HIE is controlled, interoperable and structured data. Patient involvement is also an important criterion that calls for complete medical records data. HIE will remain an important path for every EHR technology adopter. The real aim of HIE is not only mobilising the data collected by using EHR technology but making health information more accessible in all steps of the medical process. An HIE does much more than just sharing data with providers using EHR technology. Health information exchange should: ● Create a health-informed community ● Increase patient communication with care providers and education

●

● ●

network

Ensure smooth transition of health data to other healthcare facilities without data loss Help create nationwide healthcare strategies Assist care providers in making better clinical decisions with clinical decision support (CDS) tools Analyse data for informed decisions and alerts Play a pivotal role in qualitative patient outcomes

Conclusion EHs, EPs and CAHs need to use patient-centric technology tools — beyond EHR technology — to realise the CMS- and ONC-driven objectives. It’s a daunting task to combine MU requirements with HIE objectives at the national, state and enterprise level, yet the initial efforts have yielded promising results. Establishing HIE will ensure better quality of care when patients need it the most. The need to begin preparing for better quality healthcare is clear.

References 1.http://www.hhs.gov/news/ press/2013pres/05/20130522a .html 2. http://www.hhs.gov/budget/fy2014/fy-2014-budget-inbrief.pdf 3. Reforming hospitals with IT investment Laflamme FM, Pietraszek WE, Rajadhyax NV.McKinsey Quarterly. 2010 Aug. 4. Garg, Amit, et al. Effects of computerised clinical decision support systems on practitioner performance and patient outcomes: a systematic review. The Journal of the American Medical Association. 2005 Mar 9; 293(10):1223-1238. 5. HIMSS Information Exchange 2009 6.http://www.healthit.gov/sit es/default/files/draft_stage3_ rfc_07_nov_12.pdf OCTOBER 2013

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‘Since BYOD is already in, I would like to see to that we do not block it but, with the Fortinet Solutions, are able to control it’ Manipal Hospitals recently deployed Fortinet’s security systems to help secure its network and enable application access over the Internet and through mobile devices. The solutions also help Manipal Hospitals meet compliance requirements for data security and access control. Nandkishor Dhomne, CIO, Manipal Health Enterprises explains to M Neelam Kachhap the rationale for using network security platform from Fortinet Help us understand the IT environment at Manipal Health Systems. (extent of data generated, no of doctors staff accessing Internet, number of specific information systems and software deployed etc.) At Manipal we have the following key applications: ● Hospital Information System (HIS) which covers all functions from patient registration, admission, billing, pharmacy, lab, nursing, OT, blood bank, radiology, dietary, etc. and automates the flow of information from one function to another seamlessly. ● Electronics Medical Record (EMR) ● Document Management System (DMS) which is used to digitise past patients records from Medical Records Division and link the same to HIS for a single window view without referring to the physical patient file (especially for OP patients). ● Back office systems for finance, HR and materials management The back office systems are integrated with HIS for automated data exchange like revenue posting, consumption posting etc. ● Picture Archiving and Communication System (PACS) & Radiology Information System (RIS) The PACS component is a computer system that interfaces with the medical imaging device (i.e., X-Ray, CT Scan, MRI, ultrasound, etc.) used to capture the image in a digital format. Once captured, the image is stored, manipulated and transmitted

INTERVIEW

over a computer network. ● SMS alerts – HIS is integrated for real time alerts like registration, billing, critical lab alerts etc. ● Email system and collaboration – This is used for day-to-day office communication. ● Information security framework to safeguard patient information and comply with NABH requirements related to information security and controls.

Tell us about bring-your-owndevice (BYOD) environment at Manipal Hospital and how it poses a challenge for network security? In the Indian healthcare industry, there is an increase in the number of professionals using mobile devices for work purposes, whether they are using tablets to look up patient records or access personal applications. For whatever purpose, BYOD has flourished in the industry and is a trend with promising growth. At Manipal Hospital we have estimated that over the next two years, we'll have around 200+ users on mobile devices, tablets and smart phones. This is the beginning of the BYOD wave in our organisation. Initially, we will allow doctors to access outpatient (OP) records so that they can prescribe and diagnosis using their mobile device. We are in the process of evaluating mobile applications that would meet our requirement. In the next phase of the our BYOD enablement, we will allow doctors to access inpatient (IP) records from their personal devices. This will

What are National Accreditation Board for Hospitals & Healthcare Providers (NABH) compliance requirements related to information security?

help doctors carry out basic tasks like ordering, vitals monitoring, viewing of the investigation reports etc. We have prepared a multipronged strategy to allow mobile devices under certain terms with stringent security policies. Initially, we will be allowing iOS and android devices, depending on the situation, we will open it up for other OS as well. Since BYOD is already in, I would like to see to that we do not block it but, with the Fortinet Solutions, are able to control it.

What security system was used before the new system was deployed and why was it changed? Before we deployed Fortinet’s solution, Manipal Hospital did not have a structured security framework protecting our enterprise network. The earlier solutions deployed were fragmented and not adequate in terms of technology to mitigate current threats. Manageability and round-the-clock support was another area of concern. We were not in a

200+ Over the next two years,we'll have around 200+ users on mobile devices, tablets and smart phones

OCTOBER 2013

position to provide reliable access to our applications over the Internet. Mobility and BYOD were new business trends which had to be enabled to provide better services to our patients. We also had to safeguard our patients' information and meet NABH compliance requirements, which was not possible with our old security solution.

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Chapter 10, ‘Information Management System (IMS)’ of 'Guide to NABH Standards for Hospitals', provides guidelines and procedures to meet the information needs of the care providers, management of the organisations as well as other agencies that require data and information from the organisation. There are seven sections under Chapter 10 which are related to Information Technology and they are: ● Policies and procedures exist to meet the information needs of the care providers, management of the organisation as well as other agencies that require data and information from the organisation (5 Clauses). ● The organisation has processes in place for effective management of data (5 Clauses). ● The organisation has a complete and accurate medical record for every patient (6 Clauses). ● The medical record reflects continuity of care (7 Clauses). ● Policies and procedures are in place for maintaining confidentiality, integrity and security of information (7 Clauses). ● Policies and procedures exist for retention time of records, data and information (4 clauses) ● The organisation regularly carries out review of medical records (7 Clauses). Section 4 exclusively deals with information security guidelines. At Manipal, we have taken care of all these clauses, including IT security in our IT strategy and roadmap. We have implemented a comprehensive IT security solution using the Fortinet platform at an enterprise level which covers all our unit hospitals and the corporate office at Bangalore. mneelam.kachhap@expressindia.com

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‘The need of the hour is telemedicine’ Emergency medical services in India needs immense improvement and remote access information devices is one way to make EMS efficient says, Shreeram Iyer, Chairman and Group CEO, Prisma Global, in an interaction with Raelene Kambli What is an ideal emergency medical unit? What is the need of the hour? An ideal emergency medical unit is one which can deliver the right medical treatment to the patient based on all his/her latest vital parameters. The need of the hour is telemedicine which entails both remote delivery of patients’ vital data and then corresponding treatment remotely wherever possible.

What are remote access information devices? What role does these devices play in enhancing emergency medical service? Remote access information devices enable real-time access to data across long distances. In the medical world this has become imperative as more and more diagnostic data indicate that timely administering of the correct treatment would have definitely resulted in exponentially better results.

When connected, it is a complete online real time solution, providing immediate triggers for the emergency response system.

Does this product have the capability to provide telemedicine services?

What is the required infrastructure for putting such a system in place?

It is being used in a couple of hospital chains in Germany as part of a complete telemedicine solution, especially for the elderly and the disabled.

Ideally, we would require the sensors to be bluetooth enabled (which if they follow the standard ISO protocols, they should be) and to have Wi-Fi access to the Internet (which again most hospitals and middle class families in metros have) and any Internet access for the medical representatives (which again 3G has enabled most mobile device users).

Tell us about your product Medibox or MDS3. What are its benefits? ●

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In how many hospitals or EMS groups have you installed your product? It is live in around seven hospital chains of Germany and Switzerland which have some of the highest standards for medicine.

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It allows to monitor vital health parameters whenever and wherever you want with online real time information. It allows storing, accessing and retrieving patient information in a simpler, faster and convenient way. Dependability and expertise of one

through bluetooth, W-LAN and USB

What is the turnaround time of a emergency response service using Medibox?

data to either the hospital management system or to the doctors’ handheld device directly or to the patients’ relatives with built in trigger mechanisms to alert the emergency services of the hospitals for ambulance etc.

How does this system work? Our MDS3 system has a small device called the Medibox which once synchronised with all the sensors measuring various vital parameters of a patient can transmit realtime online

INTERVIEW

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person factor is no more existing as the product is user friendly platform and designed to get the health status of the patient right on mobile and PC. Fully automated, multiple devices adaptability that offers new level of productivity, safety and quality. The device can be installed in hospitals, ambulances, corporate offices and at home too, as it consumes less energy, no heat emission and workable for 24x7 Mobile and PC’s can be connected

What is the approximate cost involved in setting up this system? One standalone device which will cater to 10 sensory devices simultaneously, could be connected to multiple end user clinical systems. Based on these parameters it could cost in the range of Rs 200,000 to Rs 350,000 per device. raelene.kambli@expressindia.com

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

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Express Healthcare’s prime audience is senior management and professionals in the hospital industry. Editorial material addressing this audience would be given preference. The articles should cover technology and policy trends and business related discussions. Articles by columnists should talk about concepts or trends without being too company or product specific. Article length for regular columns: Between 1300 - 1500 words. These should be accompanied by diagrams, illustrations, tables and photographs, wherever relevant. We welcome information on new products and services introduced by your organisation for our Products sections. Related photographs and brochures must accompany the information. Besides the regular columns, each issue will have a special focus on a specific topic of relevance to the Indian market. You may write to the Editor for more details of the schedule. In e-mail communications, avoid large document attachments (above 1MB) as far as possible. Articles may be edited for brevity, style, relevance.

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Do specify name, designation, company name, department and e-mail address for feedback, in the article. We encourage authors to send a short profile of professional achievements and a recent photograph, preferably in colour, high resolution with a good contrast.

Email your contribution to: viveka.r@expressindia.com Editor, Express Healthcare

OCTOBER 2013

W H AT â&#x20AC;&#x2122; S INSIDE

Ask a question PG 56

HOSPITAL INFRA Access automation solutions for healthcare sector Cristina GarcĂa Franco, Marketing Manager, Manusa Automatic Doors talks about why it is important to have automated accesses not only in the main entrances, but also at every point of the healthcare building

Hospitals are the kind of buildings in which movement should be more fluent: both healthcare staff and patients should be able to move around without any type of hindrance. In emergency situations, the first ones are normally carrying bulky instruments, stretchers or wheelchairs. The second ones, as well as their visitors, should not encounter barriers of any kind either, especially if they are elderly or with limited mobility. This is the reason why it is extremely important to have automated accesses, not only in the main entrances, but also in every point of the healthcare building where a door is needed. The accesses need to be designed to facilitate mobility, and be able to fulfil the required functions. Each area of a hospital has specific access require-

ments. It is necessary to choose the most suitable option in each case: main, secondary and emergency entrances, doors situated on evacuation routes, doors for partitioning and doors for operating theatres, observation rooms and X-ray rooms. All of them have to ensure an efficient and sustainable healthcare environment in which different areas are separated but have no obstacles between them.

Doors for main, secondary and emergency entrances

Main entrances, secondary entrances and emergency entrances should enable heavy pedestrian traffic and be quick and safe. The most suitable types of doors for such access points are heavy traffic automatic revolving doors and sliding doors. Large diameter revolving doors allow heavier pedestrian traffic and are also ideal for maintaining air conditioning inside the building. They also enable the creation of refined and elegant entrance zones, and since they are available in a range of differ-

ent designs and finishes, they are compatible with any architectural environment. As regards sliding doors, there are dozens of options and combinations available that make it possible to adapt them to any requirement. Bi-parting sliding doors, single sliding doors, or telescopic sliding doors with central or side opening to maximise the opening area can be combined to create airlocks to preserve the climate inside the facility. Sliding doors are recommended at public entrances and exits where there is heavier pedestrian traffic or where the safety of the users is linked to the fluidity of the traffic movement, which is why they are recommended at hospital entrances. A hospital should always be open and always available. Therefore, it needs access points with proven reliability and, above all, that require little maintenance. An automatic door operator with three-phase AC motors and no reduction gear unit or brushes minimises the need for maintenance. Furthermore, the possibility of independent adjustment of force and speed of the doors helps to balance the need for the maximisation of the opening speed to facilitate access and

Main entrance - Automatic revolving door

MARKET 11 BEST OF EAST 35 STRATEGY 38 INIMAGING 57 LIFE 70 Main entrance- Two bi-parting sliding doors OCTOBER 2013

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Emergency entrance - Bi-parting sliding door EXPRESS HEALTHCARE

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Evacuation routes during panic break-out

the safety of users.

Doors situated on evacuation routes

Swing door sealing (open-closed)

Sliding door sealing (open-closed)

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Doors situated on evacuation routes must have by law an alternative system to facilitate their opening in the event of an emergency. The most suitable automatic doors in this case is one with integrated panic break-out mechanism, as it combines the function of a sliding door with the option to fold back the leaves on the sides of the door, maximising the transit area. On the other hand, this type of door can also be installed anywhere that, given its characteristics, might require a larger transit area than usual, such as high transit corridors or where very large equipment has to pass. A door with panic breakout system works in the normal way in everyday situations (sliding and automatic). In the event of evacuation or emergency, the leaves can be folded back simply by pushing them out to lie flat against the sides, to allow a wide evacuation transit area and the orderly and safe exit of users. Automatic doors with panic break-out mechanisms with framed or transparent leaves can be installed. Leaves that are fully framed around the entire perimeter are extremely strong and long-lasting, which makes them suitable for high transit areas or in areas where they are more likely to receive impacts given the type of users that go through the door (patients on stretchers, wheelchairs, bulky equipment). As for the transparent leaves option, these leaves offer the safety of the panic break-out mechanism without having to renounce the aesthetics provided by the transparency of the glass without vertical profiles.

Partitioning - single sliding door

Partitioning doors Automatic doors can also be used to sectorise spaces. When the automatic door's only function is to separate areas, there is a wide range of possibilities that can be adapted according to the needs: bi-parting sliding doors, single sliding or telescopic doors for the maximisation of the opening area. Moreover, there are specific building interior automatic doors to minimise the impact of the operator in the environment, as they are based in an automatic guide with an extremely compact design. These automatic doors can also include access control accessories to restrict access to certain areas. Partition may also occasionally be required, for example, to demarcate areas with the highest risk of fire and to prevent fire from spreading outside them. Such is the case in warehouses, car parks or in areas that, due to their function, require special protection against fire, such as new-born baby areas. In these cases, the installation of automatic doors with integrity and insulation fire wall properties, made entirely of glass and aluminium, minimises the impact of the door on the environment without renouncing safety, and combines an automatic door and a fire door in a single building element.

Doors for operating theatres, observation rooms and X-ray rooms Operating theatres, observation rooms and surgical Xray rooms are rooms where the number of particles in the www.expresshealthcare.in

Evacuation routes during panic break-out air, pressure, temperature and moisture are monitored to check the correct degree of cleanliness. It is important that this differential in the characteristics of the environment of a clean room is constantly maintained to enable the room to fulfil its function. The hermetic door that seals the gap should therefore fulfil a series of requirements in order to ensure it can accomplish the functions required of it: ● Contribute to keeping the room free of external contamination or prevent contamination from leaving the room ● Seal the entrance gap to maintain the pressure differential ● Optimise the use of treated air inside the area ● Reduce the operating costs of the clean area In order to guarantee that these functions are fulfilled, every detail of the construction of hermetic doors needs to be painstakingly controlled. In the case of hermet-

ic swing doors, it is important for the leaf to be sealed on the side and top part to guarantee a hermetic seal. Furthermore, a wind stopper that slides against the floor when the door is closed will ensure the perfect sealing at the bottom. As regards sliding hermetic doors, the leaf descends 15 mm towards the floor and moves 10 mm towards the frame to hermetically seal the perimeter of the opening, to guarantee hermetic sealing. A block frame also ensures a perfect fit with the leaf and guarantees hermetic sealing on any type of wall, allowing the opening to be clad with the same finish as the leaf itself. In addition to guaranteeing hermetic sealing, hermetic doors should also enhance functional, hygienic and aesthetic properties, which are all important in the development of health projects. The hermetic operator that Manusa doors are equipped with, provides OCTOBER 2013

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Sliding hermetic stainless steel

Partitioning fire-resistant door

Lead isolation OCTOBER 2013

Sliding hermetic HPL

excellent kinematic performance, equipping the door with unbeatable functions. Special leaf carriages for the hermetic door and the special double drop guide ensures smooth and bump-free sliding movement of the leaf. This feature enables easy manual opening of the leaves in the event of a power failure, without the need for incorporating door release handles on leaves (not very aesthetic and difficult to use). A nice looking and very functional door handle is enough to slide the leaves gently. The use of fine materials in the manufacture of automatic hermetic doors, such as stainless steel or high pressure laminate, which are both easy to clean, help to guarantee hygiene. The finishes on the door itself, with smooth or recessed surfaces, should also minimise dust and dirt accumulations at joints, a very important aspect for keeping clean environments. Aesthetically speaking, it is important for the hermetic doors to be integrated within the hospital project, whether

Swing hermetic HPL

Glazed automatic hermetic door

Lead-lined hermetic automatic door

Partitioning door

the hospital is a newly built facility or one which is already in use, all of which is possible thanks to the many different finishes and combinations available. On the other hand, the design of the door itself (recessed vision panels, door handles) can also offer a different style. In addition, the option to install a perimeter frame made of the same finish as the leaf to make the assembly both more attractive and more hermetic, provides a solid, smooth finish, guaranteeing a perfect overlap with the moving leaf. For other areas with special functions, such as observation rooms or intensive care units for example, full glass hermetic doors can be installed, offering great visibility of the inside of the spaces at the same time as hermetically insulating them. They are 100 per cent hermetic doors that maintain the required pressure, temperature and moisture despite their transparency. Furthermore, for situations in which privacy is occasionally required inside the room, the installation of electro

polarised glass that changes from transparent to opaque in a few seconds, offers the option to transform the door into a conventional hermetic door. Lead-lined automatic doors for X-Ray rooms can also be installed, guaranteeing the perfect insulation of these spaces thanks to their lead lining on both the leaf and the vision panel. These doors can be hermetic or not, depending on the space they demarcate, swing or sliding, with the same insulating attributes as hermetic doors without lead (approximation to frame in sliding doors, wind stopper in swing doors, etc.). The hermetic doors are also complemented with specific accessories, such as elbow push buttons to make it easier to open them when people's hands are busy or touchless switches that also allow opening the door without contact, preventing the contamination of already sterilised gloves.

controlled from a central control point with specialised management software, for e.g. Manulink from Manusa. Manulink software allows remote selection of automatic access opening modes (open, closed, reduced opening) and programming for areas with restricted access hours, an extremely useful function in hospital buildings. On the other hand, any type of incident that affects an automatic door can also be remotely detected immediately and integrated with other centralised management systems in the hospital. Manusa offers a complete solution in hospital doors for both specific applications that require hermetic sealing with its wide range of sliding, hermetic, swing, full glass doors for observation wards or lead-lined doors for X-ray rooms, and for applications for automatic entrance doors, corridors, specific areas, etc. All products are available in a wide range of finishes adapted to the specific needs of each hospital project, and with a wide range of accessories to equip the door with practically unlimited.

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Centralised access control system All the hospitalsâ&#x20AC;&#x2122; automatic access points can be

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PHOTO FEATURE

A ruby in the crown of Indian healthcare Ruby Hall Clinic at Wanowrie, the new entrant in the space of boutique hospitals, offers top class facilities in terms of infrastructure, technology and medical expertise

uby Hall Clinic, renowned healthcare player has recently set up a new facility at Wanowrie, Pune. The new facility is a boutique hospital that aims to serve the crème de la crème of the society and to handle the huge influx of medical tourists coming into the country.

❚ A soothing ambiance is created with green and eco-friendly materials

real-time access to patient results, radiology imaging systems that provide transcribed reports, monitoring in all patient rooms, easy registration, digital surveillance etc. The facility has been designed to offer five-star services to its patients with its private rooms, deluxe suites and global cuisine.

Comfort with care Built with the motto of providing 'care with comfort', the new 120-bedded hospital boasts of several state-of-the-art facilities like modular operation theatres, chemotherapy day care unit, surgical day care suite, dialysis lounge, endoscopy suite, cathlab and radial lounge, sports medicine, physiotherapy and rehabilitation unit etc.

Technology at its best The USP of the hospital is that it offers the latest and best in terms of medical technology with fully digital systems of electronic medical records,

Going green Though the hospital provides the best that technology has to offer it has been built as an environment-friendly hospital which includes several green endeavours. The use of green material is maximised and the ambiance created is soothing and comfortable to hasten the healing process. Few glimpses of the new boutique hospital that aims to offer comprehensive specialty care, leading edge diagnostics, surgical and rehabilitation services to its patients.

❚ Patients are offered ‘care with comfort’ with its private rooms and suites

❚ An impressive front

❚ Drawing room of the Deluxe suite at Ruby Hall Clinic, Wanowarie

❚ Convenient and comfortable waiting area for patients and family

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❚ New boutique hospital’s reception and lobby offers a warm welcome www.expresshealthcare.in

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❚ Integrated systems make the hospital’s operations more efficient and time-saving

❚ Dialysis lounges ensure that the patients get treated with utmost comfort

❚ Comfortable and Wi-Fied waiting areas ensure comfort to not only patients but their family members as well

❚ 24x7 pharmacy for patients’ medical needs

❚ Cafetaria provides healthy & tasty food for hospital’s patients and families

❚ Gym & physiotherapy unit to hasten patients’ recovery

❚ Latest equipment, technology and medical expertise ensure world class treatment to patients coming from across the globe OCTOBER 2013

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We are a group of doctors planning a 80-bedded multispeciality hospital, and wanted to know the Q requirement of structural elements in safe (hazard

Are the space allocated for triage and casualty one and the same, or is a separate triage area required to Q segregate patients according to their criticality?

preventive) building for a radiology department.

Dr Pawar, Administrator, Raipur

Dr Dhananjay, Jodhpur

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

For a radiology department, design should be as per the radiation safety norms and approval of BARC. Structural elements’ requirements include: ● Flooring should be non-conductive ● Equipment size room for X-ray: 5 sq m x 4 sq m, CT scan -110 to 120 sq m, mammography : 15-20 sq m, nuclear image -110-120 sq m approximately ● Thickness of wall: 2 mm lead thickness ● Window: Two metres above the ground and 1.5 metres above the floor inside, the partition between X ray room and control panel room should be of see through lead glass of at least 2 mm thickness ● Positioning of equipment: thickness of the wall between X ray and dark room should be at least 10 cm of brick/concrete ● Door should be radiation proof ● Beam should not be pointed towards entry door

Express Healthcare's interactive FAQ section titled – ‘Ask A Question’ addresses reader queries related to hospital planning and management. Industry expert Tarun Katiyar, Principal Consultant, Hospaccx India Systems, through his sound knowledge and experience, shares his insights and provide practical solutions to questions directed by Express Healthcare readers

What is the approximate hospital? Q 30-bedded AApproximately 18,000 sq ft

Triage is a part of emergency department/casualty and its need in casualty is very important. It differentiates the A criticality of patients which help doctors and medical professionals to prioritise the patients’ and their need. Space allocations for the triage area is very important when number of cases need to be handled at the same time. (like bomb threat, earthquake, fire, major accident etc.) While designing the interiors of a dialysis room, are any particular shade restrictions in its colouring? Q there Jessy Q, Administrator, Bangalore

Try to avoid yellow coloured interiors or yellow light in a dialysis room as it may make the skin appear yellow and A jaundiced to the patients, which in turn might aggravate their stress and worry, hence it is not advisable. Opting for lighter shades that will maintain the perception of light and make the room space look larger is actually preferable.

area required for a Dr Kunal, Gujarat

What area per sq ft is required for a nurse room or rest room in hospitals? Q staff Dr Jayant, Amravati

What kind of engineering support is required for mortuary designing?

It varies depending on the staff capacity but still you can approximately 400 sq ft. Aconsider

Dr Shankar, Hyderabad

AThere should be adequate lighting (1500-2000 lux at The following support is needed:

●

mortuary table) ● 200-300 lux in the body storage/autopsy room ● Ventilation/exhaust system ● To get uninterrupted continuous power supply, alternate sources should be available ● AC chambers (3 sq m/body ) ● Railing for sliding the trolleys in and out ● Humidity control and temp control (3.5 to 6.5 degree) with separate thermostat for every chamber - cold chambers as well as decomposed chambers ● Body storage room with refrigerated chambers, janitor closets, trolley bay, religion rise room, autopsy room, viewing room, change room, shower room and sluice room I am working with a multispecialty hospital, looking for proper space differentiation for the biomedical Q waste department at present we have a BMW department but we would like to know the proper differentiation

To build a medical college, what are the basic requirements of accommodation in the medical college Q and its associated teaching hospitals? Dr Sane, Latur, Maharashtra

In a medical college few basic requirements include: Campus, administrative block, college council, central A library, lecture theatre, auditorium and examination hall, central photographic section, central workshop, animal house, central incineration plant, gas plant, statistical unit, medical educational unit, research work, intercom network, playground and gymnasium, electricity, sanitation and water supply, laboratories, central research laboratory, training teachers in medical education unit, reception, enquiry office, store rooms, MRD linen room, committee room, registration department, statistical department, clinical departments in hospitals OPD and IPD, central sterilisation services, laundry services, central hospital pharmacy, central kitchen, central casualty, biomedical waste management department, staff quarters, hostels for students etc. If we are to start a low cost healthcare facility in any rural part of India, what considerations should Q one look into?

Kamal, Administrator, Pune

Usually it’s differentiated into four major parts: A Onsite waste storage

● ● The effluent treatment ● Space for hydroclave/autoclave/incinerator/deep

burial also

called as a final disposal for outsourced ● Transportation of waste

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Dr Prathap, Jabalpur

While looking at setting up a healthcare facility for rural India, first and foremost do a background check on their lifestyle and culture. Then, ensure what kind of facility you want to set up, and do a feasibility study on how the facility will serve that area of population. Then secondly look into your monetary requirements, and plan how you will raise the required amount. And finally, project a futuristic operation model on how financially sustainable and beneficial this will project be, both for you, and the people you will be rendering your service to. OCTOBER 2013

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A C O M P E N D I U M O N T H E L AT E S T I N R A D I O L O G Y

Dr VRK Rao: A true pioneer PG 61

MARKET 11 BEST OF EAST 35 STRATEGY 38 IT@HEALTHCARE 41 IN IMAGING 57 LIFE 70 OCTOBER 2013

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M Magnetic resonance imaging (MRI) is one of the most significant medical inventions. It is a non-invasive technique used to produce high-quality images of the human body’s interior using a magnetic field and radio waves. It has brought about an unparalleled revolution in medical imaging. With the ability to provide superb soft tissue contrast; it is the imaging tool of the future. "MRI today is an integral part of medical imaging in arriving at a diagnosis as well as in providing a roadmap to the operating surgeons," says Dr Chandrasekhar, Senior Radiologist & COO; Yashoda Hospitals; Secunderabad; Hyderabad. "Its role is of paramount importance, especially in neuro-imaging where it has revolutionised the management of stroke, brain tumours and spine pathologies," he adds.

The idea that worked When Dr Raymond Damadian, an American physician and scientist, constructed a superconducting magnet trying to produce a machine that could non-invasively scan the body, he had no idea how this would would evolve in future and become the most advanced diagnostic tool ever. Very simply put, MRI measures the changes in radiofrequency signal of protons in our body when subjected to changing magnetic field. The main component of our body is water which is made up of hydrogen and oxygen. It is the presence of the hydrogen that allows MRI to record the movement to its subatomic particle in a given magnetic field. Understandably then, the basic hardware components of all MRI systems are the magnet, producing a stable and very intense magnetic

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DR CHANDRASEKHAR field. Then there are the gradient coils, creating a variable field; and radio frequency (RF) coils which are used to transmit energy and encode spatial positioning as well as a computer to controls the MRI scanning operation and process the information. There is a patient table, coolers to cool the superconducting coils and heat exchangers that complete the MRI set-up.

More energy more cost Now, to make magnets work we need energy in the form of electricity. Because the quality of the images generated by a MRI is directly related to the strength of the magnetic field aligning the spins of the atom nuclei and the power of the gradient as well as RF amplifiers they are constantly being researched to get clearer pictures. But these efforts have also led to MRIs which require increasing power supply. “Higher the magnetic field strength, the better is the image quality in terms of contrast and resolution. This helps doctors diagnose the smallest of tumours,” explains KN UmeshKumar, Business Head – MRI, Healthcare Sector – Siemens. “Systems with high field strengths of 3 Tesla, which are often used in clinical routine by now, require high power RF amplifies and more receiving channels and hence higher energy usage,” he informs. In addition, there are other components of the MRI equipment which add to the energy burden. The components that consume maximum energy are gradient amplifier (RF sender, RF receiver and water heat exchanger), magnet (including cryo-cooling), computation and patient table. "The major power consuming units in an MRI are a cryo-cooler – Maintaining 260oC temperature within so that magnet remains superconducting and RF transmitters – Different MRI sequences require varying RF pulse parameters for high-resolution scanning,” explains Raveendran Gandhi, Senior Director, Radiology, Philips India. “To attain thinner slice thickness with larger coverage and faster scanning high performing gradients are needed, higher the gradient performance more will be power consumption," he further adds. www.expresshealthcare.in

DR MONA BHATIA

Senior Radiologist & COO; Yashoda Hospitals

HOD, Department of Radiodiagnosis and Imaging, FEHI

Energy efficient green MRI must reduce power consumption by at least 25 to 30 per cent while not compromising on the image quality, efficiency, speed of performance etc

Low power consumption, compact chiller without effecting image quality, zero helium boil off, compact MRI with smaller footprints are expected from next generation MRIs

Thus more powerful magnetic fields and amplifiers help to obtain images with less noise and higher resolutions. Therefore, an increase in the energy usage is expected. However, more energy use increases the total cost of ownership. Talking about the power consumed by a MRI, Dr Chandrasekhar says, "It is approximately 20,000 22,000 units per month including the A/C and UPS power consumption.” He says that the cost of ownership of MRI today is around Rs 1.5 - 2 lakhs a month. Concurring Dr Mona Bhatia, HOD, Department of Radiodiagnosis and Imaging, Fortis Escorts Heart Institute. Delhi says, “The cost of ownership could be estimated at approximately Rs 1-1.5 lakhs per month however values would vary depending on the equipment purchased.” In reality, the doctors in India face the double burden of the cost of the MRI as well as the cost of ownership. Both of which are high.

Karthik Kuppusamy, Director, MRI; India and South Asia, GE Healthcare. These numbers are not very impressive and undeniably one of the reasons for this is the high cost of the machine. "The cost of a 1.5 Tesla MRI equipment in India can range from Rs 2 crores for a refurbished machine to up to Rs 6 crores for a new one, depending on the features," informs Dr Chandrasekhar. While Dr Bhatia says, "The cost of new latest state of art MRI machines vary from approximately Rs 3.5 crores (1.5 Tesla) to Rs 12 crores (high end 3 Tesla machines)." Yet, we cannot think of radiology and imaging without MRI. It is the best way to examine the human body invitro. "The high expense of MRI is offset by its tremendous advantage in image analysis on account of its high contrast resolution enabling differentiation of tissues and their characteristics. This makes MRI the preferred modality for the assessment of brain, spine, abdominal and pelvic organs, breast, and musculoskeletal involvements," Dr Bhatia explains. "In fact, its recent ability to image the heart with high temporal and spatial resolution, besides characterisation of the myocardium, are fast making MRI the modality of choice in multiple cardiovascular disorders," she adds. "The non ionising properties of MRI make it the preferred and safer modality to

Expensive but necessary There are about 14001500 MRI scanners in India today; and the numbers continue to grow. Although MRI is a highly sought diagnostic tool it is not available freely. “In the US there are approximately 25 MRIs per million people, in Japan there are approximately more than 40 MRIs per million people. While in India we have approximately one MRI per million people,” reveals Dr

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power consumption,” says Dr Kuppusamy. “By incorporating innovative overnight ‘sleep mode’, efficient gradient and electronics design, as well as exceptional cooling technology, our team reduced the system’s energy consumption during both operating and non-operating hours,” he explains.

combination with smarter RF designs,” he says. Optimistic about its effort to increase energy efficiency UmeshKumar says, “At Siemens, our clear focus is to increase energy efficiency. There is scope for further improvement in areas where new sequence techniques will use less RF power and less time without any compromise on image quality.” “Our engineering teams have identified several opportunities to reduce

Innovations to reduce power consumption Manufacturers have taken numerous steps to make their

Areas of improvement It is clear that in future we will get MRIs that produce sharper images which also means that the energy consumption would increase. But the good news is that manufacturers are working on finding means to reduce energy consumption in MRIs. A report published in 2012, by Self-regulatory Initiative of COCIR, European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry stated that there is a direct relationship between the number of patients that can be examined by an MRI and the energy consumption. MRIs with higher patient per day ratio use more energy. As the patient per day ratio can be considered as the ‘productivity’ of the equipment, it seems appropriate to refer the energy consumed (per day) to the number of patient (per day): kWh/patient. Thus in principle, to reduce the energy consumption per patient (kWh/p), there is the option to reduce the time per examination which increases the number of examined patients per day. The report stated that this is not a linear calculation, e.g. in the sense of higher performance level leads to shorter investigation cycles. This reduction could be achieved only by changing the defined sequences with new ones that could produce the same images in shorter time. “Statistically, a typical MRI is ‘scanning’ and ‘becoming ready-to-scan’ for 15 per cent of the time (% hours/year) each while for another 70 per cent of the time (night) it is at standby,” informs Gandhi. “There is big scope to segregate these modes and smartly save more power while MRI is not really scanning. Moreover, when MRI is scanning, power consumption can be minimised with optimised gradient performance in OCTOBER 2013

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I|N|I|M|A|G|I|N|G products more energy efficient. “Innovation is the key,” says Dr Kuppusamy. “Our new MRI product is engineered to use ecomagination-certified technologies like efficient gradients, water-cooling, super capacitors and a power distribution unit, reducing power consumption by 50 per cent as compared to similar premium 1.5T competitor MRI systems. With all of these ecomagination features, these systems are intended to lower the total cost of ownership while still delivering excellent clinical performance. Other premium 1.5T systems require UPS ratings of 100-140KVA while MR360 Advance uses only 60KVA UPS,” he explains. “Advanced applications like propeller 3.0 which helps in motion correction while neuro, body & musculoskeletal imaging will help to reduce rescans. It reduces effects of patient voluntary and physiologic motion and thus reduces artefacts and rescans.” he adds. Informing about Siemens’ innovations in energy efficiency Umesh Kumar says, “All heat-dissipating components [of MRI] are water cooled, thus reducing the load on the air conditioning system, which helps in energy saving.” Adding further he says, “Power saving mode is available when no patients are being scanned to reduce energy consumption to a minimum while computers are kept running for doctors to review images or do post

THE PROCESS OF INNOVATIONS CONTINUES. JUST AS WE WAIT FOR THE ULTIMATE MRI WHICH WILL PROVIDE IMAGES WITH ZERO NOISE SO DO WE EXPECT THAT NEXT GENERATION MRIS WILL BE MORE ENERGY EFFICIENT. 60

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processing and stability of the system is maintained for next examination. VFD technology is used for all motors/compressors/chiller used in MRI systems, which helps to reduce energy consumption.” Philips Healthcare is not behind. They have implemented PowerSave, smart power management in MRIs that only consumes energy when really needed. “PowerSave is built around two design principles: lowering the level of energy consumption when the system is not used and lowering the level of energy consumption in between scans. Our solidstate gradient amplifier design uses energy only when the system is scanning thereby lowering energy consumption in between the scans. This feature results in up to 50 per cent reduction in energy bills,” explains Gandhi. “Philips has designed the MRI magnets with the shortest tunnel length that helps in managing RF irradiation by reducing unnecessary RF deposition on patient. Moreover, introduction of multi-transmit technology helped to a great extent in optimising performance of RF transmitters in 3T systems. Furthermore, by designing unique fully digital broadband MR technology or dStream technology in our Ingenia platform we have reduced scan time significantly which results in proportional decrease in energy consumption,” he says. “Our MRI systems have one of the industry’s best FoV and field homogeneity that enables our customers to complete their scanning with less number of stations. In addition to this, the best homogeneity of field ensures that the number of repeat scans are minimised. Both of these enable our customers to complete their scans with the industry’s highest SENSE acceleration factor,” Gandhi further adds.

Current market There are a number of products available in the Indian market that are energy efficient. “Energy efficient MRIs or green MRIs have been recently launched in the market,” informs Dr Chandrasekhar. “Yes, Power Save option using Zero Helium boil off and low power consumption when system not in use are available,” adds Dr Bhatia. On the manufacturers front in 2008, GE’s Signa www.expresshealthcare.in

RAVEENDRAN GANDHI

KN UMESH KUMAR

Senior Director- Radiology, Philips India

Business Head – MRI Healthcare Sector Siemens

We expect to bring cutting edge technologies that will bring down scan times thereby bringing down the scanning mode time of the MRI

We will continue to work particularly on three fields to increase energy efficiency; easy siting, higher performance and lower energy usage in non-productive modes

HDe, 1.5 Tesla MRI received the first ‘ecomagination’ status for a healthcare imaging system. By employing efficient gradient and electronics design as well as innovative water cooling technology, the Signa HDe became the most energy efficient 1.5T MRI system. GE continued its pursuit and brought out more energy efficient 1.5T MRI systems in the form of Brivo MR 355, MR 360 and Optima MR 360 Advance. “Siemens provides a simple active cooling system (needs regular water supply) e.g. in the 1.5 Tesla MAGNETOM ESSENZA which requires very low power and eco-friendly chiller (imported) along with the 3 Tesla MAGNETOM Spectra. Hence, despite MAGNETOM Spectra being a 3T, it requires 100 KVA only, which is the same as 1.5T requirement,” informs UmeshKumar. Talking about Phillips Healthcare's products Gandhi says, “Principles of power management are not new to Philips MRI. All Philips systems (Iegenia and Achieva series) comply to the green product requirements for sustainability improvement, which are audited by KPMG.”

least 25 to 30 per cent and occupy lesser space while not compromising on the image quality, efficiency, speed of performance and the equipment's longevity,” wishes Dr Chandrasekhar. While Dr Bhatia expects, “Low power consumption, compact chiller without effecting image quality, zero helium boil off, compact MRI, and less electronics with smaller footprints,” from the next generation MRIs. “We will continue to work particularly on three fields to increase energy efficiency; easy siting, higher performance of the systems and lower energy usage in non-productive modes,” says Umesh Kumar. “We expect to bring cutting edge technologies that will bring down scan times thereby bringing down the scanning mode time of the MRI. In addition, through our strong R&D teams and collaboration with leading researchers across the globe we expect to take the combination of our RF-Smart technology and gradient to the next level. Lastly, we see our systems becoming increasingly cryo-efficient,” informs Gandhi. MRI systems are complex. The future will see much improvement in the modes and functions of the system providing better diagnostic ability to doctors. It is evident that energy efficiency figures prominently in all manufacturers’ wish list. Let's hope we get greener MRIs in the future.

Lying in wait The process of innovations continues. Just as we wait for the ultimate MRI which will provide images with zero noise so do we expect that next generation MRIs will be more energy efficient. “An energy efficient green MRI must reduce the power consumption by at

mneelam.kachhap@expressindia.com OCTOBER 2013

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SPOTLIGHT

Dr VRK Rao: A true pioneer Dr VRK Rao has been instrumental in furthering interventional neuroradiology through his expertise and research. M Neelam Kachhap, traces his life’s journey and his commendable career that has been an inspiration to many

e earned a national reputation for his devotion to interventional neuroradiology, investing in research and education while teaching at one of the most prestigious medical institutions in India, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram. Renowned radiologist, Dr Vedula Rajani Kanth Rao (VRK Rao) has been at the forefront of important interventional neuroradiology-related developments in India. Famous for his contribution to the birth and growth of interventional radiology at SCTIMST, he is also known for developing biomaterials for therapeutic endovascular neurointervention.

Distinctive work Throughout his career Dr VRK Rao's work has been primarily focussed on vascular imaging and interventional radiology. “When I began my career in radiology, indeed there was no specially identified field of interventional neuroradiology. Though some anecdotal procedures were performed by neurosurgeons without image guidance, there was no identity to this discipline in those days, the early 80s,” he says. Much of his research focused on biomaterials for therapeutic endovascular neurointervention. Also, an astute diagnostic radiologist, his observations and publications OCTOBER 2013

on Syringohydromyelia and congenital atlanto-axial dislocation are based on personal experience in investigating these patients over more than a decade. His original observations on the integrity of the acrylic monomers used for embolotherapy received wide attention. SCTIMST at Thiruvananthapuram is well recognised as a premier referwww.expresshealthcare.in

ral centre for interventional neuro and vascular radiology. It is here that Dr Rao collaborated with the scientists and engineers to synthesise monomers and particulate materials necessary for therapeutic embolisation. Using home-grown Indian technology he demonstrated the therapeutic usefulness of stainless steel spring coils for intravascular use. This was

done at minimal cost, for bringing down the total cost of treatment for the patients as imported implants were prohibitively expensive. "For the first time to my knowledge, our Department of Radiology was given the patient admission rights with provision of two beds in the neurological wards for patients undergoing neurointervention,” Dr Rao rememEXPRESS HEALTHCARE

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bers. “This was a basic requirement and the beginning of an identity to the new discipline, for which I deeply acknowledge the support from the Head of the Institution, and also for procuring the expensive hardware, while subsidising treatment costs to the patients,” he adds. Dr Rao established the treatment modality for embolisation of brain and spinal vascular lesions which was not available readily in India. He, along with his colleagues, standardised and perfected the detachable balloon techniques for treatment of carotid-cavernous fistulae and many unusual vascular lesions in other parts of the body, peripheral vascular angioplasty etc., He simultaneously designed studies of vascular stents in animals and long-term patency. "The journey was not smooth however," Dr Rao says. "The materials were under continuous development. My junior colleagues were always a great support to me," he recollects. "I remember the late evenings we used to work in the department assembling the catheter systems for the next day’s procedure," he adds. "My enthusiasm was shared by the nursing staff and technologists, we worked on Sundays and holidays as well with intense involvement to treat patients. I believe this was the key to our carving a discipline of intervention in the Institute that gained acceptance all over," Dr Rao explains. During his term at various institutes and hospitals his contributions are duly noted. He perused the feasibility of picture archival and communications (PACS) as well as radiology information systems (RIS) related to automation in patient data and report generation with encouraging results. While in charge of the central referral hospital at Abu Dhabi, he made efforts to introduce and establish vascular interventional radiological services in the United Arab Emirates (UAE), resulting in the treatment of patients from different neighbouring countries as well. At Kasturba Hospital, Manipal, he was involved in quality improvement programme and self-audit of the

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department functioning in addition to introducing new initiatives with particular emphasis on the interventional radiology programme. For Dr Rao, achieving excellence in his work in diagnostic radiology, mainly in vascular radiology and interventional neuroradiology, has never been enough. He has always sought to expand and share his knowledge as well as his experience by involving professional bodies and mentoring students. "Each aspect of intervention was so exciting that I could not wait to share my findings with my colleagues and students. Profound passion for the subject expressed itself through my desire to communicate and share, if you want to call it ‘teaching’" he says.

Career highlights Dr Rao earned his medical degree in 1970 from Andhra Medical College, Visakhapatnam. He spent the next few years getting his post graduation in radiology from the University of Delhi and Banaras Hindu University. Dr Rao began his academic career at SCTIMST as an assistant professor in 1977. Over the next 17 years, he held many posts at the institute such as Professor of Radiology and Head of the Department of Imaging Sciences and Interventional Radiology from 1986 to 1993. Later that year, he moved to Al Jazeira & Central Hospitals, Abu Dhabi as Head of Radiology. He came back to India in 2005, working briefly at Kerala Institute of Medical Sciences (KIMS), Thiruvananthapuram. From 2006 to August 2013 he spent his time at Kasturba Hospital, Manipal as Professor and Head of Radiology and Imaging. Currently, he is the Clinical Director of Radiology & Imaging Services at Krishna Institute of Medical Sciences, Hyderabad where he hopes to continue his clinical work, research and teaching. He has authored over 116 peer-reviewed scientific articles and four book chapters. He is a member of World Federation of Therapeutic and Interventional Radiology, Member of Academy of Medical Sciences and several www.expresshealthcare.in

other international forums. He was honoured for his life time achievements by Surjeet Singh Barnala, Governor of Tamil Nadu, besides receiving many other accolades by several academic bodies. His research interests lie in the area of radiology information and management systems as well as in the progress of endovascular management strategies.

Inspiration He was inspired by the great minds of the time, doyens of radiology from around the world. He was a keen follower of the research done by other doctors whose works were published in reputed journals. "Western literature, available in the professional journals mostly, acted as stimulus. Close interaction with the most willing neurosurgeons at the time was another factor adding to my quest for knowledge," he reveals. "It was exciting to read the results of neurointervention by pioneers in France and the US. At a time when it was not possible to have formal training by pioneers in the West, Prof Luc Picard and Jack Moret of France visited my Institute. Meeting them and discussing with them was the first step for me to learn the art of science. Their subsequent visits to India paved the way for the continued growth," he further adds.

Changing scenario in interventional neuroradiology Much has changed from the time Dr Rao started giving shape to his thoughts. Now, interventional neuroradiology has a curriculum, and a sizable number of interns opt for the subject. "Over the past two decades, technology has grown by leaps and bounds with availability of a vast array of tools for safe and effective management of patients by interventional techniques. More radiologists are interested in this discipline in the present healthcare delivery," Dr Rao says. With optimism he says, "It is interesting to watch the discipline now attracting the neurosurgeons, neurologists and vascular surgeons." "With the evolution of a

three-year DM programme in neuroradiology (after MD in radiodiagnosis) in premier institutions, and neurointervention as an integral part of the training, today we have qualified and trained neurointerventionalists emerging every year from these national institutions," he informs. "Advanced Course in Neurointervention is conducted every two years at SRMC, Chennai where experts from international faculty converge and demonstrate live transmission of the procedures," he adds. "Introspection of current knowledge, skills and outcomes of treatments are extensively discussed over three days every year at Goa during Monsoon Meetings with the aim of dissemination of knowledge. Fellowship and Residency programmes approved by Universities are now available for training in vascular and neurointervention at selected institutions," he informs.

Loved by all Dr Rao is very proud of his students who have become successful in their own fields. He remembers with fondness that they are carrying his legacy to not only parts of India but around the world. "It is very much gratifying to see my students and junior colleagues leading the departments of neurointervention in reputed and premier institutions, such as the Sanjay Gandhi Postgraduate Institute at Lucknow, Kovai Medical Centre at Coimbatore, Sree Rama Chandra Medical College at Chennai and NIMHANS at Bangalore and of course my former Sree Chitra Tirunal Institute at Thiruvananthapuram," he says. "Each one of them has distinguished themselves professionally, travelled widely and are well known today in the academic sphere. The recent national conference organised at Coimbatore is a testimony to their recognition and excellence of performance. I consider their accomplishments and recognition as my own achievement," he concludes. mneelam.kachhap @expressindia.com

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VALUE ADD

Quality assurance services for radiology GP Singh Shekhawat, Director, Horizon Meditech, explains about quality assurance test and its importance

hat is a quality assurance test?

The quality assurance programme is a set of tests conducted on the X-ray-based diagnostic equipment to verify if the output radiation and leakage is within the specified tolerance limits to get optimum performance of equipment and consistent image quality. The quality assurance test is also required to comply with the Atomic Energy Regulatory Board (AERB).

Importance of quality assurance test The quality assurance test is very important for the hospital administrators, radiology department and biomedical department. The quality assurance test verifies the output of any X-ray based diagnostic equipment. It also improves the efficiency of the radiology department as the properly calibrated equipment will give consistent output and reduce the number of retakes and waste films. It helps in controlling the maintenance cost of the equipment. Regular quality assurance helps to take optimum output from the equipment, that way one can know if the machine is giving the output as selected by the operator. If the output is outside the specified limits, service intervention is

required to take the optimum performance from the equipment. This also helps in obtaining the optimum image quality. It also checks whether the leakage is within the permissible limit, which improves the safety for both operator and patients as we all know that the X-ray radiation is very harmful and has severe biological effects of the same on human body. Quality assurance test is also required for compliance with AERB and National Accreditation Board for Hospitals & Healthcare Providers (NABH).

Equipment applicable for quality assurance test All X-ray based radiation generating equipment used for diagnostic applications is applicable for quality assurance test. It includes all type of X-ray machines (fixed, mobile, dental, fluoroscopy, IITV, C-ARM), CT scanners, cathlab, ortho pantomograph graph, DEXA-based bone mineral densitometers, mammography etc.

How QA services are performed? Quality Assurance services are performed by qualified & trained engineers. The basic qualification is an engineering degree/diploma with successful completion of Radiation Safety & Quality Assurance in Diagnostic Radiology

GP Singh Shekhawat, Director, Horizon Meditech (RSQADR) Course which is conduction by Bhabha Atomic Research Centre (BARC), Mumbai. A number of QA tools (dose meter, survey meter, beam alignment test tool, focal spot test tool) and dedicated phantoms for mammography and CT scanners are required to perform the QA test. These testing instruments need regular calibration. During the test the KV, dose, dose rate, HVL, total filtration, exposure time, leakage etc are checked.) The presence of service engineer from the modality supplier is also desired to calibrate the equipment if QA test is not satisfactory.

AERB regulatory requirements

ernment body responsible for controlling all kind of ionising radiation in India. AERB has issued the following guidelines for diagnostic radiology: Quality assurance test report is required to be submitted with application to obtain: â&#x2014;? Licence for CT scanner and cathlab. â&#x2014;? Registration for all other Xray based equipment The quality assurance test needs to be performed every two years after the grant of licence/registration.

Horizon Meditech Horizon Meditech is a leading quality assurance service provider in North India. The QA test by the company is performed with the most modern QA instruments and phantoms by qualified and BARC trained engineers. Horizon QA test helps the hospitals, clinics and diagnostic centres to obtain AERB approval for licence/registration and keep their equipment in order. Horizon also provides consultancy for obtaining TLD badges and setting up a radiology facility apart from offering radiation safety training. Contact Tel: +91 11 4161 2370 Mobile : +91 8800 899361 Email: gps.shekhawat@horizonmeditech.com

AERB is the premier gov-

HIGHLIGHTS CURA Healthcare launches indigenous manual patient table It is a mobile table suited for radiology applications of supine patients URA Healthcare, Chennai has launched its first indigenously manufactured manual patient table, adding to a product line of digital radiography systems (DR), CT scanners, MRI systems, mammography systems, bone mineral densito-

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meters (BMD) and imaging software solutions. Manual patient table is a mobile table with high load bearing lockable wheels suited for radiology applications of supine/lying down patients in busy hospitals. The radiolucent table top is specially

helpful in easy positioning of patients. The sturdy table top is capable of taking a patient load of over 200 kg. This is the first of a number of new products that will enable indigenous production of CURAs patented cost effective and space saving digital radiwww.expresshealthcare.in

ology solution. Established in 2001, CURA Healthcare is an ISO 9001:2008 and ISO 13485:2003 certified radiographic imaging solutions provider in the Indian X-ray imaging space to bring affordable and global standard

products from its 60,000 sq ft new facility within MPEZ, SEZ campus, Chennai. Soon, the company will be rolling out other digital radiography/computed radiography solutions from this facility. EH News Bureau EXPRESS HEALTHCARE

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‘Our ambition is to become the leader in advanced medical imaging visualisation and analysis solutions’ Guillaume Roussel, International Sales Director, Intrasense, was recently on a visit to India. He talks about the fast-evolving imaging market in India, and discusses his company's plans for it, in an interaction with Express Healthcare How has India's imaging market shaped up over the years? The Indian healthcare industry has been dramatically shaping up over the last few years. The revenues have been shooting up and as far as diagnostic medical imaging is concerned, there is an annual growth of 12 per cent. On one hand, particularly in tier I and tier II cities, growing hospital infrastructures and healthcare spending are fostering the need for high end devices to facilitate accurate diagnoses and fast treatment. On the other hand, private healthcare providers are starting to expand their institutions from larger cities to rural areas by building new facilities and equipping them with more medical

INTERVIEW

imaging devices, which will generate even more market opportunities.

How has Intrasense's presence in the Indian market played a role in its evolution? Intrasense has been involved in the Indian market’s activities for more than four years. Thanks to our strong collaboration with Modimedicare’s team, we have implemented Myrian installations in several major tier I and tier II cities (Mumbai, Delhi, Chennai, Hyderabad, Lucknow). Our existing references include leading organisations which include public hospitals, medical colleges and private institutions and clinics. Today, India represents our biggest installed base and

market opportunities for South Asia Pacific area. This is also the reason why a dedicated Intrasense team has been created now, based in Kuala Lumpur, Malaysia), in order to follow the local partners and timely address their technical, clinical and commercial needs.

What is the objective of this visit to India? We have been working closely for the last four years with a very valuable partner company: Modimedicare. Thanks to this collaboration and their clinical and technical expertise, we managed to provide Myrian users in various installations all over India with very high levels of customer support. Now, Indian market is significantly growing and, with this visit to India, we will improve our plan of action in order to ensure more and higher quality support and service. We have great ambition in that market and we are looking forward to reinforcing our position further soon.

Are there any expansion plans for India? If yes, please elaborate. The overall response from the Indian market towards Myrian remains very good. At the beginning, this response was more oriented on very specific needs, for example in terms of post-processing diagnosis mainly dedicated to liver surgery (transplant programs, digestive surgery). Now, it seems that the market demand will

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also shape up in the future months and year, with new policies to combat chronic diseases (respiratory diseases, diabetes) and in the field on oncology. Three major characteristics will make Myrian the perfect solution to address all the above needs ● Universal post-treatment workstation: Myrian is a multimodality platform which can be easily integrated to the hospital IT ecosystem ● Oriented on clinical performance: Myrian provides the end-user with structured reading, intelligent visualisation, quantitative analysis, as well as reporting and communication capacities ● Medical imaging solution perfectly integrated to the chain of care: Myrian offers to the end-user functionalities that can fit the needs in terms of education, clinical trials, screening, diagnosis and follow-ups

What are the unique challenges and opportunities in this space vis-a-vis the global markets? Thanks to its strong drivers for growth: increase in healthcare spending, changes in demography and lifestyle, and significant increase of medical tourism, we strongly consider India as a high potential market. Indeed, the opportunity perspectives are becoming wider with PACS companies who need advanced visualisation and post-treatment software to replace or upgrade their existing system, CT and MRI modality vendors who want to complement their own workstation with high-end expert modules (eg: Brain and Cardiac analysis) or finally refurbishing companies who are looking for a competitive offer to match their requirements.

How does Intrasense plan to tap into these opportunities? Our ambition is to become the leader in advanced medical imaging visualisation and analysis solution as far as the Indian market is concerned. Keeping our focus, adapting our solution and services thanks to flexibility and agility, adding value to our partners’ business and supporting them, and finally fostering operational and customer service excellence will make Intrasense and Myrian match the needs and requirement of this challenging market. lakshmipriya.nair@expressindia.com OCTOBER 2013

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Asia’s first Intra Operative 3D Radioguided Surgery System at HCG Till date HCG has used the system to treat 15 patients

ealthCare Global Enterprise (HCG), Bangalore-based cancer hospital chain, became the first hospital in Asia to treat patients with Intra Operative 3D Radioguided Surgery System (SurgicEye). The declipseSpect is a freehand SPECT device intraoperative 3D imaging for radioguided surgery. Till date HCG has used the system to treat 15 patients and the biggest advantage of the system is that the cancer patients can avail the surgery in daycare. Sentinel lymph node biopsy (SLNB) is a method used as a minimally invasive procedure to find the first nodes in the lymphatic system in the drain of the tumour as an indicator for precise

tumour staging. Monitoring the lymphatic system and especially lymph nodes is a very efficient way of treating many types of cancers, as malignant cells use this network to spread throughout the patient’s body. Dr Krithika Murugan, Consultant, Surgical Oncologist, HCG, further stressed on the importance of this technology and added, “Traditionally, we were using the Sentinel (Gamma) probe to locate the sentinel lymph node, the accuracy of this was less desirable and involved subjective guesswork on the part of the surgeon. The declipseSPECT, on the other hand, makes this process easier, as it not only gives a 3D location of the lymph node, but also tells the surgeon of

SENTINEL LYMPH NODE BIOPSY IS A METHOD USED AS A MINIMALLY INVASIVE PROCEDURE TO FIND THE FIRST NODES IN THE LYMPHATIC SYSTEM IN THE DRAIN OF THE TUMOUR AS AN INDICATOR FOR PRECISE TUMOUR STAGING

the accurate depth at which the lymph node can be found. It is therefore, an excellent navigation tool which helps in negating unnecessary taking out of additional nymph nodes. It is helpful in localising early lesions of the breast not clinically palpable using the ROLL technique.” Dr Joerg Traub, Inventor & Founder, SurgicEye said, “I am impressed by the quality of service and the patient centered approach of HCG and I am convinced that HCG is the best location for the first declipseSPECT installation in Asia. The declipseSPECT will add one more innovation to HCG’s high quality service, providing 3D imaging and guidance support for least invasive surgery and quality assurance in the operating room to document the complete removal.” Benefits of the machine include intuitive and direct access through 3D imaging and depth information, quality assurance through image confirmation of complete resection, increased accuracy and resection control through 3D image viewing and anatomical

future. This can facilitate smaller scars, less trauma/morbidity and shorter operation time. Dr Mahesh Bandemegal, Consultant, Surgical Oncologist, HCG, said, “The usage and benefits of declipseSPECT are varied. This new technology helps us to identify and image the sentinel node intraoperatively. This will help us in accurate localisation of lymph node with smaller incisions. It is mainly used for breast cancer, skin cancer, oral cancer, gynaecological procedures.” SurgicEye channel partner in India, Advanced Medical systems, GM, Rahul Kaul said that the machine costs approximately Rs 2.5 crores and is a lifetime machine with only a disposable cover to be replaced periodically. Clinical trials on efficacy and benefits are being conducted in Europe and the data will soon be available. HCG will serve as the nodal centre for providing training and education to surgeons on 3D radioguided surgery system. EH News Bureau

Telerad Tech introduces multi-lingual radiology workflow platform Radiology workflow solutions in Chinese, Polish, Spanish, Portuguese, Dutch, French, etc to target global teleradiology needs

elerad Tech has introduced a new version of Multilingual RADSpa with enhanced features and multilingual support to meet the needs of the teleradiology market globally. Due to the nature of the radiology workflow solutions, and the ubiquitous nature of the Internet, Telerad Tech has

found that it is important to serve the global teleradiology community with a world class multilingual product. Multilingual RADSpa is a radiology workflow software that can now be hosted on a local data centre entirely complying with local rules and regulations. This feature is especially

THE NEW VERSION ALSO ALLOWS CHANGES TO THEGRAPHIC USER INTERFACE WITH LOCAL LANGUAGE SUPPORT 68

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important in the European nations. It is being touted as an alternative lower cost solution for other countries which do not have such a strong compliance need is the feature of images stored on a local cache, enabling faster access of images from a local cache server on the premises and accessing the cloud server only for patient demographics. The new version also allows changes to the Graphic User Interface with local language support. RADSpa has been currently launched in following languages– Chinese, Polish, Spanish,

Portuguese, Dutch and French, to name a few. Mohan Mysore, VP Sales & Marketing, USA and European Operations said, “We are now set to provide a truly global world class product with the multilingual new release. One of the key to supporting markets in different parts of the globe is the customisation of the software to meet the local needs. This is especially true when it comes to the user interface, local compliance rules and of course the local language.” EH News Bureau OCTOBER 2013

HR challenges in hospitals Dr J Sivakumaran, Sr VP, SPS Apollo Hospitals expounds on the importance of human resources and the need to handle them efficiently to improve healthcare delivery

Dr J Sivakumaran, Sr VP, SPS Apollo Hospitals

In spite of technological advancements, one cannot rule out the importance of manpower in hospitals. Latest and modern technologies cannot substitute the contribution made by specialised manpower in the healthcare industry. Human resource (HR) is a very vital resource, a veritable sine qua non in the healthcare industry. To err is human, goes the old adage, probably suggesting that one need not make a big deal of mistakes committed. However, in healthcare mistakes can prove quite grave, with fatal consequences for the patient. Hence, healthcare staff should have the ability to follow and implement safe and ethical practices with highest level of technical competency. There are many challenges before the human resource department of a hospital. Few of the important challenges are discussed here.

Shortage of workforce The first and foremost challenge is the identification, recruitment and retention of the required workforce. In healthcare, there is a dearth of talent and trained manpower. India faces a huge gap between demand and supply of healthcare

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workforce. This is due to the heavy shortage of beds and human resource, and to compound the situation further, a highly skewed infrastructural growth. As per a survey conducted by Tecknopak, by the year 2020, we need 2.5 million hospitals, one million doctors, two million nurses and 10 million paramedics, with the growth opportunity to do a healthcare business of $280 billion. It is a fact that we are struggling to meet the demand even for the current level of operations. The shortage of workforce is due to various reasons. Many of the quality manpower are being hired by hospitals abroad, causing shortage and brain-drain in India. Skilled workforce from India is much sought after in the international market. Indian healthcare employees seek overseas opportunities due to prevalence of poor pay scales, lack of professional growth, skill development and poor working conditions in India. These factors contribute to the flight of local talent seeking greener pastures abroad. It is to be noted that it takes at least five years to train a doctor and minimum three years to train a nurse before they attain the expected level of service delivery after their professional degree. There are no shortcuts here. Any attempt at trying to shorten the gestation period would be highly detrimental. When there is a shortage, it becomes necessary to have effective HR strategies in place to achieve better outcomes. Therefore, the HR personnel need to act as coaches, mentors, counsellors, identifiers of successors by promoting organisational www.expresshealthcare.in

ethics, values, culture and beliefs.

Training and retention of employees Apart from the challenge of having the right people for the right task, technological advancement warrants consistent training for maintaining the highest standards of medical excellence. Whether it is for accreditation, technology upgradation, service customisation, quality service delivery or developing medical tourism, constant training and retraining of the employees is essential for aligning their skill sets in line with the objectives of the organisation. A professionally trained and skilled workforce is essential for running any hospital successfully. Once trained properly, retaining the workforce is also a huge challenge confronting hospitals. Retaining talent is less expensive than hiring a new employee and training him/her to suit the organisational needs. Developing a workforce is, in a way, upgrading the skill set of the existing workforce as well as helping the staff in acquiring competencies and skills for their current and future roles. Mentoring employees to take up bigger roles within the company often helps unearth latent talents and skills, benefitting individuals and the hospitals. This will improve the motivational and confidence level of staff to perform efficiently and effectively.

Developing multi-tasking workforce Employee cost is a major expenditure in hospitals and it keeps increasing consis-

tently. Sometimes it goes beyond the budgeted level due to repeated revision of wage norms by state governments. With the healthcare sector witnessing an unprecedented boom, there is an abundance of employment opportunities for healthcare professionals, further pushing up the costs of retaining them. Due to this, hospitals are working on methods to keep the cost under control, without compromising on the quality of service. One such method is to have a multi-tasking manpower pool which can be made to perform multiple functions based on business exigencies. Identifying, orienting, training, inducting and retaining a multi-tasking manpower is an onerous task which many hospitals have taken upon themselves. Talents are being identified and trained to do multi-tasking and this task force is often called upon to make up for manpower deficiencies in specific areas. This strategy helps hospitals retain the manpower cost at a reasonable level and ensure better utilisation of the manpower employed.

Developing second line staff Migration of healthcare workers is comparatively high, as compared to other industries. In case of nurses, the hospitals are not only facing threat from competitors within the city hospitals, but also from government hospitals, teaching institutions and from healthcare institutions abroad. Retaining this vital workforce despite the â&#x20AC;&#x2DC;pullfactorâ&#x20AC;&#x2122; from competitors is a challenge. In spite of the best OCTOBER 2013

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efforts being put in by hospitals to retain talent, the employee turnover ratio in the Indian healthcare space is a whopping 30 per cent. In such a scenario, hospitals need to constantly work on developing a second rung workforce to fill in the shoes of the employees leaving them. Identification of such talent and grooming them to take up bigger roles is a real challenge before hospitals. This exercise needs to be done in all areas and at all levels. Replacing a talent from the existing work force often proves to be cheaper than hiring from outside, as long as the competency level is sufficient to meet the challenge.

Managing younger workforce The population demography of the country is heavily skewed with the youth making up for a substantial percentage of our population. Many of the fresh recruits are barely into their twenties when they are inducted into the workforce. Their attitude is different from the more seasoned seniors. The younger generation needs to be handled with care, largely

OCTOBER 2013

owing to their outlook, upbringing and attitude. The youth of today are ready to take on any challenge, assume ownership of work and run the extra mile in pursuit of their ambitions. However, the flip side is that they are fiercely independent and are generally unappreciative of a senior constantly watching over their shoulders. They are generally go getters, flexible, non-conservative and liberal in culture. Training and aligning them to the organisational culture, maintaining high decorum, sustaining a safe workplace that keeps up with their selfactualisation objectives is a

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challenge in itself. Therefore, it is essential that hospitals try and maintain a workplace which would cater to the dynamic needs of the workforce. The deserving employees need to be recognised, encouraged and rewarded for getting the best out of them.

Accountability of workforce Patient care, in general, is a team work and not an individual task. The team mix is hybrid, consisting of uneducated, unskilled workers to highly qualified doctor(s). In such a scenario, it is important to fix the accountability for each job performed by

each individual, so as to ensure seamless delivery of quality healthcare. Documentation of responsibilities given to each individual in the healthcare delivery system is very important for achieving desired results. This is again a challenge before us. In spite of all these challenges, hospitals find their own ways and means to overcome these problems. Undoubtedly, the sector is growing year after year and these challenges are expected to settle down over a period of time if the stakeholders come together and take suitable initiatives.

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OBITUARY

Dr Narendra Dabholkar: Martyr for reason ‘W Raelene Kambli traces the inspirational journey of Dr Narendra Dabholkar (1945-2013), a rationalist and humanitarian, who showed by example that we should be the change that we expect to see in the world

e must think for ourselves and examine the logic of our superstitions. We must be progressive and embrace change.’ These were the wise words uttered by a voice of reason that sought to liberate the people of India from the bondage of superstition and blind faith. Alas! the voice that echoed several times before, encouraging the people of Maharashtra to become a soldier of rationalism and dare to rely on reason has been silenced. On the dawn of August 20, 2013, in Pune, Dr Narendra Dabholkar (67), a man who waged a war against superstition and the practice of black magic in Maharashtra was shot dead. This terrible news spread like wildfire; saddening and flabbergasting thousands of people within the country. His murder not only highlights the risk a social activist faces but also the threat to rationality that exists in this country. It highlights that a large number of population in India are still in the clutches of outdated beliefs, false godmen and witch doctors and look at them as a panacea to their life’s adversities. The reason why I speak of Dr Dabholkar is because there is a deep connection to the work he did and the practice of medicine. Superstition has always reflected the darker side of Indian culture. Medicine is one discipline that has challenged these beliefs. Many medical practitioners in India have even given up their lives to build people’s trust

DR DABHOLKAR WAS A MARTYR WHO MADE EMANCIPATING INDIAN SOCIETY HIS LIFE'S WORK AND NEVER LOOKED BACK in medicine. Dr Dabholkar was one such martyr who made emancipating Indian society his life’s work and never looked back. Distressed on seeing people getting exploited by blind faith in quacks and pseudo healers, he gave up his lucrative medical career of 12 years. He trained his focus on creating awareness

amongst the public and at the political level. His journey from a medical practitioner to a full-time social worker not only speaks of his selfless personality but also about his concern towards the people he worked for. Dr Dabholkar’s tireless labour towards promoting a culture of education in the remote villages of Maharashtra and his valour to fight against all self acclaimed godmen within the country is indeed noteworthy. He has been an inspiration to thousands of social crusaders within the state of Maharashtra. He set up the Maharashtra Andhashraddha Nirmoolan Samiti in 1989 to help eradicate superstition and worked towards getting an Antisuperstition Bill passed by the Maharashtra Assembly yet did not live to see the results of his efforts. It is an irony that when Dr Dabholkar was living, he fought for many years against quackery, but it took only 24 hours after his death to get the sanction on this very important bill. Dr Dabholkar also campaigned against rituals that harmed the environment. He started a movement to promote eco-friendly ganpatis which would be made of clay in order to curb water pollution during Ganesh visarjans. His endeavours helped him win the court judgement that mandated all Ganesh idols to be made of clay and natural colours in Mumbai, where Ganeshotsav is very fervently celebrated. Additionally, he became

involved with movements like Baba Adhav’s Ek gaav, ek panavtha (One village, one well) agitation to fight social evils like casteism and supported social justice for Dalits. His work has been revered and acclaimed by many healthcare experts as well. Some experts from Mumbai say that efforts of martyrs like Dr Dabholkar and several such healthcare practitioners who have worked towards educating people about their healthcare needs have contributed to the progress of medicine in India. Today, in many remote villages of India the doctor saheb is considered to be next to god. This goodwill can be used to influence people positively. There are still many healthcare aspects that go untouched in many parts of the country. Doctors practising in these regions, apart from treating patients, also have an added responsibility of educating people on various aspects such as sanitation, immunisation, HIV and other STDs, IMR, MMR, illegal practice of female foeticide, illegal sex determination and many other healthcare concerns. It is to be hoped that his life would continue to inspire many who would carry on his good work to bring about the much needed change in the society. All in all, I would finally say that Dr Dabholkar by his work chose to be the candle that spreads the light, we must atleast choose to be the mirror that would reflect his light. raelene.kambli@expressindia.com

Dr LH Hiranandani: A life well lived C

Renowned ENT specialist, Dr LH Hiranandani (1917 – 2013) will always be remembered as much for ushering innovative techniques in the field of medicine as for his fortitude, says Raelene Kambli

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all him a social crusader, a philanthropist or a deft ENT surgeon; Dr LH Hiranandani (96) is a name that will surely go down in the annals of history for his contribution to modern medicine in India. His journey in the field of Indian healthcare is phenomenal. From a humble beginning in Thatta, Sindh, Dr Hiranandani achieved great glory in the field of

ENT surgeries. His experimental skills helped him discover numerous new innovative techniques which are now called- ‘Dr Hiranandani’s Operations’. His works have been published in medical journals across the world. His speciality was in performing difficult larynx operations, which he conducted with utmost ease. The doyen passed away www.expresshealthcare.in

on September 5, 2013, succumbing to various agerelated ailments after waging a battle for one month in the hospital. He is survived by his wife Kanta and two sons, Niranjan and Surendra, well known entrepreneurs in their own right. The news of his demise was a cause of sorrow for all who knew this great soul. I too had the honour

of meeting this stalwart four years ago at his clinic in Mumbai. He was then 92 years old. I was then working on a story that spoke about influential people in healthcare and Dr Hiranandani stood high on our list. Meeting him was an opportunity that I will cherish for the rest of my life. I was completely impressed by his personality. Even at the age of 92 his OCTOBER 2013

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enthusiasm for his work and life in general was unabated. He visited his clinic in South Mumbai regularly. He had told me that his clinic was another home to him and his work was his way of life. I still remember his words, “Medicine is the best profession and hard work gives the best results.” Dr Hiranandani had to overcome many obstacles to become a doctor, the profession of his choice. Being born in a poor family and educating himself was indeed a tall task. The most difficult decision of his life was to travel to Karachi to study medicine at a point of time when he did not have a single penny in his pocket. Yet, he had the courage to venture on a journey fraught with uncertainties and the will to succeed against all odds. Dr Hiranandani’s only mantra was to work hard. His first job was as a house surgeon at KEM Hospital, Mumbai and since then, there has been no looking back. He went on to achieve several notable feats as a result of his dedication and

DR HIRANAN DANI’S EXPERIMENTAL SKILLS HELPED HIM DISCOVER NUMEROUS NEW INNOVATIVE TECHNIQUES

hard work. His stint at Mumbai’s Nair Hospital saw him playing a crucial role in developing the ENT department at the hospital and successfully incorporating head and neck surgeries within the department. Dr Hiranandani was the first Indian to be appointed as a member by the American Society of Head and Neck. He has written many insightful journals and books which have been acknowledged by the healthcare industry across the world. He is also the recipient of the prestigious Padma Bhushan by the President of India in 1972 and has received the SAARC Doctor of the Millennium award. He was the first person to be honoured with the Golden Award by the Board of International Federation of Otolaryngology and Head and Neck societies. In the year 1988, he also received the Dhanvantari Award and became the first person in the field of ENT to receive this award. He was also appointed a member of the Advisory Committee by the Government of India for

opening of private medical colleges in Maharashtra. Apart from being a thorough professional, Dr Hiranandani was a man of great principles as well. It was one thing that he would never compromise on. His activities reached far beyond the medical field. As a social crusader he courageously took on the kidney trade in India. As a philanthropist he sponsored several medical students. He has also earned a name as the modern-day 'Robin Hood' of healthcare where he charged the rich more so that he can treat the poor free. Moreover, he also worked for the cause of removing capital punishment from the Indian law. His efforts were instrumental in stalling the Euthanasia Bill in the Parliament. Thus, he is an inspiration on how to live a life to the fullest and achieve its full potential. Though we will miss Dr Hiranandani; his teachings and techniques will continue to be revered by all. raelene.kambli@expressindia.com

PEOPLE

Dr (Prof) Ranjit Roy Chaudhury receives FICCI's Lifetime Achievement Award 2013 It applauds his services to the healthcare industry

OCTOBER 2013

he Federation of Indian Chambers of Commerce and Industry, Healthcare Excellence Awards, 2013 conferred the 'Lifetime Achievement Award' to Padma Shri Dr (Prof) Ranjit Roy Chaudhury, Chairman, Clinical Trials & Ethics SubCommittee, Ministry of Health & Family Welfare, GOI and Chairman—Task Force for Research, Apollo Hospitals Educational and Research Foundation (AHERF) at Hotel Le Meridien, Windsor Place, New Delhi. This award applauds and felicitates individuals who moved the needle and raised the bar in their respective genus. It appreciates Dr Roy Chaudhury's efforts towards transforming nation's health. In a career spanning 40 years, Dr Roy Chaudhury has spearheaded many projects as an academician, pharmacologist and researcher. He has contributed and establishing

the Delhi Society for Promotion of Rational Use of Drugs and prestigious Department of Pharmacology in Chandigarh. He was also a part of WHO HeadquartersGeneva, Regional Office at Alexandria Egypt and Rangoon, Burma as Head of www.expresshealthcare.in

Mission and at Chulalongkorn University, Bangkok. He was presented with the Padma Shri in 1998 for his perpetual contributions to the healthcare sector. Speaking on the occasion, Dr Roy Chaudhary said, “I am immensely overwhelmed and honored to receive this prestigious award by FICCI. It is an acknowledgment of the efforts of a large group of colleagues who have worked with me for the last many years. I foresee India as a healthier nation, emulating global healthcare standards. Health has to be interpreted as a total quality of life and by setting up the best practices in the field of ethics in medical practice and rational use of drugs. My endeavor has always been to set new yardsticks in the healthcare segment especially in medical teaching and health planning for the country”. Prof Roy Chaudhury was a Member of the Committee

which drafted the first Ethical Guidelines on Research in Human Subjects of the Indian Council of Medical Research (ICMR) in 1980. He has written twenty five books and has over 225 papers to his credit. He has also served as President of the Delhi Society for Promotion of Rational Use of Drugs, Founder President of the Delhi Medical Council, chaired the Committee for Postgraduate Medical Education. He was nominated as a Member of the Central Council for Health and Family Welfare in 2009. He has been recently been appointed as Advisor to the Department of Health and Family Welfare, Govt of National Capital Territory of Delhi and more recently as Chairman of the Expert Committee for Reforms in Drug Regulation and Clinical Trials set up by the MoHFW, Govt of India. EH News Bureau EXPRESS HEALTHCARE

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PEOPLE MED-EL Founder and CEO, Dr Ingeborg Hochmair receives Lasker Award The award is for development of the modern cochlear implant

ounder and CEO of MEDEL Medical Electronics, Ingeborg Hochmair, has received this year’s Lasker-De Bakey Clinical Medical Research Award for the development of the modern cochlear implant, a device that restores hearing to individuals with severe-to-profound deafness through electrical stimulation of the auditory nerve. She will share the award with Graeme M Clark (Emeritus, Univ of Melbourne, Australia) and Blake S Wilson (Duke University, NC, US).This award honours scientists whose contributions have improved the clinical treatment of patients. Ingeborg Hochmair, in electrical engineering, is being recognised for her early contributions to the field of cochlear implants starting with the development of the world’s first multi-channel microelectronic cochlear implant that was implanted in Vienna in 1977. This implant included a long, flexible electrode, which could, for the first time, deliver electric signals to the auditory nerve along a large part of the cochlea, the snail-shaped inner ear. With a modified version of this device, the next milestone in cochlear implant development was reached in 1979: the understanding of words and sentences without lip-reading in a quiet environment via a small, body-worn sound processor. The young recipient, a pioneer herself because she devoted much of her time to cochlear implant research, has enjoyed open speech understanding via a small processor for the past 34 years. Intense and continu-

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ous innovation followed, including the development of the world’s first behind-the-ear (BTE) cochlear implant audio processor in 1991. The next major advancement was the development of a high stimulation rate cochlear implant designed to faithfully implement a new speech coding strategy developed by Blake Wilson. From 1994 forward, this device took its users to the next level of performance. Respect for the cochlea and its delicate structures have guided Dr Hochmair´s research and development activities towards a highly flexible electrode array preserving the delicate structures of the cochlea despite deep insertion into the cochlea. During recent years, Dr Hochmair and Wilson have collaborated on current topics such as the benefit of bilateral implantation, combined electric and acoustic stimulation, and of cochlear implants for singlesided deafness. Dr Hochmair’s intellectual rigour, pioneering spirit, and life-long drive toward excellence have transformed the lives of nearly 100,000 individuals around the world. “Many of these achievements were attained with the shared commitment of my husband and closest collaborator, electrical engineer Erwin Hochmair, and with other outstanding partners, such as basic researchers, surgeons, clinicians, and co-workers at MEDEL and, ultimately, the endusers of the devices,” said Dr Hochmair. Together with Prof Erwin Hochmair, Ingeborg Hochmair founded MED-EL with a vision that would ultimately bring cutting-edge applications to life in more than 100 countries. The company is privately held, and Ingeborg Hochmair remains at the helm. Being CEO of MEDEL is not simply a job for Dr Hochmair; it is her life. Helping people overcome hearing loss as a barrier to communication was a founding principle of MED-EL and remains her mission and her passion. Improving the quality of life of patients continues to be a personal and professional core value that is lived every day through her leadership at MED-EL. www.expresshealthcare.in

Dr Poonam Khetrapal Singh nominated WHO Regional Director She is the first woman to be nominated to this post in South-East Asia

r Poonam Khetrapal Singh has been nominated as the Regional Director for the WHO South-East Asia region. She was nominated to the post of Regional Director (RD) for a five-year term by the 11 Member States of the region. The 32-member Executive Board of the World Health Organization (WHO) is expected to appoint Dr Khetrapal Singh as Regional Director in January 2014, in Geneva. Dr Khetrapal Singh is expected to take office as the RD at the Regional Office in New Delhi on February 1, 2014. As the Regional Director, Dr Khetrapal Singh brings a vast repertoire of experience, having worked in the health sector for over three decades

at both national and international levels. She served with WHO for the past 15 years. She is the first woman to be nominated to this post in the region. She started her WHO career in 1998 as a member of Dr Gro Harlem Brundland’s cabinet who was WHO Director-General at the time. Dr Khetrapal Singh served as the Executive Director for Sustainable Development and Healthy Environments in Geneva. From 2000 to 2013, as the Deputy Regional Director for WHO’s South-East Asia Region, she served as the principal adviser to the Regional Director, providing managerial, technical and programmatic support for WHO’s programmes. Dr Khetrapal Singh served as a senior civil servant in India as a member of the Indian Administrative Services. She was Secretary and Joint Secretary Health and Family Welfare. She has also served with Health, Population and Nutrition (PHN) with the World Bank Mission in India, where she worked to improve the efficiency and effectiveness of the delivery of health services. Recently, she has been working as an Adviser in International health to the Ministry of Health and Family Welfare, in the Government of India.

Sunil Khurana is the new President and CEO of BPL Medical Technologies He will also become a Director on the Board of BPL Med

PL Medical Technologies (BPL Med) has appointed Sunil Khurana as President & CEO. He will also become a Director on the Board of BPL Med. Khurana joins from Bharti Infratel, a leading Indian provider of tower telecom infrastructure, where he was the COO and a member of the Core Executive Council. Prior to Bharti Infratel, Khurana reportedly spent close to three

decades with the GE Group in its medical devices business in various capacities, including his last assignment as Director for Computed Tomography (CT) and VP of Services for South Asia, where he led the P&L for the region (India, Bangladesh, Sri Lanka and Nepal). Khurana said, “I am delighted to join the BPL Group, one of India's pioneers in the medical technologies space, and excited to leverage BPL’s strong brand, well-established manufacturing capabilities and distribution network to create India’s leading, medical device company.” OCTOBER 2013

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OCTOBER 2013

W H AT ’ S INSIDE

Medisystems bed-head panels, Model 9060 PG 96 ZHL@Healthex International 2013 PG 98 Ideal software for hospitals: client server or web-based server? PG 98 ‘HCU systems help in performing efficient nerve and plexus blocks’ PG 100

TRADE & TRENDS aycan’s offerings for OsiriX PRO Plug-ins and options from aycan add to OsiriX PRO’s capabilities and make it the perfect solution for fast and easy access of medical images

ycan continually develops clinical and workflow plug-ins to further enhance aycan OsiriX PRO’s capabilities. Additionally, aycan cooperates with other plug-in development companies to provide tested and certified solutions. A full list of plugins with FDA clearance and CE Marking are listed below. With these plug-ins/options, and tools for general diagnostic reading and advanced post-processing, OsiriX PRO makes the perfect solution wherever there is demand for fast and easy access to medical images.

11-Bit monitor support With this OsiriX PRO plug-in, one can attain more detailed gradiation in grayscales in the 2D and 4D viewer when using special 11-bit- capable monitors.

4D ROI statistics With the optional 4D ROI Statistics plug-in for OsiriX PRO, one can evaluate voxel values of MRI and CT multiphase series from different acquisition times.

MARKET 11 STRATEGY 38 IT@HEALTHCARE 41 HOSPITAL INFRA 51 IN IMAGING 57 LIFE 70 OCTOBER 2013

Media importer The Media Importer plug-in allows to better manage the data which has been imported to OsiriX PRO. One can choose specific studies and series, change patient demographic information, route data to a different DICOM node, or burn the

data to CD/DVD.

Advanced hanging protocols Ideal for mammography workstations, the optional advanced hanging protocols plug-in allows to save display layouts and settings in the 2D Viewer, so when reopening a study (or similar studies) one will always get the same view. This standardisation brings greater efficiency to routine diagnoses. This OsiriX PRO plugin also automatically opens up prior studies, which further increases the speed of the daily workflow. With this plug-in, OsiriX PRO can now be used as a mammography workstation in the areas of curative treatment and screening.

DICOM print film composer The film composer plugin for OsiriX PRO offers a “what you see is what you get” user interface for managing the DICOM print jobs. The simple- to-use interface allows to add and manipulate the layout and several parameters and print single images, key images, or the complete series

Ejection fraction The optional ejection fraction plug-in calculates the left ventricle ejection fraction according to the "Dodge Correction" method. (This plug-in does not serve as a tool for computer-aided diagnosis.)

Image recalculation The image recalculation option for OsiriX PRO allows to manipulate data to suit particular needs, so one can work quicker and easier. Within the option, a series can be manipulated and edited by adding custom formulas. The option also reduces the size of a series, so it’s easier to work with. Whichever way the image is recalculated, the option lets www.expresshealthcare.in

to export the results as a new DICOM series.

RECIST The RECIST plug-in with FDA 510(k) clearance for OsiriX PRO allows to quickly and easily quantify and analyse lung tumours according to the RECIST (Response Evaluation Criteria In Solid Tumors) 1.1 guideline, the WHO (World Health Organization) guidelines, and by the volume of the tumours. (This plug-in is not a tool for computeraided diagnosis.)

Vessel analysis aycan’s OsiriX PRO vessel analysis plug-in supports segmentation of vessels in CTA data sets and provides centre lines for vessel assessment. The plug-in is used to mark specific areas for vessel segmentation so that vessels can be displayed separately in different views. Based on the determination of the centre line and direction, an interactive assistant takes through the individual segmentation steps to isolate tiny arteries (e.g., coronary arteries), as well as large arteries in the area of the pelvis and legs. The diameters and lengths can be determined in a final step (3D Curved MPR).

aycan mobile iPad app Designed for the easy, fast, and secure transfer of DICOM images from hospi-

tals and imaging centres to on-call and other radiologists and referring physicians with an iPad, aycan mobile’s intuitive user interface and robust feature set make it the ideal tool for remote review, interpretation, and diagnosis of radiological images (intended use: CT/MRI); reviewing images with patients at their bedside; teleconsulting with colleagues; distributing images in- house; and much more.(FDA 510(k) cleared).

Concurrent license server Ideal for large environments, such as hospitals, the optional Concurrent License Server allows multiple users to access OsiriX PRO at the same time for easy license sharing, management, and cost savings. In addition to saving costs by minimizing the number of licenses you purchase, further cost benefits can be achieved over time as installation, administration, and maintenancetime are minimised. Contact Registered Office: 250, Powai Plaza, Opposite Pizza Hut, Hiranandani Gardens, Powai, Mumbai – 400 076. Branch Office : Saldhana Providence, Balmatta Road, Mangalore - 575 001 Tel: +91 90047 45674 / +91 77383 69799 Email: healthcare@mapledti.com EXPRESS HEALTHCARE

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Medisystems bed-head panels, Model 9060 The specially fabricated units for hospital use has been designed to converge all the essential utilities around the patient's bed

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edisystems 9060 Series bed-head panels are specially fabricated units for hospital use, designed to converge all the essential utilities around the patient's bed. These bedhead panels are configured to carry user terminals for electrical power, illumination, communications, biosignals, data, medical gas and carry a medical rail with a range of mountable accessories like examination lamps, BP instrument holder, case sheet holders, IV and infusion pump stands, bowl holders and the like. Medisystems circuit protected bed-head panels have now become part of ICU and patient room infrastructure in every hospital. Standard configuration panels are available for ICU, wards, private rooms/suites, custom configurations to closely meet user requirements are also available. Medisystems bed-head panels are constructed from light weight extruded aluminium sheets and sections and from stainless steel. The aluminium is surface treated with epoxy-polyester powder coats in a seven stage process which ensures life time protection to the metal surface with ease of cleaning and ability to withstand damage from common hospital fluids like saline, drugs, blood etc. These light weight panels can also be mounted on non-brick walls made of siporex or gypsum board. All panels have safety metal partitions between high voltage, low voltage and medical gas outlets. Medisystems manufactures a very wide range of such panels to meet practically every kind of need. Such panels are available in standardised as well as custom configurations which include horizontal, vertical, running length or wall angular orientation, in colours and finish of choice.

Bed-head panel utilities Bio-signals and data

Medical gas Terminals for oxygen, vacuum and air with redundant terminals for critical areas like the ICU, post-op recovery and trauma

Connectors for linking patient monitoring and alarm signals to centralised monitoring facilities, nurse-call systems. Connectors for input or display, links with HIS servers and or the Internet

Electrical power

Illumination

Optional utilities

Electrical sockets for all medical equipment brought to the bed-side like ventilators, monitors, infusion pumps, etc

Switches for room, reading, night lamp and examination lamps

Analog/digital clock, medical rail of international dimensions and accessories like examination lamps, I.V. Pole assembly, infusion pump stand, blood pressure intrument holder, case sheet holder, bowl holder and utility baskets

Standard panel configurations: S/N

Panel Utilities

ICU BedHead Panel

Ward BedHead Panel

Room / Deluxe Suite Bed-Head Panel Y

Extruded Aluminium epoxy-polyester powder coated

MCB wired for Isolation

6/16A Electrical Switch/Sockets

3 Switches for Patient Bed Lamps

RJ-11 for Intercom/EPABX Phone

Bio-signal Connector Slot (for patient Monitor) Y

RJ-45 Data Connector for HIS network

Nurse-Call Bed Unit Slot (for Nurse-Call System)Y

Medical Gas Terminal Slot (for Medical Gas supply)

≤6

≤2

Quartz/Digital clock (optional)

Medical Rail-Stainless Steel

Medical Rail Accessories

Colour (optional)

Finish ( Matt / Glossy

Y- Yes Available

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Standard types of panels ●

Model 9060A, ICU Bed-Head Panel Wall mounted, mains operated bed-head panel for use on ICU / MICU / SICU beds, Pre / Post-Op recovery beds and resuscitation beds. Dimensions : 1800 mm L x 250 mm H x 65 mm D ● Model 9060B, Room Bed-Head Panel Wall mounted, mains operated bed-head panel for use on patient beds in private and deluxe wards. Dimensions : 1400 mm L x 25 mm H x 65 mm D ● Model 9060C, Ward Bed-Head Panel Wall mounted, mains operated bed-head panel for use on general ward beds, light duty day care and ambulatory patient beds, and exa m i n a t i o n / c o n s u l t i n g room beds. Dimensions : 880 mm L x 250 mm H x 65 mm D

Bed-head panel features Construction Medisystems bed-head panels are constructed from light weight extruded aluminium sheets and sections and stainless steel. These provide corrosion free properties suitable for use in humid and coastal areas. Metal fabrication: Panel fabrication is designed to suit any requirement viz horizontal, vertical, at wall angles, partially or fully embedded in the wall and most importantly, light in weight so that it minimises the static load on room walls – even those that are not of full brick construction but of such light materials as siporex, gypsum board, etc. Metal finish: Suitable grades of high temperature cured epoxy-polyester coats are selected for application after a seven bath protective treatment to the metal. This ensures life time protection to the metal surfaces coupled with ease of cleaning and ability to withstand damage from common hospital fluids – saline, drugs, blood, etc. Internal safety: Ensured through fitting safety metal partitions to prevent migration of high voltage electricals to low voltage electricals/ electronics and medical gas outlets. Wire contact points are also sealed with silicone or other adhesives, OCTOBER 2013

wherever vulnerable. Electrical harnessing: All electrical wiring is preinstalled at the factory through wiring harnesses to ensure zero error in wiring and complete safety through reliable electrical grounding. Isolation circuit breakers ensure complete safety for operation as well as site maintenance. During site installation, only the incoming mains and UPS wires need to be brought into the panel, for connection.

Medisystems 9070 patient bed lamps Patient-bed lamps are designed to accompany Medisystems bed-head panels or can be purchase individually. Medisystems patient-bed lamps have carefully profiled mirror optic

reflectors, to throw uniform light towards the bed areas for examination or reading purposes. They are available in 2 feet and 3 feet lengths and mounted at a height of 1.85 m on the wall behind the patient’s bed. Patient bed lamps are made in light weight powder coated aluminium with glass diffusers and mirror optic reflectors. They come pre-fitted with uplighter, downlighter and LED nightlamps. All lamps can operate independently. Made with energy efficient 14W or 21W T5 FTL’s and electronic ballasts, they have long lamp life, low electricity consumption and are quick and easy to replace by hospital staff. Each lamp has a colour temperature of 6500 K cool daylight designed to give over 1150 lumens of uniform lighting for bedside areas.

Medisystems 3100 medical rail and accessories Medisystems also offers a range of medical rail mountable accessories. Each of these accessories is fixed on one or more sliders which can be smoothly moved on the rail and fixed at any desired location along the length of the rail. Modern hospital practice requires a large cluster of accessories, devices, instruwww.expresshealthcare.in

ments and equipments to be located around the patient’s bed at all times. This is especially so for beds in the ICU, Post–Op and emergency areas. Usually, devices like bedhead panels and pendants are of considerable help in enabling an organised equipment cluster around the patient’s bed. The availability of one or more medical rails on such panels or pendants greatly enhances the utility of these devices, especially if along with the rail, a set of conveniently mountable accessories is also installed. Medisystems series 3100 Medical Rails are fabricated from 304 grade stainless steel. An internationally standardised section dimension is employed. This ensures that equipment from diverse sources can be mounted conveniently with the help of customised adaptors. Medisystems medical rails are supplied in pre-fitted lengths on the bed-head panel. As with Medisystems bed-head panels, the medical rails also require no maintenance whatsoever. They provide a lasting and reliable convenience. A range of medical rail accessories is available. These accessories are mounted on sliders which can easily move on the medical rail and be locked into position on any desired location along the length of the rail. Medical rail accessories are described below: Case sheet holders: Medical case sheet holders come in two sizes, small and large. The large one is sized to hold X-Ray and Sonography films as well. Case sheet holders are available in the standard version – powder coated aluminium, or in 304 grade stainless steel. Bowl holders: These are ring holders assembled to hold a standard 6” bowl or a larger 8” bowl. The ring holders and bowls are made of 304 grade stainless steel. Utility basket holders: These are handy stainless steel wire baskets for general purpose miscellaneous items. They come in two sizes small and large. Blood pressure instrument holders: Mercury or

dial gauge instruments can be mounted on the medical rail slider for convenient location and immediate availability behind the patient’s bed. I-V Pole assembly: A height adjustable stainless steel pole is mounted on a slider assembly. The pole is crowned with a hook arrangement for up to two IV bags. The availability of an I-V pole on a medical rail helps reduce floor space clutter around the patient’s bed. I-V Pole Assembly w / infusion pump stand: This assembly includes an infusion pump stand, mounted on the vertical limb of the I-V pole. The pole diameter is sized to mount all international brands of syringe and infusion pumps. A stack of four to six pumps can be accommodated. Suction bottle holder: This is a simple clamp to enable mounting of the suction bottle below the vacuum terminal when medical gas outlets have been brought out through the bed-head panel or the pendant. Examination lamp assembly: An articulated examination lamp is mounted on a slider for convenient location behind the patients bed. The examination lamp is fitted with a self-reflective spotlight bulb, or optionally a compact fluorescent or led lamp. When not in use, it can be swung out of the way but is always available for use when needed.

Rail slider clamp This is a bare slider which fits and slides on the medical rail. It can be used to mount any object or accessory of convenience onto the rail. With more than 175 installations in hospitals and nursing homes all over India and overseas, Medisystems undertakes the design, assembly, factory test, supply, delivery, field testing and commissioning of bed-head panels in standardised as well as almost any type of custom configuration or finish to meet the requirement of every type of hospital. Contact Vinay Thadani, Marketing email: medisystems@gmail.com EXPRESS HEALTHCARE

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ZHL@Healthex International 2013 Z ZHL seeks to build brand awareness and create a network at the event

iqitza Healthcare Limited (ZHL) participated in Healthex International 2013 which was held from 5-7 September, 2013 in Bengaluru. The event, which was attended by healthcare professionals across the country, helped ZHL to

spread more awareness about its brand and its activities. It served as a great networking platform and the ZHL stall gathered much interest and over 200 footfalls were generated over three days. The expo was attended by over 1000 delegates in

the healthcare domain and ZHL's presence helped create an impact about its services. The company plans to attend such more events in future as it would help to build a network and create brand awareness on a national and international forum.

Ideal software for hospitals: client server or web-based server? Kishore Shinde, VPHealthcare, Indisoft Consultancy Services expounds on the differences between client server and web-based server and deliberates on which is the ideal software for hospitals

ospitals and healthcare clinics require various kind of software to keep up with the latest technologies. However, the hospital administrators are often faced with the dilemma whether to opt for web-based solution or a client-server solution. Response to this problem actually depends on following factors like:

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Practice of the doctor Average number of patients in the hospital ● Current hospital infrastructure ● The budget for the software In this article we will discuss about the client server and web based server along with their differences, pros and cons. ●

The difference between web-based and client-server software Kishore Shinde VP- Healthcare, IndiSoft Consultancy Services

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Web Application is a software where one can access the web server through the Internet using the browsers, which can go through the intranet. The image below

explains the process further. Client server application is a software which has a designated server with its client; mainly it is a network setup known as intranet. A web-based software has lower upfront cost comwww.expresshealthcare.in

pared to client-server as it has fewer hardware requirements. All it requires is a good Internet connection and workstations with a browser. There is no necessity of having an in-house server as the data will be stored on the

web server. Fewer hardware requirement cuts the implementation cost as well. The customer needs to pay a monthly subscription fee and no need to purchase the software and licenses. The vendor will be in charge of mainOCTOBER 2013

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taining the upgrades, data backup and maintenance. Many physicians worry about the server being down and whether all the patient information is secured on the net. The server where the software is hosted has a backup system already in place in case of a server failure. Similarly, like a single clients setup there are setups of other clients as well, and even their data is on the same server. So the server downtime is hardly in minutes. Coming to the data security, the system where the data is placed are HIPAA compliant and the data is encrypted with high level of security. For example we all have our important information on Gmail or Yahoo account; most importantly our bank accounts are also available on the Internet. All these data are highly secure and encrypted. Now let us look at some pros and cons of web-based system

Pros of web-based system ●

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Implementation is very simple as the software runs on web and no installation on computer required

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Easier to deploy and upgrade (No IT expert required for installing and updating patches) Easy and ecured data accessible to physicians, staff and patients. (only Internet connection is required) Low upfront cost (N\no server, licensing fees and maintenance cost) Secured HIPAA complaint server Information is readily available at the click of button Improves business efficiency

ware licenses is what needs to be purchased. Initially the upfront cost is more as you need to invest in server, purchase software licenses and have backup devices but the cost is not recurring on monthly basis. Only AMC needs to done on an yearly basis and regular software updates can be received. The software needs to be installed on server and all the client terminals as well.

Pros of client-server system ●

Cons of web-based system ●

Vital time is lost if Internet connection is slow (totally depends on Internet connection) ● Depends on hosting vendor As for client-server, till date it is the most popular and many of the hospitals are using these systems. The system is faster compared to web-based and it doesn’t depend on Internet availability for accessing patient records. Only one server, required number of clients, along with the softwww.expresshealthcare.in

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Faster response time as the data is stored on local server Complete control over data

Cons of client-server system ● ● ●

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Initial cost is higher Regular maintenance of server adds up the cost Requires an assigned employee for checking network and regular backups Deploying is cumbersome software needs to be updated on all the terminals

Conclusion All the above factors need to be considered before making a final decision on the server. It depends on your practice, budget and availability of staff. If a client has multiple hospitals or diagnostic centres then webbased solution can support you keep a track of all the centres from anywhere. If an organisation has just started and has low budget and less technical expertise, even for them a web-based solution will be ideal. Now with growing technology the Internet connection has become extremely stable and the prices have dropped as well. For example; for a hospital which has a bigger set up and good IT expertise, require high performance and want the data to be stored on their server, then client-server is the right option for them, the only thing that the client needs to be assured of is a rock solid back up system in place. Contact Tel : 9892869870 Email : kishore.shinde@indisoftcs.com EXPRESS HEALTHCARE

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‘HCU systems help in performing efficient nerve and plexus blocks’ Dr Surinder M Sharma, Vice Chairman, Ortho-Anaesthesia, Medanta – The Medicity, Gurgaon in an interaction with Express Healthcare, gives an outlook about the key distinguishing characteristics about HandCarried Ultrasound system

INTERVIEW

Does it increase the safety profile of nerve block systems? Yes, it definitely does. Earlier, it was like a blind man even without a stick, but later nerve stimulators improved block outcomes. Now, the introduction of HCU has revolutionised the practice of administering nerve blocks. Needle guidance under direct visualisation helps avoiding vital structures like blood vessels, pleura, peritoneum etc. and injecting local anesthetic more accurately thereby enhancing the safety profile of the nerve block systems. For a successful regional anaesthetic block, anesthesiologists have to make sure of optimal distribution of local anaesthetic around nerve structures.This goal is achieved most effectively under ultrasound visualisation. It can significantly improve the quality of nerve blocks in almost all types of regional anaesthesia. In addition, complications such as intraneuronal injection can be avoided.

When did you start using ultrasound and how long you have been using it? I started using ultrasound in the year 2004.Today, I use it extensively in almost every procedure.Technological advancements in ultrasound systems are providing great benefits in point-of-care (POC) delivery.

What do you find most useful about Hand-Carried Ultrasound (HCU) system in POC? The easy portability of the HCU systems is the key distinguishing characteristic. Being lightweight, it can be carried directly to the patients, enabling one to perform safe and efficient nerve and plexus blocks with quicker and more informed diagnostic decisions.

Are these hand carried ultrasound systems user friendly? SonoSite HCU system is easy to understand. It boots up very quickly and has excellent image quality with good battery backup.These are the desired key features that a healthcare practitioner always seeks in a system. It is rightly said that you only see what you know. Hence, anesthesiologists need to develop a careful understanding of the anatomical structures involved, and acquire proper understanding of ultrasound technology for the practical use of visualising nerve structures.

How accurate and efficient is HCU in nerve blocks and plexus blocks? What are the benefits of point of care ultrasound? In the past, there were no other modalities available to see the position of the needle and parasthesias were actively sought. Parasthesia for anaesthesia was the order of the day. But blind blocks that relied solely on anatomical landmarks and/or fascia clicks sometimes used to be

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ic in real time. In addition, the amount of local anaesthetic needed for effective nerve block can be managed by directly monitoring its distribution.

How efficient is HCU in putting perineural catheters?

USAGE OF HCU REDUCES BLOCK PERFORMANCE TIME AND ENABLES DIRECT VISUALISATION OF THE DISTRIBUTION OF LOCAL ANAESTHETICS traumatic and could lead to serious complications during procedure. The usage of HCU reduces block performance time and enables direct visualisation of the distribution of local anaesthetics. High quality imaging probes improve efficiency and help avoid complications.This has changed the perception of avoiding paraesthesia to avoid dysaesthesia. At the time when pain is severe and there is an urgent need to infuse the anaesthetic fluid, ultrasound guidance enables the anesthesiologist to secure an accurate needle position to monitor the distribution of the local anaesthet-

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I have been placing perineural catheters for quite some time, but since I have started using the ultrasound technique, it has made things easier. Use of point-of-care ultrasound guidance can potentially decrease neuraxial damage while correctly placing a perineural catheter.

Any role of nerve stimulator along with ultrasound? Initially, if the physicians are not well versed in the basics of ultrasound imaging they may use a nerve stimulator to identify specific nerves, as basic understanding of ultrasound theory is vitally important for the safe use of this technology.The physician’s knowledge of anatomy is fundamental to the safe practice of ultrasound-guided regional anaesthesia. However, when the physician has enough knowledge in using the ultrasound technique, there is a limited role of a nerve stimulator e.g. in deeply placed nerves. As a nerve stimulator causes muscle contractions, often patients may not be comfortable. Soon patients may ask for a block with a scanner rather than a blind procedure/nerve stimulator. OCTOBER 2013

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