Express Healthcare March, 2014 by Indian Express

VOL.8 NO.3 PAGES 84

Cover Story Healthcare leaders: Champion women Strategy TB control in India: Role of private sector

www.expresshealthcare.in MARCH 2014, `50

Knowledge Out of the crisis: Breathing new life into medical education in India

GE Healthcare

Give newborns the care they deserve with Lullaby LED Phototherapy Here’s how: Optimal wavelength of 458nm

Superior Clinical Performance Savings of up to Rs. 462,000*

Cost Savings Removable incubator head and no fan

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RoHS COMPLIANT 2002/95/EC

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Interpreting the rhythms of the heart

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CONTENTS MARKET Vol 8. No 3, MARCH 2014

Chairman of the Board Viveck Goenka

QUEST DIAGNOSTICS INDIA INTRODUCES BRC AVANTAGE

BAD HABITS ADD $33.9 BN TO ANNUAL GLOBAL COST OF CANCER: GE HEALTHCARE RESEARCH

FLUKE BIOMEDICAL ACQUIRES UNFORS RAYSAFE

BM BIRLA HEART LAUNCHES ‘24X7 CHEST PAIN CLINIC’

TRANSASIA OFFERS EXTERNAL QUALITY ASSURANCE PROGRAMME

KOLKATA TO HOST THE 14TH WORLD CONGRESS ON PUBLIC HEALTH IN 2015

‘HCL HEALTHCARE INTENDS TO PROVIDE PATIENTCENTRED CARE FOR OVER 20 MILLION PEOPLE BY 2020’

‘ASTER DM HEALTHCARE GROUP PLANS TO INVEST RS 300 CRORES IN THE INDIAN MARKET’

‘THE COLLABORATION HAS POTENTIAL TO BECOME A POWERFUL SYMBIOTIC RELATIONSHIP’

Editor Viveka Roychowdhury* Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale Usha Sharma Raelene Kambli Lakshmipriya Nair Sanjiv Das Delhi Shalini Gupta DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Layout Vivek Chitrakar Photo Editor Sandeep Patil MARKETING Deputy General Manager

Immunotherapy– A‘rayof hope’ in recurrent miscarriages Dr Mohan Raut and Dr Mugdha Raut,Co-Founders of Immunotherapy Centre for Prevention of Repeated Miscarriages,elucidate on the reasons for failed pregancies,and the benefits of immunotherapyin preventing recurring miscarriages | P39

STRATEGY

Harit Mohanty Assistant Manager

Kunal Gaurav PRODUCTION General Manager

TB CONTROL IN INDIA: ROLE OF PRIVATE SECTOR

KNOWLEDGE

B R Tipnis Manager

Bhadresh Valia Sr. ExecutiveScheduling & Coordination Rohan Thakkar

OUT OF THE CRISIS: BREATHING NEW LIFE INTO MEDICAL EDUCATION IN INDIA

Mohan Varadkar

54 37

BLUEPRINT FOR EMR ADOPTION IN HEALTH ORGANISATIONS

LIFE

PEOPLE

TRADE & TRENDS

CLEANROOM GLOVES OR MEDICAL GLOVES?

RXOFFICE WEBBASED HOSPITAL MANAGEMENT SYSTEM

RADIOLOGY

CIRCULATION Circulation Team

IT@HEALTHCARE

RGCI: AT THE FOREFRONT OF TECHNOLOGY

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 newsunder 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.

EDITOR’S NOTE

Champions of change

ll the women featured in this year's Express Healthcare Women's Day Special are leading lights of the healthcare sector in India and have chipped away at traditional notions of what it is to be a woman leader. Ameera Shah of Metropolis Healthcare did not have it easy even though she was taking her father's dream forward and was familiar with lab processes since she was a child. She worked her way up the ladder and earned the respect of the industry. Ardra Kurien, Administrator of KIMS Pinnacle Comprehensive Cancer Center, feels that women entrepreneurs are changing the face of business houses with their vibrant ideas and sensitivity while Betoshini Chakraborty, MD, Bardhaman Healthcare and FAITH Healthcare, believes that the ability of women leaders to not just lead from the front but also bring people along with them on that journey makes them better team builders and sometimes better at resolving conflict in business. In 1988, when Dr Indira Hinduja, Honorary Gynaecologist, PD Hinduja National Hospital and Medical Research Centre, pioneered the gamete intrafallopian transfer (GIFT) technique and gave India its first GIFT baby, she was offering women not just cutting edge technology and technique but extending the gift of motherhood. She was in a sense, beating both time and Mother Nature. Other luminaries like Jagruti Bhatia, Senior Advisor, Healthcare, KPMG India have used their position to lobby for what they believe in. In her case, Bhatia lent her voice to support and promote green practices in healthcare. As a serial entrepreneur, Meena Ganesh, Co-founder & CEO of Portea Medical, honed her skills in other areas before she and her husband turned to healthcare, which she feels plays right to the strength of women. Part of another power-entrepreneur couple, Sunita Maheshwari is Chief Dreamer of RXDX and Teleradiology Solutions as well as a practising paediatric cardiologist. She believes that being an entrepreneur is actually very liberating for a woman as she can choose her

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March 2014

In spite of having so manywomen leaders and entrepreneurs in the healthcare sector, the average woman in India still does not have access to adequate healthcare

work hours and hence has a better chance of achieving a work-life balance. That should be encouragement for more women in the healthcare sector to make their vision a reality. MD of Wockhardt Hospitals, Zahabiya Khorakiwala in fact quotes studies and research that prove that women on an average have a higher EQ than men and as one moves higher up in an organisation in terms of role and responsibility, the softer skills become a much greater requirement for performance. But in spite of having so many women leaders and entrepreneurs in the healthcare sector, the average woman in India still does not have access to adequate healthcare. India is a signatory to the Millennium Development Goals (MDGs) but as of now it looks as if we will miss meeting both the fourth MDG (reducing child mortality) and the fifth (improving maternal health). It’s not rocket science to see that taking care of the mother's health will automatically result in a healthier infant. So even though there has been a slight improvement in maternal mortality ratios (MMR), more work on MMR will in turn improve the infant mortality rate (IMR) as well. If art reflects reality, maybe our society has reached a tipping point. Main Kuch Bhi Kar Sakti Hoon (I can do anything), a tele-series to be launched on March 8, International Women's Day, is being positioned as a "catalyst for change" say mother-daughter duo Sharmila Tagore and Soha Ali Khan, who are championing this cause. Through the series, the producers hope to provide a platform for strong women characters mirroring the title’s claim. It is indeed worth noting that the female lead is a doctor, proof that society respects a woman as a doctor and also the notion that she can be a change-agent. This is amply borne out by the women we've featured in this issue; both practising doctors as well as those in healthcare delivery. We hope to feature many more such role models in future issues. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

QUOTE UNQUOTE

‘The state of healthcare is dismal. We are not against private healthcare, but it shouldn't take the place of public healthcare services. Relying too much on private medical care, without the availability of public health services will allow exploitation of underinformed patients and their families, because of the asymmetric nature of healthcare knowledge’ Nobel laureate Amartya Sen (Addressing the press conference at the 11th Kolkata Group workshop)

‘The life sciences sector offers a wide ranging career and entrepreneurial opportunities to women scientists, engineers and business graduates. India has an important role to play in drug research, bio-pharma manufacturing and marketing. I would urge women to pursue these opportunities with zestful interest.’ Kiran Mazumdar-Shaw Chairman and MD, Biocon

HEAD OFFICE Express Healthcare Kunal Gaurav The Indian Express Ltd, 1st Floor, Express Towers, Nariman Point, Mumbai-400021. India Tel: 67440519/502 Fax: 022-22885831 Mobile: 09821089213 E-mail: kunal.gaurav@expressindia.com kunalexpressindia@gmail.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express Limited, Basement, Express Building, 9 & 10 Bahadur Shah Zafar Marg, New Delhi, 110 002 Direct Line: 011-2346 5727 Board Line: 011-2370 2100-107 Ext-727 Mobile: 09999070900 E-mail: ambuj.kumar@expressindia.com Our Associate: Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com CHENNAI Dr Raghu Pillai

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MARKET NEWS

Quest Diagnostics India introduces BRCAvantage Expands patient access to BRCA genetic testing for inherited breast and ovarian cancers, in line with company’s focus on providing access to specialised cancer diagnostics services in India

QUEST DIAGNOSTICS India has announced the availability of BRCAvantage, a suite of labdeveloped genetic tests (LDT) that identify mutations in BRCA1 and BRCA2 genes,

which are associated with increased risk of inherited breast and ovarian cancers. The test offering in India follows Quest’s introduction of BRCAvantage to the US in October

2013, and expands on the company’s goal to provide a wider menu of advanced cancer services in India. The BRCAvantage service for India provides several of the same features as the

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: Express Towers, 2nd Floor Nariman Point,Mumbai-400 021 : MONTHLY : MS. VAIDEHI THAKAR : Yes : Express Towers, 2nd Floor Nariman Point,Mumbai-400 021 : MS. VAIDEHI THAKAR : Yes : Express Towers, 2nd Floor Nariman Point,Mumbai-400 021 : Ms.Viveka Roychowdhury : Yes : Express Towers, 1st Floor Nariman Point,Mumbai-400 021 : The Indian Express Limited Express Towers, Nariman Point, Mumbai 400021 : Indian Express Holdings & Entp Limited Express Towers, Nariman Point, Mumbai 400021 : Mr. Viveck Goenka & Mr. Anant Goenka Express Towers, Nariman Point Mumbai 400021 : Mr. Shekhar Gupta & Mrs. Neelam Jolly C-6/53, Safdarjung Development Area New Delhi 110 016

I, VAIDEHI THAKAR., hereby declare that the particulars given above are true and to the best of my knowledge and belief.

Date : 1/3/2014

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sd/VAIDEHI THAKAR Publisher

service in the US. These include the use of advanced next-generation sequencing technologies by the Quest Diagnostics Nichols Institute in San Juan Capistrano, California, US and access to genetic counselling in India to help patients and clinicians assess whether testing is appropriate. Patients can also access free home-collection services in 25 cities across India. The BRCAvantage test helps to identify mutations (abnormal changes) in two genes. These genes are called BRCA1 and BRCA2. Changes in the BRCA1 and BRCA2 genes are responsible for increasing the risk of hereditary breast and ovarian cancer and associated cancers in women, and for prostate and breast cancer among men. In India, breast cancer is the most commonly occurring cancer in women, with the relative proportion of women with cancer affected ranging from 19.3 per cent to 27.5 per cent (ICMR 2006). While large-scale studies are not yet available on the prevalence of breast cancer due to BRCA mutations in women in India, in western countries, an estimated five per cent to 10 per cent of female breast cancers are due to inherited gene mutations, with BRCA1 and BRCA2 gene mutations the most commonly identified causes. Patients that are at high risk for a BRCA mutation may seek to identify their mutation status so as to make prophylactic decisions, such as more frequent screenings or surgery. Based on medical guidelines, BRCA testing is recommended

for people with an immediate family member diagnosed with breast cancer at age 45 or younger; a personal history of breast cancer at age 45 or younger; a family member diagnosed with ovarian cancer at any age; a personal or family history of both breast and ovarian cancers on the same side of the family; a personal or family history of male breast cancer or a personal or family history of bilateral breast cancer (both breasts). Commenting on the initiative, Mukul Bagga, MD, Quest Diagnostics India said, “BRCAvantage is aimed at increasing access to testing for at-risk patients and leveraging the diagnostic insights for making empowered health choices. This new offering demonstrates our passion for bringing in the latest technological innovation and expertise in cancer diagnostics to India.” Dr Anurag Bansal, Head of Medical, Quest Diagnostics India added, “Ensuring that patients and individuals have access to a genetic test that has clinical value is important. Patients need to understand their cancer risks so they can make the most informed and timeliest decisions about their health. Although not every individual needs to get tested for BRCA mutations, now that the test is more widely available, patients who could benefit from BRCA testing will be able to access this service from a quality provider.” EH News Bureau

MARKET

Bad habits add $33.9 bn to annual global cost of cancer: GE Healthcare Research attributable for $160 million of the cost to treat colon cancer globally. Up to half of all cancer-related deaths can be prevented by making healthy choices, like maintaining a healthy weight, not smoking, eating properly, being physically active and undertaking recommended screening tests. However, this research and World Health Organization (WHO) data shows that bad habits continue to be prevalent in all markets. In seven of ten markets, over 25 per cent of those populations are still regular smokers. Smoking is most prevalent in France and Turkey where 31 per cent of adults over the age of 15 are smokers. French females and Turkish males were ranked highest groups for smokers at 31 per cent and 47 per cent respectively. In terms of physical inactivity Saudi Arabia and the UK ranked bottom. 68.8 per cent of Saudi nationals and 63.3 per cent of British nationals over the age of 18 lead sedentary lifestyles, compared to only 15.6 per cent of Indians and 28 per cent of Germans.

FLUKE BIOMEDICAL, a leading manufacturer of biomedical test instruments, announced the acquisition of Unfors RaySafe. With this acquisition Fluke Biomedical adds devices for diagnostic X-ray from Unfors RaySafe to its portfolio to broaden its customer base. Fluke Biomedical aims to provide healthcare providers, institutions and medical device manufacturers with a complete portfolio of test equipment. “The fact that our companies share a similar culture is an ideal basis for continuing our excellent relationships with our employees, customers and partners,” says Magnus Kristoferson, CEO, Unfors RaySafe. “We have experience in highly specialised markets all over the world, we know our business and we can now maximise our competencies. In the past, Unfors RaySafe has attracted the attention of the market not just for the functionality and measurement accuracy of its products, but also for the attractive design and intuitive user interface,” he added. Fluke Biomedical General Manager, Eric Conley says, "The acquisition of Unfors RaySafe brings to Fluke Biomedical a strong team that has delivered leading innovation to the radiation test and safety markets. The combination of Unfors RaySafe and Fluke Biomedical accelerates our ability to provide a broad portfolio of world class test equipment to our customers." With worldwide sales and distribution channels, Fluke Biomedical anticipates growth through innovative design and creative solutions for their customers.

EH News Bureau

Research reveals that reducing bad habits such as smoking, alcohol consumption, poor nutrition and physical inactivity could potentially save $25 billion each year globally

GE HEALTHCARE'S secondary research findings indicating that bad habits and lifestyle choices are contributing approximately $33.9 billion annually to the costs related to cancer. Furthermore, the same research revealed that by reducing bad habits, global healthcare systems could potentially save $25 billion each year. The research conducted by GfK Bridgehead on behalf of GE Healthcare in May and June 2013 focused on four key bad habits; smoking, alcohol consumption, poor nutrition and physical inactivity and their relationship to three types of cancer – breast, lung and colon. The study calculated the cancer costs attributable to bad habits in ten developed and developing markets. “The cumulative global cost of bad habits revealed in this research is staggering. I am encouraged by the potential savings that could be achieved by all of us just making a few small lifestyle changes and committing to a personal monitoring schedule,” said Jeff DeMarrais, Chief Communications Officer, GE Healthcare. “This data reinforces why our annual #GetFit campaign is so important in driving education

The research also breaks down the $33.9 billion annual global cost across ten markets and includes the current annual cost of treating cancer and the calculated potential annual savings and awareness of the link between healthy choices, early diagnosis and the possible risk of cancer.” The research also breaks down the $33.9 billion annual global cost across ten markets and includes the current annual cost of treating cancer and the calculated potential annual savings. The US with $18.41 billion or 54 per cent of the total current annual global cost of cancer is followed by China at $8.57 billion (25.3 per cent) and France, Germany and Turkey at around $1.5 billion (4.4 per cent). Developing markets such as Brazil with $378 million (1.1 per cent) and Saudi Arabia $107 million (0.3

per cent) currently have significantly lower annual costs of cancer at this point. While it has been long established that tobacco use is linked to the development of lung cancer, the data revealed that other bad habits, such as inactivity and poor nutrition, can also impact the risk of cancer. For example, inactivity and poor nutrition are often associated with weight gain, but this research also demonstrated that men who are inactive have an increased risk of developing colon cancer (relative risk score = 1.61, which means 61 per cent more likely to develop colon cancer than someone who is active). As a result, inactivity can be

Fluke Biomedical acquires Unfors RaySafe

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March 2014

MARKET

BM Birla Heart launches ‘24X7 Chest Pain Clinic’ Main objective would be to evaluate, diagnose and treat heart diseases in least possible time BM BIRLA Heart Research Centre, Kolkata, a leading super-specialty hospital recently launched its ‘24X7 Chest Pain Clinic.’ Janab Firhad Hakim, Minister for Municipal Affairs & Urban Development, West Bengal inaugurated the clinic in the presence of Rupak Barua, CEO, BM Birla Heart Research Centre, Kolkata. Later elaborating on the initiative, Barua told Express Healthcare, “This initiative by B M Birla Heart will not only help people understand the symptoms but also provide inputs on prevention. The centre aims to provide quality cardiac care to the patients and meet their urgent and critical needs. Keeping in mind that 85 per cent of heart muscle damage occurs during the first two hours of a heart attack and ir-

Janab Firhad Hakim, Minister for Municipal Affairs & Urban Development, West Bengal inaugurating the ‘24X7 Chest Pain Clinic’ in the presence of Rupak Barua, CEO, BM Birla Heart Research Centre, Kolkata

reversible damage starts within minutes, we have set up

the state-of-the-art infrastructure manned by trained per-

sonnel to diagnose the cause of chest pain and provide emer-

gency treatment. The main objective of our heart specialists would be to evaluate, diagnose and treat these symptoms in as little time as possible to not only save the person's life.” Barua claimed this as to be the first initiative in the eastern part of the country. He said, “Patients who feel pain in the chest, suffer from breathlessness or any other kind of complications can dial a dedicated number at any time of the day and we will pick up the patient from his / her residence and rush to the hospital in a fully-equipped ambulance.” The intent of this initiative is to deal with acute chest pain and to provide patients with proper medical attention required. EH News Bureau

Manipal Hospitals forays into Rajasthan Acquires a 280-bed hospital in Jaipur

MANIPAL HEALTH Enterprises, the healthcare arm of the Manipal Education and Medical Group, announced its foray into Rajasthan through SK Soni Hospital in Jaipur. This significant expansion of footprint by Manipal Hospitals is in line with its extensive growth plans which the group is now aggressively implementing. This also marks the entry of Manipal Health Enterprises into North India. The new venture will be renamed as Soni Manipal Hospital. The

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group plans to invest Rs 100 crores in Rajasthan towards healthcare. The Soni Manipal Hospital will offer a healthy combination of wellness, prevention and curative care to patients in Jaipur, as well as to the other nearby districts of Rajasthan. According to Swami Swaminathan, Executive Chairman, Manipal Health Enterprises, “This development is a part of our ongoing growth strategy to expand

The group plans to invest Rs 100 crores in Rajasthan towards healthcare

footprints in India and identified countries of the Middle East, Africa and ASEAN. We are presently executing on this growth strategy by adding to our capacity. This development is coming soon after the recent acquisition of an operational hospital and also building a new one in Kuala Lumpur.” He also added, “Enhancing medical tourism in Rajasthan will be another area where we will look for opportunities.” Speaking on the occasion

Rajen Padukone, MD and CEO, Manipal Health Enterprises said, “Manipal is a wellestablished name in Jaipur, with the presence of Manipal University, Jaipur. This is Manipal Group’s first healthcare foray into North India. With our presence in Jaipur through Soni Manipal Hospital, we will provide quality healthcare to the people of this historic city and its neighbouring regions.” EH News Bureau

MARKET

Transasia offers external quality assurance programme Aims to provide improved patient care through excellent laboratory performance TRANSASIA BIO-MEDICALS offers External Quality Assurance (EQA) programme ie. ERBA Mannheim Quality Assurance System (EMQAS) which provides inter-laboratory comparison and peer group statistics. It reportedly enables the laboratory to monitor analytes performance by method and instrument specific peer group comparison. Key highlights of the programme are : ◗ Exclusive programme for routine clinical biochemistry parameters ◗ Conducted bi- annually, with cycle of six months ◗ 26 clinical biochemistry parameters providing flexibility of selection from analytes ◗ Report pattern is based on Z Score and multi-guard rule of QC ◗ ‘Certificate of participation’ and ‘Certificate of Excellence’ are issued Key features of the programme include: ◗ Human serum controls (Lyophilized) ◗ Method wise and instrument wise report with most advanced histograms and Levy Jennings charts ◗ Technical support from strong R&D team ◗ Easy access to online EMQAS portal ◗ Monthly evaluation report with analyte specific report and summary report, online. Transasia manufactures and markets equipment and reagents, with an impressive install base of around 38,000 equipment across India. Transasia also exports to more than 90 countries in five continents. EH News Bureau

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MARKET PRE EVENT

Kolkata to host the 14 World Congress on Public Health in 2015 th

World Congress to be held under the theme “Healthy People – Healthy Environment”

THE 14TH World Congress on Public Health (WCPH) “Healthy People – Healthy Environment” will be held from February 11 to 15, 2015 in Kolkata, India. J Chauvin, President, World Federation of Public Health Associations (WFPHA )and Co-Chair 14th WCPH - International Core Organizing Committee said, “The World Congress on Public Health is a unique opportunity for the global public health community to come together to learn from each other and to adopt new, more effective ways to help people improve and protect their health. The WFPHA is delighted to be associated with the Indian Public Health Association (IPHA) in hosting

this important event." Chauvin further said, "The theme of the 14th World Congress on Public Health is very timely and pertinent. 'Healthy People - Healthy Environment' provides a forum wherein public health professionals from around the world will explore how environments, be they the built environment, the political and legal environment, the socio-cultural environment, the economic and financial environment, our ecosystem environment and the infrastructures society has created, including our health care systems, affect the health and well-being of people, whatever their life circumstances. This will be an exciting event, identifying ways and means to help communities and coun-

tries respond to the challenges to achieving Health for All.” It will provide a unique opportunity to help catalyse change, bringing together and bridging perspectives from various disciplines of public health to influence governments, organisations, agencies and institutions around the world to meet the challenge of improving people’s health. Participants of the congress is expected to include delegates from public health associations of the world, as well as representatives from the public and private sectors, representatives from public health related sectors and NGOs based in member states of the World Federation of Public Health Associations.

The key themes of the plenary sessions will be: Stream 1: Defining the role of public health in today's global setting Stream 2: Public health in the sustainable development agenda Stream 3: Public health approaches to address new challenges of sustainable development and healthy environment Stream 4: Global public health challenges Stream 5: Human rights and law as tools for sustainable development Dr Madhumita Dobe, Organising Secretary 14th WPCH 2015 said on this occasion, “Twelve congresses have taken place so far and the opportunity comes to India after

a long hiatus of more than 30 years, during which the global public health scenario has changed with a lot of exciting initiatives. The 14th World Congress on Public Health is expected to provide opportunities to the global public health community to get together and deliberate on important issues. It will also serve as a platform to showcase India’s efforts and for sharing knowledge and experiences of public health professionals from over the world. There will be sharing of experiences, knowledge exchanges, debate, discussion and learning about effective policies, programmes and best practices in support of the public's health.”

S IU to organise national seminar XVIth National Seminar on Hospital/Healthcare Management, Medico Legal Systems & Clinical Research to be held from May 2-3, 2014

SYMBIOSIS INSTITUTE of Health Sciences, a constituent of Symbiosis International University (SIU), is organising the XVIth National Seminar on Hospital/Healthcare, Medico Legal Systems & Clinical Research to be held on May 2-3, 2014 at Lavale, SIU, Pune. This annual event reportedly attracts over 1000 delegates

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from all verticals of healthcare such as doctors, medico legal lawyers, insurance and IT professionals, NGO, hospital administrators and clinical research professionals. The event boasts of stalwart speakers, contemporary topics and provides an opportunity for professional upgradation, liaison and networking. The

seminar will be inaugurated by Dr Rajani Gupte, Vice Chancellor, SIU. The Indian healthcare sector is expected to become a $280 billion industry by 2020 with spending on health estimated to grow 14 per cent annually. To elaborate on this phenomenon, a pre-conference symposium on 'Successful

Healthcare Models' has been structured. The session will be anchored by Rajan Padukone, CEO & MD, Manipal Health Enterprises. The session will have stalwarts covering the hospital, pharma, medical devices and IT sectors. To name a few; Dr Harish Pillai, CEO, Aster Medicity, Dr GSK Velu, Founder & MD, Trivitron

Group of Companies and Sadananda Reddy, MD, Goldstar Healthcare. The pre-conference symposium will be followed by select paper presentation by delegates. A session on ‘The Strategic Management in Healthcare,’ guided by Daljit Singh, President, Fortis Healthcare following the paper presenta-

MARKET tion promises to be an intellectually stimulating insight into the strategies followed by successful healthcare organisations. The seminar also comprises four intensive, domain specific master class sessions wherein delegates will get an opportunity to interact with industry experts on a one-to-one basis for knowledge sharing. A session which promises to deliver an inside ring-side view on ‘Game Changers in Healthcare: Primary Healthcare’ will be discussed by Dr Gautam Sen and Kaushik Sen, CMD, Wellspring. Dr Om Manchanda, CEO, Dr Lal PathLabs will cover the diagnostic sector, hospitals being covered by Zahabiya Khorakiwala, MD, Wockhardt Hospitals and Dr Adheet Gogate, MD, HealthBridge Advisors would discuss on entrepreneurship. A talk in sync with today’s workforce expectations and demands will be conducted by Dr Azad Moopen, Chairman, Aster DM Healthcare by way of a session on ‘Challenges in Workforce Management in Hospitals’. The final master class session on ‘Special Laws and Legal Framework: Surrogacy, PCPNDT, Clinical Establishment Act, Transplantation of Human Organs Act 1994 (THOA)’ will be presided over by Dr Sanjay Gupte, Past President, FOGSI. Day 2 of the XVIth National Seminar would reportedly comprise a horde of industry experts talking on several industry-relevant subjects. Medical tourism has captured the interest of the media. There is a compelling need for all parties involved in healthcare to become familiar with medical tourism and to understand the economic, social, political, and medical forces that are driving and shaping this phenomenon. Driving this concept home will be Pradeep Thukral – Founder & CEO SafeMedTrip.com who will talk on ‘Medical Tourism: Present & Future’. Franchising is fast becoming the ‘in’ thing in healthcare industry. To understand the fundamentals of successful franchise models and overcome challenges faced, a

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session on ‘Franchising in Healthcare’, comprising CK Kumaravel, Chairman – Indian Franchise Association (IFA), Dr Sanjay Arora, DirectorSuburban Diagnostics from the diagnostic sector has been organised. Health insurance business involves managing large repositories of data and information.

It is critical to understanding the health profile of the country and plan accordingly. The topic, ‘Health Insurance - Universal Health Insurance: Opportunities and Challenges’ shall be discussed by Yegnapriya Bharath, Joint Director, Health Insurance, IRDA. Ensuring quality healthcare delivery is the focus of all

activities in healthcare organisations. To achieve this requires multipronged strategies and standards. To ensure quality in healthcare, accreditation of hospitals is the buzz word. Taking the audience through the process of quality assurance will be Dr Yash Paul Bhatia, MD, Astron Hospital and Consultants, who will talk

on ‘Quality & Accreditation of Hospitals and Healthcare’. In recent years, the increasingly global nature of health research has given a rise to a plethora of drugs which are being brought out into the market. ‘Pharmacovigillance’, deals with the post-marketing

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SIU to organise National Seminar surveillance of a drug. Talking on this issue will be Dr ChandrashekharPotkar – Medical Advisor, Pfizer. Many decisions that healthcare professionals must make each day are affected by legal principles and have potential legal implications. Because law is in a constant state of flux, healthcare management personnel must stay updated on the knowledge of the medico legal law. The topic, ‘Legal As-

pects of Healthcare’ (landmark judgements) shall be discussed by Dr Gopinath N Shenoy, Medico Legal Consultant Worldwide all major pharma companies have a clinical trials regulatory affairs department comprising of people with many years of experience gained within pharma firms, academia and clinical research institutions. What entails ‘Regulatory Affairs in Clinical Research’

shall be dealt Dr Raman Gangakhedkar, Deputy Director, NARI. The Valedictory Ceremony will be graced by Chief Guest – Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare. The Guest of Honour for the ceremony will be Adv Ram Jethmalani, Former Union Law Minister and Dr Vidya Yeravdekar, Principal Director, Symbiosis. The ceremony will be presided

over by Padma Bhushan Dr SB Mujumdar, President & Founder Director, Symbiosis and Chancellor, SIU. The National Seminar aims to provide an ideal platform for the exchange of ideas in the critical healthcare field. A free flow of information and ideas will certainly enhance the march of healthcare sciences and herald the beginning of a new era in this sunshine industry. It is a must attend event for

professionals from all verticals of healthcare. Contact Dr Rajiv Yeravdekar Dean, Faculty of Health & Biomedical Sciences, SIU Phone: 91-020-25655023, 25667164, 20255051, 08888892258, 9552552009. Email: info@schcpune.org, dep@schcpune.org, manager@schcpune.org Website: www.schcpune.org

POST EVENT

RGCI & RC organises its 13th Annual International Conference on lymphoma RGCON 2014 provided a platform to the medical fraternity from India and abroad to discuss insights on lymphoma

RAJIV GANDHI Cancer Institute & Research Center, Delhi, organised its 13th annual conference RGCON 2014 on Lymphoma at Indian Habitat Center. The conference was held to address new breakthroughs in Lymphoma, beginning from symptoms to detection, treatment and rehabilitation. The two-day conference was inaugurated by Dr T Ramaswamy, Secretary, Science & Technology, Government of India in presence of Guest of honour Dr GK Rath, Professor & Head, Radiation Oncology, Rotary Cancer Hospital, AIIMS. RGCON 2014 was themed ‘Lymphoma- Biology to Therapy’. Reportedly, renowned cancer experts from across the globe shared the stage in seven sessions of panel discussions, presentations and case studies with leading Indian practitioners, survivors and

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their family during the two day conference. The conference focussed on various new developments in prevention, diagnosis, treatment and care for lymphoma. Dr Anurag Mehta, Secretary, Organising Committee, RGCON 2014 and Director, Lab and Blood Bank Services, Rajiv Gandhi Cancer Institute & Research Center, expressing his happiness over the success of the event said, “This year our annual conference was held with an aim to raise awareness, initiate dialogue and share recent technology updates to combat lymphoma. We had Dr Ranjana H Advani, Stanford University Medical Center, Prof. Dr Stefano A Pileri, Director of Heamatopathology Unit, Bologna University School of Medicine, Italy, Dr S David Hudnall, Director of Heamatopathology, Yale University School of Medicine, Dr

Wolfgang Hiddemann, Ludwig-Maximilians Universitat (LMU), Germany and other well known cancer experts from India and abroad, sharing their experiences and technological updates on lymphoma. Some key topics covered during sessions were Evolution of Lymphoma, Classification and Diagnosis, Case

studies of some interesting cases of low grade lymphomas, Early Stage of Hodgkin Lymphoma: Chemotherapy & Radiotherapy, Treatment of Hodgkin Lymphoma in Children, Elderly and Pregnant Women, Dietary & Other Issues etc.” Dr Vineet Talwar, Senior Consultant Oncology, Rajiv

Gandhi Cancer Institute & Research Centre underlined the achievements of RGCON 2014 in discussing the gravity of the situation of lymphoma, “Lymphoma may develop in the lymph nodes, spleen, bone marrow, blood or other organs and eventually form a tumour. Today, thousands suffer from Lymphoma in India, and millions across the globe. According to the National Cancer Institute 69,740 cases of non-Hodgkin lymphoma were diagnosed in 2013 alone. Lymphoma is one the deadliest and perhaps the fastest spreading cancer in the world. At RGCON all participants together focussed on the ways to end or at least control lymphoma cancer. We speccially focused on lymphoma and its cure as we did not want to dilute the discussions with other more well-known forms of cancers like breast and lung cancer.”

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Glocal Healthcare presents Litmus Test, an open clinical skills contest Dr Jimmy Barua from Calcutta National Medical College bagged the first prize

GLOCAL HEALTHCARE, a social enterprise based in Kolkata unveiled its first commercial product, LitmusDx, in a first-of-its-kind medical quiz contest at Calcutta National Medical College. The product is a cloud-based software solution that aims to provide an integrated clinical decision support and electronic medical record solution for private practitioners and small medical practices. The competition, aptly named Litmus Test,

was designed to test the clinical diagnostic skills of participants and attracted medical students from various institutions across the city. In addition to a stiff contest between the six finalists, audience members and participants witnessed a very innovative use of LitmusDx, wherein contestants could utilise the clinical decision support system (LitmusDx) as a lifeline to answer the more challenging questions. Dr Jimmy Barua

Dr Jimmy Barua (right) from Calcutta National Medical College receiving the first prize

Dr Sabahat Azim, CEO, Glocal Healthcare addressing the audience

from Calcutta National Medical College put the available resources to good use to bag the first prize and walked away with the prize money of Rs 50,000. After the initial success in Kolkata, Glocal Healthcare next plans to take this contest to different parts of the country. Future events are being planned in Delhi, Bangalore, Hyderabad, Chennai, Mumbai and Trivandrum.

3 Annual Health 2.0 Conference held in Bangalore rd

Experts forecast growth in wearable device market and quality healthcare delivered through innovative ways! THE THIRD annual conference of Health 2.0 was held recently at Bangalore, India. The conference witnessed the presence of budding entrepreneurs and corporates from healthcare, pharma, IT industry and start-ups. Over 40 Indian and international companies participated in the two-day event to get insights, ideas, case studies and analysis, solutions for healthcare challenges from Indian and international experts. Health 2.0 has introduced over 500 technology companies to the world stage, hosted more than 15,000 attendees at their conferences and code-a-thons, awarded over $5,277,000 in prizes through

their developer challenge programs and inspired the formation of 70 new chapters in cities around the globe. Health 2.0 also serves as a platform that helps companies get noticed and attract funding, revenue generating contracts, distribution partnerships, etc and has helped raise over $10 million so far. James Mathews, Chairman, Health 2.0 India, welcomed the delegates on the opening day of the conference. He said, “The theme for Health 2.0 India 2014 is ‘Simply Lead’ which speaks to a belief that we must reboot and reframe leadership for healthcare in the 21st century. Enabling health for a billion people is no easy task. We pres-

ent the best minds, technologies and resources in compelling panels, discussions, and live product demonstrations worldwide.” He further stated, “Our goal is to build awareness among patients, physicians and

other health stakeholders that the digital revolution going on around them can, in fact, transform health. We also need to open the eyes of Indian engineers, entrepreneurs and others that one does not have to be

a doctor, pharmacist or nurse to take advantage of market opportunities in health or to be a part of transforming the industry.” Indu Subaiya, Co-Founder and CEO, Health 2.0, shared her expertise and understanding of the various international trends in healthcare-IT sector and opportunities for India. She said, “There is an increasing trend in terms of adaptation of healthcare technology in US as well as in India across the ecosystem including patients, healthcare practitioners and other care givers.” She also gave a sneak peek into the Annual Health 2.0 Report and concluded her session by saying the three biggest challenges

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MARKET that Health 2.0 can take up in a positive approach is introducing adaptable technology, prioritising user experience and analysing the big data in an intelligent way. Simone Ahuja, Co-author of the book Jugaad innovations spoke via video link. She said, “The jugaad way of innovations has been centre theme for Indian innovations and a lot can be learnt from that. There is no direct correlation between R&D spending and innovations. Developers need to design products keeping in mind the Indian spending nature.’’ Ravi Kumar, CEO, Zanec, pointed out the few infrastructure challenges that healthcare

has to face. He said “Health infrastructure in India is non-existent. As per WHO standards, a hospital must have 2.6 beds per 1000 patients but in India the number is menial, just 1.6 beds per 1000 patients.” The other two challenges that he stated were low numbers of healthcare professionals and poor healthcare coverage of Indians. Anu Acharya, CEO of Mapmygenome, addressed the audience with her expertise in ‘The Power of Personalised Health’. She said, “In a country like India, where we have diverse population, we should be able to connect with people with what inspires them. Personalized health is a catalyst

that can drive real change in reducing medical costs and improving the collective health of a nation. ” Dr RD Thulasiraj, Director of Operations of Aravind Eye care gave excellent insights on the level of eye care present in the country along with challenges that it faces such as quality of care, diverse population, unmet needs, and the dignity of patients. He said “very small amount of population in India has access to eye healthcare and it is a sorry state as more than 80 per cent blindness is treatable. Just a 10 minute cataract surgery can restore eyesight of 7.5 million people.” Aravind Eye care is

successfully moving towards Universal Health Coverage. There were various demos by entrepreneurs and start-ups. Nakul Pasricha, Pharmasecure; Amit Bhagat, Surgerica; Ananda Gupta, TrackMyBeat; presented the audience with newer healthcare innovations which included dynamic digital and technology products. Mohammed who gave up his job at IBM to turn into a health entrepreneur, demoed his product GetActive which his team developed completely in India. He said, ‘’Wearable device market will grow and rather than blindly adapting from the west, we can create

things that would be suitable for Indian conditions.” They also mentioned the various ways Indians can develop innovative channels of care and build sustainable business models to attract more investors to digital health. The panel discussion moderated by Mathews was held on ‘Primary care for a billion people’. The panel shared their experiences and understanding about the primary healthcare requirements of people. It concluded with saying that India is going to tap into some of the most creative minds, trying to crack the code on delivering quality healthcare to those who need it.

Dr LH Hiranandani Hospital and International Oncology Services organise The Pink Meet – 2014 The conference sees leading cancer specialists from across India gather at the conference to share their latest experiences and knowledge for breast cancer care and treatment

WHAT IS novel in the treatment and care for breast cancer? All this and lot more was discussed in “The Pink Meet – 2014” by over 150 doctors assembled at Trident, BKC, Mumbai. In its second edition, “The Pink Meet – 2014”, a two-day comprehensive breast cancer care conference organised by Dr LH Hiranandani Hospital, saw topics of discussion being moved beyond the scientific realm of treatment and care. The social impact of breast cancer was also discussed with topics such as ‘Fertility beyond breast cancer’. Niranjan Hiranandani, Chief Managing Trustee of Dr LH Hiranandani Hospital inaugurated the conference. Leading cancer specialists including Dr Rajendra Badwe, Dr Suresh Advani, Dr Rajiv Sarin, IVF specialist, Dr Anirudhha Malpani and nuclear medicine

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expert Dr Vikram Lele shared their insights and experiences on the new practices in diagnoses, treatment and care for breast cancer including genetics of the disease, breast reconstruction post treatment, role of nuclear medicine in early diagnosis, etc. Oncology experts from Dr LH Hiranandani Hospital, including Dr Namita Pandey, Dr Prasad Raj Dandekar and Dr Wasim Phoplunkar were also present at the event this year. Dr Sujit Chatterjee, CEO, Dr LH Hiranandani hospital and the chief coordinator of ‘The Pink Meet – 2014’ stated, “Realising the need for medical community’s engagement in the fight against breast cancer, Dr L H Hiranandani Hospital along with International Oncology started ‘The Pink Meet’: a medical conference with social relevance. The conference today has moved

Dr Sujit Chatterjee, CEO, and Niranjan Hiranandani, Chief Managing Trustee, Dr L H Hiranandani Hospital inaugurate the Pink Meet - 2014

Dignitaries at the dais during the inauguration of The Pink Meet - 2014, a comprehensive breast cancer conference

beyond deliberating the scientific aspects of breast cancer and also discusses the social impact; such as issues of fertility after cancer treatment. We are proud to provide the experts in the field a platform yet again to interact with the fraternity and discuss their experiences.” The coordinator for the event, Dr Neeraj Mehta, & Regional Head – International Oncology Services, said, “With ‘The Pink Meet,’ we are trying to provide tremendous support and hope and in formation to help the patients (women). On such a wide platform doctors can come and share knowledge about the medical advances made in the field of breast oncology and their experiences. This would help them render the best possible treatment to their patients.”

EVENT BRIEF MARCH-MAY-FEB-2015 07

2nd Edition Healthcare & Pharma Expansion Summit

2ND EDITION HEALTHCARE & PHARMA EXPANSION SUMMIT Date: March 7, 2014 Venue: Mumbai Summary: The 2nd Edition Healthcare & Pharma Expansion Summit 2014, Mumbai sources and presents leading global case studies from top healthcare and pharma sector and service providers across India. The summit is packed full of issues and challenges faced as well the opportunities that lies within for the year 2014. The Summit will bring in 100 decision makers like the CEO, Managing Directors, Medical Officers, Medical Directors, CIO, CISO, Head IT from healthcare and pharma sectors across India.

Contact Ashfan Karkal Exito Media Concepts #677, 2nd Floor, 13th Cross, 27th MainSector - I, HSR Layout Bangalore - 560102 Tel: (080) 42015540 / 6570 5295 Fax: (080) 42012720 Email: enquiry@exito-e.com / ashfan@exito-e.com Website: http://hpesummit.com/

XVITH NATIONAL SEMINAR ON HOSPITAL/ HEALTHCARE MANAGEMENT, MEDICO LEGAL SYSTEMS & CLINICAL RESEARCH Dates: May 2-3, 2014 Venue: Symbiosis

XVIth National Seminar on Hospital/ Healthcare Management, Medico Legal Systems & Clinical Research

International University; Lavale, Pune Summary: Symbiosis Institute of Health Sciences, a constituent of Symbiosis International University th (SIU), is presenting the XVI national seminar on hospital/ healthcare, medico legal systems and clinical research. It aims to provide an ideal platform for the exchange of ideas in the critical healthcare field. Over 1,000 delegates from all verticals of healthcare such as doctors, medico legal lawyers, insurance and IT professionals, NGO, hospital administrators and clinical research professionals is expected to attend the event. The event boasts of stalwart speakers, contemporary topics and provides an opportunity for

professional upgradation, liaison and networking. Contact Dr Rajiv Yeravdekar Dean, Faculty of Health & Biomedical Sciences, SIU Phone: 91-020-25655023, 25667164, 20255051, 08888892258, 9552552009. Email: info@schcpune.org, dep@schcpune.org , manager@schcpune.org Website: www.schcpune.org

14TH WORLD CONGRESS ON PUBLIC HEALTH IN 2015 Dates: February 11-15, 2015 Venue: Science City, Kolkata Summary: The 2015 Congress will offer unique opportunities to discuss global and national public health

14th World Congress on Public Health in 2015

issues among the global public health community and other key stakeholders. It will provide a unique opportunity to help catalyse change, bringing together and bridging perspectives from various disciplines of public health to infuence governments, organisations, agencies and institutions around the world to meet the challenge of improving people’s health. Contact Indian Public Health Association (IPHA) 110, Chittranjan Avenue, Kolkata – 700073 Phone: + 91 33 32913895 Email: secretarygen@iphaonline.org Website: http://www.14wcph.org/

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‘HCL Healthcare intends to provide patient-cantered care for over 20 million people by 2020’ Recently, HCL Corporation, the parent company of HCL Technologies and HCL Infosystems, announced its entry into the healthcare sector with the launch of HCL Healthcare. HCL Avitas, in affiliation with Johns Hopkins Medicine International (JHI), is the first subsidiary of HCL Healthcare which is set to become India’s largest healthcare network with a robust technology backbone and electronic medical records. Harish Natarajan, HCL Avitas CEO, in an interview with M Neelam Kachhap, talks about the new venture and the impact it will make in the existing Indian healthcare sector

HCL has a rich history in the technology segment. How did healthcare happen? Over the last 38 years, HCL has been at the forefront of the Indian technology industry. With a very strong entrepreneurial character, HCL has always made daring forays while being constantly innovative and reinventing itself at every stage. We believe that technology, education and healthcare are the three pillars of nation building. Given our strong presence in the technology space and the significant work that the Shiv Nadar Foundation has done in the education space over the last two decades, it was the next logical step for HCL to enter healthcare. Also, the technology expertise of HCL in the healthcare vertical was definitely a contributing factor in our decision to enter healthcare. We work with some of the leading names globally in healthcare and have developed tremendous domain capabilities. For a few years, HCL had been seeking

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adjacent businesses and the team has been working in this space for the last two years and has grown to be passionate about healthcare. Innovation is our DNA and we have the expertise in technology to make a difference. What does affiliation with Johns Hopkins mean? What do they bring to the table? Our association with Johns Hopkins Medicine International (JHI) will help us marry the technology expertise of HCL and the clinical expertise of Johns Hopkins to be able to deliver our vision of providing bestin-class patient-centric healthcare experience. The partnership will bring in global best practices and the best in evidence-based medicine. Experts from JHI will also advise us on facility design. We will be drawing heavily on their expertise for training and developing clinical processes. JHI will play a very large role in training and clinical processes, which will be absolutely important for us in developing our patient-

centric approach.

HCL Corporation would be committing Rs 1,000 crores in equity towards HCL Healthcare

There are a number of players in healthcare delivery market, what are your differentiators? At the onset, we are setting up India’s first and largest chain of networked multi-speciality clinics with strong focus on patientcentricity. We have borrowed a concept largely used in the west called the 'patientcentred medical home'. The patients will be treated not by a doctor but by a team of our specialists and they will be helped to take informed treatment decision. So they can intelligently participate in the process of deciding what would be the best for them. Every patient will be treated with empathy and respect. HCL’s strong technology backbone will help establish a new paradigm in patient experience through videoconsulting; evidence-based care through tools like electronic medical records (EMR), mobile applications etc. Our association with JHI will also serve to provide our patients with best clinical

experience as all our medical professionals will be trained by JHI in evidence-based system. What was the investment in this venture and the source of investment? At present, HCL Corporation would be committing Rs1,000 crores in equity towards HCL Healthcare, to be invested as found appropriate over the next few years. What are your expectations on this investment? We plan to be India’s first and largest chain of networked multi-speciality clinics focused on patient centricity. The largest portion of our investments will go towards establishing the clinics because we do not want to compromise on patient care and experience. The second largest investment will be towards establishing the technology backbone as technology will play a large part in our offerings. The remaining would be invested in setting

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‘Aster DM Healthcare group plans to invest Rs 300 crores in the Indian market’ Dr Harish Pillai CEO, Aster MedCity, divulges the groups' plans for the Indian market, the new quaternary care hospital coming up in Kochi, and their strategies to harness the potential for medical tourism in the country, in an interview with Lakshmipriya Nair

What are the most distinguishing features of Aster Medcity? How different is it from other quaternary centres in the country? Aster MedCity, is an iconic home-grown integrated medical city of international standards coming up in Kochi, Kerala. Spread over 40 acres, Aster Medcity is built across one km waterfront, amidst serene soothing environs that will integrate nature with healing. In the initial phase, at a cost of $ 100 million, Aster Medcity will open with a 575-bed Quaternary Care Hospital with nine Centres of Excellence. In phase ll, an additional 500 beds will be opened along with a Medical Convention Centre, a 4-star Hotel and Apartments. Aster Medcity is poised to be a boon for medical tourism in India. It will not only support the medical requirements of the state and country but also provide a venue for medical tourism to the country from South Asian countries. This ‘modern healthcare destination’ is equipped with first-of-its-kind advanced technologies that will be capable of treating any disease and will take healthcare in India to international standards. The

USP of the multi-speciality hospital will be its harmonious orchestration of the physical and functional autonomy of the individual COES with Emergency and Intensive Care which seamlessly integrates with other clinical and diagnostic facilities. This provides focused care by specialists in a particular department in close coordination with others when required – a Concept of Unity in Diversity. When will you begin operations in full swing? A grand launch will take place in the last week of April or first week of May 2014. Typically for a hospital establishment as big as Aster Medcity, a grace period of 45 – 60 days is required to allow testing of facility operations, non-aligned services, staff efficiency, training and coordination. But why Kochi? Explain about ‘Tier I investment in Tier II city’ Touted as ‘God’s own country’, Kerala is unique in many ways. Having an enviable track record in delivering world standards of healthcare, Kerala has successfully made the leap from leisure tourism to medical tourism by generating the expertise for healthcare with a sustainable

Aster Medcity will not only support the medical requirements of the state and country but also provide a venue for medical tourism to the country from South Asia

model for medical education and developing the environment and infrastructure by offering world-class healthcare at affordable prices. From an investment point of view, Kochi is drawing a lot of investments from various sectors. The city is booming commercially and will witness an Info Park soon. A lot of universities will also start functioning in the next two to three years. The ongoing development on one side along with the natural beauty of Kochi, undoubtedly makes it one of the most beautiful Tier II city. From a future point of view, it makes perfect sense of having a Tier I investment in this city. Tell us about your investment plans in India? Are you looking at any other verticals in healthcare? Aster DM Healthcare group plans to invest Rs 300 crores in the Indian market via ‘hub and spoke’ model in Tier II and Tier III cities. There is a possibility to acquire hospitals in Hyderabad, Bangalore and Mumbai. Tell us how Aster Medcity has been planned from an infrastructure angle? What kind of benefits can the patients

look forward to? To provide clinical outcomes of international standards all under one roof, Aster Medcity will house nine Centres of Excellence (COEs) in various specialities such as cardiology and cardiac surgery, oncology, orthopaedics and spine surgery, neurology and neurosurgery, gastroenterology and haematology, nephrology and urology, paediatrics obstetrics and gynaecology, paediatrics and plastic surgery and aesthetics. It will also focus on specialised divisions which will consist of general medicine, pulmonology, endocrinology, dermatology, general surgery, ENT, ophthalmology and dental along with diabetology and health check-ups. The USP of the multispeciality hospital will be its harmonious orchestration of the physical and functional autonomy of the individual COEs with Emergency and Intensive Care which seamlessly integrates with other clinical and diagnostic facilities. This provides focused care by specialists in a particular department in close coordination with others when required – a concept of ‘Unity in Diversity’. The hospital will cater to all segments of

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MARKET patients across a wide spectrum of needs: diseases, emergency conditions and disabilities. A workforce of approximately 1500 team members, including world renowned physicians, expert nursing team and other administrative and support staff will be deployed for patient care. The core competency of the hospital is backed by strong technological investments. The hospital will be equipped with sophisticated operation theatres and high technology quotient to provide enhanced application support to increase workflow efficiencies in all disciplines. It will also have the highest rated Department of Emergency Medicine with radio controlled rescue systems and teams, and the Unique Water Ambulance System to cater to the unique terrains of Kerala. How do you plan to target medical tourists through this hospital? Any strategies or packages that are targeted for them? Elaborate. We have a huge geographical advantage as Kochi is quite close to both South East Asian Countries

and the Middle East. We will also be leveraging our group- Aster DM Healthcare’s network of hospitals spread across GCC region and many other locations via information kiosks thus helping in driving traffic. We are also looking at getting referral patients from Africa.

A workforce of approximately 1500 team members, including world renowned physicians, expert nursing team and other administrative and support staff will be deployed for patient care

Tell us about your strategies and plans for the current fiscal? We plan to have a successful grand launch this fiscal, consolidate operations and ensure everyone is aware of the scope of services and the USP it offers. lakshmipriya.nair@expressindia.com

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‘HCL Healthcare intends to provide... up the clinical development programmes and in training. What are your expansion plans? We are commencing with country’s first nation-wide networked multi-speciality clinics through HCL Avitas, in affiliation with JHI. HCL Avitas is the first subsidiary and healthcare delivery arm of HCL Healthcare. Our aim is to provide patient-centric care to over 20 million people by 2020. The long-term vision of HCL Healthcare is

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to be the nation’s leading healthcare company by addressing the entire spectrum of healthcare needs; providing healthcare delivery, innovative medical services, products and training to meet the growing need for quality healthcare. Would you be partnering with existing players? If yes, what kind of partnership are you looking for? We have chosen to collaborate with JHI,

The long-term vision of HCL Healthcare is to be the nation’s leading healthcare company acknowledged as a one of the best in healthcare globally, to begin with. We would

leverage the most in every aspect of clinical expertise and global best practices in healthcare from JHI. However, in the other business domains we may seek partners in order to become the long-term care partners of our patients and their families. What will be your growth strategy? It is early days to speak about growth and numbers but we hope to scale up to a considerable size. Creating

an organised technology-led health system that will be the long-term care partner is our immediate goal. HCL Healthcare intends to be that partner and provide patient-centred care for over 20 million people by 2020. What is more important for us at this stage is to set the right standards to create a healthcare system that is aligned our focus and goal of patient-centricity. mneelam.kachhap@expressindia.comn

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‘The collaboration has potential to become a powerful symbiotic relationship’ NASSCOM and NATHEALTH signed a MoU with an aim to synergise the endeavours of both the health and technology sectors and extend support to the Government of India and state governments to achieve its ‘Universal Health Coverage’ goals. Anjan Bose, Secretary General, NATHEALTH gives more details of the MoU and elaborates on its benefits to both healthcare and IT sectors in India, in an interaction with Lakshmipriya Nair

Gives us more details about the MoU with NASSCOM. What led to this move? The MoU will try to address challenges in the healthcare sector that can be significantly impacted through the use of Information Technology (IT), for e.g., mHealth can be developed effectively to enable remote diagnostics and significantly raise the level of healthcare accessibility. This is of critical importance, considering that 45 per cent of Indian population travel more than 100 km to access a higher level of care. NATHEALTH was created with the vision to be the credible and unified voice in healthcare. Leading healthcare service providers, medical technology providers (devices and equipment), diagnostic service providers, health insurance companies, health education institutions, healthcare publishers and other stakeholders are coming together to build NATHEALTH as a common platform to power the next wave of progress in Indian healthcare. NATHEALTH is an inclusive institution that has representation of small and medium hospitals and nursing homes. For NASSCOM, therefore, NATHEALTH came as a natural partner to work with. For decades, there are companies working on their own to reach the tremendous potential that IT has in healthcare, there are many

islands of excellence, but this is the first time that NASSCOM has found a collaboration partner which offers such a high level of diverse and proven competence in healthcare on one single platform. What kind of technology would be a part of the deal and how would it be harnessed to deliver better healthcare? Time will tell and sky is the limit. NASSCOM is committed to enabling and accelerating the transformative power of technology for India’s growth and development, particularly in the healthcare sector, by harnessing IT industry’s globally proven capabilities, along with the growing trend of innovation and entrepreneurship. On the other hand, healthcare sector in India has achieved capability, maturity and global recognition. India has now become a preferred global destination for advanced healthcare services at a most competitive and economical cost. Healthcare already has the benefits of great technological innovation in many areas like imaging, oncology, ophthalmology, pathology, surgery to name a few. Combining this with the deliverables from the IT sector in a focused manner and a structured approach could open up disruptive innovations and processes that will finally benefit the patients and also

contribute to progress of both the sectors.

One of the most powerful outcomes of this collaboration is the availability of the 'combined talent force' of the leaders in IT and healthcare sectors

Elucidate about the benefits of the MoU to both IT and healthcare sectors? The healthcare sector has excellent opportunities that the IT sector can capitalise on and grow further. As part of the MoU, the collaboration will aim to leverage technology for innovative solutions which will help both the sectors. Emerging technologies like cloud, analytics, pervasive presence of mobile telephony and broadband penetration have created new opportunities for both sectors to collaborate and work towards enhancing healthcare quality, accessibility and affordability. Hence, this has the potential to become a powerful symbiotic relationship benefitting both the sectors and improving patient care. What kind of investment would go into this venture? NATHEALTH and NASSCOM have just signed the MoU, hence the details have to be worked out. Let’s remember that one of the most powerful outcomes of this collaboration is the availability of the ‘combined talent force’ of the leaders in IT and healthcare sectors. Coming together of such think-tank in a structured way is itself a strong and positive resource. Both institutions will look at opportunities to invest. We will

also reach out to the central and state governments to explore the possibilities of working together for win-win solutions. What are the healthcare challenges that can be mitigated through good IT deployment? There are many areas in healthcare where IT could be of great help. Technology and mobile health could significantly address the skillset gap that is one of the biggest concerns in healthcare, particularly in the semi-urban and rural segments. Then there is the unresolved issue of database management which is another major concern in healthcare. IT could be of great help here. Electronic health/medical record (EHR/EMR) is an unmet need even today. NATHEALTHNASSCOM collaborative partnership could try to come out with pragmatic, scalable and cost-effective solutions in this critical area. Are you looking at any other strategic alliances? Yes we are, with a few other eminent Indian, as well as global institutions where there is a possibility of ‘meeting of minds’ and also aligned interest for common goals, coupled with complementary competencies. lakshmipriya.nair@expressindia.com

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Ameera Shah: Leading by example MD and CEO of a Rs 350 crores company, Ameera Shah has catapulted Metropolis Healthcare, from a single pathology laboratory in 2002 to a fully integrated multinational chain of 85 plus diagnostic centres and 600 plus collection centres across South Asia, Middle East and Africa by 2014 Who are your sources of inspiration, role models? Two people have inspired me immensely in my life. Their ideals, work and words have always inspired me. We have witnessed the power of Gandhiji’s leadership philosophy with his thousands and millions of followers from India and abroad. My central leadership style of leading by example is deeply inspired by his philosophy. “Be the change you wish to see”. A leader needs to set examples to motivate others to follow by will, not by force. I see some of his philosophies even in modern management concepts of ‘walk-around management’ and change management. These ideals have been an integral part of the Indian history and philosophy. Similarly JRD Tata’s role as an entrepreneur and businessman is remarkable. His vision for the Tata group and philanthropic approach was at a time when the Indian economy was unfavourable for businesses to thrive. His benevolence to benefit stakeholders, both internal and external; had a very positive impact on the larger business environment. His inspiration has had a huge bearing on the way I perceive my customers. We do not consider our customers as people from whom Metropolis makes profits, but as our external stakeholders and in their wellbeing lies our growth and sustainability. Tell us about your journey to the top.

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Leadership doesn’t come gift-wrapped, it has to be earned and garnered through persistence and constant efforts

The only short-cut to success is relentless hard work, unwavering focus and balanced objectivity. Leadership positions are only as powerful as the people holding them. When I returned from the US, what I had in abundance was the motivation to do something for my country. What we lacked were the necessary resources

to drive an absolutely new business concept of starting a chain-of-labs across India. Although I did have a chance to witness lab processes even as a child, a business model goes way beyond a singular lab’s functioning. What came handy was my openness to learn from both success and failures. I didn’t begin my stint at Metropolis directly as a founder or chairperson or an MD. I had to work my way up through constant learning and innovative thinking. I started from a modest marketing role, which involved a lot of travelling to explore and understand the Indian marketplace. I remember a time when I was travelling round the year. It was like I was living off my travel bags. In the initial times skilled manpower was a luxury for us, and we had to work with the limited resources we had. With the lack of human capital, I had to do a lot of ground work myself. When I look back, I recall those times as rejuvenating and hectic in the same breath. As I had joined at a young age, many people including our clients, didn’t take me seriously. Healthcare is not an industry where young age works to your advantage. I had to work twice as hard to make my leadership effective and acceptable to all. Although an entrepreneurial venture, I did have to go through the step-by-step growth pathway. Leadership doesn’t come gift-wrapped, it has to be earned and garnered through persistence and constant efforts.

STRAIGHT FROM THE HEART triking a balance is my biggest mantra. Balance between asset and liabilities, between topline and bottom line. Even being able to strike a balance between professional and personal life. Taking opinions from people about your business is central to attaining a balance perception about your business. If one doesn’t develop a balanced opinion about her own actions, it is very easy to steer away from long term goals. Balance is also very crucial for people management which today has become key to success. At times you need to step down to understand people and the challenges that they are facing, and at times you need to be assertive to get things done the way they should be. Sometimes you need to stick to your ground, sometimes you have to flex to achieve a win-win situation. Striking a good balance without compromising on your personal values is something that one needs to learn each day and through all circumstances.

What is the secret to maintain a good work-life balance? I believe in pursuing and trying many different hobbies like tennis, Kathak, trekking, reading and spending time engaging with your own self. Each of these hobbies help to cope with stress in different ways, as well as grooming your personality. How can women thrive in a man’s world without having to change who they are? In today’s world having a good work-life balance has become a constant pursuit for both genders. In a fast-paced

life of today, the least you can do for yourself is to be who you are. Role modulation is important and sign of a balanced and dynamic leadership, but this has to be done without compromising on your identity and values. The world is an equal place for both men and women, what differs are the traditional gender roles, which came into existence as human beings developed along the socio-economic path. I believe the process of evolution never stops, and as times are changing more and more women have come to the forefront of the economy. But Continued on Page 36

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Ardra Kurien: Defying the odds Ardra Kurien, Administrator of KIMS Pinnacle Comprehensive Cancer Center, has 13 years of experience in the healthcare sector. Her key strengths include operations and quality management. She is also part of various hospital committees and academic activities of the institution

Who are your sources of inspiration, role models? On a personal note – it would definitely have to be my dad. He has always been the strongest force of inspiration – he taught me to face situations boldly and has always given me the confidence to challenge the odds. On the professional side, the one who inspired me the most in my field would have to be Dr Preetha Reddy. As a student of Hospital Administration, I always looked forward to hearing her experiences in the industry at various seminars and conferences. That was the first time I realised that women can make it to the top of the league too. Her sessions always left me energised and excited. Can women thrive in a man’s world without having to change who they are? I do not feel that women have to change who they are just to fit in. Women may have to play a little harder at balancing the work and family equation, but there are no reasons to justify changing who you are. I have been able to work my way up entirely on the basis on my job performance. I must also say that I do not want to be working in a position that requires me to compromise on my ethics and beliefs. Over the years, I have grown as a person and as a professional to meet the demands of my job and the expectations of my management, but I continue to be the very same person I was. Tell us about your journey to

Women entrepreneurs are changing the face of business houses with their vibrant ideas and sensitivity the top. Has it been difficult? The journey has not been easy, but it has been a thoroughly enjoyable experience. My biggest strength is that I love what I do and that makes the whole journey more exciting. Facing each situation has only left me stronger and wiser than before. It taught me to look at a problem from a broader perspective. Sometimes, male colleagues find it difficult to acknowledge a woman colleague’s skills and

capabilities and are quicker to criticise and view each action with a lot of apprehension. But even as I say this, I must also acknowledge my colleagues who have stood by me through some of the most difficult phases of my career and supported my growth in the industry. When I was given charge of the oncology centre, my knowledge about the disease and its treatment options were minimal. It took me a while to catch up on the subject. But it’s important to learn about new areas so that you know what you are doing and how best it can be done. Again, maintaining a balance between work and family needs a lot more effort and support from the home front, without which this climb would not be possible. How do you maintain a good work-life balance? Work can have its pressure, but that stress cannot be carried out into one’s home. Likewise, there may be issues at home, which cannot be brought into office. This is one of the basic rules to maintaining a balance between one’s work and family. It is also important to take time off to relax with family and friends from time to time. Sometimes, I’m stretched for time when it comes to helping kids out with school activities and their studies. But with a supportive family to back you, all the little problems of being a working mother get ironed out easier.

STRAIGHT FROM THE HEART inning the confidence of my team and taking them along with me on the journey has been my greatest success mantra. It is important to allow your juniors to grow and support their growth as a professional and as an individual. It is a proud feeling when one of our team members are called upon to handle higher responsibilities. Sometimes experiments yield the best results. It is always a risk to implement new ideas. But if it is carefully planned out, these experiments can be the start of an exciting new find. Constantly stay abreast of what your customer expects from you and work towards delivering it Be a part of the team and join in the action. Of course organising may be our forte, but getting down to where is action is, always boosts the confidence of the team. It helps when we as leaders set examples ourselves and start off a trend. It is important to relax and clear our minds before we assess a situation. We need to have the patience to assess it from all angles before taking critical decisions. Keep one’s self abreast about the latest in the field, be it technology or management mantras.

Is the business landscape in India is changing for women? Over the recent years, corporate groups in India have been seeing women hold top positions. It is inspiring to know that more organisations give their women members an equal opportunity to grow and move up the ladder. Governments in various states are also encouraging the

professional and financial growth of their women. Women entrepreneurs are changing the face of business houses with their vibrant ideas and sensitivity to the customers’ needs. Corporate bodies are now on the lookout for people who can deliver the goods, be it a man or a woman. mneelam.kachhap@expressindia.com

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Betoshini Chakraborty: Expanding horizons A well known strategist, Betoshini Chakraborty, MD, Bardhaman Healthcare and FAITH Healthcare has created quite a stir in the Indian healthcare landscape when she launched the Rs 1,000 crore health city project in Bardhaman. The dynamic Chakraborty, is in the process of launching a nationwide chain of speciality clinics called Cresta Speciality Clinics Who have been your sources of inspiration, your role models? I strongly believe that the success of any individual is shaped by many individuals and varied experiences. To that extent, I have been fortunate to have had many role models and mentors who have inspired me. Firstly, my inspiration began with my parents – my father Prof SS Chakraborty, a resolute man, unwavering professional and an unrelenting entrepreneur who built one of Asia’s largest engineering consultancy firms from scratch (himself coming from very modest family background) and changed the face of infrastructure consulting in India. He has inspired me to be adventurous and perseverant as an entrepreneur – a trait which is quite a necessity in the sometimes adverse business environment in India. My mother, a strong academic and acclaimed writer in Bengali, has always imbibed in me to keep one’s feet firmly on the ground, to remain intellectually aligned and when in doubt fall back on one’s knowledge base and the wisdom of others, but both unanimously taught me the value of humility and honesty. In the professional sphere, I have drawn tremendous inspiration from my mentors – Howard Woods, a serial entrepreneur and the founder of Comcast, one of the largest

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A successful leader is not just one that leads from the front but one that brings people along with them on that journey cable companies in the US. Howard taught me the necessity of audacity in business, knowing one’s strength, believing in one's convictions and then go all out to achieve it. Interestingly, Howard never

forgot to remind us the importance and necessity of CSR activities as businesses and entrepreneurship. However if you were to ask me, which personality inspires and excites me professionally the most I would have to say Steve Jobs and Walt Disney – because both of them had the vision to transform customer experiences through products and services in a manner unimaginable and they did this through sheer imagination, creativity, ingenuity and building a culture of innovation. These are the same values and ethics I try to bring into any organisation that I associate with – innovation, transformation and team spirit. In essence, my inspiration comes from both small and large worlds – 3M with their post-it pads, Google with their search engines but also Godrej with their Chotu kool – the mini refrigerator for the rural areas. People who transforms the lives of others and mentor others to be the best that they can be along the way are the ones that truly inspire me. Women can thrive in a man’s world without having to change who they are. Do you agree? I do believe that there are fundamental differences between men and women, in the way that they handle conflict, in the way that they develop their teams, in the way

STRAIGHT FROM THE HEART y success mantras for business or work are simple – choose a field that excites you and develop a dream. Visualise where within this field would I love to see myself in five years and 10 years, turn the abstract dream into a tangible work plan. Now build a team of people smarter than you and as driven and then give it your best shot. If the first shot does not work then you keep trying and one of three outcomes will emerge; firstly it may work in which case the job’s done, otherwise it will fail and provide you invaluable guidance on what to do differently or better which then would lead to corrections and business model innovations which would then eventually lead to unimaginable success.

that they articulate a vision; in the way they engage with their employees and in the manner in which they transact deals. Women are programmed to bring people along with them on their journey, whether leading a large household or a large company. A successful leader is not just one that leads from the front but one that brings people along with them on that journey. It is this trait that makes women successful leaders, better team builders and

sometimes better at resolving conflict in business. In terms of thriving in a man’s world, I believe in certain industries that are more male dominant e.g., infrastructure, mining, transportation and logistics women may need to be more assertive and bold to be heard and may have to work harder to be recognised. But there are also industries such as healthcare CPG and banking Continued on Page 36

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Dr Indira Hinduja: Pioneering progress Dr Indira Hinduja, Honorary Gynaecologist, PD Hinduja National Hospital and Medical Research Centre has several feathers in her cap. She is credited with pioneering the Gamete intrafallopian transfer (GIFT) technique in India's first GIFT baby in 1988. She is also lauded for developing an oocyte donation technique for menopausal and premature ovarian failure patients

Dr Hinduja, you are a pioneer in IVF. How have times changed in this arena since you helped deliver the first test tube baby in this country? From delivering first test tube baby in 1986, progress has been multifold. Not only the techniques been refined but experience and awareness have increased. We can detect the indication as well as improve the outcome of IVF with advanced techniques such as pretested media, use of disposable tubes etc. Nowadays the indications of IVF are also expanded making use of IVF so common. Because of better research the ability to identify the quality as well as potential of eggs and sperms is improved, resulting in higher success rate of IVF pregnancies making the method cost effective. IVF in India, is still an area fraught with challenges. What can be done to ensure that it becomes more regulated and safe? With the proper knowledge, complications of IVF are much less. ICMR- the highest scientific research body is trying to lay down guidelines and regulations, not only to prevent but also to manage the complications of IVF. Such regularisation will not only prevent mal-

STRAIGHT FROM THE HEART omen should be aware of the importance of maintaining good health. The government of India needs to be more proactive in providing better facilities. Healthcare services should take initiative to spread more awareness about her health should conduct programmes, health camps, check ups as well as raise funds.

Her self confidence needs to be boosted. Not only educating her is of prime importance but making her aware of her rights in her health, security, safety should be encouraged

practices but also help patients have better knowledge about the procedure, egg donation and surrogacy. This will also help in improving outcome in terms of health of mother and health of child. What would be on your wishlist for women professionals in healthcare? It could be specific to your

area of experience/work or general. As far as I am concerned ‘respect’ is the foremost aspect, she deserves. Her self confidence needs to be boosted. Not only educating her is of prime importance but making her aware of her rights in her health, security , safety should be encouraged. lakshmipriya.nair@expressindia.com

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Jagruti Bhatia: Crusading for social change Jagruti Bhatia, Senior Advisor - Healthcare, KPMG India has advised and executed more than 200 – 250 projects across the entire spectrum of healthcare consulting. An ardent environmentalist, she lobbies for inculcating green practices in healthcare. She has set up the Foundation for Environment Conservation (FEC), an NGO and is an invited member on the advisory committee of Ministry of Environment & Forests You have had an illustrious career in the healthcare space. Who have been your sources of inspiration, your role models? I have had role models who have inspired me both on a personal and professional front. On the personal front it has been my mother from whom I learnt the core values of integrity, truth, honesty, sacrifice, ‘a never say die’ spirit and ‘to have patience because sincerity and truth will always win in the end’. Professionally, I have always been an admirer of the Late Indira Gandhi whose ability to crusade even in difficult and adverse situations was admirable. I was also inspired by her in my early days to think that gender bias is all in the mind and if a woman can rule an entire country, we can do almost anything equally inspiring. Role models like Medha Patkar inspire me to get an innate strength to fight for our rights, for the welfare of people and environment which has finally led to me setting up an NGO – Foundation for Environment Conservation (FEC) which has an 80G clearance and works towards issues like environment conservation, organic farming and improving rural healthcare delivery through education and capacity building. How have times changed for women healthcare professionals in India? What is your advice to women

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The key advice I would give to women is to have self confidence and not get deterred by people or circumstances that try to bring you down

looking to carve a career in healthcare? I think from the times where one would join healthcare as it was seen as more of a women’s profession of care and compassion, it has now moved to becoming a full fledged professionallyrun industry. We have a sleuth of managers and hard core professionals to take care of all aspects across the industry value chain. I feel women should take advantage of these changing times and move forward to take on more challenging roles. The key advice I would give to women looking to carve out a career in healthcare is to have self confidence and not get deterred by people or circumstances that try to bring you down. There are certain times where women need to make choices to attain that delicate balance between managing the family needs and having a professional career but instead of giving up either one it is possible to find solutions where both can be managed. I have always experienced that whenever women are given this flexibility their outputs have been far better. People will always be more than ready to make adjustments if you have been good at your work so keep it up and ‘never give up before you try’… You are an ardent environmentalist and have spearheaded campaigns on environmental issues affecting the healthcare

STRAIGHT FROM THE HEART f there is wish list I could make on what women want few things would be: Ingrain women support policies in the core DNA of organisations. Where few things like flexi timings, work from home during certain times required, time off during maternity and baby care not be seen as a favour done by organisations but as an incentive that ‘she really deserves’. Changing the mindset from making women as ‘that part of the population which constantly needs flexibility’ to making them as ‘partners in the professional growth ‘of organisations and work with them. It is not to indicate leniency rather more to do with looking at the ‘output and final outcomes’ expected than to do with how many hours of work o ne puts in. Provide a safe and sound environment to work. Removing the glass ceilings and decisions to be made on performance v/s time availability, flexibility etc.

industry. What are the measures needed on this front by the industry and the government? I am very passionate about the environment and being in an industry where ‘care and cure’ is the core value I feel this becomes my moral responsibility as well. ‘Greening the healthcare industry value chain’ requires making

important choices for long term health benefits to patients and workers v/s short term monetary savings and this requires perseverance to bring about change. As far as the industry goes, one needs to carefully evaluate the carbon footprint of every choice we make; be it in Continued on Page 36

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Meena Ganesh: Flying high Co-founder & CEO of Portea Medical, Meena Ganesh has a lot of experience in the entrepreneurial field. Before venturing into the healthcare space, she was the promoter and Board member of TutorVista and CEO and MD of Pearson Education Services. Prior to this, she was the CEO of Tesco's operations in India, the Tesco Hindustan Service Center

As a renowned healthcare entrepreneur, how is the playing field for women entrepreneurs in this arena? Healthcare is an area that very much plays to the strength of women. It is a field that needs to combine business sense with compassion and understanding of people and the challenges they go through due to health issues. Whether you look at the Reddy ladies or Kiran Mazumdar-Shaw, we see some really good success stories of women making it big in this space. This is a space which requires a lot of focus on use of technology and continuous execution with low tolerance for failure. Entrepreneurs who have the right mix of these skills can be successful in this space. What are the unique challenges you faced as a woman entrepreneur? The challenges I have faced at any point in time are more as an entrepreneur trying to build a business in a new field, scal-

ing, resourcing, execution etc. I have not really come across specific challenges as a woman. This is probably because by the time I started my journey as an entrepreneur, I was well established as a successful professional. However, I do know that younger women have struggled to have themselves taken seriously by investors. They also struggle with their own assessment of their capabilities, and tend to take a bit of a back seat and tend to be less ambitious than they could be.

Healthcare is an area that very much plays to the strength of women

What are your recommendations to improve healthcare delivery for women? Women tend to put their health on the back-burner, focusing more on their family and career. Preventive checks that focus on the women and helping detect illnesses early on will help in ensuring that women are better cared for. Home healthcare can actually help in ensuring that women

STRAIGHT FROM THE HEART ream big, women can achieve as much as any man can. Take help from others, but make sure that you project yourself in the most positive light, without holding back or hiding behind others.

who do not wish to travel and attend to health needs, can be cared for at their homes. This helps in integrating care into their daily routine, and hence makes it a little more accessible for the women. What would be on your wishlist for women professionals? It could be specific to your area of experience/work or general I would have a couple of cat-

egories: Table stakes or hygiene factors: Safety and security at work and outside; protection from harassment; being able to travel freely in a city without worries Professional: Being treated equally, provided with the same opportunities Environmental: More role models, mentoring and networking opportunities lakshmipriya.nair@expressindia.com

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Dr Sunita Maheshwari: Thriving on challenge Sunita Maheshwari dons several hats. She is the Chief Dreamer of RXDX and Teleradiology Solutions and jolly paediatric cardiologist apart from being an active social worker. She believes in the use of technology to successfully educate doctors and to help patients in remote areas of India and other parts of the world. An innovative e-teaching programme, accredited by the National Board in Delhi, for postgraduates in Pediatric Cardiology is also her handy work

Who has been your sources of inspiration, your role models? Sources of inspiration have been those continuously doing good for the world e.g. other doctors, people working in NGOs in remote parts of India and Africa and so on.

STRAIGHT FROM THE HEART

Women can thrive in a man’s world without having to change who they are. Do you agree? Yes, as long as one is comfortable with oneself and the differences with men, one can thrive without having to change. It is essential though to be confident of one’s abilities and proud of one’s differences! Describe your journey to the top. Has it been difficult? Difficult? Yes and no. Yes, because it involved long hours of work, being ‘on’ 365 days, constantly needing to think and innovate. No, because it was exhilarating! Taking an idea and making it work is immensely satisfying. At a personal level, do you maintain a good work-life balance? I did not (maintain a worklife balance) in the early years of my career when I was a ‘workaholic’. However, as my

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elegate but supervise! I constantly look to do new things or the old things better. I believe we need to be open to do things differently. Find a need, and fulfil it-one can call it innovation, but the more the number of people trying to fulfil those needs, the more everybody benefits from the system. The more we give and share, the more comes back to us. I want to think of bigger and better ways to give and to inspire others to give.

To some extent, being an entrepreneur is liberating for a woman-one can choose the hours to work, where to work from and so on. Hence can actually achieve a good life-work balance

kids grew and expressed their discontent with my lack of life balance, I readjusted my scales and yes, now I can say I maintain good work-life balance. Once I decided to work on this, I was able to readjust my schedule to make it happen. When they were young I took them to my weekend conferences. Now, as a doctor cum entrepreneur I moved my clinic to an appointment basis and do my entrepreneurial meetings in a way that I can have evenings with the family and

then do work before and after. Do you think the business landscape in India is changing for women? Yes, there seems to be more interest among women in starting and running businesses and more notice taken of the ones that do. To some extent, being an entrepreneur is liberating for a woman-one can choose the hours to work, where to work from and so on. Hence can actually achieve a good life-work balance! mneelam.kachhap@expressindia.com

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Zahabiya Khorakiwala: Changing the rules of the game The MD of Wockhardt Hospitals, Zahabiya Khorakiwala, is probably the youngest mind to join the healthcare arena in India. The young strategist is the driving force behind the resurgent new-age chain of multi super-speciality Wockhardt Hospitals. A firm believer of inclusive growth, she has also taken on the mantle of developing leadership at the senior level within the organisation Tell us about your sources of inspiration, your role models? Andre Agassi - one of the greatest tennis players of all time. He changed the rules of the game and played on his own terms. Women can thrive in a man's world without having to change who they are. Agree? Yes. It has been shown through various studies and research that women on an average have a higher EQ than men. In today's world which is far more connected, interacting across countries, cultures and different diversities is quite common. I believe women have an advantage in overcoming those diversities and therefore being more effective in their work. Also, as one moves higher up in an organisation in terms of role and responsibility, the softer skills become a much greater requirement for performance. How has been your journey to the top? The journey till date has been challenging as well as fun. It's been four years now that I have been shouldering this responsibility. I've learnt more in these four years than I have in my entire life. It's been incredibly exciting given a large platform to really contribute and make a meaningful impact on.

I spent the first two years or so on the ground a lot, spending time at our seven hospitals interacting with doctors, nurses, administrators etc. always keeping my eyes and ears open. And because my approach is also quite participative it enabled me to build trust and credibility whilst I started contributing. Besides, at home, my brothers and I have been brought up equally with no exceptions made what so ever, so in my own mind I don't believe that I can't aspire for or achieve anything that my brothers can.

STRAIGHT FROM THE HEART erseverance - nothing comes easy or automatically. You have to be persistently impatient to get things done in the manner that it needs to be done. Professionally humility - regardless of one's role or experience there is always an opportunity to learn. And only if you are truly humble about what you don't know, can you create that space to learn, absorb and be creative. Success comes with hard work. Nothing happens in a day. This is something I learnt from my father long time ago. For me, doing hard work and taking up your responsibility with full commitment is equal to achieving success. Also, having a goal and a positive outlook towards achieving it helps.

At a personal level, do you maintain a good work-life balance? It is a challenge to maintain work-life balance for any professional, but being passionate about your work helps. When I started, I must admit that for the first couple of years I probably didn't maintain a good balance. There was a lot to be done and I was entering a business I didn't know very much about so it was work, work, work and work. Now however, I think I do have a pretty decent work life balance. Is the business landscape changing in India for women? Yes, definitely. I find that for women today it is more of a norm to be working and having a career. Which in itself is quite different from even women one

I believe today women's careers and professional choices factor into larger decisions of their lives. I see women making strides in the corporate world at an unprecedented level

generation older. Also, I believe today women's careers and professional choices factor into larger decisions of their lives. It is no longer an irrelevant aspect of who they are and what they want to be. Today, I see women making strides in the corporate world at an unprecedented level. mneelam.kachhap@expressindia.com

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Continued from Page 30 Continued from Page 28

Betoshini Chakraborty where women leaders are so common now that they no longer need to play along their gender stereotypes, they just need to be a good leader – persuasive with a clear vision, innovative, a people developer and build a culture that rewards sincere and focused hard work rather than just results allowing people the opportunity to experiment and the luxury to fail, as it is only by experimenting that one strikes upon products, platforms, services, solutions and business models that are unique and transformational. I don’t think women have to change to thrive in a man’s world, men and women have to both realise and recognise that they bring in different skills sets and should therefore play from their respective areas of strength to lead and succeed. How difficult has been your journey to the top? I am still on my journey and nowhere really close to the top but the journey has been difficult. Being an entrepreneur in India must rank amongst career choices that

one can make world-wide. This choice brings with it repeatedly dealing with failed ventures and also facing constant hurdles to get to the next milestone whether that be the bureaucracy, antiquated laws, poor law enforcement, limited legal options and a lackadaisical work culture. As an entrepreneur in India, I believe that one requires a tremendous amount of drive, belief in one’s dreams, lot of support of one’s family, friends and mentors and a healthy dose of luck! At a personal level do you maintain good work-life balance? To be perfectly honest work-life balance has always been my Achilles heel and professional drive often pushes me and our team to keep on going at it till we solve the professional issue at hand, this in turn requires long hours of work and sometimes not achieving the healthy work-life mix that one desires and even requires for long term success. Do you think that the business landscape in India

is changing for women? Absolutely. Firstly, I think more women work in a job outside of their home than ever before in the history of India and more and more women are joining everyday both into the job force and business landscape. From a perceptions perspective, India has become more accepting of ‘business women’, Women from business families have become more accepting of both daughters and daughter-in-laws joining, leading or starting their own businesses. More impressive than all of this, India is witnessing a tremendous number of first generation business owners in this generation many of who are women. The reasons for all the above are multi-factorial – economics (free markets have raised the upside of engaging in self-owned businesses as evidenced by multiples that PEs are willing to pay for successful businesses), social (greater gender empowerment and greater familial support to women in the family to be both in business and run a family), greater levels of

female education especially in professional fields (e.g., education/healthcare/law), male acceptance of the changing role of the woman in the family (e.g., most successful women leaders describe their spouses to be tremendously understanding and supportive). This perception change has been further fuelled by the media which has done a tremendous job in creating and showcasing successful women business leaders for the young Indian female talent to emulate (e.g., showcasing Indra Nooyi from Pepsi CEO, Kiran MazumdarShaw CMD of Biocon, Chanda Kochhar- MD and CEO of ICICI bank and Vinita Bali – MD of Britannia Industries).So in essence both the macro climate of India is changing and so is the perception at the level of families both in urban and rural areas, all contributing to greater female participation in business, decision making and in contributing to the growth and development of this country.

communities. But we would do better if we had stronger implementation strategies that ensure these laws are followed all over the country. The thought of introducing ‘Carbon Tax’ can be evaluated. I feel in rural areas where there is a lack of electricity and modern equipment we need to think differently and help them overcome these issues through effective capacity building. The government as a ‘provider’ needs to be much more conscious of keeping the environment in mind before passing large tenders. It

would help if ‘environment friendly and reduced carbon footprints’ become one of the ‘technical criteria’ when the government in the role of a provider procures and consumes large materials. What will happen to the non biodegradable waste during large programs like immunisations etc. needs to be thought through. The government can thus play a big role both as policy makers and consumers in protecting the environment through this industry.

Is the business landscape in India is changing for women? Yes, but very gradually. Although there are many women executives holding leadership positions in organisations, very few women are entrepreneurs. The landscape change is notable only in the executive world therefore. Entrepreneurship is a different ball game altogether and the business environment more unpredictable. The organised structure necessary to back you up to deal with market odds is virtually non-existent. If women are to be entrepreneurs, they would need much more familial and societal support. Entrepreneurship doesn’t restrict to your restricted domain responsibilities, but would entail going out in the field and dealing with all kind of circumstances and people. There is a limited scope for delegating a job. I would therefore say, that although we do see more and more women executives at leadership position, the landscape for entrepreneurship has almost negligible women leaders and founders.

lakshmipriya.nair@expressindia.com

mneelam.kachhap@expressindia.com

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Jagruti Bhatia building infrastructure or managing it during operations. Promoters may want to give a serious thought to using ‘Green Concepts’ to reduce artificial lighting and ventilation, using more environment friendly materials, those that have less carbon footprints while manufacturing during the construction phases. During operating and managing these facilities one can look at various environment friendly options like reduce use of PVC and similar materials, optimise biodegradable materials, judicious use of disposables, reduce mercury

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and heavy metal poisoning etc. We plan to put up all this information on our NGO website www.fec.org.in to help people get free access to build and manage environment friendly healthcare facilities. The government in the role as ‘policy maker’ has done quite a bit and put up many laws and acts like the biomedical waste management handling rules, pollution control norms on incineration equipment, sewage and effluent treatment etc. These have helped us in creating environmentally conscious healthcare

Ameera Shah the gender diversity doesn’t call for women to change who they are. In fact, women can leverage their natural instincts and empathy to understand their business and people better. As businesses are becoming more and more dynamic, they are also becoming more peopleintensive. When leadership role calls for moving alongwith people I feel women have a natural advantage to drive and grow with their teams. If women compromise on who they are they might compromise on their natural advantages and the entire cause of bringing in genderdiversity would take a beating.

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FO C U S :WO M E N â&#x20AC;&#x2122;S DAY

Mother and child: The foundation of a healthy nation Dr Hemanth Paul, Country Director, American India Foundation gives an insight on the current Indian scenario in maternal and child mortality while urging that this should become a healthcare priority to ensure the progress of the nation

ach year, an estimated 358,000 women die from complications during pregnancy or childbirth and more than seven million children die before their fifth birthdays. Most of these deaths occur in developing countries and are preventable. Many mothers lose their lives during or immediately after childbirth due to excessive bleeding, high blood pressure, prolonged and obstructed labour, or infections. Many more infants and children die from preterm birth, severe infections, asphyxia, pneumonia, diarrhoea, malaria and malnutrition. India is a signatory to the Millennium Development Goals (MDGs). The fourth MDG is the reducing of child mortality and the fifth MDG is aimed towards improving maternal health. Reducing maternal, neo-natal, infant and child mortality is not just an issue of development, but also an issue of human rights. Preventable maternal and child mortality also represents a violation of the right to life. At present, the health indicators of our country mirror poor maternal and child health conditions, along with practices of early marriage and childbirth during adolescence in the country. According to Sample Registration System (SRS) Report by the Census office,

Reducing maternal, neo-natal, infant and child mortality is not just an issue of development, but also of human rights. Preventable maternal and child mortality is also a violation of the right to life the maternal mortality ratio (MMR) has come down to 178 (2010-12) from 212 in (2007-09). Similarly, the Infant Mortality Rate (IMR) has also registered two points decline to 42 in 2012 from 44 in 2011, though every sixth death in the country pertains to an infant. The MDG

target for India is to bring down maternal deaths to 109 and to reduce IMR to 28 by 2015. At the current rate of decline, India will miss the MDG-4 & 5.

Differences/disparities Maternal, neonatal, and

under-five mortality rates are the highest in sub-Saharan Africa and Southern Asia. Children born in low-income countries are nearly 18 times more likely to die before age five than children born in highincome countries. The maternal mortality

ratio in developing countries is 240 per 100000 births vs 16 per 100000 in developed countries. There are also large disparities within countries, between people with high and low income and between people living in rural and urban areas. A deep divide exists in access to quality healthcare among various socio-economic classes of rural and urban areas. Disparities exist even across the states in India. The MMR ranges from 81 in Kerala to 390 in Assam, while Rajasthan, Uttar Pradesh (UP) and Uttarakhand have recorded MMRâ&#x20AC;&#x2122;s of more than 300. The IMR ranges from 67 in Madhya Pradesh to 12 in Kerala. Eight states contribute to 75 per cent of infant mortality: UP, Bihar, Madhya Pradesh (MP), Rajasthan, Andhra Pradesh, Orissa, Gujarat and Assam. 56 per cent of all newborn deaths occur in five states: UP, Rajasthan, Orissa, MP and Andhra Pradesh. With a view to improving IMR and MMR in the country, the government has identified high-priority districts (HPDs) where the MMR and IMR is significantly high and more focus is required to achieve the MDGâ&#x20AC;&#x2122;s. National Rural Health Mission (NRHM) is running special programmes in these HPDs for vaccination, nutritional needs and to provide

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more health facilities to mothers and children, which could improve their health. Jharkhand faces higher maternal and new-born mortality ratios than India as a whole and the villages of the Seraikela block, a region of Jharkhand with difficult geographic terrain and low levels of literacy, experience even higher ratios than the state. 11 districts in Jharkhand have been identified as HPDs, one of which is Saraikela Kharsawan.

Improving the way forward through PPPs Public health has made breath-taking strides globally, but those benefits have not been equally shared, either among countries or the various social groups within them. Maternal and child mortality ratios strongly reflect the ineffectiveness of India’s health system which can be strengthened by combining the potential of technology and knowledge management. Most of the causes of deaths can be prevented or managed by households, communities and health facilities. However, they often are unable to provide the required care that involves a chain of interventions beginning with complete antenatal care, skilled attendance at birth, equipping first referral units to deal with emergency obstetric care and ensuring that both the mother and new-born are followed up postpartum. These interventions could sharply reduce both maternal and neonatal deaths. The Indian government has the reach and the resources to make a difference but by partnering with a private player it could spread the knowhow to the remotest of areas. Such initiatives, therefore, require public private partnership (PPP) models to be successful in the long term. The Maternal and Newborn Survival Initiative (MANSI) programme by American India Foundation is one such program that is committed to saving lives by establishing a communityfocused health intervention by partnering with, the Gov-

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The Indian government has the reach and the resources to make a difference but by partnering with a private partner it could spread the knowhow to the remotest of areas. Such initiatives, therefore, require Public Private Partnership (PPP) models to be successful in the long term ernment of Jharkhand, the widely recognised technical partner- Society for Education, Action, and Research in Community Health (SEARCH) and Tata Steel’s Rural Development Society (TSRDS). Jharkhand’s many rural and tribal areas make it consistently one of the highest risk states in terms of maternal and child mortality in India. MANSI’s public-private partnership improves the existing health system and health status on a concentrated population of nearly 83,000 residents in 167 villages with an approach that focuses on training the local

female community health workers, identified by the National Rural Health Mission as Sahiyya. The rationale behind this programme is Home Based New-born Care (HBCN), which has been acknowledged and recommended by WHO. In rural areas, the problem is of access to emergency care as most Community Health Centres (CHCs) and Primary Health centres run short of Medical officers and trained ANM’s, gynaecologists, obstetricians, as well as anaesthetists (In India, neither a nurse nor a doctor with post

graduate degree can administer anaesthesia or perform emergency care services). The only option left is to travel to the closest district hospital which in some cases is several kilometres away. Many districts will not even have that facility as it is in the case of Jharkhand’s Saraikela Kharsawan district. It is in this context that efforts were initiated to upgrade the existing community health centres and sub-district hospitals into First Referral Units (FRUs), to be equipped for providing delivery of emergency obstetric care to pregnant women

with complications. Greater emphasis should be put on building health infrastructure. This would include revitalising existing facilities, constructing clinics and hospitals, and creating incentives that will help retain skilled health professionals. Building a strong pool of health personnel is equally important. In addition to the shortage of human resources discussed earlier, the distribution of health workers is uneven with greater concentration in urban areas as compared to the rural areas. With three quarters of all maternal deaths occurring during childbirth or the immediate post-partum period, having skilled health personnel attend deliveries is crucial to reduce maternal mortality. The MANSI programme is being implemented in Jharkhand and follows the model of primary intervention by training Sahiyyas to provide home-based pre and post pregnancy care to women and infants. AIF supports the government healthcare system to improve mechanisms in maternal and new-born and child healthcare by increasing the capacity of Sahiyyas to provide life-saving healthcare. Sahiyyas are trained in identifying and managing the new-borns with asphyxia, hypothermia, sepsis, pneumonia and low birth weight. Another example is the state of Gujarat where the shortage of skilled healthcare providers has prompted the state government to join with private hospitals to provide free obstetric care for pregnant women living below the poverty line. But building infrastructure and expanding medical interventions is just one part of improving maternal and newborn health. We need to boost women’s empowerment by ensuring that girls as well as boys are educated and are provided basic public health awareness. Till the time a mother is not educated and empowered, achieving MDG 4 and 5 would remain just an aspiration!

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FO C U S :WO M E N ’S DAY

Immunotherapy – A‘ray of hope’ in recurrent miscarriages Dr Mohan Raut and Dr Mugdha Raut, Co-founders of Immunotherapy Centre for Prevention of Repeated Miscarriages, elucidate on the reasons for failed pregancies, and the benefits of immunotherapy in preventing recurring miscarriages

iscarriage is always a traumatic experience for couples, but going through it several times is devastating. The emotional, physical and financial trauma is not the end of their troubles – repetitive miscarriages can mean the loss of valuable ovarian time for the patient, along with frustration and disappointment for the couple and the doctors involved. Recurrent pregnancy loss is defined as two or more failed clinical pregnancies. The risk of pregnancy loss increases with successive pregnancy loss. The chances of having a miscarriage are around 11-13 per cent. After one miscarriage the risk is 18 per cent. After two miscarriages, it shoots up to 40 per cent. One per cent of all women suffer from repeated miscarriages (RM).

Causes of RM The usual reasons for pregnancy loss are chromosomal abnormalities (genetic), defects in the uterus, infections in the body or the uterus and hormonal defects (thyroid disorders, diabetes, polycystic ovarian disease etc). In 50 per cent of couples, these causes are not present. In these couples, the cause of RM

may possibly immunological.

munological tests are done to confirm the presence of an immunological cause. Immunotherapy treatment is provided to these select couples.

Immunological factor in miscarriages Our body has a defence system called the immunological system. It protects us from any foreign substance or organisms like bacteria or viruses. Even in any organ transplant, such as kidney transplants, the body accepts that kidney which immunologically matches the recipient. When there is a pregnancy, 50 per cent of the foetus is from the father, who may be immunologically different from the mother. However, it is not rejected by her body, as the pregnancy is protected by certain immunological mechanisms. In some women, these mechanisms are disturbed, leading to an immunological reaction against the pregnancy which in turn causes a miscarriage. This process may repeat itself in subsequent pregnancies, leading to RM.

Treatment of repeated miscarriages Treatment of couples with RM involves performing all possible tests to rule out the usual causes as mentioned above. If they are within normal parameters, certain specialised im-

What is immunotherapy? Immunotherapy is treatment involving the modulation of the immune response. This is done so as to induce certain immunological changes in the mother’s body so that immunological rejection of the foetus is prevented in cases of RM.

History of immunotherapy

In a case of RM, it is important to rule out all known causes before testing for immunological factors. Hence, one must rule out genetic, anatomical, infection, endocrine and thrombophilia factors. The immunological factor in recurrent miscarriages can be confirmed by conducting certain tests

Some women who had repeated miscarriages were given blood transfusions for unrelated reasons. Later, it was found that they had subsequently had fullterm deliveries. Hence, for some years, random blood transfusions were used as treatment for RM. However, further research demonstrated that the lymphocyte component of blood was helping women conceive. Thereafter, such patients were given pooled lymphocytes as treatment. Finally use of the lymphocytes of the patient’s husband was started.

Diagnosis of immunological factor In a case of RM, it is impor-

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cover tant to rule out all known causes before testing for immunological factors. Hence, one must rule out genetic, anatomical, infection, endocrine and thrombophilia factors. The immunological factor in recurrent miscarriages can be confirmed by conducting certain tests, which are based on following observations: ◗ The endometrium of non pregnant patient of RM shows a high concentration of natural killer cells ◗ The number of activated natural killer cells is greater in the peripheral blood ◗ Certain cytokines (immune molecules that control immune cells) are found to be of a higher level in patients with RM. The immunological tests are: ◗ Lymphocyte crossmatch ◗ NK cells in blood ◗ Immunophenotype ◗ NK cells in endometrium

Role of immunotherapy Two kinds of immunotherapy are used in patients with RM and implantation failure: (A) Active immunotherapy: This procedure is also known as lymphocyte immunisation therapy or LIT. When it is conducted, lymphocytes from the husband, or pooled donor lymphocytes are used to cause

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immune-modulation in the mother, leading to the prevention of RM. (B) Intravenous immunoglobulin: In this procedure, immunoglobulin injections are used to prevent immunological rejection.

Patient selection As stated earlier, it is very important to conduct all possible investigations related to the causes of RM. Once these factors are ruled out, immunological tests are done to ascertain whether immunological causes definitely exist.

Active immunotherapy (LIT) LIT involves the separation of a type of white blood cells, (lymphocytes) and injecting them into the patient. This is a day care procedure and involves a 4-6 hour stay at the centre. After the therapy, a pregnancy is planned between 4-6 weeks after the procedure and the next year, so as to achieve the best results.

Intravenous immunoglobuline (IVIg) IVIg has been used to treat both pre-implantation and post implantation recurrent pregnancy losses. Multiple injections of IVIg are required.

DR RAUT’S IMMUNOTHERAPY CENTRE FOR PREVENTION OF REPEATED MISCARRIAGES (ICPRM) ICPRM is the first centre established in India to provide specialised treatment to patients suffering from repeated pregnancy loss. It boasts of a complete diagnostic set up and comprehensive treatment, including, immunotherapy for women with RM. ICPRM has a fully equipped facility for Specialised & Advanced Care. Located in Mumbai, India, it provides services to patients across India and abroad. Further, it has obtained a clearance from the Drug Controller General of India (DCGI) and the Director General of Health Services (DGHS) for Active Immunotherapy treatment.

Minor side effects of treatment with IVIg include nausea, vomiting, chills chest pain. Other theoretical side effects are transmission of infection and allergic reactions. IVIg treatment requires multiple injections and is rather expensive.

Risks of immunotherapy LIT may be associated with minor side effects like pains and itching at the injection site. Sometimes, there may be mild fever, but there are usually no major side effects. Other side effects are minor, and include those caused by treatment with IVIg which have been enumerated earlier.

Worldwide experience Immunotherapy for RM has been practised across the globe. There are trials which have proved the effectiveness of immunotherapy in several cases. It has been shown that LIT was in fact more effective in primary aborters (those with one living child). Also, the effect of LIT increased with the number of previous miscarriages. IVIg has been found to be more effective in secondary aborters (those with a previous living child). In Mumbai, we have provided immunotherapy treatment to 350 couples with RM. The success rate was 88.71 per cent.

Conclusion Repeated miscarriages are a devastating experience for a couple. After treating couples who have known risk factors, a large number of couples remain in whom the immuno-

logical factor could be responsible. A proper diagnostic work up, followed by the appropriate immunotherapy treatment, can help these couples fulfil their dream of having a healthy baby. As new technologies emerge and a better understanding of how the many components of the immune system interact to aid in the growth of the foetus, new treatments will be available to help women with RSA or implantation failures. Almost 40 per cent of unexplained infertilities and as many as 80 per cent of unexplained pregnancy losses could be due to immunological problems. Couples with RM will surely benefit from immunological testing. Further, couples with good embryos that fail to implant during IVF procedures are good candidates for immunological screening and treatment. Active immunotherapy is an effective treatment for unexplained primary RM when re-treatment antipaternal antibodies are absent. IVIg is effective in secondary RM. Thus, immunotherapy presents itself as a ‘ray of hope’ to couples facing the problem of repeated miscarriages. It gives them a chance to have a healthy baby and have the family they always dreamed of.

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STRATEGY OPINION

TB control in India: Role of private sector Dr Sanjay Sarin, Regional Director/Global Health (Asia Pacific), BD asserts that the private sector has a very vital role to play in effective management and control of TB in India

INDIA IS presently home to one in four patients of TB globally and constitutes 26 per cent of the global TB burden. According to the WHO Global TB Report (2013), 75 per cent of the missed cases of TB reside in 12 countries with India leading the list of countries and accounting for nearly 31 per cent of those cases estimated at 9.3 lakhs. Additionally, there were 4.5 million new cases of MDR-TB worldwide in 2012 with a large percentage of this increase being in India, Ukraine and South Africa. This is an alarming situation and threatens to roll back the tremendous progress made by India’s Revised National Tuberculosis Control Program (RNTCP) in the last few years. RNTCP released its National TB Strategic Plan for 2012-17. The key elements of this plan which has set an ambitious goal of testing 48 million new people for TB include ◗“early and improved” diagnosis of all TB patients including those with drug resistance and HIV-associated TB; ◗“access to high-quality treatment to all patients” who have been diagnosed ◗Emphasis on “scaling up access to effective treatment”

for those with drug resistance ◗Increase focus on decreasing death and morbidity figures. ◗Extend RNTCP services to patients diagnosed and treated in the private sector. Out of all the above objectives, perhaps the most radical is the extension of services to patients being managed in the private sector. This affirms the fact that effective management and control of TB in India has to be inclusive of the private sector. Private sector currently plays a significant role in India’s healthcare scenario by providing access to close to 70 per cent of patients. It is the first point of contact for most suspects1, which makes it critical for RNTCP to engage with the healthcare providers in the private sector and achieve its goal of universal access to TB care. Private sector has its own challenges however especially in case of TB, where many a times it takes weeks and often months to get access to the right technology and drugs and that too at a very high cost. On account of low penetration of healthcare insurance in the Indian populace, majority of patients end up spending this money from their own pockets which further exacerbates the socio-economic situa-

tion of these patients. In the past there has been limited engagement between RNTCP and the private sector except a few projects. Ironically, private sector has often been blamed for fuelling the spread of TB/MDR-TB on account of irrational diagnostic and treatment prescriptions. In fact the plan states that RNTCP will endeavour to overcome the barriers of mistrust and fully encompass and improve the spectrum of TB care being provided through the private sector. However, in order to do so, there are significant challenges that will need to be overcome, foremost amongst them will be to ensure that the private sector follows and adheres to the International Standards of TB Care (ISTC) in terms of both drug regimens and WHO approved

diagnostic tests which will require a concerted effort from the government, civil society and the private sector.2 In a recent study done by TB Alliance and IMS Health, it was reported that the private sector will need to ensure proper usage of recommended TB regimens to prevent the development of resistance against both existing and new TB drugs. The research further indicated that in countries with large private TB drug markets such as India, creating effective public private links could help increase 3 access. Previous efforts have shown that effective engagement with private sector has always yielded good results. For example in 2003, the RNTCP launched intensified PPM DOTS activities in 14 urban districts4 as a part of which medical consultants and field supervisors were recruited and posted in these districts. The data from the intensified PPM sites showed an overall increase in the number of TB cases notified under RNTCP. Currently, there are close to 150 industries partnering with RNTCP, prominent amongst them being Tata Steel, Reliance Industries, Birla group, Jubilant Organosys, Becton Dickinson

(BD) and Eli Lilly with their engagement varying from community activities, workplace DOTS programmes, laboratory strengthening, home-based care of MDR-TB patients and technology transfer in the manufacturing of MDR TB drugs. BD has been partnering with FIND and RNTCP to enhance access to advanced TB diagnostics in the Intermediate Reference Labs of RNTCP. BD further partnered with Alliance Biosciences (a US-based company) and FIND to develop a National Centre for Training in Biosafety. Very recently, BD partnered with the National Institute of TB and Respiratory Diseases, a designated National Reference Lab to create a Centre of Excellence in mycobacteriology aimed at capacity building in liquid culture and DST and evaluation of novel TB diagnostic technologies. Studies have shown that collaboration with the private sector to be affordable and cost effective approach for improving TB control in India5, however the challenge has been to develop scalable PPP models. In view of the critical role of private sector in providing provision of healthcare services coupled with the proof of effectiveness of public

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STRATEGY private collaborations, it is important to develop strategies to support sustainable access to TB control via private sector. In another instance, the RNTCP initiated a public private partnership on TB culture and DST as a part of which it is offering an opportunity to the labs in the private sector to get empanelled with the programme and offer TB culture and DST to patients being treated in the private sector at fixed charges. Under this initiative, several accredited labs from the private sector are now a part of this extended network. Another challenge in the private sector has been the rampant use of serology-based tests due to lax regulatory controls along with financial incentives. Taking note of WHO’s negative policy guidance on serology based tests, this situation changed in 2012 when the Government of India banned the use, import, manufacture and sale of antibody- based tests for TB and discouraged the use of

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It is important to develop strategies to support sustainable access to TB control via private sector Interferon-gamma release assays such as ‘TB Gold’. This further underlines the need to develop strategies to provide access to quality

assured and nationally/internationally approved TB diagnostics via the private sector. Initiative for Promotion of Quality 6 and Affordable Tests (IPAQT)

is one such initiative which is engaged in increasing access to WHO endorsed TB diagnostic technologies via affordable pricing through a coalition of private laboratories in India supported by manufacturers of TB diagnostic technologies (LED microscopy, liquid culture, line probe assays and cartridgebased molecular test) and nonprofit organisations (Clinton Health Access Initiative, IUATLD etc). IPAQT members include over 50 private sector labs, 10,000 collection centres and have presence across the country. Any private laboratory that has been accredited by RNTCP, National Accreditation Board of Laboratories (NABL) and College of American Pathologists (CAP) can become a member of IPAQT. The manufacturers currently supporting IPAQT include Hain (Hain Genotype MTBDRplus), Cepheid (Xpert), Biomerieux and BD for liquid culture. It is clear that a mere mention in the strategic plan and

adoption of standards alone may not lead to improved TB management and control practices in the private sector. This will require consistent and ongoing engagement with the diverse private sector including taking cognizance of the ongoing efforts in this domain with a view and intent for potential scale-up for the ultimate benefit of TB patients in India. References 1. J Glob Infect Dis. 2011 Jan-Mar; 3(1): 19–24. 2. Bull World Health Organ. 2004 August; 82(8): 580–586. 3. http://www.tballiance.org/acces s/tb-market-detail 4. http://www.who.int/bulletin/volumes/85/5/06-036277/en/ 5. O. Ferroussier, M. K. A. Kumar, P. K. Dewan, P. K. J. Nair, S. Sahu, D. F. Wares, K. Laserson, C. Wells, R. Granich, L. S. Chauhan. Cost and cost-effectiveness of a public-private mix project in Kannur District, Kerala, India, 2001–2002; INT J TUBERC LUNG DIS 11(7):755–761 6 .www.ipaqt.org

STRATEGY I N T E R V I E W

â&#x20AC;&#x2DC;We intend to float a chain of multispeciality hospitals shortly at Rajarhat, Siliguri etcâ&#x20AC;&#x2122; Nearly five-decades old, The Calcutta Medical Research Institute (CMRI) today has established itself as a leading multi-speciality healthcare and research institutes in Eastern India. Suyash Borar, who has taken over as the CEO of CMRI divulges more information about the hospital and its future plans, in an interaction with Express Healthcare What are the main priorities that you have chalked out for yourself after taking on the mantle of CMRI ? The main priorities would be clinical excellence, service excellence and ethical excellence. These three things would be our top most priority. A special drive would also be undertaken to improve the existing clinical and non-clinical infrastructure of the hospital. CMRI has set up Centres of Excellence (COEs) to focus on some of the specialties. Do you plan toset up some more COEs in the coming years? CMRI intends to set up centres of excellence initially in four major disciplines viz. gastroenterology and GI surgery, orthopaedics, women and child care, as well as cosmetic and plastic surgery to bridge the demand and supply curve in these major specialities. Most of the hospitals in the city, do have these specialities but not at par with the international standards. Surprisingly, a good number of our prospective clients move either to the South ern or Northern parts of the country for better medical care. Our COEs would offer services at an affordable price and would also attempt to deter the exodus of clients to other states. Today, CMRI is a renowned player in this part of the country. How do you plan to offer more services for the welfare of the masses,

especially the weaker sections of the society in the rural areas. A major chunk of our population does not have access to quality healthcare. In order to cater to the weaker sections of the population mainly in the rural areas, CMRI is exploring the possibility of accelerating the existing health programmes undertaken in collaboration with various leading organisations and NGOs. It is learnt that CMRI plans to set up telemedicine centres in different parts of the state. Can you elaborate on the same? The telemedicine/outreach centre will be set up in different parts of the state to meet the ever changing need of our customers stationed at different locations. These units shall mainly function as the spoke for the main hospital situated at Kolkata. You have been advocating 'sustainability' and 'green initiatives' in the healthcare sector at different symposiums/ platforms. What are your ideas and recommendations in this regard? CMRI is the only hospital in Eastern India that has launched a campaign called 'Green Hospital, Clean Hospital' to awaken the common masses and the healthcare players about the importance of green initiatives. These initiatives have helped us to optimise the

usage of existing resources without any additional cost.

CMRI is the only hospital in Eastern India that has launched a campaign called 'Green Hospital, Clean Hospital' to awaken the common masses and the healthcare players about the importance of green initiatives

Can you elaborate on CMRI's initiatives to ensure patient safety and security? Under no circumstances, CMRI will compromise on patient safety and security foray. Therefore, we have set out on a daunting and challenging journey to acquire the most sought after Joint Commission International (JCI) accreditation after successfully bagging ISO, National Accreditation Board for Testing and Calibration Laboratories (NABL ), College of American Pathologist (CAP) accreditation.

How do you plan to strengthen your community service initiatives? In order to strengthen our community service initiatives, we have conducted a couple of health related programmes in collaboration with Rotary, Lions International, CII, and other bodies for the poor and needy of our society. What are the Group's future expansion plans? The upcoming multispeciality hospital at Jaipur will be functional by April, 2014. We plan to have healthcare facilities at other places as well. joy.roychoudhury@expressindia.com

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KNOWLEDGE INSIGHT

Out of the crisis: breathing new life into medical education in India Dr Adheet Gogate, MD and Abhishek Yadav, Program Manager, Healthbridge Advisors, highlight the challenges plaguing medical education in India and recommend reforms to pave the way for the creation of a world-class medical education system

veryone has high expectations from healthcare in India. In addition to providing care for 1.25 billion Indians, the industry is expected to be an engine of economic growth in itself, adding investment and creating millions of jobs that enables people to do well while doing good. But the ability of our educational system to provide the required talent is deeply deficient. Other than massive quantitative shortages, the quality of education and the skill levels of the medical workforce are highly variable and unpredictable. Even at the current pace of reform, the situation is not likely to ease or improve for the next decade. Indeed, worsening, before any real improvement is highly likely. Left unaddressed, the shortage will materially affect health and hence the overall economy and economic outcomes, a cost India cannot afford to bear. India needs bold and dramatic reforms to address this issue. First, India needs to move from an input driven license raj to a competence based practice certification system. Second, it needs to remove barriers that thwart innovation and obstruct the

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INDIA FACES A MASSIVE PHYSICIAN SHORTFALL Too few physicians

Ratios for specialists are also poor

Per 1000 population ( 2010)

Per 1000 population

India

USA

20 India

14 Pakistan

10 1.5

China

1.8

Brazil

Gynaecologist Pediatrician

Anesthetist

Radiologist

Access is poorer in rural areas

2.4

USA

Physicians per 1000 population

1.3

2.7

1 3.4

France

0.6

1.5

Global average

Exhibit 1

Primum non nocere

0.3

4.3

Russian Federation

Urban

Rural

National average

WHO norm

Sources: World bank data, HLEG report by Planning Commission of India, KOL, PHFI report, Apr 2010

entry of more players into this space. Finally, and perhaps most importantly, it needs to thoroughly redesign incentives for becoming a medical teacher and make it an accessible, rewarding and impactful career choice.

A grim diagnosis Over the past decade, rapid and resilient growth in India’s healthcare industry has seen this sector attract significant interest. Exuberant estimates note that in under a decade, the country’s hospital industry may well triple in size and create over 15 million direct jobs as a result. Several

observers also note that India’s so-called demographic dividend – her youth – are an ideal base to create this worldclass talent pool. However, a closer look at our health education system reveals that India is ill prepared to produce adequate talent of reasonable quality. India’s overall healthcare talent canvas has massive gaps, with several critical talent pools virtually non-existent. But even in the core pool of doctors – an area where India’s talent has earned worldwide acclaim – there is cause for alarm.

The doctor isn’t in

amenities (such as schools) exist. As a result, barely 26 per cent of doctors live and work in rural areas – home to over 70 per cent of the country. A shortage of this severity also creates another problem: it leaves little to no talent available for the training of future doctors. (Exhibit 1)

India has a severe doctor shortage; according to 2011 World Health Organization (WHO) data, India needs over 450,000 additional doctors to meet basic WHO norms. When compared to G20 nations – an appropriate comparison for a nation with global aspirations the shortage is even more alarming: India comes out over a million doctors short. From general practitioners to cardiac surgeons, there are simply too few. In an industry where care is largely paid for out-of-pocket, physicians choose to set up practices only where it is economically viable and where reasonable

But the problem is not merely about quantity. The quality of physicians being produced by medical schools in the country is also a concern. Direct, rigorous studies of the quality of medical education are few but emerging evidence indicates that trouble is indeed brewing. Educational studies have shown that the quality of education is overwhelmingly dependent on the quality of teaching and tutelage – both factors directly dependent upon teachers. Against this background, the 25-30 per cent faculty vacancy rates reported at Indian medical schools is alarming. With every fourth teacher missing, it is obvious that Indian medical students are simply not getting enough teaching with significant implications for overall skill levels (Exhibit 2).

KNOWLEDGE RESEARCH CONTRIBUTION OF INDIAN MEDICAL ACADEMIA VERY LOW Further, the quality of faculty is also questionable. A milestone study demonstrated that India’s medical research performance – a critical indicator of teaching quality – is extremely poor. Despite having the largest number of medical schools and the second largest patient population in the world, India’s medical academia produces barely two per cent of all academic research. Over a thirty year period, India’s participation in global research has fallen far behind that of China’s, which has grown ten-fold. Further, nearly half of all research was done in just 10 medical schools (out of over 300). The implication: the education imparted to our doctors is of a significantly lower standard than across the world. Outside of the elite institutions, a further drop may be calamitous. Poorly trained physicians extract a terrible price: they increase the cost of care, risk of errors and are causally linked to poorer outcomes. A poor doctor today also means more poor doctors tomorrow: tomorrow’s doctors are the teachers to tomorrow’s doctors. Further, India’s practitioner licensing system – the bedrock of managing workforce quality – is also broken. Unlike in several countries, India does not have a graduating licensing exam: passing the final MBBS exam constitutes a de facto license. With over 300 schools, each with their own teaching and evaluation, there is little control over the quality of physicians entering the workforce. As a result, the quality of clinical acumen (when it is available at all) is extremely variable and unpredictable. One World Bank study revealed that even in the National Capital Area (New Delhi and its exurbs – India’s largest and wealthiest urban agglomeration), barely half the

India’s share in medical research is low…

… and has lagged China’s significantly

Percent share of global output (2008)

Percent share of global output

India

USA 4.7

23.01

USA 7.89

UK Germany

5.4

China

1.9

5.24

Japan

4.88

Italy

4.13

France

4.08

Canada

3.83

Spain

0.6 0.5

1989-1993

1994-1998

1999-2003

1.5

2004-2008

Existing research limited to few medical schools

2.94

Australia

0.6 0.4

2.91

Netherlands

40.8

2.52

India

1.88

Brazil

Share of 10most productive medical colleges

1.8

Switzerland

1.5

South Korea

1.45

59.2

Rest of the medical colleges

Sources: A scientometricanalysis of Indian research output ,Gupta & Bala; Medical education in India: Is it still possible to reverse the downhill trend? “ National medical Journal of India, 2010

Exhibit 2

doctors were able to clinically diagnose a heart attack. In poorer rural areas, this number dropped to barely one out of five (20 per cent) with 80 per cent of physicians in the sample being unable to clinically diagnose a heart attack. As always, the burden of absent or poor quality physicians is borne almost entirely by the poor.

Signs of life Cognisant of the challenge, state governments have begun the process of adding medical capacity – at least at the undergraduate level. Since 2005, capacity has nearly doubled with most of the new capacity being added in the private sector. Although this capacity addition is welcome, it is nowhere close to enough. Our analysis indicates that even at this rate of new capacity addition, quantitative shortages will not ease for the next 15-20 years; longer, if India aspires to G20 levels of physician availability (approximately 40 per cent higher

Dr Adheet Gogate, MD, Healthbridge Advisors

Abhishek Yadav, Program Manager, Healthbridge Advisors

than WHO’s norms). Though more capacity is being added, the process of capacity creation remains a complex license raj of permissions, approvals, inspections and quotas that obsesses over minutiae such as the number of microscopes available for teaching. Approvals hence take years, delaying the addition of crucial talent. Overall, current process of running and starting medical educational institutions contin-

ues to be hobbled by three deeply flawed mindsets:

Premise 1: Control inputs, ignore outcomes India’s medical education system is governed by a strong bureaucratic mindset that controls every input into medical education. From syllabi, methods of teaching, methods of evaluation to even the fee structure, every aspect of a medical college’s functioning is defined and de-

cided by central or regional decision-making authorities with little room for innovation outside a handful ‘autonomous’ institutions. Several regulations, in fact, actively obstruct innovation in teaching. Licensing rules, for instance, mandate library sizes and presence of labs on all wards, as pre-requisites to approval. In addition to driving up costs, these requirements actively obstruct introduction of new technologies and methods that eliminate the need for such facilities. The impact of such requirements and regulations on teaching and learning quality has never really been audited or sought to be improved. Similarly, controls over fee structures have moved several payments off the books, creating a ‘donation’ economy. In addition to being illegal,monies from this parallel economy can never be ploughed back into actually improving the quality of education. But perhaps no other input focus has caused as much damage as the magnificent obsession over entrance examinations. Over the past two decades, the country as a whole -- and several individual states -- has toyed with myriad entrance examinations. Frequently ill conceived and hastily implemented, exams have come and gone, each with different goals. From exams that are focused on ensuring equity to students across syllabi, equity to students across years (for a syllabus) and across regions to exams designed to replace other exams, the country has tried them all. The constant tinkering and experimentation has led to scores of court cases, costing crores and delaying hundreds of thousands of careers. In contrast, regulators have been singularly disinterested

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KNOWLEDGE in the mainstay of a strong talent pool: stringent, higher quality licensing standards. In the US for example, prospective doctors are required to clear the highly gruelling, formidable and expensive Board Certification exams in addition to their individual degree examinations. India has none (other than the DNB). Though the concept does find a mention in the MCI’s 2015 vision document, it is dismissed in a paragraph. More space is devoted, in contrast, to the fees to be charged for entrance examinations across different socio-economic groups! The net result of this License Raj is a profound deadening of innovation and experimentation in every aspect of medical education. In response to these incentives, institutions focus merely on meeting real-estate and infrastructure criteria and are singularly disinterested in the quality of doctors they produce.

Premise 2: Teachers don’t matter Research all over the world has shown that the quality of education – in each and every discipline – is exquisitely sensitive to the quality of faculty and teaching. Despite this knowledge, policy planners have made little effort in this area; teacher shortages are endemic. Though the shortage has existed for years, policy planners have made little effort to address the root causes of poor teacher availability. Real issues – such as the extremely poor economic prospects of a life of teaching, the near total absence of meaningful research opportunities and the reduction of academia to a token meritocracy – remain unacknowledged and unaddressed. Little to no effort has been made in defining innovative ways to make teaching economically attractive legally and avenues to widen the pool of teachers have been systematically closed over time. As a consequence, the ‘practice to academia’ divide is widening, leaving students with increasingly limited exposure to goings on in the wider workplace.

Premise 3: India can only

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Planned Intervention Will Reduce The Gap Somewhat But Not Cover It Even In Next Decade Number of doctors 13,80,000 12,10,000 330,000

+79%

122,000 50,000

7,70,000

6,12,000

Current WHO Norm

2012 base

New physicians

Natural attrition

Emigration & Total by 2023 Requirement by 2023 WHO other losses

Source: HBA analysis of secondary data

Exhibit 3

have quality or quantity, not both Instead of charting out a roadmap to raise standards of teaching quality at the time of capacity expansion, policy planners in recent times have recommended (and approved) a steep dilution in teaching competence standards. In area after area, parameters of achievement and experience have been significantly diluted (see Exhibit 3). At a time when capacity is being rapidly added, the dual impact of more doctors, with poorer tuition cannot be taken lightly. And yet, no formal research of these reforms has been conducted. Indeed, the basic question: is there a better way of growing quality and quantity has not even been asked. In sum, left on the current trajectory, India will enter a vicious downward spiral where she will have more medical schools, with fewer skilled teachers, a far less diverse teaching faculty and no means to gauge and manage the quality of physicians being produced. The costs of this misadventure, and its impact on the poor, can only be imagined.

Way forward Though the challenges facing medical education in India are significant, they are not insurmountable.

Before any ‘reforms’ are undertaken, however, policy makers need to pause and establish clearer goals first. For a while, the job of creating healthcare professionals and doctors was seen as a necessity and a societal obligation towards nation building. Policy makers need to introspect and assess whether this goal remains true. We believe that healthcare and medicine are not merely an obligation but a sector of the economy with tremendous potential to do well and do good. Planners hence need to thoroughly redefine their view towards medical education and commit themselves to a far higher goal: to create a system of medical education that attracts the best and brightest individuals, teaches them the most relevant skills innovatively and grooms them into highly sought after healthcare leaders. To embark on the journey of creating this system, India needs to usher in three sets of bold reforms:

Reform 1: Migrate from an input-based licensing system to a competence based one With the sheer diversity of medical colleges and programmes, establishing a rigorous, comprehensivemandatory certification system that governs the entry and continuation of practitioners into

the workforce based upon their talent and professional competence is imperative. This regulating system must be built to deliver the following: ◗ Ensuring mandatory, third party, independent certification at graduation as a practice requirement. India requires a national certification examination to ensure that all physicians meet universal, non-negotiable criteria of competence and professional aptitude independent of their school of graduation. Using a variety of testing methods (written, oral, practice simulation), this examination should ensure that prospective doctors have a) adequate medical knowledge, b) are skilled enough to apply their knowledge in making clinical decisions, c) have the right professional skills such as basic practice management, ethical concepts and legal principles to practice. The standard of examination also needs to be periodically studied, subject to evidence-based review and raise. Over time, newer skills and capabilities (e.g. ATLS stages, competence in basic intensive care, surgical skills) should be made mandatory for licensing. A professionally managed and appropriately incentivised independent institution should be created explicitly for ensuring enforcement of the licensing process (vide infra).

◗ Mandatory, competencebased practice certification renewal system. In addition to graduation testing, periodic testing to ensure competence to practice is essential and must be established. The system should issue renewals based upon direct competence and skill testing and not merely against participation in CMEs and seminars. ◗ Establish a licensing control system. In addition to practice certification checking and evaluation, a clear set of conditions for granting, suspending or permanently delicensing should be established. These should, as a means of policy, be linked to transparent criteria to reduce subjectivity in adjudicating these decisions that may get very politically charged. The creation of such a regulatory system will require significant institutional reform of national and state medical councils. The biggest change will be one of mindset – from a machinery designed to scrutinise inputs and grant licenses to colleges to one that defines competence-based standards for ensuring talent quality (while continuing to set common minimum standards for infrastructure). The journey of creating this regulator will be a long and arduous one but is not without parallel and success stories – even in India itself. India would do well to consider the following principles in setting up the system: ◗ Restructure the MCI as a performance regulator and not a license issuer. This would include reconstituting the MCI as an independent body with its own Governing Board that sets clear five-year mandates and remains at arms’ length from management. It would also require to comprehensively re-structure the Council’s selection policies to attract appropriate talent to the role. For e.g. key management positions should be filled using global searches by emphasising right track record and achievements over qualifications and cadres. Selected individuals must be given specific, finite, measurable result areas and

KNOWLEDGE performance goals for their tenures. Financial autonomy, achieved through the levy of a fee (to teaching institutions) will also help ensure independence and mutual accountability. ◗ Decentralise the operation of regulatory governance into regional hubs, similar to that employed by the UK’s Royal Colleges. In addition to reducing administrative delays, regional (autonomous) hubs will also encourage innovation and competition among bureaux and accelerate the development of best practices. ◗ Establish a strong culture of review, audit and continuous improvement. The process of governing talent levels must itself be reviewed periodically. The correlation between methods, systems of evaluation and actual talent outcomes must continually be monitored. Standards of competence must periodically be reviewed and raised. Above this, new goals and targets must specifically be assigned to office bearers to ensure performance and accountability. ◗ Roll-out competence-based practice certification in a phased manner, including setting ‘lapse out’ clauses for older practitioners and so on. Several lessons in phasing in change may be learnt from other public agencies such as the Election Commission, pollution control boards and others.

Reform 2: Liberalise the industry to raise participation and spur innovation As the competence based evaluation and certification system establishes, India rapidly needs to dismantle the license raj in medical education. Colleges must be given more leeway and flexibility over time to shape their agenda and test, validate and replicate innovative ways of teaching. Specific areas for liberalisation include: ◗ Enable participation in medical education. India should not discriminate against agencies from delivering education-based upon their business model: public, not for profit, private not for profit, and private for profit entities must be

allowed to compete for students. Colleges should also be allowed greater autonomy in selecting candidates to admit and, over time, in charging their fees. Rules that impose outdated or economically unviable real estate requirements on hospitals (with little known benefits) also need to be done away with. ◗ Liberalise syllabi and pedagogy. Across the world, tremendous innovations are being attempted to fundamentally change how medical education is being delivered. A variety of innovations are being attempted – from shorter educational programmes to more immersive methods of teaching and usage of technology. Notably, these innovations have been possible only when institutions have been given both the autonomy and the incentives to do so. By removing input controls and establishing a strong skill focused regulatory system, India will create a strong platform for innovative ways of teaching while also ensuring that all graduates conform to a national standard of competence. Calibrated approaches may be used to achieve these goals, such as giving higher level of autonomy to institutes with a solid track record in producing quality medical graduates. Fee structures and charging methods will also need to be liberalised to enable institutions to generate adequate surplus to invest in teaching and care innovation and reward performance. ◗ Incentivise patient-friendly education. Traditionally, most Indian medical colleges have been attached to free or nearly free public hospitals. This has been necessary to attract poor patients on whom medical students learn clinical skills, principally via experimentation and trial and error. It is not uncommon for students to learn CPR (and make mistakes) on an actual human being, an ethically questionable practice. Policy planners must create strong incentives to replace direct patient experimentation with technology-based learning tools such as endoscopic learning labs,

SO-CALLED ‘SHORT TERM’ SOLUTIONS TO ADDRESS THE SHORTAGE MAY SERIOUSLY AFFECT TEACHING QUALITY From higher standards…

… to lower ones

Teaching eligibility; main specialities Professor: 4 research publications in national journal and 1 in international journal; 4 yrs experience as reader

Professor: 4 research publication in national journal, 3 year experience as reader

Associate Prof/ reader: 5 years experience as lecturer; 4 research publications Post graduate education Professor and 1:1 for other cadre Medical qualification granted by selected foreign medical institutes recognised

Associate Prof/ reader: 4 years experience as lecturer; 2 research publications PG teacher to student ratio 1:2 for Professor and 1:1 for other cadre For anaesthesiology, forensics and Radiotherapy, the ratio is 1:3 and 1:1 respectively More of the foreign medical institutes were included in the list of recognised institutes in subsequent schedules

Source: MCI website

computerised robotic dummies, among others. Appropriate policies to incentivise the local manufacture and local development of these techniques needs to be strongly encouraged. ◗ Re-define the MCI. Finally, the role of the MCI too needs to be redefined from an organisation that sets entry parameters to an organisation that sees itself as the custodian and regulator of health education (e.g. like the TRAI or IRDA). The MCI must be reformed to play a larger policy and direction setting role to steward rather than license the growth and transformation of medical education.

Reform 3: Reform academia to make t eaching a competitive career choice In addition to creating a stronger licensing system and more innovative, inclusive educational institutions, real change will not happen (and sustain) unless India can also attract and retain high quality physicians and other professionals to become teachers. India should aspire to create an inclusive academic environment that allows teachers to be economically successful even if they do not practice. To achieve these goals, two key shifts are essential: ◗ Enable participative teaching. Indian policy planners need to create a far more

nuanced, participative framework for governing teaching activities. At present, most regulations in most states grant teaching status to physicians largely based upon whether they are ‘full time’ or not. As a result, several highly competent physicians, with a flair and passion for teaching, find themselves debarred from playing a teaching role. To enable this, policy makers need to make a fundamental mindset shift: granting of teaching privileges should be based upon the teacher possessing the required clinical competence (usually acquired through clinical practice) and a fundamental interest in teaching; it should be delinked from modes of employment or association. Modern technologies such as biometric checking may be used to ensure requisite participation and logging of hours in teaching activities. ◗ Enable monetisation of teaching skills. Finally, policy makers would do well to keep in mind a fundamental economic reality for physicians: choosing a life of teaching i nvolves major income loss due to the reduction in clinical practice. In several specialties, the magnitude of foregone income is a barrier to attracting teachers. Only when choosing a life of teaching represents a viable career option to private practice, will India be in a position to sustainably solve its medical teacher problem. We

believe that while higher salaries may help; their role is likely to be limited. Instead,policy planners must encourage physicians in academia to create synergies between their employment and other opportunities. In the leading business schools across the US, professors have successfully created a virtuous cycle of academic work that creates external advisory/ teaching opportunities that provide additional perspectives to further the teaching/ academic goals. In a similar vein, India too must allow medical school teachers to monetise their teaching skills. For instance, a highly sought after classroom teacher should be allowed to license out broadcasts of his or her lectures to other medical schools or teaching companies for a fee/royalty, similar to digital downloads of music. Through these reforms, India will pave the way for creating a medical education system that is likely to be far more innovative, responsive to talent needs and sustainable than it is today. These reforms will also enable India to address the dual concerns of quality of teaching and quantity of physicians in a sustainable way.

Conclusion Reforming medical education in India is likely to be challenging. With healthcare being a concurrent subject, it will be impossible for either the centre or an individual state to change the landscape of this sector holistically. The long lead times in medical education and the time duration between reforms and results (typically a decade or longer) will stress political systems and shortterm incentives. Strong crossparty political support will be crucial to making any meaningful headway. The road to a world-beating medical education system will hence be long, arduous and challenging. It will be a test of Indian politicians’ leadership to ensure that they stay the course. But stay the course they must: nothing less than the lives of 1.25 billion Indians are at stake.

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March 2014

RADIOLOGY DEPARTMENT SCAN

RGCI: At the forefront of technology With the patient at the centre of its philosophy, the Rajiv Gandhi Cancer Institute and Research Center, New Delhi is setting new standards in patient care with newer applications in radiology By Shalini Gupta

RAJIV GANDHI Cancer Institute and Research Center (RGCI & RC), New Delhi, started in 1996 primarily as a cancer diagnostics and treatment hospital geared for tertiary care and today stands as a pioneering institute in the field of cancer research and treatment. The hospital which acquired NABL (2011) and NABH (2012) certification was the first globally to qualify for ISO 9002 and 14001 certification in 2001. Express Healthcare was keen to find out what the radiology department of this hospital is upto and hence paid a visit to find out more. Located on the ground floor, in the A block of the hospital and 2nd basement in the C Block, it offers easy access to patients. Armed with linear accelerators, simulators, high dose rate remote after loading Brachytherapy system, dedicated treatment planning computers and mould room to fabricate lead shields and templates in house, it is intricately networked to CT scan and MRI with DICOM image

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March 2014

transfer capability. Talking about the early days, Dr AK Chaturvedi, Director, Radiology says, “We acquired the first state-of-the-art stereotactic mammography machine from Siemens (Mammomat 3000) soon after our inception. It was a sophisticated breast diagnostic system which could do biopsy of lesions.” He added that even AIIMS did not have one that time. Today the digital version takes its place of pride, a newer more advanced system that integrates a small field digital mammography (SFDM) with digital breast tomosynthesis (DBT) and results in computer generated good quality images that are clearer and hence help in better diagnosis. The department prides itself in having a fully functional PACS with secure private cloud storage in a complete digital environment that ensures reports are generated within a day, optimised imaging protocols conforming to international practice with a focus on clinically oriented reports and carrying out most

bed side interventional procedures. Care is also taken to ensure patient management through active participation in multi-speciality clinics (held on a daily basis) and tumour board meetings. “The radiologist plays an important role in staging the disease and detailing its exact extent which is a driving factor for treatment by the physician. This includes evaluation of the treatment being given to understand its responses so that the physician can either change the dose or suggest an alternative course,” adds Dr Chaturvedi. With more than 200 radiofrequency ablations (RFA) to its credit, the department is a pioneer in the treatment, which is ideal for patients with local tumours or those who have failed conventional therapies. Not only does it save the trauma associated with surgery, but also reduces hospital admission time to a day or so. RFA is performed under CT guidance and combined with chemotherapy for best results. The hospital's

reputation in image guided interventions is evident by the number of referrals coming in from multiple hospitals across the country, most of which are carried out on an outpatient basis. Another technique called Transarterial Chemo Embolisation (TACE) therapy involves administration of chemotherapy directly to the liver tumour via a catheter that reduces many side effects of traditional chemotherapy that is given to the whole body. Apart from the ultrasonography (USG) guided fine needle aspiration cytology (FNACs) and biopsies (with yield rates as high as 96 per cent), stereotactic biopsy procedures and guided wire localisations are also performed. A state-of-theart MR guided biopsy system takes care of any abnormalities detected on MR mammography. Last year saw the addition of TrueBeam technology for the first time in Northern India at RGRC. The advanced radiotherapy device dynamically synchronises imaging, patient positioning, motion manage-

ment, and treatment delivery with precision. With applications in all modalities including Image Guided Radiotherapy, Radiosurgery (SRS, SRT), Intensity-Modulated Radiotherapy (IMRT), Volumetric Intensity Modulated Arc Therapy (VMAT) and Stereotactic Body Radiotherapy (SBRT) along with conventional and 3-D conformal radiotherapy. “We have breached the stratosphere of operative technology with the addition of cuttingedge technology of Da Vinci robot assisted surgery and addition of four more modular operation theatres,” informs Dr Chaturvedi. Touching upon the merits of functional imaging, he further elaborates how PET CT scans have changed the course of management of cancer. “So far in radiology, the focus was on studying the internal composition of the body, whether through CT scan, X-Ray. However, certain molecular changes also need to be mapped. A PET CT scan gives structural image with

RADIOLOGY

a superimposed functional image detailing the metabolic processes in the body which leads to better insights into the disease.” An 18 channel, high gradient 1.5T MRI performs dynamic studies and multiphase angiographic studies alongwith venography, MR spectroscopy, perfusion, diffusion imaging and mean curve analysis functions for evaluation of complex cases. Breast imaging is routinely performed with a high resolution breast coil with advanced software available for analysis of post contrast kinetics of mass lesions. The machine is equipped with a unique ‘total imaging matrix’ (TIM) technology making it possible to combine the elements for more than one coil for optimal imaging. Currently, the department has 10 radiologists and five more in training. Almost 12 s tudents have passed out so far as a part of its postgraduate DNB programme in radiology (three-year residency)

With more than 200 radiofrequency ablations (RFA) to its credit, the department is a pioneer in the treatment, which is ideal for patients with local tumours or those who have failed conventional therapies accredited by the National Board of Examinations, New Delhi which started in January each year. Apart from this, it runs a one-year fellowship programme in oncological radiology for radiologists certified by IMA academy of medical specialities, a shortterm training programme in radiology (two to four weeks) recognised by the Indian Radiological & Imaging Association (IRIA) and Indian College of Radiology, as well as diploma courses in X-ray and medical Imaging Technology for techni-

cians (two-year programme recognised by Delhi Medical Association). Dr Chaturvedi is currently working on a project for early detection of breast cancer under International Atomic Energy Agency (Vienna) and recently conducted a workshop in interventional procedures for radiologists in Malaysia. All in all, the department, with its cutting-edge technology supplemented with training and research, looks poised for growth. shalini.g@expressindia.com

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March 2014

TECHNOLOGY FOR HEALTHIER LIVES

REVOLUTIONARYSILENTSCAN MR TECHNOLOGYNOWAVAILABLE ININDIA For decades now, MRIs have been associated with loud scans. Dr Harsh Mahajan of Mahajan Imaging shares with us how the new introduction from GE Healthcare-Silent Scan is proving to be a game changer

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March 2014

EXPRESS HEALTHCARE USER CONNECT INITIATIVE

IMAGINE GETTING an MRI done in absolute silence. It is now possible to experience it for real with GE Healthcare's Silent scan which has revolutionised the way traditional MRs function. Image quality has been at the heart of technological advancements in the MR industry, however little or no attention was paid to excessive acoustic noise generated during an MR scan. This loud, anxiety elevating noise is often a common refrain of patients, which can be intimidating as well. It is to be noted that conventional MR scanners generate noise in excess of 110 dBA (decibels) levels, similar to what we hear at a rock concert and hence patients are usually given headphones prior to a scan to protect their ears.The noise generated is related to changes in the magnetic field that allow the slice by slice body scan to be carried out. Efforts to speed up the scanning process in the next generation of MRs have further resulted in more louder scans. To counter this, acoustic noise mitigation techniques so far focused on insulating components and muffling sound as opposed to treating the noise at the source. So even as the MRs were getting technologically advanced and scanning faster, what they lacked was a patient centric approach making their experience more comfortable. It was with this in mind that GE achieved acoustic noise elimination right at the source with its new 3D scanning and reconstruction technique called Silenz in combination with its new high-fidelity MRI gradient and RF system electronics. This reduces MR scanner noise to near ambient (background) sound levels (close to 76 dBA) making a patient’s MR exam experience more relaxed and comfortable. The Silenz data acquisition method uses gradients continuously, not switching them on and off eliminating mechanical vibration, thus resulting in a silent scan. At the same time, it acquires three-dimensional MR data, yielding isotropic resolution along with a very short echo time thus helping improve image quality and signal from all tissues of inter-

est. A high fidelity power electronics platform ensures gradient stability and radio frequency (RF) required to avoid generating image artefacts during reconstruction. Further, the GEM Suite of coils helps maximise signal-to-noise ratios within the images by switching from transmit to receive mode within microseconds. Dr Harsh Mahajan, Founder and Chief Radiologist at Mahajan Imaging, Delhi has installed the Silent Scan capable Discovery MR750w 3.0T at his Defence Colony Center a month and a half back. His centre is one of the few all across the world and the first in whole of Asia to have this innovative technology. “I have been a practising radiologist for the last 27 years. As a physician, I have always wished for companies to make the magnet larger and the device shorter in length as well as reduce the sound from the scanner, something which was considered impossible so far.” MRIs typically have a long and narrow tunnel. That along with the staccato like sound during scanning can be a terrifying experience for a patient. To take the patient experience further up a notch, the MRI room at the centre gives a

The benefits of the technology are a boon for all including the patient, physician and radiologist feel of a living room with artistic Rajasthani décor on the walls and subdued lighting. “The idea has been to give the patient a positive experience with a friendly environment, something that they won't remember with trepidation,” he adds. It is easy to see that patient experience stands at the core of such a thought process, making the scan experience more comfortable especially for those who are claustrophobic. The centre which started two months ago sees 500-600 patients a month, with 35 to 40 per cent of those scanned for the brain on the silent MR. Scans for joint problems, spine, musculoskeletal, abdominal

investigations, liver and angiography are also conducted. For 80 per cent of brain applications, the scans are silent, there are one or two sequences in the brain which are nonsilent and are being worked upon. There are a few silent sequences for body applications also and a lot of work is going on to make all sequences silent. The benefits of the technology are a boon for all including the patient, physician and radiologist. “We were pleasantly surprised that when we run these silent sequences they are actually silent. We thought that the machine will bring down the sound from a certain decibel level to a tolerable level, but standing next to the machine, with the patient in the scanner, neither the patient nor anyone can hear anything. Sound of scanning and gradient is taken off. Hearing is believing, way beyond our wildest expectations. For someone involved with MR for so long, it is a dream comes true,” emphasises Dr Mahajan. Talking about the patient experience, he says that those who have been through the experience earlier on traditional MRs, think that the machine is not running, with even the purring sound absent.

“We have to reamplify that the machine has not stopped. The reactions have been consistently positive,” he adds. A quieter, less noisy environment means that the radiologist can focus more on the patient and communicate better with him along with reduced prep and scan times. Other team members such as nurses and anaesthesiologists can also communicate effectively. The other major advantage is a wide bore MRI, shorter in length, offering the best of both worlds. The machine is also very fast since it is the most advanced 3.0 tesla ever made and is able to do a quicker scan. Despite the silent nature of the scans there is no compromise on image quality; rather it is enhanced with these newer silent sequences, which is a positive development. The machine is also capable of detecting liver fat quantification or fatty change in liver, which is leading cause of cirrhosis in liver. Summing up, Dr Mahajan says, “For us it has been well worth the money spent, with a smile on patients face relieving them of a traumatic experience, a huge reward for someone in the healthcare space.”

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March 2014

IT@HEALTHCARE INSIGHT

Blueprint for EMR adoption in health organisations Johnny Ma, General Manager, APAC Industry Solutions, Hitachi Data Systems presents a medical content management blueprint for the HIMSS EMR adoption model in Asia Pacific MANY HEALTH organisations now use the Healthcare Information and Management Systems Society’s (HIMSS) EMR Adoption Model (EMRAM) to set the strategy for their path to adoption of electronic medical records (EMR). This eight-stage (0-7) model measures a hospital’s

implementation and utilisation of information technology applications, providing logical and progressively sophisticated steps for full EMR adoption. However, as they progress towards this goal, many physicians and managers remain confused as to how they can simultaneously

manage two important needs for content management. One need is to identify appropriate IT solutions to manage the increasing volume and variety of EMR content. The other need is to ensure seamless interoperation among healthcare applications and databases.

To help health organisations in Asia Pacific effectively and confidently move towards full EMR adoption, Hitachi Data Systems has created the industry’s first medical content management requirements to match the HIMSS EMR Adoption Model. The result is a valu-

MEDICAL CONTENT MANAGEMENT REQUIREMENTS FOR EMRAM Stage

HIMSS Analysis Asia Pacific EMR Adoption Model Cumulative Capabilities

Medical content management requirements

Stage 7

Complete EMR; CCD transactions to share data; data warehousing; data continuity with ED, ambulatory, OP

Deliver 100 per cent availability and security to ensure non-stop operation Extraordinary flexibility and scalability to support growth

Stage 6

Physician documentation (structured templates); full CDSS (variance and compliance); closed loop medication administration

Enable rapid content retrieval for all clinical systems High flexibility and scalability to support information growth Stringent business recovery plan, acquiring solutions like real-time replication, snapshots and cloning

Stage 5

Full R-PACS

Upgrade to an enterprise-class content management platform Enable real-time access and fast retrieval of medical information Enhance private cloud, storage virtualisation and unified content storage Further enhance the business continuity plan

Stage 4

CPOE; Clinical Decision Support (clinical protocols)

Provide higher levels of information sharing and collaboration Optimise performance, security and availability for applications and content management Adopt cloud and storage virtualisation to support increasing applications and workloads Improve the business continuity plan

Stage 3

Nursing/clinical documentation (flow sheets); CDSS (error checking); PACS available outside Radiology

Enhance scalability, compatibility and cost-savings for future development Improve RTO and RPO with improved data protection and long-term archiving The intention to adopt cloud becomes apparent

Stage 2

CDR; controlled medical vocabulary; CDS; possible document imaging; HIE-capable

Unified content management and business continuity become equally important Empower more sharing and reviews of medical content Consider to implement cloud to enhance efficiency, reduce costs and enable mobility in the future

Stage 1

Ancillaries – Lad, Rad, Pharmacy – all installed

Unified management of all types of content, including files and images Content protection is a must to meet regulatory requirements Disaster recovery plan for data protection

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March 2014

IT@HEALTHCARE

able blueprint that organisations can use to confidently plan their IT and fully optimise their IT investments. The following table shows how medical content management requirements correspond to each stage of EMR adoption. Based on the blueprint created by HDS for HIMSS EMRAM, we can identify which IT applications and solutions can be used to meet the specific medical content management requirements of each stage.

and reliable virtualisation solution can also help centralise all sources of storage. Whether the storage sources are internal, external, in legacy systems, or even on incompatible platforms, the right storage system can effortlessly manage them all in a single storage pool. Cloud computing and virtualisation can greatly enhance efficiency and deliver significant cost-savings as a business grows, and its user and database requirements increase.

Enterprise-class management system

Unified content management Health organisations must now deal with an everincreasing volume of contentintensive clinical data, medical images and files. The cornerstone of full EMR adoption is to implement a unified content management system that can handle all types of data, including files, images and block data. By simplifying the management of all data types, health organisations can store, share, and retrieve files and images from a single system with greater simplicity, reduced costs and lower risks. Since IT requirements will be added in accordance with the progression of the EMRAM, the chosen solution should not only meet the organisationâ&#x20AC;&#x2122;s current needs, but also lay the groundwork for future expansion. The solution must be highly scalable and flexible to allow the organisation to grow. For example, it should be easily scalable from a few terabytes to tens ofpetabytes, and enable users to effortlessly add functions like dynamic provisioning, dynamic load balancing, auto-tiering and replication tools. As EMR is critical for daily operation, the content management system should also support SLAs, data integrity and availability.

Since IT requirements will be added in accordance with the progression of the EMRAM, the chosen solution should not only meet the organisationâ&#x20AC;&#x2122;s current needs, but also lay the groundwork for future expansion. The solution must be highly scalable and flexible to allow the organisation to grow Business continuity Business continuity and disaster recovery plans are essential for all businesses today. In the healthcare sector, where reliability can literally be a matter of life and death, it is vital to ensure the non-stop running of health applications and information delivery. Thatâ&#x20AC;&#x2122;s why the disaster recovery plan should be prepared at an early stage of EMR adoption. Both the recovery time objective (RTO) and recovery point objective (RPO) should be well-defined, with

an appropriate business continuity system. Health organisations should also choose a content management solution that can dynamically provide exceptional flexibility and expandability in terms of functionality, scalability, reliability and performance. The most important criterion is whether it can provide 100 per cent data availability to protect overall, organisationwide data. This is necessary because EMR implementation will ultimately reach stage 7 (full EMR adoption)

where 100 per cent data availability is a must.

Virtualisation and cloud computing To support the increasing applications, data consolidations and information processing that start from stage 4 onwards, health organisations should consider leveraging cloud and storage virtualisation technology. By setting up a private cloud platform, they can provide secure remote access, information-sharing and file synchronisation for distributed users. An effective

To support progressive EMR adoption and top-of-theline, complete EMR operation, HIMSS and HDS recommend deploying an enterprise-class management system in the later EMRAM stages. When a health organisation develops its EMR in these final stages, it is preparing to operate in a fully-digital, paperless environment (namely, the full EMR adoption of stage 7). At this stage, only an enterprise-class management system can provide the highend, cutting-edge capabilities and functionalities that are required, such as dynamic tiering, storage virtualisation and leading performance, as well as 100 per cent data availability to guarantee uninterrupted operation. An enterprise-class platform can also help reduce the capex and opex of overall data management. These medical content requirements provide practical guidelines to help health organisations of all sizes to meet their operational needs today and tomorrow. This blueprint creates a solid foundation to ensure guaranteed sustainability on a health organisation's journey to EMR, while also protecting its IT investments.

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March 2014

HOSPITAL INFRA

ASK A QUESTION What are your recommendations for ICUs, unit size of 6 to 12 beds? We recommend the following: Q Bed space- minimum 100 sq ft (Desirable) >125. Q Additional space for the ICU (storage/nursing station/doctors/circulation etc) 100 per cent extra of the bed space (Keep the future requirement in mind) Q Two oxygen outlets Q Two vacuum outlets Q One compressed air outlets 1 Q 12 electric outlets, of which four may be near the second floor on each side of the patient. Electric outlets/inlets should be commonly 5/15 amp pins to accommodate all standard international electric pins/ sockets. Adapters should be discouraged since they tend to become loose. Utilities per bed as recommended: Q Three oxygen outlets, two compressed air, two vacuum (adjustable), 12 to 14 electric outlets, a bedside light onetelephone outlets and one data outlet. Why does a hospital need a marketing department? It’s a valid question if you think about ‘marketing’ only on a basic level. But nowadays, it is about more than just the service. The community is served by a number of hospitals, and we all can’t be everything to everyone, so it is important for the community to know what hospitals are offering. The changing landscape of healthcare reform will also change our marketing strategy. The medical facilities are accountable when it comes to patient care. Hence it is necessary to know how will

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March 2014

continued care be beneficial to us. Patients will play a more active role in their care choices, and we need to provide them the best information available to make those choices. How do you know about something if someone doesn’t tell you? What are the major functions of a bio medical department ina hospital? Q Equipment & Supplies Committee Q Perform incoming inspection, installation, preventive and corrective maintenance, and special request service on clinical equipment owned, and/or used within the hospital in compliance with regulatory manufacturer’s representative/agencies. Q Provide pre-purchase evaluations of new technology and equipment Q Assist clinical departments with service contract analysis, follow up, negotiations and management Q Provide coordination of clinical equipment installations including planning, scheduling, oversight and acceptance Q Research equipment issues for hospital professional and administrative staff. Q Participate in various committees Why is health insurance important? Even if you are usually in good health, you will need to use the health care system at some point in your life. You never know when an accident may happen or your family member may get sick and need to see a doctor. Health insurance provides you with an affordable way to get medical care when you need it. It also protects you and your family

from the high cost of healthcare. The cost of even routine care can quickly add up, but the cost of care for a major illness or injury can be devastating. At any age, and every level of personal health, healthcare costs should be something you take seriously. That is what health insurance is all about — covering the expenses that come with preventing illness and staying healthy, and being prepared for the worst that could happen. How do we estimate the cost of construction of a hospital? Hospital costs vary greatly depending on locality, availability of capital, and interest rate charged. There are some good sources of current information on hospital construction: the "Dodge Building cost calculator" and "Means building construction cost Data" give costs of different elements of construction to compare and find the approximate cost of hospital construction, closely enough for planning purposes. Developing countries have less information and a greater spread of construction costs. What are the main objectives of manpower planning? The main objectives of manpower planning are: Q Ensuring maximum utilisation of the personnel Q Assessing future requirements of the organisation Q Determining the recruitment sources Q Anticipating from past records, i.e. resignations, simple discharge, dismissal and retirements Q Determining training requirements for management’s development and organisational development

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

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

LIFE PEOPLE

Joy Chakraborty takes over as the new COO of PD Hinduja JOY CHAKRABORTY has taken over as the COO of PD Hinduja Hospital & Medical Research Centre. He has held other key positions such as Director – Administration and Senior Director - Operations in the same organisation. Speaking about his core responsibilities as the new COO he told Express Healthcare, “My core responsibilities will be to reiterate and strengthen the core values and ensure delivering healthcare through a patient- centric approach which we have been practicing over the last six decades. Patient care delivery needs to be more process and system driven for better outcome and my responsibility will be to make it affordable for the community. One of the other major responsibilities will be optimal utilisation of available skills and resources in the hospital through technology and better patient awareness. In alignment with our value system we need to continue to retain trust and confidence shown by the patients for the hospital.” Speaking about his vision for the organisation in his new position he said, “PD Hinduja Hospital & Medical Research Center is committed towards ‘Quality healthcare for all’. My endeavour along with my team and the support of trustees will be ensuring safe to safest care for every patient who visits us for seeking healthcare services. PD Hinduja Hospital is growing organically by adding 100 beds. However, our endeavour is to reach our community at their doorstep. Our organisation has taken initiative to make healthcare more virtual through embracing technol-

Neeraj Lal is Sunshine Group of Hospitals’ new Group COO NEERAJ LAL has joined Sunshine Global Hospitals as their Group COO. Earlier, he was the CEO of BAPS Shastriji Maharaj Hospital, a trust-run organisation in Vadodara. Sunshine Global Hospitals are the largest group of hospitals in Gujarat having three hospitals in Baroda, one in Bharuch and one coming up in Surat. He stated his pleasure on his new job and spoke about his role for Sunshine Hospitals Group. He told Express Healthcare that his responsibilities include: ◗ Creating comprehensive and true multispeciality care across Gujarat ◗Imbibing quality culture in terms of patient care and safety as per accreditation standards across all hospitals in the group ◗Being responsible for profit and loss (P&L) of the group ◗Connecting all specialists and

ogy and innovation model of care delivery. My pursuit will be implementation of these strategies so that healthcare does not remain restricted within brick and mortar and goes much beyond the geographical boundaries. We are also in the process of coming up with a knowledge centre which will integrate, research, innovation, technology, healthcare delivery and education for the betterment in future. We are leaders in TB research and have been acknowledged, as well as awarded by national and international agencies. Our focus will remain on similar kind of research and initiatives in all areas of healthcare to improve the quality of life of our population.” Vinoo Hinduja, Executive Trustee, PD Hinduja Hosptial & Medical Research Center, spoke on Chakraborty's appointment as COO and said, “At PD Hinduja Hospital and

Medical Research Centre we work with a team of professionals but as a parivar and this culture has been our strength for over six decades. Joy over his tenure has illustrated this work ethos in various ways. He is a leader who carries his team with him and ensures that due credit is given to his team, thereby inculcating the parivar culture into everyday management. He has helped PD Hinduja Hospital receive accreditations and accolades by initiating quality initiatives with his colleagues and peers as a team. Joy’s biggest asset has been transparency and understanding which has contributed in the institute’s growth, not just as a revenue driver but as a quality driven organisation striving for the betterment of India’s healthcare sector. Hence, he is the best choice for the COO’s position.”

super specialists in all their group hospitals via video conference to share medical successes and interesting cases specialty wise for knowledge sharing ◗Assisting in the expansion in cities like Rajkot, Ahmedabad etc.

Varian Medical Systems elects R Andrew Eckert as Chairman of Board of Directors VARIAN MEDICAL Systems has elected R Andrew Eckert as the Chairman of the Board of Directors for the company. Eckert takes over from Richard M Levy, who has served as as the CEO for the company from 1999 to 2006. Eckert, 52, has served on the board of Varian Medical Systems since 2004, and has served in the capacity of independent lead director since 2012. He is the CEO of CRC Health Corporation and has served previously as the CEO for several healthcare and software companies, including Eclipsys Corporation, SumTotal Systems, and ADAC Laboratories. Eckert is recognised for his knowledge of Varian and his extensive experience serving in medical imaging and healthcare information

management, as well as his expertise in operational, financial, strategic planning, product development and marketing matters. “We are grateful for the leadership and energy that Dick Levy has given to Varian during a more than 45-year career here,” said Eckert. "Under Dick's guidance, the company established itself as the world's leading innovator and supplier of products for treating cancer with radiation oncology. Furthermore, the company has capitalised on components technology developed under Dick's leadership to advance the science and benefits of X-ray imaging. Dick has made an indelible mark on the company and on the world and it has been an honour for all of us to work with him.”

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March 2014

BUSINESS AVENUES

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

Medical Grade

SILICONE TRANSPARENT TUBING

Printer

USFDA approved raw material of European origin

ETO Cartridges KA - 2 MODEL Fully Automatic with Printer

Imported state of the art machine having the most advanced auto-curing system Excellent heat resistance (-50°C to 250°C) Odourless Completely nontoxic Repeatedly autoclavable

ied Certif om Cleanro

v External Compressed Air Requirement – Optional v In Built Printer Facility & PC Connectivity v Entire process fully automated – PLC Controlled

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

v 4 digit, 2 row LED display Process Controller

v Process indicators for cycle status

v In built Printer gives record of entire cycle

v Auto / Manual changeover possible

v Simple and safe to operate

v Operates on single phase, 230Volts A.C.

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No leaching of particles

v Operates on domestic power supply v Built in auto aeration facility

Does not support bacteria growth

v World class unique cartridge puncturing system, Automatic & Manual – both modes provided.

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Capturing physical assessment and vital signs data is routine.

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IgE & IgG antibodies to Food....

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TRADE & TRENDS

Cleanroom gloves or medical gloves? Suppliers of specialist gloves are often asked to supply medical gloves for use in cleanroom applications. However, the introduction of medical gloves into a cleanroom could have serious repercussions. Derek Watts, MD, Nitritex explain why the two applications are often incompatible PERCEIVED WISDOM is that gloves used in medical environments are sterile, as the purpose of medical gloves is to prevent cross-infection from the clinician or surgeon to the patient. Surely, therefore, medical gloves must be very clean. This is a misconception and only partly true. The ultimate purpose of sterilising surgical gloves to be used in operating theatres is to prevent infection from bacteria which would otherwise be present on the gloves. Contrary to the belief of many, the standard dispenser boxed examination gloves used in medical and dental environments are not sterile, and all they can do is prevent cross infection spreading from the wearer of the gloves to the patient. The patient is not protected from the multiple bacteria that are already present on the gloves. Dentists are still allowed to use powdered gloves but all medical gloves used in hospitals in the UK have to be powder free. The traditional way to make a glove powder free was for it to be put through a process of chlorination after it had been removed from the production line. The process of chlorination not only removed all the powder but it also killed the bacteria on the glove. As such, provided the packers of the exam gloves wore clean gloves, one could be reasonably assured that the examination gloves would have a very low bacteria count. Nowadays, however, powder free medical gloves are rarely made through a process of chlorination (inside and out), as in the interests of economy, other manufacturing methods for these gloves have been developed and established. Most powder free medical examination gloves are now either produced on-line by dipping them into a polymer

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March 2014

coating or by chlorinating them on-line prior to stripping them off the glove formers. Because gloves are moulded inside out, chlorination takes place only on what is ultimately the inside of the glove. The outside does not come into contact with the chlorine and therefore the gloves will be prone to having a lot more bacteria as compared with offline chlorinated gloves. Pharma manufacturers will normally require sterile gloves, but in addition to the sterility, they also require the gloves to be low in particulates, especially if they are making injectables. There are many ways that particles get on the gloves. The main origin of the particles is human cells, followed by tiny fibres from clothing. There is little emphasis during the production and packing of surgical gloves on the minimisation of either of these, and as a result sterile surgical gloves frequently have high particle counts, albeit of sterile particles. As a further indication of the lack of concern for particles in medical environments, you just have to look at the packaging of standard surgical gloves (see Figure 1). They are packed in paper inner wallets which are then, traditionally, sealed into paper pouches that have a tendency to shed particles when peeled open. The sealed pouches are then further packed into card-

board boxes. Paper is a no-no in all non-medical cleanroom environments, so all of this packaging is unacceptable. In contrast to the paper packing of surgical gloves, sterile cleanroom gloves are packed using non-particulating materials such as polyethylene inner wrappers and easytear pouches (see Figure 2). All this packaging is itself manufactured in a cleanroom to ensure its cleanliness, and comes technically specified. In some cases, it will not be necessary for pharma manufacturers to use sterile gloves, for instance if making tablets. However, it is still important that the particulates on the gloves are low. Not only do the particulates need to be low, but the bacteria count on the non-sterile gloves will also need to be very low. This

Figure 1: Surgical glove packaging showing peel pouch and paper wallet

is why it is important that cleanroom gloves are used for this application. All good cleanroom gloves are chlorinated off-line, meaning that both the inside and the outside of the gloves are thoroughly dosed in chlorine. They are then washed in highly filtered water to remove the residual chlorine and other particles. Whilst the removal of particles is important for gloves used in the manufacturer of pharma products, removal of ionic contamination is not of importance. However, for the micro-electronics industry, whilst a low particle count is extremely important, in addition to this, many manufacturers also consider low ion counts to be a critical requirement. Ionic contamination can greatly reduce the yields in the manufacture of electronic products such as hard disk drives, printed circuit boards and silicon wafers. Ions such as chlorides, nitrates, sulphides, sodium, potassium, etc are by-products of the chemicals used in the manufacturing process. All of these particles rest on the surface of the glove and require mechanical removal. This is achieved by washing the gloves in ultra-pure, de-ionised water, and then drying just before packing. Having demonstrated that medical gloves are not suitable

Figure 2: Cleanroom glove packaging showing easy tear pouch and PE wallet

for cleanroom use, we have to ask â&#x20AC;&#x153;What actually are the important characteristics of cleanroom gloves.â&#x20AC;? The number one characteristic, which has already been established, is the cleanliness of both the glove and its packaging. However, beyond that, users have a wide selection of gloves to choose from to match their application. It is probably true to say that for every cleanroom application there will be a number of options available to the purchaser, and that final selection frequently comes down to the preference for one glove over another based on purely subjective criteria such as fit and feel, level of grip etc. One thing that the user should be able to take for granted, is that the physical properties of the gloves should reach minimum standards. However, the cleanroom glove community has evolved without defining exactly what the minimum standards should be. This void has been partially filled by glove manufacturers using the existing medical glove EN 455 standards1-3, to define dimensions, strength and limits on the numbers of pinholes as a basis for quality assurance and quality control in their factories. What is equally important is that glove manufacturers specify the cleanliness class for which the glove is suitable, as defined in EN ISO 14644-14, e.g. ISO Class 4 or ISO Class 5. It should be noted that some cleanroom gloves are also specifically chosen because they protect the wearer from harm from chemicals. These gloves are classed as Personal Protective Equipment (PPE) and are regulated under the European PPE Directive5 and its associated standards6. Obviously such gloves must at the same time comply with

TRADE & TRENDS TABLE 1. RELATIVE PERFORMANCE OF THE FOUR MAIN GLOVE MATERIALS Comfort

Elasticity

Strength

Durability

ESD performance

Latex

Excellent

Good, but punctures can be hard to spot

Very poor. Latex is an excellent insulator

Polychloroprene

Good; very close to Latex

Good

Poor – Good Insulator

Nitrile

Good; comfort improves with wearing

Medium

Good

Good. Static dissipative and improves with wearing

Vinyl

Fair; relatively stiff

Low

Medium

Good. Static dissipative and improves with wearing

cleanroom requirements. The other issues that the specifier needs to consider are the shape of the gloves and the type of rubber used for their manufacture. Lower cost bulk packed non-sterile gloves are normally flat form, ambidextrous, with the thumb emerging at the side, allowing the glove to be donned on either hand. These gloves are excellent for general purpose use in the cleanroom, but every movement of the fingers and thumbs has to overcome the resistance of the glove material, which has a natural tendency to maintain its original shape. In most applications, this will not present a problem, however, if the wearer is constantly engaged in very fine work, requiring precise movements, then the resistance of the glove can cause fatigue in the hand and, in particular, the finger

muscles. For precision work, hand specific gloves are a much better option. Hand specific gloves are moulded with a slight curve to the fingers, and with the thumb offset to the front in a much more natural position than ambidextrous gloves. These design features mean that the wearer is not fighting against the natural behaviour of the rubber and instead the rubber is assisting the wearer where fine control is required. If operators are involved in very fine work, the thickness of the glove becomes important, as does the level of grip and the texture of the fingertips and palm. In terms of wearer comfort, natural rubber latex (NRL) is probably the best option because of its elasticity and strength. However, there are concerns surrounding latex allergies which can affect the

wearer and also make the gloves unacceptable in some pharma manufacturing applications where possible contamination with NRL proteins would render the processed drugs unusable. The alternative synthetic rubber materials are polychloroprene, nitrile and vinyl. Amongst the synthetic rubbers, polychloroprene has the characteristics closest to NRL and provides a very good alternative. Nitrile and Vinyl are stiffer materials with vinyl being the least elastic; however both nitrile and vinyl have good electrical conductivity properties making them ideal for use in electronics manufacturing or other static-sensitive environments such as explosive or combustible atmospheres. In conclusion, it is simple to state that medical gloves should not be used in a cleanroom

environment. Medical gloves may appear to be clean (and might even have been sterilised), but in cleanroom terms they can be very dirty. Cleanroom gloves are available in different materials, different shapes, different lengths, different thicknesses and different textures and levels of grip. It is, therefore, important that the person specifying the gloves knows a) what level of performance is required to match their process, and b) what the requirements of the wearers are. For some applications, the selection of the correct glove will be straightforward, but for others a bit more work may be required. Any good manufacturer of cleanroom gloves will be able to provide written specifications, advice and samples to aid the decision making process.

References 1. EN 455-1: 2000, Medical Gloves for single use – Part 1: requirements and testing for freedom from holes. 2. EN 455-2: 2009, Medical Gloves for single use – Part 2: requirements and testing for physical properties 3. EN 455-3: 2006, Medical Gloves for single use – Part 3: requirements and testing for biological evaluation. 4. EN ISO 14644-1:1999, Cleanrooms and associated controlled environments, Classification of air cleanliness 5. 89/686/EEC, Council Directive on the approximation of the laws of the Member States relating to personal protective equipment 6. Gloves as PPE: Standards for permeation and penetration, Derek Watts, Clean Air and Containment Review, Issue 2, April 2010

RxOffice web-based hospital management system Kishore Shinde, VP Healthcare, IndiSoft HMS talks about how RxOffice web-based HMS has been designed to cover all the basic needs of the hospital management

THERE HAS been rapid development in medical science in past few years. Individual doctors and hospitals have been investing substantial amount towards latest machines and tools. Patient awareness has also been increasing with demand of thorough investigations, cross-examination and expla-

nation from doctors for the treatment. The challenge today for hospitals and doctors is to manage high degree of patient satisfaction, maintain transparency for patient medical history and at the same time make the hospital financially sound. RxOffice web-based HMS

is designed in such a way that it cover all the basic needs of the hospital. It covers patient registration (indoor/outdoor), doctor’s appointment details, medical history, regular examination, investigations, operation theater details, inventory, HR. RxOffice HMS helps hospital to keep all the departments properly synchronised

by ensuring even operations.

Why RxOffice HMS: ◗ Increases productivity due to auto operations ◗ Increases profit and revenue for the hospital ◗ Improves clinical decision ◗ Enhances documentation ◗ Helps deliver better care for the patients

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TRADE & TRENDS

Software features: ◗ Personalised dashboard as per user type (doctor, frontdesk, nurse, billing, lab, radio) Front desk dashboard ◗ Appointment scheduler ◗ Nurse duty roaster with efficient user interface ◗ Easy and efficient medical records handling ◗ Online billing ◗ Secured access management for each stakeholders with audit trial ◗ Compliance with international standards (ICD-10, HL7, HIPPA) ◗ Sending scheduled SMS ◗ Ability to integrate with other systems (tally integration, machine interfacing)

Modules covered ◗ Registration module This is integrated patient management system. It gives you complete patient information. It provides better patient process management. ❑ Patient registration and allocation of unique patient ID. ❒ OPD ❒ IPD ❑ Patients demographic details ❒ Address ❒ ID card details ❑ Patient contact information ❑ Next to keen details ❑ Patients medical/Allergy alerts ❑ Patients TPA/Insurance details ❑ Patients search (by id, name, mobile number) ❑ Upload patient photo

OPD module ◗ Quick OPD The outpatient module serves as an entry point to schedule an appointment with the hospital resident doctor or consultant doctor for medical consultations and diagnosis. ◗ Scheduler ❑ Scheduler or calendar ❑ Appointments ❑ Block Slot ❑ Cancel appoINTment. ❑ Reschedule appoINTment. ◗ IPD module This module manages dayto-day activities and functions of the Inpatient. It provides data for managerial and ad-

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ministrative functions pertaining to admission of patients, ward management, bed occupancy, service orders, investigations ordered, discharge summary and details. ◗ Pathology module This module keeps track of the tests performed on different patients and its records will be maintained by the system. Machine interfacing can be done which helps in getting the values directly from the machine. ◗ Radiology module This module covers various tests like X-ray, sonography, etc. Master templates can be created and it can be updated patient wise. It has all the features like spell check, auto complete etc. ◗ Billing module ❑ Estimation bill ❑ Pathology bill ❑ Radiology Bill ❑ Patient Bill Search ❑ TPA/Comp (Insurance) ❑ Doctor charges setting ❑ Packages ❑ Concession ❑ Stage Bill ◗ OT module ❑ OT scheduling ❑ Pre/Post OT Details ❑ Post OT charges to bill ❑ Cancel OT ◗ HR module ❑ Shift list ❑ Duty allocation to employee ❑ Employee attendance ❑ Salary calculation ❑ PF & PT Settings ◗ Inventory module ❑ Opening stock feature ❑ Purchase order ❑ Purchase Invoice (PI) ❑ Delivery Challan (DC) Generation ❑ Patient sale ◗ SysAdmin module ❑ Create users ❑ Assign privileges ❑ Add doctors/services ❑ Define beds/packages ❑ Bed wise rate list ❑ Add TPA/Insurance with rate list ❑ Define doctor referrals ◗ Reports module ❑ Reports ❑ Daily OPD/IPD User wise report ❑ Department wise collection ❑ Doctor-wise referral reports ❑ Patient outstanding report

Patient Health Information Screen

Patient portal is one of the most important features of RxOffice Web HMS. The user has the option to download the test reports and avoid coming to the hospital to collect the reports

The Login panel

Front Desk Dashboard

❑ Day summary (Covers all department collection, bed occupancy, stock status, equipment amc, warranty details and many others)

patient will have a unique ID and password wherein the confidential data is secured. The patient can download his reports easily.

Patient portal

Benefits

Patient portal is one of the most important features of RxOffice Web HMS. The user has the option to download the test reports and avoid coming to the hospital to collect the reports. Every

◗ Patients can access their health record anytime ◗ Download lab reports online ◗ Secure communications with doctor via email ◗ Schedule appointment via portal

The figure above shows the Patient Health Information Screen. Indisoft Consultancy Services with more than 200 clients has made its mark in Healthcare Application Software development. They are an ISO 9001:2008 certified company, providing software solutions to the healthcare industry since 2001. kishore.shinde@indisoft-cs.com

TRADE & TRENDS

Labtop launches Biofreeze and Laminar air flow cabinet Biofreeze provides an ideal freezing environment for advanced medical and industrial applications while Labtop laminar air flow cabinet is an enclosed bench designed to prevent contamination of semiconductor wafers, biological samples etc Biofreeze

easy to use. The micro controller controls the ON/OFF for blower operation, UV germicidal light, fluorescent light, and mains. A high quality air velocity sensor helps in sensing the actual air flow in FPM. This microprocessor warns for any deviations in the air velocity from normal velocities.

Labtop micro-controller based biofreeze provides an ideal freezing environment for advanced medical and industrial applications. Use includes preservation of plasma, related blood components, vaccines, micro-organism, and testing of materials and electronic components at desired low temperature. The system includes micro controller-based temperature controller with digital temperature display of set value and process value.

Blower motor assembly Dynamically balanced, direct drive highly efficient centrifugal blower to provide adequate air flow over the entire surface of HEPA filter. These are directly coupled to an inbuilt motor and operate with minimum noise level i.e. lower than 65 db on scale and vibration less than 2.5 um.

Calibration The equipment is calibrated with the help of master calibrator, which is certified for its accuracy by Electronics Regional Testing Laboratory (ERTL West) Government of India recognised testing laboratory with reference to National Physical Laboratories (NPL).

Cabinet construction and refrigeration system The cabinet of Labtop freezers is insulated with high density CFC free Poly Urethane Foam. The interior of the chamber is of stainless steel (304 SS, 1.0 mm thick). The exterior is white powder coated (1.0 mm thick) mild steel and the door has a magnetic gasket with a keyed door lock. Stainless steel trays are provided for storage inside. The cooling is effected by a hermitically sealed Danfoss compressor. GMP models are in total stainless steel (Inside SS 316 and outside SS 304).

Special features ◗ Foamed-in place PUF insulation ensures temperature stability and reduced energy consumption. ◗ Audiovisual alarm if the temperature deviates from

the pre-set temperature. ◗ Display of set value and process value. ◗ Precise control of temperature by using micro controller based temperature controller. ◗ Refrigeration system with CFC free eco-friendly refrigeration system with time delay. ◗ Password protected keypad lock.

Air flow and filtration

Optional accessories Mobile alert: Via GSM technology in case system fails Data scanner: Eight Channel temperature scanner complete with sensors and printer interface and data storage facility. Software: CFR 21 Part 11 compliance windows based communication software for data management. Complete with RS-485 multi dropping to monitor multiple chambers to one software. Documentation: Labtop offers IQ, OQ and PQ validation with documentation, reports, calibration and test certificates.

Laminar Air Flow Cabinet Labtop laminar air flow cabinet is a carefully enclosed bench designed to prevent contamination of semiconductor wafers, biological samples, or any particle sensitive device. The cabinet is made of mild steel or stainless steel. These laminar airflow units are used for applications such as tissue culture, media preparation, sterile handling, PCR sample preparation and many more. Labtop laminar flow chamber exist in both horizontal and vertical configuration. These

laminar air flows are widely used in pharma industries, hospitals, manufacturing facilities, blood banks and research centres. Laminar flow cabinets may have a UV-C germicidal lamp to sterilise the cabinet and contents when not in use.

Construction All laminar flow clean air cabinets are basically constructed with an outer body of mild steel duly powder coated. The inner work table is made of stainless steel. The front of the cabinet is provided with motorised glass door which is very

Laminar air flow principle involves double filtration of air. Atmospheric air is drawn through pre filter and is made to pass through highly effective HEPA (High Efficiency Particulate Air) filters having efficiency rating as high as 99.99 per cent with cold DOP and 99.97 per cent with hot DOP, thus retaining all airborne particles of size 0.3 micron and larger.

Contact Byju George Director Labtop Instruments Labtop House, Plot No. 59, Opp. Amarson, Waliv Phata, Sativali Road, Vasai (E), Thane- 401 208, Maharashtra, India Tel: +91 250 6457 376 - 99 Email: byju@labtopinstruments.com www.labtopinstruments.com

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TRADE & TRENDS I N T E R V I E W

â&#x20AC;&#x2DC;Our products are used by US FDA approved facilities in Indiaâ&#x20AC;&#x2122; Zoru Bhathena, Founder, Periclave speaks about the company's growth prospects

How has Periclave managed to keep up with the constant changes in the Indian market and its consequent demands? Today the healthcare industry is growing at a very fast rate. Increased growth has lead to an increased demand of medical equipment. With one of the most modern plant in the country, we are fully equipped to meet this exponential demand not only in terms of turnaround time but also providing the most innovative solutions for complete CSSD /TSSU, laundry and kitchen equipment which were never seen and heard in the country. We have standardised the entire process of manufacturing over the last many years and already have a good portfolio of products to serve the unique needs of not only small hospital setups but also huge medical institutions, pharma industries, medical colleges and research institutes, etc. and we are selling these products with 100 per cent customer satisfaction. Despite this, we always aim to communicate effectively with our customers and if need arises, we are definitely open to introducing custom-made equipment in the market based on individual customer requirements. What does Periclave offer the life-sciences sector ? Periclave offers a broad array of products and solutions for life sciences, research laboratories, pharma and biotech companies. The production steps in the life science industry are aimed at maximum safety, top quality

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and high economy. This applies in particular to the sterilization processes. Periclave has pioneered in preventing contamination by providing superior products and services in the field of sterilisation. Our unique integrated offering of reliable sterilisation equipment and services allows Periclave to support the entire process from research and discovery to manufacturing. Many of our products are used by the US FDA approved facilities in India. As the technology leader and with several systems installed nationwide in leading pharma and biotech companies, Periclave has been offering unique flexibility in the engineering and manufacturing of tailor-made solutions. Periclave is familiar with the requirements of the healthcare industry and for decades, has been a reliable and competent partner to this industry. What are Periclave's targets and goals for this fiscal? The most important thing to remember about any enterprise is that, there are no results hidden inside its walls. The result of any business is a satisfied customer and at Periclave, we only strive for customer satisfaction using the best available technologies and man power. Our goal is to utilise the results of intensive dialogue with our customers to further develop our products and to incorporate relevant innovations so that we set our products as a benchmark on international platform. We at Periclave are striving to give our customers 100 per

We at Periclave have developed laundry equipment which use zero per cent direct heat from fossil fuels

are our main forte. Any new launches or expansion plans in the offing? In the hospital laundry, the major running cost is for generating heat which is used in dryers and presses. In most of the big hospitals the steam generated from burning fossil fuels is used as the heating medium. Burning fossil fuels generate sulphuric, carbonic, and nitric acids, which fall on the earth as acid rain, impacting both natural areas and the built environment. . The transportation of fossil fuel requires the combustion of additional fossil fuels. In order to minimise the exponential cost and hazards incurred due to use of fossil fuels in running a laundry and also as a social responsibility, we at Periclave have developed laundry equipment which use zero per cent direct heat from fossil fuels. This year we will be upgrading our laundry equipment which will work without the use of fossil fuels and the running cost for the entire laundry will reduce at least by 50 per cent in comparison to those running on fossil fuels. This will not only reduce the laundry running cost but also help in preventing biohazards.

cent equipment uptime, irrelevant of the size of the hospital or its location and manufacturing equipment which meet or exceed the international standards. The promptness in attending to our customers' needs and availability of the spare parts and cost of after sales services

How is India's medical equipment market? India is one of the largest emerging medical equipment markets in the world. This market is expected to grow to around $5.8 billion by 2014 and $7.8 billion by 2016, growing at a CAGR of 15.5 per cent, according to an industry report. Also, Indiaâ&#x20AC;&#x2122;s medical

device market is currently the fourth largest market in Asia with 700 medical device makers, and ranks among the top 20 in the world, according to data from the India Semiconductor Association. With six per cent of GDP expenditure on healthcare, the government proposes in 12th five year plan to increase it by 2.5 per cent, which would bring opportunities and growth in healthcare facilities including infection control. The challenge would be penetration into TierII and Tier-III cities and cost competition from unorganised and substandard equipment manufacturers. High excise duty adds to challenge in this highly price conscious market which has a very large potential. How do you stay ahead of the competition ? Dedication and innovation helps us to get and keep an edge over our competition. We at Periclave say that we give our customers 100 per cent satisfaction because, we have over 100 employees ,and each key employee is having over a decade of experience in handling their respective departments .Thus the customer can be assured that whatever is being done for them is being done by the most experienced person in the industry. Further, Periclave on all India basis has over 25 experienced engineers to provide after sales support, some of whom have expertise of over 40 years in this field. info@periclave.com

GE Healthcare

CAN YOU PLEASE KEEP IT DOWN UP THERE? INTRODUCING SILENT SCAN

Humanizing MR isn’t just our philosophy. It’s our promise. Our promise to change how patients feel, see and hear MR for the better. However, now is the time to break the silent barrier and change the way patients hear MR forever. Introducing Silent Scan*. Using a unique combination of breakthrough technologies, we’ve made MR as silent as a whisper. The day when your patients can undergo an MR scan without the added anxiety of loud noise is here. And we’ve accomplished this while still providing the excellent image quality you need to make a confident diagnosis. It’s time to hear the difference.

© 2014 General Electric Company. All rights reserved. GE Healthcare, a division of General Electric Company. GE and GE monogram are trademarks of General Electric Company. * Trademark of General Electric Company

REGD. WITH RNI NO.MAHENG/2007/22045. REGD.NO.MH/MR/SOUTH-252/2013-15, PUBLISHED ON 8th EVERY MONTH & POSTED ON 9, 10 & 11 EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE.