Express Healthcare June, 2014 by Indian Express

VOL.8 NO.6 PAGES 80

Cover story Investors call in home healthcare Knowledge Golden hour in acute ischemic stroke Strategy Advancing UHC in India: Learning from international experience

www.expresshealthcare.com JUNE 2014, `50

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CONTENTS Vol 8. No 6, JUNE 2014

Chairman of the Board Viveck Goenka Editor Viveka Roychowdhury*

Needed:Innovations in maternal and infant care

Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bangalore Assistant Editor Neelam M Kachhap Delhi Shalini Gupta

MARKET

GAVI: INDIA'S NEW GOVT SHOULD BOLSTER ROUTINE IMMUNISATION

FORTIS HOSPITALS, BANNERGHATTA RECEIVES JCI ACCREDITATION

LILAVATI HOSPITAL CONDUCTS HEALTH CHECK-UP CAMP FOR TRIBAL WOMEN

SEMINAR@ SYMBIOSIS

INTERVIEW: GUNJAN SACHDEV, GM, NATIONAL BUSINESS HEAD (TOUGHBOOK DIVISION), PANASONIC INDIA

INTERVIEW: PHILIPP RELLERMEIER, AREA SALES MANAGER, MIDDLE EAST, CENTRAL AFRICA, INDIA

DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Dr. Raghu Pillai - South Sanghamitra Kumar - East Harit Mohanty - West Marketing Team Kunal Gaurav G.M. Khaja Ali Ambuj Kumar E.Mujahid Yuvaraj Murali Ajanta Sengupta PRODUCTION General Manager B R Tipnis Manager Bhadresh Valia Scheduling & Coordination Rohan Thakkar CIRCULATION Circulation Team Mohan Varadkar

Vijayshankar R Andani, Independent Management Consultant – eHealth & Health Economics Analyst shares his insights on how to improve maternal and infant care in India | P39

KNOWLEDGE

GOLDEN HOUR IN ACUTE ISCHEMIC STROKE

INTERVIEW: DR PP ASHOK, HEAD, DIVISION OF NEUROLOGY, HINDUJA HEALTHCARE SURGICAL

STRATEGY

41 37

INTERVIEW: DR FARIBA NAYERI, FOUNDER, PEAS RESEARCH INSTITUTE

ADVANCING UHC IN INDIA: LEARNING FROM INTERNATIONAL EXPERIENCE

RADIOLOGY

READY FOR FUTURE, RIGHT FOR PRESENT

INTERVIEW: PROF HANS RINGERTZ PROFESSOR OF RADIOLOGY

LIFE

DR HARSH VARDHAN: HELMING INDIA TO GOOD HEALTH

KMES: A COLLABORATIVE SUCCESS

P20: EVENTLISTING P29: COVER STORY: INSIGHT Improving healthcare with home care services

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

Make health a social movement:Dr Harsh Vardhan

recent article in The Economist presents some very excellent examples on how emerging multinationals in Asia are reforming corporate culture and will impact global trends. (econ.st/1madjpF). A prediction which caught my attention is that as demand for health care in Asia rises, it is likely to create a whole new generation of companies. The potential for growth is huge, considering that the industry comprises only four per cent of the region’s stock market, compared with 12 per cent in the rich world, according to the article. We are already seeing that happening and the home healthcare market is just the latest example. (See cover story: Investors call in home healthcare; pages 22-28) What seemed fairly nascent when we first covered one of the players, Portea Medical, in February this year (See interview: http://healthcare.financialexpress.com/cover-story/2434-the-target-is-to-be-in-every-city-with-a-population-of-morethan-10-lakhs) seems to have spawned several more players in just a few months. And as the cover story points out, is already attracting good investors. If there is one threat to the home healthcare story, it’s the lack of skilled manpower. The National Skill Development Corporation (NSDC) has projected that by 2022, the healthcare sector will have an incremental requirement of 12.7 million trained people, ranging from home health aides, diabetes educators, medical laboratory technicians and the like. The Healthcare Sector Skill Council (HSSC), a Confederation of Indian Industry initiative funded by the NSDC, has formulated courses in these areas and through affiliated training partners, has trained approximately 8000 students since it was set up in 2012. But these numbers clearly will not keep pace with demand. The 2013 Budget speech proposed incentivising skill certification through the proposed Standard Training Assessment & Reward (STAR) scheme, so numbers might pick up but another concern is the quality of manpower. Are such courses updated frequently enough to be in tune with industry needs? The HSSC has founder members from both

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The newHealth Minister seems to have his work cut out for him.The highest number of pending bills in the Rajya Sabha (11) are from the Ministry of Health and FamilyWelfare

government (AIIMS) and private healthcare players like Apollo, Fortis, KIMS, Manipal Hospitals, Max, and Medanta. For good measure, the pharma and medical tech sector, represented by Johnson & Johnson, Pfizer and Wipro-GE Healthcare are also listed as founder members as well as the Public Health Foundation of India (PHFI). With such a line up, it is hoped that we will have both the quantity and quality of skilled professionals in the healthcare sector. The new Health Minister Dr Harsh Vardhan thus seems to have his work cut out for him. The highest number of pending bills in the Rajya Sabha (11) are from the Ministry of Health and Family Welfare, according to PRS Legislative Research (See : http://healthcare.financialexpress.com/latestupdates/2779-pending-bills-in-the-parliament-whatwill-be-the-new-health-minister-s-next-move). The good news is that India will have no dearth of manpower to meet the demands of fast growing sectors like healthcare. Census data (September 2013) points to the country’s demographic dividend. India’s youth bulge is now sharpest at the key 15-24 age group. Looking ahead, the country is likely to have 700 million+ people in the working age group by 2022. Creating sustainable employment for this age group need not become a problem, if the government plans for adequate skill development programmes and with the HSSC and other efforts, the impetus seems to be in the right direction. What’s needed is continuous re-evaluation of the content of these courses and mapping them to evolving industry needs. While tweeting to thank Prime Minister Modi for reposing faith in his abilities, Dr Vardhan has promised to live up to his expectations and make health a big social movement in our country. We, at Express Healthcare, applaud his sentiment and hope that this social movement will mobilise us towards preventive healthcare as well. As the old adage goes, prevention is better (and definitely less expensive) than cure.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

LETTERS QUOTE UNQUOTE

MAY, 2014

INTERESTING READ Very good article (Cover story on IVD in the May EH issue). I think the way you worked different people into the text was very good Carl McEvoy McEvoy & Farmer LLC

NOTE OF APPRECIATION I would like to appreciate the writers for their efforts to write this article (Cover story - EH March issue). I have read each and every interview and all its details. Wishing all these great ladies best of luck! This article was a beacon of light for me. Monica Shityalkar Android developer in healthcare apps

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MARKET NEWS

GAVI: India's new govt should bolster routine immunisation This year India will continue the national roll-out of the 5-in-1 pentavalent vaccine THE GAVI Alliance is calling for renewed efforts in India to bolster routine immunisation coverage and protect more children from vaccine preventable diseases following the results of the country’s elections. It urges the new Indian government to make childhood vaccination a key priority. “The case for increasing immunisation coverage is clear — to protect the most vulnerable children from leading causes of death and disease — and India will play a vital role in realising that,” said Dr Seth Berkley, CEO of the GAVI Alliance. “By accelerating access to new and underused vaccines we can enable more of the world’s poorest children to grow up healthier, so they can spend more time at school and have a better opportunity to live healthy and productive lives,” he added. With GAVI Alliance's

GAVI will provide $107 million until 2016, towards health system strengthening in India, targeting lower performing states. This will help India to strengthen routine immunisation nationally support, this year India will continue the national roll-out of the 5-in-1 pentavalent vaccine, which protects against diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenza type B disease. GAVI will also provide $107 million over three years, until 2016, towards health system strengthening in India targeting lower performing states. This will help India to capitalise on the success of its polio campaign to

strengthen routine immunisation nationally. “In January 2014, India became GAVI’s newest donor, and the first implementing country to do so. This demonstrates India’s continued leadership in immunisation and is a testament to its willingness to contribute to reducing child mortality. Additionally, we look forward to working with the new government in its initiatives to ensure that all Indian children

have access to the benefits of a full range of vaccines,” said Dr Berkley. In a recent journal article published in the Lancet Global Health, co-authored with 28 leading health economists, epidemiologists and other global health experts, Dr Berkley, explained how the full benefits of childhood vaccination can impact well into a child's life, through adulthood, into the wider community, and, ultimately, the national economy. “Vaccines aren’t just a best buy in terms of preventing death and illness, although this is reason enough to have every child on this planet fully immunised,” said Dr Berkley. “But we now know that vaccines also have a much wider impact, maximising the full lifetime potential of these children and the economic health of the families and countries in which they live.” EH News Bureau

Indian Spinal Injuries Centre ties up with Delhi Heart and Lung Institute INDIAN SPINAL Injuries Centre (ISIC) and Delhi Heart and Lung Institute (DHLI) have joined hands to provide services in orthopaedics, joint replacement, spine injury & disease, neurology, and neurosurgery at DHLI, New Delhi. ISIC was started in 1997 by its Chairman, Major HPS Ahluwalia, who survived a bullet injury in the Indo-Pak war of 1965 as a unique centre for spine injury and its treatment using the latest technology. DHLI specialises in cardiac and pulmonary care. Hence they are going to be complimentary to each other. Under this initiative, specialist doctors from ISIC will be conducting OPDs at DHLI. Initially surgeries will be done at ISIC. Surgeries would resume at DHLI once there are enough number of cases and it develops support manpower like resident doctors for 24 hours back up. EH News Bureau

M*Modal’s new healthcare tech centre in Bengaluru Unveils key development hub for clinical documentation product offerings M*MODAL, a provider of clinical documentation services and speech understanding solutions announced the opening of its India Technology Center in Bangalore. Located in Cessna Business Park, Bangalore, it is a 320-seat facility spread over 34,000 sq ft which will reportedly focus on driving innovations in existing

and emerging healthcare technologies, particularly in the clinical documentation space. The centre is also a part of M*Modal’s expansion plans in India to help accelerate overall company growth. “Our new centre will not only be one of our key technology hubs for developing, delivering and supporting cutting

edge solutions to our healthcare customers around the world, it will also be one of the best centres in Bangalore for professionals to pursue their technology careers,” said Detlef Koll, CTO, M*Modal. The Bangalore Technology Center complements M*Modal’s existing IT facility in Hyderabad and is part of the company’s ef-

fort to consolidate technology development at key sites in India and around the world. "We are delighted to open this dedicated technology centre in Bangalore," said Bill Donovan, Sr Vice President, Human Resources at M*Modal. “The new centre, with all its modern amenities and hightech infrastructure, will spur

creativity among the employees and help them work in a highly collaborative environment. The new center and our experienced technology staff will enhance the value we provide our customers and expand our global leadership position in clinical documentation.” EH News Bureau

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XY Clinics, preventive medicine firm, launched in Bengaluru To expand its operations across India in the next 24 months XY CLINICS, a Dubai-based personalised medicine clinic, launched its first clinic in Bengaluru. The clinic focuses on problems that are not treated effectively in a standard medical facility. XY Clinics is part of Diagnostika, a molecular diagnostics facility located at Dubai Bioetchnology and Research Park. A pioneer in the field of treatment of autism spectrum, reportedly XY Clinics has worked successfully with over 500 children in Dubai. The

Sam Rao, Founder & Director of XY Clinics with Dr Shilpa Rao, Head Paediatrician at the launch of XY Clinics

Infosys wins global award for innovation in osteoporosis diagnosis Award-winning design makes it easier to diagnose fracture risk INFOSYS, A global leader in technology, consulting and outsourcing solutions, has been recognised as a winner in the 2014 Simulating Reality contest. The contest was organised by MSC Software, a worldwide leader of multidisciplinary simulation solutions. The winning team from Infosys used MSC’s simulation technologies to better diagnose osteoporosis and accurately quantify fracture risk. The innovative solution designed by Infosys applies the proven principles of mechanical engineering to understand the biomechanics of the human vertebrae and reduce the scope of errors in estimating fracture risks.

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Sudip Singh, VP and Global Head, Engineering Services, Infosys said, “Our engineering capabilities for the life sciences industry focus not only on innovation but also on improving existing medical procedures and processes. This breakthrough in reimagining osteoporosis diagnosis and treatment provides medical practitioners with a new, comprehensive, and non-invasive way to examine individual bones and skeletal structure, and determine the best course of action. As the technology is tested and adopted, our engineers will continue to refine the solution to attain greater visibility into patients’ condition and progress.” EH News Bureau

specialists at XY Clinics have pieced together a molecular understanding of the issues in autism, involving the immune system, brain’s neurotransmitters and genetics. In India, XY Clinics will also focus on ADHD, women’s hormone disorders, sleep disorders and chronic fatigue other than autism spectrum disorders. “At XY Clinics, we strive to understand the makeup of each individual, creating highly personalised treatment methods for each person. We offer evidence-based time-

bound solutions to problems that currently do not have an easy, zero-side effects pharma solution. Our branch in Bengaluru with liase with operations in Dubai, and the testing will be done in Germany, ensuring a comprehensive, best treatment option for each individual,” said Sam Rao, Founder & Director of XY Clinics. XY Clinics intends to expand its operations across India in the next 24 months. EH News Bureau

Nimhans launches tech de-addiction clinic in Bengaluru It provides treatment for compulsive dependence on social networks, instant chatting sites, texting and mobile games NATIONAL INSTITUTE of Mental Health & Neuro Sciences (Nimhans), recently launched a technology de-addiction clinic in Bengaluru. Reportedly India's first such clinic in India, it provides treatment compulsive dependence on social networks, instant chatting sites, texting and mobile games. Teenagers are particularly prone to the addiction. Two common symptoms of technology addiction among teenagers are— steep academic decline or withdrawing from family and social interactions. Nimhans earlier this year screened 400 teenagers in Bangalore from private schools to government-run schools. The survey confirmed excessive use of mobile phones, social networking

Teenagers were found to be particularly prone to tech addiction sites and multi-player online games among them. Indian Council for Medical Research study last year too showed an alarming rate of technology dependence among subjects in the age group of 18-40 years. A national-level study on tech addiction in urban India is in the works. Launched a month ago, the tech de-addiction

clinic in Bengaluru is a clinical set-up to diagnose and suggest therapy measures. Technology addiction or internet addiction are similar to addictive disorders concerning drugs or alcohol. Patients suffering from it engage excessively in activities involving the cellphone, internet and social networking sites leading to the detriment of one’s health, social life or mental state. The addiction manifests itself in acts like constantly checking instant messaging apps, frequently changing status messages and profile photos on social networks, and uploading selfies daily. In many cases, the addiction leads to insomnia, depression and social withdrawal. EH News Bureau

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Fortis Hospitals, Bannerghatta receives JCI accreditation It has received the accreditation for the third time running FORTIS HOSPITAL, Bannerghatta Road, Bengaluru, has received the Joint Commission International (JCI) accreditation for the third time running. Fortis Hospital, Bannerghatta Road, becomes the third Fortis facility in India to maintain its accreditation status for the third consecutive term. A JCI accreditation is valid for three years, following which the facility is reassessed. Notably, Fortis Bannerghatta Road was assessed on the recently revised JCI standards, which are more stringent and demanding. “JCI’s primary focus is to ensure improvement in patient safety and quality of healthcare through education, advisory, accreditation and certification services. We are proud to have achieved this distinction for the third time and to be looked upon as one of the most efficient multi-speciality hospitals,” said Karthik Rajagopal, Regional Director-South, Fortis Hospitals. “This accreditation will add more value to Fortis Hospital Bannerghatta and will further enhance the confidence of our patients in quality, safety, treatment and services,” said Dr Deepak Balani, Medical Head, Fortis Hospitals, Bannerghatta Road. The JCI grants accreditation to healthcare facilities in more than 60 countries after a rigorous evaluation of several parameters, including the quality of patientcare and patient-safety. The JCI accreditation is widely considered as a “seal of approval” by medical travelers seeking quality healthcare services. EH News Bureau

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HLL launches multipurpose condom vending machines at Delhi Metro stations The machine uses ‘Vend Sensor’ wherein if the user fails to get the product due to any reason, he/she will get the money back HLL LIFECARE Ltd (HLL), a large manufacturer of contraceptives, has decided to associate with Delhi Metro Rail Corporation (DMRC) to make available male and female condoms at its stations across the national capital. Keralabased HLL, a Central PSU of Union Ministry of Health and Family Welfare, will also provide its array of products like sanitary napkins, oral contraceptive pills, deodorants and Ayurvedic products (joint pain cream and hair oils) -- through vending machines. Delhi Metro operates about 2800 services every day with its daily ridership averaging 24 lakh commuters. Such an initiative will help travellers to replenish their stocks of contraceptives even if they

miss their date with a chemist’s shop or government dispensaries. Dr M Ayyappan, Chari-

man and MD of Kerala HLL said that the company would, in the first phase, install 25

Jiva Ayurveda opens four clinics in Mumbai Plans to enhance its reach to 50 clinics by 2015 JIVA AYURVEDA has launched four clinics in Mumbai. The launches are part of Jiva's plan to create a network of Ayurveda clinics across the country. With these clinics located at Andheri (West), Kandivali (East), Thane (West) and Mira Road; Jiva Ayurveda has marked its entry into Maharashtra. In its second phase, Jiva plans to open clinics in Pune, Chembur, Navi Mumbai, Kalyan, Nagpur and Nashik.

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The organisation plans to open 25 more clinics across India in the next year. With the launch of the new clinics in Maharashtra, Jiva Ayurveda now operates a chain of 25 clinics spread across nine states in India. Through its clinics, Jiva Ayurveda offer Ayurvedic treatment services for lifestyle and degenerative disorders such as diabetes, joint pains, skin disorders, obesity, etc. Jiva Ayurveda also runs a large telemedicine centre that offers Ayurvedic consultancy and treatment services to its patients across 1500 cities and towns in the country. Announcing the launch and

entry in the state, Dr Partap Chauhan, Director, Jiva Ayurveda said, “Jiva Ayurveda is dedicated to bringing high quality, affordable and authentic Ayurveda to people. It is with the same vision of taking Ayurveda to every home that we have opened these new clinics, to serve the people of Maharashtra.” Dr Kuldip Raj Kohli, Director of Ayurveda, Government of Maharashtra, the Chief Guest at the launch said that with the growing lifestyle disorders in Maharashtra, Ayurveda will play a key role in ensuring complete health. EH News Bureau

vending machines at 21 metro stations. “Our endeavour is to make condoms, sanitary napkins, deodorants and contraceptive pills available to the commuters of Delhi Metro, who can avail this facility while on move. It will also contribute to social issues of family planning, HIV/AIDS prevention and women hygiene leading to their overall health,” he pointed out. Operated by Instago, a leading vending company in India, the fully automatic multipurpose vending machines dispense the product at the press of a button after inserting Indian currency. A unique feature of the machine is that it accepts all Indian currency, both in paper and coin forms. It also returns the excess credit, if any, inserted by the

user. The machine uses ‘Vend Sensor’ wherein if the user fails to get the product due to any reason, he/she will get the money back. HLL also plans to install two electronic vending machines for sanitary napkin and condoms in corporate offices, schools and college washrooms, and various other public locations to make these products available for the people. “The need for making condoms at the right place, right time and with minimum of embarrassment calls for an innovative method of condom distribution. Multipurpose condom vending machines are a novel way to address this situation,” Dr Ayyappan said. EH News Bureau

Vitiligo clinic launched in Mumbai The clinic performs Melanocyte Transplantation surgery for select patients SURGEON AND dermatologist, Dr Sanjeev Mulekar has launched a specialty clinic for vitiligo in Andheri, Mumbai. Vitiligo means leukoderma, a disease that causes the loss of skin color in blotches. It occurs when the cells that produce melanin die or stop functioning. The primary services rendered at the clinic include in-depth consultation, counseling and group meetings. Home units of phototherapy, camou-

flage or covering make-up along with Melanocyte Transplantation are the latest surgical treatment. Dr Mulekar has established a Vitiligo Treatment Clinic in Riyadh, Saudi Arabia and has trained dermatologists in the US, Canada, Brazil, Uzbekistan, Bangladesh, and Saudi Arabia. He has also established a Vitiligo Surgical section at the Henry Ford Hospital in Detroit. EH News Bureau

MARKET POST EVENTS

Lilavati Hospital conducts health check-up camp for tribal women Mangaldas Oza Charitable Trust also supported the camp children AS PART of the social initiative, ‘Save and empower girl child’ (SEWA) - Mangaldas Oza Charitable Trust along with Lilavati Hospital, Mumbai organised a free mega health and medicine distribution camp for adivasi girls and women at Village Dhundalwadi, Dahanu, Thane. During the health check-up it was found that majority of women were suffering with high diabetes, anaemia, malnutrition and vitamin deficiency.

Around 11 girls who were suffering from serious illnesses were brought to Lilavati Hospital for further treatment. “Lilavati Hospital has pledged to carry out 50,000 free health check-ups in one year for girls and young women in and around Mumbai. This is the first check up by Lilavati in the Dahanu area and based on

the response, they have plans for more such camps in and around Dahanu,” said Dr Premraj Battalwar, Associate Medical Superintendent, Lilavati Hospital and Research Centre. The camp was organised under the guidance and in close co-ordination with Ami Choksi, a Trustee of Mangaldas Oza Charitable Trust. Reportedly,

around 576 girls and women benefited from this health camp. This medical camp included eye, nose, throat, gynaec, nutrition, diabetes and overall health check-up was done by doctors and staff from Lilavati Hospital and free medicines were distributed. “We are pleased with the grand success of this medical

camp by Mangaldas Oza Charitable Trust along with Lilavati Hospital. In future we both plan to conduct more such camps with follow up check up camps. The aim of this medical camp is to reach and provide health benefits to maximum people,” said Sanjay Jambhulkar, Trustee, Mangaldas Oza Trust and DCP - Mumbai.

International Biologics Orthopaedic Meet 2014 concludes in Mumbai It saw participation from around 200 doctors from across the country THE INTERNATIONAL Biologics Orthopaedic Meet (IBOM 2014), an initiative of Dr LH Hiranandani Hospital was recently held in Mumbai. The event saw participation from around 200 doctors from across the country. It provided a platform to discuss developments and innovations in the field of ortho biology with an aim to increase awareness on sports medicine in India. The conference was organised in collaboration with Hi-

ranandani Orthopaedic Medical Education (HOME), the orthopaedic research division of the Dr LH Hiranandani Hospital, and the Biological Orthopaedic Society, USA. Biological Orthopaedic therapy is fast becoming the most popular treatment option in Orthopaedics and Sports Medicine worldwide. A number of options including platelet-rich plasma (PRP) therapy, autologous chondrocyte implantation (ACI) and

stem cell therapy are the treatments available for orthopaedic surgeons today. Commenting on this initiative, Dr Vijay Shetty, Organising Chairman, IBOM 2014, stated, “We are delighted with the success of IBOM 2014. The objective of the meet was to exchange thoughts and knowledge with eminent national and international experts who have spent considerable time in this field. And we have successfully managed to

achieve the objective with the help of the renowned experts in the field.” Dr Sujit Chatterjee, CEO, Dr LH Hiranandani Hospital, while commenting on the event said, “IBOM is an opportunity for renowned orthopaedic and sports medicine experts across the globe to gather on one platform to interact and gain maximum knowledge on the developments in the field. Taking note of the growing significance of sports medicine in

India, we at Dr LH Hiranandani Hospital have introduced specialised Sports Medicines centres.” The prominent national faculty included Deepak Goyal, Dinshaw Pardiwala, Jaspal Sandhu, Mandeep Dhillon, Nicholas Antao, Roshan Wade, Sanjeev Jain, Yajuvendra Gawai, and Vaibhav Bagaria. The international faculty included Dr Allan Mishra, Dr Richard Villar, and Dr Vikas Khanduja among others.

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Seminar@Symbiosis XVI National Seminar on ‘Hospital & Healthcare Management, Medico Legal Systems & Clinical Research’ was attended by over 800 delegates from all over India and abroad

SYMBIOSIS INSTITUTE of Health Sciences (SIHS), a constituent of Symbiosis International University (SIU) recently organised the XVI National Seminar on ‘Hospital & Healthcare Management, Medico Legal Systems & Clinical Research.’ The seminar was inaugurated by Dr Vidya Yeravdekar, Principal Director, Symbiosis and Dr Rajani Gupte, Vice Chancellor, SIU. She discussed about the future plan of setting up the Symbiosis Health Science and Technology Park which will focus on R&D activity with progressive involvement of the pharma sector. Dr Gupte brought to the attention of the gathering that the US and European Union Market are looking at India with regards to the implementation of intellectual property laws in India. This was followed by felicitation of the dignitaries and traditional lamp lighting ceremony. Dr Rajiv Yeravdekar, Dean, Faculty of Health and Biomedical Sciences (FoHBS) delivered a key note address on successful healthcare models. He shared how Symbiosis has spearheaded the Health Promotion University concept in India by providing on-campus preventive, promotive and curative

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(L-R) Dr Harish Pillai, Rajen Padukone, Dr Rajiv Yeravdekar, Sadananda Reddy, Dr Vidya Yeravdekar, Dr Rajani Gupte and Sudarshan Jain

(L-R) Dr Rajiv Yeravdekar, Shivinder Mohan Singh, Dr SB Mujumdar, Adv Ram Jethmalani, Dr Rajani Gupte and Dr Vidya Yeravdekar

services which is widely practiced across the globe. The pre conference symposium also comprised a session on ‘Successful Healthcare Models’ which was anchored by Rajen Padukone, CEO and MD Manipal Health Enterprises. Dr Harish Pillai, CEO, Aster DM Healthcare, conveyed that liberalisation and the entry of global pharma companies have contributed to the growth of the Indian healthcare industry. Sudarshan Jain, MD, Healthcare Solutions, Abbott India gave an insight about Indian pharma industries and their contribution for contract research through the development of biosimilars, therapeutic equivalents and medical devices. Sadananda Reddy, MD, Goldstar Healthcare, briefed about healthcare infrastructure in various ways right from digitising medical test, diagnostic and therapeutic procedures to enhancing the reach of healthcare through telemedicine and

health IT. Dr GSK Velu, MD, Trivitron Group, enunciated that medical electronics industry has witnessed double digit growth in recent years and this growth trajectory is expected to continue. Chronic diseases, changing life style, increased urbanisation and growing elderly population are considered as the drivers for the medical electronics industry. This was followed by scientific paper presentation by delegates. Daljit Singh, President, Fortis Healthcare, briefed the audience on strategic management as an ongoing process that evaluates and controls the business and the industries in which the company is involved. He said, “Strategy tells where to compete and how to compete. Flexibility and adaptability have become key management concepts to develop a sustainable competitive advantage, and successful firms apply them in new organisational strategies.”

This was followed by four Master Class sessions on game changes in healthcare. Dr Gautam Sen, Chairman, Wellspring Healthcare, spoke on 'Transforming Healthcare Delivery for 21st Century and the Technology Boom in India.’ Dr Om Manchanda, CEO, Dr LalPathLabs, talked on the Indian healthcare industry, market segments and drivers as well as on the changing market and consumer trend. He said that Indians are becoming more aware of their health due to the improved availability and accessibility of better health-related information. Dr Adheet Gogate discussed on the entrepreneurial tidal wave with an out of the box thinking mind-set which is waiting to sweep across the Indian landscape. Dr Sanjay Arora, Director Suburban Diagnostics from the diagnostic sector, mentioned that the diagnostics franchise market is highly fragmented and yet to be tapped

with a distinct possibility of more players coming here in the future. In the concluding session for the day, Dr Azad Moopen shared his knowledge on challenges faced by the human resource in healthcare industry by way of the identification, recruitment and retention of the required workforce. Dr Sanjay Gupte briefed about the special laws in healthcare with a focus on PCPNDT Act, Transplantation of human organ Act 1994, Surrogacy and its ethics and Maharashtra Clinical Establishment Act. Day 2 of the National Seminar began with a talk on Medical Tourism: Present & Future by Pradeep Thukral, Founder & CEO SafeMedTrip Consultant who highlighted that inflated cost of treatments in the developed countries such as the US and UK, has driven patients from such regions to look for alternative and cost-effective destinations such as India to get their treatment. Dr Yash Paul Bhatia, MD, Astron Healthcare spoke that when a hospital earns international accreditation, the patient is assured that the facility has been inspected by an outside source and found to be of good quality. Dr Shreeraj Deshpande, Head, Health Insurance Future Generali India Insurance Company , discussed on the opportunities and challenges in the health insurance field and the role of Insurance Development & Regulatory Authority (IRDA) in guarding against the ill effects of privatisation on the healthcare of a large segment of rural population in the country. Dr Milind Sardesai, Assistant Director, Lupin Pharmaceuticals indulged the audience in the domain of pharmacovigillance observing that there is a need for transparency in the pharma industry relating to the collection, detection, assessment, monitoring, and prevention of adverse effects with pharma products. Dr Raman Gangakhedkar, Deputy Director, NARI

MARKET stressed upon the objectives and necessity of laws in clinical research and notable incidents which triggered the need for Law in Clinical Research. Dr Shubnum Singh, Chairperson, Healthcare Sector Skill Council, Advisory Committee expressed her views on creating a robust and vibrant eco-system for quality vocational education and training in allied healthcare and paramedics space. Sandeep Ahuja, MD, VLCC & Chairman, FICCI National Wellness Committee emphasised that wellness and health goes hand in hand in day-to-day life and that the scope of wellness extends beyond health by way of mental, spiritual, social wellbeing. Dr Gopinath N Shenoy, Medico Legal Consultant spoke about various legal aspects and landmark judgments in healthcare. He highlighted on the Drugs and Cosmetics Act, Drug Price Control Order, Human Organs Transplantation Act, Surrogacy Act & Clinical Establishment Act. The valedictory ceremony was organised on the second day to conclude the two-day seminar. The valedictory ceremony was graced by Chief Guest, Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare. The Guest of Honour for the ceremony was Advocate Ram Jethmalani, (Former Union Law Minister). The ceremony was presided over by Dr SB Mujumdar, President and Founder Director, Symbiosis and Chancellor, SIU. Singh shared his views on changing trends in healthcare, infrastructure gap between the public and private sector and the necessity for standardisation to come in healthcare in order to provide the authentic health care service. He also mentioned that India will become the cheapest country to provide quality health services in the world. Jethmalani spoke on the important issues of surrogacy and euthanasia stating that surrogacy should not be practiced and should be substituted with adoption and euthanasia is the constitutional right of everybody. He further stated that the best path to walk upon is the path of knowledge. Dr Mujumdar addressed the gathering and conveyed that in order to become the super-

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power by 2020, India must increase the spending on healthcare. He concluded his speech by stating that quality education and quality health services is the need of the country and it can be achieved only with the improvement in technology and innovation of ideas. The ISBN numbered â&#x20AC;&#x153;Symbiosis Health Timesâ&#x20AC;? was released by Singh

Valedictory ceremony was organised on the second day to conclude the seminar

who appreciated the efforts of Symbiosis Institute of Health Sciences in organising an Educative Seminar on a magnanimous level. Valedictory function was followed by convocation ceremony of PGDHHM, PGDMLS, PGDCR and PGDHIM students. The certificates of merit were awarded by Singh. All in

all, over 800 delegates from all over India and some from abroad participated in this seminar. Over 80 civil surgeons, district health officers and senior faculty of medical colleges were deputed by the Directorate of Health Services and Directorate of Medical Education & Research thereby making it a very successful event.

MARKET I N T E R V I E W

‘This technology will play a pivotal role in terms of giving new dimensions to the healthcare sector’ Gunjan Sachdev, General Manager, National Business Head (Toughbook Division), Panasonic India, speaks about Panasonic Toughbook and its features that help improve healthcare outcomes, cost effectiveness of the solution, company’s plans to market them in India, and more, in an interaction with Lakshmipriya Nair How does Panasonic Toughbook serve the healthcare space? The Toughbook is a highly reliable computing device that functions in the harshest of conditions, with almost negligible failure rates which help mission critical applications like HIS, ERP etc. to work on a device seamlessly. Catering to the healthcare industry, Panasonic is offering its mobile clinical assistant CFH2, a specially designed tablet for this vertical. The Toughbook CF-H2 is a unique tool in its ability to transform the way mobile professionals work – wherever and whenever they might be. It is powered with a Windows 7 Professional and latest Intel Processor. The weight of the device is only 1.58 kg which makes it easy to be carried even in the most unadaptable conditions. How will it help improve healthcare outcomes in the Indian scenario? Any specific areas where the technology can be implemented for optimal benefit? Toughbook devices come with a high degree of ruggedness which can withstand heat, water, dust, fall, vibration etc. The dual hot swappable batteries provide an uninterrupted service up to seven hours andthe integrated bar-code reader

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options make it a useful tool for nurses and doctors working in hospitals while maintaining the patient’s record. These features provide a unique opportunity for doctors; nurses and other caregivers to work, thus, improving both nurse and patient outcomes. How user-friendly is the product? Panasonic Toughbooks are easy to be carried and the excellent part about this device is that it can be sanitised completely. With its fan-less design and sealed ports, the CF-H2 is easy to disinfect. Moreover these devices can be used by medical practitioners in rural villages and can withstand all harsh conditions. How do you plan to promote it in the Indian market? Who all have adopted the technology in the Indian healthcare sector? Our first action plan is to expand our network with all leading hospitals and inform them about the utility and benefits of mobile solutions, educating them about Panasonic’s mobile clinical assistant devices which can bring a difference in their daily operations. We will also be investing in conducting a 'proof of concept' by putting the customer applications into our devices and demonstrating the same in

their live environment. Leading hospital chains are already moving towards modernisation by adopting applications like HIS and have begun implementing these solutions in order to enhance their service quality standard and customer satisfaction.

Panasonic Toughbooks are easy to be carried and the excellent part about this device is that it can be sanitised completely

Are there any competitors to Panasonic Toughbook? If yes, who are they? How does Panasonic Toughbook differentiate itself from its counterparts? With 16 years of experience in R&D, designing and manufacturing of rugged devices at the Japan plant, Panasonic India has maintained a consistent lead in the rugged space over the years. In India, currently some of hospitals are using Computer on Wheels (COW) which is bulky and cumbersome. Our devices basically target the healthcare industry and have various advantages like sleekness, easy to carry, can be sanitised, have a high battery throughput along with a hotswappable option etc. Also, these devices have an optional SIM slot due to which they can be used in ambulances, remote sites and in any environment where other devices fail to work. How much would it cost the users to implement this solution? Average life of the

Toughbook product is five years. With our superior technology, we ensure that the total cost of ownership is much lesser in the long run when compared to the contemporary technology deployed. How will this technology evolve in future? This technology will play a pivotal role in terms of giving new dimensions to the healthcare sector in the coming years. It will help improve processes, enhance accuracy and speed up accessibility to patients’ records and fast treatments. We also believe that anything that has to do with patients can be accessed by doctors with relative ease, improved technology and enhanced mobility. Critical information will even be accessible while doctors are on the go, this will remarkably save the lead time for treatment. What are Panasonic's other plans for the Indian healthcare market? There is a continuous need to address problems of errors in healthcare and serious safety issues, fundamental changes of healthcare processes are necessary and need to be aligned. We understand the need of fast technology in the healthcare segment and will continue introducing such products for the Indian market. lakshmipriya.nair@expressindia.com

MARKET I N T E R V I E W

‘We make innovative products for three segments ENT, surgery care and gynaecology’ In the field of medical technology, ATMOS MedizinTechnik GmbH & Co KG (ATMOS) is a global player with three centres of excellence in Germany and Asia as well as 11 sales subsidiaries around the world. With renewed interest, the company is focusing on India and its growing potential. M Neelam Kachhap catches Philipp Rellermeier, Area Sales Manager, Middle East, Central Africa, India during his busy schedule to find out more How long has Atmos been in India? We have a sizeable presence in the Indian market. ATMOS MedizinTechnik GmbH has been around for almost a century now. We have had a very long relationship with India and recently we brought strategical changes to support the market. In India, we have been active through our sales channels for about 30 years and we established our representative office here in 2012. Do you have plans to open a manufacturing unit in India? We have our headquarters in Lenzkirch, Germany and we manufacture all our products there. At present we do not have plans to open a manufacturing unit in India. Several OEM's have used reverse innovation to tailor-make products for emerging markets. Do you have any plans for the same?

We develop solutions for the world market which are not only affordable but also reduce treatment costs We develop solutions for the world market, which are not only affordable, but also reduce treatment costs by providing the medical professionals with optimal operational processes to speed up the treatment. Like I said, our products are best in quality and I don’t think we want to compromise on that. Having said that, we also realise the needs of our clients. We have not yet made tailored products for emerging markets but we do give our clients options in terms of basic tools and softwares to high-end multi-functional products. The price varies for basic to high-end models of the equipment and thus the client is at freedom to choose.

What are the segments you are currently present in? Are there any new segments that you would be exploring? We make innovative products for three segments ENT, surgery care and gynaecology. In India, our primary product is an ENT work station. The quality of our products is very high and the equipment lasts for about 20-25 years. In fact, one of our machines in India has been working excellently for the past 30 years. It was installed in 1984 and is still functional. Our clients see our products as long term investment with minimal repair. What is the size of market

for these segments in India? Currently, about 50 per cent of the worldwide produced medical technology products are used in the US. The markets in Asia, Africa and Latin America are growing with a growth rate of 15 per cent per year. What are your plans for the Indian market? In terms of sales, a small percentage of our total revenue comes from India but in the future it can attain double digit growth. We want to invest in the market and hope to attain full coverage of the continent in terms of sales and service structure. At present we have nine channel partners who specialise in specific products and we have a liaison office in Bengaluru. Depending on the sales in the region our expansion plans will gather pace. We want to have offices in other bigger cities. mneelam.kachhap@expressindia.com

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EVENT BRIEF SEPT 2014-FEB 2015 11

11th Healthcare Executive Management Development Programme

11TH HEALTHCARE EXECUTIVE MANAGEMENT DEVELOPMENT PROGRAMME Date: 7-13 September 2014 Location: Hyderabad Summary: The programme is designed for professionals occupying or likely to occupy leadership positions in government/private organisations with atleast 15 years of progressive experience in the field of healthcare. The aim is to enhance healthcare leaders' abilities to plan, organise, control, and lead their organisations and enable them discover new ways to handle issues, seize challenges and take their organisations and people to new directions. Participant profile: Those involved in policy formulation, project management, programme development and implementation at hospitals / medical colleges / healthcare organisations and responsible for healthcare capacity building, efficiency & excellence in medical service delivery, etc. would be the ideal participants. Intake capacity: 50 participants only

Green Lean Six Sigma Certification Training and other Hospital Management Workshops

Organisers: Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS) Contact: Programme Co-ordinator, HxMDP Room No. 6 A, MS Wing, Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS) Ansari Nagar, New Delhi - 110029, INDIA. Tel: +91 9013956633, 9968953731, 9582222521 Email: info@hxmdpaiims.com Website: www.hxmdpaiims.com

GREEN LEAN SIX SIGMA CERTIFICATION TRAINING AND OTHER HOSPITAL MANAGEMENT WORKSHOPS Training calender: May 2014 to December 2014 Location: Mumbai, Delhi, Ahmedabad, Pune, Jaipur, Bangalore, Chennai and Hyderabad Last date to register: May 19, 2014 Summary: Green Lean Six Sigma in Healthcare Certification Training for: 1. Green lean six sigma in healthcare (yellow belt)

2. Green lean six sigma in healthcare (green belt) 3. Green lean six sigma in healthcare (black belt) This programme module is specially designed for hospital managers and other healthcare professionals and shall focus on six sigma methodologies, lean concepts in healthcare systems and service delivery. Hospital management MDP workshops on: 1. Service management in hospitals 2. Healthcare quality (clinical audit) 3. IT in healthcare 4. Marketing of healthcare services 5. Healthcare quality (patient safety) 6. Quality management in hospitals These one-day MDP workshops envisages to build participants on various hospital management practices aspects as per the respective topics. Participant profile: hospital ceos /coos, management executives, hospital operations managers, marketing managers / it managers, mha / pgdha / mba (hcm) final year students. Organisers: Aum Meditec,

Medicall 2014

14th World Congress on Public Health in 2015

Mumbai, India Trainer: Certified lean six sigma master black belt: Meeta Ruparel

14TH WORLD CONGRESS ON PUBLIC HEALTH IN 2015

Contact Email: meeta@meditecindia.com, meetaruparel@hotmail.com Website: meditecindia.com

Dates: February 11-15, 2015 Venue: Science City, Kolkata Summary: The 2015 Congress will offer unique opportunities to discuss global and national public health 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 .

MEDICALL 2014 Dates: 1-3 August, 2014 Venue: Chennai Trade Center, Chennai, India Summary: Medicall is India’s premier B2B medical equipment show and healthcare trade fair and provides a cost effective and accessible opportunity for healthcare entrepreneurs, management professionals and physicians with relevant group of products and services. Contact Sundararajan-Project Director Medexpert Business Consultants Pvt ltd., 7th Floor, 199, Luz Chruch Road, Mylapore, Chennai - 600 004. Tamilnadu, India Phone: 91 44- 24718987 Mob: +91 98403 26020 Email: info@medicall.in

Contact IPHA 110, Chittranjan Avenue, Kolkata – 700073 Phone: + 91 33 32913895 Email: secretarygen@iphaonline.org Website: www.14wcph.org

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cover )

INVESTORS CALL IN HOME HEALTHCARE Experiencing an entrepreneurial explosion and high investing action, home healthcare services is targeting the untapped mega market in India. The recent M&A activity has spiced up the new hot segment even more BY M NEELAM KACHHAP

Rs 12,600 cr Rs 19,00,000 cr HOME HEALTHCARE MARKET IN INDIA

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GLOBAL HOME HEALTHCARE MARKET BY 2018

HOME HEALTHCARE MARKET IN INDIA FOCUSES ON PULMONOLOGY, CARDIOLOGY, METABOLIC DISEASES, NEUROLOGICAL HEALTH, ORTHOPAEDICS, GERIATRICS, REHABILITATION AND POSTOPERATIVE SURGICAL SITE MANAGEMENT

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SERVICES INCLUDE BEDSIDE NURSING CARE

PRESENT IN TIER 1 CITIES

AT HOME, PHYSICIAN CONSULTATION, NURSING CARE, LAB SAMPLE COLLECTION AND REPORTING, PHYSIOTHERAPY, MEDICAL DEVICES,AMBULANCE SERVICES, PHARMACY SUPPORTAND RELATED MEDICAL SERVICES IN A HOME SETTING

NEW DELHI AND ITS SUBURBS; MUMBAI; CHENNAI; AND BENGALURU

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cover )

ome-based healthcare (HHC) services are not new to India. Yet, the recent flurry in the market as a result of fresh focus on organised and accessible home healthcare services signifies the changing dynamics of the Indian healthcare delivery landscape. “Home healthcare as a concept and business has existed in India for many years,” says Vishal Bali, Co-founder & Chairman, Medwell Ventures, Bengaluru. “However, in recent times this opportunity is being pursued under new business models by organised players and that has given the sector tremendous visibility since there is new customer centric orientation and specialisation of services that these players are bringing to the market,” adds Bali who has recently acquired Bangalore-based Nightingales Home Health Services. Talking about the new buzz, K Ganesh, Co-founder and Chairman, Portea Medical says, “Much of the excitement stems from the fact that the Indian healthcare industry is at an inflection point. The first phase of healthcare development was in the hospital space; now that is largely completed. Hence, post discharge care, geriatric care, and chronic disease management, all key areas for home healthcare, have come into the spotlight.”

The next big bang There has always been an unmet demand for quality healthcare in India. In the last couple of years many private players have invested in the

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KEY PLAYERS IN THE MARKET Name

Promoter

Location

Employees

Portea Medical

Krishnan Ganesh and Meena Ganesh

Bengaluru

700

HealthCare At Home India

Burman family, promoters of Dabur India Ltd & Healthcare at Home, UK

Delhi

200

Homital

Dr Rajesh Vasudeva & RR Energy

Delhi

India Home Health Care

VThiyagarajan and BAYADA Home Health Care, US

Chennai, Bengaluru

300

Nightingales Home Health Services

MedWell Ventures

Bengaluru

150

sector and new investors are still flocking in. But, a large vacuum still existed for HHC services. Neighbourhood clinics and home visiting doctors were not able to fill this gap. While HHC was already a billion dollar market in the developed countries, Indian market was being serviced by small agencies or independent service providers reaching out to a very small consumer base. “Today, India has world class tertiary care facilities, latest equipment, best doctors and specialists but anything outside that, like organised, branded, high quality reliable home healthcare, is non-

existent. This is the area we are addressing,” explains Ganesh, who provides HHC in 18 cities in India. In fact, HHC is said to have lowered the cost of healthcare in the developed countries, especially for the elderly. India, has just recently started to focus on the special needs of the elderly and is trying to set up national programmes for the same. Including HHC in this environment is an ideal way to deliver care to the elderly. “There are established models of home healthcare in the developed countries which have documented excellent continuity of care in the out of

hospital setting, particularly for the elderly population. The US continues to use home healthcare delivery models to reduce the cost of care and the insurance sector has very effectively utilised home healthcare companies as adjunct to hospitals to optimise the level of care to patients. All these factors make home healthcare an excellent care delivery model for India,” says Bali.

Market talk India's HHC service industry, which consists of rehabilitation service, unskilled home healthcare, infusion therapy and

respiratory therapy, is growing faster than the private hospital market. “Portea believes the home healthcare market to be between $ 2-4 billion and growing more quickly than the hospital market,” says Ganesh. So how do the two business models compare? “The private hospital business is a different business focused on return on capital employed and average revenue per operating bed while home healthcare is all about last mile logistics, using technology and healthcare workers to ensure timely care at doorstep in a convenient and affordable manner,” explains Ganesh. Providing a different

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F O C U S : H O M E H E A LT H C A R E

view, Bali says, “Home healthcare starts where hospitals stop as far as treatment of medical events are concerned. However home healthcare can play a very vital role in management of chronic diseases and also preventive care.”

Gaining market share There are a number of small players dotting the HHC market space. Since 2013, the space has seen aggressive M&A activity and JVs to capture majority share in the market. Global players making the first move propelled many Indian entrepreneurs to take note of the growing demand. The Western players who have already established successful businesses based on this concept have been eyeing the untapped Indian market. Understandably then, two large global players, US-based BAYADA Home Health Care and UK's largest home health-

care providers Healthcare At Home, are making inroads into the Indian market. Both the companies have chosen not to venture as standalone entities into India. While Bayada picked up 26 per cent shares in the Chennai-based India Home Healthcare in September 2013, Healthcare At Home joined hands with the Burman family, promoters of natural healthcare products maker Dabur India to launch HealthCare At Home India (HCAH ) based at Delhi in November 2013. “HealthCare at Home is a joint venture between the Burman family, promoters of Dabur, and founders of the UK-based Healthcare at Home. The two partners will invest Rs 200 crores in the next three-four years to expand operations in India. We aim to break-even in the next two years,” informs Dabur Group family scion, Gaurav Burman. The HHC market has also

cover ) The size of the (home healthcare) industry in the next 10 years would grow to over $15 billion in India K Ganesh Chairman & Co-Founder, Portea Medical

Healthcare at home fulfils an unmet need in the market. I therefore see a great demand for these services in the future Vishal Bali Co-founder & Chairman, Medwell Ventures

Introducing accreditation will help standardise the business and care processes Dr Anitha Arokiaswamy President, India Home Healthcare

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attracted Indian entrepreneurs like Bengaluru-based serial entrepreneurs K Ganesh and his wife Meena Ganesh; Dr Ferzaan Engineer, Chairman of Cytespace Research and versatile healthcare administrator Vishal Bali, former Group CEO, Fortis Healthcare, among others. Ganesh bought Delhibased Portea Medical in 2013 and raised eight million dollars from Accel Partners and Ventureast. Bali and Engineer led MedWell Ventures acquired Bengaluru-based Nightingales Homes Health Services for an undisclosed amount in April 2014. While Homital Medcare was started with an undisclosed amount of seed funding from Chhattisgarh-based RR Energy and personal capital from Dr Rajesh Vasudeva, MD of Delhi-based Homital Medcare. “We have invested about one million dollars and we will continue to invest and expand over the next two years,” says Dr Rajesh Vasudeva, MD, Homital.

Growth drivers India's ageing population, changing disease patterns, rise and shift of acute illnesses such as heart failure into chronic diseases have all added to the demand for HHC. “Ageing population, medical developments and the nuclear family will lead to an increasing demand for home healthcare. In the future, home healthcare will be an integrated part of recuperation together with hospitals and doctors, like in the Western world. The market will grow to a multibillion dollar size over time,” says Frank Goller, CEO India Home Health Care, Chennai. Understandably then bedside care is one of the most requested service at HHC. “Care of disabled and bed ridden, medication administration and management, physiotherapy and post hospitalisation care are some of the most requested services at Homital,” informs Vasudeva.

Talking about the services Burman says, “All our services are much in demand. But to name a few, our ICU services, post operative care services, elderly care services, chemotherapy services and physiotherapy services have particularly become very popular.” “Over the last three years, healthcare delivery in India has attracted a high degree of investments and interest from the private equity and venture capital world. The investing world understands the demand-supply gap of healthcare in India and healthcare at home fulfils an

unmet need in the market. I therefore see a great demand for these services in the future,” opines Bali. Care in the comfort of home, which also saves time and the cost of hospital stay is not yet ingrained in the public consciousness.

Revenue, returns and expansion plans At present, most start-ups are hesitant to share revenue details and targets, but are forthcoming about expansion plans. “We expect to break even in 2016. Our long term projections are $50–100 million. But for the current

year our projections are about Rs 16 million,” says Vasudeva. “We have successfully completed our pilot in Delhi. We would be increasing our penetration in Delhi NCR and then move to six metros in the next two years after which we will be going to the tier two cities, moving towards a pan-India presence in the next few years,” he adds. Ganesh sketches his plans for Portea and informs, “Portea aims to be one of the largest healthcare providers in Asia. Since our Series A fund raise of $ eight million six months back we have

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Sharing the vision of Medwell team for enhancing Nightingales in Speciality Home Healthcare Bali says, “Medwell expects to invest $15-20 million in this business, increasing its subscriber base to 500,000 families and reaching 10 Indian metro clusters over the next three to five years.”

Challenges

grown to current status of 18 cities, with over 15000 visits a month through over 700 employees across India. We plan to be in 50 cities in India which we will cover in the next 24 months. We look to raise our series B funding in the next 12 months. We will add several new package services catering to chronic and geriatric patients. We would also be launching proactive monitoring programs through personalised monitoring devices this year.” Confident of his business, Burman outlines his plans. “As I have already pointed out, we aim to break-even

in the next two years. We are targeting a business of Rs 500 crores in the next five years,” he says. “We started our operations in Delhi in April last year. After a successful start in the national capital we entered the Punjab market in March this year and in Jaipur, Rajasthan. Plans are afoot to cover whole of Punjab, Rajasthan and Himachal Pradesh by the end of this year and go pan-India in the next two years,” he adds. Reflecting on IHHC's growth path, Goller says, “We used a small investment in the first two years to develop the concept and to gain expe-

rience in the market. With our partner BAYADA Home Health Care joining IHHC in 2013, we are able to invest up to $10 million in the next years. On city/office level, the break-even has been achieved beginning of 2013.” “In the next years we will invest in people and in geographic expansion to other metros. We are targeting cities with more than one million people right now. Our focus is on organic growth as we want to build a company based on shared values and goals. In 2014 we will add two to four cities and at least six more in 2015,” he adds.

While HHC has a promising future it does have its own challenges. “One of the main constraints is the availability of high quality manpower suited to work in the home environment,” says Dr Anitha Arokiaswamy, President, India Home Healthcare, Chennai. “Absence of structure and processes in the organisation is another challenge,” she says. Mulling over the challenges faced by the industry, Ganesh says, “Home healthcare is a very logistically intensive and service-focused business, so getting quality right is not only absolutely required but also very challenging.” Clearly, convenience and quality are the mainstay of the industry and the company that gets it right will succeed in the long run. “The winners in this space will be determined based on the quality of their execution. Scaling is very difficult unless you have a strong technology backbone as there is no central place like an hospital where healthcare is delivered. This also requires large investments in technology, training and in systems and processes. So the upfront capital required is high and the model becomes profitable only at large scale. So, unless you have a strong execution capability understanding and ability to build technology , the ability to hire , train , deploy monitor and motivate thousands of remote healthcare delivery employees, the business will not be able to scale and succeed,” Ganesh says.

We would be increasing our penetration in Delhi NCR and then move to six metros in the next two years Dr Rajesh Vasudeva Managing Director, Homital Medcare

We are targeting a business of Rs 500 crores in the next five years Gaurav Burman, Burman family member & Investor, HealthCare At Home

People management Indeed managing a large flock of employees is pivotal to success in this industry.

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cover ) “The shortage of staff in healthcare is a worldwide problem. We have established plans to ensure that we will become the employee of choice for any healthcare staff in India,” says Goller. “We have worked heavily in the last years to establish relationships which ensure that recruitment will be manageable. With our partner BAYADA we will be able to also recruit more registered nurses as we can offer them jobs in the US also,” adds Goller. With competing providers in the space, attrition and poaching of trained employees will increase. “The attrition has so far been much better than in the industry. One of the most important reason is that we are able to provide a very enabling environment to them. So they can provide one-on-one care to the patient, which they would not be able to do otherwise. We also have better salaries, flexible working hours and other such benefits because of which people stick to us,” says Burman. Providing his views, Goller says, “We are all about the people and we see that our staff appreciate that. We are on the right way to ensure that attrition is low. In the last three years we have seen that attrition has gone down to a low on figure percentage per year! This shows that we have the right attitude and process to retain the staff.” “Poaching by competition will happen if they pay above market salaries, but we have seen that even though staff is attracted by those, they realised quickly that work is not all about money but also about team work and respect for each other - something IHHC is proud to be the leader in the market – and return back to us,” he adds.

Training and education At present there is no industry ready course for HHC workers. However, the recent approval of a three-year-course, Bachelor of Science (Community Health) in state universities for specialised cadre of healthcare workers in rural areas will ease

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Many of the current business models in the home healthcare space will mature to provide niche services with good clinical outcomes to consumers some burden on the companies looking for trained manpower. Others are instituting their own training centres to create a steady stream of workers. “We have a constantly evolving training and recruitment programme,” informs Vasudeva. “We are co-ordinating with training institutes and investing in our own training facilities,” he further adds. Speaking on creating awareness about the job prospects in the industry, Goller says, “Working with NGOs and media to build awareness for a career in home healthcare is another initiative of us. Currently, with the support of BAYADA, we are developing a certification of home care aides and a residency programme for regis-

tered nurses to certify them on high-tech tracheostomy care. We will be able to offer this to all of our staff soon.” Other providers have an equally supporting view on staff training. “We have already developed an excellent training programme in partnership with Berkeley HealthEDU which has its own training and certification facility. All our providers undergo a six-week training programme and are AHA-certified BLS providers,” informs Burman.

In time to come Home healthcare will be a dominant force in the Indian healthcare delivery landscape in the coming years. Many of the current business models in the home healthcare space

will mature to provide niche services with good clinical outcomes to consumers. Accreditation will lead the way to standardisation. “There needs to be some regulation/ standardisation to ensure that high quality of care is provided to the patients in need. It would be critical as the nature of business itself has some inherent risks for both patient and staff safety. We need to be proactive and set this up, as more and more entities are entering this industry. Introducing accreditation will also help standardise the business and care processes,” says Arokiaswamy. Predicting better days for the industry, Ganesh says, “Home healthcare will be very much the norm in India in the medium term. Patients will

only go to the hospital for procedures and specialist consultations and receive all other healthcare services in the home setting. We expect there would be three or four major players in India. The size of the industry in the next 10 years would grow to over $15 billion in India.” Sharing his enthusiasm, Bali says, “Home healthcare will continue to see upwards of 35 – 40 per cent growth on a per annum basis since the sector is at a nascent stage and more number of entrants will ensure that the business continues to clock this level of growth.” While the industry awaits innovative insurance packages for HHC it has no doubt that insurance will play a bigger role in the success of this segment. India is the perfect platform to launch innovative healthcare services and solutions. It will be interesting to watch the success story of HHC providers unfold on this large canvas. mneelam.kachhap@expressindia.com

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F O C U S : H O M E H E A LT H C A R E

INSIGHT

Improving healthcare with home care services

DR GAURAV THUKRAL Head Medical Services, HealthCare At Home

Homecare services model, a proven concept in the West could be a solution to the lingering problem of providing quality healthcare in India, writes Dr Gaurav Thukral, Head Medical Services, HealthCare At Home

ealthcare is a major concern in India, which is battling to provide quality care to its 1.2-billion populations. Despite the best efforts of the government for creating world-class health infrastructure in the country, situation has so far remained bleak. Numerous projects which are meant to give a fillip to the healthcare sector continue to remain on papers only, with many getting mired in red tape. The country is facing innumerable health challenges and is staring at crises particularly related to cancer- and cardiac disorders. Hospitals in metropolitan cities and big towns are teeming with patients who travel from far corners of the country in search for high-end healthcare facilities. While, participation of private sector has improved the condition by several notches, the burden is too gigantic to handle. Beds are either full, leaving no space for other patients in dire need, or hospitals bills are too high for the patients to afford. Patients find themselves in lurch and the government is struggling to find a concrete plan. However, there is an urgent need in India to provide quality and cost-effective care to patients. Amidst the clamour for creating a patient-friendly healthcare set-up, many forces at public and private sector level need

to work in tandem to achieve the goal. Home care services can play a significant role in perking up the sagging condition of healthcare in the country. The high-end services being provided by home care providers, like HealthCare at Home, addresses one big major issue of creating capacities in hospitals, among several others. After preliminary treatment at hospitals, patients can get further treatment at

$2 BILLION

Value of the home care market in India. It is growing at 20 per cent annually

their homes which is at par with the care being provided at the hospital. While such facility empties beds in hospitals, for patients too it is affordable as it cuts down various indirect expenditures, including the cost of hospital stay and travelling to and fro to hospitals. At HealthCare At Home, at all times the doctor is kept in loop and the treatment is led by his/her prescription only. Due to this the patientsâ&#x20AC;&#x2122; doctors have a complete control over the treat-

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cover ) ment and at the same time they can focus on others patients in hospital. Home care services can change the way healthcare is delivered in India. Healthcare needs to be patient-centric, which benefits them in more way than one. Providing treatment, along with mental peace, is the need of the hour. Home care services offer these twin benefits simultaneously.

Home care services: The way forward! The home care market in India is valued at $2 billion and is growing at 20 per cent annually, according to Pricewaterhouse Coopers (PwC). Rise in income levels and awareness about diseases and its care is swinging the pendulum in favour of patient care to home than in hospital. Creating capacities: As per a 2012 report by McKinsey and CII, the hospital bed density (per 1000) stands at 1.3 in 2010 against the World Health Organizationâ&#x20AC;&#x2122;s standard of 3.5. Due to non-availability of beds, patients remain devoid of treatment, and in severe cases succumb to the diseases. The availability of home care creates capacities in tertiary hospitals. Post a major-surgery or when a patient is staying at hospital for the sake of care which can be easily replicated at home, then he/she is occupying a bed which can be used by a critically-ill patient. The availability of world-class care at home addresses this concern to a great extent. Access to care: In India, patients move to metropolitan cities and towns from far and beyond for getting the treatment done due to lack of quality healthcare infrastructure at the respective places. After the initial treatment, they continue to stay in hospitals for further treatment and care

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Home care services are cost-effective as it reduces the burden of indirect expenditure on travel to hospital and spend on hospital bed, among others. There is continuous monitoring and so the chances of developing complications are remote, which at the same time cuts the probability of re-admission to hospital which could be handled at home if there are proper channels and arrangements for the same. The scenario is challenging. Home care services successfully plug such loopholes. For example, HealthCare at Home at all times keep treating doctors in the loop and the treatment which is carried by it is led by their prescriptions only. Doctors are kept updated about the patientsâ&#x20AC;&#x2122; conditions, so the treatment is your doctor- driven. Home care services bring

high-end care to the doorsteps and increases the access to quality healthcare facilities even beyond the metros. Cost effective: Home care services are cost-effective as it reduces the burden of indirect expenditure on travel to hospital and spend on hospital bed, among others. There is continuous monitoring and so the chances of developing complications are remote, which at the same time cuts the probability of re-admis-

sion to hospital. Home care services are 50-70 per cent cheaper than hospitals. Also, the services reduce the overall burden of disease on patient, family and hospitals. Empowering healthcare manpower: The growth of home care services market has expanded the horizon for healthcare professionals. As home care service providers are present in segments ranging from oncology (cancer care), pulmonology (lung care),

post-operative care (orthopaedics, to cardiac, bariatric -- weight loss surgery-- etc), critical care and palliative care, the scope for professionals in the respective fields has grown manifold. Even a 12th pass student can be trained to become an assistant. This helps in bridging employment issues as well. It is providing an altogether new stream of growth to all healthcare providers. Besides, the chances of contracting infections are higher in hospital than at home, so homecare facilities are much safer. The level of confidentiality is also high when a treatment is being done at home than at hospital. When India is gaining ground as a medical tourism hub, serious measures are required to provide quality and affordable healthcare facilities to the citizens also. The concept of homecare facilities will turn out to be a big game changer.

KNOWLEDGE INSIGHT

Understanding Brain Aneurysm

DR VIPUL GUPTA, HEAD, Neurovascular Intervention Centre, Medanta - The Medicity

Dr Vipul Gupta, Head, Neurovascular Intervention Centre, Medanta - The Medicity enlightens on the causes and effects of brain aneurysm, its signs and symptoms while elaborating on its treatment methods

Diagram of brain aneurysm

he recent canonisation of Pope John Paul II was hailed as a global historical event, however it also highlighted a serious medical condition which the late Pope is said to have healed miraculouslyintracranial aneurysm. An intracranial aneurysm (also called cerebral or brain aneurysm) is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localised dilation or ballooning of the blood vessel. Almost 500,000 deaths worldwide each year are caused by brain aneurysms and half the victims are younger than 50 and the ratio of men versus women is 3:2. Women over the age of 35 are particularly exposed to the risk. In fact, results of various studies shows that females are up-to two times more likely to develop cerebral aneurysms compared with males. A recent report from the Institute of Medicine (IOM), arm of the National Academy of Sciences confirms that there are several instances of sex differences in the incidence and sign of cerebrovascular disease and trauma that warrant further investigation. Smoking, high

blood pressure, and a family history of brain aneurysms seem to further increase a woman's risk of developing this potentially fatal condition.

What is cerebral aneurysm? An aneurysm is an outpouching from the blood vessel or dilatation of the blood vessel that has a potential for rupture or other related complications. Almost five per cent of adult population can have an aneurysm. They do not have a single cause. Common causes are of intracranial aneurysms are vessel degeneration from haematologic factors, atherosclerosis, high flow states, underlying vascular disorders, trauma, infection drug abuse and neoplastic invasion. Disorders associated with aneurysm formation include hypertension, aortic coarctation, adult polycystic kidney disease, fibromuscular dysplasia, connective tissue disorders and Moyamoya disease. In most cases, a brain aneurysm causes no symptoms and goes unnoticed. In rare cases, the brain aneurysm ruptures, releasing blood into the skull and causing a stroke. The most common location for brain aneurysms is in the network of

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KNOWLEDGE blood vessels at the base of the brain called the circle of Willis.

Aneurysm facts ◗ Ruptured brain aneurysms are fatal in about 40 per cent of cases. Of those who survive, about 66 per cent suffer some permanent neurological deficit. ◗ Brain aneurysms are most prevalent in people ages 35 60, but can occur in children as well. The median age when aneurysmal haemorrhagic stroke occurs is 50 years old and there are typically no warning signs. Most aneurysms develop after the age of 40. ◗ Women, more than men, suffer from brain aneurysms at a ratio of 3:2. ◗ Ruptured brain aneurysms account for five per cent of all new strokes. ◗ Accurate early diagnosis is critical, as the initial haemorrhage may be fatal, may result in devastating neurologic outcomes, or may produce minor symptoms. Despite widespread neuroimaging availability, misdiagnosis or delays in diagnosis occurs in up to 25 per cent of patients with sub-arachnoid haemorrhage (SAH) when initially presenting for medical treatment. Failure to do a scan results in 73 per cent of these misdiagnoses. ◗ There are almost 500,000 deaths worldwide each year caused by brain aneurysms and half the victims are younger than 50

Problems caused by aneurysms The most feared complication caused by aneurysm is subarachnoid haemorrhage (SAH). Sometimes aneurysms occur due to mass effect and unusually due to thromboembolic phenomenon.

Why is treatment of SAH an emergency? SAH is always an emergency because ruptured cerebral aneurysms continue to be a significant cause of death as well as a health and economic problem which can be significantly reduced if treated early. It is an important cause of mortality and morbidity because young and middle-

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The most feared complication caused by aneurysm is sub-arachnoid haemorrhage (SAH). SAH is always an emergency because ruptured cerebral aneurysms continue to be a significant cause of death as well as a health and economic problem. Hallmark of SAH is a sudden, usually severe headache and about 80 per cent patients give such a history. Sentinel headaches may occur a few hours to a few months before the rupture, with a reported median of two weeks prior to diagnosis of SAH

aged adults are most often affected. Studies to date show peaks at various ages in the 40-70 year range. An estimated 12 per cent of patients die before reaching the hospital. Epidemiological studies estimate that about 40 per cent of those reaching hospital die. Re-bleed due to re-rupture of aneurysm is a very important factor, which makes early treatment all the more important. With modern surgical and interventional (endovascular) techniques, most of the aneurysms can be treated with reasonable safety. The peak risk of re-bleed is within the first 24 hours after SAH, thereafter the rate declines to 1.5 per cent per day, with a cumulative risk of 19 per cent in the first two weeks. Early treatment in selected cases not only prevents morbidity and mortality due to re-bleed but also enables aggressive treatment of secondary complications such as vasospasm and hydrocephalus.

What are the common signs and symptoms of SAH? Hallmark of SAH is a sudden, usually severe headache and about 80 per cent patients give such a history. Sentinel headaches may occur a few hours to a few months before the rupture, with a reported median of two weeks prior to

500,000 Deaths are caused by brain aneurysms worldwide each year

50% 3:2 Victims are younger than 50 Ratio of men versus women is

Women over the age of

are particularly exposed to the risk

Most aneurysms develop after the age of

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diagnosis of SAH. Headache of SAH is usually typical but sometimes is variable as to render the diagnosis difficult. Most common incorrect diagnosis in order of decreasing frequency are systemic infection or viral illness, migraine, hypertensive crisis, cervical spine disorder such as arthritis or herniated disc, brain tumour, aseptic meningitis, sinusitis and alcohol intoxication. Ominous features associated with headache are vomiting, alteration in consciousness, meningism, seizure or focal neurologic deficit. Physical examination findings may be normal, or the clinician may find some focal neurological deficits. There might be varying degrees of level of unconsciousness depending on the grade of the patient. Patients usually have nuchal rigidity as a sign of meningism. The focal deficit usually pertains to the vascular territory involved, like bilateral lower limb weakness in anterior cerebral artery territory or hemiparesis in middle cerebral artery territory or third nerve palsy in posterior communicating artery territory.

What are the investigations needed? Computed tomography (CT) This test should be the first investigation to be performed

particularly to look for presence for bleeding. In most of the cases, CT will show evidence of blood in sub-arachnoid space although one should be aware that three per cent of patients might have normal scans within 24 hours of confirmed SAH. CT scan also helps in diagnosis of associated intraventricular haemorrhage, intra-cerebral haemorrhage, as well as for presence of mass effect, ischemic changes and hydrocephalus. With passage of time, sensitivity of CT to detect SAH in a patient decreases and by Day-five, significant number of patients may have normal CT in spite of the presence of bleed and aneurysm. Lumbar puncture (LP) Lumbar puncture is done to detect RBCs and xanthochromia as an evidence of SAH. LP is indicated in case where the clinical history is strongly suggestive of SAH with a negative CT or the patient presents many days after the episode with a negative CT scan. Magnetic resonance imaging (MRI) Although some reports show that MR can detect acute haemorrhage, CT should always be done first to rule-out haemorrhage. Catheter angiography (DSA- digital subtraction angiography) This is the most accurate investigation in diagnosis and evaluation of aneurysms causing the SAH. Cerebral angiography is performed once the diagnosis of SAH is made. This study assesses the ruptured aneurysm, vascular anatomy, presence of other aneurysms and secondary vasospasm. In particular, 3-D DSA is most accurate in evaluating assessment of intracranial aneurysms. CT/MR angiography Although CT/MR angiography can detect intracranial aneurysms, its sensitivity in detection of small intracranial aneurysm is poor.

What are the various types of treatment for intracranial aneurysms? Aneurysms can be treated by endovascular and surgical

KNOWLEDGE techniques. The primary goal of treatment is complete, permanent and safe aneurysm occlusion. Surgery Surgery has been the conventional method of aneurysm treatment. Surgery entails direct exposure of the aneurysm, the parent vessel(s) and surrounding structures. The aneurysm is then secured by the placement of a metallic clip along the neck thereby excluding it from the circulation. Problems with surgery include invasiveness and trauma to normal brain parenchyma. Surgery has an edge over the endovascular method in cases of large haematoma or hydrocephalus where a decompression would always benefit the patient.

this is about 50 per cent Almost 60 per cent of patients with thick clots develop moderate or severe angiographic vasospasm in at least one major artery. ◗ Hydrocephalus ◗ Hyponatremia ◗ Hypoxia/hypotension from cardiopulmonary complications ◗ Systemic sepsis, meningitis ◗ Cardiovascular complications- such as ECG abnormalities are quite common in these patients. Unusually, they may be associated with underlying cardiac damage manifest as contraction band necrosis and elevated cardiac enzymes.

Endovascular coiling of aneurysms In this treatment a microcatheter is placed from one of the leg arteries into the aneurysm, which is then occluded with coils (usually detachable platinum coils) so as to prevent repeat bleeding. A recent randomised, multi-centre trial conducted in Europe and North America has shown that long-term clinical results were better with embolisation than open surgery in certain subset of patients. Endovascular treatment is usually the treatment of choice of patients with surgically poorly accessible aneurysms (posterior circulation, cavernous ICA aneurysms), in patients with medical risk factors and in patients with poor clinical status after the bleed.

International subarachnoid Aneurysm trial (ISAT Trial) ◗ Randomised, prospective, international controlled trial compared neurosurgical clipping with endovascular treatment in aneurysms and concluded that results of coiling were better than surgical clipping . ◗ The early survival advantage was maintained for upto seven years and was significant. The Barrow Ruptured Aneurysm Trial (BRAT Trial) ◗ Endovascular coil embolisation is superior to microsurgical clipping.

How is coiling procedure performed? The procedure is done under general anaesthesia. A guide catheter is placed through in one of the femoral (leg) vessel into the appropriate parent vessel. Multiple angiograms are done to localise the aneurysm and to assess its morphology. 3-D angiogram is of great help in this process and it guides the interventional radiologist in selecting the approach. A microcatheter is carefully navigated into the aneurysm under roadmap guidance. An appropriate sized

Results of coiling are better than surgical clipping

Cerebral aneurysm surgery

Effective management in a stroke centre, with a team of doctors specialising in different aspects, is important because patients with SAH are prone to secondary complications, which can cause delayed onset of worsening after SAH coil is then placed into the aneurysm. Specially shaped coils (such as 3-D coils) are available for this purpose. Angiogram is done to confirm the placement of the coil before it is detached. This detachment is usually done by electrolytic method, sometimes by mechanical means. Further, the aneurysm is packed by placing more coils until complete occlusion is achieved. Patient is brought out of general anaesthesia depending upon the clinical situation. Patient always need follow-up angiograms to assess the stability of occlusion. Unusually, aneurysm may re-canalise or grow and patient may need a repeat procedure.

Why is it important to manage such patients in specialised centres? A comprehensive stroke centre

is defined as a facility or system with the necessary personnel, infrastructure, expertise, and programmes to diagnose and treat patients who require a high intensity of medical and surgical care, specialised tests, or interventional therapies. This kind of a centre has: ◗ Stroke team/physicians ◗ Diagnostic techniques such as MRI, CT (with CT angiography), digital subtraction angiography (DSA) and transcranial Doppler. ◗ Surgical and interventional therapies- well established surgical procedures such as haematoma removal, clipping of aneurysms as well as interventional neuroradiology and endovascular therapy ◗ Infrastructure such as neurosurgical ICU, and round-theclock interventional and surgical facilities Studies have shown that

patients treated in stroke centres have better outcomes as compared to patients treated in regular hospitals. Results of both surgery and intervention are also largely dependent upon the expertise of the treating physician. Effective management in a stroke centre with a team of doctors specialising in different aspects is important because patients with SAH are prone to secondary complications, which can cause delayed onset of worsening after SAH. These include: ◗ Cerebral ischemia due to vasospasm - Symptomatic vasospasm is narrowing of vessels that have resulted in cerebral ischemia with clinical symptoms and signs. Angiographic vasospasm is arterial narrowing demonstrated on angiography after SAH and overall incidence of

References ◗ Molyneux AJ, etal; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005;366:809-17 ◗ Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): longterm follow-up. Lancet Neurol. 2009 May ; 8(5): 427–433.

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KNOWLEDGE INSIGHT

Golden hour in acute ischemic stroke Dr Viswanathan Iyer- Consultant Neurosurgeon, Kohinoor Hospital throws light on the fundamentals in stroke management and the significance of providing immediate medical help to patients who have suffered an ischemic stroke

n ischemic stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a ‘brain attack’. It occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways: ◗ Thrombotic stroke: A clot may form in an artery that is already very narrow. This is called a thrombus. If it completely blocks the artery, it causes a stroke. ◗ Embolic stroke: A clot may break off from another place in the blood vessels of the brain, or some other part of the body, and travel up to the brain to block a smaller artery. This is called an embolism.

Non-modifiable risk factors for stroke ◗ Family history: Risk of having a stroke is higher for people whose parents or siblings have had a stroke. ◗ Age: Stroke risk increases with age; doubling every 10 years after the age of 55. ◗ Gender: Before the age of 55 years, men are more likely than women to have strokes. Thereafter, the risk is the same for men and women. ◗ History of prior stroke, TIA or heart attack: Person who

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has had a stroke in the past is at much greater risk for suffering from another one. Risk of stroke after a TIA is greatest within the first 48 to 72 hours.

Modifiable risk factors for stroke ◗ High blood pressure: The most important modifiable risk factor for stroke. Controlling high blood pressure will greatly reduce risk of stroke. ◗ Cardiovascular disease: Congestive heart failure, a previous heart attack and atrial fibrillation can all raise the risk of stroke. ◗ Cigarette smoking: The risk of stroke is two to three times greater for smokers versus non-smokers. ◗ Carotid artery disease: Fatty deposits from atherosclerosis may cause significant narrowing in the carotid arteries. This can limit blood flow to the brain as well as acts as a potential source for cerebral emboli. ◗ Diabetes: Diabetes doubles stroke risk. Many people with diabetes also have high blood pressure, obesity and high cholesterol which increase their stroke risk even further. ◗ Undesirable blood cholesterol levels: High blood levels of low-density lipoprotein (LDL) cholesterol and low levels of high-density lipopro-

KNOWLEDGE

REMEMBER FA S T RULE tein (HDL) cholesterol increase stroke risk. ◗ Obesity: Excess weight could double the risk of an ischemic stroke. ◗ Lack of exercise and physical activity: Doing some kind of activity for at least 30 minutes every day will help decrease stroke risk.

Common symptoms of ischemic stroke are ◗ Sudden weakness of a leg, arm or one side of the face ◗ Sudden trouble speaking or understanding speech ◗ Sudden vision problems, such as blurred or double vision ◗ Sudden loss of coordination or problems with balance ◗ Sudden numbness, weakness or dizziness

Treatment Over 80 per cent of all strokes are ischemic and are commonly caused by blood clots that interrupt blood flow in an area of the brain. It is imperative for people with stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clotbusting drug (thrombolytic therapy) may be given to dissolve the clot. The drug breaks up blood clots and helps restore blood flow to the ischemic area. tPA acts by dissolving these stroke-causing blood clots. The efficacy of Intra-Venous Thrombolysis has been proven by several large clinical trials which

show a greater chance of recovery in stroke patients who are treated with it. However, these trials also show that, if given later than three hours after stroke onset, tPA can cause dangerous bleeding in the brain. Hence, it is only safe to give tPA within three hours of the beginning of stroke symptoms, which is why we think of this time as the ‘golden three hour tPAwindow.’ Recently, the European Cooperative Acute Stroke Study (ECASS 3) study suggested that tPA was safe and effective up to 4.5 hours symptom onset for some patients.

F-Face-ask the person to smileDoes one side of the face droop?

Concept of ‘Golden Hour’ If flow through an artery supplying an area of the brain is stopped for some reason, other portions of the vasculature reperfuse the ischemic area. Contrary to popular belief, neurons do NOT die in few minutes, they, like other cells, can go an hour or more before death. However, they DO lose their function with a few minutes of ischemia. Ischemic neurons can regain function over time by either eliminating the cause of ischemic attack or collateral reperfusion will eventually make ischemic area smaller and smaller.

A-Arm- ask the person to raise both hands. Does one arm drift downwards?

Time is equal to brain ◗ Every minute counts ◗ Permanent neurologic damage is more likely to occur the longer a stroke goes un-

Over 80 per cent of all strokes are ischemic and are commonly caused by blood clots that interrupt blood flow in an area of the brain. It is imperative for people with stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot

S-Speech- ask the person to repeat a sentence. Is the speech slurred?

T-Time-If the person has any of these symptoms, send him to a stroke unit immediately. Call the hospital/consultant so they can activate the stroke protocol.

treated. ◗ Rapid intervention is crucial in the treatment of stroke. ◗ For every minute a large vessel stroke goes untreated, as many as: ◗ 1.9 million neurons are lost ◗ 14 billion synapses are lost ◗ 7.5 miles of myelinated fibers are lost The National Institutes of Health recommends time interval for tPA–eligible acute ischemic stroke patient presenting to the emergency department to receive treatment within 60 minutes. 0 min: Suspected acute ischemic stroke patient arrives at hospital <10 min: Initial MD evaluation (including patient history, lab work initiation, and NIHSS assessment) <15 min: Stroke team notified (including neurologic expertise) <25 min: CT scan initiated <45 min: CT and labs interpreted <60 min: tPA given if patient is eligible Before thrombolysis can begin, patients must undergo blood and radiological investigations, including a brain scan to ensure the stroke is ischemic and not haemorrhagic. These investigations also take time. The golden window is often missed due to delays in treatment attributable to the patient and the medical system. Because of this only a small fraction of stroke patients receive tPA. The most common cause of delay is the lack of awareness about stroke signs and symptoms in the general public. Most people wait up to a day after their symptoms start before seeking medical attention because they simply don't know their symptoms are those of a stroke. Each of us can help get this message across by educating people before they are ever affected by a stroke. Teach the symptoms of stroke to your parents, your children, your patients and other people around you. A stroke is a medical emergency. Immediate treatment can save lives and reduce disability.

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KNOWLEDGE I N T E R V I E W

‘A dedicated stroke unit in every hospital should be the goal to provide best care’ The burden of brain stroke in India is on the rise. Various studies indicate that as a result of increased lifespans, urbanisation and changing lifestyles, ischaemic stroke has become a major public health problem in India. Dr PP Ashok, Consultant Neurologist and Head, Division of Neurology, Hinduja Healthcare Surgical explains the various reasons of a brain stroke, the causes for its rising burden on India and the role of a stroke management team in a hospital, in conversation with Raelene Kambli What is a brain stroke and what are its causes? The blood vessels in the heart get blocked to produce a heart attack, a similar problem occurs in the brain to produce a brain stroke. Unlike the heart, where only the blood vessels can get blocked, causing low blood flow, the blood vessel in the brain can not only get blocked but can also rupture, producing bleeding into the brain. Such rupture does not happen in the heart. Occlusion of a blood vessel in the brain produces ischemic infarct in the brain tissue, whereas rupture produces brain haemorrhage. In both situations, the site of the brain, where this happens, decides which part of the body can get

Brain CT showing the ischemic stroke

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paralysed. Such paralysis can involve one arm or one arm and leg on the same side, a speech defect or a visual loss. One suspects an individual to have suffered an acute stroke by the sudden appearance of weakness in a part of the body. Stroke is caused by various conditions which are similar to those that cause a heart attack like high blood pressure, diabetes, smoking, heart disease, high lipids, obesity, sedentary habits etc. Explain the rising burden of brain stroke in India? India is a developing country with a high incidence of diabetes. In fact, India has already become the diabetic capital of the world. Metabolic

Patients with acute stroke should be treated immediately with thrombolytic therapy syndrome is highly prevalent in Indian subjects. In a recent study conducted at Hinduja Hospital, it was found that there is a high prevalence of small blood vessel blockage in the brain among Indian patients. This is in sharp

contrast to large blood vessel blockages in the Western countries. We believe high blood pressure and diabetes amongst Indian subjects cause small vessel disease, peculiar to Indian and some of the Asian countries. Some of these patients may not suffer from acute stroke, but years of small vessel occlusion can cause cognitive decline and dementia. Unless we educate our Indian public about the need to control body weight, regular exercise etc. to prevent diabetes, we will end up with more patients suffering from this malady.

at least a team which recognises the importance of speed. 'Time is brain'. The earlier we treat them, less the chances of residual handicap!!!

What is the role of a stroke management team within the hospital? Stroke has to be prevented through lifestyle management, prompt treatment of diabetes, blood pressure etc. Also, patients with acute stroke should be treated immediately by thrombolytic therapy, for which patients need to be administered the 'tPA drug' within 3 to 4 ½ hours. To achieve this, one has to quickly transfer the patient to the hospital, where a quick assessment, urgent imaging and interpretation is done, so that the window period of 4 ½ hours is achieved. For this we need a dedicated stroke unit or

Is stroke still treated by general practitioners within hospitals or by specialists. Do you think that hospitals need to have a separate stroke centre within hospitals? If yes, how will it help in providing better treatment? Stroke should be treated by a neurologist; certainly the neurologist can take help of a general physician/cardiologist for supportive treatment. However, a dedicated stroke unit in every hospital should be the goal to provide the best care in the management of acute stroke.

What were the traditional ways of managing stroke within hospitals? Prior to the advent of thrombolytic therapy or in those patients who come to the hospital after the window period, there is precious little that we can achieve in the form of treatment. In such patients, after the imaging is over, we can only put them on antiplatelets and statins to try and control all risk factors.

raelene.kambli@expressindia.com

KNOWLEDGE I N T E R V I E W

‘The specificity of the Dexact-f test to rule out infectious focus in the bowel in over 92 per cent’ On a recent visit to India, Dr Fariba Nayeri, Specialist and Senior Consultant at the Department of Infectious Diseases, University Hospital in Linköping, Sweden and the Founder of PEAS Research Institute shared details of her research, the urgent measures needed in the infectious diseases arena and more, in a tete-a-tete with Lakshmipriya Nair Tell us about your research in the arena of infectious diseases A large amount of cases presented to the doctors are either directly related to the field or in urgent need of consultation with an infectious disease specialist. Chronic infections prevent healing and cause complications that in many cases lead to unnecessary invasive interventions. The goal of our research has been to investigate the true cause and achieve healing of diseases. Since 1999, we have studied the presence and biological activity of cytokines such as thehepatocyte growth factor (HGF) in blood and locally at the site of injuries caused by infection. We tried to develop reliable and reproducible methods for determination and evaluation of cytokine. HGF is a protein produced by neighbour cells to heal injured organ cells. This protein is a potent healing factor which helps in the healing of injuries by at least three mechanisms : ◗ The healthy tissue cells increase in number (mitogen effects) ◗ The produced cells go to the injured area (motogen effect) ◗ The injured tissue grows back to the original healthy form (morphogen effect) We found that the amount

We hope that Dexact-f, as a complementary diagnostic tool to direct microscopy, might help to decrease antibiotic consumption in 50 per cent of cases of HGF increased after all sorts of injuries, acute as well as chronic. However the acute injuries healed as soon as the infectious agent was eliminated. The chronic injuries on the other hand did

not heal. Chronic ulcers are examples of chronic injuries that are very difficult to treat. We observed thatthe application of HGF to chronic injuries sometimes caused rapid healing. In some other cases, no positive effect was observed. During the past ten years we have tried to find answer to the following questions: ◗ Why don’t chronic injuries heal?

◗ The concentration of HGF in the secretion from chronic injury is even higher than in acute injuries. Then why did application of HGF cause healing in some chronic injuries but not in all injuries? ◗ What are the properties that differentiate between the HGF produced during acute injuries and chronic injuries? ◗ Are there some infectious agents that are important in

the chronicity of injuries? ◗ A chronic injury is always colonised with several bacteria. How can we recognise the responsible bacteria? ◗ Besides antibiotics, what other manoeuvres can be used to get rid of infection? The summary of results achieved from the investigations so far is that: ◗ Changes in the shape of HGF (configuration) might cause

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KNOWLEDGE

differences in binding this cytokine to the receptors and thereby in the activity of protein in the body ◗ Some bacterial agents might cause changes in the configuration of HGF ◗ Inactive HGF does not bind to the extracellular matrix and cannot interact with the high affinity receptor on cell membrane ◗ Bacteria responsible for injuries produce peptides that are similar to the human body and hide from the immune responses (mimicry peptides) ◗ By production of antibodies in human cell cultures we can recognise such mimicry peptides ◗ A combination of effective antibiotics and biologically active HGF with high affinity to the extracellular matrix might treat chronic injuries rapidly ◗ Characterisation of biologically active HGF might be used to differentiate between acute and chronic injuries in body fluids Based on the achieved results we have developed rapid tests to recognise the site and severity of infection. You have developed Dexact-F, a strip to diagnose diarhhoea? What are its benefits, especially for a country like India? Diarrhoea is a common symptom of several diseases, and a well-known cause of morbidity and mortality in the world. The major cause of diarrhoea is infection and therefore in order to avoid devastating complications, numerous cases are treated blindly by antibiotics. This has been an important cause of resistance development in bowel bacterial flora. The conventional diagnostic routines in diarrhoea are stool direct microscopy, stool cultures and antigen detection methods in some medical centres. Due to

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tissue response is the valid answer of the body to the injury that can be determined and monitored. We develop diagnostic and monitoring markers for diagnosis of bacterial infection in sterile samples. We also develop high specific antibodies for detection of microbial antigens such as mycobacterium tuberculosis in blood samples.

vast antibiotic consumption and susceptibility of common causes of infectious gastroenteritis such as salmonella to antibiotics, the sensitivity of stool cultures are very low. Direct stool microscopy is a valuable method for diagnosis of parasites but cannot differentiate between infectious and non-infectious gastroenteritis. Dexact-f is a marker of acute inflammation and the severity of inflammation. The specificity of the test to rule out infectious focus in the bowel in over 92 per cent and the sensitivity to diagnose a bacterial infection in the bowel is >92 per cent as long as inflammation causes injury. Therefore, during viral gastroenteritis the test turns to negative within 72 hours after the debut of infection. In cases with inflammation caused by parasites, positive test might be observed in acute phase of disease. The test is negative in carriers. During the study of faeces samples with Dexact-f in Sweden, Egypt and India we

I am keen and curious to find out and learn about the clinical practices and traditions in India and to contribute to the outline of future medical services in this country

have found that the test was positive in 20-30 per cent of cases with diarrhoea. Therefore, we hope that Dexact-f, as a complementary diagnostic tool to direct microscopy, might help to decrease antibiotic consumption in at least 50 per cent of cases and to differentiate the cases of acute inflammation in bowels that are in need of immediate care, such as during sepsis with systemic inflammatory response syndrome (SIRS). Are you working on developing similar solutions for other infectious diseases as well? Our proposed solution for rapid diagnostic of infectious focus is based on the tissue responses to the infection. We intend to recognise and determine such responses by means of rapid tests. The value of such an approach is that the physician is not bound to previous antibiotic consumption, poor sensitivity of cultures and too high sensitivity of PCR-based methods to set diagnosis. The

What are the three important things that need to be done for curbing the growing incidences of infectious diseases? The immediate measures needed are as follows: ◗ Promoting public as well as professional awareness ◗ Research and development of reliable and available diagnostic tools ◗ Decreasing antibiotic consumption and applying focused treatment Tell us about the purpose of your visit to India? As a researching doctor, I am keen and curious to find out and learn about the clinical practices and traditions in India and to contribute to the outline of future medical services in this country. Furthermore, I was very interested to meet and get acquainted with colleagues and medical staff. What are the lessons that Sweden and India can learn from each other to improve their respective healthcare sectors? Hopefully, the Swedish doctors can learn about the work load, burden from the large number of patients that Indian doctors are responsible for and get insights into the value of patient contact, viewing the patient as a whole. Swedish doctors may be the models in restrictive prescription and intensive follow-ups. lakshmipriya.nair@expressindia.com

KNOWLEDGE INSIGHT

Needed:Innovations in maternal and infant care

VIJAYSHANKAR R ANDANI Independent Management Consultant – eHealth & Health Economics Analyst

Vijayshankar R Andani, Independent Management Consultant – eHealth & Health Economics Analyst shares his insights on how to improve maternal and infant care in India

hristened as an emerging economy, India has been at the forefront of the economic boom for past two decades, partly due to burgeoning population. Ironically, considering Human Development Index (HDI), India bottoms out compared to other countries, depicting the poor state of health affairs. Many developing/underdeveloped nations ostensibly face a similar quandary. Subsequently, Infant Mortality Ratio – per 1000 live births (IMR) and Maternal Mortality Ratio – per 100000 live births (MMR), the main contributors of HDI in India, represent an alarming quarter figures of the world. Governments, public, private and world organisations have been addressing this perplexity by introducing maternal and infant care initiatives for some time now. According to Life Science Intelligence report, the global market for products used to monitor and treat neonatal and perinatal patients will grow at a compound annual growth rate (CAGR) of 5.2 per cent to $1.5 billion by 2013. Two million children under five years of age die—one in every 15 seconds—each year in India, also the highest anywhere in the world. Of these, more than half die in the first month of their birth. If the Indian government on one side is scuttling to curtail these figures via National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY) schemes, private organisations such as GE, Philips and other local

players on the other side are addressing this conundrum by introducing innovative maternal infant care (MIC) concepts – Lullaby and Intellivue from GE and Philips are few of them. Deciphering the mortality statistics about India, it can be observed that IMR is highest in the rural areas and Empowered Action Group (EAG) of states: Bihar, Jharkhand, MP, Chhattisgarh, Orissa, Rajasthan, UP, and Uttarakhand, which have been deprived of healthcare the most. Although, MIC equipment has been designed considering developing countries’ environ-

With 70 per cent of Indian population in rural areas, accessible to quality healthcare at affordable cost is a still distant reality. Medical device vendors, by joining hands with government and low-cost healthcare providers could deliver economical MIC solutions to afflicted areas with economies of scale

ment, the sophistication and price may still impede reaching out to the masses– rural and EAG states in India. A two prong strategy to curb infant mortalities could be looked at by public authorities with the help from medical equipment firms to address different set of regions (urban and healthcare deprived areas), one utilising and improving existing solutions and the other, developing new solutions.

Rural possibilities IMR in rural and EAG states is estimated to be 55 in India. Around half of the

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KNOWLEDGE infants die due to malnutrition. Low birth weight babies have a greater risk of dying from diarrhoea and acute respiratory infections. Also, the limited healthcare facilities available in the country are skewed more in favour of the affluent population. Only 20 per cent of doctors, 25 per cent of dispensaries and 40 per cent of hospitals are situated in non-urban areas. ◗ Containing infant mortality: When addressing the mass population, it is necessary to address the predicaments in a holistic way rather than in silos. Lack of appropriate care during pregnancy and childbirth, and the inadequacy of services for detecting and managing complications explain most of the maternal and infant deaths. If these concerns could be addressed by adding/developing solutions to offer services beyond infant care and collaborating with other specialised vendors (for nutrition etc.), this disorder can be subdued. GE Healthcare has demonstrated how to address disease holistically in the past by owning a cancer disease (extending end to end support). ◗ Class for mass: 80 per cent of the time, baby incubators are used to only keep the baby warm. And 80 per cent of Indian hospitals use baby warmers, which provide direct heat in open cradles and are usually intended to help newborns adjust to room temperature. Embrace Innovations, an organisation analysing these facts has introduced a baby warmer that costs less than $200. With frugal innovations as exemplified by MAC 600 ECG machines and Embrace portable warmer, many medical devices firms could empower high infant mortality afflicted areas with no-nonsense solutions. ◗ Product configurations: Addressing the healthcare deprived areas where mass population needs to be served with limited facilities and cost, the medical equipment firms, in collaboration with government, could introduce different products

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IMR in rural and EAG states is estimated to be 55 in India. Around half of the infants die due to malnutrition. Low birth weight babies have a greater risk of dying from diarrhoea and acute respiratory infections targeted to specific needs rather than offering all-inone solutions. For eg., if warming therapy, phototherapy, neo-natal monitoring and ventilation, are offered as separate products, then the cost factor comes down and more babies could be served at the hospitals or even in the primary health centres (PHCs) and community health centres (CHCs). ◗ Service delivery models: With 70 per cent of Indian population living in rural areas, access to quality healthcare at affordable cost is a still distant reality.

Medical device vendors, by joining hands with government and low-cost healthcare providers such as ‘LifeSpring hospitals’ could deliver economical MIC solutions to afflicted areas with economies of scale. Financing models such as revenue sharing, fixed installments or monthly fees would help to reach the masses (BOP – Bottom of the pyramid).

Urban possibilities Increased women’s participation at work, education, stress levels, food habits, and surrounding environment are few

main factors leading to decreased birth rate (TFR of 2.6). Hence urban and working women are becoming more conscious about maternal care and infant care. ◗ Specialised hospitals for women: More birthing centres are coming up in urban areas that specialise in child birth and neo-natal care. Lady Hospitals, Cloud Nine are some of the specialised chains that operate in India. Medical equipment companies could tie-up with such hospital chains and become an official partner in supplying MIC solutions. Being able to customise solutions as per the needs of such chains would strengthen this partnership. Also, this may lead to reduction in upfront marketing costs. ◗ Bundling: Competition in the MIC area, especially for baby-warmers and incubators has become intense with 50+ companies offering solutions, priced as less as $500. With an array of solutions for every MIC area and other hospital needs, leading medical device firms could

try offering MIC solutions by bundling them with other healthcare solutions as per the customers’ need. This differentiating factor can also fend off competition significantly. ◗ Multi-purpose products: Each MIC product addresses a specific area of infant care. For each area, such as warming therapy, jaundice management, ventilation and others, a specific product is in place. But, sizeable hospitals that are treading on the path of quality with minimal operational costs would be willing to adopt solutions that can address multiple infant care areas in one product. If the features such as warming therapy, jaundice management and ventilation can be combined, then the same product could be used for multiple purposes. ◗ Home care solutions: Wealthy parents may be willing to welcome their loved ones at home as early as possible. Infant care solutions, if designed considering the home environment, can be offered with multiple business models.

Innovations in infant care With more developing/emerging economies committing to increased healthcare expenditure, there needs to be enough focus on combating IMR and MMR. The fact that 70 per cent of these mortalities are preventable through low-cost, timely interventions, would urge most of the nations to welcome innovative solutions in MIC area. The public sector, along with private sector, (through public private partnerships) could herald new infant care through smart and cost effective innovations, thus ensuring win-win for all. References 1. Sample Registration System Office of Registrar General, India, 2011 2. DLHS 3 – District Level Household and Facility Survey, India 3. NFHS 3 – National Family Health Survey, India 4. Wall Street Journal 5. Stanford Business Magazine 6. CNN IBN Portal

STRATEGY INSIGHT

Advancing UHC in India: Learning from international experience DR NATA MENABDE WHO Representative to India

Dr Nata Menabde, WHO Representative to India enlightens on the measures that India can adopt to achieve Universal Health Coverage for its citizens and opines that much can be learnt from the efforts and experience of other nations in the same direction

he concept of Universal Health Coverage (UHC) is core to the health development and needs of the people, anywhere in the world. In the words of Dr Margaret Chan, DirectorGeneral of the World Health Organization (WHO), UHC is the “the single most powerful concept that public health has to offer.” Understandably, in last few years, UHC has caught the imagination of a number of national governments, political decision makers and people alike. It has received a further boost with experience emerging from a number of countries clearly indicating that UHC is possible even in low and middle income countries. Evidence suggests that the ‘returns on investment’ in health are greater than previously thought, accounting for as much as 24 per cent of growth in developing countries as a result of better health outcomes UHC entails that ‘all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.’ The major challenges in moving towards UHC are cited as poor political will, weak and poorly performing health system, limited evidence for decision making and low government spending on health, among others. There are global examples that low GDP can’t be a hurdle in adopting, implementing and progressing towards UHC. A number of countries, categorised as low and middle-income countries, in Asia and

Africa have successfully moved towards UHC. Experience from these countries re-affirms that political will is the first and foremost for moving towards UHC. The governments must have the political will to commit to UHC which needs to be translated into right instruments i.e. changes to a country’s policy and legal framework to facilitate the process and adoption of new laws and regulations to implement UHC reforms. UHC implementation in the countries has often been complemented by efforts such as developing mechanisms to generate additional revenue through taxing products such as tobacco and alcohol that are harmful to people’s health (sin taxes). Tackling corruption in the health system, innovating financing mechanisms and increasing efficiency in tax collection for raising revenue for UHC are other approaches successfully attempted by a number of countries. The policy decision for UHC needs to be informed by evidence. However, there is limited research capacity in a majority of developing countries. The need for setting up research wings, where evidence informs policy making, has been aired. Brazil, Mexico and Thailand have done so and it has worked. There is something to learn for UHC from India’s polio eradication programme. The programme was based on high political will and meticulous planning to the extent that every functionary knew what his/her role was. Micro-plans available at all levels and implementation of these plans was

well monitored. UHC in India could follow a similar approach. Experts believe that not enough time has been given for planning for UHC in India. What is needed at this moment is to step back, take stock of the situation, plan effectively, prepare a detailed implementation plan and develop a monitoring mechanism before embarking upon UHC. UHC efforts in low and mid-

There is a need to step back, take stock of the situation, prepare an implementation plan and develop a monitoring mechanism before embarking upon UHC dle-income countries, with large informal sectors and many outside the formal sector (where direct taxation is harder to implement), would require a number of reforms. This approach moves away from a principal focus on earmarked payroll taxes and a contributory basis for entitlement. Such are the lessons from recent innovations in Brazil’s expanded “right to

health,” Kyrgyzstan’s Mandatory Health Insurance Fund, Mexico’s ‘Seguro Popular’ and Thailand’s Universal Coverage scheme, among others. International experiences also show that reforms in large federal systems (for example, China and Mexico) must devote attention to the role of local governments, with the centre using inter-governmental incentives to stimulate attention to health at state/provincial levels. The core empirical lesson from Brazil, China, Mexico and Thailand is that reforms to make progress towards UHC can and indeed must, given the expectations of the population, be implemented at a faster pace than in Europe in the last century. The main lesson is that the same degree of thought and effort that goes into developing policies should also go into developing an implementation strategy, distinguishing between the long steady necessary processes and the importance of seizing political windows of opportunity when they arise. While global evidence is useful, any effective strategy needs to be ‘home-grown’. There is clearly no ready-made solution or approach to be ‘copied’ or ‘imported’ from other countries; each one needs to arrive at its own solutions. As India moves towards implementation of UHC, two points are worth keeping in mind. First, no country (with the possible exception of China) has ever taken on such a complex endeavour at such massive scale. The 12th Five Year Plan rightly recognises that the pursuit of UHC will last for at least

two to three plan periods i.e. 10–15 years. This would require strategies to go beyond the script of one single plan period. Therefore, attention needs to be paid by policy makers to identify priority issues, key implementation challenges and main barriers, as also customising solutions across health system functions. Second, implementation needs to be accompanied by analysis, so that the solutions are found through policy analysis and research embedded into implementation. This calls for strengthening ‘evidence-to-policy’ links. State-level experiences and good practices need to be documented and shared widely. In parallel, India needs to carefully design the institutional/organisational arrangements for implementation. The tools, management of partnerships, access to up-to-date health analyses for informed decision making, etc. need to be crafted. However, one caution for policy makers in this process is to temper ambition with realism in terms of what could be implemented and then move forward. To conclude, political will, rather than national wealth, is the critical pre-requisite for moving towards UHC. Experience has shown that UHC is needed and is feasible. Necessary knowledge and skills exist to implement it in the country. Policy makers need to design a detailed plan supported by an implementation strategy and appropriate legislative steps. Countries have shown that a strong political will is the first and the most important step to achieve UHC.

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STRATEGY IN FOCUS

KMES: Acollaborative success KMES, an EMS system operating in Kolkata, by example teaches how to utilise the existing resources optimally through effective collaborations for public welfare, finds Lakshmipriya Nair

olkata Medical Emergency System (KMES) was born out of a very real and urgent need for an efficient emergency medicine system in the country. The founders of this venture, Dr Rajib Sengupta, his wife Rita Bhattacharjee, and friend, Dr Tanmay Mahapatra, realised that the ‘Ambulance-only model’ was woefully inadequate when it came to providing sustainable and effective emergency services to a diverse country like India.

Raison d’être The founders felt that an ideal medical emergency system should comprise three essential stages: ◗ Sense - locate the nearest facilities ◗ Reach - get to the facility under proper-care ◗ Care - handled by the respective facilities upon arrival They found that while the ‘care’ part was being handled effectively by the hospitals, ‘sense’ and ‘reach’, two important aspects were severely lagging, and thus sought to bridge this gap. They chose Kolkata to begin their venture as they felt that as a very congested metropolis in India, its emergency medical system was deplorable. The aim was to optimally utilise the golden hour of emergency, stabilise the patient at point of contact and transport him/her to the nearest facility as soon as possible under proper care. So, while other emergency service providers have launched different types of services (such as ambulance services, neighbourhood critical care units), KMES founders chose to integrate the existing services for better utilisation

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and enhancement/strengthening of the services, as required with the proper tool-set such as product, people or processes – for e.g. providing paramedic training, GPS enabling etc. The two key concepts on which KMES was founded by the social entrepreneurs were: ◗ Enhance and strengthen the existing service instead of introducing a new emergency service ◗ Empower citizens for crowdsourced quick, response

Modus operandi L-R: KMES Founders, Dr Tanmay Mahapatra, Rita Bhattacharjee & Dr Rajib Sengupta at KMES call centre

The project has created a centralised, real-time, integrated

‘We expect KMES to be an end-to-end solution like a 911/112-type emergency system’ Dr Rajib Sengupta, Co-Founder, KMES shares details and insights about their projects and its impact, with Lakshmipriya Nair Tell us about the dynamics of the model on which KMES operates? The primary cost of KMES was developing the platform, this was done with the grant money from Rockefeller Foundation. For operations, KMES is sustained by itself, as it is not about any new services but enhancement of the existing emergency services. The other operational costs are the emergency inquiry centre that will be manned 24X7 and occasional system updates. We are taking the following three routes to tackle these costs: ◗ Enabling interactive voice response (IVR) and SMS, thus eliminating/minimising the need of human resources for responding to a phone call ◗ Working with the government to see if they can adopt the emergency centre within their existing emergency response

centre ◗ We will provide consultancy for implementing the system in any city of India and in any other developing countries. We have heard that such a central system does not exist even in few of the developed countries. We will be able to provide consultancy to implement such a software platform in all the cities that are interested in putting such a system in place. We will not only bring software expertise, but will also provide the best practices of implementing such a centralised, real-time medical emergency system in a metropolis like Kolkata ◗ We also have plans for few other related healthcare projects which will help to sustain KMES easily What are the challenges that you came across while setting up KMES and

during operations? At the very onset of the project, we identified the following complexities in implementing a medical emergency system in Kolkata, where emergency care is provided by multitude of service providers with varying capabilities: ◗ Each hospital has different workflow and it is very difficult to standardise bed management ◗ The service providers are very heterogeneous when it comes to data and information management ◗ All hospital information management systems are proprietary, closed and isolated. Several of them do not have any internal IT staff to integrate the internal systems ◗ Though several standards exist for interoperability of clinical data (HL7, CCR etc), none exist for medical emergency

STRATEGY and mobile phone enabled medical emergency system in Kolkata. Designed to manage availability of the existing emergency healthcare facilities and products, the venture connects the medical emergency supply-chain to help people of Kolkata with information needed to make crucial, lifesaving decisions. People availing this service can easily get vital information on urgent care, the availability of critical care unit (CCU) beds and blood products. The whole enterprise works in collaboration with Kolkata’s primary hospitals and blood banks. KMES gathers and broadcasts data in realtime to the general public, healthcare providers, and emergency responders through multiple channels; provides technology infrastructure, supply chain management support, and engages the citizen in a bid to operate a highly functional system for medical emergency care. KMES data enables citizens to act fast with purpose during a medical emergency. Citizens, regardless of their socio-eco-

services ◗ No hospitals want to share their patient data due to privacy and financial reasons ◗ Several of them did not want any automated interface between their internal system and KMES due to fear of theft of patient list ◗ And finally, several of the hospitals manage the beds using paper tickets (known as bed-tickets) and do not have any electronic system in place How did you tackle these issues? We tackled these issues by following few pragmatic approaches such as: ◗ Multiple options to integrate, instead of dictating a specific standard to everyone. KMES provides customisable solutions for each hospital/blood bank to integrate its own data source ◗ If permitted, real time integration with internal electronic systems ◗ Easy, one-click update for hospitals that do not have any electronic bed management system or not willing to opt for automated integration. ◗ Minimalistic intrusion into the existing internal system. ◗ The KMES platform only captures supply chain information (CCU, BSU) without any patient record. ◗ Efficient and optimum implementation framework using Opensource technolo-

nomic status, can access data through multiple channels (Phone, Internet, SMS etc) to help a family member or a fellow citizen during a medical emergency. Along with the general public, doctors, caregivers, smaller hospitals, nursing homes, ambulance services, police, fire-fighters also gain easy access to real-time blood and bed information resulting in lifesaving interventions.

Sui generis The vision behind the formation of KMES was to establish a system which would be similar to North America’s 911 or UK’s 112 systems. Yet the similarity ends pretty much at the concept level. Realising that the socio-economic situation in India is very different from the US and UK, the implementation model of KMES is radically different from the 911 system. While in the US (and the UK) emergency healthcare is standardised and government financed, in India emergency healthcare is varied and disorganised. So, the founders faced the challenge of creating an

gency response centre to efficiently coordinate and dispatch the nearest networked ambulance and paramedic wherever there is an emergency. People who need help may also be able to get in touch through a mobile phone or a wearable device designed to send an alert to the medical emergency centre.

Kudos galore

Patient receiving onsite care

effective EMS system where the quality and responsiveness varies considerably in areas within the same city. So, as is the case often, they hit upon a solution which was brilliant in its simplicity. Their formula was very simple – ‘Instead of competition let’s collaborate.’ And not only collaborate among institutions but bring general public in the mix, recognising the fact that in a megametropolis like Kolkata, government or private, no one can do this alone. Neither is it financially feasible or sustainable. The whole system is based on the premise that when proper toolsets (such as information)

gies so that the wheel is not recreated. Importance is given to implementation rather than on technology. What are your future plans and expansions? We would like to extend KMES to other parts of West Bengal where the healthcare provider is government hospitals. As such it is very important that the West Bengal public health system integrates with KMES. In fact, we consider this to be in the current scope of the project and we would like to collaborate with government hospitals, starting with tertiary hospitals, as soon as possible. To make it fully useful and effective for the people of Kolkata, the second phase of KMES will be the ‘reach’ phase by integrating, strengthening and improving the current existing infrastructure. Also, the byproducts of the KMES project will be: the Free and OpenSource Software (FOSS) platform, and the best practices for implementing an emergency medical system in densely populated urban areas. The software platform will be published under OpenSource licensing, and any organisation will be able to use the software free of charge and change it as they see fit. With minimal changes it is likely that the system can be implemented

are provided to the general public they can do wonders. Envisioned as an end-toend centralised medical system, the founders of KMES, in the next phase called ArogyaCare, intend to combine, improve, fortify and manage the existing ambulance services in Kolkata. The idea is to equip the ambulances with GPS tracking software which would assist in capturing real-time location and availability information. They also aim to create a pool of paramedics and train them for recruitment by ambulances, hospitals, police and fire alongwith setting up a high-tech, multi-lingual emer-

in other cities in India as well as across South-East Asia, Africa, and Latin America. KMES can help other civic bodies and governments to implement this system in their respective cities based on the best practices learned during the pilot implementation. We are already in discussions with an NGO in Cairo, Egypt. Where do you envisage KMES in the next five years? In the next five years, we expect KMES to be an end-to-end solution like a 911/112-type emergency system. We also expect KMES to take the concept of community help to create a crowd sourced activism/response. We hope that our project will bring the following significant changes in this unequal system: ◗ With a centralised system where all hospital data is exposed to the general public without any restriction, the perception of divided healthcare system will change ◗ Every citizen with this information will feel empowered to help a fellow citizen, whatever their respective social status ◗ Every citizen will feel comfortable going to a hospital based on proximity and availability, the most important criteria during a medical emergency.

Many have recognised the potential of KMES and have lauded the project even before it began operations. It was one of the eight winners of the 2012 Innovation Challenge organised by the Rockefeller Foundation. The project also received a $100,000 grant from the Foundation to set up the project and the Free and OpenSource Software (FOSS) platform used for operations by KMES. The project has also won the 2nd prize for healthcare innovation in the Emergency Service Award programme conducted by AIIMS, New Delhi. The jury found the KMES model very innovative, yet practical and feasible, a concept which can be replicated across cities with varied emergency service providers with varying capability. Recently, ArogyaCare, second phase of the KMES project, has been selected by Grand Challenges Canada (GCC) as one of the 65 Innovative Projects of ‘Stars in Global Health.’ Grand Challenges Canada is funded by the Government of Canada and is dedicated to supporting “Bold Ideas with Big Impact in Global Health.”

Exemplar endeavour The project’s success lies in a workable and sustainable, strategy and that is replicable in other over-populated areas of India as well. Thus, the KMES project possibly could pave the way in reforming the dismal EMS scenario in India. It can also be implemented in other emerging countries of South-East Asia, Africa, and Latin America as they face issues similar to that in our country - densely populated urban areas with disorganised and fragmented EMS services. lakshmipriya.nair@expressindia.com

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RADIOLOGY INSIGHT

Ready for future, right for present

AMIT SINGH General Manager - Computed Radiography Solutions, Carestream Health India

Amit Singh, General Manager - Computed Radiography Solutions, Carestream Health India speaks on the advancements in radiology and advises that the smartest strategy is to invest in technology that would serve both today and tomorrow

dvances in radiology technology are happening at an extraordinary and ever accelerating pace. This, in turn has empowered radiology departments and their standard of care and efficiency is increasing continuously. However at the same time, this rapid evolution also has a serious implication - equipment are getting outdated well before they reach the end of their useful life. To remain ahead of the competition and maintain their edge, facilities are caught in a situation where they need to replace technologically obsolete equipment on an all-toofrequent basis. This cannot be done without incurring huge costs, which no department in this age of tightening budgets can afford. In light of this serious challenge, the question that arises is ‘How can you run a facility with the best and latest technology and without a financial breakdown?’ The answer is you need to opt for future proof technology – a specifically designed, scalable technology that grows along with your needs. Such a solution can minimise your worries about technology obsolescence, as well as result in extending the life of your existing equipment apart from helping to leverage your current investments continuously. A technology serving all these purposes is 'Right for Today, Ready for Tomorrow'.

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Road ahead

You need to opt for future proof technology – a specifically designed, scalable technology that grows along with your needs. Such a solution can minimise your worries about technology obsolescence, as well as result in extending the life of your existing equipment apart from helping to leverage your current investments continuously. It would be 'Right for Today, Ready for Tomorrow'

As radiology departments and imaging facilities explore their future course, the formidable challenge of continuously tapping into advanced technology while maintaining costs will continue to bother us. The smartest strategy to succeed in such a scenario would be to invest in imaging solutions that can adapt to your needs as you progress along the imaging continuum. What is right for today has to ready for tomorrow as well.

RADIOLOGY I N T E R V I E W

‘A lot of good radiological research comes out of India’ Recently, world renowned radiologist Prof Hans Ringertz was in India to conduct Specialized Training in Advances in Radiology (STAR), an internationally coveted education programme by Siemens Healthcare along with Bayer Zydus Pharma. M Neelam Kachhap interacted with him to know more about his work and views on radiology How has the role of radiologists changed? The role of a radiologist has evolved from that of a 'photographer' to a centrally positioned medical professional without whom the modern healthcare system would collapse. What are common mistakes that lead radiologists to make incorrect diagnostic decisions? The most common radiological healthcare error is using imaging when it is not needed or when the treatment is independent of the radiological findings. The other common error is probably inexperience but 'satisfaction of search' is frequent which means that once something has been observed, a second more important finding is missed. Other mistakes are mistaking an abnormal structure for a normal, or right and left errors. How can these be avoided? With good training. The average number of all errors (important or not important) is said to be around four per cent. This can be reduced to about two per cent by double reading - that is two radiologists read the cases independently.

more and more pronounced. Having worked in the radiology sector for a long period, how do you perceive radiology talent from India? Indian radiologists are very well trained and many are working abroad. The continuing medical education system in radiology is well developed which keeps the radiologists up-to-date.

Indian radiologists are very well trained and many are working abroad Why are training programmes like STAR necessary? STAR is necessary for radiologists today because of the fast technical development in the field. All types of modalities are geting better and hence more and more medical problems can be approached. The subspecialisation are also getting

How would you rate the research in radiology coming out of India? A lot of good radiological research comes out of India. But a higher percentage published in the international journals rather than the local could probably be achieved. The size of the population makes it possible to study large numbers, even those suffering from rare diseases if co-operation between centres are set up. What is your advice for young radiologists in India? Get a good complete radiological training in an established department. Then sub-specialise in one anatomical area of radiology (chest, body, musculoskeletal etc.) and in one radiological modality (ultrasound, CT, MRI etc.).

HIGHLIGHTS

Carestream miniPACS software receives FDA 510(k) clearance FDA clearance is for new tablet viewer option can help enhance patient care CARESTREAM’S NEWEST version of Image Suite software has received FDA 510(k) clearance for a Tablet Viewer option that allows viewing of X-ray imaging studies on the iPad 2. This capability is now available in many countries around the world. Users of Carestream’s latest version of Image Suite software can add the Tablet Viewer Option, while users of previous generations of Image Suite software can upgrade to the newest software to gain access to the Tablet Viewer and other advanced features. Image Suite delivers a flexible image acquisition, processing and storage platform that supports Carestream’s wireless DRX-1 systems as well as CR imaging systems and an optional mini-PACS. Image Suite offers web-based patient scheduling, image review and reporting and flexible archiving solutions. These features are reportedly ideal for urgent care facilities, imaging centres and physicians’ offices. “With the Tablet Viewer, consultations can be more personal since patients

will be able to see evidence of their disease or condition on X-ray images as a physician is explaining diagnosis and treatment options,” said Heidi McIntosh, Carestream’s Global Marketing Manager for X-ray Solutions. Physicians can also view patient images from home or any remote location on their iPad 2 mobile devices by logging into their mini-PACS system. Image suite delivers advanced reading and reporting tools. Carestream’s optional mini-PACS delivers advanced reading and reporting tools and supports a wide variety of speciality measurement tools including LippmanCobb angle, goniometry and coxometry. The software also supports transfer of images to OrthoView software for preoperative orthopaedic planning and templating. Image suite systems provide DICOM storage for MR, CT and ultrasound exams and allows users to create, edit and view reports. Users can output imaging exams to CD/DVDs, DICOM printers and other PACS systems.

mneelam.kachhap@expressindia.com

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June 2014

IT@HEALTHCARE CASE STUDY

Promoting work life balance in office with ProHance A case study on how Acusis, a medical transcription/clinical documentation firm improved their transparency and productivity by adopting ProHance software ACUSIS, A leading company offering home-based medical transcription/clinical documentation was facing some challenges in having authentic and factual data with respect to their employees’ compliance with organisation norms related to ‘Logged Hours’ and ‘Productive Hours’. To tackle this challenge and obtain greater insight into the work time of their employees, Acusis deployed ProHance, a productivity enhancement software, for their employees spread across

geographical locations in India. This helped to provide complete workplace transparency with analytics to Team Managers as well as individual employees on their work styles.

Healthier work life balance Once ProHance was deployed, it was observed that a set of employees were regularly putting in extra work hours. Necessary steps were taken for these employees to bring about a healthier work life balance in their work style.

Improved compliance to organisational norms ProHance captures the logged hours of an employee based on the actual login and logout times on the system and automatically tracks how well employees utilise time in office with respect to their defined work profile. ProHance’s intuitive dashboards and reports provide insight into compliance by employees to office norms related to work time. ProHance provided the

Actual Productive Hours

ProHance Implementation Phase

15:07 Hours

13:15 Hours

ProHance Implementation Phase

ProHance Steady State Phase

9:05 Hours

8:08 Hours

ProHance Steady State 9:00 Hours Phase

ABOUT ACUSIS Acusis provides home-based medical transcription/clinical documentation in India. It serves some of the most reputed healthcare providers of US.Acusis handles and deliver their medical transcription/clinical documentation on time; maintainng high quality, technology, and confidentiality standards. It has operations in US, India, and Philippines.Acusis India headquarters is in Bangalore with additional offices in Mysore, Chennai and Coimbatore.

Results ◗ Healthier work life balance for employees ◗ Increase in compliance to logged hours ◗ Improvement in productive time

Expected Logged Hours

Actual Logged Hours

ProHance’s intuitive dashboards and reports provide insight into compliance by employees to office norms

necessary data to Acusis to bring about greater level of compliance to organisational norms and benefitted from employees spending more productive time in office as highlighted below:

9:00 Hours

Actual Logged Hours

Expected Productive Hours

Actual Productive Hours

8:40 Hours

8:00 Hours

6:50 Hours

9:05 Hours

8:00 Hours

8:19 Hours

IN A NUTSHELL Challenges ◗ Employees stretching their work hours resulting in work life imbalance ◗ Lack of insight into employee activities & their usage of work time ◗ Inconsistency in compliance by employees to expected logged hour

Solution

Benefits

ProHance - Aproductivity enhancement software was deployed for employees across their India offices to gain insight into employees’workstyle in office, improve compliance and promote work life balance

◗ Healthier work life balance for employees ◗ Increased clarity to employees on their productive time and hence better compliance ◗ Greater consistency by employees in complying with logged hours

WORK STYLE IMPROVEMENT 09.36

08.40

09.05 06.50

07.12 04.48 02.24 00.00 Logged Hours Pro Hance Implementation Phase Pro Hance Steady State Phase

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Productive Hours

08.19

IT@HEALTHCARE I N T E R V I E W

‘IT initiatives are slowly but steadily emerging as a key focus area for public healthcare’ Recently, Orange Business Services partnered with International SOS for the transformation and management of the latter's entire communications infrastructure including its emergency network. Yee May Leong, Senior VP – Asia Pacific, Orange Business Services shares more details about the deal, the growth potential for IT in healthcare, trends in healthcare IT and more, with Lakshmipriya Nair Tell us about the deal with International SOS? What would be the distinctiveness of the solution that Orange would provide? Orange Business Services is supporting International SOS, the world’s leading integrated medical, clinical, and security services organisation, in the transformation and management of its entire communications infrastructure. As part of the five-year contract, Orange will redesign, consolidate and manage International SOS’s various networks across 118 locations in 50 countries. In addition, Orange will provide a fully managed, integrated and optimised network solution that empowers International SOS with application prioritisation and enables visibility and control over its infrastructure. Consolidation of existing firewalls and security architecture will enable centralised governance and control. Orange will also develop a centralised call centre architecture for the 27 assistance centres and add business continuity enhancements by providing a managed IP telephony solution. The solution is distinct as it transforms International SOS’s existing architecture by making it centralised, visible

and highly optimised. A robust, secure and reliable infrastructure is the centrepiece for effectively reaching out to International SOS’s members/customers. By making the assistance centres and the support infrastructure highly secure, robust and efficient, they are better equipped to handle emergencies, support people in need and move swiftly in a difficult environment with the help of reliable and industry leading technology. A study by Frost & Sullivan claims that Healthcare IT market in India may touch $1,454 million by 2018. How poised is Orange Business Services to optimise the growth potential in this arena? We provide a wide range of e-health solutions including machine-to-machine (M2M), embedded devices, security, infrastructure and networking – to build a connected healthcare ecosystem. We have gained significant knowledge in e-health through Orange Labs, our research and development test-bed, and through our partner network. For the last 15 years, we have been equipping hospitals and clinics with software, communication and

infrastructure solutions. Today, we provide solutions that can help all players in the healthcare ecosystem work together, while focusing on the ways in which the latest technologies can make life easier for professionals and patients alike.

Increased expenditure by both government and private players, coupled with a need to provide access to a large and dispersed population is driving IT adoption

As a global player dealing in various markets around the world, how has Healthcare IT changed over the years? How receptive has India been visa-vis its global counterparts? The level of IT maturity in healthcare varies across markets, and there are different solutions being adopted to suit each market’s unique needs. As an example, in certain mature markets, healthcare providers are adopting innovative solutions to address issues of rapidly ageing population. Networking of homes and care centres, machine-to-machine (M2M) solutions for gathering patient data for monitoring and research, wearable tech devices that can transmit a patient’s real-time health statistics to their physician for remote monitoring etc. are some solutions being adopted. The vast amount of data collected can also be used for Big Data analytics to assess patient heath, identify patterns and for advancement of medical research.

On the other hand, in markets like India, IT initiatives are slowly but steadily emerging as a key focus area for public healthcare. Emergency response management delivered through contact centre solutions is one of the ways in which we are supporting the public healthcare sector in India. Orange has worked in more than 11 states for emergency response and management solutions. We have successfully implemented India’s first Emergency Response Centre integrated with the local authorities like police, fire, medical providers and other departments, capable of providing emergency services as quickly as possible. We have also partnered with the Royal Government of Bhutan to deliver real time healthcare services to the people of Bhutan. We set up a Health Help Centre (HHC) that addresses health line call centre needs and emergency management with an anytimeanywhere approach. The new communication infrastructure provides the citizens of Bhutan access to a variety of healthcare services including a health advice solution, emergency response and emergency management through a health helpline

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IT@HEALTHCARE call centre. What are the focus areas for healthcare IT players in India? Which segments have the maximum potential? With the rise of Indian middle class and access to better healthcare services, especially in the urban regions, Indian healthcare market is poised to grow rapidly. The use of information technology (IT) is playing a very important role in enhancing the healthcare delivery mechanisms. Continued investments in research, manufacturing and delivery of quality IT solutions for healthcare shows the commitment of IT players in this growing market. There is a need for IT automation for supply chain management, healthcare governance and providing access for public healthcare in many markets across Asia Pacific. Technologies such as

There is a need for IT automation for supply chain management, healthcare governance and providing access for public healthcare in many markets across Asia Pacific video conferencing, remote monitoring, contact centre services (Dial 108 projects) will help in bridging the gap between governance and public distribution of healthcare services even in remote locations. On the other hand, virtualisation, cloud, DR will enable care givers and hospitals to focus on the real task at hand and stop worrying about IT.

solutions to organisations worldwide. Asia-Pacific is a very important market for us as the adoption of IT healthcare in countries like India is fast transforming the healthcare services and facilities in these countries. While we have been working with several providers, we cannot share details at this stage. What are the reigning trends in this industry? How beneficial are they in streamlining and improving healthcare delivery? The healthcare industry is undergoing a transformation. It is gaining strength due

Are there any more deals in the pipeline for Orange Business Services? If yes, elaborate. Orange provides healthcare technology

to hospital modernisation, home healthcare, patient care innovation, medical tourism, rising government investments and the benefits of the public-private partnership model. Some of the key trends in this industry are: ◗ ICT is enabling healthcare providers to streamline their offerings through the adoption of IT solutions for effective management of resources, improvement of time-lines for patient care delivery, conditioned health monitoring of patients and access to healthcare in remote locations ◗ Big Data Analytics and

Cloud are being used for effective catalogue and management of patient records and research ◗ Cloud computing offers a huge opportunity for IT deployment in hospitals across India. Hospitals can leverage their IT assets across key functions through cloud computing. Cloud allows healthcare providers to do more with less investment and increase operational agility. ◗ Telemedicine, the use of IT for delivering health services and information over distances, has a substantial scope for growth in India. The use of telemedicine can aid in dealing with the shortage of healthcare staff and also improve the penetration of healthcare infrastructure and resources in the underserved rural areas. lakshmipriya.nair@expressindia.com

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A MARKETING INITIATIVE

WEST INDIA UPDATE

AN EXPRESS HEALTHCARE UPDATE OF THE RECENT HAPPENINGS IN THE HEALTHCARE SECTOR OF WEST INDIA

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June 2014

WEST INDIA UPDATE I N T E R V I E W

‘Improvement in healthcare delivery through insurance is the need of the day’ Bomi Bhote, CEO, Ruby Hall Clinic, talks about his plans for the boutique hospital at Wanowrie, new hospitals by the Group coming up at Hinjewadi and Amanora Park, opportunities in the Western region and more, in an interaction with Express Healthcare How has the year 2014 shaped up for Ruby Hall clinic? Our focus in 2014 has been mainly on ramping up operations of our new boutique hospital located at Wanowarie and catering to foreign patients for the same. What have been the most notable initiatives taken this year? Considering the response that we have been getting from foreign patients coming for treatment to India we thought it proper that we should reach out to our patients and have tied up with two hospitals one in Muscat and one in Nairobi to function on management basis, wherein our doctors and nurses would be deputed on

assignment basis. As it is, we are aware that most of our nurses leave and go abroad for greener pastures and hence we thought it would be better if they could be sent on assignment from our side to foreign countries. What are the projects and initiatives underway or planned for this region? Our hospital at Hinjewadi is under construction and would be the only hospital in that IT belt. Plans are underway to start a new hospital at Amanora Park which would be a dedicated state-of-the-art cancer hospital. Both these hospitals would be quite different from a general hospital as the hospital at Hinjewadi would

cater to the needs of IT professionals and hence the hospital has been designed with more emphasis on typical problems which IT professionals face, sitting on the computer for long hours. The cancer hospital at Amanora would have a dedicated out-patient centre which would have all types of linear accelerators including tomotherapy and cyber knife. Thus the patient would have multiple choices for the line of treatment.

Plans are underway for a new cancer hospital at Amanora Park

Any expansion plans in the offing? If yes, what kind of investment are you looking at? The new hospital at Hinjewadi, with an investment of Rs 80 crores, is scheduled to start operations in 2015 and

2016 would see the commencement of operations at the new hospital at Amanora Park. What are the areas that need more focus to improve healthcare delivery in the Western region? What is Ruby Hall doing to fill the gaps? Improvement in health care delivery through insurance is the need of the day and finally the solution to providing health care down to the last person would only be achieved through a comprehensive insurance model. What are the opportunities and challenges that are peculiar to the Western region of the country? The Western region has been far more progressive, with a number of hospitals having high end technology though the main challenge of shortage of doctors and nurses is a deterrent to growth. Three recommendations that would help to take healthcare in the Western region to the next level ◗ Penetration of insurance down to the last person. ◗ IT in health care ◗ Fixed price packages and star rating of hospitals. Charging based on rating of hospital. lakshmipriya.nair@expressindia.com

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WEST INDIA UPDATE

StossWelle Healthcare brings ‘Extracorporeal ShockWave Therapy’to India The new technology uses shockwaves to treat painful conditions SOUND WAVES travels at a very high speed. But when another object travels at a speed higher than sound it generates ‘shockwaves’ at the time when the sound barrier is broken. If this phenomenon of breaking the sound barrier is initiated within a controlled environment, the shockwaves can be focused and used for various medical benefits. This is the basis of StossWelle’s healing. The technology, though, is not as simple. Physicists and doctors world over have dedicated their careers to evolve this technology that is now patented. It has proven its invaluable healing properties across many countries across Europe and is now finding its position in other parts of the world. Extracorporeal Shock Wave Therapy (ESWT), as it is widely known, is a new technology that uses shockwaves created by high energy pulses to treat painful conditions. Shockwaves are created by very short duration, high energy pulses that travel at a

speed faster than that of sound. ‘Extracorporeal’ means outside the body. The energy pulse literally breaks the sound barrier, generating the shockwave. The shockwaves are then delivered by a specialised machine under the supervision of a medical expert. The machine generates, controls and focuses the shockwaves with great precision. The shockwaves can be manoeuvred to pass through the uninjured portions of the body and deliver the energy to a focal point at the affected area. They break down pathological deposits, stimulate cells responsible for healing of bone and connective tissue, reduce pain and generate an overall wellness. This entire process is carried out using a strobe that is placed on the body above to the area to be treated. Thus, there is no invasion of body tissue, no anaesthesia, cuts, or insertions. StossWelle is bringing this technology to India for the first time. The technique has been tried and tested abroad for over a decade and is found to

The technology has been widely used and accepted in most of the European countries. There have been no reports of any side effects

an OPD. Life becomes synonymous with a feeling of well being. At Stosswelle’s state-ofthe-art clinic, the patients will be in the hands of some of the best medical practitioners in the country.

Pain free and without anaesthesia

Advantages

No known side-effects and easily repeatable

Due to the inherent nature of this technology, there are inevitable advantages that can prove far more valuable than what it may seem.

Non-surgical The treatment requires only a probe to be kept in contact with the part of the body that is to be treated. It is completely non-surgical/noninvasive.

The treatment does not require any anaesthesia as it is pain free. The only sensation one may feel and even enjoy is tingling or ticking against their skin.

The technology has been widely used and accepted in most of the European countries. There have been no reports of any side effects. The procedure is risk-free and safe. The treatment is given over a series of sessions. One can avail of the treatment whenever the health requires it, even after a gap of some time.

Out-patient therapy No hospitalisation have virtually no side effects. It even works on chronic cases, where traditional therapies have limited healing power. StossWelle Healthcare envisions a healthier life for the people of India. Now one can get treated for major illnesses just as if they were walking into

Apart from the pain and expense, any conventional surgery would normally require intensive post operative care. Whether one is hospitalised or treated at home, there is a danger of infection, complications, bleeding, rejection and trauma. None of that happens at StossWelle.

Stosswelle’s trained team of experts includes specialists in cardiac care, orthopaedics, urology and other fields of medicine. Their priority is to give the best possible medical care and personal attention to each individual. In special cases, they can even provide this treatment in the comforts of a patients’ home.

International SOS enters into partnership with Amas in India The companies are aligning their service portfolios, especially in the oil and gas sector INTERNATIONAL SOS has got into a strategic partnership with AMAS Medical Services in India. It has invested in a minority stake in the AMAS business, which is based in Mumbai. By joining forces, the companies aim to align their service portfolios to the benefit of their Indian and global members with Indian operations. Specifically, the synergies

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June 2014

exist in the oil and gas sector, as well as the aviation industry via International SOS’ subsidiary MedAire. Whilst the companies will continue to be operated independently, they will be combining their service offering in this market to provide clients with a broader choice of services. Dr Anil Mehra, CEO and MD of AMAS will also become Chairman of the

International SOS India Medical Advisory Board, and a member of the International Medical Advisory Board, which comprises prominent medical members from International SOS on a regional and worldwide basis. Dr Mehra said, “We are excited to be formally partnering with International SOS. With the partnership we

are coordinating our service offering, specifically in the oil and gas sector, as well as the aviation industry. Together, we very much look forward to expanding our high level medical services throughout the region to help our clients.” Nicolas Bertsche, General Manager India at International SOS added, “With this partnership we are able to combine our expert-

ise. Dr Anil Mehra and his team bring outstanding local insights and relationships complementing International SOS’ global footprint and strong proprietary capabilities. By partnering, we are committing our combined strengths to India and its growing and buoyant client needs.” EH News Bureau

WEST INDIA UPDATE HIGHLIGHTS

Wockhardt Group launches Wockhardt Heart Hospital in Nagpur It is equipped with comprehensive facilities for cardiac-related problems WOCKHARDT HOSPITAL recently launched Wockhardt Heart Hospital in Nagpur. The hospital has well equipped with state-of-the-art technology and will have full-time cardiologists and cardio surgeons to drive the cardiac services. The ICU is managed and monitored round-theclock by the cardiologists to ensure timely care during cardiac emergencies. The team will be ably supported by skilled and qualified nurses and care takers, informs the hospital. Speaking about the launch, Zahabiya Khorakiwala, MD, Wockhardt Hospitals said, “We have ensured getting the maximum facilities available for heart treatment under one roof. Considering that cardiac cases are on the rise in today’s population, it is our privilege to be able to help the people of Nagpur with a specialised hospital.” The Guest of Honour, Dr Mathew Samuel K said, “Wockhardt as an entity is always engaged in patient care

Cath Lab launch by Dr Mathew Samuel K, Zahabiya Khorakiwala, Managing Director, Wockhardt Hospitals and Shyam Wardhane, Muncipal commissioner, Nagpur

by providing quality services. By launching Wockhardt Heart Hospital, Nagpur, the group is taking efforts to provide the people of Nagpur and neighbouring cities with high quality service.”

Sunil Sahasrabuddhe, Center Head, Wockhardt Heart Hospital said, “With this launch, we take immense pride in being able to take patient care to a new level; the facility will be equipped by

dedicated specialists and advanced new-age cath lab services. The structure of this hospital is designed in such a way that it meets all the requirements of the patient.” EH News Bureau

ABMH Laboratory receives CAP accreditation Aditya Birla Hospital laboratory is one of more than 7,000 CAPaccredited facilities worldwide THE ACCREDITATION Committee of the College of America Pathologists (CAP) has awarded accreditation to Aditya Birla Memorial Hospital, Laboratory, Pune, Maharashtra, based on the results of a recent on-site inspection as part of the CAP’s Accreditation

Accreditation was given based on the results of an onsite inspection

Programs. The facility’s director, Rekha R Khedekar was advised of this national recognition and congratulated for the excellence of the services being provided. Aditya Birla Hospital laboratory is one of more than 7,000 CAP-accredited facili-

ties worldwide. The US federal government recognises the CAP Laboratory Accreditation Program, begun in the early 1960s, as being equal-to or more-stringent-than the government’s own inspection programme. EH News Bureau

CLINICARE (India) launches FRIO Insulin Wallet CLINICARE (INDIA), a Mumbai-based company has launched the FRIO Insulin Wallet in India. The wallet is meant for cooling insulin and is of great use for those who are on the move and have no access to refrigeration or during power outages while travelling. Unlike traditional insulin carrying cases, FRIO Insulin Wallet’s cooling properties are not derived from an ice-pack or anything that needs refrigeration. It is easily activated by water. The wallet is an environment-friendly green re-usable product. It can conveniently be carried around on oneself or in one’s hand baggage. FRIO Insulin Wallet was invented by a first-generation UK-based entrepreneur Garnet Wolsey over 15 years ago. The product was evaluated by the British Diabetic Association in 1999 and was awarded a Millennium product status by the then Prime Minister, Tony Blair. Over the years, the product has become popular across the world. FRIO Insulin Wallet is an evaporative cooling unit that has been designed to keep in use insulin and other temperature-sensitive medications cool, within safe temperature of 18-26°C for upto 45 hours, in a constant environmental temperature of upto 37.8°C. The wallet can be re-activated every other day for the life of in-use insulin i.e. 28 days. “The best part is that, even after years of using the FRIO Insulin Wallet, its effectiveness does not diminish, unless damaged.” FRIO Insulin wallet is available in all major metros in India. The product is also available for online procurement on domestic health portals. EH News Bureau

EXPRESS HEALTHCARE

June 2014

WEST INDIA UPDATE

Bringing the best of healthcare to the West West India has always found favour with healthcare players, be it primary healthcare centres, single- and multi-speciality hospitals or renowned hospital chains. Two healthcare majors, share their views with Express Healthcare on the opportunities that make the Western region attractive for setting up base and the challenges that need to be mitigated to keep the growth momentum going in the sector

‘Exorbitant real estate costs ‘Mumbai has is an entrybarrier for many been the ‘Kashi of Medicine’ investors in healthcare’

DR SUJIT CHATTERJEE Chief Executive Officer Dr LH Hiranandani Hospital

t is my opinion that the Western region of India in general, and Mumbai in particular, is the economic hub of the country. Also some of the best known names in the field of medicine are from this region. Moreover, the political climate is quite stable.

Government should support through lower taxation for hospitals

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June 2014

There is a long history of medical excellence in the Western region of India. Thus new modalities will be looked at eagerly. The doctors also have the skill sets to utilise the new equipment and so the word about the spreads to the rest of the country through conferences or meetings which helps to be the first mover in the field. In healthcare, one needs to keep ahead in the race with technology and newer modalities of diagnosis. This can get quite expensive and hence is a real challenge. Newer modalities of therapy need to be implemented and that may not always be possible. Maharashtra government should be alive to the fact that Mumbai has been the 'Kashi of Medicine'. To keep that status, there is a need for government support through lower taxation for the hospitals to help them generate funds needed to stay ahead in the race.

GAUTAM KHANNA Chief Executive Officer PD Hinduja Hospital & MRC

estern region’s healthcare industry has grown over several decades. Mumbai has many reputed providers and other cities like Pune, Ahmedabad also boasts of several major players. The factors attracting healthcare entrepreneurs to the Western region are as follows:

The economic condition of the Western states has improved significantly since independence and the industrial growth has been visible. It has indirectly fuelled the growth of the healthcare sector as well. This region has grown not only in selected metros but also in the tier II cities and non-metro cities. They have grown significantly, with huge number of population base and a bigger catchment area. Industries and sectors complimenting the growth of healthcare sector are prominently present in the Western region, an influential factor for healthcare entrepreneurs to set up base in this area. Medical, nursing and other training institutes from the

The good economic condition of the Western states has fuelled the growth of the healthcare sector as well

Western region are delivering a high number of trained professionals and healthcare resources which indirectly facilitate the growth of the healthcare sector. Good connectivity with international markets has also benefitted the Western region cities by making them international hubs. However, though there are benefits galore, there is a major challenge in the form of infrastructure development. In a city like Mumbai, exorbitant real estate costs is an entry barrier for many investors in healthcare. Recently introduced policy on restriction of hospital building heights has also been a hurdle for developing hospitals. The lack of infrastructure to support emergency medical services has remained one of the challenges and concerns. Finally, most of the reputed hospitals in Mumbai are run by trust organisations. Over last few years, these trust organisations have faced several regulatory issues which are a big concern to all.

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LIFE DR HARSH VARDHAN:

HELMING INDIA TO GOOD HEALTH The new health minister of India is known for his exemplary work in implementing the pulse polio programme

NT surgeon, Dr Harsh Vardhan is the new Health Minister of India. Fondly called 'Doctor Saab' in the Delhi circles, Dr Harsh Vardhan is known for his simplicity and transparency at the work. The veteran politician started his political journey in Delhi and rose in ranks to become the Delhi Party President. A post he held on to till he became the cabinet minister in the Narendra Modi government. He is inspired by the teaching of Swami Vivekananda and wants to make health and education a social movement and a national goal. He is quite techno-savvy and has not only a website of his own but is also active on social media sites. The country's new Health Minister started his tenure by wishing India good health. “My innings as Union Health Minister commences today. Need the good wishes and blessings of India. Wish you good health,” the minister tweeted on May 27, 2014. He is said to be remarkably accessible and has a hands-on

style of functioning. He held the portfolios of Education, Health and Law in the Delhi government between 1993 and 1998 and is known for initiating the pulse polio programme. He believes that a new and integrated holistic system of medicine is the need of the hour, which should incorporate the best of all systems including Ayurveda, Siddha, Yoga, Naturopathy, Homeopathy (AYUSH) and our other ancient systems. The second child of late Om Prakash Goel and Snehlata, Dr Harsh Vardhan was born in December 13, 1954. He has an older sister and younger brother. Young Harsh Vardhan did his schooling from different schools in the Chandni Chowk area and went to Kanpur to attend the GSVM Medical College, from where he obtained his MBBS and later MS with specialisation in ENT. He returned to Delhi and set up a private practice as an ENT surgeon. But his restless soul, which had manifested itself earlier and drawn him towards the RSS, persuaded him to take up projects for the betterment of the society. He joined the Indian Medical Association's Delhi Chapter and worked hard in East Delhi, which is his immediate neighbourhood, to build up a solidarity of medical practitioners. He held various posts in the Delhi Medical Association – from Secretary and President (East Delhi) to State Secretary and President, where he showed early signs of his leadership qualities.

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June 2014

LIFE He is widely recognised as the man who took the initiative to start the pulse polio programme in India. In 1993, as the Minister for Health and Law in the Government of Delhi, he launched pulse polio first in Delhi, which was then home to 10 per cent of polio cases in India. In 1994, on a single day (October 2, the birthday of Mahatma Gandhi), he organised the mass immunisation of 1.2 million children. Today, India is a 'Polio Free Country' certified by World Health Organisation (WHO) along with other countries in the South East Asia region. On January 13, 2014, India completed three full years without a single new case of polio being reported –the last of the cases having been reported on January 12, 2011 in Howrah district of West Bengal. He was also instrumental in bringing the first ever anti-tobacco legislation in India. In 1997, under his bold leadership, the Delhi Prohibition of Smoking and Non-Smokers Health Protection Act was passed. A major pioneering initiative of Dr Harsh Vardhan was implementing WHO's Essential Drug Programme, which revolutionised government's attitudes on public healthcare. Under the concept, maximum budgetary outlay was apportioned to those drugs which were most needed by the people. It was henceforth known as the 'Delhi Model' and taken up by several foreign countries and at least a dozen state governments in India. The Delhi Society for Promotion of Rational use of Drugs, which is a powerful movement now, was thus born and Dr Harsh Vardhan continues to be associated with its progress. His missionary zeal touched other areas of healthcare as well. Under him, Delhi's Maulana Azad Medical College got the country's first ever Department for Occupational and Environmental Health. He launched the Matri Suraksha Programme to ensure proper mother and childcare for Delhi's middle and lower income groups. The Cancer Control Programme, the Cataract Free Delhi Programme and the Shravan Shakti Abhiyan

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Dr Harsh Vardhan promotes the 'human face' of medicine and says that considerable effort is needed to inculcate these virtues among our budding physicians for the rehabilitation of the elderly and the hearing impaired, were begun under his leadership. His administration also launched the Healthy City Project, the Hepatitis B Immunisation Programme and a Delhi Research Centre for Modernised Promotion of Ayurveda. Two other significant pieces of legislation that bear his stamp are the Delhi Physiotherapy and Occupational Therapy Act as well as Delhi Artificial Insemination Act. He believes, “A major and the most important task in my

view remains that politicians, decision makers and those who rule have to appreciate the importance of health. They should become equal partners in health promotion movement and preventing illness. Secondly, the allocation for health should be augmented from present abysmal levels to more realistic levels. Let health be the concern of one and all.” Dr Harsh Vardhan promotes the 'human face' of medicine and says that considerable effort is needed to inculcate these virtues among

our budding physicians. He strongly feels that the biggest challenge is to change the mind-set of our healers so that the poor and needy do not feel unwanted. Dr Harsh Vardhan also believes that organisations and associations like Chambers of Commerce and Industry, Rotary and Lions International with branches all over, and numerous social and philanthropic organisations representing important groups of citizens may be roped in to build a strong movement of

'health for all'. They may be motivated to divert part of their energy and resources to take up health issues and become active partners in the endeavour of preventing illness and promotion of health. They may be urged to wholeheartedly support government initiatives on positive health, rehabilitation and care of the disabled. He says that a total attitudinal transformation of people in thought, action and belief based on our ancient culture is required to make health a meaningful and purposeful concept so that everyone visualises himself as a guardian and defender of environment and health. A number of prestigious social organisations have honoured Dr Harsh Vardhan with awards and recognitions. The WHO recognised his contribution to society and awarded him the Director-General's Commendation Medal at a prestigious function held in Rio de Janerio, Brazil, in May 1998. In 1994, he received the 'IMA President's Special Award of Appreciation' and was given the 'IMA Special Award to Eminent Medical Men for Distinguished Achievement of Highest Order' for two successive years – 1995 and 1996. On 'Doctor's Day', July 1, 2002, he was named 'Doctor of the Last Decade' (Swastha Ratna) by the New Delhi branch of the Indian Medical Association for being the "noblest medical campaigner of the last decade". Married to Nutan, a specialist in hospital administration who preferred to be a homemaker, Dr Harsh Vardhan has two sons – Dr Mayank Bharat, who has done his MBBS and MBA from Indian School of Business, Hyderabad. Younger son, Sachin who did his Accountancy and Finance graduation from Monash University in Australia is at present completing a course in Certified Public Accounting (CPA). His daughter, Inakshi, graduated with B.Com (Hons) from Delhi University and went on to take a MBA degree from Amity University. Dr Mayank and Inakshi work in the corporate sector. (compiled by Neelam Kachhap)

LIFE PEOPLE

Dr NK Pandey, CMD, AIMS receives Padma Shri award Recognition for his contribution to healthcare DR NK PANDEY, Chairman and MD of Asian Institute of Medical Sciences (AIMS) has been conferred the Padma Shri award by Pranab Mukherjee, President of India for his distinguished contribution in the field of healthcare. “I’m deeply humbled by the honour conferred on me by the

President of India, but I also recognise the responsibility of

living up to this honour by redoubling my efforts to further improve the healthcare sector in our country,” said Dr Pandey. An alumnus of Patna Medical College, Dr Pandey has contributed immensely to healthcare and medical education over the past five decades and is amongst the most renowned medical professionals of the country. He has a vast and varied experience servicing the healthcare sector and has held various prestigious positions during his tenure.

Lifetime Achievement Award for Dr Batra Recognition for his pioneering work in homeopathy DR MUKESH BATRA, Founder-Chairman of Dr Batra's Group, was honoured with the 'Lifetime Achievement Award' for his service in homeopathy by the World Medical Council (WMC), at an award function held in Dubai. Accepting the award, Dr Batra said, “I feel honoured

and humbled to receive world recognition for my efforts to promote homeopathy. The award accords due and deserving recognition to homeopathy – the world’s second-largest medical system, according to WHO. The core belief on which I have built my company is to provide health

and wellness to those in need, through cost-effective and safe homeopathy, along with the best of scientific and technological advance.” Beginning as a modest clinic in Mumbai in 1982, Dr Batra’s Positive Health Clinic is reportedly the world's largest homeopathic healthcare corporate with 143 clinics spread across 73 cities in India, Dubai and UK.

1st Vivian Fonseca Scholar award for Dr Vijay Viswanathan Recognition for the research and work done by him and his hospital in diabetology DIABETOLOGIST and Director of MV Hospital for Diabetes, Chennai was honoured by American Diabetes Association with the 1 st Vivian Fonseca Scholar award. The award has been given in recognition of the work done by him and the hospital in the field of diabetology and the research carried out by the institute, especially on 'Diabetology & TB Connection in India.' The Institute has also recently tied up with CBSE for a diabetic prevention programme for students. The Institute has developed a special treatment based on research findings for those diabetics who suffered from tuberculosis. The Institute has also developed a diabetic foot care. Prof M Viswanathan

Diabetes Research Centre, which is a WHO collaborating centre, is also recognised by the Department of Scientific and Industrial Research (Govt. of India) as a Scientific and Industrial Research Organization (SIRO) and has been actively involved in scientific and academic research activities to address the problem of diabetes and its associated complications. The MV Hospital for Diabetes and its research centre has been initiating several community-based educational and screening programmes to educate and identify people with high risk of diabetes.

PD Hinduja appoints Gautam Khanna as CEO He will be responsible for the overall growth of the healthcare vertical within the Hinduja Group PD HINDUJA Hospital & Medical Research Centre announced the appointment of Gautam Khanna, as its CEO. In addition to the role of CEO, Khanna will be responsible for the overall growth of the healthcare vertical within the Hinduja Group.

Speaking on the appointment Vinoo Hinduja, Executive Trustee, PD Hinduja Hospital & Medical Research Center said, “We believe Khanna with his extensive experience will achieve our dream of virtual healthcare by innovation and

creating synergies with international institutes of excellence. We look forward to Khanna partnering with our medical fraternity to lead our disease management programmes and to create more managed integrated care, which in turn ensures patient-centricity. Khanna will work closely with our knowledge partners to spearhead our three pillars of delivery, research and academics into the bigger vision of a “Nurturing Innova-

tion Park”- the dream project of SP Hinduja, Chairman of Hinduja Group. We at PD Hinduja Hospital welcome Gautam Khanna into our parivaar. Khanna joins PD Hinduja Hospital & Medical Research Center from 3M where his last held position was Executive Director – Healthcare Business for India and Sri Lanka. In the past he has been Chairman, FICCI MDF, Co-Chairman, AMCHAM Medical Equipment & Device

Committee & Chair, India Working Group, ADVAMED; US. “I am excited and honoured to join PD Hinduja Hospital to embark on the journey for further growth and innovation in healthcare and contribute to Hinduja vision of –‘Quality Healthcare for All’. This is a wonderful opportunity for me personally to contribute more meaningfully to the Indian healthcare scenario and help the Indian population,” said Khanna.

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Intrasense@ ASCO 2014 Intrasense is a leader in multimodal imaging software in oncology

INTRASENSE, A GLOBAL leader in multi-modal medical imaging software in oncology, participated in ASCO 2014 held in Chicago. ASCO provides the 25,000 oncology professionals attending the annual meeting with cutting-edge scientific presentations and comprehensive educational content. The congress, with its technical exhibition, is also a very special opportunity for oncologists, investigators, pharma companies and their suppliers to meet and exchange on bestin-class oncology-oriented solutions and products. Myrian, developed by Intrasense, is the ultimate solution for image-based diagnosis and follow-up in oncology. Myrian platform and its range of clinical modules including Myrian XL-Onco, Myrian XP-Liver, Myrian XPBreast, Myrian XP-Prostate,

Myrian, developed by Intrasense, is the ultimate solution for image-based diagnosis and follow-up in oncology

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Myrian XP-Colon, Myrian XPLungNodule and Myrian XTBrain - allow CROs and hospitals to improve their oncology work-flow for clinical research and patient care and to improve quality of care. Moreover, the solution allows them to benefit from multiparametric and multimodal imaging, qualitative and quantitative information and biomarkers, to standardise imaging assessments for clinical trials through structured reading, to facilitate tumour boards and to enhance reporting and communication.

About Intrasense Created in 2004 with an innovative technology of tissues detection in CT scan, Intrasense designs, develops and markets Myrian, a unique, vendor-neutral software suite for the visualisation and advanced processing of multimodal medical images such as MRI, CT scans, PET, X-rays, and more. Developed with leading academic and scientific partners, Myrian combines and uses all of the various medical images to extract information vital to the patient's care, to evaluate treatment efficiency and to assess drug candidates in oncology and other pathologies. With more than 700 client sites around the world, Myrian has been certified as a ‘medical device’ in over 40 countries including the US (FDA), Europe (CE) and Asia. Intrasense SA is listed on the Alternext (FR0011179886 - ALINS). The company employs 70 people, including 25 dedicated in R&D. Labelled ‘innovative company by Oseo, Intrasense has invested more than € 9 million in R&D since its creation. For more about Intrasense, please visit www.intrasense.net

OR light on wheels Polaris 100 and Polaris 200 now mobile and height adjustable WITH THE Polaris 100 and Polaris 200 Mobile, OR teams have for the first time mobile, OR lights which can be adjusted in height depending on the situation in the OR and the size of the surgeon. The mobile Polaris 100 and Polaris 200 lights can be used in addition to ceiling-mounted OR lights when the surgeon needs an additional light source for more complicated surgeries. In the case of several adjacent treatment areas, for example in emergency rooms, the physician can move the Polaris 100 or Polaris 200 between the treatment areas and use it on site as a single light for minor surgeries.

Easy to transport In its transport position, the light has a height of approximately 6 feet (1.85 m) so that

clinical staff can easily push it through standard doors. In its operating position, the physician has a working height of up to 6 ft 7 in. (2.17 m) under the light body at the operation site or in the treatment room. The mobile Polaris 200 has an illumination intensity of 160,000 lux. The built-in battery allows for mainsindependent operation for at least three hours with full light intensity. A visual and acoustic warning informs the OR team

when the battery charge falls below 25 per cent. Dräger Medical GmbH is the manufacturer of the Polaris 100 and Polaris 200.

Contact Corporate Communications Melanie Kamann Tel +49 451 882-3998 melanie.kamann@draeger.com Drägerwerk AG & Co. KGaA Moislinger Allee 53-55 23558 Lübeck, Germany www.draeger.com

TRADE & TRENDS

Redefining medical tourism Abhik Moitra, Nandita Gupta, and Ratul Moitra talk about HBG Medical Assistance and how it can contribute to India's healthcare industry “ WE HATE to call it Medical Tourism,” is the answer you get, when you ask Abhik Moitra, Director and CoFounder of HBG Medical Assistance company, of his thoughts on international patients travelling to India. Tourism to us is a word of luxury. The person who is travelling from African countries, CIS Countries or from the Middle East is a case of serious nature. The patients can barely avoid going to the hospital when they land in India, leave apart any indulgence. At best it can be called Medical Travel. But beyond the medical care, these travellers need language experts, cost advocacy, escorting, accommodation, logistics etc. Broadly, they need ‘assistance’ and that is why we call our business, a business of medical assistance. HBG Medical Assistance or ‘High Beam Global,’ as it is popularly known, is one of the most organised players in the market. The reach of their service covers Kenya, Nigeria, Ghana, Ethiopia, Tanzania, Uganda, Uzbekistan, Armenia, Iraq, Oman and Yemen. The portfolio covers referrals, institutional, Internet, travel companies and government sector. “Our aim is to win customers through service excellence. That is why we have possibly the largest patient servicing team in India. Each patient who is using our service is assigned a case manager who is responsible for even smallest of the needs of that patient. It is like having a personal protocol manager,” says Nandita Gupta, Fellow Director and Co Founder. The service orientation is paying off. Today HBG has possibly the largest list of insurance customers amongst industry players. Some of the

Abhik Moitra, Director& Co-Founder

Nandita Gupta Fellow Director & Co Founder

Ratul Moitra COO, In-charge of HR, Compliance and Business Intelligence

HBG Medical Assistance’s reach covers Kenya, Nigeria, Ghana, Ethiopia, Tanzania, Uganda, Uzbekistan, Armenia, Iraq, Oman and Yemen. Their portfolio covers referrals, institutional, Internet, travel companies and government sector. Today, HBG has possibly the largest list of insurance customers amongst industry players key accounts that they manage have been there since the day they started about four years back. They have been growing together. So, what has been their key strength? “Our team,” answers Ratul Moitra, Chief Operating Officer and incharge of HR, Compliance and Business Intelligence. Today, HBG has not only gained a leadership position in the industry, it has given this industry many trained personnel. In a scenario where professionals with domain knowledge are scarce, this is another contribution HBG has been making to the industry. Thanks to their robust training and knowledge sharing culture.

So what next? The answer is almost unanimous. We have just started. There are many sectors to be explored, many more geographies to be covered and more destinations to make a presence in. The industry is supposed to become $40 billion in size in next two to three years. We wish to become the largest contributor to this number. We wish to contribute in Indian healthcare in whatever way we can and we wish India to be proud of us. Nandita says, “Our immediate goal is to expand beyond the current geographies we are catering. Any new market takes nine to 12 months to give results. Thus we need to start now to expect later. We are

eyeing the western markets. If they can contribute to Turkey and Thailand, they can definitely contribute to India. Also, with the Government proposing Visa On Arrival for 80 countries soon, our horizon has increased too. We wish to use this opportunity to the best.” Ratul adds, “We have plans of getting into training and use e-commerce platform to expand our business. Outsourcing remains another area which we are exploring.” When faced with a question of challenges, Nandita indicates towards lack of structure in the industry today. She says, “There are no entry barriers. Anyone can become a player given the absence of ground rules. Some

of these new entrants are there for short term gains and destroys the image of the country as a destination.” Ratul says, “As industry is still gaining domain knowledge, to get an employee and make him learn the business increases the time gap to make him/her productive, thereby increasing the manpower costs.” However, Abhik remains bullish. He comments that these are the days which are shaping the industry and they are happy to contribute in this evolution. There is a huge potential in the market and many sectors still remain unexplored. He keeps investing his time and energy into newer avenues of growth. “We will redefine medical travel. The days are not far when other industries like banking, pharma, hospitality and travel will sit up and accept the contribution medical travel companies have made to their books. Soon the hospital will understand that we are their distribution arms and we can reach faster into any market with lower costs. Many have already started to put us in their annual plans and add us in their overall structure.” Does competition play any role? “An organised and healthy competition ends up increasing the market size. Thus it is more than welcomed,” says Abhik. “However, the threat comes when the very brands you are selling start becoming your competitors within the same customer segment. Though we are not afraid of competition, it definitely increases the cost of doing business. But this will not deter us from achieving what we intend to. Competition pushes us to innovate and demands us to remain ahead of the curve. High beam global is happy doing so.”

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TRADE & TRENDS

Hospital furniture from ACME Enterprises ACME Enterprises executes all its business activities by keeping quality in mind, as quality is given foremost priority ACME IS a name synonymous with medical industry and is not only known as professional hospital furniture manufacturers, but it is much beyond that. The company offers a wide range of advanced hospital furniture which is in great demand in medical industry. Its team of well experienced skilled workers and experts is well equipped with latest machines to emerge as a leader in designing, planning and developing hospital furniture. ACME is committed to offer quality products in terms of durability, simplified operation providing maximum comfort to the patients and more convenient for the staff to handle. With head office in Delhi and dealer network in the cities like Dehradun, Mumbai, Jaipur,

The company offers a wide range of advanced hospital furniture which is in great demand in the medical industry. There are about 100 items in the company’s manufacturing line

Patna, Kathmandu, ACME Enterprises pride for its fine infrastructural set-up. The factory, situated at Hirawala Industrial Area, Jaipur (Rajasthan) is a well thought oriented and planned manufacturing unit. There are about 100 items in the manufacturing line and the company’s R&D is capable of manufacturing customised patient care furniture items. The company has been consistently growing

through the team which is well experienced and skilled. It takes pride on its infrastructure that has been taking the company to growth and success. The infrastructure, with well equipped with latest equipment and machines, helps ACME become the leader in all its business aspects. The items manufactured are tested, checked and evaluated at each stage of manufacturing process so as to produce a faultless and defect free item. The company specialises in providing the finest finishes to items manufactured to satisfy each customer according to his choice and, as far as possible, his budget also. Of course the budget in no case is allowed to eat into the performance of the company’s items as it does not compromise on dependability and performance of the patient care furniture. ACME Enterprises executes all its business activities by keeping quality in mind, as quality is given foremost priority. The company's utmost concern is to offer maximum comfort to the patients, and the goal is regularly achieved through quality aspects and their effective implementations.

ECG Academy India joins hands with BPLMedical Technologies The tie up is for offering ECG Academy Indi's certification courses along with BPL ECG devices ECG ACADEMY India, a medical education division of Westcoast Corporation - pioneers in state-of-the-art medical equipment, in association with ECG Academy US, has been offering offering online ECG interpretation certificate courses for continuing education at subsidised subscription rates for India, Sri Lanka, Bangladesh, Nepal and Pakistan. Now, ECG Academy India

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has announced its association with BPL Medical Technologies, to offer the courses along with BPL ECG devices. BPL would be offering the online courses to its existing and upcoming clients as an independent product or bundled with the ECG machines. Vijhay J Shetty, CEO, ECG Academy India is confident of a huge leap in the subscriptions and of reaching the doctors in the remotest part of the coun-

try with this tie up since the courses are completely online and the subscriber requires only a PC/laptop/tablet with an average speed internet connection.

Contact: ECG ACADEMY INDIA www.ecgacademyindia.com Contact: +91-8097091722 Email: info@ecgacademyindia.com

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.