Express Healthcare November, 2014

VOL.8 NO.11 PAGES 68

Cover story Defence against diabetes Strategy Quid pro quo healthcare Radiology Siemens launches new SPECT system

www.expresshealthcare.com

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NOVEMBER 2014, `50

CONTENTS MARKET Vol 8. No 11, NOVEMBER 2014

Chairman of the Board Viveck Goenka

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GOVERNMENT TO FRAME NATION'S FIRST MENTAL HEALTH POLICY

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METROPOLIS HEALTHCARE INDIA EXPANDS ITS FOOTPRINTS TO MAURITIUS

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PM NARENDRA MODI INAUGURATES SIR HN RELIANCE FOUNDATION HOSPITAL

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STUDY ON GOVT HEALTH INSURANCE SCHEME SHOWS REDUCTION IN MORTALITY AMONG POOR

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MUMBAI TO HOST PREMIER HOSPITAL INFRASTRUCTURE SHOW

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ISCCM, IAPC OBSERVE ISCCM FOUNDATION DAY, WORLD PALLIATIVE CARE DAY

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SOCIAL MEDIA WEEK FOCUSES ON ‘IMPACT OF SOCIAL MEDIA IN HEALTHCARE SECTOR’

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HEALTH EXPERTS PRESS FOR EARLY INTRODUCTION OF INJECTABLE POLIO VACCINE IN INDIA

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THE NTERNATIONAL SYMPOSIUM ON COCHLEAR IMPLANTATION HELD AT JASLOK HOSPITAL

ROUND TABLE

Editor Viveka Roychowdhury*

DEFENCE AGAINST

Chief of Product Harit Mohanty

DIABETES

BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bangalore Assistant Editor Neelam M Kachhap Delhi Shalini Gupta DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar

Express Healthcare, in its diabetes special, showcases the examples of three leading hospitals and their measures for managing the malady which has become a serious public health concern | P24

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

STRATEGY

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QUID PRO QUO HEALTHCARE

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MAINTAINING FINANCIAL HEALTH OF A HOSPITAL

IT@HEALTHCARE

40 41

REPORT: HEALTHCARE IT SECTOR ATTRACTS $956 MILLION IN VC FUNDING IN Q3 INFOR LAUNCHES INFOR CLOUDSUITE

RADIOLOGY

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SIEMENS LAUNCHES NEW SPECT SYSTEM CARESTREAM SHIPS 15,000TH VITA CR SYSTEM

P28: COVER STORY The nexus between diabetes and CVD

P30: COVER STORY Overpowering diabetes with preventive healthcare

P31: INTERVIEW: ANAND SHIRUR CMD, South Asia & China, ConvaTec

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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

Polio-free but far from corruption free

W

ith November 14, World Diabetes Day around the corner, this issue of Express Healthcare presents different perspectives from diabetologists and other experts in the field. The Government of India is reportedly evaluating a proposal for conducting free glucose tests for the entire population, adopting a philosophy that if India can be polio free thanks to a mass polio vaccination campaign, country-wide glucose testing can take us closer to be diabetes free. Of course this cannot happen as diabetes is not a disease but a condition and can therefore be managed but not cured in the true sense of the word. But widespread testing for glucose will be a very useful step towards early diagnosis which in turn will reduce treatment cost and incidence of associated conditions like heart disease. There is also now solid evidence that diabetes weakens immunity systems and thus triples the risk of TB, which is worrying for India, as it already has a high incidence of both TB and diabetes. While the intent is commendable, we need to wait and see if the implementation lives up to the vision.

Another area where we have good intent (read guidelines) but poor implementation, is the interactions and payments between pharma and medical device companies and doctors. The issue hits the headlines after TV sting operations catch doctors red-handed, and then each side restates its position and the issue fades out, only to be resurrected after a few months. The British Medical Journal had also exposed this facet of Indian healthcare (BMJ 2014;348:g4184) and in my edit in Express Healthcare's May issue, (http://healthcare.financialexpress.com/editorial/2879-can-we-cure-ourselves-of-corruption) I had commented on the BMJ’s plans to launch a campaign against corruption in medicine, beginning with a focus on India.

Associations of both stakeholders, pharma companies as well as doctors, already have guidelines but these are not mandatory and only binding on the members of these associations. Such self

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Nowthat India is polio-free,the Government is focusing on defeating diabetes,but can we also hope for a corruption-free healthcare system?

regulatory mechanisms only work if they are followed in letter and spirit and it is amply clear that this is not the case in India or for that matter, elsewhere in the world. For instance, there has been widespread criticism from pharma companies as well as doctors in the US when the Open Payments database administered by the Centers for Medicare & Medicaid Services, as mandated by the Physician Payments Sunshine Act, a part of the Affordable Care Act, went live on September 30.

We did a dipstick survey of doctors and healthcare professionals in India to gauge their reaction to this development. Most of those who shared their views in the Strategy section, (Quid pro quo healthcare, pages 32-35) agree that we need such an Act in India as well. They admit that this ‘cancer’ has spread and made Indian healthcare ‘terminally ill’ but point out there will always be ways to “manage” the law. Unless there is political push to cleanse the system, things will stay the same. Will a black list of such doctors help discourage unethical practices?

But such a blacklist needs whistle blowers, from within the industry, who will be protected from the backlash. Or will the reverse strategy work better: a ‘white list’ recognising honest doctors who refuse bribes or make unrestricted declarations of all gifts/payments accepted? But how do we go about measuring honesty? If doctors can agree that sometimes it is better to amputate a gangrenous limb to save the rest of the body, will they agree to expose the ‘bad apples’ to redeem the rest of the fraternity?

Reacting in Parliament to a sting operation conducted by a TV channel in July this year, which exposed doctors accepting commissions from diagnostic clinics for conducting MRI scans and the like, health minister Dr Harsh Vardhan promised that his ministry would crack down on such corrupt practices in the healthcare sector. Will the sun finally shine on such practices in India so that we can have a corruption-free healthcare system?

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

QUOTE UNQUOTE: Speaking at DIA 9th ANNUAL INDIA CONFERENCE, titled 'The Future of Indian Healthcare: Patients, Access and Innovation'

SWATI PIRAMAL, Vice Chairman, Piramal Enterprise

NATA MENABDE, Representative to India, WHO India

The world is re-visiting models of healthcare.

Holistic, integrated solutions are required. We cannot have pro-poor policies which are poor policies. We should have a combination of private and public insurance. Access should be independent of the ability to pay. The government and private sector should work together to improve access.

When you reduce the cost of the drug to the cost of the chemical but exclude the cost of safety, then price control does not help access.

DR DEVI SHETTY, Chairman, Narayana Hrudayalaya Group of Hospitals (via telecon)

Though we produce a lot of doctors, India still lacks doctors. (This is because) We have a first world regulatory structure with a third world infrastructure. We need to liberate medical education from the license raj.

FERZAAN ENGINEER,

RAJESH BALKRISHNAN, Associate Professor Health Outcomes,University of Michigan, US

Co-Founder and Chairman, Cytespace:

Home-based care could become the Flipkart of healthcare. Entire housing societies could subscribe to a health plan, which is based on incentives to take care of people's health rather than curing them after they fall sick. When subscribers do fall ill, it’s detected early so costs of care are less.

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Comparative effectiveness is very relevant to India when resources are few.

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MARKET NEWS

Government to frame nation's first mental health policy Dr Harsh Vardhan, Union Health Minister made this announcement after a visit to Agra's Institute of Mental Health and Hospital DR HARSH VARDHAN, Union Health Minister, after a visit to the 155-year-old Institute of Mental Health and Hospital, Agra, said that the country’s mental illness burden has grown to such proportions that the government has decided to frame the first ever official national policy on mental health.

“There has been considerable progress in treatment methods for mental patients and their recovery rates have improved. Unfortunately, society still stigmatises those who suffer from routine psychiatric problems and so their treatment is either delayed or denied. We need to build up a social movement to change mindsets and focus on the human dimension of mental illnesses,” he said. The minister also announced that October 10 would henceforth be observed throughout the country as National Mental Health Day. Dr Harsh Vardhan said, “It will be a day for raising people’s awareness on mental illnesses and removing the false perceptions attached to them. We want a nation that upholds the human rights of mental pa-

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tients. Also, it will be an occasion to generate awareness against stigmatisation of people with mental illnesses and highlight the symptoms and remedial opportunities for those with depression, schizophrenia, bipolar syndrome, etc.”

The minister also announced that a National Mental Health Policy is being developed. It will reportedly involve the country’s best experts in the field and cover complex issues linked to this branch of medicine. He also indicated that some more institutions replicating Na-

tional Institute for Mental Health and Neurological Sciences, Bangalore, are being considered. He also mentioned that the government had granted Rs 28.8 crores to upgrade the infrastructure of the Agra hospital and expand the teaching facilities. Dr Harsh Vardhan said, “I have already taken the first reformative steps. The Universal Health Assurance Mission (UHAM) which is under development will not ignore mental illnesses. The New National Health Policy, which will come about in consultation with the states, will also have a focus on mental health. Universal Health Insurance, which will be a component of UHAM, will also cover those who need treatment for common problems.” Admitting that mental health services in India is a neglected area which needs immediate attention, he said that despite the existence of a National Mental Health Programme since 1982 there has been a very little effort so far to provide mental health services, particularly in rural areas.

EH News Bureau

Metropolis Healthcare India expands its footprints to Mauritius Plans are to set up 25 collection points across different locations in the coming year

METROPOLIS Healthcare has announced a joint venture with Bramser Corporation.

The joint venture, Metropolis Brasmer Lab Services Mauritius will introduce pathology services to the nation. To begin with Metropolis has one central laboratory with collection points across Mauritius, Madagascar, Seychelles and Reunion. The central laboratory is located on the premises of the Apollo Bramwell Hospital and pathology services will be available to patients in the hospital as well as the citizens of Mauritius.

Plans are to set up 25 collection points across these locations in the coming year.

Metropolis Healthcare will be

Metropolis Healthcare will be opening five collection points at Port Louis, Curepipe, Moka, Quatre Bornes and Rose-Hill

opening five collection points with immediate effect at Port Louis, Curepipe, Moka, Quatre Bornes and Rose-Hill, with two more laboratories coming up across Central Flacq and Black River in the next three months. Investments planned around the joint venture are in the region of 50 million Mauritian rupees.

Speaking at the occasion of the joint venture, Ameera Shah, MD & CEO said, “As India’s most respected chain of pathology laboratories, we are looking at 1000 tests being performed locally in Mauritius. We also have the advantage of offering 4500 tests with the best turnaround time.

We would be the first and foremost in the Mauritius diagnostic industry to offer the widest test menu combined with the highest standard of quality at an affordable rate.”

Claudio Feistritzer-Rawat, Director of Metropolis Bramser Lab Services Mauritius explained, “There is a growing need for quality diagnostics in Mauritius. Our understanding of the market, combined with Metropolis’ expertise in global healthcare diagnostics, we look to bridge that gap while ensuring affordability and quality.”

EH News Bureau

Apollo Hospitals launches superspeciality hospital in Indore, MP It is a 125-bedded facility, another 100 beds proposed to be added in the next one year APOLLO HOSPITALS recently inaugurated a super speciality hospital in Indore, Madhya Pradesh marking the hospital group's entry into the state. Apollo Hospitals, Indore is a 125 bedded hospital with over 50 specialities and super-specialities.

Reportedly, the hospital’s 45 bedded critical care unit will be backed by e-ICU services.

Experts will have the ability to monitor a critical care patient in real time from a remote command centre in Hyderabad, thus making critical care more efficient. This is the first phase of the facility, and another 100 beds are proposed to be added in the next 12 months.

Apollo’s Indore facility will also offer a complete range of diagnostic services including a 128-slice CT Scan, 1.5T 18 channel MRI, high end 4D ultrasonography etc. The emergency services will be operational 24X7, thus providing healthcare services to patients at all times, irrespective of day and time. Operational theatres with adequate post-op facilities will enable physicians to perform the most complex surgeries with ease, informed a company release.

Dr Prathap C Reddy, Chairman, Apollo Group of Hospitals said, “This is indeed a proud moment for us. Since the foundation of the first Apollo Hospital in 1983, our motto has always been quality healthcare service accessible by one and all. We are humbled with the opportunity provided by the State to help us serve them with advanced medical care and patient management that stands unparalleled till today.

This is only the beginning of our journey in Madhya Pradesh and we are looking forward to adding more facilities in Indore and Bhopal.”

EH News Bureau

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MARKET

PM Narendra Modi inaugurates Sir HN Reliance Foundation Hospital Reliance Foundation and its Chairperson, Nita Ambani has dedicated this hospital to the city of Mumbai ON OCTOBER 25, 2014, Narendra Modi, PM of India inaugurated the Sir HN Reliance Foundation Hospital & Research Centre which has been rebuilt into a modern 19-storey tower and two heritage wings by Reliance Foundation led by its Chairperson Nita Ambani. Located in South Mumbai, the hospital set up in 1925 as Mumbai’s first general hospital, is currently in its 90th year.

The hospital informs that it has collaborations with John Hopkins, MD Anderson Cancer Centre, Massachusetts General Hospital and University of Southern California. It also boasts of state-of-the-art operation theatres equipped with robotic surgery and on-line video conferencing, a hybrid

PM Narendra Modi, Reliance Foundation Chairperson Smt. Nita M Ambani, RIL Chairman Shri Mukesh D Ambani and Governor of Maharashtra C Vidyasagar Rao, at the Neonatal ICU

cath-lab, and high-end diagnostics facility. Reportedly, the hospital is also equipped with

high-end Obstetrics & Gynaecology services, Neonatal Intensive Care Unit (NICU) and

a learning centre, adapting the Millennium Development Goals of the United Nations.

The hospital also claims an outreach programme that apparently covers over 310,000 individuals in the vicinity providing preventive and primary healthcare on a digital platform virtually free of costs. It has initiated steps to adopt the nearby congested areas as part of PM’s Swachch Bharat Abhiyan.

The hospital informs that it has adopted green measures such as water recycling and rainwater harvesting. The hospital’s digital initiatives include RFID tags for patients, end-toend digitisation of medical records and real-time remote access to these records.

Reliance Foundation and its Chairperson has dedicated this hospital to the city of Mumbai.

EH News Bureau

Study on govt health insurance scheme shows reduction in mortality among poor Researchers studied nearly 80,000 households from 600 villages and found a 64 per cent drop in mortality from diseases covered by the insurance A GOVERNMENT programme to provide health insurance for catastrophic illness to households below the poverty line in Karnataka, lowered both mortality rates and out-ofpocket expenses for the residents, according to a recent evaluation published in the leading global health journal The BMJ. The programme is implemented by the Karnataka

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government with support from the World Bank Group.

An evaluation of the programme, the Vajpayee Arogyashree Scheme (VAS), funded by the World Bank Group and led by Neeraj Sood, Professor and Director of Research at the Schaeffer Center for Health Policy and Economics at the University of Southern California, found that:

Evaluation of the VAS programme was funded by the World Bank Group

◗ The risk of dying from conditions covered by the insurance dropped by 64 per cent for residents with the insurance. ◗ Out-of-pocket health expenditures for hospitalisations due to the covered conditions dropped by 60 per cent. ◗ Utilisation of healthcare facilities for the covered conditions may have risen.

"This World Bank study

clearly shows how this programme benefits the health of the poor in Karnataka," said UT Khader, State Minister of Health and Family Welfare. "It provides hospital care that the poor would have difficulty receiving without the help of the scheme," he added.

The free insurance covered specific high-impact medical conditions - such as heart dis-

MARKET ease and cancer - which poor residents often die from because they are unable to pay for the necessary expensive treatments. Some of the unique features of the VAS programme includes free tertiary care at both private and public hospitals empaneled by VAS for below-the-poverty-line (BPL) families with little or no access to tertiary care; automatic enrollment of all BPL families with no annual premiums, user fees, or copayments; and health camps in rural areas by empanelled hospitals, which helped screen patients for tertiary care and transport them to hospitals in urban centres.

"The results of this study are important to India as it makes choices on how to make progress towards universal health coverage," said Onno Ruhl, World Bank Group Country Director for India.

"The programme shows how purchasing health services for the poorest can both improve health and provide protection from impoverishment due to out-of-pocket payments for healthcare," he added.

The evaluation included more than 82,000 households.

Since the programme was phased, covering poor households in the northern part of Karnataka in the first phase before expanding to the rest of the state, the study compared the health outcomes of roughly 45,000 households from villages that were covered by the insurance to roughly 37,000 households from villages that were not covered by the programme.

"The study shows that public policy can play a strong role in reducing disparities in health due to socio-economic status. In villages without insurance, the poor had much higher mortality than the rich, but such disparities were completely eliminated in villages with insurance coverage," said Sood.

"Rates of early death and illness from chronic conditions - such as heart disease and cancer - have increased dramatically in India in the past few decades, putting the poor at high risk of not having ac-

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The free insurance covered specific high-impact medical conditions - such as heart disease and cancer - which poor residents often die from because they are unable to pay for the necessary expensive treatments

cess to services they need and incurring payments for health care that push them deeper into poverty," said Patrick Mullen, a World Bank Group senior health specialist and the manager of the evaluation.

The study was funded by the World Bank Group's Health Results Innovation Trust Fund, which supports innovative results-based financing strategies such as the health service

purchasing done by this programme.

Sood's coauthors were Eran Bendavid from Stanford University, Arnab Mukherji from the Indian Institute of Management in Bangalore, Zach Wagner from the University of California, Berkeley, and Patrick Mullen and Somil Nagpal from the World Bank Group.

EH News Bureau

MARKET PRE EVENT

Mumbai to host premier hospital infrastructure show HIM to held in December 12, 2014 at Bombay Exhibition Center HOSPITAL INFRASTRUCTURE & Management (HIM) is being organised in Mumbai on December 12, 2014. The event aims to provide a platform for companies trying to win tenders, drive sales and increase their market share in infrastructure, construction, fit-out and management.

HIM is projected to be the most credible trade fair

witnessed by the hospital industry with validated industry buyers including key budget holders, policy makers and investors in healthcare projects visiting the show; they represent the real power behind this thriving industry. The organisers of HIM, The Ideas Exchange inform that the event is set to be bigger than ever with over 100 exhibitors covering over

5,000 sq m of exhibition floor space, and an estimated 4,000+ trade visitors. HIM is expected to raise the benchmark for the hospital industry with leading and relevant names at the show, because it’s here where ‘Decision Makers Get Together; and Business Happens,’ inform the organisers.

“We strive to make Hospital Infrastructure & Man-

agement an exceptional experience and platform for the Indian hospital industry for the latest developments, trends, equipment and launches. We have attempted to create a knowledge-sharing platform and pave the way to discover the latest trends and techniques which have emerged in current times and we look forward to further supporting

India’s healthcare industry to grow further,” said Vikas Vij, MD, The Ideas Exchange.

Contact Khyati Mishra Marketing Manager Email: khyati.mishra@ideasexchange.in Tel: 0091 22 6171 3211 Website: www.hospitalinfra.co.in

POST EVENT

ISCCM,IAPC observe ISCCM Foundation Day,World Palliative Care Day India figured 39th in a list of 40 countries evaluated for 'quality of death' in an international study conducted by the Economic Intelligence Unit in 2012

INDIAN SOCIETY of Critical Care Medicine (ISCCM) and Indian Association of Palliative Care (IAPC) came together on the occasion of ISCCM Foundation Day (October 9, 2014) and World Palliative Care Day (October 11, 2014) for creating awareness and establishing consensus about difficult ethical, legal and medical issues in “End of Life Care” in India along with senior doctors from ISCCM, IAPC, other medical societies, National Accreditation Board for Hospitals and Healthcare Organizations (NABH), and senior members of legal fraternity.

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The theme for the ISCCM day, jointly celebrated with the World Palliative Care Day was “We must know when to stop the care of the terminally ill patient in ICU ” “Who cares? - We do” “Together we choose” India figured 39th in a list of 40 countries evaluated for 'quality of death' in an international study conducted by the Economic Intelligence Unit in 2012.

Explaining about the issue, Dr Rajesh Chawla, Chancellor Indian College of critical care medicine said, “Recently there has been discussion on the con-

Medical profession wishes to draw the attention of the public to an important issue which is referred to as end of life care

troversial issue of euthanasia.

The medical profession does not endorse euthanasia but wishes to draw the attention of the public to a more important issue which is referred to as end of life care. All over the world there has been a movement away from applying aggressive treatment to persons dying from incurable disease. By current estimates such deliberate withholding or withdrawal of life support happens in 75 – 90 per cent of ICU deaths. This practice is called limiting life support or foregoing of life support that is applied in many countries with appropri-

ate supportive legal framework.”

ISCCM aims to play an important role in this debate and facilitate the development of appropriate laws by parliament. To this end, ISCCM has intervened in the case before the Supreme Court with an impleadment motion filed by ISCCM. ISCCM and IAPC had published a joint position statement in the September 2014 issue of the Indian Journal of Critical Care Medicine . The two societies intend to involve other national medical societies in this effort.

MARKET

Social Media Week focuses on ‘Impact of Social Media in Healthcare Sector’ Patient engagement and community building are the unexplored mediums SOCIAL MEDIA Week (SMW), a worldwide event exploring the social, cultural and economic impact of social media, was held simultaneously in 12 cities including Berlin, Chicago, Johannesburg, London, Los Angeles, Miami, Rome, Rotterdam and Mumbai recently.

It focused on the impact of social media in the healthcare sector and a panel discussion on the topic was held on the third day of the Social Media Week. It revolved around the various challenges faced by healthcare and pharma sectors to reach out to their audiences through social media.

The panel discussion also touched important aspects of ‘patient engagement’ and on how to make patient education more interesting.

Priti Mohile, MD of MediaMedic Communications spoke about healthcare searches and conversations on social media. She mentioned that while people increasingly search for health related information, they hesitate to converse openly about their illness. Cultural and traditional aspects of our society play an important role in whatever is expressed on social platforms. Hence, interpretation of such data needs special expertise.

She also said, “There is now a shift observed when we track such conversations, the younger generation who is on social media tends to be more open. Moreover, entertaining,

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MARKET fun-filled stuff is more readily consumed on social media.”

She also gave examples of some international case studies carried out by her company on Progeria.

Dr Aniruddha Malpani, Medical Director, HELP, spoke about the change that has taken place in social media in India. He also emphasised that the doctor’s key focus should be patient education. Doctors should take the initiative to reach out to their patient and help them understand their health conditions. He also encouraged doctors to have their own websites and interact with patients more.

Dr Shashank Akerkar, Consultant Rheumatologist from Mumbai gave examples of how he was able to get solutions from people around the world for health issues about his patients. He strongly expressed the need for doctors to connect with their patients.

(L to R) - Dr Aniruddha Malpani, Medical Director, HELP; Dr SM Akerkar, Consultant Rheumatologist, Mumbai Arthritis Clinic & Research Center; Priti Mohile, MD, MediaMedic Communications; Rahul Avasthy, Head-Digital Marketing (Group Marketing Team), Abbott India and Dinesh Chindarkar Co-Founder, MediaMedic Communications

Rahul Awasthy, Head Digital Marketing, Abbott India, gave the pharma industry's perspective and said that he felt it was possible to provide scientific information to pa-

tients in an interesting manner. He further added that healthcare can be made relevant and interesting. Dinesh Chindarkar, Co-Founder, MediaMedic Communications

anchored the session.

The Social Media Week in Mumbai helped pharma and healthcare professionals get insights on newer innovative ways to reach out to their

target audience, build awareness in simple yet attractive format. The Indian Express and The Financial Express was the official media partners for Social Media Week 2014.

Health experts press for early introduction of injectable polio vaccine in India Top doctors and medical professors say the injectable vaccine is much more effective than oral vaccine and eliminates the risk of vaccine-polio TOP DOCTORS and medical professors who participated at the Ranbaxy Science Foundation’s 32nd Round Table Conference on “Lessons from the Success of Polio Elimination” highlighted the importance of switching from the oral polio vaccine (OPV) to the injectable polio vaccine (IPV) in India beginning next year.

They warned that any delay in introducing it can have detrimental effect on public health.

Dr T Jacob John, Chairman, Child Health Foundation, said, “Though we have successfully combated the menace of polio using oral vaccines containing live viruses, it has

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Health experts warn that delay in introducing injectable polio vaccine (IPV) can have detrimental effect on public health. IPV, planned to be introduced in 2015, is expected to prevent vaccine-derived cases of polio and achieve total eradication of the disease to be kept in mind that only the wild polio viruses have been eliminated from India, while the vaccine-derived polio viruses still remain a threat. IPV, planned to be introduced in 2015, is inevitable

if we have to prevent vaccinederived cases of polio and achieve total eradication of the disease. Once IPV is launched to preempt circulating vaccine-derived polio virus, we can gradually discontinue

OPV, starting with type 2 component.”

According to health experts, IPV, though more expensive, carries inactive forms of all three strains (Type 1, 2 and 3) of the polio

virus, with no risk of virulence.

In contrast, OPV carries live but weakened form of the virus which can give rise to occasional cases of polio, especially of the Type 2 strain, the wild counterpart of which is now absent. Said Dr John, “IPV is much more effective than OPV in a country like India when introduced in the routine immunisation programme. Had we adopted IPV earlier, we could have banished polio years ago from our shores due to it having much higher efficacy than OPV. As India moves to IPV next year, it would be critical to achieve and retain high levels of rou-

MARKET tine immunisation in all states.”

Prof NK Ganguly, Former Director General, Indian Council of Medical Research, said, “For a successful rollout of IPV in the country, the government needs to build capacity and ensure sufficient stocks and logistics. The availability of the vaccine would be a critical factor. We also need to build advocacy among the people and have trained manpower ready from the primary immunisation field to administer the injections.”

Dr John added, “Policies on polio immunisation, polio control and polio elimination ignored results from Indian research for too long and science continued to be neglected during program design. The importance of science was only appreciated in 2005, followed by a flurry of science reviews and new research in tackling the problem. It was only after science offered solutions that polio could be successfully eliminated in the country. This offers important lessons for controlling other diseases like TB in India.”

According to experts, the polio programme was a success because it gave equal importance to three crucial areas of sociology, epidemiology and vaccinology. Many challenges still remain, however.

India needs to sustain its wild polio-free status, prevent the importation of the virus, begin phase two (end game) of the war on polio, and withdraw Type 2 from the trivalent oral polio vaccine because it causes polio at an unacceptable frequency.

Health experts also warned against the threat of the wild polio virus infiltrating into India from Pakistan and restarting the epidemic that was eliminated recently after a nationwide struggle spanning decades. Prof Ganguly said, “The threat of virus importation from Pakistan is very real.

Though it is now mandatory for everyone from the neighboring country to take an additional dose of polio vaccine before entering India, measures like this can only reduce the risk, not eliminate it. The number of polio cases in Pakistan

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have already crossed 200 this year, the highest in more than a decade, setting alarm bells ringing. It is necessary for India to keep 100 per cent immunity status against polio until Pakistan gets polio-free. Till that happens, we have to act as if we continue to have polio in our country.”

Health experts warn against infiltration of wild polio virus from Pakistan

The conference also discussed various aspects of India’s disease-control policy, data-driven strategies and interventions, polio laboratory network and economic benefits of polio elimination. Health experts such as Dr Sunil Bahl from WHO, Dr Jagadish Deshpande from Enterovirus Re-

search Centre, Dr Arindam Nandi from Public Health Foundation of India, Dr Roma Soloman from the Core Group Polio Project, Dr Shobha Broor from AIIMS, Dr Anis Siddique from UNICEF, Deepak Kapur from Rotary International, attended the conference.

MARKET

The International Symposium on Cochlear Implantation held at Jaslok Hospital It comprised lectures and live surgical demonstrations by experts

THE INTERNATIONAL Symposium on Cochlear Implantation was conducted at the Jaslok Hospital, Mumbai recently. It focussed on how totally deaf children and adults who cannot benefit from hearing aids can be helped through cochlear implants.

A cochlear implant is an electronic device, the internal component of which is implanted during the surgery while the external component is later worn on the body as the speech processor. With the implant, children born deaf can hear and be taught to speak while patients who become deaf after acquiring speech are given hearing and can continue living normally.

Dr Sandra Desa Souza, Director ENT, Jaslok Hospital and ENT Consultant at Breach Candy and Desa’s Hospital convened the symposium.

Day 1 saw the inauguration of the Symposium by Dr Tarang Gianchandani, CEO of Jaslok Hospital. This was followed by lectures on: ◗ History of cochlear implant surgery by Dr Sandra Desa Souza

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◗ Cochlear implantation candidacy anatomical considerations by Dr Dillon D’souza ◗ Bilateral cochlear implantation and ABI by Prof Jacques Magnan ◗ Minimally invasive Veria Technique by Dr JM Hans ◗ Demonstration of cases operated at Jaslok Hospital

by Shehnaz Sheikh in the last two to three years Day 2 saw live surgical demonstration by Dr Jacques Magnan on patient Om Deokate with a posterior tympanotomy and cochleostomy to introduce the device.

Dr Dillon D’souza operated on a patient named Riddhi Bagadkar using the Inverted Veria Technique and Cochleostomy without exposing the facial nerve and Dr JM Hans operated on patient Jafin Sheikh using a minimally invasive Veria Technique. All patients are doing well, reportedly.

The programme ended with a valedictory function at which certificates were distributed to the attending delegates.

ENT specialists at the inaugural function of the symposium

Dr Sandra Desa Souza and Dr Prof JM Hans in surgical garb

EVENT BRIEF NOV-DEC-2014 12

MEDICA 2014, COMPAMED 2014

MEDICA 2014, COMPAMED 2014 Date: November 12-15, 2014 Venue: Düsseldorf Trade Show Complex, Düsseldorf, Germany Summary: More than 4,500 exhibitors from around 65 nations are expected at MEDICA 2014 to present the entire spectrum of new products, services and procedures to raise efficiency and quality in outpatient and in-patient care. The MEDICA trade show’s focus would be on electromedicine medical

12

HOSPITAL INFRASTRUCTURE AND MANAGEMENT

technology, laboratory technology/ diagnostics, physiotherapy/orthopaedic technology, commodities and consumables, information and communication technology, medical furniture and specialist furnishings, and building technology for hospitals and doctors’ offices.

COMPAMED 2014 is an international platform for suppliers. Around 700 exhibitors would present their technological and service solutions for use within

the medical technological industry – from new materials, components, primary products, packaging and services.

Contact Messe Duesseldorf India Centre Point Building, 7th floor,Santacruz West Mumbai 400 054 Phone: +91 (0)22 6678 9933 Fax: +91 (0)22 6678 9911 E-mail: messeduesseldorf@mdindia.com Website: www.md-india.com

HOSPITAL INFRASTRUCTURE AND MANAGEMENT Date: December 12 -14, 2014 Venue: Bombay Exhibition Centre, Mumbai Summary: Hospital Infrastructure & Management (HIM) is all set to provide the perfect platform for companies trying to win tenders, drive sales and increase their market share in infrastructure, construction, fit-out and management.

It is a leading trade show

to know about the latest developments, trends, equipment and launches in the Indian hospital industry.

Contact Khyati Mishra Marketing Manager Email: khyati.mishra@ideasexchange.in Tel: 0091 22 6171 3211 Website: www.hospitalinfra.co.in

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‘India needs a nationwide comprehensive screening strategy’ Research in diabetes has become very pivotal to find ways and means to curb the malady’s growing menace. Raelene Kambli meets Prof (Dr) Shashank Joshi, President, Indian Academy of Diabetes (IAD) and an endocrinologist affiliated with Lilavati Hospital, Bhatia Hospital, Grant Medical College and Sir JJ Group of Hospital to learn about his research on this disease and major developments in the field of diabetes management

What is the current state of diabetes in India?

We have around 65 million people living with diabetes and around 130 million people in the pre-diabetic stage. The good news is that we have been able to bring down the rate at which diabetes was growing. Due to increased awareness about the disease and its associated complications, people are now resorting to leading a healthy lifestyle. As healthcare providers, our aim is to stop the 130 million Indians who are currently at high risk of becoming diabetic. And for this, we are constantly researching on various strategies that can help these people.

You have covered two important aspects on

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underlying risk factors. This study has opened our avenues for further studies.

diabetes - obesity and hypertension, in your research. Share some insight on your findings.

Our research related to the ‘thin-fat Asian Indian’ phenotype indicated that diabetes in India is due to evolutionary enrichment of thrifty genes, which long ago enhanced survival during periods of famine. Due to this, Indians have a higher proportion of fat in their body

composition and more so in the abdominal area.

Our second research work -The Screening India's Twin Epidemic (SITE) study aimed at collecting information on the prevalence of diagnosed and undiagnosed diabetes and hypertension cases in outpatient settings in major Indian states to better understand disease management, as well as to estimate the extent of

What are the other research areas that you are currently working on?

We are currently working on a study that examines the association between obesity and low relative skeletal muscle mass (sarcopenia) with type 2 diabetes. Apart from this, we are also working on developing low cost solutions. We are also working on developing a mobile app to measure sugar levels. On the research front, we are working on a programme called NEAT (non exercise activity thermogenesis), which is the energy expended for everything we do apart from sleeping, eating or sports-like

exercise. It is a critical component to find out how we maintain our body weight and/or develop obesity or lose weight.

As per our findings it is important to have physical activity for 60 minutes per day. This physical activity should be categorised in three different ways: working, muscle strengthening and destressing. The other areas of our research is based on environment disrupting hormones and the relation between diabetes and cancer.

What according to you is the way forward to curb diabetes?

The only way to keep diabetes at bay is to live a healthy lifestyle and screen for diabetes every year after the age of 20. The mantra that

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Follow the ABCDE of healthy living (A1C level below seven, blood pressure below 120-80, cholesterol below 70, have a proper diet and exercise regularly)

healthcare professionals should give their patients is 'to strictly follow the ABCDE of healthy living (A1C level below seven, blood pressure below 120-80, cholesterol below 70, have a proper diet and exercise regularly). For this, each one should eat less, eat on time, walk more, sleep well and always keep smiling'.

I always tell my patients that 1000 steps a day will keep diabetes at bay.

On the national front, India needs a nationwide comprehensive screening strategy supported by the government. We need cheaper drugs and have to increase the availability and accessibility of these drugs.

As an industry, we need to build our capacity for the same. The good news from the industry's side is that we

have developed our first new chemical entity (NCE) called saroglitazar.

We need more of such NCEs to be developed

by Indian pharma companies.

Lastly, it is important to educate the GPs on diabetes management because it is a treatable disease which can and should be managed at the grassroot level. raelene.kambli@expressindia.com

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‘Diabetes is caused by multiple factors and genes contribute to about 30-40 per cent’ Dr Anoop Misra, Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology; Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC); Director, Diabetes and Metabolic Diseases, Diabetes Foundation (India) (DFI) shares information about diabetes, its etiology, diabetes management in India and more, in conversation with M Neelam Kachhap

What are the hallmarks of Indian diabetic patients?

How are they different from other patients?

Indian patients are younger by a decade, have high body fat and low muscle mass. They also have higher increase in blood sugar after the meals as compared to other races because of dysfunctional insulin response. Indian patients have more severe problems of kidneys, eyes and heart, several times more than other races. Infections are highly prevalent because of unhygienic contacts, thus causing bacterial infections and tuberculosis. In summary, diabetes in Indian patients is more problematic, and leads to early complications and even death if not treated aggressively.

Tell us about the new

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diabetes management drugs in the market? How are they different from the existing drugs for glucose control?

Discovery that incretin hormones (incretins) produced in intestine decrease blood sugar has revolutionised treatment of diabetes. Use of drugs acting on these hormones does not lead to as much hypoglycemia (low sugar) as compared to conventional drugs like sulphonylureas. They have several beneficial effects for metabolism and pancreas as well; are multifaceted in action as compared to many conventional drugs which have a uni-faceted action profile. Injectable drugs also lead to significant weight loss.

They have a better safety profile than many conventional drugs. These drugs are available in India since the last five years. High

prices of these drugs remain an area of concern.

Diabetes is recognised as a lifestyle disorder and there is a fair bit of awareness among Indians on the same. But what are the genetic causes of diabetes?

Usually diabetes is caused by multiple factors, and genes contribute to about 30-40 per cent. More than 40 genes have been implicated in diabetes, and it is also possible that several genes together or in unison lend tendency for diabetes. In addition, several genes implicated in obesity may also be linked to diabetes.

Interestingly, one gene Myostatin, researched by us, causes excess adiposity and low muscle mass, both important factors for diabetes development. There are some rare forms of diabetes which are clearly linked to single

gene (e.g. maturity onset diabetes in young). Finally there are some genes which are triggered only when linked to bad food habits and physical inactivity.

What is steroid-induced diabetes and how can this be managed?

Steroids decrease body’s ability to use insulin effectively, and cause weight gain and increase blood pressure. A combination of insulin resistance and weight gain causes diabetes. Further, these drugs may uncover diabetes in those people who already have tendency to develop the disease. Diabetes may get resolve after stopping the usage of steroids. Some people who are already at higher risk of getting diabetes may continue having the disease, it needs to be managed by weight loss and

correct drugs.

What is your take on stemcells treatment for diabetes?

The potential of the stem cell approach for diabetes is particularly attractive because it offers hope for curing the disease.

Unfortunately, many factors limit the usefulness of this approach; such as the type of stem cells, source from where they are obtained, number of stem cells used in therapy, and patients’ response to stem cell treatment. In general, this approach would be more useful in those with complete deficiency of insulin producing cells (type 1 diabetes) than partial deficiency of cells as in adult onset of type 2 diabetes. Some trials in type 1 diabetes have shown promise, and patients’ insulin dependency was reduced for a short period

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Discovery that incretin hormones (incretins) produced in intestine decrease blood sugar has revolutionised treatment of diabetes

time, however, in most of the cases, insulin was required again to control blood sugar.

What is new in dietary management of diabetes?

Low carbohydrate diet: Several diets have been suggested for weight loss and control of blood sugar, but low carbohydrate diets seems to be winning according to recent studies. Evidence exists suggesting that low-carbohydrate diets can lead to improvements in HbA1c and reductions in body weight in the short term (less than one year).

Use of pistachio nuts in Indian diets: A study, carried out by the Diabetes Foundation of India (DFI) and the National Diabetes, Obesity and Cholesterol Foundation for a period of six months was published in US-based journal Nutrition two months back. Adding pistachio nuts to the diet can lead to multiple health benefits like reduced body fat, improved insulin action, reduced harmful fatty acids and improved blood oxidation. This study shows, for the first time, that Indians who have multiple risk factors could modulate their diets by including pistachio nuts.

Increasing beneficial fatty acids (monounsaturated fatty acids) in diets: In another study conducted by our group (published in US-based journal Atherosclerosis) dietary oils were replaced with oils high in monounsaturated fatty acids (Olive, rapeseed oils) in patients who have high amount of fat in the liver. After six months of intervention, and decrease in abdominal fat, significant improvement in action of hormone insulin on blood glucose and tissues, decrease in lipids; significant reduction in triglycerides, and increase in good cholesterol HDL were observed. Most importantly, liver fat decreased in about 60 per cent of patients with improvement of liver enzymes levels indicating significant improvement in liver metabolism.

Bariatric surgery is hailed as a way to manage diabetes? What are your views on this?

Bariatric surgery leads to a remarkable impact on type 2 diabetes mellitus. Remission of the disease occurs in 50-70 per cent of

the patients undergoing surgery i.e. these patients are off any antidiabetic medication while maintaining normal blood glucose levels. Interestingly, the impact may start early in the post-operative course even before any significant weight loss has occurred. Thus, factors other than weight loss are responsible. The possible mechanisms include role of gut hormones like GLP1, faster gastric emptying, and decrease in inflammatory status and improvement in insulin resistance.

Recent studies have shown regression of diabetes could be maintained even upto six years after surgery. Finally, bariatric surgery, in the long term has been shown to reduce deaths due to heart disease and prolong life. Clearly, management of type 2 diabetes now includes bariatric surgery as an important treatment to control blood sugar in obese patients.

What are the main points for awareness programes for diabetes?

Principally, efforts should be directed towards correct diet and exercise in the following manner: ◗ Five dietary principles: ❍ Decrease carbohydrates, and opt for complex carbohydrates (Whole cereals, unpolished rice, barley [jaun], buckwheat [kuttu], oats [jai], millets, etc.) ❍ Limit sugar intake ❍ Eat high fibre foods (100 g of whole wheat flour gives 1.9 g of fibre). ❍ Limit fats but take more of monounsaturated fats (nuts, olive and rapeseed oil) and omega-3 fatty acids (fish, flaxseeds) ❍ Salt intake should be less than 5 g of sodium chloride (or about 2 g of sodium)/day. ◗ Three principles of physical activity: recommended physical activity for adults is 45-60 min every day ❍ At least 30 min of moderate intensity aerobic activity (leisure time) ❍ 15 min of work-related activity (five minute walk every 2 hours of working in office) ❍ 15 min of muscle strengthening/resistance exercises. ◗ Quit smoking and alcohol mneelam.kachhap@expressindia.com

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R O U N D

T A B L E

DEFENCE AGAINST

DIABETES

Diabetes in India is fast approaching endemic proportions and The country is also faced with the herculean task of managing this disease effectively. According to the International Diabetes Federation (IDF), India is home to more than 65.1 million people with the disease, compared to 50.8 million in 2010. These increasing numbers drive home the point that urgent measures are imperative. Healthcare providers have realised that being a lifestyle disease, managing diabetes would need an integrated approach. Hence they are moving beyond just treatment and are adopting measures which would aid their diabetic patients to lead a healthy lifestyle - a must to cure or curb diabetes. As a result, apart from awareness campaigns and corrective action, healthcare players are investing significantly on setting up diabetes management clinics and fitness centres to promote healthy living which would prevent the advent of diabetes in the long run.

Express Healthcare, in its diabetes special, showcases the examples of three leading hospitals and their measures for managing the malady which has become a serious public health concern

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‘Hospitals should focus on forming support groups for those suffering from diabetes’ Protection from pain We are investing in pain management clinic which will also focus on diabetic neuropathy a major complication in diabetic patients. Our dedicated pain management specialist will determine a comprehensive plan of care including, but not limited to, procedures such as nerve ablation. Also, we have invested in a dialysis department to provide reliable and expert care for patients suffering from diabetic nephropathy (kidney failure as a complication of diabetes.)

Fitness is the key At our hospital, our team of doctors, nutritionists and physiotherapists together manage

patients suffering from diabetes with an integrated approach.

However, in the near future we are setting up a special fitness centre managed by a qualified diabetologist. Nutritionist and physiotherapist would work in collaboration with the diabetologist at this fitness centre. Our centre would primarily focus on orientation, fitness assessments, personal exercise plans, group exercise classes, regular monitoring of blood sugar pre/post exercise etc. To begin with, the emphasis of the programme will be on type 2 diabetes which usually occurs later in life and is mostly a lifestyle disease that results from obesity and lack of exercise. Insulin may

be insufficient or the cells that take up glucose may be resistant to the action of insulin. Ultimately, the result can be the same as in type 1 diabetes, that is, a complete failure of the beta cells and insulin supply.

Trials have shown that attention to lifestyle with nutrition and exercise, and a weight loss of 7 to 10 per cent of body weight, can reverse pre-diabetes. Other than weight loss, for people with diabetes and pre-diabetes, formal exercise programmes help manage blood glucose by making insulin action more efficient and by using and enhancing the storage of blood glucose in muscle, thereby lowering abnormal blood glucose

levels. Hence aerobic exercise and strength training will be main focus of fitness centre, coupled with orientation and awareness about diabetes management and nutrition recommendation to members.

K SUJATHA Centre Head, Wockhardt Multispeciality Nagpur

Uniting to fight diabetes Hospitals should focus on forming support groups for those suffering from diabetes.

Through these groups, hospitals can educate patients suffering from diabetes in a group setting, covering diabetes self-management topics and training. Sharing success stories of those living with diabetes can inspire

HOSPITALS SHOULD FOCUS ON FORMING SUPPORT GROUPS FOR THOSE SUFFERING FROM DIABETES

Continued on page 27

‘Kohinoor Hospital aims to focus on holistic prevention and treatment plan’ KOHINOOR HOSPITAL has a Diabetes Specialities Centre offering comprehensive diabetic services. The unique selling point of this centre is Total diabetes care under one roof which treats all the problems related to diabetes that result in blindness, kidney disease, heart attacks and amputations. The aim of this centre is to provide stateof-the-art, efficient and comprehensive care at affordable costs.

The number of people with diabetes is increasing due to population growth, aging, urbanisation, and increasing prevalence of obesity and physical inactivity.

We at Kohinoor Hospital aim to

focus on a holistic prevention and treatment plan for such patients.

The treatment of diabetes at Kohinoor Hospital follows wellestablished protocols with ample scope for individualisation depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at time of diagnosis. Care is delivered by a diabetes management team comprising different cadres of staff – medical registrars, consultant diabetologist, consultant endocrinologist, dia-

betic educators – specialised dieticians , diabetic foot surgeon, ophthalmic technicians and surgeons, specialised diabetes nursing team, cardiologists, nephrologists, neurologists, bariatric surgeons, Physiotherapists, Intensivists, dental care unit and Counsellor cum stress management unit.

High level of care Comprehensive care is provided at three levels- primary, secondary and tertiary. At primary level, people with family history of diabetes and anyone with symptoms of diabetes are offered preliminary screening

with blood tests. At the secondary level, people with known diabetes are offered blood tests, urine tests, eye examination, Xray, scan, Doppler, ECG, Biothesiometry, dental and foot examination at regular intervals. The types of tests to be undergone at different intervals are presented to patients in a chart which is very informative. At the tertiary level, patients with high sugar, or with one or several of the serious complications of diabetes, are admitted in the hospital for evaluation and further management. Laser procedures and

DR RAJEEV BOUDHANKAR Vice- President Kohinoor Hospital

THE TREATMENT OF DIABETES AT KOHINOOR HOSPITAL FOLLOWS WELLESTABLISHED PROTOCOLS

Continued on page 26

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cover ) ‘Rockland hospital focuses on the promotion of preventive care’ THE GROUP organises regular weekly health awareness camps in the rural areas with the help of the village heads, RWAs and inside the factory and office complexes in the Delhi NCR. Rockland group has initiated a campaign by the name of Rockathon to promote running as a part of our lifestyle.

Over 2000 participated in a 5Kms Marathon and a 1 Km Power Run in the first event itself. Rockathon will be followed by a series of events to promote the concept of preventive healthcare through

various forms of sports, life style correction and exercising. Running benefits almost every part of the body, and costs nothing so it became the first choice for the Rockland team.

Research shows that a long period of physical inactivity raises the risk of developing heart disease, diabetes, cancer, and obesity. Human beings evolved by exploring the world on their feet so spending a full day in a chair is against our basic nature.

It's a form of physical arrest.

The Rockland team has

been propagating a simple three-step formula to stay free from diabetes: ◗ Choose whole foods and cooked at home instead of buying pre-packaged food which are high in fat and salt.

Choose a variety of yellow, red and green fruits, limit sugar intake by drinking green tea and avoid sugary drinks. This one step alone can help you lose or maintain a healthy weight and will reduce the risk of heart disease, obesity and diabetes. ◗ Walking to someone else's desk rather than sending an

e-mail, parking farthest from the building, taking the stairs more often, walking, cycling or playing with the kids and engaging in house cleaning or gardening will burn calories and give you enough exercise. ◗ To sleep well, remove the television, computers, and gadgets from your bedroom and avoid large meals before bedtime. Set firm bedtimes and wake up times. Make sure that heavy reading, text messaging, video games or social networking are restricted to mornings.

RAJIV TEWARI Director, Health & Wellness Rockland Hospitals Network

LONG PERIOD OF PHYSICAL INACTIVITY RAISES THE RISK OF DEVELOPING HEART DISEASE, DIABETES, CANCER AND OBESITY

Continued from page 25

‘Kohinoor Hospital aims to focus on a holistic prevention and treatment plan’ amputation surgeries are performed for diabetic retinopathy patients and patients with foot ulcer respectively. A team of diabetic educators take the complete diet history of patients and depending upon the diabetologist's prescription, individualised diet advice is given to the patients. We have a dialysis centre and renal transplant centre for diabetes induced end stage renal disease.

The whole process is standardised in the form of SOPs and a team of people is responsible for each area. Once the patient registers, he/she will be seen by the junior doctors for preliminary screening, followed by diabetic counsellor who takes patient history and sends them to diagnostic area where the blood samples are collected. Based on the condition, necessary examinations are done before they see the senior

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consultants. Following the consultants' advice the counsellors explains the diet procedures and follow up details to the patient. Since the work load is divided among many cadres of staff, and diabetic counsellor shares the major work of communicating to the patient, on any given day a consultant may see 20 to 30 patients.

Since diabetic retinopathy is considered one of the leading causes of blindness after cataract, Kohinoor Hospital has developed special expertise in the treatment of diabetic retinopathy under the specialised ophthalmic surgeons.

The hospital has a set of unique protocols for screening diabetic retinopathy patients. Every patient who visits the diabetic centre is advised to undergo routine eye screening. If a patient is found to have diabetic retinopathy, they will be evalu-

ated for further intervention using specialised tests. Based on the results of these tests, laser procedure is advised for the retina.

Kohinoor Hospital has state -of-the-art laboratory facilities for diagnosis. It does routine bio-chemistry investigations and performs special tests such as thyroid, insulin and C-peptide. The laboratory is equipped with auto analysers and provides round the clock service.

Since kidney disease is a wellknown complication of diabetes, Kohinoor Hospital does micro albuminuria test to diagnose this. A foot pressure measurement system is used to detect areas of high pressure under the foot which is a major cause for diabetic ulcer.

Counselling and education Diabetic counsellor is a unique cadre that is developed

at Kohinoor Hospital. Those who have completed their bachelor's degree in nutrition and diet are recruited for this.

They are given training on diabetic related diet procedures.

Their role is history taking and educating the patient on the life style changes they need to make. They explain to the patient about insulin administration, diet guidelines, self-monitoring of glucose and physical exercises. Since they do part of the consultant's job, it saves the patient's time and makes them efficient.

In addition to providing services, Kohinoor Hospital gives great emphasis on educating the patients. It has a separate department called corporate communication which is dedicated to creating awareness among the public. It educates patients through awareness camps, mass exhibitions and organises

events during World Diabetes Day and World Health Day. Apart from this, it also educates general physicians about the checkups that diabetic patients need to undergo. This will enable them to educate their patients. We publish a newsletter called “K-Lifeline” every three months which is circulated amongst the general population and is a tool for health education activities in general.

Focus on fitness Our physiotherapists run a specialised fitness centre for controlling diabetes and other life style diseases. It guides patients on the type of exercises that are individualised for specific needs of the patient.

In addition, we have a “Fit Friday” every week where anybody can walk in and avail of free consultation advice and diagnostic tests.

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HOSPITALS SHOULD ALSO SET UP NEIGHBOURHOOD SUGAR CLINICS EQUIPPED WITH NECESSARY EXPERTISE, DIABETOLOGIST, NUTRITIONIST, PHYSIOTHERAPIST, DIABETES EDUCATORS AND TECHNOLOGY Continued from page 25

‘Hospitals should focus on forming support groups for those suffering from diabetes’ other diabetics and encourage them to fight the disease and not succumb to it.

Hospitals should also set up neighbourhood sugar clinics equipped with necessary expertise, diabetologist, nutritionist, physiotherapist, diabetes educators and technology. These clinics should focus on individually-tailored customer profile including annual

assessment, as well as plan of care including lifestyle and diet modifications. To go a step further, the hospitals can engage employees suffering from diabetes to work at these clinics.

Utilising technology effectively With technology increasingly impacting our lifestyle we strongly believe in utilising it

effectively to not only treat but also for prevent diabetes.

Hospitals, in association with pharma companies, can design smartphone applications to help people make healthy lifestyle choices at home or on the job so that they can effectively manage the various aspects of diabetes. It is of utmost importance to customise these apps to suit In-

dian culture and food habits.

These apps can also help keep track of not only blood glucose levels but also carbohydrates, medication doses and exercise. They can also help educate about nutritional value or calorie counts of foods you eat at home or at restaurants. Exercise being a key component of lifestyle modification, the apps can

also help keep a track on the amount of calories burnt.

Children can be engaged by designing interactive games through which they can learn about carbohydrate counting and living with diabetes. Hospitals should design an interactive diabetes website to help support people who have diabetes and their family and friends.

cover ) INSIGHT

The nexus between diabetes and CVD

DR AJIT MENON Sr Interventional Cardiologist attached with Lilavati Hospital, Breach Candy Hospital and Wockhardt Hospitals

Dr Ajit Menon, Sr Interventional Cardiologist attached with Lilavati Hospital, Breach Candy Hospital and Wockhardt Hospitals, explains about the axis between diabetes and CVD while giving pointers on how to handle CVD patients with diabetes

V

ery innocuous chest pain caused by exertion, led 42 year old Raman to consult a cardiologist. His cardiologist asked him to undergo various investigations, the results of which came as a bit of a shock to him. His blood glucose levels were high and the stress test was positive. Further tests including coronary angiography revealed that two of his major arteries had severe disease and he had to undergo a multi vessel angioplasty which he chose as a treatment option. He was one of the many patients who suffered with a cardiovascular patient along with Type 2 Diabetes Mellitus.

Post a successful angioplasty, Raman now leads a normal healthy life.

Cardiovascular disease (CVD) is currently the leading cause of death globally. The ubiquity of smoking, obesity, diabetes, and hypertension has been gradually escalating, and is thought to be the driving influence behind the epidemic of heart disease faced today. India has the second highest number of diabetic patients in the world – a staggering figure of 67 million with another 30 million in pre-diabetes group and this is projected to increase further by the year 2030 positioning India on the number one pedestal. Indians tend to be diabetic at a relatively young age of 45 years which is about 10 years earlier than in West.

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There are an estimated 55 million patients of coronary artery disease in India. An increasing number of young Indians are falling prey to coronary artery disease. One fifth of the deaths in India are from coronary heart disease. By the year 2020, it will account for one third of all deaths

There are an estimated 55 million patients of coronary artery disease in India. An increasing number of young Indians are falling prey to coronary artery disease. With millions hooked to a roller-coaster lifestyle, the future looks even grimmer. One fifth of the deaths in India are from coronary heart disease.

By the year 2020, it will account for one third of all deaths. Sadly, many of these Indians will be dying young.

CVD, one of the most common non-communicable diseases, have become a major health concern in many developing countries including India. It affects many people at midlife, as well as in old age. It can also happen to those who "feel fine."

The majority of CVD is caused by risk factors that can be controlled, treated or modified, such as high blood pressure, cholesterol, overweight/ obesity, tobacco use, lack of physical activity and diabetes.

And every risk factor counts.

Research shows that each individual risk factor greatly increases the chances of developing heart disease. Moreover, the worse a particular risk factor is, the more likely you are to develop heart disease. For example, if you have diabetes, the higher it is, the greater your chances are of developing heart disease, including its many serious consequences.

According to statistics CVD is a major complication of dia-

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betes and the leading cause of early death among people with diabetes. Adult diabetics are two to four times more likely to have heart disease or suffer a stroke than people without diabetes and about 65 per cent people with diabetes die from heart disease and stroke. Indians have an increased susceptibility to diabetes which can be attributed to genetic factors as well as environmental factors.

In addition to several features of urban life such as physical inactivity and unhealthy dietary practices, outdoor and indoor air pollution tend to increase the prevalence of diabetes and CVD also in urban India. The association between physical inactivity and obesity and the prevalence of diabetes has been established.

Despite these statistics, nearly 70 per cent of the people living with diabetes aren't aware that they are at an increased risk of heart attack and stroke. Further, there are several misconceptions about the “diabetes – CVD” connect that increases ones risk of heart disease manifolds. One such misconception is “Diabetes won’t threaten my heart as long as I take medication”.

But the truth is that treating diabetes can help reduce your risk for or delay the development of cardiovascular diseases. But even when blood sugar levels are under control, it can still increase your risk for heart disease and stroke. That’s because the risk factors that contribute to diabetes onset also make one more likely to develop cardiovascular disease.

These overlapping risk factors include high blood pressure, overweight and obesity, physical inactivity and smoking.

To further add to the complications, the risk of death due to myocardial infarction is three times higher in diabetics as compared with non-diabetics. Adult diabetics are two to four times more likely to have heart disease or suffer a stroke than people without diabetes.

About 65per cent people with diabetes die from heart disease and stroke. This occurs

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DIABETIC PATIENTS IN INDIA. THE SECOND HIGHEST NUMBER OF IN THE WORLD

MILLION

55

MILLION

PATIENTS OF CORONARY ARTERY DISEASE IN INDIA

65

PER CENT

Adult diabetics are two to four times more likely to have heart disease or suffer a stroke than people without diabetes and about 65 per cent people with diabetes die from heart disease and stroke because of damage to the circulatory system from elevated blood sugars along with high blood pressure and abnormal blood cholesterol and fat metabolism.

Diabetics have multiple comorbidities. The cardiovascular disease patterns are different in them. They have much more long vessel disease, diffuse disease and smaller arteries. The result of this is difficult treatment options and more often than not, angio-

plasty has a very high rate of recurrence/failures.

But with the advent of newer drug eluting stent, especially the Resolute Integrity, the first and only FDA approved drug eluting stent for use in diabetics; angioplasty has become a preferred choice of treatment for many diabetics. As diabetic patients have special needs since the vascular anatomy is different, Resolute Integrity has come across as a boon to these patients in

terms of granting them excellent long-term results.

Resolute Integrity is exceptionally easy to navigate through the coronary vasculature to the narrowed arterial segment that requires treatment, as already mentioned the arteries of the diabetics may be more tortuous and smaller and therefore difficult to navigate through for the operating surgeon. Also it is biocompatible biolinx polymer, which is used to bind the drug

PEOPLE WITH DIABETES DIE FROM HEART DISEASE AND STROKE

to the stent achieves an extended 180 day drug elution, thereby meeting the longer healing time requirements of the diabetic patients. Resolute Integrity, because of its continuous sinusoidal technology is very flexible and more deliverable as compare to many other drug stent available.

Diabetes and CVDs share an evil axis and the only way to control this is by understanding the complications and making healthy choices.

Whatever the age or current state of health, it's never too late for people to take steps to protect their heart. It's also never too early. The sooner you act the better. So, people should find out more about the state of their heart, learn about heart healthy living, and start taking action to improve their heart health today.

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cover ) INSIGHT

Overpowering diabetes with preventive healthcare

RICHIN BHANDAVAT Marketing Manager, Point of Care Business Unit, Siemens Healthcare, India

Richin Bhandavat, Marketing Manager, Point of Care Business Unit, Siemens Healthcare, India, explains how preventive healthcare could be key to curbing diabetes in India and explains the importance of tests like A1c to track people in the pre-diabetic stage and take remedial measures to prevent these patients from developing the disease

I

n India, about 63 million people are suffering from diabetes and this figure is likely to reach touch 80 million by 2025. Additionally, there exists a huge population in the pre-diabetic stage - a condition in which patients have high blood glucose level, but are not in the diabetes range. These people are at high risk of getting diabetes.

However, with the proliferation of technological developments, early diagnosis of this pre-diabetic state can give an indication if the patient is at risk and course correction can be done immediately to reverse the impact of this disease state. A test known as A1c can work wonders for pre-diabetic patients, to diagnose the risk level of getting diabetes.

A1C GOALS FOR PATIENTS WITH DIABETES Patients with diabetes should keep HbA1c levels below seven per cent to minimise the risk of diabetes complications. However, each patient is different and physicians will set the appropriate HbA1c goal.

There are many side effects if diabetes is left undiagnosed, untreated, or poorly controlled.

These can include: ◗ Increased risk of heart disease and stroke ◗ Circulation problems and nerve damage, particularly in the feet ◗ Foot ulcers and complications that can lead to amputations ◗ Vision problems that can lead to blindness ◗ Increased risk of kidney disease and kidney failure

What is A1c testing?

A1c is a simple test that can help to diagnose and control diabetes. The test measures an important diabetes indicator in blood called haemoglobin A1c (HbA1c). Patients with diabetes are advised to check their blood sugar at different times of the day, which is an easy and relatively cost-effective way to manage diabetes.

In reality, blood-sugar levels change from minute to minute causing difficulty to gauge overall control using standard blood glucose meters. Many physicians thus, prefer to periodically check HbA1c levels.

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With in-office testing and just one drop of blood, HbA1c tests can accurately measure overall blood glucose levels with immediate availability of test results. It is not only an important measurement for diagnosing diabetes, but can also be used for overall management of the disease. The biggest advantage with HbA1c testing is that it can be conducted any time and requires no patient preparation, unlike fasting plasma glucose (FPG)

measurements, where it’s necessary to fast at least eight hours prior to testing.

How does it work?

The HbA1c test measures the amount of sugar (glucose) that binds to haemoglobin. When a patient’s blood-sugar levels are consistently high, excess glucose molecules have the opportunity to attach to hemoglobin cells. These so-called glycated haemoglobin proteins stay in the body for the life of

DIABETES FAST FACTS: ◗ An A1c test measures a patient’s average blood-sugar levels over the preceding three to four months! ◗ You don’t get diabetes from eating too much sugar. Genetics and culture, as well as obesity and lack of exercise, can play influential roles in diabetes risk.

the red blood cell (about three to four months). Since it acts as a long-term indicator, glycated haemoglobin is a valuable gauge for diagnosing and managing diabetes.

HbA1c testing at the point of care Benefits of point of care tests are umpteen, for both patients and physicians. These tests help save valuable time by consolidating patients’ visits.

On the other hand, especially with A1c tests, physicians can avail results in minutes, immediately review them and discuss necessary adjustments to treatment plans. Moreover, only a single measurement is needed during HbA1c testing, as opposed to blood glucose testing, which involves serial blood draws over several hours.

Notably, in-office diabetes testing is expanding, considering the increasing incidences of diabetes in India. Very recently the medical community has recognised HbA1c’s clinical utility in the disease diagnosis, with convenience cited as a significant patient advantage.

HbA1c testing though commonly used to manage diabetes patients; it still needs more popularity in the physicians’ community.

REFERENCES 1. http://www.diabetesfoundationindia.org/

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I N T E R V I E W

‘85 per cent of all amputations due to diabetes are preventable’ Diabetic foot ulcers precedes 84 per cent of all diabetes-related lower-leg amputations and require specialised care. Anand Shirur, CMD, South Asia & China, ConvaTec, explains about the need for effective wound management services to bring in a new paradigm in diabetic foot care, in an interaction with Lakshmipriya Nair

What are the steps to improve diabetic foot ulcer management in India?

According to a recent WHO report on diabetes and associated ailments, five per cent of all diabetics’ patients are prone to foot ulcers every year. 30 per cent of the diabetics get admitted in hospitals for diabetic foot and the number of days spent by these patients in hospitals are more than the days spent due to all other complications. A diabetic patient is always prone to a foot ulcer but regular care must be taken to avoid such critical situations.

A regular foot check up especially of the plantar area (foot sole), keeping the foot dry, using proper footwear, checking for vascularity and neuropathy are few measures which help in preventing an ulcer. It was estimated that an ankle is lost to diabetes somewhere in the world every 30 seconds; however, a more important fact is that up to 85 per cent of all amputations due to diabetes are preventable. Diabetic people with one lower limb amputation have a 50 per cent risk of developing a serious abrasion in the second limb within two years.

How is wound care in diabetic patients different?

Wound care, specially, chronic wound care, needs to be handled aptly for correct

resolution of condition. In the current scenario, most of the foot ulcers are detected at very advanced stage. The key challenge in this case is to restore vascularity in the affected area to help promote healing of wound and recover the toe or affected area. It is vital for the patient to be put on an advanced treatment protocol that will include timely detection of the ulcer, usage of appropriate advanced wound care dressings like the ones with hydrofiber technology offered from ConvaTec, proper diet and oral medications, and regular checkups.

How can ConvaTec Wound Management Center help to streamline wound care?

Our “Advanced Wound Care Center” is a ray of hope for patients suffering from foot and limb associated diseases. Amputations and complications are preventable, as long as appropriate diagnosis and management is done at the right stage. With the launch of this clinic we aim to educate patients and reduce these complications.

The centre’s wound management plan includes a standardised record of clinical assessment and etiology of the wound. The model of care would be to apply a stepwise approach implementing advanced wound management

by addressing the underlying factors which could influence the potential for wound healing.

An ankle is lost to diabetes somewhere in the world every 30 seconds modalities as a part of the wound care algorithm. All aspects of care from initial presentation to treatment and evaluation would be documented. Following assessment, treatment goals would be agreed with the patient and a time frame would be fixed for the achievement. Holistic and all round care as well as treatment would be ensured

What are the major challenges in diabetic foot ulcer management?

The immediate major challenge for diabetic foot ulcer management is the stage at which it is being detected.

The shift should be to move towards the prevention of diabetic foot ulcers in all diabetic patients. To be able to achieve this, a much higher level of awareness needs to be instilled in the population prone to this condition.

Continuous improvement and ongoing patient education is a definite need of the hour.Only with awareness and education can there be an early intervention to prevent foot deterioration. The other major challenge, which has surfaced in the past few years, is the lack of a dedicated centre to diagnose/treat such wounds. Most patients are unsure where to go when it comes to such chronic conditions. By the time they do the rounds of some centres and end up in a right one, they would have done considerable damage to the already ailing foot.

How will ConvaTec play a role in DFU management?

ConvaTec is a global MNC dealing with innovations in the

field of advanced wound care management. With the help of its own patented Hydrofiber technology, the company is manufacturing and marketing dressings worldwide aiming to heal exudating and difficult to heal chronic wounds. As already highlighted, lack of awareness, a proper treatment centre etc. are big challenges in the Indian market for diabetic foot ulcer.

ConvaTec has world class dressing to offer. In India, it is also a pioneer who has introduced the concept of an advanced wound management centre. In the year 2013, the first centre was launched in the Narayana Health City, Bangalore Campus in collaboration with the vascular sciences department of the hospital. The second such centre was recently set up in association with the M.S Ramaiah Memorial Hospital, Bangalore. These centres aim at providing a dedicated facility for all such major chronic wounds. They also provide diagnostic and treatment capacities and are manned by well trained nurses and experienced consultants to aid the process of prevention and healing of wounds. These centres also look at bridging gaps like the the lack of awareness and treatment options for patients with diabetic foot ulcer condition. lakshmipriya.nair@expressindia.com

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STRATEGY OPINION

Quid pro quo healthcare In India can there be transparency around the financial relationships of manufacturers (pharma products and devices), physicians, and hospitals? Are the Indian physicians willing to disclose payments they receive from pharma and device manufacturers?

Industry answers these tough questions

By M Neelam Kachhap

F

rom the time Open Payment database went online in the US, debates on the financial relationships among doctors and industry have erupted everywhere. In India, The Indian Medical Council (professional conduct, etiquette and ethics) regulations, 2002 guides the relationships of manufacturers (pharma & device), physicians and hospitals. Despite the blanket ban on accepting gifts, travel facilities and hospitality from pharma companies in lieu of promoting their products perpetrators find ways to flout the norms.

While the interaction among pharma and device manufacturers and medical practitioners have always been opaque in India, the industry is clearly rooting for greater transparency in its financial relationships. We asked the industry if there can be transparency around the financial relationships of manufacturers, physicians, and hospitals and almost everyone replied in an affirmative.

But how can it be achieved and should it be made public is an idea the industry is grappling with.

Experts believe that greater transparency might influence patients’ trust in their doctors. It may also influence the patients’ perceptions of their doctor’s expertise and patient decision-making with regard to selection of a hospital might be affected. Like the issue of

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ANOOP MISRA What is an Open Payment Database?

The Open Payments database is an implementation of the Physician Payment Sunshine Act (PPSA), passed as part of the Affordable Care Act in 2010, requires manufacturers of drugs, devices, biologics, and medical supplies to track and report “all transfers of value”to physicians or teaching hospitals.

MCI Guideline on Payments The amendment to the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation 2002”has brought out the code of conduct for doctors and professional association of doctors in their relationship with pharma and allied health sector industry which prohibit them from accepting any gifts, travel facility or hospitality, from any pharma company or the healthcare industry.

black money in India, the issue of transparency in financial dealings in the healthcare industry should be considered serious and dealt with an iron hand. The industry experts share their views.

device), physicians, and hospitals. All markups, which Chairman, Fortis-C-DOC are required and pricing of Centre of Excellence for Diabetes, Metabolic Diseases devices as charged by the and Endocrinology; hospitals must be clearly Chairman, National Diabetes, displayed and informed to Obesity and Cholesterol the patients in advance. All Foundation (N-DOC); Director, Diabetes and payments as per MCI and Metabolic Diseases, Diabetes international norms (e.g.

Foundation (India) (DFI) honorarium, consultancy with manufacturers, company) should be revealed at appropriate places there is Yes, there should be scope for law like the US and there can be trans- Physician Payment Sunparency around the finan- shine Act (PPSA) in India. cial relationships of manu- Indeed, a law like this is esfacturers (pharma & sential for India to curb un-

savoury practices. Honorarium, travel payment, payment for conferences, any expensive gifts or favours should all be listed in an open payment database.

punishments for doctors who accept gifts worth Rs 1,000 from any pharma or allied healthcare company instead of a total ban including one on research projects. The punishments range from censure (for accepting gifts valued between Rs1,000 and Rs 5,000) to removal from the Indian or State Medical Registry for more than one year (for accepting gifts worth more than Rs 1,00,000).

The only issue is its strict implementation. We in India are not allowed to accept any gift travel etc. from pharma companies, even sponsorship for conference is not permis-

sible. So the only way pharma companies oblige physicians is by enrolling them as researcher/consultant for providing post usage inputs. We already have strong MCI guidelines but as in every country people find ways to manage the law.

DR HIMANSHU BANSAL Scientist Spinal Cord Neurodegenerative Disorders & Stem Cell research Mothercell-StemCell Research & Solution, Uttrakhand

In India, we already have strong guidelines by MCI. Indian Medical Council (professional conduct, etiquette and ethics) Regulations, 2002, was amended in 2009 and later in 2010 where MCI has suggested various degrees of

DR ANIRUDDHA MALPANI Medical Director,HELP– Health Education Library for People

YES, OF COURSE THERE can and there should be transparency around the financial relationships of manufacturers (pharma & device), physicians, and hospitals. After all, this was the norm until a generation ago.

This secrecy was introduced in order to hide underhand dealings and has gone completely out of hand. It has spread like a cancer. Sadly, it has become the norm, and distorts the care patients get today. The healthcare system has become sick because of these distorted incentives, and we need to heal the

system.

Manufacturers use medical representatives to try to influence doctors to prescribe their products. Sadly, because so many of the products are “metoo” products, they are forced to resort to bribes in order to persuade the doctor to prescribe their brand. Rather than spending money on innovation, the companies find it much easier and more lucrative to bribe doctors for prescriptions. Targets are set for medical representatives, who believe that the only way they can succeed is by giving the doctor whatever he demands.

Companies are extremely smart and they are very clever at disguising these bribes as “educational grants” or “payment for travelling abroad to attend medical conferences.”

They manipulate doctors and these payments lead to unethical behaviour on the part of medical professionals.

The ones who are ashamed of the money they receive will refuse to disclose these payments. They know that they are guilty and their conscience pinches them, but they are smart and are able to rationalise their behaviour. A common justification is – “After all, if the senior doctors do it, why shouldn’t I ? I’d be a fool to refuse this easy money."

Yes, there is scope for a law like the US Physician Payment Sunshine Act (PPSA) in India

and because medical corruption is so much more prevalent in India, we should implement a similar measure to encourage honesty. Good doctors will appreciate a law like this.

If a database of payments were created in India what would show that often it’s the most respected doctors – the “KOLs or knowledge opinion leaders” – who are the ones who take the most money from pharma. After all, they have the most clout, which is why pharma wants to pander to them. This list would literally be a “ Who’s Who” of Indian doctors – and would feature many who are extremely influential, and are considered to be the leading lights of the medical profession.

The Indian healthcare system has become sick and openness and transparency can be powerful healing measures. Indian patients deserve a better deal!

DR ALOK ROY

SAMAR KHAN

Chairman, Medica Group

Managing Director, Brainlab India

We must strive for transparency around the financial relationships of manufacturers (pharma and device), physicians, and hospitals. This alone can bring significant cost reduction to the payers It is highly unlikely that Indian physicians will be willing to disclose payments they receive from pharmaceutical and device manu-

Yes, I strongly think there can be transparency around any relationship the industry has with the physicians and the hospitals and I would strongly advocate for the same. This would bring the trust of the patients back into the system as other than a few stray cases here and there which bring a lot disrepute to the whole healthcare industry, the primary aim of all the constituents of the industry is the well-being of the patients.

Any step that can make it more transparent and fix accountabilities is always welcome and would help in further providing a growth impetus to the industry by giving it the much needed credibility which is getting affected due to a few outliers in the industry.

practice is so rampant that the protocols can be implemented only through laws, constant monitoring and penalties. It will be a long drawn process.

To begin with, Association of Healthcare Providers (India) is working on a code of ethics which will be promoted as self-regulating code, which will require them to desist from taking any cuts or commission. The practice is so deep rooted that physicians’

willingness or acceptance could be implemented only through law. AHPI is making members conscious of the growing perception among society that the healthcare sector is prone to unethical practices and is urging the industry to take proactive measures against it. There is certainly scope for a law like the US Physician Payment Sunshine Act (PPSA) in India. It is probably the only means to clean up the system.

facturers? Yes there must be scope for a law like the us physician payment sunshine act (PPSA) in India. Significant transactions of monumental size across India would be revealed if a database of payments were created in India

DR GIRDHAR GYANI Founder Director General Association of Healthcare Providers (India)

India certainly can work towards implementing transparency protocols around the financial relationships of

manufacturers (pharma and device), physicians, and hospitals.

However, currently the cut-

KULDEEP TYAGI Global Head of Medical Practice, Cyient

Yes, in India there can be transparency around the financial relationships of manufacturers (pharma and device), physicians, and hospitals. This is expected and should be there. However, it all depends on how strictly you enforce the law. The law should not lacks teeth and should not have loopholes and should be legally binding on companies.

There seems to be good paper work with Western organisation since they follow their global policies and try to enforce the same in India. I am not really aware of the practices followed by local manufacturers. But again, since there is a ambiguity in law. It may be hard to measure the effectiveness.

I don't think there is any system where public can see payments doctors' receive from manufacturers. There is hardly any transparency. But for an Indian patient to decide on the treatment or doctor based on their ethical behaviour may be a little futuristic at the moment.

Yes. There is scope for a law like the US Physician Payment Sunshine Act (PPSA) in India. If a database of payments were created in India it would reveal payer, receiver and amount and what is the reason for payment at a minimum. There is further need to frame new rules to deal with other corrupt unethical practices like cuts/commissions to doctors for referring cases.

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STRATEGY DR NANDAKUMAR JAIRAM Chairman and Group Medical Director, Columbia Asia Hospitals, India

There needs to be transparency around the financial relationships of manufacturers (Pharma & Device), physicians, and hospitals; this can be the only way of ensuring sanctity to the delivery of health. Appropriate direction from regulating bodies can achieve this. Mandated disclosure is the only way to achieve this.

VINEET KAPOOR MD, Inhx Indian Healthcare Exchange

I think that transparency is a credible means to create accountability in healthcare delivery. It has a clear bearing on both prescribing and purchasing habits which in turn impact patient care and safety.

Can we do this in India? Yes. There is nothing that can stop this. Ethical business rules find

DR KAREN MARLYN SYIEM Principal Consultant, Integra Ventures, Guwahati

Financial transparency would definitely be a good option for India and would help in ethical and compliant functioning and relations between manufacturers (pharma and device), physicians, and hospitals.

However, we do not see such mature relationship amongst the stakeholders in the current

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Sponsorship by pharma industry towards achieving improvement in skills, and knowledge of physicians can only help

their place in every ecosystem provided there is political will for the same. Will they get enforced in the true form is the real question.

Pros: Will make it difficult to break the rules - will not stop until a more holistic multipronged approach is adopted.

Cons: It may add to the cost of doing business in India and may lead to more cost being passed on to the customer.

Supplier-provider/physician interactions follow a similar pattern across the world. But like the traffic on the road, more developed the healthcare ecosystem, it has more rules that make it more organised with lesser tolerance for breaking the rules. Scope for breaking the rules is higher in emerging markets due to possibilities of

scenario and as with most other industries it may not happen in the very near future.

The pharma and device manufacturers are in a very competitive sector and are sales/revenue driven organisations. In their quests to ensure top/bottom lines, many a times due to pressure the companies or employees acting independently may have turned to gift distribution/cheque distribution to put it very mildly. On the other hand poor pay/income and no proper standardisation of the healthcare practitioners/ sector in the country may have driven the physicians to ac-

improve patient care, however malpractice can be garbed and misuse of such financing is and will be rampant. Therefore disclosure to regulatory authorities, authorities at work and patients is the best solution.

Stringent measures to ensure that disclosures are complete and unrestricted; powerful punitive action for failed disclosures are obviously a corollary.

Some percentage of Indian physicians would be willing to disclose payments they receive from pharma and device manufacturers, the rest would be unwilling. But that should not be a deciding factor; mandating

such disclosures is the need of the hour.

Absolutely, there is a scope for a law like the US Physician Payment Sunshine Act (PPSA) in India. There is a huge opportunity to clean up the system by introducing such laws with due modifications for the Indian context.

If a database of payments were created in India it would differentiate ‘clean’ from ‘unclean’. I can assure you there is a sect of providers and doctors who are clean, however there is equally a group that is not. Exposing the latter is necessary and will only do good to all concerned.

breaches in accountability in the overall business environment - black money (cash dealings) being a key area to state in this case in India. This is aided by the unorganised channel of small dealers to go to market, who bridge the compliance re-

quirements of the foreign parent (FCPA or the like) and the local realities to serve the needs of customer relationships. Currently, compared to Indian regulators, there is more enforcement in India due to compliance requirements like FCPA (or similar) of the MNCs doing business in India.

Hence, to start, absolute enforcement may be challenging in the Indian context - as a large part of this will either escape reporting or be masked under alternate expense heads. But either ways, it will be a welcoming step. Counter controls can be set-up by strengthening the healthcare supply chain to correlate patronage of drugs and devices with possible financial relationships between suppliers and providers.

cept/demand such relationships. Minimal or no regulations regarding such relationships may be another contributing factor.

I am not sure if Indian physicians will come out clean to disclose all payments received directly or indirectly.

Proper regulations and standardisation will be required before implementation of such laws (like the US Physician Payment Sunshine Act) in the Indian setting. Also proper implementation and ensuring control to prevent misuse of the law need to be in place.

If a database of payments

were created in India it would it reveal a Pandora's box and better left at that. For creation of such a database we need to ensure proper legislation and ensure bringing physicians, physician associations, pharma/device industry, hospi-

DR ARJUN KALYANPUR CEO, Teleradiology Solutions

Yes there can be transparency around the financial relationships of manufacturers (Pharma & Device), physicians, and hospitals in India. Typically pharma and device manufacturers interact with physicians through sponsorship of educational activities and CME programmes.

I can't really speak for all physicians. Presumably if there was a law requiring discloser of payments then Indian physicians would be willing to disclose payments they receive from pharmaceutical and device manufacturers.

There is always a scope for regulation, however what ultimately matters is how the regulation is enforced.

tals and healthcare institutions, insurers/TPAs/Payors under one department/ministry. Currently each of them function under different structures which gives rise to ambiguity of regulations which may be one of many loopholes to the functioning of physician-industry interactions.

Current tightening of certain regulations/guidances – e.g. clinical trial participation, video recording of consent, MCI guidance on accepting gifts, foreign travel by physicians, OPPI guidance etc., may have been deterrents but these need to be consolidated.

SOM PANICKER VP, MRI Division, Sanrad Medical Systems

In India can there be transparency around the financial relationships of manufacturers (Pharma and Device), physicians, and hospitals? My answer is a big 'Yes�, as every human being like the quality of being honest, and keep good qualities of having good integrity and character. Like corruption, it is a social evil and doctors are no exception and

perhaps there are more temptation or opportunity for those have an extra need or greed.

Good civic sense and education and social obligation will make any citizen to follow ethical practices and surely a majority of Indian physicians can follow the same. Presently, I do agree lot of trade practices are happening in India which are considered as normal but ethically wrong and can fall within the definition of corrupt practices.

It is not just the responsibility of pharma companies or medical device manufactures to correct and clean the system. If everyone work towards ethical

and non corrupt practices it is achievable just like removing corruption from politics. Today the way of interaction involves lot of trade fares, marketing visits, free samples, incentives, travel facilities, sponsorships etc. which are considered part of promotional activates and many times no one defines it as unethical.

I am sure only a small section of people accept unethical norms and they can be brought back to the main stream and government can make strict guidelines for ethical trade practices and value based medical business.

I think eventually we need to make a law very similar to what US is doing and it will slowly but surely pick up momentum. Common man wants

ASHOK K KAKKAR Senior MD, Varian Medical Systems International India

Can there be transpar ency around the financial relationships of manufacturers (pharma & device), physicians, and hospitals? Why not, provided there is a strict law in this regard that is enforced as well. Recently MCI has tried to bring in regulations that restrict such financial transactions between vendors and HCPs, but then they don’t have the mechanism to check and

THERE IS NOT ONLY SCOPE FOR A LAW LIKE THE US PHYSICIAN PAYMENT SUNSHINE ACT (PPSA) IN INDIA, BUT DIRE NEED TO HAVE ONE IF WE HAVE TO WEED OUT CORRUPTION FROM THE HEALTHCARE SPACE enforce the same unless they receive specific complaints with adequate proofs.

It is difficult to generalise how pharma and device manufacturers interact with physicians, as many companies follow stringent ethical norms while there are others who compromise and offer in-

DR PURSHOTAM LAL Chairman and Director, Interventional Cardiology, Metro Group of Hospitals

There can be transpare ncy around the financial relationship of manufactures of pharma and devices, physicians and hospitals. The pharma and the device manufactures interact with the physician through their representatives directly. The physicians in India should be willing to disclose payments they re-

ceive from pharma and device manufactures as per the ethics. There is scope for a law like the US physician payment sunshine act in India suitable to Indian condition. The database of payments will reveal the nature and extent of financial relationship among all the three stake holders (manufactures of pharma and devices,

centives to the HCPs as quid pro quo for favourable recommendations/purchase decisions.

Very much doubt that Indian physicians would be willing to disclose, but if there is strict regulations then suppliers can be mandated to dis-

physicians and hospitals), waste full healthcare spending and inappropriate influence on research, education and clinical decision making. There should be an appropriate frame work to include all the payments made directly to physicians and teaching hospitals, also the payments made indirectly to the physicians and teaching hospitals and payments made to third party by designated physicians or teaching hospitals. This will provide financial probity, transparency and all round growth of the health sector and will make the healthcare affordable and serve healthcare needs of the suffering mankind.

close. Problem is most of these transactions happen in cash, hence difficult to trace.

There is not only scope for a law like the US Physician Payment Sunshine Act (PPSA) in India, but dire need to have one if we have to weed out corruption from the

a system corrupt free and ethical dealings and any civil society will eventually accept it as the best form to have an equal justice honest system.

If a database of payments were created in India. It can be the same effect like Income Tax Department reveals the names or deals which requires explanation or legal action but revealing such information do not generalise a system or point out everyone is part of such unethical system.

healthcare space. It should however not be limited to interactions between vendors and HCPs but also extended to interactions between say HCPs and diagnostic centres or clinics/nursing homes/hospitals etc. There is lot of internal referral that goes on within the HCP community which also hikes patient charges.

It is impossible to create a database given mostly these are cash payments or benefits passed on in terms of free international trips etc. But one thing is sure, if this malpractice is curtailed it can bring down the price of drugs, medical devices and patient diagnostics and treatment costs.

DR SUJIT CHATTERJEE CEO, Dr L H Hiranandani Hospital

Yes there can be transparency around the financial relationships of manufacturers (pharma & device), physicians, and hospitals but very difficult under these circumstances.

There is no legislation in our country and hence no transparency.

If the Government has the

will, there is scope for a law like the US Physician Payment Sunshine Act (PPSA) in India.

If a database of payments were created in India, firstly there needs to be a statute that the disclosure is compulsory like IT return. Then it would be very effective. But till then it's wishful thinking.

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STRATEGY INSIGHT

Maintaining financial health of a hospital Dr Param Hans Mishra, Medical Superintendent, Indian Spinal Injuries Centre, outlines strategies to generate good revenue in a hospital and make it financially sustainable

I

t is daunting task for all CEOs and CFOs to generate and increase revenue with efficient services. However, good revenue generation and financial health of institutions give enough leverage to start new facilities, opt for better technology, recruit of better manpower, marketing etc. It is also a part of many CEOs, CFOs appraisal. Many hospitals pay their employees with minimum guarantee and shares are linked to their performance.

There may be many ways of increasing the revenue but following are the ways of maintain the health of any hospital in good shape without indulging in any kind of unethical practices:-

to multitask than one person just doing only one kind of work. Then they can be utilised for many works in case of any crisis or if any employee leaves the job.

The procedure for employment is as follows: ◗ Analysing the current manpower inventory ◗ Making future manpower forecasts ◗ Developing employment programmes ◗ Design training programmes ◗ Easing off redundant manpower

Need for manpower planning

Manpower planningBe lean and mean With increasing cost of manpower, 30-40 per cent of revenue goes into it. Manpower planning is also called as human resource planning and consists of putting the right kind and right number of people in the right place at right time, doing the right things i.e. for which they are suited. Human resource planning has an important place in the arena of corporatisation.

It has to be a systems approach and is to be carried out through a set procedure.

Many organisations tend to get influenced by referrals for promotions and appoint very

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senior people for each post without adequate focus on middle level management who are actually the working hands of the organisation. Senior people are usually retired or past their prime. They do not have the same zeal to work

hard yet come at a high cost.

Hence, we should be careful in appointing seniors, especially in areas which require lots of dynamism. In fact, HR and Management should focus on appointing more working hands to provide good serv-

ices. If the experience of seniors is so vital and indispensable for the organisation, they should be appointed on minimum guarantee or fees for service basis. If they are good enough, they will earn enough.

Manpower should be trained

Manpower planning is a two-phased process because it not only analyses the current human resources but also makes manpower forecasts and thereby draw employment programmes. Manpower planning is advantageous to firm in the following manner: ◗ Shortages and surpluses can be identified so that quick action can be taken wherever required. ◗ All the recruitment and selection programmes are based on manpower planning. ◗ It also helps to reduce the labour cost as excess staff can be identified and thereby overstaffing can be avoided. ◗ It aids to identify the available talents in a concern and accordingly training programmes can be chalked out to develop those talents. ◗ It helps in growth and diversi-

STRATEGY fication of business. Through manpower planning, human resources will be readily available and they can be utilised in the best manner. ◗ It helps the organisation to realise the importance of manpower management which ultimately helps in the stability of a concern.

Steps in manpower planning Analysing the current manpower inventory: Before a manager makes a forecast for manpower, the current manpower status has to be analysed wherein the following things have to be noted: ◗ Type of organisation ◗ Number of departments ◗ Number and quantity of such departments ◗ Employees in these work units Once these factors are registered by a manager, he goes for the future forecasting.

Making future manpower forecasts: Once the factors affecting manpower forecasts are known, planning can be done for future manpower requirements in several work units. The manpower forecasting techniques commonly employed by the organisations are as follows: ◗ Expert forecasts: This includes informal decisions, formal expert surveys and theDelphi technique. ◗ Trend analysis: Manpower needs can be projected through extrapolation (projecting past trends), indexation (using base year as basis), and statistical analysis (central tendency measure). ◗ Work load analysis: It is dependent on the work load in a department, branch or a division, and future expansion. ◗ Work force analysis: Whenever production and time period has to be analysed, due allowances have to be made for getting net man-

Relationships in an organisation become strong through effective control, clear communication, effective supervision and leadership

power requirement. ◗ Other methods: Several mathematical models, with the aid of computers, are used to forecast manpower needs like budget and planning analysis, regression and new venture analysis. ◗ Developing employment programmes: Once the current inventory is compared with future forecasts, the employment programmes can be framed and developed accordingly. It will which will include recruitment, selection procedures and placement plans. ◗ Design training programmes: These will be based on the extent of diversification, expansion plans, development programmes, etc.

Training programmes would depend on the extent of improvement and advancement which would take place in technology. It is also done to improve upon the skills, capabilities and knowledge of the workers.

Importance of manpower planning ◗ Key to managerial functions: The four managerial functions, i.e., planning, organising, directing and controlling are based upon the manpower. Human resources help in the implementation of all these managerial activities. Therefore, staffing becomes key to all managerial functions. ◗ Efficient utilisation: Efficient management of personnel becomes an important function in the industrialised world of today. Setting of large scale enterprises requires management of large scale manpower. It can be effectively done through staffing function. ◗ Motivation: Staffing function not only includes putting right men on the right job, but it also comprises motivational programmes, i.e., incentive plans to be framed for further participation and employment of employees in a concern.

Therefore, all types of incentive plans become an integral part of the staffing function. ◗ Better human relationships: A concern can stabilise itself if strong human relationships are developed. Relationships in an organisation become strong through effective control, clear communication, effective supervision and leadership. Staffing function also looks after training and development of the workforce which leads to co-operation and better human relations. ◗ Higher productivity: Productivity level increases when resources are utilised and supervised in the best

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STRATEGY possible manner. Higher productivity is a result of minimum wastage of time, money, efforts and energies.

This is possible through proper staffing and related activities (performance appraisal, training and development, remuneration)

changing content generated for the campaigns.

General revenue: By giving space for parking and outlets like gift shop, fruit shop, CaféCoffee Day, ice-cream parlour, cafeteria etc. on rental or share can improve the revenue of the hospital.

Manpower control and review ◗ Any increase in manpower should be considered by the top level of management ◗ On the basis of manpower plans, personnel budgets are prepared. These act as control mechanisms to keep the manpower under certain broadly defined limits.

The productivity of any organisation is usually calculated using the formula: Productivity = Output/Input But a rough index of employee productivity is calculated as follows: Employee productivity = Total production/Total number of employees

Other measures to maintain financial health The other steps that need to be implemented to sustain the financial health of the hospital are as follows: Save energy: A building is more than a static entity of wood or brick. It can be a living, breathing contributor hospital’s success if you have the tools to manage it well.

Schneider Electric healthcare solutions will give you these tools and help you achieve many benefits: ◗ Improved financial performance through advanced energy management ◗ Sustainable utility cost savings throughout the life cycle of your building can generate new cash and more capital on an ongoing basis. Receive as much as a 30 per cent savings in energy costs over a traditional building. ◗ Reduced risk of carbon taxes and penalties as energy efficiency grows more important in the future. ◗ The ability to fully comply with regulators and accrediting organisations throughout the life of the building. ◗ Using optimum sunlight, solar energy for heating, LED

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Focussed specialities: High revenue generating and high turnover specialities like oncology, joint–replacement, laparoscopic surgery, cardiology etc. should be focussed on and promoted.

Publications and conferences: These will increase the visibility of the hospital and act as advertisement. It will also increase the goodwill of the hospital.

Higher productivity is a result of minimum wastage of time, money, efforts and energies. This is possible through proper staffing and related activities (performance appraisal, training and development, and remuneration) lights and giving a written instruction to switch off lights and A/C etc when not in use as well as keeping a vigil on misuse will go a long way in saving lots of energy.

Save energy: Nowadays it is mandatory to have effluent treatment plant/sewage treatment plant (ETP/STP) so that the water from toilets, washroom etc. can be recycled and used in gardening, air conditioning etc. This saves lot of money on water bills. By saving water we can control the budget. Following are the ways to prevent water wastage: ◗ Replace leaking toilet by flapper valves if needed ◗ Measure your showerhead flow rates and install free showerheads ◗ Measure faucet flow rates and provide faucet aerators for kitchens and bathrooms ◗ Identify broken or mismatched sprinkler heads, high water pressure, and

other common problems. ◗ Develop a prioritised list of how you can start using water as efficiently as possible.

Negotiate for equipment/ consumables: Good negotiation power can save a lot of money for the hospital. Negotiations should always be done by a purchase committee to avoid any bias or unethical practices. The need to acquire equipment should, wherever possible, be identified as early as possible and a Statement of Need (SON)/Specification of Requirement (SOR) should be prepared. Vendors should be evaluated on several criteria including objective factors such as price and warranty, and subjective data which would include past experience with the vendor and the quality of their customer service.

We should also try to avail offers and discounts offered by vendors and suppliers such as: ◗ free spares

◗ free training ◗ free maintenance cover ◗ improved specification, or lower specification at a lower price ◗ ex-demonstrator or refurbished equipment ◗ more favourable payment terms Create a brand – Jo dikhta hai wo bikhta hai The brand launch includes exploring the hospitals’ internal signage, brand-inspired interior décor, digital displays and website to introduce the brand to the doctors, patients, family and visitors passing through hospital each day. An integrated, mass market campaign followed with creative executions for print, television, outdoor and online advertising will also help. The hospital website should be completely redesigned and overhauled to reflect the new brand and accommodate the deep and

Research: It increases the scientific value of the hospital and establishes it as a stateof-the-art centre which in turn increases footfall.

Research can bring grants from outside agencies which increases the quality of research work undertaken and may add to equipment, personnel and infrastructure.

Goodwill: Free camps, telemedicine and website improve the visibility of the hospital. It also brings clinicians close to the patients. and provides information about the facilities at the hospital without much effort to the patients.

Networking: Contacts with with high officials, media, politician and stars not only give good publicity to the hospital but also brings in high paying patients.

Accreditation: JCI, NABH helps in getting international and national patients through referrals and affiliations.

Quality of work: Focus should always be placed on SOPs, logarithms and good work. Different committees like hospital infection committee, medical audit committee, mortality review committee and management review committee can help monitor performance.

IT@HEALTHCARE HIGHLIGHTS

Report: Healthcare IT sector attracts $956 million in VC Funding in Q3 2014 There were 252 investors that participated in this quarter including angels, VCs, private equity, and corporate VCs MERCOM CAPITAL Group has released its report on funding and M&A activity in Healthcare IT (HIT)sector for the third quarter of 2014. The report reveals that venture capital (VC) funding in the sector came to $956 million raised in 212 deals globally. Total VC funding yearto-date adds up to $3.6 billion.

The quarter was dominated by over a 100+ funding deals of less than $2 million, as per the report. There were 252 investors that participated in this quarter including angels, VCs, private equity, and corporate VCs. The quarter also included 12 accelerators/incubators.

Consumer-focused technologies received 65 per cent of all VC investments in the third quarter of 2014, with $623 million in 140 deals compared to $678 million in 100 deals in Q2 2014. Areas that received the most funding under this category were Mobile Health with $345 million in 82 deals, followed

by Telehealth, which had its best quarter, with $101 million in 16 deals, Personal Health with $85 million in 24 deals, Social Health with $70 million in three deals, and Scheduling, Rating & Shopping with $23 million in 15 deals.

Practice-centric companies received $333 million in 72 deals in the third quarter of 2014, compared to $1.1 billion in 61 deals in Q2. Under this category, the areas that received the most

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Consumer-focused technologies received 65 per cent of all VC investments in the third quarter of 2014 with $623 million in 140 deals. Areas that received maximum funding are Mobile Health, Telehealth, Personal Health, Social Health and Scheduling, Rating & Shopping funding were Revenue Cycle Management with $75 million in eight deals, and Data Analytics with $71 million in 19 deals.

The top five VC funding deals in Q3 2014 were the $70 million raise by DXY (Ting Ting Group), an online healthcare community for medical institutions and healthcare providers in China, from Tencent Holdings, a provider of internet services in China, followed by the $52 million raise by Proteus Digital Health, a developer of products and services integrating medicines with ingestible sensors, wearable sensors, mobile and cloud computing. Teladoc, a telehealth company raised $50.3 million from Jafco Ventures, FLAG Capital Management, Greenspring Associates, Mellon and QuestMark Partners, Cardinal Partners, HLM Venture Partners, Kleiner Perkins Caufield and Byers, New Capital Partners, and Trident Capital.

Chunyu, a Chinese mobile

healthcare app company raised $50 million from China International Capital Corporation (CICC), Rushan Venture Capital under DunAn Holding Group, Pavilion Capital run by Temasek, and BlueRun Ventures, and HealthEdge, a provider of a cloud-based or on-site integrated financial, administrative and clinical software platform for healthcare payers focusing on medical claims and benefits management brought in $30 million.

Globally, US companies raised $760 million from 174 deals. Companies from 18 other countries participated in funding in Q3 2014, compared to 13 in the second quarter. With almost $200 million raised in 38 deals, countries outside of the US accounted for about 21 per cent of the fundraising this quarter, the largest share since we started tracking funding activity in 2010.

In the US, 54 deals came out

of California, followed by New York which recorded 17 deals, Texas and Massachusetts with 11 deals each, and Pennsylvania with eight deals each. Among cities, San Francisco Bay Area had the highest number of funding deals among cities with 46, followed by New York with 17.

There were 55 M&A transactions in Q3 totalling $4.7 billion, compared to 57 transactions totaling $2.2 billion in Q2 2014. While consumercentric companies dominated the fundraising, M&A was a different story with 46 of the 55 transactions involving practice-focused companies, accounting for all of the disclosed $4.7 billion. Consumer-centric companies saw just nine M&A transactions. Health Information Management (HIM) companies saw the most M&A activity this quarter with 32 transactions, followed by Service Providers with nine, Revenue Cycle Management with five,

Mobile Health with four, Personal Health with three, and Social Health and Telehealth with one transaction each.

Of the top M&A transactions, the largest was the $2.7 billion acquisition of TriZetto, a provider of healthcare IT software and solutions, by Cognizant, a multinational information technology, consulting and business process outsourcing company. This was followed by the $1.3 billion acquisition of Siemens’ health information technology business unit, Siemens Health Services, by Cerner, a provider of healthcare information technology solutions. Conifer Health Solutions, a provider of business process management solutions for healthcare providers and subsidiary of Tenet Healthcare Corporation, acquired SPi Healthcare, a provider of healthcare revenue cycle management and physician billing services, for $235 million. Another top disclosed transaction was the $142 million acquisition of Sg2, a provider of healthcare market intelligence, strategic analytics and clinical consulting services, by MedAssets, a healthcare performance improvement company.

Announced debt and public market financing in HIT amounted to $28 million in four deals in Q3 2014.

EH News Bureau

Infor launches Infor CloudSuite Healthcare for healthcare delivery organisations It builds upon Infor’s offerings available on Amazon Web Services (AWS) INFOR, PROVIDER of business application software, has launched Infor CloudSuite Healthcare, offering access to solutions within the industry’s leading cloud environment. Infor CloudSuite Healthcare builds upon Infor’s offerings available on Amazon Web Services (AWS). It combines software with a comprehensive solution that includes healthcare-specific functionality, analytics and an implementation accelerator for rapid time to value.

Carol Jones, Director of Financial Systems, Billings Clinic said, “Infor Lawson financial,

supply chain and human resources solutions in the cloud provide us with the scalability to support our operations while having the right functionality with minimal complexity and lower cost of ownership. This was accomplished through the due diligence, time and effort of the Billings Clinic project team and the Infor Implementation Accelerator for Healthcare,” she added.

Reportedly, Infor CloudSuite Healthcare provides care delivery organisations with state-ofthe-art capabilities when utilising the full suite of solutions to meet the needs of the health-

care industry and healthcarespecific business processes including managing complex clinician pay plans, tracking and validating clinical competencies and job specific performance reviews, grants management, coordination of recalls, patient charge capture, care workloads and assignments, pre-built clinical system connections and patient-specific supply reordering amongst many others.

In addition, the suite can apparently help significantly lower capital and ongoing investment in IT, while still providing the most current functionality for organisations to respond to

changing needs, sustainable margins and comply with complex regulations and requirements while delivering high quality care.

Infor CloudSuite Healthcare is cost effective throughout the total lifecycle of the managing enterprise software solutions because it precludes the need to purchase additional onsite servers, hardware, operating systems or databases, and hire supplementary IT staff or contractors for peak support or upgrade services.

The solution also enables care delivery organisations to take on innovation at their own

pace, upgrading at a pace that accommodates their unique timing and business needs with functionality specifically engineered particularly for healthcare, delivering a dramatically different approach than other horizontal ERP solution providers.

Mike Poling, VP, Healthcare, Infor said, “Infor CloudSuite Healthcare delivers a complete, scalable, proven suite of solutions designed specifically to help healthcare organisations run their business efficiently which results in quality, safe, affordable care.”

EH News Bureau

RADIOLOGY HIGHLIGHTS

Siemens launches new SPECTsystem Symbia Evo Excel SPECT system reportedly offers high throughput and exceptional detector flexibility at minimised costs SIEMENS HEALTHCARE introduced the Symbia Evo Excel SPECT system at the 27th Congress of the European Association of Nuclear Medicine (EANM). The system is a new version of the successful Symbia E. Reportedly, it combines industry-leading SPECT image resolution and detector sensitivity with the smallest room size requirement in its class.

Designed to fit into almost any existing nuclear medicine exam room, Symbia Evo Excel virtually eliminates costs associated with room renovation and expansion, claims a company release. With a high-capacity patient bed, larger bore size compared to

previous systems and highly flexible detectors, the system is optimised for obese or critically ill patients and increases the variety of applications a healthcare institution can offer.

Symbia Evo Excel fits in a room as small as 3.60 m (11 ft.

8 in) x 4.57 m (15 ft.). The system improves patient comfort with a 30 per cent larger bore [102 cm (40.2 in)], compared to its predecessor, and a highcapacity patient bed that supports patients up to 227 kg (500 lbs.). The bed also improves accessibility for patients with limited mobility with a convenient minimum access height of 53 cm (21 in).

The exceptional detector flexibility allows imaging of criti-

cally ill patients on a gurney or in a hospital bed.

Additionally, the short tunnel length and maximum scan length of up to 200 cm (6 ft 7 in) improves patient comfort for claustrophobic and tall patients.

Symbia Evo Excel offers the ability to scan a broad range of patients for a variety of applications. The detector heads easily rotate into numerous positions, including caudal/cephalic tilt, providing comprehensive imaging con-

figurations for general purpose, cardiology, oncology and neurology studies.

“Symbia Evo Excel addresses the pressing demands of today’s healthcare environment as a cost-effective modernisation option for nuclear medicine departments looking to avoid renovation of existing infrastructure,” said James Williams, CEO, Siemens Healthcare, Molecular Imaging.

Symbia Evo Excel is a multi-purpose, versatile SPECT system for hospitals and outpatient centers with general nuclear medicine imaging demands. It can also be upgraded as needs and budgets evolve over time.

EH News Bureau

Trivitron acquires full stake in Kiran Medical Systems,Imaging Products India Since 2011, Trivitron has owned 26 per cent in Kiran Medical MEDICAL EQUIPMEN manufacturer, Trivitron Healthcare has fully acquired Mumbai-based imaging accessories and radiation protection apparel maker Kiran Medical System and Imaging Products India (IPI).

Details about the timing of the transactions and the deal values were not made public.

The firm had revealed about the twin transactions as part

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of its corporate newsletter at the beginning of this year.

Kiran Medical is a manufacturer and supplier of image enhancement accessories and radiation protection products such as cassettes, screens, grids, shields and computer radiography systems. It also provides accessories to leading imaging product manufacturers like Fuji, Agfa and Kodak.

The firm had revealed about the twin transactions as part of its corporate newsletter

Kiran operates a manufacturing facility in Mumbai.

In 2011, Trivitron had picked up 26 per cent stake in Kiran Medical and later increased it to 51 per cent before completely buying the company.

Imaging Products India (IPI) is a manufacturer and marketer of contrast products in association with Bracco Spa of Italy. The

acquisition of this firm is expected to help Trivitron strengthen its hold in the South Asian market for radiology.

Trivitron had received Rs 150 crores from private equity firm India Value Fund Advisors (IVFA) which had picked up a minority stake in the company last year.

EH News Bureau

Carestream ships th 15,000 Vita CR system It has provided almost 30,000 tabletop CR systems to healthcare providers worldwide CARESTREAM HAS shipped its 15,000th Vita CR System and has installed almost 30,000 tabletop CR systems since the company’s first point-of-care system became available.

These tabletop systems make it possible for small to mid-size hospitals, clinics and practices to achieve the convenience and flexibility of excellent quality digital images at an affordable price.

CARESTREAM Vita CR systems perform general radiology and long-length exams and are also suitable for military, mobile, veterinary and other diverse imaging environments. Carestream’s Vita CR family includes the CARESTREAM Vita, CARESTREAM Vita LE, and CARESTREAM Vita XE CR Systems. Throughput ranges from 30 to 69 plates per hour for 14 x 17 inch cassettes.

“Our portfolio of CR systems enables imaging services providers to expand their workflow and capabilities by migrating from film to CR systems and then to our family of DR systems that produce digital images in seconds,” said Heidi McIntosh, Marketing Manager for Global X-ray Solutions Carestream.

“We have designed our imaging solutions with a modular approach that is right for today and ready for tomorrow.”

Carestream’s Image Suite software allows patients to be registered on-site or remotely using a web-based interface, and each X-ray system’s touch screen allows users to select desired body parts and views to speed the imaging process.

Technique information can be acquired automatically, eliminating the need for manual

Image Directview Vita_XE

Vita LE System - Veterinary

Carestream’s Image Suite software allows patients to be registered on-site or remotely using a web-based interface entry and the possibility of inconsistent X-ray exposures among different users.

Carestream software also allows images to be enhanced

using slide bars on the screen to adjust brightness, contrast or detail. Specialised measurement tools provide diagnostic information for chiro-

practic, orthopaedic or mammography imaging. Imaging providers can use automatic or manual stitching to paste individual images together to create the long-length view that is desired. Radiology reports can be generated on multiple workstations throughout a facility and optional software allows facilities to manage and view images from CT, MR and ultrasound imaging systems.

EH News Bureau

High-field MRI scans identify language centres in brain MEDICAL UNIVERSITY of Vienna has conducted a study which reveals that 7-Tesla ultra high-field magnetic resonance imaging (MRI) can be utilised to clearly show the brain areas responsible for speech processing and production.

Discovered by the scientists from the Neurology Clinic at the university, this approach demonstrates much higher sensitivity and better diagnosis on these areas of the brain than standard clinical MRI scanners.

These findings may prove very vital for future brain operations as the language centres could be better-protected during invasive surgeries. Knowledge about the location of these language centres prior to an operation is very important, as they can shift significantly due to tumours or injuries. The flexibility of the brain allows for such shifting. Gamage caused to any of the language centres during the course of brain surgery, in particular the Broca or Wernicke areas, could lead to the loss of the speech faculty.

The new MRI approach identified even very weak signals in the brain that would otherwise be overlooked, informed Roland Beisteiner from the Department of Neurology at the Vienna University.

The results from the study have been published in the brain function journal, NeuroImage.

EH News Bureau

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HOSPITAL INFRA

ASK A QUESTION In which places we require handicapped toilet in the hospital?

NILESH SHAH , Surat

As per NABH norms, toilets for the disabled is compulsory in the OPD area. IPD doesn’t require a toilet for handicapped people as such because wards have separate toilet for patients. Still if you want to place it in the IPD and in other sections you can do so but it’s not mandatory.

What is the job description of an MD in a hospital?

DR DEBASHISH DEO, Hubli

The job description of an MD in a hospital is: ◗ Commitment to the hospital’s strategic principles. ◗ Establishing a culture of collaboration and integration that enhances the provision of excellent patient care and improved patient satisfaction, provides a safe employee and patient-care environment as well as supports innovation and creativity. ◗ Overseeing strong workforce development through recruitment and retention, employee satisfaction and engagement, maximising growth potential of employees and strong succession planning, embracing diversity as a strategic advantage. ◗ Maximising operational efficiencies to provide the quality of

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safe and appropriate patient care. ◗ Ensuring regulatory and other compliance along with achieving and maintaining financial health. ◗ Participate as needed in physician recruitment efforts and continuing leadership in environmental and community stewardship. ◗ Support planning and development of capacity expansion projects and guide the development of services for new facilities. ◗ Build on the current fiscal strength and stability of hospital through proper management and oversight; proactively lead the organisation in a challenging, competitive and more regulated environment to meet shorterand longer-term (five to 10 years) capital requirements. ◗ Direct efforts towards making the hospital safe by incorporating high-quality, service-oriented, safe patient care. ◗ Create an environment of continuous improvement that fosters physician and staff collaboration, enhance revenues, controls costs and improves overall performance.

What is petty cash and its policy?

DR ASHISH JAIN, Indore

Petty cash funds are used for expenditures in connection with approved hospital activities. Its amount and significance is so small that it precludes request of

FAQs ON HOSPITAL PLANNING AND DESIGN | MEDICAL EQUIPMENT PLANNING | MARKETING | HR | FINANCE | QUALITY CONTROL | BEST PRACTICE

disbursement by cheque. The amount of the fund requested should be limited to minimum operating requirements to prevent theft of cash.

Petty cash policy: ◗ The account executive in consultation with the head accounts is responsible for approving and controlling all petty cash funds. ◗ The account executive is responsible for approving and embossing all changes to petty cash funds and establishment of petty cash funds. ◗ Account executive can be responsible for only one petty cash fund. ◗ The executive accounts is responsible for controlling and safeguarding the fund. ◗ All petty cash expenditures must be supported by a petty cash voucher slip and a receipt. The petty cash voucher slip must be approved by the account executive and signed by the recipient of the cash. The voucher slip and receipt must be submitted along with the request. ◗ Responsible department must notify the treasurer when there is a change to the petty cash fund. ◗ The amount of the fund should be limited to the total of three week’s expenditures. ◗ All petty cash funds must be replenished atleast on a monthly basis and original receipts as well as voucher slips must accompany all reimbursement requests.

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

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

BUSINESS AVENUES

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BUSINESS AVENUES

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

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ACCESSORIES . ..for Artificial Respiration AIR COMPRESSORS RESPIRATORY HUMIDIFIERS HUMIDIFICATION CHAMBERS PEDESTAL ASSEMBLIES

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C - ARM OT TABLE & L 5002 OT LIGHT

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Distributors wanted all across the country Send your enquiry to easylifehbmeter@gmail.com

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Because contamination can ruin our hospital’s reputation

We use

Arcania Automatic Bedpan Washers... guaranteed 100% disinfection!

Manufactured by world leader from France, Sofinor

The seriousness of contamination and generation of infections from bedpans and other hospital utensils cannot be trivialized. Pharmalab, your trusted steralisation partner, now introduces washers manufactured from 100% high quality stainless steel.

Clinox 3A – Hygienic, Ergonomic and safe • Only Bedpan washer with NO manual Contact • Compact and a comprehensive washer • Completely automatic operation – Pedal operated • Top loading washer, ensuring hygienic and ergonomic usage • Cleans and disinfects a diverse range of equipment, not just bedpans and urinals • Sluice function with a flush facility • High performance washing with 12 jets, 4 of which have a rotary function • Thermal disinfection with steam at 85c to 90c for 1 minute, cycle approved by the institute Pasteur in Lille • Washer complies with European directive 93/42/CE and certified under EN ISO 15883-1, EN ISO 15883-3, EN ISO 15883-5 and EN ISO 13485 version 2003

Pharmalab India Private Ltd. Kasturi, 3rd Floor, Sanghvi Estate, Govandi Station Road,Govandi, (East), Mumbai - 400 088.

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Capturing physical assessment and vital signs data is routine.

Accessing them should be too.

Connect your patient vitals with Welch Allyn Connex®.

Give clinicians immediate access to accurate patient vital signs with the Welch Allyn Connex Electronic Vitals Documentation System. With Connex EVD, you can capture vital signs with the wall-mounted Connex Integrated Wall System or Connex Vital Signs Monitor and wirelessly transmit patient vitals to your EMR in seconds—all without the paper, mistakes, or delay that come with manual transcription.

Visit www.welchallyn.com/connex to learn more today.

Wirelessly transmit patient vitals to your EMR right from the bedside with Connex® vital signs devices

Connex® Integrated Wall System

Connex® Vital Signs Monitor

Ask about our full solutions: Blood Pressure Management | Cardiopulmonary | Vital Signs Monitoring | Women’s Health | Endoscopy Eye, Ear, Nose & Throat | Thermometry | Lighting | Services Welch Allyn International Ventures Inc. India Liason Office #15, Royapetah High Road, 3rd Street , Mylapore, Chennai - 600 004 INDIA Tele : +91-9560800119 / +91-9899062673 Email: IndiaSC@welchallyn.com ©2014 Welch Allyn MC11237

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TRADE & TRENDS

Decoding Ebola An insight on the deadly ebola virus and ways to prevent it EBOLA VIRUS Disease (EVD) formerly known as Ebola haemorrhagic fever is a rare but deadly virus often fatal to human life. EVD kills up to 90 per cent of people who are infected. As the virus spreads through the body it weakens the immune system and the organs.

Symptoms of EVD EVD or Ebola fever can feel like flu or other illness and symp-

toms show up two to 21 days after the infection and usually include: ◗High fever ◗Sore throat ◗Lack of appetite ◗Weakness ◗Stomach pain ◗Joint and muscle aches This is followed by vomiting, impaired liver and kidney function and in some cases internal and external bleeding takes over.

How it is transmitted?

It spreads to people by contact with the skin and bodily fluids.

One can’t get Ebola from air, water or food.

Prevention Few primary prevention measures have been established and no vaccine exists.

Risk of transmission is increased in the healthcare setting where the patient is treated.

◗Wearing of protective clothing (such as masks, gloves, gowns, and goggles) ◗Using infection-control measures (such as complete equipment sterilisation and routine use of disinfectant) ◗Isolating patients with Ebola

from contact with unprotected persons For more details contact ziqitza.blogspot.in Harsha Pradeep Ziqitza Health Care

4th CMC,Vellore Advanced Coagulometer series 4th CACS was attended by 30 renowned haematologists from all across Asia AFTER THREE successful CACS meets, Department of Transfusion Medicine and Immunohematology, Christian Medical College Vellore organised a series of educational programmes in the field of practical day-to-day haemostasis work, during September, 26- 27, 2014 with the theme: ‘Coagulometry- Simple modification

reveals more?’

CMC Vellore Advanced Coagulometer Series – CACS, a CPDP (Continuous professional development programme) on Coagulation and coagulometer science, focussed on topics such as, complex issues related to coagulometers, clinical coagulometry, thrombosis, pre-analytical variables

and interferences in hemostasis testing.

4th CACS was attended by 30 renowned haematologists from all across Asia, who presented interesting study or case or pattern that they had identified or seen at their centre, which lead them to a diagnosis or had been frequently troubling the laboratory.

Apart from the above, 4th CACS had many useful sessions that helped participants overcome many of their day-today issues. 4th CACS benefitted from one of the best experts from the haemostasis workbench – Prof Richard A Marlar from the University of Oklahoma, USA. He has more than 200 publications and he has au-

thored books on topics related to regular hemostasis work. Dr Marlar shared his experiences and his challenges. Being an authority in D Dimer, the participants welcomed his insights and appreciated it as well.

4th CACS was very well received by all participants.

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