Express Healthcare December, 2014 by Indian Express

VOL.8 NO.12 PAGES 100

Cover story Makeover for Mumbai hospitals Strategy Healthcare: Just a click away Life An exemplar of excellence

www.expresshealthcare.com DECEMBER 2014, `50

CONTENTS Vol 8. No 12, DECEMBER 2014

Healthcare: Just a click away

Chairman of the Board Viveck Goenka Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das

MARKET

NEW WOCKHARDT FACILITY LAUNCHED IN SOUTH MUMBAI

HINDU MISSION HOSPITAL LAUNCHES DIABETES INSTITUTE

IKEA FOUNDATION CONTRIBUTES $31.5 MILLION TO UNICEF

CM DEVENDRA PHADNAVIS INAUGURATES MOBILE CANCER DETECTION VAN

‘WE ARE SETTING UP 50 CLINICS ACROSS 18 CITIES OF INDIA’

MERCK SUPPORTS FREE DIABETES SCREENING FOR MORE THAN 15,000 COMMUNITY MEMBERS

ASTER MEDCITY HOSTS INTERNATIONAL CONCLAVE ON CANCER CARE IN KOCHI

SAVE THE CHILDREN NGO LAUNCHES ‘GIGGLE OF LIFE’ CAMPAIGN

WOCKHARDT HOSPITAL AND WOCKHARDT FOUNDATION JOIN FORCES TO FIGHT CHD

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 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

Patient portals, a growing trend in India, is improving healthcare connectivity and communication between doctors and their patients, with the help of easy-to-use technology | P48

P34: INTERVIEW: ADHEET S GOGATE Partner & Head, Philips Healthcare Transformation Services

LIFE

P36: INTERVIEW: AJAY GUPTA Executive Director, Kgd-architecture

P40: INTERVIEW: DR ROBERT GALLO Co-discoverer of HIV as cause of AIDS

P53: INTERVIEW: AJIT PARULEKAR

58 61

AN EXEMPLAR OF EXCELLENCE JP NADDA IS NEW HEALTH MINISTER

Dean—Healthcare Management, GIM

STRATEGY

LEARNING FOR DEVELOPMENT

IT@HEALTHCARE

VITAL SIGNS FOR HEALTHCARE IN 2025

Scheduling & Coordination Rohan Thakkar CIRCULATION Circulation Team Mohan Varadkar

Corrigendum : The original version of an article titled, 'Role of imaging in orthopaedic surgical innovation', carried in the October 2014 issue contained an erroneous image. This error has now been corrected in the PDF and HTML versions of the article.

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

What ails healthcare in India?

wo incidents in November raise very serious questions about the state of healthcare in India: the botched up sterilisation drive in Bilaspur, Chhattisgarh and the mishap involving an MRI machine at Tata Memorial Hospital's (TMH) Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) in Kharghar, Navi Mumbai. The Bilaspur incident, in early November, resulted in the deaths of at least 14 young mothers. Investigations later revealed that both the medical staff as well as the medicines used were at fault. In the haste to achieve targets, the doctor concerned reportedly conducted 83 operations in five hours. Disregarding all medical practice guidelines, he reportedly used just one instrument for all operations. And to top things off, the drugs used were later found to be laced with rat poison. The doctor concerned cited his past record as evidence of his expertise: he had received an award for conducting 50,000 laparoscopic tubectomies from the Chief Minister. And the owner of the company which made the drug turned out to have close political connections. There are many blind spots in rural India; Bilaspur is the rule and not the exception. But it seems that all the bad press and inquiries into the Bilaspur tragedy were in vain. On November 30, there were reports that a doctor had used bicycle pumps to pump air into the abdomen of women during the course of laparoscopic tubectomies at yet another sterilisation camp, again organised by government authorities at yet another rural outpost, this time in Banarpal village, about 150 km from Bhubaneswar. This doctor, who like his peer in Bilaspur is also the recipient of government awards for his past enthusiasm towards this cause, said this was a routine practice and was an example of India's famed 'jugaad' innovation to cope with the lack of funds for proper equipment. According to him, he sterilised the pipe and nozzle tip of the pump before use, which to his mind was adequate due diligence. In the ACTREC incident, there are conflicting reports of what actually happened. The facts are that an MRI machine's magnetic field sucked an oxygen cylinder, trapping a ward boy and technician against the machine for four hours, resulting in severe damage to the latter’s kidneys. Preliminary investigations as part of a larger inquiry by TMH

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December 2014

The botched up sterilisation drive in rural Bilaspur and the ongoing investigation at Tata Memorial’s ACTREC layhollow all claims that ‘all is well’

point to the possibility that the switch to deactivate the magnetic field had either malfunctioned or had been disabled by the medical equipment company concerned, ironically to prevent accidental operation by patients. Unfortunately, the ACTREC facility is on the outskirts of Navi Mumbai, hence it was a good four hours before the maintenance staff could respond to ACTREC’s call and release the two ACTREC staff. The report of the medical equipment company’s own parallel investigation is expected in early December and should throw more light on what actually went wrong? Was it a freak mishap? Did the machine malfunction and if so, was it a maintenance issue or something else? Or was it human error, due to ignorance or worse, negligence? If both parties can learn from the incident, rectify systemic errors if any, as well as strengthen staff training and patient awareness, and be transparent about these remedial measures, it will go a long way towards putting patient care back at the centre of healthcare. On one hand, we applaud our Government’s move to grant visas on arrival, which will encourage medical tourists coming to India. But on the other hand, certain pockets of India continue to exist in a different era. That India’s public healthcare system is non-existent is not news. But the widening and glaring gap between public and private healthcare is nothing short of a national shame. Sprucing up public healthcare is not about cosmetic gestures like an exterior paint job or dressing up the OPD and waiting areas. It is not an overnight process nor is it only about the money. It is about committing time, money and resources over the long term. As our cover story in the December Hospital Infrastructure special issue shows, quite a few of Mumbai’s public/charitable hospitals, some of them over a century old, have been or are in the process of being revamped. A sign that when the heart is willing, the head finds a way. PM Modi’s push for a universal health insurance scheme seems like a distant dream for the families who lost their daughters and daughters-in-law and the children who lost their mothers in Bilaspur and elsewhere. Until we find a way to marry the technical expertise and technology of private healthcare with the access and affordability of the public healthcare system, achhe din will not be a universal dream.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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QUOTE UNQUOTE

J P NADDA

DR POONAM KHETRAPAL SINGH

Union Minister for Health and FamilyWelfare on World AIDS Day

Regional Director,WHO South-East Asia

It is a day when we gauge how far we have come in our fight against the disease, what are our shortcomings and how do we, as a nation, collectively fill this gap. It is not only the fight of the patients, doctors and scientists. It needs to be team effort involving all stakeholders, families and communities who must unite in helping those inflicted with HIV+ and AIDS to live a life of dignity, free from any stigma. The society needs to play a supportive role in this endeavour

HEAD OFFICE Express Healthcare MUMBAI: Kunal Gaurav The Indian Express Ltd Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821089213 Email Id: kunal.gaurav@expressindia.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express Ltd Business Publication Division Express Building, 9&10, Bahadur Shah Zafar Marg, New Delhi- 110 002 Board line: 011-23702100 Ext. 668 Mobile: +91 9999070900 Fax: 011-23702141 Email id: ambuj.kumar@expressindia.com CHENNAI Yuvaraj Murali The Indian Express Ltd Business Publication Division

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December 2014

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Massive gains have been achieved in our fight against HIV. We now have more than 10 million people on HIV treatment globally. Efforts continue and are being accelerated to achieve the ambitious target of ending AIDS by 2030. On the World AIDS Day let us resolve to continue our fight until we have seen the end of AIDS and secured ourselves a generation free of HIV.

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MARKET NEWS

New Wockhardt facility launched in South Mumbai 16 medical experts from hospitals in Boston, US inaugurated the new hospital WOCKHARDT HOSPITALS inaugurated its South Mumbai hospital recently. The 350-bed multi-speciality hospital at Mumbai Central hosts two institutes of excellence: Wockhardt Heart Institute and Wockhardt Critical Care Institute. The hospital has a longstanding collaboration with Partners Medical International (PMI), an associate of Harvard Medical School affiliated hospitals. The partnership is expected to help bring to Wockhardt’s patients, global standards of care and clinical expertise. Senior staffs at the hospital, including doctors and nurses, have reportedly undergone training at Harvard Medical School. Wockhardt Hospital in South Mumbai has a dedicated heart institute and 100 beds for critical care. An expert team from Partners HealthCare International (PHI) led by Dr Gilbert Mudge – President & CEO, PHI and Professor of Medicine – Harvard Medical School was present at the inauguration. The hospital is Wockhardt Group’s largest flagship hospital. Right from the design of the hospital to the processes, the hospital aims to make safer treatments and diagnosis and thereby adhere to the philosophy of ‘Life Wins’, informed a press release. Dr Habil Khoraki-

MD, Wockhardt Hospitals, said, “The new age Wockhardt hospital is built on the ethos of ‘Life Wins’. Through this mantra, it is our endeavour to provide the best quality of patient care and better clinical outcomes." Dr Mudge said, “Partners Medical International is happy to have been associated with Wockhardt since the last 12 years and supporting them in their endeavour through superior advice and medical expertise.”

APOLLO HOSPITALS intends to launch 500 Apollo Sugar Clinics by 2019-end in India and overseas to spread network of diabetes care programme. "We plan to open 500 Apollo Sugar Clinics across the country and outside by end of 2019. We will be have 50 clinics in the country by the end of this year," said Gagan Bhalla, CEO, Apollo Sugar. He also informed that Apollo is planning to expand to the Middle East countries. Speaking on the investments planned, he said, "On an average, an investment of Rs 50 lakhs is required to open a clinic but it varies depending on the locations." It would be financed through the funds from Apollo Hospitals Group, informed Bhalla. The company has sugar clinics in Hyderabad, Chennai, Bengaluru, Delhi, Kolkata, Ahmedabad, Indore, Karimnagar, Pune, Kakinada, Nashik, Tiruchirappalli, Raipur, Bilaspur, Bhubaneshwar, Mysore, Visakhapatnam and Madurai. Apollo Hospitals had joined hands with Sanofi in September to provide diabetes care programmes through Apollo Sugar Clinics. Apollo Sugar is part of Apollo Health & Lifestyle, the arm of Apollo that is into primary and secondary healthcare

EH News Bureau

The newly inaugurated Wockhardt facility in South Mumbai

wala, Founder Chairman, Wockhardt Group said, “We realised that Mumbai has a serious requirement for emergency services. Our new facility is an answer to this unaddressed gap. Our association with Boston’s key hospitals including Massachusetts General Hospital, Brigham and Women’s Hospital and Dana–Farber Cancer Institute will ensure that the best medical expertise in the world is available to the patients here. The hospital is also equipped with world-class advanced technology which

Senior staffs at Wockhardt Hospital have undergone training at Harvard Medical School guarantees best care and facilities.” Zahabiya Khorakiwala,

Apollo to open 500 sugar clinics

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MARKET

Hindu Mission Hospital Saket City launches Diabetes Institute Hospital to invest Rs 300 crores for expansion In addition to treatment for diabetes, the institute will address associated treatments including diabetic retinopathy, footcare, as well as neurological and cardiac management

DR SHANTARAM, Vice Chancellor of Dr MGR Medical University inaugurated the Diabetes Institute at Hindu Mission Hospital, Tambaram Srinivasan K Swamy, President of the hospital, delivered the welcome address where he highlighted the facilities available at the hospital to prevent diabetes and provide complete care. In addition to treatment for diabetes, the institute will address associated treatments including diabetic retinopathy, footcare, neurological and cardiac management. To further aid in the prevention of disease progression, the institute will also provide diabetic education and dietician inputs. Dr Shantaram spoke about non-communicable diseases like diabetes increasing at an

Dr Shantaram inaugurating Diabetes Institute at Hindu Mission Hospital

alarming rate which affects people during most productive years of their lives. He stressed on the need to screen and treat diabetes adequately as the “Tsunami of diabetes” was affecting the health of the peo-

ple and the health of the nation. The Vice Chancellor praised the services and facilities provided at Hindu Mission Hospital for the treatment of rural and urban populace. EH News Bureau

WEF selects Transasia Bio-Medicals as ‘Global Growth Company 2014' The award recognises the company’s potential to be a global economic leader TRANSASIA BIO-MEDICALs has been selected as ‘Global Growth Company- 2014’ by the World Economic Forum (WEF). The award was presented to Suresh Vazirani, the company’s Chairman and MD, at the India Economic Summit held in New Delhi. Transasia was selected as a dynamic and high-growth company and considered to be a trailblazer, shaper and innovator. It was

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recognised as one of the companies with the potential to become global economic leader. The nominated GGCs represented a broad cross-section of industry sectors but share a track record of exceeding industry standards in revenue growth, promotion of innovative business practices and demonstration of leadership in corporate citizenship. EH News Bureau

The award was presented to Suresh Vazirani, CMD, at the India Economic Summit

To add 370 new beds in Phase I, taking the capacity to 600 beds SAKET CITY Hospital has announced an investment of Rs 300 crores towards expansion. The hospital will add a new tower, consisting of 370 new beds, taking the total capacity of the hospital to 600 beds. For this expansion, Saket City Hospital will be recruiting approximately 600 physicians, 1000 nurses, 300 paramedics and 500 support staff. The hospital has appointed real estate firm – Jones Lang LaSalle as consultancy partner to manage the design and construction of the new tower, which is targeted to be completed by end of 2017. The new block will be spread over three lakh square feet, with 10 floors and three basements, and will be a state-of-the-art ‘green’ facility, which will set new standards, informs a company release. Dr BK Modi, Chairman, Saket City Hospital, said, “In a relatively short span of time, Saket City Hospital has managed to win the confidence of lakhs of customers, offering world class healthcare facilities, delivered to patients with our vision of keeping ‘You First’. With 600 beds, Saket City Hospital will become largest private full-service hospital in South Delhi. The new tower at Saket City hospital will offer complete transplant facilities ranging from bone marrow, heart, kidney, pancreas and liver transplantation. It will also have a full-fledged oncology department which will offer treatment for all types of cancers.” Dr Modi said, “I firmly believe a much awaited renaissance strikes us today as we

The new block will be spread over three lakh square feet, with 10 floors and three basements long for a healthier future. We have been witness to an era of suppressive medicine based on a symptom based approach to cure diseases, while ignoring preventive medicine. Aspiring for a meaningful, successful, healthy and long life demands incorporation of ‘preventive’ rather than curative strategies which converge to aim for a ‘optimally’ healthy , happy and better way of living that is Smart living.” “Smart Living constitutes dynamic scientific steps to achieve health, wellness and happiness coupled with mindfulness, holistic medicine and regenerative medicine leveraging the best of medical technology, in an environment that reveres innovation and employing best-in-class professionals. The unique powerful combination of mindfulness and science makes it an apostle of health. Smart Living will support R&D in a big way where latest technologies like stem cell therapy, genomic sequencing, natural medicine, nutrigenomics, metabolomics and likes will be researched in an Indian context,” he concluded. EH News Bureau

MARKET

IKEA Foundation contributes $31.5 million to UNICEF The grants will help advance children’s rights TO MARK the 25th anniversary of the Convention on the Rights of the Child, IKEA Foundation has offered six new grants to UNICEF, amounting to $31.5 million (€24.9 million). Reportedly, the grants will focus on reaching the most marginalised and disadvantaged children living in poor communities and in strengthening UNICEF’s response in emergency and conflict situations. Five of the IKEA Foundation grants will support UNICEF programmes in Afghanistan, China, India, Pakistan, and Rwanda. The new grants will focus on early childhood development, child protection, education, and helping adolescents to improve their lives and strengthen their communities. A sixth grant will enable UNICEF to develop information management tools to strengthen emergency response and monitoring. “UNICEF’s partnership with IKEA Foundation has helped advance the rights and improve the lives of children growing up in some of the world’s most difficult places. We are grateful to the Foundation and look forward to continuing our work together to reach the children we have not yet reached, and to put equity and children’s rights at the centre of an agenda of action for all children,” said UNICEF Executive Director Anthony Lake. Per Heggenes, CEO, IKEA Foundation said, “We are very proud of our longstanding partnership with UNICEF, helping to develop new approaches leading to improved lives for millions of vulnerable children around the world. These new grants will ensure this work continues, helping even more young adolescents, children and families enjoy their basic rights.” EH News Bureau

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MARKET

CM Devendra Phadnavis inaugurates mobile cancer detection van The van was donated by Subhash Runwal Education Foundation and will be operated by Marvadi Yuva Manch

SUBHASH RUNWAL Education Foundation has launched a mobile cancer detection van. It will visit various parts of the country inviting people to test for cancer. Subhash Runwal Education Foundation has donated this van to Marvadi Yuva Manch to operate it. CM of Maharashtra, Devendra Fadnavis said, “This is a very good way to fight the deadly diseases like cancer. If detected early one can fight it with medical help. Early detection is the best prevention. I congratulate Subhash Runwal Education Foundation for coming up with this innovative idea to promote check-ups and I wish all good luck to Marvadi Yuva Manch for their efforts in creating awareness through this van.” Subhash Runwal, Chairman

CM Devendra Fadnavis at the inauguration of the mobile cancer detection van

of the Foundation said, “We always live in the world of denial. ‘Nothing can happen to

me’ mentality is so strong that people generally do not tend to go for medical check-ups of

life-threatening diseases. And it gets too late when they really face the threat. This van will

motivate more people for check-ups and this is how we intend to make a small but significant change in the society.” Starting from Mumbai, the van will reportedly move in various parts of the country. The state-of-the-art van is equipped with mammography machine, biopsy machine, X-ray machine, centrifuge, microscopes, biochemical analyzer, along with qualified technicians and doctors to undertake diagnosis for breast cancer, skin cancer and various types of cancer. In the trial run from Delhi to Mumbai, six camps were conducted and over 200 people tested over 70 were found to have various kinds of cancer in first stage. EH News Bureau

Dräger India launches ‘Mission Suraksha’ A roadshow across major industrial belts across India to reinforce safety awareness DRÄGER HAS INITIATED ‘Mission Suraksha’, a roadshow to reinforce safety awareness across India. ‘Mission Suraksha’ aligns with Dräger’s philosophy of protecting, supporting and saving lives. As part of the mission, Dräger has designed a truck featuring its safety solutions for key industries including oil & gas, chemical, heavy metals and pharma. ‘Mission Suraksha’ was flagged off from Westin Hotel in Mumbai. The event was reportedly attended by eminent thought leaders from government and corpo-

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rate businesses. After being flagged off, the next destination for the truck is the safety event, OSH India, 2014, at Bombay Exhibition Center. The truck would then be showcased at the National Safety Council (NSC) in Belapur. Dräger has partnered with the National Safety Council in this mission to address the safety challenges across the key industrial belts of India. Speaking at the occasion, Nikil Rao, Country Manager for Dräger in India, said, “I am confident that with ‘Mission Suraksha’ we shall be able to

Dräger has designed a truck featuring its safety solutions for key industries like pharma reach out to the remotest parts of India creating awareness about safety. I am delighted at the response that we have

received at the launch events. Dräger is very happy to be associated with the National Safety Council in this mission. Through this association we want to reinforce safety practices across India.” Inaugurating Dräger’s Safety event, VB Sant, Director General, National Safety Council (NSC) mentioned, “Safety is an intrinsic element towards protecting and saving human lives. At NSC our aim is to work collaboratively with stakeholders in building a national movement on safety, health and environment. We

are delighted to associate with Dräger in their ‘Mission Suraksha’ as it complements our vision of creating preventive culture through raising awareness and rendering services that can further drive impactful measures in making workplaces safer, healthier and environment friendly.” In a three phased launch, the Dräger truck plans to tour across India to enable visitors get a first-hand experience of Dräger’s latest innovations in safety technology. EH News Bureau

TEGRIS redefining OR Integration

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MARKET I N T E R V I E W

‘We are setting up 50 clinics across 18 cities of India’ In September this year, Apollo Hospitals and Sanofi joined hands to set up Sugar Clinics for diabetics. With 65 million people affected from diabetes and 77.2 million in the pre-diabetic stage, India's pie in diabetic patients is expected to swell up to 109 million by 2035. Shalini Gupta finds out more about their initiatives from Gagan Bhalla, CEO, Apollo Sugar

What is the objective behind setting up Apollo sugar clinics? How was this not being met earlier? Given the size of the diabetic population in India, it is important to have a focused and comprehensive approach to the management of the disease. While Apollo has been in the diabetic care space for a fair amount of time, there is clearly a need to address the endemic, through dedicated efforts. Apollo’s vision to provide accessible diabetic care to all, clearly entailed having a separate entity, focused towards addressing the concerns of the large diabetic population, who have limited access to quality and affordable care, across the country. How is Apollo going to capitalise upon its existing network to make this more effective? The model of Sugar Clinics is indeed designed to capitalise on the existing Apollo network of hospitals and clinics. Apollo Sugar is modelled on a hub and spoke network – the Advanced Diabetes Management Centres in the hospitals act as hub for the Apollo Sugar Clinics spokes, present as shop-in-shop inside The Apollo Clinic or smaller hospitals and, the standalone clinics in some locations. This optimisation and scale-up is critical to help enhance reach

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December 2014

to all parts of the country. What have been the unmet needs in diabetic management in a country like India? Patients consult diabetologists and endocrinologists only when there is dire need. Facets of lifestyle counselling, care for complications arising from high blood sugar such eye and podiatry (foot) care and other critical organs such as heart, kidney etc. need concerted care by the patient and the care-giver. Lifestyle support is a key missing link for diabetics and access to comprehensive care for the patient is another piece in the pie which makes the care complete. Another critical aspect which I would like to touch upon, in the Indian context, is prevention through screening. We believe every Indian should screen themselves to understand their risk of developing diabetes. Selfawareness is the only way to win over this epidemic and lose the misnomer which India has earned of being the ‘Diabetic Capital’ of the world. Hospitals traditionally have been one stop shops for all diseases and conditions. Are we going to see more such standalone clinics? What is the model going to be like? As I mentioned earlier, Apollo Sugar is modelled on a hub and spoke model with the

Apollo Sugar has designed a range of packages which will address concerns of the patients at large

facilities in the hospitals acting as the hubs, and the clinics as spokes. Broadly there are three formats – Advanced Diabetes Management Centres inside Hospitals, shop-in-shop Sugar clinics inside Apollo Clinics and standalone Sugar Clinics. Apollo Sugar Clinics inside The Apollo Clinics and standalones will address basic diabetes screening and diabetes management and are present to provide easy access to all. The requirements of advanced management of diabetes and co-morbidities or complications management, will be met by the Advanced Diabetes Management Centres (ADMCs) placed inside the hospitals. With the hospital eco-system capable of managing cardiac, nephrological and neurological complications, arising out of diabetes, the ADMCs acting as the hub was a natural choice. Basic screening can also be done in kiosk-like facilities, which can be housed at large corporates, which will effectively help them reduce healthcare costs and boost productivity, in the long run, when addressed timely. Management of chronic diseases requires a lot of tracking as well patient monitoring. How can this be done, especially for conditions such as diabetes? Apollo Sugar has designed

a range of packages which will address concerns of the patients at large. Those who sign up to be a part of the robust programme, will have access to detailed tracking of their condition, as required clinically. Diabetic lifestyle support, aside from clinical care by our expert doctors, through our call centre support, interactive app and web-based trackers are amongst the services that a patient gets, to help in ensuring better monitoring of his condition. Apollo Sugar is also setting up the framework for at-home counselling and care for patients to ensure convenient care. What is the number of clinics now? Which states would they serve? Which states do you plan to cover in phase II? We are setting up 50 clinics across 18 cities of India. Some of the states that would get covered include Tamil Nadu, Telangana, Andhra Pradesh, Karnataka, Delhi, Chhattisgarh, Orissa and West Bengal. Phase II would expand to cover the states of Gujarat, Madhya Pradesh, Maharashtra and Jharkhand. We are also looking at setting up Apollo Sugar in international locations, starting with the Middle East. How much would a basic service cost? What kind of packages would you have? Enumerate on the most basic

MARKET to advanced service? What services would a typical clinic provide? Is there any assistance for the rural population? Apollo Sugar will have a wide range of services from basic screenings to comprehensive one year long packages. Simple diabetes screening could be as low as Rs 300. Our comprehensive packages which are clinically defined, range from an advanced programme for one year which includes periodic consultations, diagnostic tests and home care services, and our robust lifestyle support. A clinic typically would offer all the above mentioned from basic screenings to comprehensive packages. The intent is to provide 360 degree care to the patient to help manage all the critical parameters, for all diabetics, which can be sustained for a longer term. Apollo Group in the past has conducted mass screening across the country for the rural population, the intent to provide similar care at the grassroot level will remain, going forth too. Diabetes is rampant in the rural urban as well as in urban and rural population. How do you plan to track and put down data that could give insights into the epidemiology of the disease? The Apollo Group, with its reach across the country, through its hospitals and clinics helps in touching lives of the urban and rural population. Another step that Apollo Sugar would like to make in that direction is through the PPP model and tying up with government agencies to ensure screening and care delivery services to reach the real masses. In line with the non-communicable diseases (NCD ) prevention and control philosophy of the government, Apollo has its eyes set in democratising diabetes and making it â&#x20AC;&#x2DC;disease-freeâ&#x20AC;&#x2122; for all diabetics. Apollo Sugar has unique, ultra-modern screening equipment that can reach the remotest parts of the country and in partnership with the

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Apollo Sugar would like to tie-up with government agencies through the PPP model to ensure that screening and care delivery services reach the real masses

public sector and government agencies, we can gain very meaningful insights for further studies. What are the future plans? Expansion, services, packages etc We are looking to expand with more centres within, as I talked about before and overseas too. The Middle East

is already on our radar screen and by early next year we should have a facility there. Collaborations with international universities and other world-class centres to promote diabetes education and awareness, through various formats, will be some of the future plans that Apollo Sugar will partake. shalini.g@expressindia.com

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‘We expect to invest no less than $100 million in the next three to five years’ The UK-based Bourn Hall Clinic is expanding base in India. On his recent visit to India, Mike Macnamee, CEO, Bourn Hall Clinic spoke to M Neelam Kachhap about the hospital's future plans and investment route What is your biggest challenge at the moment as CEO of Bourn Hall? The biggest challenge in the current scenario is to get trained manpower that has specialisation in infertility treatment, from doctors and embryologists to support staff like nurses etc. The other challenge, especially for the Indian market, is lack of awareness and lack of proper regulatory authority for infertility treatment. What are your plans to tackle the challenge? We are doing a lot of workshops and training sessions for the team members, internally and externally. You currently operate in three very different markets. How would you describe these markets and what has been your experience?

Yes, we operate in the UK, Dubai and Indian markets at present and these markets are very similar. We are very culturally sensitive and strictly Shariah compliant in Dubai. In terms of religion we don’t have any issue. There are slight demographic differences in terms of patients and slight differences in how women respond to medications. In UK, there is less taboo talking about the cause of infertility than in India. In terms of revenue, all the three locations differ as cost of operations is different at all the locations. What have been your biggest learning from your initial failure in the Indian market? In India people are still unaware about the treatment available for infertility. People are still moving towards alternative therapies and reaching out to the specialists a bit late. The major learning is

to make couples aware about treatment availability. We are running a lot of awareness campaigns to provide proper information to the couples through educational seminars, fertility camps etc.

We will work on the hub-and-spoke model and shall open around 18 more clinics across India

How do you perceive India as a market for IVF? India is home to 30 million childless couples. One out of six couples in India has fertility problems and the incidence is growing at a very alarming rate. Some of the main causes of infertility among couples are the rising levels of stress and other lifestyle disorders like smoking, alcohol, late marriages and delayed child birth. Share your plans for the growth of Bourn Hall International? We are currently looking at the Indian healthcare market in greater detail and based on

early indications we expect to invest no less than $100 million in the next three to five years, but we are taking our steps with caution and at the right time. Growing a business across India needs to be carefully planned and executed. We will work on the hub-and-spoke model and shall open around 18 more clinics across India. We have already done a tie-up with Muthoot Healthcare to provide infertility treatment in South Kerala. Now we plan to expand more in North India, starting with spokes in Delhi NCR. After that, we are planning to open greenfield, full-fledged centres in different geographies like Punjab, Uttar Pradesh, Rajasthan and J&K. Gradually, we will open greenfield centres across the nation. mneelam.kachhap@expressindia.com

PRE EVENTS

Mumbai to host premier hospital infrastructure show HIM to held from December 12-14, 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

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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 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 & Management 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 for-

ward to further supporting India’s healthcare industry to grow further,” said Vikas Vij, MD, The Ideas Exchange. Contact Khyati Mishra, Marketing Manager Tel: 0091 22 6171 3211 khyati.mishra@ideasexchange.in Website: www.hospitalinfra.co.in

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Kochi to host IRIA 2015 The event would focus on the latest advancements in the field of radiology and imaging THE 68TH annual conference of IRIA will be hosted by Kerala chapter of IRIA. It will be held from January 29 to February 1, 2015 at the Hotel Le Meridien in Kochi. It will comprise various segments for radiologists including a scientific programme oriented to practising radiologists and focussed on sub-speciality work. Wide ranging academic feast including workshops, lectures, paper/poster presentations, image interpretation with audience response and orations will also be part of this conference. It will also consist of prime time sessions offering guidance to exam going PGs and young radiologists entering practice. Some highlights of IRIA 2015 would be: ◗ ICRI CME featuring outstanding faculty on Day-1 ◗ ASNR & AIRP workshop ◗ Onco imaging and PET-CT ◗ Innovative neuroradiology programme featuring case studies and mini-workshops ◗ Comprehensive sessions on HCC, integrating imaging, interventional treatment and recent advances ◗ Listen, Learn and Do! Step by step 'How I do it' session on basic CT/US guided procedures by experts ◗ A to Z. Full day single hall MSK program ◗ All you wanted to knowfoetal imaging/infertility and breast imaging sessions ◗ Separate session on Contrast Enhanced Ultrasound featuring the leading lights in India From basics to routine practice and beyond ◗ Introducing dialysis fistula imaging and intervention ◗ Great panel of national and international speakers ◗ Special interactive session planned in collaboration with National Board of Examinations specifically to help and enhance performance in MD/DNB PG exam. ◗ Starting your practice: A special session offering perspectives for young radiologists seeking to set up their practice.

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Advice from seniors who are at the top of the ladder! ◗ Seminar on Business in Radiology by Prof David

Yousem Contact Dr K Mohanan

IRIA 2015 Secretariat IMA House, Stadium Link Road, Kathrikadavu, Kaloor

Kochi-682 017 (M) +91 85890 54499 Email: iria2015kochi@gmail.com Website: www.iria2015.com

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Govt bracing up to popularise traditional medicines Healers from the South, West, Central and Northeast India at the World Ayurveda Congress expressed anguish that traditional treatment systems in India were not getting their due recognition even as they formed the basis for modern medicine INDIA’S ANCIENT medicinal systems are being given a ‘new-look image’ as part of the new government’s effort to popularise them without losing their essence, Union Tribal Affairs Minister, Jual Oram said. Such a concerted exercise will specially benefit rural India where people largely rely on local herbal doctors, he said while inaugurating a two-day Traditional Healers Meet in the national capital as part of the Sixth World Ayurveda Congress (WAC). “Deliberations are on with experts and practitioners to ensure that such a plan benefits the country’s huge number of villages,” Oram told a gathering of healers, who called upon the government to

give accreditation to deserving traditional healers. The minister, while interacting with the Pragati Maidan gathering that had 100-plus healers, expressed optimism that the meet would facilitate exchange of ideas between practitioners of different branches of ancient medicines. “The outcome of the deliberations would further enable the government to chart ways on empowering Ayurveda and traditional Indian treatment systems,” added Oram, himself a tribal leader. Bengaluru-based scholar, Darshan Shankar said in his keynote address that the healers’ fraternity had two suggestions before the government to strengthen traditional cure in India.

Union Minister of Tribal Affairs, Shri Jual Oram seen here with Shri A Jayakumar of World Ayurveda Forum at the Traditional Healers Meet organised on the sidelines of the 6th World Ayurveda Congress & Expo

“One is a scheme that would ensure a home-level network of use of herbal medicines. The other is fast and prompter accreditation of healers by a competent body of experts,” said

Prof Shankar, who is Vice Chancellor of Institute of Trans Disciplinary Health Sciences and Technology (ITDHST), Bengaluru. Prof Ritu Priya of Jawahar-

lal Nehru University, Delhi, stressed the need for bridging a gap between traditional and modern medicines in present-day India. Healers from the South, West, Central and Northeast India at the meet expressed anguish that traditional treatment systems in India were not getting their due recognition even as they formed the basis for modern medicine. ITDHST’s Prof G Hariramamurthi welcomed the gathering. The sixth WAC began with PM Narendra Modi addressing the valedictory session, wherein he stressed the importance of Ayurveda. The Union government was one of the organisers of the event.

RSSDI and Ranbaxy join hands to help juvenile diabetes patients 507 doctors came together to create a blue circle, the universal symbol of diabetes to spread awareness RESEARCH SOCIETY for the Study of Diabetes in India (RSSDI), Bengaluru 2014 and Ranbaxy Laboratories joined hands with doctors to form a blue circle, the universal symbol of diabetes, at the 42nd Annual Conclave, which was held recently organised by the Karnataka Chapter of RSSDI, Bengaluru. Doctors participating in the national conference on diabetes were invited to hold each other’s hand and stand around the blue circle (modelled on the International Diabetes Federation’s blue circle) in concentric circles. For every doctor who formed the circle, RSSDI Bengaluru 2014 and Ranbaxy decided to adopt a juvenile diabetes patient for his/her insulin requirements for full one year.

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Dr KR Narasimha Shetty, Director of Karnataka Institute of Diabetology and Chairman, of the Organizing committee, said, “The 42nd Annual Conclave of RSSDI is being attended by more than 6,000 doctor-delegates coming from different parts of India. Speakers from India and abroad are delivering talks on various aspects of diabetes with focus on multiple organ morbidity. Major purpose of the conclave is to evaluate the factors responsible for the increasing trend of Type-II diabetes that is being seen in India among the youth and children, and discuss the role of diabetes in cardiac dysfunction. The event provides a platform for medical experts in the field of diabetes to exchange notes and discuss latest re-

search. I am therefore delighted that Ranbaxy has organised the blue circle event at the venue to increase awareness about juvenile diabetes in India among medical professionals and public alike. This would help a great deal in helping diagnose this disease in children earlier.” At the RSSDI conclave, Ranbaxy launched its medical collaboration portal and gave a demonstration of Google Glass and how it can be of great help to the healthcare fraternity. The doctors were made better aware of apps and utilities such as video recording, taking photographs through glass, searching at google platform and interactive maps. Information was provided about valueadded services of Ranbaxy such as Dial a diet/Dial a Sam-

ple, Medical and apps such as Fit heart and My Steps APP. On the occasion, Rajeev Sibal, Vice President and Head, India region, Ranbaxy, said, “There are approximately 70,000 patients with Type I diabetes (juvenile diabetes) in India. Our intention behind forming the blue circle is to create awareness about the rising menace of diabetes in the society, especially juvenile diabetes. There is a common assumption that diabetes affects only adults, not children. Most child patients of Type I diabetes are not diagnosed on time due to a lack of awareness about this disease. We are very happy to organise the formation of the blue circle with the help of doctors to unite everyone in the fight

against diabetes.” Adding further, Sibal said, “RSSDI Bengaluru 2014 and Ranbaxy have committed to adopt juvenile diabetes patients in terms of their insulin requirement for a year. We would also contribute towards International Diabetes Federation’s ‘Life for a Child’ programme.' Dr MR Mohan, Specialty Consultant, Karnataka Institute of Diabetology and Secretary of the Organizing committee, 42nd Annual Conclave said, “I am excited to be a part of the blue circle organised by Ranbaxy on the sidelines of this conclave. I think this will go a long way in spreading awareness about diabetes in the country and make a difference to my patients and other people suffering from this disease."

MARKET POST EVENTS

Merck supports free diabetes screening for more than 15,000 community members In collaboration with Maharashtra University of Health Sciences, the screening is a part of its capacity advancement programme in India MERCK, A leading company for products in the pharma, chemical and life-science sectors, rolled out its diabetes awareness and prevention campaign in collaboration with Maharashtra University of Health Sciences in order to improve diabetes awareness and community health level in India.

Merck provided the necessary support to conduct diabetes free screening and education to each medical college in Maharashtra University of Health Sciences in a bid to raise awareness about diabetes and empower community members on how to better manage and prevent it

On the occasion of World Diabetes Day, Merck supported diabetes awareness at 15 medical colleges in Maharashtra, aiming to screen and educate more than 15,000 community members across Maharashtra state. Dubbed â&#x20AC;&#x2DC;Get Informed- Get Active- Get Healthierâ&#x20AC;&#x2122;, the campaign aimed to reverse

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MARKET this worrying trend by preventing or delaying the development of diabetes in the Indian population. Rasha Kelej, Vice President, Head of Global Business Responsibility and Market Development of Merck Serono emphasised, “We are pleased to engage with DMER and Maharashtra University as we are celebrating the World Diabetes Day focusing on ‘Healthy Living and Diabetes’ in order to improve access to better

diabetes care as part of our commitment to the social and economic development of India. Supporting diabetes education and diabetes community outreach programmes of the University will contribute significantly to improving awareness, early diagnosis and prevention of the disease across India.” Dr Stefan Oschmann, Member of the Executive Board of Merck and CEO Pharma said, “Merck is

pleased to collaborate with Maharashtra University of Health Sciences and Directorate of Medical Education & Research as part of our commitment to building healthcare capacity and providing sustainable access to highquality health solutions and safe medicine in India.” Merck provided the necessary support to conduct diabetes free screening and education to each medical college in Maharashtra University of Health Sciences

during the week of the WDD to raise awareness about diabetes and empower community members on how to better manage and prevent it. Ali Sleiman, General Manager of Merck Serono India added, “We hope to maintain a long-standing relationship with Maharashtra University and DMER to improve the standard of healthcare and research capacity in order to tackle diabetes and non–communicable diseases as a part of Merck Capacity Advance-

ment Program (CAP).” Merck Diabetes Capacity Advancement Program (CAP) is a five year programme which was kicked off in India recently and has been implemented successfully in seven sub-Saharan countries including Kenya, Uganda, Namibia Angola, Ghana, Tanzania and Mozambique and will further expand to other Sub-Saharan and Asian countries targeting 12000 medical students by 2018.

Aster Medcity hosts international conclave on cancer care in Kochi International experts like Dr Robert Gallo, co-discoverer of HIV and Dr Neal Flomenberg, pioneer in bone marrow transplant were among the prestigious speakers at the event ASTER MEDCITY, a quaternary care medical centre in Kochi, recently hosted a major international cancer conclave titled ‘New Horizons in Cancer Care.’ The event witnessed participation from 150 eminent national and international medical personalities. Experts present at the event deliberated on harnessing multi-disciplinary treatment resources, economics of treating cancer, need for a population-based cancer registry for India and most importantly the role of media and the public in creating awareness on early detection and possible prevention. “Every year nearly one million new cancer cases are diagnosed in India according to reports. The number of deaths per year due to cancer is expected to rise to 1.2 million every year by 2035. This conclave provides a platform to bring in latest developments and technological innovation regarding cancer care. Through Aster Medcity, we will enable best-in-class treatment for cancer patients,” said Dr Azad Moopen, Chairman,

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Global medical experts at the International Oncology Conclave organised by Aster Medcity

Aster DM Healthcare. Dr Robert Gallo, co-discoverer of HIV and winner of the prestigious US Lasker award was one of the speakers at the event. He addresses the session on relation between viruses and cancers. Dr Neal Flomenberg, a pioneer of bone marrow transplant, elaborated on the advances in the field and shared his experience of contemporary technology and treatments available for cancer management.

A one-day conclave was spearheaded by Dr MV Pillai, Senior Medical Oncologist at Thomas Jefferson University, Philadelphia US and Dr Harish Pillai, CEO, Aster Medcity. The thrust of the event was upon greater innovations and medical excellences in cancer treatment. Speaking about the conclave, Dr Harish Pillai said, “Cancer is a disease that most people have heard, however, awareness in terms of its

treatment and prevention is relatively low. Through this conclave want to draw attention towards need of a cancer registry in India which will help track the incidents and treatment developments. As a further step in our efforts to fight cancer in India, we will soon announce the opening of Aster Medcity Oncology Centre of Excellence which we are certain will be the best in class centre for cancer care.”

Commenting on the newer heights of achieving cancer care in India, Dr MV Pillai, Senior Medical Oncologist at Thomas Jefferson University, Philadelphia US said, “It gives me immense pleasure to spearhead this conclave and address the expert oncologists present at the conclave. While India has largely evolved in stepping up cancer treatment, there is still lot to consider in terms of its awareness and prevention among general public.”

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Save the Children NGO launches ‘Giggle of Life’ campaign The public mobilisation initiative is an effort to catalyse a movement for ensuring survival of children under the age of five, who die due to reasons that can be easily prevented

NGO, SAVE the Children has launched its campaign “Giggle of Life.” A release stated that it is an attempt to build public momentum that can help amplify a collective voice amongst decision makers to show that India cares for her newborns and children, through public mobilisation. The campaign will use digital medium and enable people to tweet about their support to the Prime Minister. Internet and

mobile users can pledge their support to the campaign at youthkiawaaz.com/giggleoflife/. Giggle of Life aims to help India achieve MDG 4 on newborn and child survival. Save the Children through this campaign is making an effort to address the health and wellbeing of newborns, children and mothers. Thomas Chandy, CEO, Save the Children, described the campaign, “The first hour, first day

Giggle of Life aims to help India achieve MDG 4 on newborn and child survival

and first month of a new born are the most critical and need maximum guard. Giggle of Life is an opportunity for everyone to conquer every challenge of child mortality and save our newborns through awareness of practical and inexpensive methods.” Reportedly, Save the Children, in collaboration with ‘Youth Ki Awaaz’, will popularise this campaign to reach millions

of online audiences. Youth Ki Awaaz will have a dedicated page with campaign content and will serve as a microsite for Giggle of Life. Save the Children will be promoting a pledge of action on Facebook and Twitter. Save the Children works across 17 states of India to ensure proper education, health and protection of children, and also responds to their humanitarian needs across India.

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Wockhardt Hospital and Wockhardt Foundation join forces to fight CHD A kite-flying activity for 300 children in Mumbai was organised to pledge support to save young lives IN ITS quest to fight congenital heart disorders, Wockhardt Hospitals, South Mumbai, recently undertook a unique initiative in association with Wockhardt Foundation. The hospital organised a kite-flying activity for 300 kids at Girgaum Chowpatty, Mumbai, and entreated Mumbaikars to donate generously for the cause. Wockhardt Hospitals, South Mumbai, organised this initiative ‘Dil Se Dil Milate Chalo’ on the eve of Children’s Day with the support of Wockhardt Foundation. The aim was to spread awareness about congenital heart disorders and to persuade people to come together and support a life by donating money. As a part of the initiative, Wockhardt Hospitals pledged to support one child for each child supported by the people. The children were seen enjoying the fun activity and were soaring the kites as high as they could. Speaking about the initiative, Zahabiya Khorakiwala, MD, Wockhardt Hospitals said, "We cannot all be surgeons, but we can still support saving a little child’s life. Excellent medical care for treating congenital heart disorders comes to about three lakh rupees. A financial support of Rs 50,000 can make a huge difference to the life of the suffering child and his/her family. When you support one child, you save two lives, because for every one child supported by you, we solemnly pledge to support another child at the Wockhardt Heart Institute. We have taken this pledge because we genuinely believe that indeed ‘Life Wins’. Dil Se Dil Milate Chalo because when Hope Wins, Life Wins."

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Zahabiya Khorakiwala, MD, Wockhardt Hospitals and Dr Suresh Joshi, Director, Paediatric & Congenital Heart Centre, Wockhardt Hospitals along with the slum kids at the kite flying event

Wockhardt Hospitals, South Mumbai, organised this initiative ‘Dil Se Dil Milate Chalo’with the aim to spread awareness about congenital heart disorders and to persuade people to come together and support a life by donating money.As a part of the initiative,Wockhardt Hospitals pledged to support one child for each child supported by the people Dr Suresh Joshi, Director Paediatric and Congenital Heart Centre, Wockhardt Heart Institute, Wockhardt

Hospitals South Mumbai, said, “Congenital heart efects (CHDs) are the most common types of birth defects. The

incidence of CHD worldwide is around 10-12/1000 live births. In India, around 2,00,000 to 3,00,000 children

are born with heart defects each year in India. Of these, only around 10,000 children are operated in 13 major centres in India." He further added, "There is a need for more dedicated centres for treating congenital heart disorders in our country. At Wockhardt Hospitals, South Mumbai, we have a dedicated centre and a committed team to treat congenital heart disorders both in children and adults. The state-of-the-art paediatric cardiac centre at Wockhardt Heart Institute is designed to take care of one year to sixty years old patients with birth defects of heart."

EVENT BRIEF DEC-2014 - JAN 2015 12

HOSPITAL INFRASTRUCTURE AND MANAGEMENT

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@ideas-

IRIA 2015

exchange.in Tel: 0091 22 6171 3211 Website: www.hospitalinfra.co.in

IRIA 2015 Date: Jan 29 - Feb 1, 2015 Venue: Hotel Le Meridien, Kochi, Kerala Summary: The 68th Annual conference of IRIA will be hosted by Kerala chapter of IRIA. It will comprise a sci-

entific programme oriented to the practicing radiologist and focused on sub-specialty work. Wide ranging academic feast including workshops, lectures, paper/poster presentations, image interpretation with audience response and orations are also a part of this conference. It will also consist of prime time sessions offering guidance to exam going PGs and

young radiologists entering practice. Contact Dr K Mohanan/Dr PC Shaji IRIA 2015 Secretariat, IMA House, Stadium Link Road, Kathrikadavu, Kaloor KOCHI-682 017 (M) +91 85890 54499 Email: iria2015kochi@gmail.com Website: www.iria2015.com

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cover )

BY RAELENE KAMBLI

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(

FOCUS:INFRASTRUCTURE

n November 2012, Express Healthcare reviewed Mumbai's hospital sector and found that the industry which was once a mecca for all kinds of medical aid had suddenly reached a plateau. Reasons for the stagnation being increasing real estates prices, disproportionate distribution of healthcare services within the city and lack of manpower to tackles epidemics and disasters. At that juncture, the sector needed a renaissance. Nevertheless, Mumbai is a city that possesses the valour to break all the possible jinxes and prove its 'never say die' attitude. The city's healthcare sector has already started taking confident strikes towards reviving its lost glory.

The first move The hospital sector in Mumbai is mainly dominated by multi-speciality institutes built during pre and post independence. Most of these centres of excellence are run by the Brihanmumbai Municipal Corporation (BMC) or various trusts and are structures that have stood for more than 50 years. However, it has been noted that these hospitals are soon reaching a dilapidated state and technologies used in these hospitals are very old and need to be changed or replaced. Hence, the first step to usher renaissance was to restore and revamp these structures which are the backbone of the healthcare sector in Mumbai. Earlier, in the year 2010, the BMC had announced the sanction of around Rs 750 crores for revamping civil run hospitals. However, the actual process started only in 2012.

The KEM effect The first hospital to start off this trend was the King Edward Memorial (KEM) Hospital. The 82 year-old heritage

structure built out of stones and teak wood has been associated with the history of modern medicine in India. The hospital is a Grade II heritage structure and is spread across approximately 5,23,400 sq ft, comprising two buildings. A sum of Rs 120 crores was allotted towards the entire restoration project and the contract was awarded to the Neev Group, a well-known construction and architecture company. Express Healthcare had also covered how the historic KEM Hospital was supposed to receive its new avtaar. The then COO, Mayank Madhani, Neev Group had explained how restoring a heritage structure was a challenging task, especially if the restoration work had to be conducted while the hospital is fully functional. He had informed that when Neev began restoring the hospital, KEM's building housed around 2000 beds with about 390 staff, physicians and 550 resident doctors, and about 1.8 million out-patients and 85,000 in-patients visiting the hospital on an annual basis . Here the challenge was to manage the functioning of the hospital without disturbing patients, visitors and whole staff as well as carry out the revamp while maintaining the essence of the heritage structure. In consequence to this, the whole project was divided in six phases. Each of the phase had a specific amount sanctioned to carry out the revamp. The restoration included increasing the strength of the structure and augmenting capacity of resources like water supply, and replacing the Medical Gas Pipeline System. The revamp included upgrading various wards and OTs, introducing new infrastructure for waste management etc and control-

Above: Pictures of the renovated KEM Hospital Building

In 2010, the BMC had announced the sanction of around Rs 750 crores for revamping civil run hospitals. However, the actual process started in 2012

ling HAIs. Also, where the interiors are concerned, every ward has been revamped with better flooring, plastering and tiling, painting as well as new beds and patient service furniture have been incorporated. Apart from this, the hospital also installed GRC domes instead of the conventional domes. GRC domes are lighter in weight, do not corrode and have substantial life. This revamp certainly gave a new lease of life to thousands of patients who commute to the hospital. Many departments which were not functional opened their doors to the patients increasing the capacity of the hospital. This landmark step urged the government to turn towards hospital like Bhagwati Hospital, Cooper Hospital, Nair Hospital, Lokmanya Tilak Hospital, Sion etc. This revamp included increasing capacities of the hospitals and also upgrading them with newer technologies. Apart from this, the Corporation also introduced a new medical college attached to the Cooper Hospital that spreads over three acres, and will house additional 150 MBBS seats. BMC has also applied for essential approvals from Medical Council of India (MCI), New Delhi, to expedite the process. Dr Suhasini Nagda, Director, Major Hospitals in a press meet that happened this August had said that they would apply for the approval by August 31, 2014. The MCI team would eventually come to inspect the facilities. The medical college will begin functioning with firstyear MBBS courses, commencing from June 2015. Courses in anatomy, biochemistry, physiology and preventive social medicine will be offered, starting next year. The hospital will commence interviews for

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cover ) NANAVATI HOSPITAL: TIMELINE

Laying the foundation stone

hiring teaching and non-teaching staff for the medical college from next year, January onwards. The medical college in Cooper Hospital will be the first such institution in the Western suburbs. Currently, there are three functional medical colleges run by the BMC â&#x20AC;&#x201C; Topiwala Medical National College run along with Nair Hospital in Mumbai Central, Seth Gordhandas Sunderdas Medical College run along with KEM Hospital in Parel and Lokmanya Tilak Medical College run along with Lokmanya Tilak Municipal General Hospital in Sion. The Corporation took the first step, and the private sector followed suit. Revamp and restoration within the private sector took a different form. Most of the private hospitals in Mumbai are upgrading various departments within the hospital set-up to provide better services. On the other hand, hospitals like there are Sir Hurkisondas Nurrotumdas Hospital and Research Centre and Dr Balabhai Nanavati Hospital and Research Centre were taken over by organisations like Reliance Foundation and Radiant Life Care who completely transformed these

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Mahatma Gandhiâ&#x20AC;&#x2122;s visit to Nanavati Hospital

hospitals into centres of excellence.

Reliance's 19 storey swanky hospital Sir Hurkisondas Nurrotumdas Hospital and Research Centre, now christened as Sir H N Reliance Foundation Hospital and Research Centre is a 19-

storey buildging with around 345-beds. The earlier structure was built in 1925, and the hospital is one of Mumbai's premium hospitals. It has witnessed the freedom struggle and the Second World War. One of its most frequent visitors then was Mahatma Gandhi. The hospital cele-

Founder trustees

brated its Silver Jubilee with Sardar Vallabhbhai Patel as its Chief Guest and the Golden Jubilee celebrations was graced by Lok Nayak Jayaprakash Narayan. However, in the last eight years the hospital was battling with financial instability and so Reliance foundation acquired it to rebuilt its glory.

Reliance began the hospital restoration project with a vision to make the hospital of the future. This hospital has collaboration with John Hopkins, MD Anderson Cancer Centre, Massachusetts General Hospital and University of Southern California and is currently a multi-speciality tertiary care hospital with six thrust areas: cardiac sciences, nephro-urology, neuro sciences, oncology, orthopaedics and spine, and woman & child health. The hospital also has a medical mall with progressive diagnostic services, including laboratories, radiology and imaging, and nuclear medicine. The newly restored heritage building can easily be mistaken as the front of a hotel. The heritage wing of the hospital which is connected to the new tower by a sky bridge has an antique elevator excavated from the godown and reinstated. It reminds you of the bygone Victorian era that the Britishers brought to India. Well, while Reliance has maintained the old world charm of the heritage building, it has also fully digitised the hospital. It has a suite of operation rooms on every floor, some equipped with robotic arms for

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Dr Balabhai Nanavati Hospitalâ&#x20AC;&#x2122;s old building

microscopic surgeries, and cutting edge hybrid cath-lab (a machine that does advanced imaging and allows doctors to perform interventional

Mother Theresaâ&#x20AC;&#x2122;s visit to the hospital

surgeries at the same time. The hospital has adopted technology in a big way with colour-coded floors and restricted passage ways

covered by RFID tags for equipment management. What's more interesting is that, the charitable wing of the hospital, where under privi-

Interior lobby of the hospital

leged patients will be treated also have the same set-up and technology as in the executive suite of the hospital. Additionally, the hospital has

an outreach programme that currently covers over 310,000 individuals in the vicinity, providing preventive and primary healthcare on a digital

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December 2014

cover ) platform virtually free of costs. Also, it has initiated steps to adopt the nearby congested areas as part of Prime Minister’s call of Swachch Bharat Abhiyan. To make the hospital the greenest healthcare facility in India, Reliance has adopted methods like water recycling and rainwater harvesting. Just as Reliance acquired Sir H N Hospital and transformed it into a healthcare centre, Radiant Life Care, promoted by former investment banker Abhay Soi has acquired Dr Balabhai Nanavati Hospital through an operations and management (O&M) alliance and has remodelled the hospital to make it into a preferred healthcare destination for Mumbai. The hospital is now named as Nanavati Super-speciality Hospital.

Adjacent left: The model for Sir H N Reliance Foundation Hospital and Research Centre which was recently inaugurated by PM Narendra Modi Below: PM Modi along with Reliance Foundation Chairperson, Nita Ambani and Mukesh Ambani

Radiant takes over Nanavati hospital Nanavati Hospital has a legacy of service to the people of Maharashtra. The hospital has been a witness to the city's effort in developing healthcare services. After experiencing a northward incline for many years, the hospital was faced with high operating costs, financial crunch and inability to compete with other private sector players, Nanavati Hospital, therefore decided to opt for a revamp. This July, the hospital entered into an O&M alliance with Radiant Life Care. The Nanavati Trust says that the brand Nanavati will remain intact. As per the alliance, Radiant Life Care will help streamline operations of the hospital by bringing in global practices and introducing a wide range of medical services. The new design of the hospital is in line with Delhi's BLK Hospital which is also transformed and managed by Radiant Life Care. The revamp has already began. As per the alliance, Radiant is looking to almost treble the capacity to 900 beds at a cost of over Rs 350 crores and upgrade the 64-year-old facility, inaugurated by the first PM

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December 2014

Abhay Soi, Chairperson, Radiant Life care

Radiant's alliance with Nanavati reflects that healthcare management firms are seeking avenues to enter Mumbai's healthcare sector in the form of M&A, O&M and even complete buyouts

Jawaharlal Nehru. The money will be used to add 600 more beds to the existing 350-odd beds. A good portion of the capex will be spent to add more super-speciality wings as well as to install state-of-theart technology The new management wishes to transform this hospital into a high-end quaternary care institute with world-class treatment facilities to provide healthcare solutions, like the the Mayo Clinic in the US. Speaking about the vision and plan for the hospital, Soi, says, “The hospital has a very strong legacy of more than 50 years. Secondly, it is an iconic part of Mumbai’s landscape and the third important aspect is the academics. So it is inherent in developing Mumbai's healthcare fabric of serving the people of Mumbai and North India. Although it is not a heritage building, the art décor of the hospital does remind us of Mumbai's old structures that you will find around the Marine Drive . So we decided to retain the old charisma, build upon the legacy and widen the ambit of healthcare services. So our vision for the hospital is that in a year or two we want Nanavati Super-speciality hospital to be the hospital of choice for Mumbai. Thereafter, we also have a 500-1000 sq feet of FAR, to build a new building where we will incorporate the 500 new beds. The hospital is also adjacent to the Mumbai airport and Juhu airport, so we intend to cater to the rest of the state. We also intend to build another IPD wing in the current premises while maintaining the current décor of the hospital.” The interesting part of this transformation is that Radiant did not choose to stop the functioning of the hospital while conducting the revamp. Even more interesting is that the revamp work is carried out without any glitches, opines Soi. “We have been very careful in our work, as the hospital has been fully operational. We

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have maintained high standards of hygiene and other factors in order to keep dust and infections at bay. In fact, we have been receiving a good response, the hospital's occupancy has increased by 60-70 per cent. This itself demonstrates that we have been able to carry on our work without any settlements on standards and practices.” The initial focus of the revamp is the facet, lobby, the ground, upgrading the wards to modern standards, and upgrading the cath lab with Philips' modern equipment. So, in the next two to three years time, the hospital will complete the entire revamp.

Sparking a trend Radiant's alliance with Nanavati also reflects that healthcare management firms are seeking avenues to enter Mumbai's healthcare sector

in the form of M&A, O&M and even complete buyouts. On the other hand, hospital entrepreneurs who are battling with instability in their business are scouting for prospective buyers for their hospitals. For example, recently SevenHills Healthcare's founder, Dr Jitendra Das Maganti and private equity investor JP Morgan mandated Goldman Sachs to find buyers for the over three-decade-old multi-speciality hospital chain. This serves an opportunity for the industry to acquire these hospitals and transform them for the better. This is just a drop in the ocean, there is more to come in the forthcoming year. Mumbai's healthcare scenario is witnessing the winds of change and we hope that they will usher prosperity to the sector in the times to come. raelene.kambli@expressindia.com

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cover ) I N T E R V I E W

‘A good refurbishment plan executed brilliantly is better than the best refurbishment plan executed badly’ Realising the need for timely renovation to keep hospitals in good health, government and private healthcare providers are investing on revamping and restoring old healthcare institutions. Dr Adheet S Gogate, Partner & Head, Philips Healthcare Transformation Services speaks on vital aspects to be considered in such projects, to Raelene Kambli

What are the important elements that need to be covered while revamping or restoring an old hospital? There are usually three strategic questions to be clarified before undertaking any renovations or refurbishments: First, it is critical to be very clear about the absolute necessity for refurbishment. Specifically, what is the goal in structural, configuration (number of beds, capacities etc.) and clinical/operational terms? And what is the budget/investment appetite for the effort? Establishing this clarity is the most important element – and often – the most neglected or unclear one. Hospital administrators need to establish a clear view of these questions before inviting planners or designers. Lack of clarity on these issues is the single most common reason for massive delays, cost overruns and generally unacceptable outcomes. Very often, many hospital administrators believe that poor business results are the result of infrastructure limitations and that refurbishment is a sure shot solution. In reality, the problem often lies elsewhere – in a poor business model, sub-optimal business models or quite simply poor

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management. Establishing that refurbishment is indeed the main solution to your business problems is absolutely important. Second, it is important to establish how well these goals will be met. A key challenge with every refurbishment is the reality of limitations imposed by an older structure. It is absolutely important to have a clear understanding of what expectations may or may not be fulfilled by refurbishment of your older facility through a rigorous cost benefit analysis. In many hospitals in more mature markets, for instance, planners have established clear evaluation stage-gates to decide whether refurbishment should even be considered! In several cases, they’ve seen that refurbishment is not even justified because many buildings may not even be able to bear the shift to modern standards: issues such as very narrow passages, the inability of accommodate extensive cabling, ventilation, ducting and other engineering services may make benefits so small that refurbishment may not be warranted. Thirdly, be clear on how you will do it. Will you shut the hospital? Will you do it in phases? What are the regulatory implications? Modern hospitals are highly

Key challenge with every refurbishment is the reality of limitations imposed by an older structure complex and inter-dependent facilities; deciding on the execution plan requires careful thinking. On one hand, shut-down may impose a crushing financial burden. On the other hand, patient volumes drop dramatically when hospitals undergo refurbishment/repairs, so the losses may be a lot less than

expected. Keeping patients in a hospital with civil work can also be fairly traumatic and unsafe. In some cases, a total shut-down may be desirable – to address other non-facility related issues. On the other hand, phasing merely prolongs the pain and exposes the project to higher financial risks. Careful analysis is warranted. Finally, India has the most Byzantine and unpredictable building regulations and approvals systems. In planning any refurbishment, it is absolutely imperative to fully understand and be prepared for managing permissions and approvals. The best laid plans are worth nothing if they cannot meet regulatory requirements and withstand scrutiny! What are the unique challenges in revamping heritage buildings? Some problems are unique to heritage buildings. In general, with few exceptions, heritage buildings are not suitable for delivering complex acute care that modern hospitals are expected to deliver (especially very old ones). Their structures may impose major limitations (such as dragging cabling through stone walls; passage sizes unsuitable for stretchers and smooth patient movement etc). Several

modern facilities – such as high-grade operating theatres with engineered ceilings and ICUs with air handling capabilities -- are simply not possible. Then there is the matter of regulatory approvals. It is hence important to maintain a pragmatic distinction between buildings that are merely old and those that are truly heritage structures (for historic or other reasons) and decide on refurbishment versus new development: caring for people must take precedence over keeping buildings simply for their age. Truly heritage structures have a very powerful historic rooting/anchoring role. They have been refurbished – with strikingly beautiful and pleasing results – into administrative spaces, museums, or para-clinical spaces. Several examples of such renewals exist, both within India and worldwide. Treated well, they, can enhance the most modern hospital! But not everyone may have that luxury, unfortunately. What are the engineering areas that are involved in projects concerning refurbishment? Structural and fire-safety integrity are major

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engineering challenges on older buildings. Modern safety codes are very demanding and bringing older buildings up to specifications can be a challenge. Other engineering considerations for refurbishment are no different from those for new hospitals. Modern buildings have a plethora of services: MEP, HVAC, IT, networking, transportation, logistics, services, others. Hospitals have their own special needs too â&#x20AC;&#x201C; such as material transport engineering (e.g. via pneumatic chutes), highspeed movement, sterile movement and so on. What are the challenges associated with such projects? Especially, if the hospital is functional while the revamp is on? In my experience, the biggest challenges I have observed have occurred almost entirely due to insufficient attention to the three key strategic questions mentioned earlier. Some projects, for instance, get delayed for years, because the goal of the refurbishment, the boundary conditions, the priorities are unclear. There are few things in this space more challenging than undertaking a major renewal project if the goal is not clear. Mention some learning lessons based on such projects. Learning 1: Use refurbishment as a starting point of a performance transformation and not as an end in itself. The distance between being a good hospital and a great hospital is largely bridged by better management, operations and functional discipline: infrastructure renewal can take you only so far. Refurbishment may give you a nicer hospital but it wonâ&#x20AC;&#x2122;t give you a better one: that is entirely dependent on the people, resources and processes within your walls! The biggest potential of a refurbishment is to create a new slate for transformations.

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Use the change to usher in fundamental changes: design simpler, patient friendly workflows, establish newer organisational structures to enable better care or even restructure your clinical departments for care, quality

and safety. Learning 2: A good refurbishment plan executed brilliantly is better than the best refurbishment plan executed badly. Be practical in your goals, accept that compromises and

adjustments are inherent in refurbishments, brownfield expansions â&#x20AC;&#x201C; or even in the most ambitious new projects! Learning 3: For real returns, invest in your people. Even as you invest in new property, plant and equipment, ensure

you focus equally on people, processes and training to ensure you actually deliver improvements in patient care in your new infrastructure. Those elements matter more than anything else! raelene.kambli@expressindia.com

cover ) I N T E R V I E W

â&#x20AC;&#x2DC;Hospital expansion in India has become imminent as the norms and needs are changingâ&#x20AC;&#x2122; Renovating an existing hospital structure while it is functioning is difficult and requires joint effort of construction and hospital operation. Ajay Gupta (AIA), Executive Director, Kgd-architecture explains to M Neelam Kachhap several aspects of construction process and potential problems for hospital operations during renovations

What is the biggest challenge for an architect while working on a hospital project? A hospital is a unique building and probably the only one which requires more than 20 specialised consultations to be integrated into efficient design. For example; each hospital room is not only designed for efficient space but also factors like power, water, hygiene and sanitation, medical gases, acoustics etc need to be considered. Flow of operation is the priority and the hospital is designed with this in mind. With each project the approach has to be different. Besides, a hospital is a service oriented building with constant human interaction. This makes proper space allocation for all needs very crucial. These make a hospital project very challenging for architects but at the same time very exciting. A well executed hospital project is a matter of pride. How are hospital projects different from other commercial projects? The basic difference between a hospital and a commercial project is the fact that the owner and operator is the same entity in the former. As compared to commercial or residential projects where the owner usually sells it of or rents

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December 2014

the building. A hospital project is therefore a better project to execute as the owner is more sensitive to the design aspects and is in sync with the architect. However, a hospital project has a more aggressive schedule and a tight time frame. In addition, the project is not only CAP-ex sensitive but also OP-ex sensitive. How has your experience been working with the hospital sector? It has certainly been a good experience working in this sector. Kgd-architecture has been in this segment for the past seven years and we have traversed our learning curve. For an architect, a hospital is the most organised sector to work on a building project. The mandate of a hospital is very clear and this helps in design and execution. We have till date worked on 20 hospitals across India and neighbouring countries, besides working on projects in GCC area and North Africa. Tell us about any memorable project you have worked on? Columbia Asia East (Whitefield) has been one of the most exciting projects we have worked on till date. Itâ&#x20AC;&#x2122;s a brownfield project but the building acquired by the hospital had only the skeleton

concealed the medical stuff behind beautiful paintings. The use of natural light, art work, appropriate colours and right material was done to reduce the stress level of the attendee, patients, staff and doctors, as well as to enhance the hospitality services offered.

In India, people believe that once a building is constructed it should last multiple lifetimes structure in place as it was made keeping retail in mind. So, converting this retail building to suit the standards required for a multispeciality hospital was quite exciting. With a total area of 200000 sq ft, this hospital was completed in a record time of 16 months at total project cost of about Rs150 crores. We have tried to give the hospital a very non-clinical feel, for example ;

While considering hospital expansion what factors should be kept in mind? Hospital expansion in India has become imminent as the norms and needs are changing. Working on a running hospital is very tough as several factors have to be controlled, primarily infection. The hospital can opt for modular construction which is done off-site and later assembled into place. Construction techniques like pre-cast modular construction, steel fabrication etc can be adopted for the hospital. This has many advantages like speed of construction, flexibility and minimum disruption of existing operations. What are the options for small hospitals if they are 20 years old and the area around the hospital has developed with no room for expansion? How can they expand and increase their FSI? In India, the practice of demolishing and reconstructing a building after it has run the course of life is

alien. Elsewhere in the world, every building is constructed with a lifespan in mind. In India, people believe that once a building is constructed it should last multiple lifetimes. For expansion in an existing building, it should be structurally sound. Once that is determined the architect can work around horizontal expansion designs with less weight bearing material. The philosophy of life safety should not be compromised. What is your advice for hospitals looking at remodelling or renovating the present structure? The hospitals around the world are facing the challenge of designing a flexible hospital to suit unpredictable future needs. Change is a constant feature in architecture, yet the pace at which our healthcare is changing is greater than any other field and thus the demand for evolving hospitals is also mind boggling. The hospitals should have provisions for change and adaptability. Hospitals, thus, should opt for a flexible design keeping in mind the future requirements. A variety of construction tools and new technology that not only provides space but also pleasant and non-stressed healing environment is ideal for utilisation. mneelam.kachhap@expressindia.com

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FULLY AUTOMATED PATIENT TRANSFER LIFT

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‘We specialise in providing solutions in a cost-effective manner’ Express Healthcare speaks to Rupesh Pandey, Director, RSG Infotech to understand how a hospital can upgrade its IT infrastructure in a cost-effective manner Do you feel that IT solutions for healthcare in India has come of age? There are very few IT partners in the healthcare industry who can provide hospitals with the kind of IT support that they require. There are some big brothers of the industry. However, these do not provide hospitals with solutions at affordable rates. What are the important aspects that need to be considered while upgrading a hospital with IT infrastructure? Aspects to be considered while upgradation differ from department to department. For example, the demand for IT infrastructure in a cardiology department will differ from radiology and a from a cath lab to a laboratory. So basically, it all depends on the demand of the department and the kind of technology that is being installed. How can this be done in a cost-effective way? What is the role of RSG Infotech in doing so? There are many important aspects that need to be considered, especially because each department of a hospital

has different needs. For example, take the radiology department which needs monitors that can provide the radiologists and the technicians with good imaging pictures. So, our role here is to check on the existing monitors and IT infrastructure present in the department to see if these can be upgraded to a level that can provide better images. Upgrading the existing endoscopy SD system with the right kind of HD scaler and professional monitors will help hospitals to save cost on buying new equipment. What is unique about these solutions? We specialise in providing solutions in a cost effective manner. Moreover, in the Western countries we have noted a trend wherein hospitals are getting rid of medical films in order to stop burdening the ecosystem. Also, the cost of disposing medical films is high. Therefore, people in the West are avoiding the usage of medical films. Now we also have some solutions for the same. We have DICOMJet software and printer solutions that give out DICOM paper

print. This reduces costs while increasing capabilities within radiography suites. With our solutions, radiology departments can save time and money while expediting the sharing of exam results among medical teams and with patients.

With our solutions, radiology departments can save time and money while expediting the sharing of exam results among medical teams and with patients

Some of the unique features of the printers: ◗ Seamless integration in any DICOM network ◗ In small imaging centre, DICOMJet can be coupled even with a single modality supporting DICOM print ◗ Dramatic cost reduction ◗ Near-diagnostic print quality ◗ Easy filing, storage, shipping and disposal of paper printouts ◗ Environment-friendly Apart from this we have monitors that provide high resolution, high quality and ranging from 19” Desktop monitor upto 65" Large Display. What are your future plans? In the future, we would like to help more hospitals who are looking at upgrading their hospital with IT solutions in a cost effective way. raelene.kambli@expressindia.com

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Anandaloke Hospital & Neurosciences Centre: Committed to provide best healthcare facilities

iliguri-based Anandaloke Hospital & Neurosciences Centre, the 150-bedded multispeciality hospital spread over 85000 sq ft provides all healthcare services under one roof, except cardiothoracic and oncology. It has critical care, neonatal care, haemodialysis, emergency services and five operation theatres. Diagnostic and imaging facilities include 1.5 Tesla MRI, 16-slice CT, X-ray, USG, Color Doppler, TMT, Spirometry, EEG, NCV, EMG, laboratory with automation in haematology, biochemistry,

microbiology, Karl StorzHD Laproscopic System and Zeiss Surgical Microscope. It offers super-speciality services in neuromedicine, neurosurgery, plastic surgery, gastroenterology, nephrology, urosurgery and cardiology. It is managed by a team of around 500 committed professionals: administrators and team of doctors including superspecialists, specialists, junior doctors; nursing professionals and paramedical staffs. The hospital has risk management department and is implementing 10 JCI safe healthcare goals and monitoring safety

indicators to benchmark with the best in the health industry. It is ISO-certified and ClassI service provider of the West Bengal Health Scheme. It is also a preferred service of medical insurance company and TPA. Anandaloke is empaneled by NF Railway, Sikkim Government Health Scheme, Airport Authority, FCI, SSB, Union Bank, NHPC and PHPA (Joint Venture of Bhutan & India). It treats around 8000 indoor patients per year and around 70000 OPD patients per year. The hospital also operates a nursing school under West Bengal Nursing Council,

recognised by Indian Nursing Council. Paramedical courses like Diploma in Critical Care, Dialysis Technician, OT-Technician, Radiology Technician, Laboratoy Technician under State Medical Council are also provided. The present hospital was set up by Dr Sushanta Kumar Roy. He was a teaching faculty as associate professor at MGM Medical College (Kishanganj) and a radiologist by profession who started as a Consultant Radiologist in Siliguri. Later he started his own USG Clinic and expanded it to a complete diagnostic centre equipped with

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latest generation equipment. The lab at the hospital is NABL accredited. Dr Roy set up this hospital in 2003 with 25 beds and a vision to provide comprehensive and affordable health care. Under his dynamic leadership, the hospital has made significant growth. This growth accelerated under the tenure of Dr AK Khandelwal, the Medical Director who joined the hospital four years back. New infrastructure was added, training institute for GNM and paramedics were started to meet the

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KNOWLEDGE

hat have been the major breakthroughs in AIDS research in the 30 years since you co-discovered HIV as the cause of AIDS? The major breakthroughs are as follows: ◗ Our development of the HIV blood test in 1984 and the application of that blood test by some of the big companies to make a global test possible. ◗ Of course, additionally the development of drug therapy

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December 2014

beginning in 1986 with AZT, make these the two great practical advances in the field. ◗ The demonstration by ‘Slim’ Karim of South Africa that microbicides could block HIV infection when used properly by women. While this may not be so readily applicable, when properly done drugs can be long-lasting and act to prevent infection in the female genital track. ◗ The detailed understanding

of how HIV enters cells and approaches now of how to take advantage of this knowledge for the development of a vaccine, though this is still in progress. We don’t yet have an effective vaccine. ◗ The US President’s Emergency Plan For AIDS Relief (PEPFAR) programme initiated by former US President, George W Bush to bring therapy to needy nations in Africa and the Caribbean.

Can genes play a role in increasing susceptibility towards AIDS? Yes, and resistance as well. How close are we towards finding a cure for AIDS? Is it possible to eliminate it completely? It is not possible to eliminate it completely. The prospects are remote. But since we can manage the virus with therapy, it is already a well-treated

disease. So, when you know you are infected, and when you have access to properly trained physicians and you adhere to the regiments it is a well-treated disease. When people talk about cure today, people are generally talking about what we call a functional cure. This means you may not need the drugs any longer that the virus is so low in amount that the remaining immune system can keep it in check forever more – this is a possibility but

World AIDS Day Special

I N T E R V I E W INTERVIEW

‘ONE SUSPECTS THAT WITHIN FIVE YEARS A FUNCTIONAL CURE MIGHT BE ACHIEVED’ Dr Robert C Gallo is best known as the co-discoverer of HIV as the cause of AIDS. He is also the Co-Founder & Director, Institute of Human Virology at the University of Maryland School of Medicine and Co-Founder & Scientific Director, Global Virus Network. He shares his insights about AIDS, research on the disease, challenges associated in managing it effectively and more, in an interaction with Lakshmipriya Nair

I cannot tell you when that will be forthcoming. One suspects that within five years a functional cure might be achieved. Tell us about your recent research in this sphere? There is not much to say about our research into the cure. It is complicated and not yet at a practical level. Indeed, we are spending more time on trying to develop an effective preventive vaccine sponsored mainly by the Bill & Melinda Gates Foundation in Seattle, Washington, US and in part by the National Institutes of Health in Bethesda, Maryland, US. We are beginning phase 1 clinical trials for the preventive vaccine next year. India has a huge AIDS burden (third largest in the

It is not possible to eliminate it completely.The prospects are remote. But since we can manage the virus with therapy, it is already a well-treated disease.

world). What should be some of our immediate measures to intensify the fight against AIDS? To be certain that there is nationwide adequate testing and to reach out to clinics, hospitals, doctors, to be sure there is adequate testing of people. The blood test is essential to find out who is infected. Even in the US, where we have long experience and a lot of testing being done, it is estimated that 20 per cent of infected Americans don’t even know they are infected. So, the most important thing is reaching out and testing people as much as possible, and once known to be positive to be sure they are on therapy immediately with proper follow up by doctors well-trained in HIV therapy.

What should be the focus areas globally to control the AIDS pandemic? Where are we lagging behind? Money. We need much more finances to make sure people who are infected are treated. Trying to reach as close to 100 per cent as possible. Again this requires reaching out and testing, and adequate testing for therapy. As I mentioned before, the US PEPFAR programme has been involved in greatly increasing the number of people treated in Africa but we need much more of that and we need more nations participating as the US has done, and to help people in need. The US needs to continue this and, if possible, to increase it. lakshmipriya.nair@expressindia.com

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December 2014

KNOWLEDGE

World AIDS Day Special

I N T E R V I E W

‘HIV and TB seems to go hand in hand in India’ As the global efforts to curb HIV-AIDS accelerates, the World Health Organization (WHO) issues new recommendations for countries to address important gaps in HIV prevention and treatment services. The new recommendations advocate using antiretrovirals as an emergency prevention following HIV exposure, and urges prevention and management of common opportunistic infections that affect a large number of people living with HIV. So, is India on the right path to become an AIDS-free country? Raelene Kambli speaks to Dr Anita Mathew-Davis, Physician & Infectious Disease Consultant, SL Raheja Fortis, Mumbai on the current state, research done so far and ways to overcome the peril

What is the current state of HIV AIDS in India? In the league table of top 10 HIV affected nations, India is currently the third country with an epidemic proportion. Almost 0.3 per cent of our population, i.e. 2.1 million are reportedly affected with HIV/AIDS. The positive note being that overall we have shown a reduction in the number of patients in the last decade. What makes Indians more susceptible to acquiring HIV? According to a study done by All India Institute of Medical Sciences (AIIMS), Indians are lacking in the protective gene and have genes which make them more susceptible to the disease and its rapid progression. What is India's contribution towards fighting against HIV-AIDS? Various programmes are being run by the Government of India through National AIDS Control Society (NACO) that looks into the treatment and prevention of HIV/AIDS. We also have

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December 2014

Indian Council of Medical Research (ICMR) and NACO-funded research being done in ICMR, various government medical hospitals and NGOs. These have been successfully implemented and have been major contributors to the reduction in the prevalence.

countries in fighting HIV? India has been doing its bit in the fight against HIV/AIDS with active support from the government and also by various foundations like Gates and Clinton Foundation which are involved in research.

What are the new roles for emerging economies in fighting HIV – countries such as China, India, Russia, Brazil, and South Africa? In October this year, South Africa has already confirmed that their trial on HIV vaccine have shown comparable results with more long lasting protection than the trial conducted in Thailand six years back. We might see a vaccine in the market for the same by 2019 if the efficacy and prevention rate is over 50 per cent. In the emerging economies, the ministry of health and other government agencies act either as barriers or facilitators for research ethics approval process.

What is the relation between HIV and tuberculosis? If there is a strong linkage between TB and HIV, how grave is the problem on a larger context, especially in terms of the growing number of people with HIV and TB in India? How can we curb this kind of incidence in India? We are probably holding the dubious distinction of being the TB capital. We have a huge burden of TB, even in non-HIV individuals. HIV and TB seems to go hand in hand. A HIV-positive with TB co-infection has a 50 per cent lifetime risk of developing TB. The lower the immunity, higher the risk of TB. Various studies have already shown the relation of HIV and TB co-infection. We are facing lot of problems with co-infection

Where does India stand when compared to these

Indians are lacking in the protective gene and have genes which make them more susceptible to the disease and its rapid progression

which leads to severe drug interaction and increases the toxicity and thus the mortality and morbidity. Now in addition, we are also dealing with multi drugresistant/extensive drug resistance and off-late, total drug-resistant TB cases. These will have a huge burden on our existing health resources besides increasing the mortality. Early detection and judicious evidence-based treatment of TB patients in the population will be a positive step towards reducing the incidence. Some experts claim that India is close to getting some leads for developing a vaccine against HIV that causes AIDS. What is your opinion on the same? Researchers from HIV Vaccine Translational Research Laboratory in India have said that once they are able to isolate the neutralising antibodies in patients who are infected but have not progressed to the disease, they would have a clear understanding of how to go about with vaccine development. raelene.kambli@expressindia.com

KNOWLEDGE

World AIDS Day Special

I N T E R V I E W

‘Testing policies must be streamlined and brought in line with the modern best practices’ AIDS Healthcare Foundation (AHF) is a non-profit HIV/AIDS healthcare provider that provides medical care and services in 36 countries worldwide. AHF India functions under the AHF Global to tackle the huge AIDS burden in the country. Dr Nochiketa Mohanty, Country Programme Manager - AHF India talks about dealing with the huge AIDS burden, treatment strategies, need for rapid testing and prevention programme, policy changes needed and AHF India’s role in fighting AIDS, in an interaction with Lakshmipriya Nair India, with a huge AIDS burden, has been waging a war against it for decades now. So, what have been our major achievements? Some of our major achievements have been access to affordable generic medications for India’s citizens and people in the developing world, and a position on intellectual policy rights that has prioritised public health over corporate interests. But, now this progressive position is increasingly under attack as a result of continued pressure on intellectual property enforcement from the US and the EU. A stronger stand needs to be taken by the government keeping the interest of the public in view so that flexibilities existing in the current Intellectual Property (IP) laws are not affected. Tell us more about AHF’s 20X20 campaign to provide AIDS care to 20 million individuals by 2020. 20×20 is a global campaign to scale up access to antiretroviral therapy (ART) for at least 20 million people by the year 2020. Currently, only 12 million people out of 35 million are on ART, which is far too low. Millions of people still die of AIDS-related causes every year because they cannot get the medicine they need. The chief aim of 20×20 is to spark a renewed vision—that investing in treatment scale up will yield humanitarian and economic benefits that far

outweigh the initial costs. This campaign seeks to change the global mindset and reinterpret the AIDS response not as a burden, but as a smart longterm investment that will pave the way to ending AIDS, boosting economic growth and saving millions of lives. AHF has been against PM Narendra Modi’s decision to lift the restrictions on pricing of 108 drugs in India. Can you explain your stand? In a press statement issued on October 13, we respectfully asked Prime Minister Modi to reinstate these potentially life-saving drug price caps for the benefit of Indians as well as the entire world. Our stand on the move by the government is: “Now that drug pricing restrictions have been lifted, prices will likely increase, making medicines unaffordable, especially for the estimated 30 per cent of India’s population that lives below the poverty line.” The setback is doubly disappointing, because United Progressive Alliance (UPA) — the ruling coalition prior to Modi’s election—had to overcome substantial pressure from the pharma lobby in order to implement these price caps in the first place. A UNAIDS report informs that a huge number of HIVpositive people are unaware of this fact and this is accelerating the spread of AIDS. How can the situation

There needs to be strong linkage to care and services for those who test HIV-positive be reversed? HIV testing must be scaled up in a big way around the world. Governments from across the world need to embrace community-based streamlined testing models that use rapid testing technologies and make testingfree, convenient, hassle-free and easily accessible, particularly for the most affected populations. Testing results should be available the same day and there needs to be strong linkage to care and services for those who test HIV-positive.

What are the major challenges in the fight against AIDS? How to mitigate them? Low level of testing is a major problem — many HIV positive are unaware of their medical status, rendering them incapable of taking the necessary steps to protect their partners and loved ones. Government policies and bureaucracy make the testing process long and cumbersome, so many people are lost along the way before they ever get to see a doctor and receive treatment. Prevention programmes are being scaled down, especially, with many centres facing stock-outs for condoms and HIV test kits. This decreases the faith of those accessing prevention programmes in the existing facilities and risk behaviours go unprotected thereby, increasing the risk of transmission. Treatment as prevention is an accepted international standard and is recommended in all international guidelines. Therefore, early treatment initiation irrespective of CD4 counts or at least below CD4 count of 500 has been recommended by WHO. India is still lagging behind in the implementation of these recommendations. A political and bureaucratic will to attain these international standards is lacking. Stigma towards people living with HIV and sexual violence towards women is also

among the major problems. People are afraid to receive treatment or reveal their status out of fear of being shunned by their family and community. Each of these issues require a specific strategy to mitigate it, but if the government makes a commitment to prioritise HIV/AIDS in India and take concerted steps to address the epidemic, as has happened in South Africa, this would go a long way in helping India get AIDS under control. What are the policy changes needed to fight AIDS more effectively? Testing policies must be streamlined and brought in line with the modern best practices, such as the use of two rapid tests to establish a diagnosis instead of using blood draw and slow lab tests that take up to a week for results. Testing must be scaled up across India in a major way. The treatment initiation threshold should be brought in line with the WHO recommendations, so that people can start treatment sooner, when their CD4 count is 500, instead of the current 350. India must maintain a strong stance on prioritising access to essential medicines over granting patents to pharma companies. Condoms should be widely promoted and freely distributed as the most cost effective way to prevent new infections. lakshmipriya.nair@expressindia.com

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December 2014

KNOWLEDGE INSIGHT

Safe babies for HIV-infected mothers

DR GAURAV THUKRAL Head Medical Services, HealthCare at Home

Motherhood is a feeling every woman wants to experience. HIV-infected women are no exceptions. Like normal expecting mothers, they too can deliver a baby who is not HIV infected, writes Dr Gaurav Thukral, Head Medical Services, HealthCare at Home; and a master trainer in HIV-AIDS prevention training

Ever since India reported its first case of HIV/AIDS in 1986, the disease has grown at a monstrous pace, infecting over five million populations until now. What is alarming and disturbing is that the disease is being passed on from infected adults to children, putting not only their entire life at stake, but also putting a huge economic burden on the country. Presently, India has 5.7 million people afflicted with HIV/AIDS, as per UNICEF, which further states that around 38 per cent of the total figure are women, who must have given birth to a child in the past or might do so. HIV-infected expecting mothers are always running a risk of transferring the HIV virus to the new-born child. Going by UNICEFâ&#x20AC;&#x2122;s figures, around 2,20000 children in India are infected with HIV/AIDS and 50,000 to 60,000 newborns are given birth by HIV/AIDS-afflicted mothers every year in the country. These figures can be troubling enough to take remedial actions to avoid the situation from flaring up to a point where it gets difficult to employ corrective measures. Apart from what the disease does to HIV/AIDSinfected children, the social stigma that is associated with

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Studies show that only 33 per cent of the babies born to HIV-infected mothers who are not taking ART medicines have HIV. This percentage, the studies say, can be brought down to one per cent if women with HIV begin subscribing to ART medication

the disease puts enormous metal burden on children, spoiling their growing up and formative years and making them lead a life of complete isolation and seclusion. The major challenge is to ascertain whether the mother is HIV-infected or not as the symptoms are asymptomatic. Gynaecologists prescribe mandatory HIV test post first-time antenatal check-up. If the woman is found to be HIV-infected and the viral load is high, delivery is planned accordingly. There is a myth that children born to women afflicted with HIV are infected as well in 100 per cent of cases. Baseless is the reasoning! Studies show that only 33 per cent of the babies born to HIV-infected mothers who are not taking ART medicines have HIV. This percentage, the studies say, can be brought down to one per cent if women with HIV begin subscribing to ART medication. So the claims that HIVinfected women should not bear babies and that all of them born to such women are infected are unfounded.

How newborns get infected? Newborns mostly get HIV virus from infected mothers

KNOWLEDGE at the time of labour. While infections can pass on to the unborn children at any stage of pregnancy, chances are much higher for them to contract the virus during the delivery process. Risks rises manifold if the delivery takes a long time than usual. The fact that the child comes in direct contact with infected mother’s blood during delivery increases at that stage. If the delivery period is longer, the child is exposed to the infected blood for a much longer time and so the risks are even higher. Other than delivery, the newborn is susceptible to contract the virus through infected breast milk of the mother, if she is not subscribing to ART medication during the breastfeeding sessions. As per the guidelines of the World Health Organization (WHO), HIV-infected mothers should take ART when they breastfeeding their babies. In some countries like the US breastfeeding is not allowed by HIV-infected mothers, and they are asked to rather go for infant formula instead of their own milk.

Preventing newborns from contracting HIV Unlike normal expecting mothers, women afflicted with HIV/AIDS run the risk of passing on the virus to their babies. While the fear is genuine and obvious, taking a few

World AIDS Day Special

As per the guidelines of the World Health Organization (WHO), HIV-infected mothers should take ART medication during the breastfeeding sessions. In some countries like the US, breastfeeding is not allowed by the HIV-infected mother and they are asked to rather go for infant formula instead of their own milk

measures can cut the risk substantially. Consultation with HIV specialist: Women already afflicted with HIV virus should consult a specialist before planning a baby. If a woman comes to know that she is suffering from HIV during an antenatal check up, she should immediately consult a specialist. A thorough examination to check the level of HIV in mother’s body can help in better planning and cut chances of the baby contracting the virus. The sessions help understand the pros and cons of pregnancy and dealing with it better. Viral load can be gauged during the examination and accordingly medications and care can be suggested. Women who have

suppressed virus have less chance of passing it on to the baby against those whose virus is present in the blood. Thereby, consulting a doctor becomes imperative. Proper medication: After diagnosis, combination of drugs are prescribed which the women should take religiously. There should be regular meetings with the specialist who keeps altering the course of medicines with the progression of pregnancy. HIV medicines are available free of cost at all governmentrun hospitals in India. Delivery of baby: The virus in the blood around delivery determines whether it would be caesarean or vaginal. If the viral load is high or if the mother is not taking medi-

cines, the procedure recommended is always Caesarean so that the baby does not come in contact with mother’s blood and even if the contact is there, it must be as low as it can be. In case the presence of virus is negligible and the mother is properly taking drugs, vaginal delivery is as good to be performed. Breastfeeding the baby: HIV virus can possibly pass to the baby from HIV-infected mother. So either the mother should refrain from breastfeeding or do so while taking proper antiretroviral (ART) medication. Even though mothers with HIV are on medication, chances in some cases are still there of virus transmission if the viral load in mother is exceedingly high. In developing nations where

availability of infant formula is scarce, there is no ban on breastfeeding. However, it is advisable to do so under the guidance of HIV specialist to minimise virus transmission to newborns. Early diagnosis: It is very important to get the babies tested post delivery for any HIV transmission. Some blood tests are performed to make out the HIV viral load. In India, diagnosis was possible among infants only after the age of 18 months, due to which crucial time was lost and led to late start of treatment and care. However, in 2010 the government rolled out a programme for diagnosis among infants who were less than 18 months. During 2012-13, 12,169 infants, less than 18 months, born to HIV-infected mothers were tested till December 2012, as per NACO’s Annual Report 2012-13. India is behind Western nations where infants are tested in just a few weeks of birth. So infants should be tested for HIV transmission as soon as they are the prescribed age to get tested in India, without waste of time. HIV might afflict a woman for any reason. But the fear of HIV transmission should not become a deterrent for becoming pregnant. Just being cautious can help!

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KNOWLEDGE I N T E R V I E W

‘ROP affects about 30-50 per cent of premature babies in India’ On completion of 15 years of the retinopathy of prematurity (ROP) screening programme, LV Prasad Eye Institute (LVPEI) rededicated its teams in Hyderabad, Bhubaneshwar, Vijayawada and Visakhapatnam to further expand the newborn eye screening programme and spread its reach to every baby to enable them achieve their 'Right to Sight'. M Neelam Kachhap spoke to Dr Subhadra Jalali, Associate Director, Consultant, Smt. Kannuri Santamma Retina Vitreous Service and Jasti V Ramanamma Children’s Eye Care Centre, LV Prasad Eye Institute, Hyderabad about the issues related to the disease

What are the causes and risk factors for ROP? There are a number of causes and risk factors related to ROP such as prematurity, birth weight, oxygen fluctuation, sepsis, anaemia, ventilation, multiple pregnancy, diabetic mother with premature baby, blood transfusions in baby, apnoeic spells etc. Bigger and heavier weight babies in India and the developing world get ROP, and more severe ROP as compared to Western countries. These are due to differences in maternal and postnatal care factors. (data published by Clare Gilbert in Paediatrics) What is the pathophysiology of the disease? Avascular and immature retina at birth of a premature baby is vulnerable to external insults of post natal care as well as postnatal and prenatal growth. Failure or derangement of vasculogenesis and angiogenesis of retinal vessels lead to accelerated ischaemic events in retina, manifesting as dilatation and tortuosity of vessels, vitreous haemorrhage and tractional and exudative retinal detachments. These are mediated by increased levels of vasculoendothelial growth factors (VEGF) and reduced

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levels of insulin-like growth factors (IGF) in the growing eye outside the womb. Is this a sudden onset disease or is it gradual vision loss? In the acute phase, it develops within two to four weeks of birth and is called as aggressive posterior ROP. This is seen in most tiny and most sick babies, especially with poor weight gain. This is supposed to be due to failure of vasculogenesis. In others it progresses from three to eight weeks or so of birth rapidly but not as aggressive as first category, and is due to failure of angiogenesis and often leads to irreversible retinal detachment in 9-15 per cent babies. In some babies, disease is mild and regresses on its own, generally around expected date of delivery that is by 4042 weeks post-menstrual age. So, in most cases there is an optimal two weeks or so of window period where the disease can be assessed and treated well so that any adverse effects on the growing eye can be prevented. It is, hence, a rapidly progressive condition and is treated as a medical emergency- once vision threatening stage is detected it should be treated within 72 hours. As the child grows, in chronic phases slow and

progressive vision loss can occur due to amblyopia, refractive problems, glaucoma, cataract, lateonset retinal detachments, late-onset vitreous haemorrhage, squint etc.

Standard of care is laser photocoagulation of the avascular retina to remove the source of abnormal VEGF secretion

A premature baby requires oxygen how then can this be controlled so that ROP does not happen? Fluctuating and intermittent oxygen administration, administration of unblended oxygen or unmonitored oxygen are all very bad practice oxygen strategies. Slow and steady weaning of oxygen is recommended. Oxygen monitoring by pulse oxymeter (should be maintained between 85-93 per cent or so) and blood gas estimations whenever needed are strongly recommended. Proper use of continuous positive airway pressure (CPAP) strategies is recommended. For best practice care, doctors can refer to National Neonatology Forum (NNF) clinical practice guidelines (CPG) 2010 available onthe NNF website of India. Oxygen requirements can be reduced by antenatal steroids to the mother. Oxygen need will also reduce by strict attention to asepsis and nutrition of the baby. However, one must

remember that oxygen strategies only modify the ROP process. Babies who are premature and never received oxygen can still get severe ROP and vision loss. How is ROP detected? Who can do this diagnosis? ROP is easily detected by periodic fundoscopy starting from 20-30 days of birth. Any person trained in neonatal fundoscopy can screen for ROP. Main instrument used is the binocular indirect ophthalmoscope. Alternatively, digital fundus camera can be used in some stages of the disease. Most cases are detected by eye specialists. However, there are some attempts to detect ROP by trained technicians using telemedicine techniques. Are there different types of ROP? Major differences are in vasculogenic ROP and angiogenic ROP as mentioned earlier. They differ in onset, severity, rapidity of worsening, resistance to treatment, outcomes etc. How are these treated? Standard of care is laser photocoagulation of the avascular retina to remove the source of abnormal (VEGF) secretion. The

KNOWLEDGE outcomes of the therapy are very good if screening and laser are done earlier in the progressive disease than later. Alternatively, cryopexy is used though results are less optimal than laser and is more painful with more side effects. Recently, anti-VEGF injections are considered as rescue therapy or as monotherapy but these are as off-label usage. These injections are still under research considerations for dosage and the short-term and long-term ocular and systemic adverse effects. Can vision be restored 100 per cent? Vision loss can be prevented and the macular structure can be preserved to what the child was born with, in more than 90 per cent babies if detected and treated on time. The ROP treatment is directed to the

ROP is easily detected by periodic fundoscopy starting from 20-30 days of birth. Any person trained in neonatal fundoscopy can screen for ROP. Main instrument used is the binocular indirect ophthalmoscope. Alternatively, digital fundus camera can be used in some stages of the disease retina which is only one of the components of a good vision. Other components include development, cognition, attention, medications for epilepsy etc., all of which can affect visual performance. Some premature babies may not get completely normal vision due to these neuro-developmental issues even though the macula is well preserved with ROP

treatment. Most premature babies need glasses for getting best visual outcomes.

and more mature babies in India than in Western populations.

What is the prevalence of ROP in India? ROP affects about 30-50 per cent of premature babies in India. Severe vision threatening ROP that needs treatment occurs in about 20 per cent of these. About 16-20 per cent of severe ROP is seen in large

What are the steps that neonatal intensivecare units (NICUs) should take to prevent ROP? Follow all the antenatal and postnatal good CPG as outlined in the India NNF guidelines 2010 (available on their website). These include practices before and at time of

delivery, first golden hour practices, baby transport, oxygen, lungs management, asepsis, nutrition, transfusion etc. Always get every preterm baby Retinal examination between 20-30 days of life and ensure that this importance is understood by all staff and parents- put up awareness charts in waiting areas of NICU and make a mandatory column in discharge summary of all NICU and sick newborn care unit (SNCU) graduates. In follow-up ensure that timely ROP screening and its follow-up has been completed. These practices reduce the prevalence of ROP and severe ROP and also reduce the chances of blindness. However, ROP cannot be completely eliminated and hence timely ROP screening is also essential. mneelam.kachhap@expressindia.com

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EXPRESS HEALTHCARE

December 2014

STRATEGY TREND

Healthcare: Just a click away Patient portals, a growing trend in India, is improving healthcare connectivity and communication between doctors and their patients, with the help of easy-to-use technology BY LAKSHMIPRIYA NAIR

ndia’s healthcare system is witnessing rapid growth with increasing coverage, services and spending in both public and private sectors. As a result, it has paved the way for a huge market for healthcare-related IT solutions like patient portals The trend is already well-placed in developed countries like the US and the UK and is set to grow even further. A Frost and Sullivan report titled, ‘US Patient Portal Market for Hospitals and Physicians: Overview and Outlook, 2012-2017’ predicts a 221 per cent growth in the market to nearly $900 million by 2017. However, in India, the trend began only in 2008 when some tech entrepreneurs, recognising the potential in such kind of services, decided to invest in patient portals and EMR software to improve healthcare connectivity and better communication between doctors and their patients.

electronically and offer secure medical information to improve patient care. Lately, several such portals have made their entry into this largely unexplored, yet lucrative market in India driven by growing consumer awareness, Internet-penetration, increasing bent for technology-adoption and larger concerns like need for accountable care and accessibility of healthcare etc.

Convenience is the key

Drivers of demand Over the years, the concept has found acceptance among the youth and tech-savvy individuals as it allows them to easily fix appointments with preferred practitioners, opt for second opinions and maintain their electronic health records

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(EHR) through these portals. Moreover, the adoption of meaningful use (MU) and its stages have ensured that ‘providers need to show they’re using certified EHR technology in ways that

can be measured significantly in quality and in quantity.’ MU Stage 2 especially focuses on advanced clinical processes, stressing on ‘health information exchange between providers and promoting

patient engagement by giving patients secure online access to their health information.’ This has given an impetus for patient portals to grow since they allow patients to access their health records

One such portal is Practo.com which was co-founded in 2008 by Shashank ND and Abhinav Lal, two final year engineering students. “We dreamt of a day when every patient has access to all medical records, when he/she can seamlessly find and choose a new doctor through informed decisionmaking and be able to pass on medical history and records at a click,” shares Shashank, speaking about the motive behind launching such a portal. He further informs, “Today, Practo.com has over 1,00,000 doctors listed from over 310 Indian towns and cities, with comprehensive coverage from the metros of Bangalore, Mumbai, Delhi, Hyderabad, Chennai, Pune and Singapore. It has over 1.3 million page views and 30,000 appointments booked every month,

with traffic growing at 24 per cent per month.” Similarly, HelpingDoc is an online gateway for healthcare providers to connect to their patients. Founded by a UK-based team comprising Amit Bansal, Dr Hemant Singhal, Julian Hall and Srinivas Gattamneni, its inception in 2011 was a result of a need to structure the largely fragmented healthcare delivery mechanism in India. Bansal, CEO, HelpingDoc.com says, “The idea took shape during an extensive survey we conducted in India to understand the healthcare needs of general public. We found out that people usually ignore going to the doctor as they are afraid of the hassles in taking the doctor’s appointment. Hence, we conceived this idea of launching HelpingDoc. It intends to enable a digital platform to enhance the healthcare visibility and convenience via Internet mobile and telephone.” He also informs that the site observes close to one lakh visits in a month and has around 4000 doctors listed on the site. Addressing the unmet healthcare needs in semi-urban and rural India is what prompted Sanjoy Mukerji, Ex-Chief Commercial Officer of Vodafone India and Varun Berry, MD, Britannia Industries to launch iClinic Healthcare, another health portal. It seeks to offer onsite specialist medical care by connecting local doctors and specialists in metros with small town patients to ensure best medical assistance, even in tier-II and tier-III cities. “The long term vision is to have ‘iClinic consult facility’ in every hospital in tier-II, tier-III India and connecting their patients with super specialist doctors. Healthcare should no longer be a distant dream for these people,” says Mukerji. Even alternate medicine streams like homeopathy are getting on to this bandwagon. Recently, Welcome Cure, a homeopathic portal was launched under the aegis of Dr Jawahar Shah, MD, Wecome Cure. Talking about

Several patient portals are coming up driven by growing consumer awareness, Internetpenetration, increasing bent for technologyadoption and larger concerns like need for accountable care and accessibility of healthcare the venture, he says, “Welcome Cure is a unique disease treatment and health maintenance portal born out of the desire to treat individuals with holistic medicines globally regardless of their location. This vision, when combined with the modern principles of homeopathy and global expertise, makes Welcome Cure a one-stop solution for disease treatment, prevention, and wholesome health.” So, what are the major features and benefits offered by these portals? How do they seek to simplify and improve healthcare delivery? Most of these portals offer common features such as online appointment requests, availability of medical reports, communication with the concerned physician and patient education material. The beneficial aspects of

these portals and their features are: ◗ Understanding of medication ◗ Knowledge sharing regarding medical awareness and diseases ◗ Automatic tracking of medications and reports ◗ Cost effectiveness ◗ Open and easy line of communication A study published in the Journal of Medical Internet Research, an international scientific journal for medical research, information and communication on the Internet claims, “Portal group patients demonstrated increased satisfaction with communication and overall care. Patients in the portal group particularly valued the portal’s convenience, reduced communication barriers and direct physician responses. More online messages from patients contained

informational and psychosocial content compared to telephone calls, which may enhance the patient-physician relationship.”

The differentiators But, what set these portals apart from each other? What are the USPs? Answering this question, Shashank, CEO, Practo Technologies says, “Practo.com solves the consumer problem of meeting the right healthcare provider by enabling powerful search, empowering instant comparison and executing online appointment booking. It also enables patients to securely store, access and easily share their electronic medical records across healthcare service providers, something that no other player in India is doing at such scale.” Bansal informs, “The key

differentiator for HelpingDoc is the instant appointment to a panel of doctors in real time compared to the other directory services in the market like Just Dial or access to Google which provides a list of medical offerings, all based on a different business model. The portal is supported by contact centre and automated reminder system. The venture is improving transparency and visibility of healthcare in India, empowering patients to make more informed decisions in managing their health.” Mukerji, on the other hand, feels, “Most patient portals are information portals only with a few offering appointment services. A few portals like ours actually enable the patients to connect with doctors and actually do a consult online. However, we are differentiated from all other portals due to our tie up with over 100 specialists who are available to our online patients through appointments. Also our on-site services, wherein we tie up with small hospitals in small towns that deploy our platform and are able to do doctor assisted consults is unique and this is the main stay of our proposed expansion plan.”

Streams of revenue So far so good. But how do the entrants in this segment make these portals financially viable? Practo platform has three business models. They offer Practo Ray, a practice management Software as a Service (SaaS), for healthcare providers which comprises: ◗ A free appointment schedule manager through a practo.com profile. ◗ A software product for practice management, retailed on a subscription-based SaaS model Practo.com, the free-for-use web portal for both providers and patients, is monetised through sponsored listings and contextual advertisements that are independent of the organic listings. HelpingDoc also offers a SaaS-based subscription

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STRATEGY model for doctors. It charges a subscription fee from each of the doctors enlisted in its website but the services to patients are free. Welcome Cure operates on a different model. The patients are charged a fee for their services.

Fad or trend? More and more players are entering this arena, signalling that the concept has found many takers and they see a lot of growth potential for these kinds of digital platforms. Most of them are of the opinion that e-health segment in India is set to grow further and are in a bid to leverage the opportunities available. Bansal opines, “The online healthcare industry in India is still in a nascent stage and has the potential to grow rapidly over the next three to five years. The team at HelpingDoc has a strong vision and is likely to develop the platform into a key player in this nascent industry. The doctor to patient ratio in India is amongst the lowest in the world. The technology would help to improve efficiencies in the healthcare industry. The efficiencies would be brought in multiple ways — exposing hidden supply of doctors, filling unutilised time slots, self and remote health management, and pre and post consultation patient engagement.” Shashank predicts, “Moreover, with new and upcoming applications such as electronic medical records and e-prescriptions, IT investments on software would further increase with a focus on integrated billing and seamless online availability of patient records. As patient education and insurance penetration simultaneously increase, the demand for EMR is anticipated to increase robustly.” Mukerji reiterates this view and states, “The future of telemedicine, given the availability of 3G is extremely bright and is bound to proliferate.” Dr Shah also believes that e-health in India is set to rise. He says that due to growing computer literacy and tough work as well as personal schedules, e-health has a major scope of development in

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We will expand to around 6-12 tier-II cities like Ahmedabad, Chandigarh, Jaipur and Cochin in 12-18 months

HelpingDoc aims to scale up by four to five times and enroll over 20,000 doctors in the next two years

We plan to reach all towns outside of the top 20-30 towns (these already have specialists) that have 3G or good quality broadband

We also look forward to being a part of various health-based government projects giving quality treatments to government employees and their families

Shashank ND

Amit Bansal

Chief Executive Officer, Practo Technologies

Chief Executive Officer, HelpingDoc.com

Sanjoy Mukerji

Dr Jawahar Shah

Managing Director, iClinic Healthcare

Managing Director, Welcome Cure

months,” reveals Shashank. He also informs that Practo could look at raising more capital in 12-18 months. However, most of the expansion would come from internal accrual. “We have been growing 50-100 per cent quarter on quarter, and are looking to close this fiscal year at Rs 20 crores,” he adds. They are also looking at expanding their footprints overseas. He imparts, “We entered Singapore market around 18 months ago. We are looking at entering one more country by later this year or early next year—we are looking at the markets of Philippines, Malaysia and the Middle East.” Welcome Cure, though recently launched, has also charted its growth plan. Dr Shah imparts, “We have a vision of being able to reach 500 expert panel doctors across 150+ countries for homeopathic and wholesome treatments. We also look forward to being a part of various health-based government projects (state and national) giving quality treatments to government employees and their families. We are also looking at tie-ups with various hospitals and medical institutes.” iClinic Healthcare intends to raise Rs 25 crores for its expansion. Mukerji says, “We

are talking to a number of large individual investors plus venture capital firms. We plan to reach all towns outside of the top 20-30 towns (these already have specialists) that have 3G or good quality broadband. These are places which can operate our platform due to availability of 3G. The number of such towns (with 3G but lacking specialists) is over 1000. The top 20-30 towns will act as hubs where the specialists are present.”

care providers, or should the patients be able to enter their own data? How to ensure that the information received are reliable and authentic? How to avoid information overload for both patients and clinicians and make the data useful and usable to both?

India. “It is convenient, reliable and anyone can seek it with the help of their laptops, tablets and even through mobiles,” he adds. Looking at the growth potential in e-health, the players have already put their strategies in place for the next years, indicating that patient portals are a trend that is here to stay and not just a fad.

Gearing up for the future Bansal informs, “HelpingDoc plans to grow beyond the Delhi-NCR area into other major cities of the country like Mumbai, Bengaluru, Kolkata and Chennai over the next 18-24 months. It also aims to scale up by four to five times and enroll over 20,000 doctors in the next two years.” In August this year, it had raised Rs 10 crores in Series A funding from a Singapore firm, from Senior Marketing Systems (SMS). A company release from HelpingDoc had informed that the capital will be used to enhancing technology back-end and strengthen the field force. Practo also has huge expansion plans. Already present in six cities, it intends to expand its presence in tier-II cities. “We will expand to around 6-12 tier II cities like Ahmedabad, Chandigarh, Jaipur and Cochin in 12-18

Dealing with the pitfalls and challenges Thus, the patient portal market is all set to broaden their areas and range of services in the coming years. But, is it going to be plain sailing journey for them? Not really. Though there is growing IT implementation, a large of part of the populace in India are slow to adopt technology. Building their faith in these methods of healthcare delivery and would be a huge challenge. Striking a balance between providing security of data and validating its authenticity alongwith offering easy access to medical records will be another challenge to tackle. They will also have to decide on crucial issues like: Medical data should be provided only by their health-

The way forward Challenges exist but it is undeniable that the healthcare IT space is thriving with opportunities. As Shashank puts it, “Indian healthcare is experiencing a great transformation, with the application of newer, better IT systems and application, and adoption of IT has become one of the top priorities for healthcare companies. The healthcare sector spend is projected to grow to nearly $40 billion, which throws up a lot of opportunities for IT players as more and more healthcare practices adopt information technology apart from medical technology.” Patient portals have also opened up new avenues to improve healthcare and their global experience has been largely positive. If leveraged well, India too can benefit and mitigate some of its healthcare challenges. lakshmipriya.nair@expressindia.com

STRATEGY INSIGHT

Learning for development

DR AK KHANDELWAL Medical Director, AnandaLoke Hospital & Neurosciences Centre, Siliguri, West Bengal

Dr AK Khandelwal, Medical Director, AnandaLoke Hospital & Neurosciences Centre, and NABH Assessor, recommends making a healthcare set up into a learning organisation for development and progress

hospital is a complex organisation. Problems or errors are bound to occur in any complex human endeavour, and healthcare is no exception. Medical errors are ubiquitous and the costs (human and financial) are substantial. Preventable medical errors are responsible for around 90000 deaths per year in the US (IHI). It is the second leading cause of deaths in the UK.1 Approximately, 80 per cent of medical errors or failures are system-derived.2 Simply, good people working hard will be insufficient to overcome the complexities inherent in today’s systems of care and prevent errors and harm to patients. The solution lies in learning from these failures to prevent the recurring of these mistakes in future. Unfortunately research literature reveals that, in spite of increased emphasis on these issues, hospitals are not learning from the daily problems and errors encountered by their workers. So, it is imperative that a healthcare organisation should learn from its failures.

Why aren't hospitals learning from their failures or errors? ◗ Emphasis on individual vigilance in healthcare: Each caregiver tend to work on their task without altering the underlying process ◗ Unit efficiency concerns: Each staff is interested in maximising their unit output ◗ Empowerment: No power

Experts opine that a leader's role in a learning organisation is that of a designer, teacher, and steward who can build shared vision and challenge prevailing mental models. A leader is responsible for building organisations where people are continually expanding their capabilities to take corrective action

What is organisational learning? Argyris (1977) defines organisational learning as the process of detection and correction of errors.

How can an organisation learn from its failures or errors? Literature mentions that there are two methods of process improvement3 or problem solving.4 They are as follows: First order improvement or first order problem solving: First-order process is implemented by hospital staffs when they compensate for a problem by getting the

supplies or information needed to finish a task that was blocked or interrupted. In such situations, hospital staff does not address the underlying causes, thus not reducing the likelihood of a similar problem or failure or error occurring in the future. This first-order improvement process can be counterproductive. It keeps communication of problems isolated so that they do not surface as learning opportunities. Sometimes this can create problems in other areas. Thus, first-order improvement, ironically, can preclude improvement by obscuring the existence of problems and errors and preventing operational and structural changes that would prevent

the same failures from happening again. Thus, this process does not help in organisation learning. What they do: Simply solve problem as they face, avoid unpleasant task of contacting higher authority to prevent it further. Second order improvement or the second order problem solving: The second-order improvement requires that hospital staff not only solve the problem so that the immediate task at hand can be completed, but also takes action to address underlying causes. Example of second-order improvement: Hospital staff communicates about the problem to the person or the

HOW DOES LEARNING ORGANISATION DIFFER? Problem or error

Typical response

Learning organisation’s response

Missing materials or information

Adjust to shortcomings in materials and supplies without bothering managers or others

Remedies immediate situation but also inform the manager and supply department regarding failure

Others’ errors

Seamlessly correct for errors of others - without confronting the person about their error

Report about error without blaming

Own errors

Create an impression of never making mistakes

Take responsibility of error and report as per organisation protocol.

department responsible for handling it; and bring it to the manager’s attention. Hospital staffs also share ideas about what caused the situation and how to prevent recurrence with the appropriate authority so that necessary changes can be implemented to ensure that the changes have the desired effect. The second-order improvement process help in organisational learning and it achieves both detection and correction of error.

How to make a learning organisation? Peter Senge, a leading researcher in the area of learning organisations, describe five disciplines that must be mastered when introducing learning into an organisation.6 A successful organisation in Senge’s theory has the capacity to change and manage change where individuals in an organisation adopt systemic thinking, attain personal mastery, share mental models, have shared vision and learn as a team.

Five requirements for a learning organisation Shared vision: Literature mentions that the shared vision of a healthcare organisation must be built on the individual visions of its members. Healthcare organisations should develop shared vision of its team members. The leader of a healthcare organisation should ensure that the organisation’s vision is not created by the leader; rather the vision should be created through interaction

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STRATEGY with all team members of the healthcare organisation. Team learning: Researchers opine that team building is the process of aligning and developing the capacity of a team to create the results its members truly desire. It builds on the discipline of developing shared vision. It also builds on personal mastery, for talented teams are made up of talented individuals. Systemic thinking: It is the process of integrating all five disciplines, fusing them into a coherent body of methods, tools, and principles, all oriented to looking at the interrelatedness of forces, and seeing them as part of a common process Mental models: The assumptions held by individuals and organisations are called mental models. Leaders in learning healthcare organisations should be getting in touch with the thinking going on about change in their workplace, challenge or clarify assumptions and encourage people to rethink in order to build shared thinking.

learning and organisations cannot learn until their members begin to learn. So leaders’ job in the learning healthcare organisation is to be the teacher or coach who helps to unleash the creative energy in each individual.

What's the leader’s role in a learning organisation? Experts opine that a leader's role in a learning organisation is that of a designer, teacher, and steward who can build shared vision and challenge prevailing mental models. A leader is responsible for building organisations where people are continually expanding their capabilities. Leaders have an essential role - assisting with problemsolving efforts, providing support for workers who attempt to improve their work systems, and valuing them as motivated employees. By reframing workers' perceptions of failures from sources of frustration to sources of learning, leaders can engage employees in system improvement efforts that would otherwise not occur.

Recommendations Personal mastery: As per researchers,6 personal mastery applies to individual

◗ Leaders must make an effort to be regularly available for at least part of all shifts. The

90000 DEATHS OCCUR PER YEAR IN THE US DUE TO PREVENTABLE MEDICAL ERRORS SOURCE: (IHI)

physical presence of leaders increased the likelihood of their being informed of problems occurring on the unit; this, in turn, allowed leaders to investigate and support possible work system changes. Next, leaders can counteract time pressure by providing assistance for frontline problem-solving efforts. In addition, by acting as role models of second order improvement, leaders can teach staffs to think about what could be done to prevent similar problems from occurring in the future. ◗ To learn from failures, people need to be able to talk about them without fear of ridicule or punishment. Leaders can help create an environment where staffs feels safe taking the interpersonal risks that second-order improvement

or problem-solving entails, thereby making this behaviour more psychologically feasible. ◗ Leaders must respond to initiative by following through on these suggestions and facilitating boundary-crossing improvements that help reduce the rate of problem emergence. In short, if second-order problem-solving effort does not lead to any positive changes; workers will be discouraged about spending their time on this in the future. ◗ Leaders should encourage staff to learn from other organisations. Ensure that the best industry practices are uncovered, analysed, adapted and implemented

Conclusion Hospital administrators should ensure that healthcare organisations adopt the culture of learning organisations to make their organisation safe. Safe patient care is facilitated by individual professional learning, team learning and organisation learning. Top management should ensure that staffs are continuously learning to deliver best possible care.

References 1. Botwinick L, Bisognano M, Haraden C. Leadership Guide to Patient Safety. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2006. 2. Leonard M, Frankel A, Simmonds T, with Vega K. Achieving Safe and Reliable Healthcare: Strategies and Solutions. Chicago, Illinois: Health Administration Press; 2004, p. 5. 3. N. Repenning and J.D, Sterman, "Capability Traps and Self-Confirming Attribution Errors in the Dynamics of Process Improvement." AdministrativeScience Quarterly, 47 (2002): 265-295 4. A Tucker, A.L., and Edmondson, A.C. (2003). “Why hospitals don't learn from failures: Organisational and psychological dynamics that inhibit system change.” California Management Review,45,2: 55-72. 5. Argyris, Chris. May/June 1991. Teaching Smart People How to Learn. Harvard Business Review, Vol. 69, No. 3, pp. 99-109 6. Senge, Peter. 1990. The Fifth

Discipline: the Art and Practice of the Learning Organization. New York: Doubleday.

Continued from Page 39

Anandaloke Hospital & Neurosciences Centre... challenges of shortage of skilled and qualified manpower. This has brought significant improvement in the standard of bed side care. Several risk management programmes are being implemented to provide safe healthcare. Several safety goals like improve accuracy of patient identification, reduce risk of HAI, improve safety of drug administration, prevent pressure ulcer, prevention of sudden death, improve effectiveness of communication amongst care giver, prevent fall in hospital, reconciliations of medicine at

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discharge, prevention of suicides, prevention of risk associated with blood transfusion, safe transport of patients, reduce TAT of critical values, sentinel events reporting, etc. are adopted by the hospital. Top management support these risk management programmes and all stakeholders are trained, aligned, and monitored to ensure that goals are achieved. Results are compared with the benchmarks of the industry.

Hospital key clinical indicators Management tools like lean

AHNC

Benchmark

HAI - Hospital

4.70%

<5%

Crude Death rate

7.40%

Bed sore

1.20%

<2%

Fall from Bed

2 fall per year

1.4 fall per bed per year

Blood transfusion reaction

Suicide rate

2 per lakh

six sigma and balance score card are used to improve key processes of organisation. Regular cost and quality analysis of all processes and services are done to ensure that affordable and

5-15 per lakh

safe healthcare is provided.

Reaching out to the underprivileged As part of its CSR activities, Dr Roy has set up a trust in the

name of his parents - 'Uma Suresh Memorial Charitable Trust'. Besides other social services, regular surgery for cleft lip and palate are performed by the plastic surgeon under 'Smile Train Project' by the trust. Periodic health check ups and health education programmes are conducted at near by villages .

Road ahead Future plans include installation of a cath lab, enlargement of critical care unit, paediatric critical care unit, burn unit and a new super-specialty hospital.

STRATEGY I N T E R V I E W

‘It is the most comprehensive healthcare and lifesciences management programme in India’ Dr (Prof) Ajit Parulekar, Dean—Healthcare Management, Goa Institute of Management talks about their newly introduced PGDM course in healthcare, its USPs, GIM's growth strategy and more, in an interaction with Lakshmipriya Nair GIM has introduced a Healthcare MBA (PGDM) programme. Tell us about its USPs? USPs of this programme are: comprehensive healthcare and lifesciences management focus; emphasis on hands-on learning; and strong industry connect. It is the most comprehensive healthcare and lifesciences management programme in the country. All the others, over 100 healthcare management programmes, either focus on hospital administration, pharma management or public health management. We see a convergence happening in the healthcare and lifesciences sector and this is something that we have corroborated with senior healthcare industry leaders. The programme at GIM allows students to get a bird’s eye view of the entire industry and appreciate the interdependence between various parts of this industry. This programme was conceptualised under the guidance of a steering committee comprising senior industry leaders from pharma, medical devices, hospitals, IT/ consulting, public health and senior academicians. Two unique initiatives that provide high emphasis on hands-on learning are the Know Your Healthcare Provider (KYHP) programme in the first year and the Give Goa Health initiative in the second year. As part of the KYHP initiative, each first year student (in small groups) spends one day every week mentored by faculty in an healthcare environment in Goa. They work on live projects like conducting a time motion study at a hospital registration or

OPD, inventory management at a device company, auditing quality systems or understanding manpower planning/allocation. For the KYHP initiative, we have partnered with over 40 healthcare institutions including the Goa Medical College, Siemens Healthcare, Merck, Victor Apollo Hospital, Pfizer, Tulip Diagnostics, Lupin, Manipal Hospital, and the Directorate of Health Services (DHS) – Govt of Goa. As part of the Give Goa Health initiative, our students engage with an NGO working in healthcare in Goa. These include organisations such as Sangath, Voluntary Health Association of Goa, Alcoholic Anonymous, National Institute of Malaria Research and healthcare programmes delivered through PHCs in Goa. The Give Goa Health initiative serves two purposes: to socially sensitise our students and also to give back to the Goan society by way of expertise to healthcare related NGOs, shramdaan, organising healthcare camps and helping raise funds for healthcare initiatives in Goa. The strong industry connect is done through initiatives like: 1) Steering committee that advises the curriculum design 2) KYHP and Give Goa Health initiatives 3) Summer internship programme 4) Eminent healthcare industry practitioners who engage with our students through guest lectures, visiting faculty engagements and workshops/panel discussions. What kind of response did the course elicit from the students and the industry?

At GIM, we have innovation, creativity and entrepreneurship as an integral part of the curriculum

Prior to launching the programme, we conducted an exhaustive study of the best healthcare management programmes across the globe and also undertook a survey of prospective students and employers/recruiters. The response from both prospective students and industry has been very encouraging. Our student body is quite diverse, coming from 17 Indian states and half the students have prior work experience. For the first batch of the programme, we received close to 900 applicants (for 60 seats on the programme). Our students come from varied educational backgrounds including medicine, dentistry, pharmacy, biotechnology, nursing, engineering and also

commerce and economics. Many senior industry leaders from organisations like Apollo, Sanofi, Ranbaxy, Accenture, Johnson & Johnson, Aravind eye care, WHO, KPMG, Pfizer, Wockhardt, Ernst & Young and Narayan Hrudayalaya have addressed these students. Leading healthcare, lifesciences, IT, insurance and consulting companies participate in the placement process of this programme. For our first batch, offers for summer internship exceeded the number of students. Are you planning to introduce any more new courses in the near future? We are expanding into related areas and have conducted several management development programmes, research projects and consultancy assignments in the healthcare-lifesciences space. The healthcare management dedicated faculty have published numerous books, case studies, journal articles and lay press articles. We have completed consulting/research projects for the Department of Woman & Child Development, Water Resources Development and the Goa Medical College. We have recently successfully bid to conduct the National Family Health Survey for the Ministry of Health and Family Welfare in four states in India. What is the growth strategy for GIM in the next five years? GIM strives to provide quality management education and believes strongly in valuesbased education. The institute currently offers four long duration programmes: a twoyear fulltime PGDM in business management, a part-time

PGDM in business management for working executives, a two-year fulltime PGDM in healthcare management and a PhD in management. The institute also offers short duration executive development programmes and consults with several organisations. GIM has two campuses in Goa: a new stateof-the-art 50 acre campus in Sankhali and a city campus at Ribandar (5 km from Panaji) housed in a 350 year old neo-gothic heritage building. In the next five years GIM plans to strengthen its faculty by recruiting to a total faculty strength of 70 members and has also embarked on an ambitious star faculty programme to attract globally renowned management faculty to work at GIM. How does GIM plan to address issues plaguing Indian healthcare education? Every country in the world is struggling to achieve its healthcare objectives. Most countries are trying to devise and implement region specific Universal Health Coverage plans. Innovation alone seems to be the way forward and this orientation has to come from the classroom. Educational institutions carry a big responsibility in training prospective managers and inculcating an innovation mind-set that challenges existing norms and constraints. At GIM, we have innovation, creativity and entrepreneurship as an integral part of the curriculum. We have set-up a creativity and innovation centre and are in the process of setting up an incubation centre. lakshmipriya.nair@expressindia.com

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IT@HEALTHCARE INSIGHT

New care delivery models: Vital signs for healthcare in 2025

RON EMERSON Global Director, Healthcare Solutions and Market Development, Polycom

Ron Emerson, Global Director, Healthcare Solutions and Market Development, Polycom talks about the need to find new and innovative ways to provide patient-centric and cost effective healthcare services while predicting how the industry is going to shape up in the coming years with the help of technology

hen it comes to a vision for the future of healthcare, it is clear that organisations and governments are recognising the need for many changes in the way we care for patients. At the heart of healthcare reforms lies the need for massive improvements in productivity and efficiency, in light of challenges such as physician shortages, delivering healthcare to rural populations, rapidly ageing societies, and unnecessary expenditures. The global healthcare industry faces renewed pressure to find new and innovative ways with which to extend healthcare services that are patient-centric and cost effective. Studies show that better care coordination and reducing avoidable hospitalisation results in better clinical outcomes for patients, thereby reducing costs. On a global scale, we are seeing a paradigm shift from treating the ill to preventing illness with associ-

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Polycom Group Series and EagleEye Director cameras

ated cost reduction. There is also renewed focus on prevention and wellness programmes to reduce hospitalisations, and a shift towards more patientcentred care models. This would rely heavily on factors such as changing patient behaviour through better education and awareness, and treating patients at the pointof-care (such as their homes or local community centres). What does this mean for the state of healthcare in the decade to come? For a start, changes in mindset and strategic objectives are becoming evident, as healthcare organisations focus on three main areas to increase efficiency and reduce costs: ◗ How to keep in contact ◗ How to keep people healthy ◗ How to keep chronic disease from quickly turning into an acute episode (and thereby reduce hospitalisation and treatment costs). In the face of future challenges, today’s healthcare model requires prevention and wellness programmes, and easy access to expert consultations no matter where or when the need arises. Furthermore, there is no question that it is more efficient to move information than to move people – and this paves a clearer path to productive healthcare delivery. Distance technology for healthcare – particularly the growth of telemedicine or telehealth – has offered opportunities to realise these new models of care delivery. Telehealth or telemedicine, broadly speaking, is the electronic exchange of medical information – this could mean something as simple as sharing a photo of a lesion, to viewing a patient’s blood pressure status, to accessing a patient’s complete medical history, to specialists discussing a clinical study. The growth statistics for telehealth are staggering; market research firm IHS predicts the US telehealth market will grow from $240 million in 2013 to $1.9 billion by 2018, representing an annual growth of 56 per cent. Globally, the growth is predicted to be even more astounding as BCC

Polycom RealPresence Mobile app on iPad in a hospital environment

Research suggests the telemedicine market will triple to $27.3 billion in 2016, from $9.8 billion in 20101. These statistics make it all the more evident that the landscape of healthcare delivery is changing – and requires rapid transformation to cope with the pressures placed on the industry. Private sector organisations in particular are choosing telehealth as they focus on being measured on value and quality of care services rather than just a feeper-service model. The reality is that people spend the majority of time at work or in their homes, but these are the two locations where it has been more difficult to get the same level of care as you would by visiting a hospital. As governments and healthcare organisations realise this, there is also an increasing shift towards home care and remote patient monitoring (outside hospitals, clinics, and nursing homes), to deliver effective healthcare services with reduced expenditure. Statistics show that three million patients worldwide are already receiving professional care by being connected to home medical monitoring devices; this number is ex-

pected to grow to 19.1 million patients around the world by 20182. A greater emphasis is now being placed on population health management, focusing on preventing problems before they develop for better clinical and patient outcomes and more cost-effective delivery of care.

Video-enabled care delivery Video collaboration technology and telehealth are effective tools in shaping these new care delivery models. In addition to traditional doctor-patient consultations, video technology enables face-to-face collaboration across the whole spectrum of stakeholders – between doctors and hospitals, patients and consultants, and other supporting professionals – independent of physical barriers. We have seen some incredible instances of video-enabled care delivery in practice and the resulting benefits to patients and care providers. For example: ◗ The National Health Service (NHS) in the UK utilises video to provide a range of services such as reaching new mothers in their homes for lactation consulting and well-baby visits, connecting stroke victims with

remote doctors, providing specialist paediatric neurology services to more patients, and enabling nurses to monitor the progress of renal care patients ◗ South Carolina Department of Mental Health in the US connects to patients in emergency rooms via video for telepsychiatry consultations and rapid intervention, a move which resulted in a saving of $24 million over three years ◗ The Canterbury and West Coast District Health Boards in New Zealand use telehealth solutions to reach a larger population over vast distances, increasing the number of cases paediatricians are able to handle and reducing the burden on patients to travel long distances ◗ Silver Chain Group in Western Australia uses mobile video solutions to connect patients in the comfort of their own homes with specialists who can, for example, view wounds and monitor medication adherence For a healthcare organisation, video-enabled care delivery makes strategic and financial sense. Likewise, for patients it puts management of their health back into their own hands and reduces unnecessary travel time and

associated costs. For medical professionals, video collaboration opens up new opportunities in coordinated care delivery, sharing of expertise, and continuing medical education and training. Fundamental to any technology deployment in healthcare is that quality of care is not compromised. Video collaboration solutions not only provide the human interaction and face-to-face element, so important for any consultation, but innovation and a broad range of technology have enabled customised solutions for patient examinations and a multidisciplinary approach to healthcare delivery. This means that with high definition (HD) visuals, bespoke accessories on telemedicine carts, or remote patient monitoring capabilities on mobile devices, clinical work-flow becomes much more efficient and collaboration happens naturally – without the barriers of distance and accessibility.

Healthcare in 2025 The healthcare industry is indeed evolving – ageing populations, healthcare reforms and rapidly increasing costs are forcing us to do things differently. As we move more towards population health, the entire care team will be responsible for the patients’ outcomes instead of just the physician/ clinician. With these changes, comes the need for connecting care team members, patients, and families in an effective manner – regardless of location or device. Increasing patient engagement and awareness through greater collaboration and information exchange will become a key driver in achieving better clinical outcomes. As such, the realities of geography, demographics and provider shortages is making video and collaboration tools key to the changing landscape of healthcare.

References 1 BCC Research (March 2012) – Global Telemedicine Market to Reach $27.3 Billion in 2016 2 Berg Insight (June 2014) –mHealth and Home Monitoring

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

‘We have a freemium model for this application and the first six months of usage is free of cost’ Gautam Rege, Co-founder, Kimaya NICU gives details of their TPN solution for NICUs, its myriad benefits, the learning experience of using it in major healthcare institutions like KEM, and more, in conversation with Lakshmipriya Nair What was the rationale behind developing a solution for neonates? It started off as a chance opportunity about a decade ago in 2004. During that period a friend of mine introduced me to Dr Umesh Vaidya when I made a visit to NICU where my friend’s baby was admitted. Dr Vaidya and I got talking about the need for some software for total parenteral nutrition (TPN) calculations and he actually showed me some staff members doing manual mathematical calculations to prepare a TPN feed to be given to the babies in the form of dextrose/glucose. TPN is a process where the baby is intravenously administered feeds. For a baby, it’s not just survival that is important but also to grow healthy. Hence various nutrients like proteins (amino acids), sodium, calcium, phosphate and magnesium are critical. These nutrients need to be mixed with the dextrose solution that is administered via the intravenous drip. However, there are several constraints; if the concentration of solution is very high, the veins may dissolve and if the infusion rate, that is the speed of drip is too fast, the veins could burst, both of which could be fatal! Since these calculations were earlier done manually, it was an error prone, less accurate and a time consuming process, taking about half an hour at least for a single calculation. This is how the

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idea Kimaya NICU application was born. Along with the expertise of doctors at KEM, we build Kimaya TPN for these calculations to be accurate and give zero errors in the results. This small conversation with the doctor inspired us to develop a programme for the NICUs which will save these precious lives. Even though the neonatal mortality rates in India are going down, it’s still a grave reality for every hospital in the nation. The visit to the NICU few years back made us think and prompted us to provide a solution that will give another chance not only to the babies but also to their parents. It gives us an immense satisfaction that we are somewhere involved in saving lives of babies who haven’t even seen the world and are on the brink of life and death. We wrote a sample programme on a compact disc and provided it to the NICU. Within a couple of years, the doctors came back to us saying they were being asked by a lot of other hospitals for this programme. This gave us an opportunity to create a product out of the programme that we gave to the KEM initially. How will it help streamline operations in NICUs? We started giving this product on a CD as the Internet connectivity in India was bad and lots of hospitals lacked internet connection at that time. Recently, we have

revamped the entire application and put it on the cloud as we know that the Internet connectivity is much better that what it was a few years back. This has now become a game changer for us because the doctors now require less than two seconds for TPN calculations instead of approximately 30 minutes to calculate TPN for neonates. Through this solution we have enabled the doctors to give accurate and error-free nutrition solution for the babies in NICU within a few seconds.

Through this solution we have enabled the doctors to give accurate and error-free nutrition solution for the babies in NICU within a few seconds

What is the framework for this solution? How adaptable is it in the Indian scenario? As I have mentioned initially we started giving off this application on CD due to lack of internet connectivity and now as we have a better situation in terms of internet connectivity we revamped the application and put it on cloud. The application is built using open source technologies - the Ruby on Rails framework and MongoDB as the database. Solutions built on the Rails framework are extremely adaptable and flexible. This application is very much adaptable in the Indian scenario catering to more frequent TPN calculations and frequently changing marketing additives. We have put brand names of different nutrients marketed by pharma companies in India

and whenever there is a change in market name of the nutrient that’s required to be added in the nutrient solution we make that necessary change of name in the application hence we keep it up to date. How cost-effective is the solution? When we distributed the application as a CD, it required a license for each machine that it was installed on. Now, since there is no installation required, doctors can start using the application immediately and can access this from multiple locations and multiple devices like laptops, desktops, tablet and even their mobile phones. Similar to how we log in to Gmail, we can log in to Kimaya NICU application using the desktop, laptops, tablets or mobile phones with Internet connectivity. The application is used as Software As A Service (SaaS) with an annual subscription. We have a freemium model for this application and the first six months of usage is free of cost. After that we charge a nominal annual fee to doctors or hospitals. This solution is also cost-effective for us as we do not need to send software updates of the CD to every doctor who has the software installed. Now, we simply update the cloud application and everyone benefits instantaneously. The solution has been used

IT@HEALTHCARE in hospitals like KEM? What have the learning and results of it so far? So far, this solution has given us amazing results in terms of saving lives of neonates. Neonatal mortality has reduced substantially due to various reasons and Kimaya NICU application is one of the major contributors. We have learned that accuracy and less time consumption is a factor which cannot be compromised, atleast not in the field of healthcare where every minute and second counts. The medical fraternity has appreciated the application but more crucially taken the lead in demanding improvements and suggesting upgrades. So it has been a collaborative effort. Are you looking at upgrading this software in the near future?

We are looking to upgrade this software in the future and the new features will be a result of medical requirements and the demography of the region. Kimaya NICU is the first of hopefully a long series of path-breaking, cutting edge applications that are going to prove crucial and critical in equipping NICUs with the best available help to help babies survive and thrive IT as a field is inherently geared towards upgrades. When we are providing a solution we also take care of its upgrades on a specific frequency. Yes, we are looking to upgrade this software in the future and the new features will be a result of medical requirements and the demography of the region. If

doctors need to add more basic nutrient in the neonates, yes we will definitely upgrade our application accordingly. Now also we keep on upgrading the application in terms of brand name of nutrients marketed by pharma companies. Moreover, the open framework on which this application is built

undergoes regular upgrades of its own which improves functionality. What are your other offerings for the healthcare space? Kimaya NICU is the first of hopefully a long series of pathbreaking, cutting edge applications that are going to

prove crucial and critical in equipping NICUs with the best available help to help babies survive and thrive. In addition to the critical TPN calculations, other modules are being developed like the Enteral Feeds module that calculates the amount of proteins and calories being given to the neonate from human milk, formula feeds or a mix along with Human Milk Fortifier (HMF) and Medium Chain Triglycerides (MCT) oil. This will help doctors manage enteral and parenteral feeds. We also plan to incorporate a Discharge module that manages the discharge summary and follow up for babies that â&#x20AC;&#x153;graduateâ&#x20AC;? from the NICU. The plan is to slowly evolve into a holistic NICU Management Software Suite. lakshmipriya.nair@expressindia.com

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LIFE

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efore he became a star neurosurgeon, Dr Venkataramanaa Neelam Krishnan (Dr VNK henceforth) was a shy boy with a modest dream-- to become a doctor and make his parents proud. In the course of fulfilling his dream, Dr VNK met neurosurgery and was lost in the labyrinth of the intricacies of the brain. He carries the spark with him till date. Nothing gives him more pleasure than detangling the mysteries of the neuronal network. As the Vice Chairman & Chief Neurosurgeon, BGS Global Hospitals, Bengaluru, Dr VNK gets the opportunity to live his dream everyday.

activist and humanist. “My father inspired me. He motivated me to excel in everything I did,” says Dr VNK. And truly he never let his father down. Dr VNK was an astute student, excelling in academics and co-curricular activities. “There was a notice board at school where the names of best students were displayed. It was my father's wish to see my name there,” Dr NVK remembers. “I was the best outgoing student of my batch,” he adds. After school Dr VNK attended SRS Junior College which was far from his village. “My village did not have higher education college, so I used to travel 8 km everyday to the nearest college,” he recollects.

not comprehended the severity of the situation," recalls Dr VNK. "Medicine as a subject was not difficult but the medium of instruction was foreign to me," he adds. In fact, till then Dr VNK's education had been in Telugu language. Although familiar with English, the sudden change in the instruction medium threw him off-guard. He found it difficult to keep pace. But the hard-working doctor did not give up. Instead, he taught himself to read and write English and went on to excel in the subject. Later on, it unlocked the fascinating world of medicine for him.

Picking the brain As life went on, Dr VNK finished his MBBS with a distinction and

surgery, because brain is one tissue you cannot cut or ligate so you won't enjoy it,” says Dr VNK. “As I heard different opinions flying around me, I felt compelled even further to take up neurosurgery. As luck would have it, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru had an opening for neurosurgery residency. I applied and got through to the five-year programme,” he informs.

Stint with NIMHANS NIMHANS is one-of-its-kind institute in India. It is not only the foremost institute for mental health and neuroscience but it also has a multidisciplinary approach in patient care, training

Dr Venkataramanaa Neelam Krishnan, a neurosurgeon par excellence, has shown that success and progress indeed favours the brave and the persistent

BY M NEELAM KACHHAPt The early years

Nurturing a dream

Born in 1958 to a government school teacher, N Krishnan and a home-maker, Susheelamma; Dr VNK spent his childhood in rural Andhra Pradesh. “My father was a teacher and had a transferable job so we moved along with him to various small villages in Chittoor district in Andhra Pradesh,” he reminicises. They finally settled in a town called Karvetinagar, where Dr VNK did most of his schooling. Being the son of a principal is tough, but being the son of a principal and attending the same school is tougher. “My father told me that he did not want to hear any complaints about me from other teachers in the school,” he recalls. He remembers his father as a disciplinarian, educationist, social

Science was his first love and he was always attracted towards medicine. Dr VNK informs that he always wanted to be a doctor. “In those days we were told stories of the successful people in the village and we looked up to them as our role models,” explains Dr VNK. “We had two role models from our village. Professor PV Arunachalam, a renowned mathematician and his brother Dr Chandrasekaran. I was inspired by Dr Chandrasekaran and wanted to be a surgeon like him," he adds. After college, Dr VNK applied for a medical seat and was selected to study at Sri Venkateswara Institute of Medical Sciences (SVIMS) located at Tirupati. "I was very happy when I got selected but had

was looking to do his post-graduation in surgery. However, he was good at his subjects and each of his teachers wanted him to join their own streams. “My medicine professor wanted me to be a generalist whereas my obstetrics and gynaecology teacher wanted me to take up gynaecology, likewise for my other teachers,” says Dr VNK. However, he had made up his mind to pursue neurosurgery. “Since my anatomy days, the brain had started to attract me and I was sure falling for it. By the end of my graduation, I was as sure as the sun that I wanted to get into neurosurgery,” he says. One of his professors even tried to talk him out of it. “My professor told me don't take neurosurgery. Pick any other surgical stream but neuro-

programmes and also in the promotive, preventive and curative aspects of clinical services in mental health and neurosciences. "I spent a better part of my life at NIMHANS. It was my second home," says Dr VNK. Looking back at those days, Dr VNK recalls his mentor at NIMHANS, Prof G Narayana Reddy. "Dr Reddy was not only a teacher but a mentor and an inspiration to me. He always encouraged me to explore and do more," says Dr VNK. At the end of his residency, Dr VNK was invited by Dr Reddy to join the staff at NIMHANS. Dr NVK joined NIMHANS as Assistant Professor in 1986 and enjoyed an academic career till 1991. "I enjoyed my time at NIMHANS. Teaching, learning, research work and academic pub-

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LIFE

lishing were all part of my work," says Dr VNK. During this time he also went abroad for further training. He did his Micro Neurosurgery Training at Nordstadt krankenhaus, Hanover, Germany and Neuro Endoscopy Training at Johannes Gutenberg University, Mainz, Germany. “I was very fortunate to have learned from Professor Madjid Samii the distinguished Iranian neurosurgeon and medical scientist at Hanover. My stint at Germany opened my eyes to new possibilities and avenues of micro-surgery. I got to learn and use the latest gadgets applied in neurosurgery," says Dr VNK.

Entry into private sector By 1990s, privatisation had entered India's healthcare system. State-of-the-art hospitals which were a far cry from the existing government hospitals were matching steps with the speciality hospitals in the West. Around this time, Manipal Hospital, Bengaluru approached Dr VNK to start a specialised neurosurgery department. He saw this as a unique opportunity as till then a specialised neurosurgery department in a private hospital was unheard of. “We took it up as a challenge and in 1991 the Manipal Institute of Neurological Disorders was born with help of Dr AS Hegde,” says Dr VNK. It was a professionally fulfilling experience for Dr VNK. “I spent 16 years at Manipal and it was quite a satisfying journey for me. We established a credible department, state-of-the-art neuro ICU, PG programmes, research programmes, and all this was very satisfying,” says Dr VNK.

Dial an ambulance Throughout his career, Dr VNK found head injuries to be a grave issue. He was moved by the number of people dying due to trauma and head injuries. “On one New Year's eve I had to certify five head injury deaths. I was very moved and disturbed by the deaths because they could have been avoided,” laments Dr VNK. While he was in Germany, Dr VNK was quite impressed by their organised trauma care system. “Germany at that time had a beautifully organised

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ATA GLANCE Dr VNK was born in 1958 at Tirupathi.He is married to Dr Shobha Venkat,Consultant Obstetrician and Gynaecologist and they have a school-going daughter.Dr VNK loves to travel and enjoys holidaying in pristine beautiful locales.He is not fussy about food and enjoys all kinds of vegetarian fare.He is not a movie bluff but once in a while enjoys it.Last movie he saw in a theater was Avatar.

ACHIEVEMENTS Establishment of brain tumour bank in India Introduced micro dialysis for brain for the first time in India Established prehospital care for trauma Established stemcell laboratory & Research Foundation at Bengaluru Performed: First disc nucleoplasty for lumbar and cervical disc prolapse in India First neuro endoscopic surgery in Karnataka First CT guided stereotactic surgery in Karnataka First deep brain stimulation (DBS) surgery for Parkinson’s disease in Karnataka First sacral nerve stimulation for neurogenic bladder dysfunction in Karnataka First transplantation of autologous bone marrow derived mesenchymal stem cells for Parkinson’s disease,head injury and cerebral palsy

AWARDS RECEIVED Gold medal from Rotary International – Young Surgeons Award Felicitation by Lions Club,2001 Karnataka Seva Puraskara Award byAshraya Seva Trust,2001 B C Roy Doctor’s DayAward by IMA,June 2002 Outstanding Public Service Award by Rotary Club,2003 Outstanding Service Award by Nightingale’s Life Saving Services, 2004 Best Public Service Award by Lions Club International, 2005 Sujayashree Award by Raghavendra Swamiji Mutt,2006 Best contribution to profession - Neuroscience Award by Rotary Club, 2006 Ragiv Gandhi Shiromani Award,2006 Chanakya Award for Social Leadership by Public Relations Council of India, 2007 Sadhana Rathna Prashasthi,2008 Karnataka Rajyothsava Award,2008 Druvarathna Award by Gurusai International Cultural and Education Academy,2009 B V Shivarama Karanth Sadbhavana Prashashti by Karnataka Rajya Kalavidhara Kalyana Vedhike,2009 TrinityVaidya Rathna Award byTrinity Hospitals and Heart Foundation,2010 NTR Award from Akhila Karnataka N T R Abhimanigala Sangha,2010 Felicitation for Contribution to Neurosurgery by Lions Club,2010 Felicitation for contribution to Neuroscience by Rotary ,2010 Bharatha Rathna Sir M.Visvesvaranya Global Leadership Award for Excellency in Environment – Social Work ,Puttanna ChettyTown Hall, 2nd July 2011 Dayananda Sagar Award for excellence in Medical Profession , July 2011 Aryabhata Award - Award for excellence in Medical Profession , Ravindra Kalakshethra ,22nd June 2014,

emergency care system. It was centred around life and the respect for it,” he recalls. “When I compared it with the Indian scenario, I found that people were dying, not only due to lack of treatment but also because of lack of knowledge of pre-hospital care,” he says. He stared to research the challenges faced by trauma patients and found that people did not know where to go, how to take the trauma patient to the hospital. As a result they arrived at the hospital late and were in very bad shape. Comprehensive Trauma Consortium (CTC) was born out of this concern in 2000. Dr VNK's brainchild, this NGO was the first attempt in India to consolidate trauma care by bringing the police, fire brigade, hospitals, educational institutions, enterprises and other voluntary organisations on the same platform to save lives. For the first time, CTC introduced the concept of an emergency central control room and an emergency no - 1062 to be dialled at the time of trauma. He established a dedicated network of ambulances with trained paramedics who were commissioned in and around Bengaluru city to render pre-hospital care to victims in all accident and medical emergencies. With this model the NGO was able to reduce trauma deaths from 22 per cent to three per cent within a year. This model was very successful and a report published in a Telugu magazine led the former chairman of Satyam Computer, Ramalinga Raju to take up the project and name it EMRI. Today, this service is known as Dial 108, GVK EMRI.

New growth avenues In 2005, Dr VNK teamed up with his old college friend to setup a quaternary care state-ofthe-art hospital, BGS Global Hospital in Bengaluru. “Dr K Ravindranath was my senior at medical school and when he brought this proposal to me I could not refuse," reveals Dr VNK. The hospital provides preventive, diagnostic, therapeutic, rehabilitative, palliative and support services under one roof and is one of the best hospital for multi-organ transplant and cancer treatment.

Researching for progress Dr VNK has been an avid researcher since his NIMHANS days. "One of the areas that I am working on is prevention of programmed cell death. For patients, we not only want to prolong life but we want to provide a better quality of life," says Dr VNK. Another area he is passionate about is brain cancer. “Glioblastoma is one of the most malignant tumour and the survival is 1.2 to 1.6 years. We are working on genetics and immune-mediated work and stem cells that improve drug delivery system,” informs Dr VNK. It has been an interesting journey for Dr VNK. “I have enjoyed my journey so far. Everyday is fascinating for me as I continue to learn new things,” he says with a childlike enthusiasm. “For me every surgery is a challenge. We can plan as much as we want but when we openup the patient we always encounter the wonders of God,” he adds. “No two cases are similar, each case has its own complexities,” he says when asked about any memorable case.

Living life to the fullest Dr VNK has a musical bent of mind. “Had I not been a surgeon, I would have been a musician. It fascinates me,” he says. He frequently listens to Indian classical and devotional songs. His day begins with meditation, exercise and some quiet breakfast. His work begins by seeing his in-patients. Then he meets his team to discuss and plan surgeries. He operates on three to four patients a day and in between also finds time to see new patients. Then, he devotes some time to his administrative duties. A few evenings per week is devoted to research work. Dr VNK spends late evenings with the family and reads before going to bed. His advice to the new generation of surgeons is to take advantage of current technology and knowledge, keep learning new things and focus on research. He believes that Indians have the best minds and if put together they can solve the unmet medical needs and make the healthcare system more effective and simpler. mneelam.kachhap@expressindia.com

LIFE

PEOPLE

J P Nadda is new Health Minister Political parties cry foul at change of guard AS PART of PM Narendra Modi’s recent Cabinet reshuffle/ expansion, Dr Harsh Vardhan has made way for JP Nadda. The former was shifted to the relatively low profile, Science and Technology, Earth Sciences

portfolio but political observers say the lighter profile will allow him to take a more active role in the BJP’s Delhi Assembly campaign as elections are due to be held early next year. Nadda (born 2 December

1960) is a Rajya Sabha MP from Himachal Pradesh and was the former member of Himachal legislative assembly. More recently, he is believed to be behind the removal of Sanjiv Chaturvedi from the post of

CVO, AIIMS. In an official statement, political party AAP has said, “It is shocking that despite written evidence being available with the Prime Minister’s Office about the role of Nadda in getting whistleblower officer

Sanjeev Chaturvedi removed as Chief Vigilance Officer of AIIMS, he has been made a Cabinet minister.” (http://indianexpress.com/article/i ndia/politics/aap-slams-naddasinclusion-in-cabinet/)

Professor K Srinath Reddy honoured by HRH Princess Anne at Buckingham Palace Recognised for his outstanding contributions to public health and cardiology PROF K SRINATH Reddy, President of the Public Health Foundation of India (PHFI), was conferred the degree of Doctor of Science (Medicine) Honoris Causa by the University of London on November 26, 2014. This was awarded to him by The Princess Royale of Britain, Princess Anne, who is also Chancellor of the University, at a special ceremony held at the Buckingham Palace. Professor Reddy received this honour for his outstanding contributions to public health and cardiology. The oration was read out by Baro Peter Piot, renowned microbiologist, AIDS researcher and discoverer of the Ebola virus and Director & Professor of Global Health, The London School of Hygiene & Tropical Medicine (LSHTM). A recipient of Padma Bhushan, by the President of India (2005), Professor Reddy has headed the PHFI since its inception in 2006. Under

his leadership, PHFI has established five Indian Institutes of Public Health (IIPHs) in different regions of India and is working to transform public health through education research, policy support, public communication and development of affordable technologies for primary health services. Professor Reddy was previously Head of Cardiology Department at the All India Institute of Medical Sciences (AIIMS). He also presently serves as President of the World Heart Federation (WHF) which is the umbrella organisation for all national and continental cardiac societies and heart foundations across the world. He is the first Indian to have been elected as President of WHF. Accepting the award of the Degree of Doctor of Science (Medicine) Honoris Causa at the 2014 Foundation Ceremony of the University of London, he said, “I am grateful for this

Professor Srinath Reddy receiving the honorary doctorate from HRH Princess Anne at Buckingham Palace (Photo courtesy: Andrew Dunsmore, Picture Partnerships)

recognition of my lifelong commitment to improving the health of the people of India and my contributions to global health. I believe it is a tribute to India’s resolute pursuit of good health and wellbeing for all of its people and its steadfast solidarity with other nations

who seek the same for their people. In an increasingly interconnected and interdependent world, global health is the best unifying platform. The PHFI, which I am proud to lead, represents these values. My work reflects the contributions of the collective

PHFI family.” Apart from leading research that has tracked the trends of heart diseases in India and other developing countries over the last three decades, Prof Reddy has also created large scale worksite and school based programmes for prevention of heart disease and diabetes. Their impactful results have been published in prestigious journals and acclaimed internationally as ‘best practices’ for replication. He has been acclaimed as a global leader in tobacco control and played a prominent role in the development of WHO’s Framework Convention on Tobacco Control (FCTC) while representing India in the international treaty negotiations during 2000-2003. The five IIPHs, established by PHFI, under his leadership, is scaling up public health capacity for strengthening health systems across the country.

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IMA Medicine Millennium International Award 2014 for Dr Robert Gallo, Dr Azad Moopen and Dr Narendra Kumar The award recognises the recipients’ contribution towards medical sciences and developing medical facilities globally DR ROBERT C GALLO, co-inventor of HIV, Dr Azad Moopen, Chairman and MD, Aster DM Healthcare and Dr Narendra Kumar, President of Association of Physicians of India received the International Award 2014 from Oommen Chandy, Chief Minister of Kerala for their contribution towards medical sciences and developing medical facilities globally. The award was given at the 57th global annual state conference at Kovalam, Trivandrum, organised by Indian

Medical Association (IMA), Kerala State Branch. Dr Gallo, an American biomedical researcher, is best known for his role in the discovery of the human immunodeficiency virus (HIV). Dr Gallo is the Director and co-founder of the Institute of Human Virology (IHV) at the University of Maryland, School of Medicine in Baltimore, Maryland. He is also a Co-founder of the biotechnology company Profectus BioSciences and Co-founder and Scientific Di-

Dr Robert Gallo

Dr Azad Moopen

rector of the Global Virus Network. Dr Moopen has built a large network of healthcare facilities comprising hospitals, medical centres, diagnostics, and pharmacies and includes a wide spectrum of healthcare services from primary care to quaternary care. Dr Kumar was conferred with the award for his active role and contribution to the medical fraternity, especially the physician community in the US and in Kerala.

Dr Deepak Patkar elected as Chairman of ICRI

Sushant Kinra joins Carestream

He is also the Head of Department of Radiology of Nanavati Super Speciality Hospital

To lead its sales and operations in India and cluster countries as Country Business Manager

DR DEEPAK PATKAR, a leading consultant radiologist and Head of Department of Radiology of Nanavati Super Speciality Hospital, has been elected as the Chairman of Indian College of Radiology and Imaging (ICRI), an academic wing of Indian Radiology and Imaging Association (IRIA). The appointment is for two years from January 2015 to December 2016. Dr Patkar has been fellow of Indian college of Radiology and has already been elected as Secretary of ICRI in 2008 and 2009. A globally reputed radiologist, he has been in the profession for 24 years in the UK and in India. He is also Director of Teleradiology Diagnostic Services dealing in teleradiology with clients in US, Africa and

CARESTREAM HEALTH India has announced the appointment of Sushant Kinra as its new Country Business Manager. Kinra will look after the sales and operations of Carestream Health in India, Bangladesh, Bhutan, Nepal and Sri Lanka. Prior to joining Carestream, Kinra was working with Siemens Healthcare Diagnostic as Divisional CEO - South Asia and had earlier worked with Dade Behring Diagnostics and Ranbaxy. Kinra has 24 years of experience, in several roles in sales and service, managing India business and later Asia Pacific region. He said, "I am delighted to join Carestream Health and look forward to working with our team to further enhance

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the Middle East. He has been associated with Nanavati Super Speciality Hospital since last 22 years and has been responsible for setting up the new radiology wing there. Dr Patkar has been the Organizing Secretary of National

Conference of Indian Radiological and Indian Association – 2007, Mumbai. He has more than 150 international publications, predominantly on neuro and musculoskeletal MRI related topics, one of the best being ‘Central Nervous System Tuberculosis: Pathophysiology and imaging findings’ published in Clinical review articles of Neuroimaging Clinics of North America. Speaking of his selection as chairperson, Dr Patkar said, “It is a great honour and privilege to be elected as Chairman for the ICRI. During its 36 years of journey ICRI has helped many budding radiologists to quench their thirst for knowledge through its various academic projects and programmes.”

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ASK A QUESTION What is the importance of feasibility study?

SWATI N Karnataka

hospital is: ◗ Developing, implementing and maintaining general accounting systems and controls, supervising and participating in the review and analysis of accounting records. ◗ Assisting in the preparation of detailed financial plans by analysing and evaluating statistical and financial data and preparing budgets within projected patient levels, proposed staffing requirements and projected operating costs. ◗ Defining the accounting requirements for incorporation into the patient accounting system, fiscal and statistical information system and other medical centre accounting systems. ◗ Analysing data and proposing methods for tracking and reporting financial information to various external agencies. ◗ Preparing financial reports including cost reimbursement plans for insurance providers, preparing reports of hospitals fund activities to meet County requirements. ◗ Planning, assigning, and reviewing the work of subordinate accountants and clerical personnel, training and evaluating personnel. ◗ Preparing and publishing monthly financial statements including Balance Sheet, Statement of Revenue and Expenses, and Statement of Cash Flow. ◗ Preparing intergovernmental transfers to the state, billing state for government programmes. ◗ Preparing and filing hospital surveys for Public Health Agencies and economic bureaus.

The job description of a manager accountant of a

What is petty cash and its policy?

DR VISHAL Virar

As the name indicates, a feasibility study is an analysis of the viability of an idea. The study focuses on answering the essential question of should we proceed with the proposed project idea? It can be used in many ways but primarily focuses on proposed business ventures. A feasible business venture is one where the business will generate adequate cash flow and profits, withstand the risks it will encounter, remain viable in the long term and meet the goals of the founders. What is green building concept? LEELA Pune

Green building refers to a structure built using a process that is environmentally responsible and resourceefficient throughout a building's life-cycle: from sitting to design, construction, operation, maintenance, renovation, and demolition. In other words, green building design involves finding the balance between home-building and sustainable environment. This requires close cooperation of the design team, architects, engineers, and the client at all project stages. How can you define the job description of a manager accountant of a hospital?

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DR. SHAH Surat

Petty cash funds are used for expenditures in connection with approved hospital activities. The amount and significance of petty cash is so small that it precludes requesting disbursement by check. The amount of the fund requested should be limited to minimum operating requirements to prevent theft of the cash. ◗ 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 only be responsible for one petty cash fund. ◗ The Accounts Executive 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. ◗ The responsible department must notify the Office of 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 at least on a monthly basis and original receipts and 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

TRADE & TRENDS

Maquet Medical India wins “Operating Room Solutions Company of the Year”Award Recognition received at Frost & Sullivan’s 6th Annual India Healthcare Excellence Awards 2014

MAQUET MEDICAL India, has been awarded the ‘Operating Room Solutions Company of the Year’ for 2014 at Frost & Sullivan’s 6th Annual India Healthcare Excellence Awards. Reportedly, the thought process and the vision of Maquet Medical India, has showcased a focus on quality, customer satisfaction, and innovation, coupled with recruitment of medical professionals for best clinical support in its entire bouquet of operating room solutions (which includes operating tables, lights, pendants, anesthesia systems, and operating room integration solutions). Further, with a strategic intent to offer high quality services in India, Maquet Medical India, has started offering consultation to hospitals ranging from design to installation for its comprehensive range of operating room solutions, thus making the company a very trusted and dependable partner of choice for its customers. Speaking about this award, Bhavesh Y Bhatt, General Manager - Maquet Medical India, said, “We would like to thank Frost & Sullivan for this award. We started our journey in India 10 years back, as an equipment selling company and gradually moved to the therapeutic selling model recruiting Clinical Specialist, Respiratory Therapists, and a Perfusionist. The healthcare

The vision of Maquet Medical India, has showcased a focus on quality, customer satisfaction, and innovation, coupled with recruitment of medical professionals for best clinical support in its entire bouquet of operating room solutions market in India is definitely a challenging one and like all challenges, it has made us stretch ourselves to higher levels of delivery. We would like to thank our sales, clinical

marketing, service team for their support, and last but not the least, the healthcare fraternity in India, for its appreciation, support, and patronage.”

Congratulating Maquet Medical India on the award, Jayant Singh, Director, Healthcare and Life Sciences Practice, Frost & Sullivan, said, “It is recognition for the

tireless efforts of Maquet Medical team which has helped them in establishing the company as a one stop solution for operating room needs of a hospital, best in class products, along with an equally good sales and service support system which makes the company stand apart from its peer group.” The Frost & Sullivan India Healthcare Excellence Awards are presented to companies that demonstrate best practices in the Indian healthcare and life sciences industry. The awards programme follows a rigorous methodology to recognise superior planning and execution of product launches, strategic alliances, distribution strategies, technological innovations, customer services, healthcare delivery services, and mergers and acquisitions. Other crucial factors used to evaluate the nominees included leadership qualities, strategy, growth, service, innovation, integration, marketing, and financial performance. This process involves external jury members, eminent personalities, and key opinion leaders in the healthcare industry, in rating each nominee across 8 - 10 parameters based on research data provided by Frost & Sullivan and the jury members’ own understanding of the market as a subject matter expert.

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TRADE & TRENDS

Importance of healthy stock Dr J Sivakumaran, Kovai Medical Center and Hospitals, COO, KMCH, Coimbatore says that a balanced tradeoff between stock out and over inventory has to be worked out to keep cost under control, and expounds on the importance of maintaining a healthy inventory NATIONâ&#x20AC;&#x2122;S LARGEST spending of healthcare expense happens through hospitals. To beat the competition, hospitals always invest in expensive technologies, due to which the cost of medical care is on the increase. One of the cost drivers for such increase is the cost of material. In any hospital, material cost (surgical + pharmacy) account for the highest per cent of the turnover. It is important for the top management to focus attention on this area so that the costs can be reduced, efficiency could be increased and patient care could be provided at an affordable cost. Apart from economic healthcare delivery, it is also important to deliver quality healthcare to patients to improve the satisfaction level. One of the ingredients of quality health delivery is the availability of quality material whether it is disposable, reusable, consumable or capital nature, consistently. Hence material function in a hospital is very important for financial improvements, quality clinical outcomes, physician and patient satisfaction. Better managed hospitals are those who procure material at a reduced cost and deliver improved clinical outcome without compromising quality of care. Even a smallest percentage of savings in the material cost will have high impact on the bottom line.

Challenges Unlike the manufacturing industry, the availability of an item cannot be postponed, as it results in the life and death of patients in a hospital. Non-availability of a smallest item could result in stoppage of a procedure to a patient who is fighting for his life. Most of the products are available in a range of sizes and brands to suit the requirements of the users. Having all the sizes of different brands at all times is a real challenge to the materials

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manager of a hospital. He has to run the department without shortage but also without excess inventory so that the cost of material is at the desired level. A balanced trade-off between stock out and over inventory has to be worked out, to keep cost under control. Most of the hospital consumables bear expiry date after this date they are not usable to the patient care. Hence, every incoming and outgoing item needs to be monitored closely. Stocks are equivalent to cash and if inventory is not tracked and managed properly, chances of revenue leakage is high. While cost of care is of prime importance to the patients, efficiently managing the material cost is highly important for the hospital administrators in this competitive environment. Without having an idea of how much material is required for the next day, the materials personnel need to plan, procure and supply at the expected service level, economically.

Reasons for stock pile up There are many reasons for inventory pile up in hospitals. Improper planning, non-involvement of users, preference of different brands by different doctors of the same speciality, improper control on inventory movements, too many stocking points, change of technology, change of speciality doctors, fear of scarcity, etc. are few of the major reasons. Though zero inventory system will not be successful in the hospital setup, at least the stock level can be reduced, if local suppliers are willing to keep inventory on behalf of the hospital. Many products are not readily available with the supplier and takes longer lead time to supply. As procedures cannot wait for products, the materials personnel necessarily needs to keep more stocks than required, to avoid any stock out. When the

sation is done then proper check and balances is required for sustaining the system. By this exercise, lot of items lying unutilised could be issued to the area where there is a demand for usage. Monitoring slow moving and non-moving stocks also need to be exercised periodically by various ward staff to reduce the inventory. The expiry of each item needs to be checked at least once in a month and short expiry items, say less than three months expiry should be sent to stores for replacement. This will help the stores personnel to take steps for either moving these stocks with other departments before expiry or to get replacement from the supplier. The time limit of three months can vary from hospital to hospital depending upon their policy. System of surprise checking stock and expiry by an external person from other departments will bring more desired results.

Check on surgery sets patient load is high, the users have a tendency to keep more stocks to avoid running here and there, when an item is needed. Though the users keep this as a safety measure, the material department will not have any clue on such stocks and this will be out of their control. When the patient load goes down, the extra items will not be returned back to the stores, resulting in excess inventory at each user area. Over a period of time, a few of these stocks will become slow moving, non-moving and subsequently they will get expired. Suddenly these items will be sent back to the stores either for replacement or for return. As these stocks were already expired, they could neither be returned to the suppliers for replacement nor push them to other departments where this is being used. Ultimately the hospital has to write off these stocks

and get hit at the bottom line.

Care while indenting It is very important to take care while raising indent to the stores by user departments. Only those items that are really needed in that ward for a particular period need to be indented. Due to the work pressure or lack of training, without assessing the real need, indenting will happen based on the previous indents. This will result in stacking items without usage. Every stock point needs to be checked periodically by the user supervisor to ensure that items relevant to that area only are kept as buffer stocks. Any unrelated items should be removed from the ward. Once such items are removed, the left over items need to be properly arranged, stocked and codified so that arrival of any unrelated items, in future, could be easily identified. Once such standardi-

The unnoticed area where focus needs to be applied is the central sterilisation department (CSSD), where various surgery sets are prepared, packed and sterile for doing different surgeries. Each set is customised to individual operating doctors. For the same procedure the number of instruments in the pack may vary from doctor to doctor. The list instruments needed in a pack need to be validated by the user doctor at least once in a year. Many times, out of say 20 instruments packed in a set, only 10 to 15 items will get regularly used and the balance five items would not have been touched during the surgery. This may be due to the change of technology, doctorâ&#x20AC;&#x2122;s choice of instruments or change of doctor himself. But these five instruments, every time will undergo sterilisation, given for surgery and returned back to CSSD without use. If

TRADE & TRENDS each set is going to have such unused instruments, it could be visualised the total wastage per day, per month and per year. This will lead to shortening the life of the instruments, wastage of man power, packing materials, wastage of energy in sterilisation and artificial shortage of instruments. As long as there is no shortage of instruments in the set, nobody will take the initiatives to highlight and remove these instruments from the set. CQO movement: Association of Healthcare Resource and Materials Management, Chicago has introduced a new movement called CQO movement which is the intersection of three components cost, quality and outcomes. Instead of measuring the performance of the materials de-

partment only by cost, it insists that the quality and outcomes are also need to be incorporated to have more meaningful measurement. Mere reduced cost of material does not ensure the quality of care which is very much needed in this competitive environment. Here the cost refers to the total cost of care which includes supplies, services and other activities related to materials function, quality refers to the best possible clinical results and outcomes refers to the cost reimbursement based on clinical care. Though the third component is not much related to the Indian healthcare scenario, the first two components cost and quality is to be necessarily linked into. Whenever there is an effort for cost reduc-

The inventory reduction is not only the responsibility of the materials personnel but with every user in a hospital

tion, it should be related to the level of quality care, to make it more meaningful.

Who is responsible? The inventory reduction is not only the responsibility of the materials personnel but with every user in a hospital. Unless the user takes initiatives, materials department in isolation can’t do much in reducing the inventory. The stocks lying at various user stock points will be under control of users only. The materials department loses its control, once an item is issued to the user department. The users must collaborate more effectively with the materials department, to get the desired results. Barriers, if any in participating and shouldering responsibilities is often

cultural problem rather than a technical problem. All beneficiaries should come forward as a team and try to reduce the inventory for better financial results of the hospital. By holding dead stock or non-moving stock or excess inventory, nobody is benefitted, except the suppliers. On the other side, if only required quantity is indented and kept in the inventory, the financial burden of the hospital will ease out and performance will get improved. Hospital should treat this department as a contributing center and must extend the professional acceptance. Reduced inventory cost will lead to reduced cost of patient care which will lead to the improved image and reputation of the hospital.

Volk’s Eye Check: Aportable ophthalmic exam tool Mobile, handheld instrument aids in paediatric examination of Strabismus Amplitude VOLK OPTICAL’S Eye Check, an electronic handheld ocular measurement device, aids in the diagnosis of ophthalmic abnormalities. Capable of a number of key measurements including pupil diameter, horizontal visible iris diameter, inter-pupillary distance, margin reflex distance, pupil eccentricity and strabismus angle, Volk Eye Check helps practitioners screen, diagnose and document ocular characteristics for contact lens fitting and general diagnostic purposes. Volk Eye Check’s intuitive user interface is easily navigated by physicians and support staff for seamless integration into the practice environment. Its realtime, accurate and objective results enable quick decision making and can be output to electronic records management systems with Wi-Fi connectivity. For general diagnosis and documentation, Volk Eye Check measures: ◗ Inter-pupillary distance for eyeglass fitting ◗ Margin reflex distance for detection and documentation of ptosis in endocrine disorders, as well as pre- and post-surgical

critical role in early diagnosis of eye diseases. Also, in the rural interiors and even in smaller towns, you require a portable device for diagnosis. This innovative ophthalmic diagnostic device can also find many other applications in general patient care.”

Reference 1. New Data on Contact Lens Dropouts, 1/15/2010 (John Rumpakis OD)

comparison ◗ Strabismus angle for Amblyopia and Strabismus screening with objective documentation of Strabismus amplitude Volk Eye Check can also help to quickly identify patients that are candidates for specialty lenses and reduce practice dropout rates. An estimated six million contact users drop out of

lens wear each year, 12 per cent of those due to the discomfort of poorly fitting lenses1. Eye Check measurement parameters that facilitate lens fitting are: ◗ Horizontal Visible Iris Diameter (HVID) to assess correct contact lens diameter ◗ Pupil diameter and eccentric-

ity for GP lens fitting and multi focal contact lens choice ◗ Lid margin to pupil margin for bifocal lens fitting Mahadev Dhuri, who is launching Volk Eye Check in India adds: “Volk has a tremendous reputation in ophthalmic lenses and diagnostic imaging devices. In India, paediatric ophthalmic devices can play a

Contact Mahadev Dhuri, General Manager – India (Volk-Keeler) Tel: 91-22-67080400 Mob: +91 99303 11090 E-mail: mahadev.dhuri@halma.com Website: www.volk.com Or Sunil Balan Marketing Manager Halma India B-1, Boomerang, Chandivali, Andheri (East), Mumbai – 400 072 Board : +91 22 6708 0400 Mobile: +91 77381 61211 E-mail :sunil.balan@halma.com Website: www.halma.com

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TRADE & TRENDS

Sanrad@CT Fest 2014 The event, organised in association with Sanrad Medical Systems, focussed on neck, chest and abdomen, across both modalities, CT and MRI, and their value and advantage in different diseases and organ imaging THE 4TH edition of MSBIRIA's CT Fest was held at Pune, this year. Like last year, the focus was on cross sectional imaging with the lectures based on both CT and MRI and the advantages of each of there modalities applicable to different diseases conditions and organs imaging. The event was conducted in association with Sanrad Medical Systems, a leading refurbished equipment player in India. The event had an array of speakers of renowned international faculty and national faculty. It also comprised interesting segments like poster presentations, spotlight speakers and resident corners. It was a memorable event for doctors and residents alike. Few glimpses CT Fest 2014

Ratish Nair, CEO, Sanrad, interacting with a delegate at CT Fest 2014

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Delegates attending the CT Fest sessions

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TRADE & TRENDS

Halma India opens new branch office in Vadodara It marks Halma India’s first major expansion outside Mumbai HALMA INDIA’S MD, Prasenjit Datta inaugurated the Vadodara branch office on November 6, 2014. The office, located on the fourth floor of Atlantis Heights in the busy commercial area of Vikram Sarabhai Marg, Vadodara, marks the first expansion of Halma India outside Mumbai where the main office of Halma in India is located. Prasenjit announced, “Halma is looking at India to fuel the growth of Halma companies as well as tap into its vast and experienced pool of skilled engineers in setting up knowledge

Prasenjit Datta opening the Vadodara office

Prasenjit Datta and Nitul Sanghvi inside the Vadodara office

and development centres. The Vadodara office will help Halma companies be closer to its customers who are located in Gujarat.” The Vadodara office, spread over more than 1100 sq ft, will currently serve as the base for

lock’s main customers are oil and petrochem firms and consultants.

Nitul Sanghvi, the Area Sales Manager for South East Asia and his team for Netherlock’s range of products. Netherlock is a leading supplier of safety and valve control systems for major industrial operations as well as smaller firms. Nether-

Contact Sunil Balan Marketing Manager Halma India

B-1, Boomerang, Chandivali, Andheri (East), Mumbai – 400 072 Board : +91 22 6708 0400 Mobile: +91 77381 61211 E-mail :sunil.balan@halma.com Website: www.halma.com

Compamedic Instruments: Ready to explore the latest medical avenues Compamedic reaches the remotest parts of the India with its medical technology and related services ESTABLISHED IN 2003, Compamedic Instruments Pvt. Ltd. is an ISO 13485 certified company, dealing in designing, manufacturing, marketing and supply of medical equipment related to the field of respiratory care and diagnostic cardiology. The company was started and is headed by Mayank Aggarwal under the guidance of Anil Aggarwal, who is an Electronics & Communication Engineer, with over 40 years of experience in the medical and healthcare industry, as a dynamic leader in developing, de-

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livering quality medical equipments and having a proven track record of revitalising, turning around and profitably growing businesses. Compamedic is one of India’s fast growing medical companies with the dream of making medical technology affordable to everyone and is achieving what was once considered impossible. Compamedic connects and empowers clinicians with innovative respiratory technologies and services to improve safety and lowers the cost of care.

Mayank Aggarwal MD, Compamedic Instruments

Compamedic reaches the remotest parts of the India with its medical technology and related services. “We believe in owning and controlling the primary technologies behind the products and participate only in markets where we can make a significant contribution. We believe in deep collaboration of our departments, which allow us to innovate in a way that others cannot. And further to have the self-honesty to admit when we're wrong and the courage to change; so as

to offer a high quality, safe and cost effective solution for health care. We make quality technology solutions for the industry through a combination of indigenous manufacturing capabilities and key partnerships with multinational medical technology companies & research institutes from around the world. Our Vision is to bring high quality, cost effective medical technology solutions to emerging markets Continued on Page 92

TRADE & TRENDS

Peripheral applications around Hospital Management Software (HMS) With the RxOffice patient portal, patients no longer need to wait in a queue

JUST AS the peripheral devices connect with the computer to add functionality similarly peripheral applications enhances the scope and applicability of Hospital Management Software.

Few top peripheral apps are listed below: Patient portal A patient portal is a secure portal that provides patients convenient 24X7 access to his personal health information from anywhere in the world through web with a secure authentication. This is typically crucial when someone travels abroad and needs medical care. With patient portal his vitals, allergies and active medication list is available to download in Consolidated Clinical Document Architecture (CDA), internationally acceptable format at a click of button (Blue Button). A number of wearable devices are available in the market for tracking the vitals. With CDA, the vital patient health information gets available to doctors directly. The wearable data is directly sent to the portal interface which in turn sends the data to the doctor’s HMIS. This would help the doctors to track the abnormalities in the vitals like BP, sugar levels etc. Doctors can pro actively call the patients rather than a reactive response. With the RxOffice patient portal, patients no longer need to wait in a queue. Patients can request for appointments online. The one touch 'My Health' empowers the patients

PatientPortal

to keep track of their medical records like ◗ Allergies ◗ Diagnosis ◗ Medication ◗ Immunisation ◗ Lab results

RxOffice patient portal provides patients with the following access

RxTextSave architecture and interface diagram

◗ Special emergency login available with a relative in case of an accident, the (predefined) limited critical data will be readily available to cater to the emergencies. ◗ Direct interaction between the doctors and patients ◗ Enables them to view their

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TRADE & TRENDS encounter details and visit notes ◗ Keep a record on the vitals like blood pressure and glucose ◗ Send recorded vitals to the doctors ◗ Receive lab test results online ◗ Request for refill prescriptions ◗ Securely download patient data in various formats ◗ View patient education and awareness documents

hospitals.

How it works: From the hospital list, the doctors can select the hospitals and make the patient entries. At the end of the month, they will also get patient reports per hospital. RxOffice Consultant application, also provides doctors an option to enter their payments received from the hospitals and get a reconcilation report.

4.WipeOut Security Tool RxOffice RxTextSave (Messaging Mobile Application) RxOffice RxTextSave is a mobile application designed to help healthcare stakeholders (doctors and patients) to securely save the text messages into respective Electronic Medical Records (EMR)/ Electronic Health Records (EHR) systems. This supports the doctors to keep track of communication done via mobile platform, those later syncs with EMR / EHR system. This way important text messages become a part of the patient chart.

Rx Consultant page

Confidentiality is the primary goal for the people who handle sensitive data like patient medical records or accounts related data. When you delete files from the computer, they are all merely tagged for 'being deleted', but not actually deleted. This exposes an organisation to a possible noncompliance with data destruction policies, as well as endangering the safety of personal information in cases where a computer is hacked, stolen, or simply repurposed after upgrading to a new machine. WipeOut is an advanced security tool, which allows the user to completely remove sensitive data from the hard drive. The pattern used for overwriting, effectively removes the files/folders from the hard disk while making the data recovery impossible.

RxOffice webpage

RxTextSave architecture and interface diagram This application also acts as a secured storage vault for your text messages. Any message saved in this would get encrypted and is only accessible to authorised user, thus protecting the text messages in case of loss of mobile. On connecting to the computer the data can be backed up to the PC.

Benefits

How it works Once the user has logged in, he will have options of selecting and viewing the existing selected messages. The application also provides the option of sending text messages to the patients directly. There is also an additional facility to set a priority message with a colour option, which prioritises messages as per importance. This facility helps doctors to prioritise text messages for the follow ups later.

3.RxOffice Consultant RxOffice Consultant is a mobile application for visiting

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This supports the doctors to keep track of communication done via mobile platform, those later syncs with EMR / EHR system. This way important text messages become a part of the patient

doctors in multiple hospitals. In today’s multi-specialty hospital it’s an easy app to monitor your patients. In the present scenario, the hospitals provide the doctors with a list of patients they have examined along with the amount payable at the end of each month. With the RxOffice Consultant mobile application, the doctors can also keep track of the patients they have diagnosed and get a monthly report as well. This will enable them to cross check the report send by the

◗ Secures wipe out of any file/folder on the PC ◗ Protects privacy by ensuring that the wiped out file cannot be recovered ◗ Permanent removal of old wiped out files from the hard drive ◗ Cleans Internet history, cookies, and temporary files ◗ Prevents identity thieves from retrieving personal information from the system ◗ Helps clean your old PC or laptop data before donating or selling them WipeOut has one more unique feature that is 'Rescue Me'. It is a feature provided to help users wipe out files specified in the option menu instantly. Multiple files can be selected here and wiped out as and when required using this feature.

TRADE & TRENDS

PRP: Indispensable to advanced dental implantology

Picture 1

Kandhappan M Pillai, Professor and Head and Dr Yeshwanth Rao, Senior Lecturer, Department of Oral and Maxillofacial Surgery, Daswani Dental College, Kota, Rajasthan impart insights on the use of PRP and its advantages in dental implantology DENTAL IMPLANTS are now becoming the mainstay of replacing lost natural tooth with artificial ones, thanks to the process of osseointegration. Osseointegration is achieved when there is no progressive relative movement between the implant and the bone in direct contact with itand is the result of two complex stages. Osteoinduction is the process by which osteogenesis is induced and osteoconduction is the growth of bone on a surface. Unfortunately not every case is endowed with the needed amount of bone for successful osseointegration or functional loading and life of implants. In such cases, it becomes mandatory on the operator to resort to various bone augmentation with autogenic or allogenic bone substitutes, to achieve a favourable implant bed. Favourable implant bed can be qualitatively and quantitatively enhanced by using growth factors and the quickest, safest and the most efficient way to extract growth factor is through PRP or Remi PRP extractor. Platelet-rich plasma (PRP) is an inexpensive way to obtain many GFs in physiological proportion and has already been largely applied as a carrier of GFs in different fields of medicine (sports medicine, orthopaedics, dermatology, ophthalmology, plastic and maxillofacial surgery, neurosurgery, urology and cardiothoracic surgery) due to its property of favouring tissue healing even in tissues with low healing potential.

with osteogenic properties (osteoconduction and osteoinduction). Guided bone regeneration is an accepted surgical method to help achieve this goal. PRP derived from autologous blood is safe and rich in growth factors like— a) PDGF b) TGFß c) PDEGF d) IGF1 PRP and its constituents are obtained by centrifugation of autologous blood and addition of CaCl2 and thrombin which makes it into PRP gel. This has a high concentration of platelets and fibrinogen. The addition of thrombin and CaCl results in the release of a cascade of growth factors from the platelets (a-granules). PRP is being used nowadays to derive these factors in high concentrations to sites requiring osseous-grafting, prior to or in conjunction with implant placement. Advantages of autologous PRP include: ◗ Quick and substantial alveolar bone augmentation ◗ Better handling of the graft material(alloplastic/autogenous) in the presence of an adhesive medium aiding in compaction ◗ Increased rate of collagen matrix synthesis ◗ Increased rate of bone deposition and quality of bone achieving along with quick soft tissue healing ◗ No risk of infection or disease transmission ◗ Obvious ease of procurement and preparation.

Discussion Implant dentistry entails surgical reconstruction of localised alveolar defects to improve quality and quantity of the host bone using bone substitute

Case studies A 24-year-old male patient reported to our OPD with a traumatic injury to the face sustained following a road traffic

accident. Pre-operative picture 1 shows shows the extent of damage. Preoperative radiographs showed that 12 — the upper right lateral incisor was impacted into the bone close to the floor of nose. After primary care it was decided to rehabilitate the patient dentally. During the course of conversation with the patient and his family it was more than abundantly clear that they did not want to opt for any replacement that looked or felt like artificial. Keeping in mind the patient’s insistence on wanting a replacement as natural as possible it was decided to replace the lost teeth using two Endosseous TS-III implants for missing 12,11. The main problem that we faced was that there was severe bone loss secondary to trauma especially the outer or the buccal cortical plate was totally shattered and thus there was just not enough bone bed to anchor the implants for initial stability critical for osseo integration. This quest for favourable bone bed led us to cotemplate bone grafting by allogenic graft materials mixed to patient’s own PRP for optimum results. The patient was taken under local anaesthesia and Muco-Periosteal flap raised and the Impacted Lateral Incisor exposed and extracted. Note the complete loss of buccal cortical bone upto the level of piriform aperture and floor of the nose in Picture 2. Osteotomy on the palatal cortical plates in the apical third done for anchorage of implants, lack of bone support led us to obtain purchase only on the apical third of the implant length. Picture 3 shows installation of implants 12, 11. Please note that almost the entire buccal surface of the implant is exposed and is devoid of any

Picture 2

Picture 3

Picture 4

Picture 5

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TRADE & TRENDS bone coverage. 10cc of blood is withdrawn from the patient’s arm for extraction of PRP in Remi’s specially designed refrigerated centrifuge. After two rounds of centrifugation cycle PRP is extracted using the PRP kit, thus in matter of few minutes PRP gel was ready, PRP gel was mixed with Bone Graft Allogenic - Combination of Beta TCP and Hydroxy – ApatiteOssify from Equinox, Netherlands used, shown in Picture 4, covering the exposed surface of the implants and sutures placed following insertion of membrane – guided bone regeneration technique. Patient was regularly followed up for post-operative difficulties of complications, but as it turned out that the healing was rather surprisingly quick and uneventful. Also, it was noted that the post-operative oedema was significantly lesser

than the cases where only bone graft of similar kind was placed alone of course barring individual patient factors that come into play. The antibiotic regimen was continued for the first seven days post operatively and the sutures were removed on the fourteenth day following surgery. Picture 5 shows one month post operation. Note the quick and amazing thickness of bone formation, smooth contoured surface, implant or its threads were not perceptible. In fact it is worth to note that the bone is much thicker on the grafted side as compared to the natural side which would eventually normalise as the bone underwent functional remodelling. Also as noted and experienced that the epithelisation is also effectively speeded up when PRP is used, thus resulting in quick wound healing and flap

Advantages of PRP has been proven beyond any doubt, future is development of standard protocols and practises for clinical application preservation even in cases where the blood supply to the flap may be compromised or the flap has been stretched beyond usual.

stated and practicality of use and advantages as experienced, lead us to inference that PRP is an indispensable armamentarium in the hands of implantologist who plan to push the limits beyond the limits of currently accepted good case domain. The advantages of PRP has been proven beyond realms of doubt by various authors and studies, what needs to be seen for the future is development of standard protocols and practises for clinical application. It is also important the PRP is harvested using REMI PRP Centrifuge which comes in refrigerated version, since during harvesting the temperature of blood should be between 20 to 24°C. Any increase in temperature will result in disruption in platelet count, which will affect the therapy.

References Conclusion Theoretical

advantages

1. Mavrogenis AF, Dimitriou R, Parvizi J, Babis GC: Biology of im-

plant osseointegration. J Muscoloskelet Neuronal Interact 2009, 9(2):61–71. 2. Albrektsson T, Johansson C: Osteoinduction, osteoconduction and osseointegration. Eur Spin J 2001, 10(Suppl 2):S96–101. 3. Effect of heat on platelet structure and function; Dr James G. White; Blood, Vol.32, No. 2 (August), 1998 4. The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence Rozalia Dimitriou1†, George I Mataliotakis1†, Giorgio Maria Calori2† and Peter V Giannoudis1,3- Dimitriou et al. BMC Medicine 2012, 10:81 http://www.biomedcentral.com/17 41-7015/10/81 5. Anitua E. Plasma Rich in Growth Factors: Preliminary Results of Use in the Preparation of Future Sites for Implants. Int J Oral Maxillofac Implants. 1999; 14(4):529-35.

Widex launches DREAM CIC MICRO hearing aid Donates hearing aids to underprivileged children from Josh Foundation worth Rs 4.50 lakhs WIDEX INDIA (100 per cent subsidiary of Widex-Denmark), recently launched its new ultrasmall DREAM CIC MICRO hearing aids. Jesper Funding Andersen, Senior VP for Global Sales and Marketing, Widex unveiled the new product at a launch ceremony held in Mumbai. The company also donated the hearing aids to the underprivileged children from Josh Foundation, Mumbai worth Rs 4.50 lakhs. Widex is the largest supplier of digital hearing aid devices in India. Since its launch in May 2013, the DREAM family of advance hearing aids from Widex has set a new standard in hearing aid performance, said Shakeel H Rizvi, Head Marketing, Widex India. By dramatically increasing the input range and maintaining the fidelity of all sounds entering the hearing aid, DREAM gives users incredibly rich and detailed sound. And now a recent trail of hearing aid users confirms that DREAM significantly helps in improving speech perception among hear-

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(L-R) Bhupendra Chaudhary, MD Widex India, Shakeel Rizvi, Lene Bulow and Jesper Andersen, Senior VP Widex

ing aid users, particularly in noise. DREAM also has less battery drain; a recent comparison test of high-end hearing aids showed that DREAM had the longest battery life when streaming. Bhupendra Chaudhary, MD and CEO, Widex India said, “The new ultra-small DREAM CIC MICRO from Widex is the perfect choice for hearing aid users, looking for a discreet solution

that does not compromise on sound. Built on the successful TRUE ISP platform, which is a proven performer, the CIC MICRO provides outstanding sound quality, particularly in difficult listening situations. The new ultra-small micro CIC from Widex is a welcome addition to the discreet segment. Using the latest advanced technology that makes the DREAM family such a success, the CIC MICRO

proves that all good things come in small packages. Chaudhary stated, “We know that many hearing aid users are concerned about the size and looks of their hearing aids. One recent study in the US revealed that over 80 per cent of users would prefer to wear a hearing aid that is small, discreet and almost invisible. With that in mind, we have developed the new CIC MICRO to look as invis-

ible as possible. It is one of the smallest Completely-in-canal (CIC) models on the market; it’s even up to 30 per cent smaller than our own current CIC hearing aids. But small size doesn’t means ‘small sound. The CIC Micro uses Technology that has been proven to provide outstanding sound. So having difficulties hearing in noisy situations such as restaurants or at sporting events is a thing of the past if you are wearing the CIC Micro.” “The new product is easy to use, requiring no adjustment –after your fitting, you simply turn it on and forget that it is even there. And if you are using hearing aids for the first time, then the special Personal Acclimatisation feature in the CIC MICRO makes it easy to adapt to new sound. The product is available in four prices with different performance levels. Dream 440 Micro CIC at Rs 250,000; Dream 330 Micro CIC at Rs 165, 000; Dream 220 Micro CIC – Rs 105,000 and Dream 110 Micro CIC - Rs 55,000,” he further informed.

TRADE & TRENDS

Krishna Medi Equipments set to launch new line of hospital furniture KME is in the process of appointing nationwide dealers in all strategic locations in India for distribution of its products and also providing efficient support to its valued customers

KRISHNA MEDI Equipments (KME) is a professionally run organisation with a vision to address the needs of physicians and providing them with high quality, reliable and cost effective medical equipment and supplies. KME is a recognised player in India’s healthcare segment and a pioneer in delivering quality healthcare solutions employing ethical business practices. KME is promoted by a group of qualified professionals with rich experience in the healthcare industry. The promoters have expertise in the fields of medical industry, medicine, finance and business management. “Our mission is to emerge as an outstanding organisation in India, providing quality medical products and services. Enhancing healthcare by providing quality and cost effective solutions to the physicians and gynaecologists in India is what we believe in,” says Mahesh K Malik, CEO, Krishna Medi Equipments. Mahesh Malik, is a widely travelled professional and a well known personality in the healthcare industry since last 20 years. He is a member of various national and international organisations like Rotary, Cancer Foundation and Freemasonry. KME’s product range includes: ◗ ECG machines ◗ Spirometers ◗ Patient monitors ◗ Pulse oximeters ◗ Foetal monitors ◗ Video colposcopes ◗ Ambulatory ECG ◗ Amb blood pressure systems ◗ ECG event recorders ◗ Syringe infusion pump ◗ Vol infusion pump ◗ Blood and fluid warmers

“We make serious efforts to provide excellent after-sales support to our customers. Further the company is also keeping its focus on cardiology, gynaecology and critical care products to develop expertise in these product segments on long-term basis. The company is also in the process of finalisation of distribution rights for various other innovative products in the near future,” says Malik. His younger son, Mrinal K Malik, joined the industry in the year 2010. Like his father Mahesh, Mrinal’s interest lies in healthcare. Mrinal has a degree in Business Management. With his innovative and vibrant ideas, Mrinal is all set to expand the family business with a new line of hospital furniture. The company under Mrinal’s leadership will soon witness the launch of: ◗ Fowler/Semi fowler beds ◗ ICU beds (Three function electric/manual beds) ◗ ICU beds (Five function electric manual beds) ◗ Emergency trolly ◗ Home-care beds ◗ Bedside lockers ◗ Baby cribs

3-function electric bed

Mahesh K Malik, CEO, KME

◗ Accessories for furniture like ABS Head and Foot Board, Food Attachment etc. “Hospital furniture, along with modern medical equipment, has a pivotal role to play in the healthcare industry. They not only help doctors to perform the critical surgery with utmost safety of the patients, but also make patients feel relaxed during their stay in hospital as well. KME’s hospital furniture are designed and produced, keeping in mind the well-being of the patients. Safety, comfort, innovative designs and effectiveness are the highlights of our health-

care furniture,” says the young entrepreneur. KME uses the most advanced and sophisticated technology to develop the products keeping in mind the end users, with the objective of maximum comfort and safety to patients and convenience to medical staff. The manufacturing process involves most modern, scientifically-controlled treatments. KME’s medical beds, which offer quality beyond comparison, are engineered to international standards and helps in the recovery of the patients. The company’s ability to delight customers by innovating and expanding the portfolio of patient care equipment and clinical solution services has ensured that KME maintain its lead. “We have supplied patient care equipment to most of leading hospitals in India and offshore and have received appreciation for our quality and service,” says Mrinal Malik. KME is also a distributor of M/s Bionet Co. Ltd from Korea for over 15 years to distribute their product range in whole of India. The products of M/s

Bionet Co. Ltd are rich in features but cost effective besides being USFDA certified. The remarkable support and commitment of M/s Bionet Co Ltd to KME and the customers is becoming major reason for the ongoing success of this joint venture in India. KME has a huge Installation Base. The company is also focusing in mainly in health institutions in army and paramilitary such as CRPF, BSF, SSB, etc. Gradually and steadily more products are being added to provide cost effective solutions to the physicians in India in all sectors. KME is in the process of appointing nationwide dealers in all strategic locations in India for distribution of its products and also providing efficient support to its valued customers. Good marketing support, regular trainings, efficient after sales support to its dealers and customers are the strategies of KME to achieve great success. The company maintains strict quality parameters at all levels of their operations and manufacturing process such as recruitment and retaining technically competent persons, procurement of quality rawmaterials and components, technically advanced machineries, R&D, prompt after-sales services, timely delivery and execution of orders. KME follows fair business practices and is committed to providing their customers economical, cost effective, high quality products and services in the shortest possible time schedules. Leaders of KME are committed to preserving the natural resources, by strictly monitoring their processes to minimise the impact on the environment.

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December 2014

TRADE & TRENDS

Akhand Enterprises: One stop shop for repairing and servicing medical equipment The company offers a comprehensive range of technical advisory and repair services and prides itself on its high standards of workmanship and after-sales service WHETHER IN a bustling emergency room or a secure medical laboratory, medical equipment used in a hospital can help save lives. This is why the sensitive medical equipment must work at all times - if something is down for even a minute it can mean huge risks. This thought paved the way for the setting up of Akhand Enterprises by Jatinder Pal Singh. Jatinder Pal Singh, a B.Tech in Electronics from Patiala, always felt the need for a one stop shop for the servicing and repairs of all emergency medical equipment. Starting his career with a top healthcare company, Singh realised the need for a company which will specialise in medical equipment repairs. In the year 2006, he ventured out on his own with Akhand Enterprises which provides sale, service, repair and maintenance solutions in the field of: ◗ Cardiology ◗ Critical Care ◗ Anesthesiology

◗ Emergency and OT equipment “We sell and repair all types of ECG machines, fetal monitors, ultrasound machines, anesthesia machines, cardiac monitoring systems, colour doppler, CT scan, MRI, C-arm, defibrillators, syringe pump, pulse oximeter and their accessories. Our working territory is New Delhi NCR, Haryana, Punjab, Jammu, Rajasthan, Gujarat, Lucknow, Uttar Pradesh and many other cities. Our mission is to be a call away for any medical equipment repair anytime anywhere,” says Singh. Akhand services and repairs a large variety of medical and laboratory equipment. “Our biomedical technicians are experienced and factory trained. We provide quick repair turnaround time and warranty our workmanship. Our service repairs are performed by qualified and certified technicians. Our company prides itself in the quality and honesty of our work practices.

Jatinder Pal Singh CEO, Akhand Enterprises

We strive to provide a quick turn–around times and customer satisfaction,” says the young entrepreneur. Akhand has a state-of-the-art workstation with most modern test and service equipment and other facilities along with a pool of qualified and trained technicians ready to take the plunge for the fastest and convenient service. Akhand has displayed outstanding service and results in cases where the product’s re-

spective companies have pulled their hands in the matter of cost effective repairing. As the reward, the best hospitals and nursing homes are Akhand’s loyal clients in Delhi and other cities. The technical and educated staffs are always dedicated to provide their best services to fulfill the customer’s satisfaction. Akhand is a specialist in the repair of medical equipment and surgical instruments that meet the exacting requirements of health industry professionals and medical service practitioners. The company offers a comprehensive range of technical advisory and repair services and prides itself on its high standards of workmanship and exemplary ongoing and after-sales service. Key features of Akhand Enterprises ◗ India’s most popular medical equipments company, for service and support ◗ The company has done major installations for medical equip-

ment in the private and public sector ◗ Provides service backup of qualified and trained service engineers ◗ Team of qualified and talented engineers ◗ Provides online services for all 24 hours and 365 days ◗ Undertakes AMCs and CMCs of life saving medical equipment ◗ Upgrades itself for awareness of new technologies ◗ Professionally trained service engineers for various types of equipments Regarding their future strategies, Akhand Enterprises is also actively engaged in advanced research and development studies and soon plans to introduce new products under the company banner. Akhand Enterprises aims to become the most admired Indian medical company through service, repair manufacturing, wide-ranging product solutions and world class customer service support.

arm, etc. These products have been developed on time tested technology, offering the best trade-off between technology and price. The company can undertake manufacture and export of medical equipment conforming to the buyer's design and specifications. Compamedic also act as OEM suppliers for its products to many companies across the world. Compamedic has been at the forefront, bringing quality medical technology to healthcare providers in India and emerging markets for over a

decade now. The future plans of Compamedic is to introduce some new models of neonatal CPAP system, respiratory humidifiers and air compressors, based on the requirements and features asked by the customers and to keep in pace with the dramatic advancements in the field. The company is planning diversification into other related areas and accordingly, will be pleased to have proposals for joint ventures with other international majors in the field of respiratory care and cardiology.

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Compamedic Instruments... and reaching further into international markets with highly cost-effective medical technology solutions and putting India on the global map of Medical Technology,” says Mayank Aggarwal, the young entrepreneur and MD of Compamedic Group. Compamedic’s initial capabilities are rooted in development and manufacturing. The engineering team transforms the functional prototype designs into manufacturing, costeffective, validated equipments. The barcode identified lots are stored and dispatched

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December 2014

by computerised logistics - providing full traceability for each product delivered to the customer. Further the company’s robust quality assurance and regulatory system provides confidence in distributing approved, reliable equipments that meet the strictest standards and requirements of the leading medical device companies. All the products of the company are supplied in compliance with international regulatory requirements such as CE Mark for the European market. Customer satisfaction is

Compamedic's highest priority and the company is committed to its traditional values and goals with a progressive eye to the application of new technologies, and to developing even stronger relationship with its customers, dealers, and OEM partners. Compamedic manufactures a wide range of premium quality: ◗ Neonatal CPAP systems ◗ Respiratory humidifiers ◗ Air compressors ◗ Medical treadmills ◗ Accessories like humidification chamber, circuit support

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