Express Healthcare (Vol.9, No.5) May, 2015 by Indian Express

VOL.9 NO.5 PAGES 72

www.expresshealthcare.in MAY 2015, `50

CONTENTS Vol 9. No 5, MAY 2015

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 Bangalore Assistant Editor Neelam M Kachhap Pune 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,Rakesh Sharma 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 Arun J Ajanta Sengupta PRODUCTION General Manager B R Tipnis Manager Bhadresh Valia Scheduling & Coordination Mitesh Manjrekar CIRCULATION Circulation Team Mohan Varadkar

WAGING A WAR AGAINST

TOBACC

Slamming the Central Government's decision to delay the deadline of increasing the size of pictorial warnings on tobacco products, healthcare providers, health activists and public health groups put forth arguments and facts to link tobacco consumption with cancer. They also question the government's commitment to ensure good health for its citizens and recommend the way forward| P38 P14:INTERVIEW: SANDEEP PATEL MD and CEO, Cigna TTK

P16:INTERVIEW: BN MANOHAR

CENTRE FOR CONTROL OF CHRONIC CONDITIONS (CCCC) LAUNCHED IN INDIA

AERB TO CONDUCT SURPRISE INSPECTIONS OF X-RAY FACILITIES

DEAKIN UNIVERSITY AND MAX HEALTHCARE COLLABORATE

DY PATIL UNIVERSITY HOSTS 6TH NATIONAL CONFERENCE CAREER CONCLAVE-

MUMBAI HOSTS ULTRAFEST 2015

LIFE

IT@HEALTHCARE

CEO, Stempeutics

P32:INTERVIEW: NAOTOSHI NISHIDA VP, Infrastructure Systems Company, Hitachi India

MARKET

REMEDINET SOLUTIONS AND MANIPAL HOSPITALS: PARTNERS IN PROGRESS DIGITAL IMAGING FOR DOCUMENT MANAGEMENT

VIKRAM PATEL FROM PHFI NAMED IN TIME MAGAZINEâ&#x20AC;&#x2122;S LIST OF 100 MOST INFLUENTIAL PEOPLE

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

Rage of India’s nursing angels

n one hand, doctors and nurses employed in the National Health Mission (NHM) were forced to go on strike to demand the same wages as other health centre employees. And even when they called off the strike on April 22, after 42 days on strike, the matter remained unresolved. The President of the nurses association of NHM, Karamjeet Kaur warned that though they had decided to join work, they were forced to give a 10-day ultimatum to the state government, during which employees of two districts would continue their dharna at Chandigarh. If their demands were not addressed, they threatened to resume the strike. And on the other hand, the US is going all out to attract doctors from countries like India and Pakistan. Two US senators, from opposite sides of the political fence, (Grace Meng, a Democrat from New York and Tom Emmer, a Republican from Minnesota) have introduced the Grant Residency for Additional Doctors Act (GRAD Act), aimed at speeding up the visa approval process for overseas doctors who had been selected by US hospitals. Doctors in India still command a 'god-like' devotion but not many spare a thought for the ‘angels’ behind the show. We tend to take them for granted and reserve our worst comments for those who seek better wages. Sample this gem from the Goa Chief Minister Laxmikant Parsekar in late March this year. When nurses and others workers attached to the state-approved but privately run 108 ambulance service went on a hunger strike, the Goa CM had this sage, almost fatherly, advice for the nurses: Protesting in the sun will darken your complexion and ruin your marital prospects. The world has realised the worth of nursing talent from India, with special praise reserved for those from southern states who have served in war-torn zones, most recently in Iraq, Libya and Yemen. But most of these nurses resisted efforts to bring them back and now want to return, even if it means facing daily bomb threats and risking capture by warring factions. Most of them have huge debts, incurred to pay for their nursing educa-

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Sample this gem from the Goa CM Laxmikant Parsekar. When nurses and others workers attached to the state-approved but privatelyrun 108 ambulance service went on a hunger strike,he had this sage,almost fatherly, advice for the nurses: Protesting in the sun will darken your complexion and ruin your marital prospects

tion as well as passport/visa fees to touts who arranged contracts and travel documents. Worse, some fear that they will not get their past wages as they violated the contract by leaving. Poor wages seem to unite nurses across the world. What differs is only the scale. For instance, for the first time in their 134-year history, members of the Royal College of Midwives in northern Ireland staged a four-hour strike in late April to call for a one per cent pay increase, as was given to their colleagues in other parts of UK. Acknowledging their immense contribution, Express Healthcare’s May issue marks May 12, World Nursing Day, with a cover story touching on the newer avenues opening up, slowly but surely, for nursing staff in India. ('Ushering a new era in nursing', pages 20) In more ways than one, change will come only with pressure from the public voice. Another focus area of the May issue is the government's backtracking on its commitment to increase the size of pictorial warnings on cigarette packs. The lead story in the Strategy section, ('Waging the war against tobacco’, pages 38) tries to raise the consciousness around this action. The good news is that the youth, a category of ‘new’ users being targeted by tobacco companies, seem to have decided to hit back. May 1 will see a youth-led press conference jointly organised by Public Health Foundation of India (PHFI) and WHO, HRIDAY (Health Related Information Dissemination Amongst Youth) where the youth will sign a petition demanding 85 per cent pictorial health warnings on tobacco packs. With youth icons like cricket hero Rahul Dravid, who is also the country's ambassador for tobacco control, lending more power to the punch, one hopes the movement will pick up momentum across the country. The medical community will have to do their bit to magnify the message as the tobacco lobby is sure to hit back. The world is usually deaf to the silent scream. India needs the rage of angels for change. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

LETTERS QUOTE UNQUOTE

“To increase and sustain vaccination coverage, we need to strengthen health systems and link vaccine delivery to other health interventions. Addressing the resource crunch, competing health priorities, poor management of health systems, inadequate monitoring and supervision and low awareness level among parents is critical to making vaccination available to all children”

APRIL, 2015

EXCELLENT ARTICLE

saw your very well researched and excellent article on medical device industry in India and the Make in India/ Make for India campaign. Compliments to you on capturing the mood of the industry accurately and communicating it so aptly.

Dr Poonam Khetrapal Singh Regional Director,WHO South-East Asia

Rajiv Nath Forum Co-ordinator, AIMED

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(Celebrating World Immunization Week)

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MARKET NEWS

Centre for Control of Chronic Conditions (CCCC) launched in India The Centre is an international partnership between AIIMS, New Delhi; Emory University, the London School of Hygiene & Tropical Medicine and PHFI THE CENTRE for Control of Chronic Conditions (CCCC) was launched recently by YS Chowdary, Minister of State for Science and Technology. The Minister also released a joint report on ‘Chronic Conditions in India – Evidence based solutions for a growing health crisis.’ The report addresses the rising tide of chronic conditions in India and argues that the cost of inaction towards chronic conditions would be too high for India to bear. CCCC is an international partnership between the All India Institute of Medical Sciences, New Delhi, Emory University, the London School

of Hygiene & Tropical Medicine and the Public Health Foundation of India. The secretariat for this global partnership will be at the Public Health Foundation of India. The Centre is a multi-disciplinary group of researchers and health professionals representing a spectrum of clinical, public health, genetics, biochemistry and social science disciplines. The work focuses on the priority chronic conditions of cardiovascular diseases and stroke, mental disorders, diabetes, chronic lung diseases, cancers, injuries and chronic kidney diseases. Prof MC Misra, Director AIIMS said, “This international

collaboration between AIIMS, Emory University, LSHTM and PHFI will be the beginning to strengthen institutional framework, national and international capacity building and networks in the regions that will translate evidence into policy and practice.” Prof James Curran, Dean, Rollins School of Public Health, Emory University, Atlanta US, said, “There is also an urgent need to advocate the integration of best practices for various chronic diseases and injuries with one another as India progresses with its national health agenda, hence this international partnership serves as a

platform that will try and make a real difference to health outcomes in this enormously important area.” In his address Dr K Srinath Reddy, President, Public Health Foundation of India said, “The Increasing burden of chronic conditions has had not only obvious health implications but also economic and developmental consequences. It is in response to this public health challenge that Centre for Control of Chronic Conditions will generate world-class knowledge which can impact policy and practice, and will work with and educate the wider community about

lifestyle-associated diseases to improve quality of life and reduce the burden of chronic conditions.” Prof Anne Mills, Deputy Director & Provost and Professor of Health Economics and Policy, London School of Hygiene and Tropical Medicine (LSHTM), emphasised, “The launch of the Centre for Control of Chronic Conditions will further augment targeted healthcare initiatives, capacitybuilding and policy engagement, to prevent and control chronic diseases in other low and middle income country settings.” EH News Bureau

NATHEALTH initiates ‘Make For India in Healthcare/MedTech’ It will result in many benefits for healthcare industry as well as Indian citizens, claims NATHEALTH SUPPORTING THE GOVERNMENT’S initiative of Make in India Campaign, NATHEALTH (Healthcare Federation of India) has started working on a concept note on ‘Make For India in Healthcare/Medical Technology’. Anjan Bose, Secretary

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General, NATHEALTH said, “Make in India is an excellent concept, in order to articulate the steps for necessary incentivisation for making in India. At first demand has to be created in order to build ‘economy of scale’ which will justify investments for local innova-

tion and manufacturing. It will also take some time. Medical technology and diagnostic services could be two areas of consideration. Demand will be the basis of making choices for such local manufacturing. India already manufacturers many medical products like diagnostic X-ray machines, ECG machines, ultrasound, some internal devices etc… A demandsupply gap matrix will create the roadmap for the needed focus areas.”

It will result in many benefits for both healthcare sector/industry as well as citizens of India. Past studies have revealed that around 30-35 per cent of cost of healthcare delivery is towards technology. Therefore any cost reduction due to local innovation/manufacturing should translate into lower cost of delivery and therefore increase affordability. For solution of this problem, Bose emphasised, “India still imports around 80-85 per cent

of its medical technology. With judicious plans and efficient implementation, the private sector and government need to work hand in hand as one team to make further progress and make India one of the global hubs of innovation and manufacturing in healthcare particularly medical technology. We can also learn from the models adopted by other countries successful in this area. Ireland is an example.” EH News Bureau

Sankara Eyecare bags IMC Ramakrishna Bajaj National QualityAward SANKARA EYE CARE Institutions India has been conferred with IMC Ramakrishna Bajaj National Quality Award 2014 in healthcare sector by the IMC Ramkrishna Bajaj National Quality Award (IMC RBNQA) Trust-a joint initiative of the Indian Merchants’ Chambers and House of Bajaj. Named after Late Ramkrishna Bajaj, the award, established in 1996 to provide special recognition to excellence in organisations, is a prestigious national quality award in India. Dr RV Ramani, Founder & Managing Trustee, Sankara Eye Care Foundation India, received the award from Vishwanathan Anand at the Making Quality Happen Awards Ceremony held in Mumbai. As winner of the IMC RBNQA award, Sankara is now eligible to apply for the Global Performance Excellence Award, the only formal global recognition of performance excellence. In his comments, Dr Ramani said, “Sankara’s recognition for best practices and quality systems in healthcare is even more gratifying and noteworthy given the presence of the best of corporate hospitals in the country vying for this national recognition. Winning the RBNQA was the culmination of the tremendous effort, the team at Sankara Eye Care put in while implementing the world-class practices across its hospitals. This famed Sankara Quality eyecare is available pan India including Mumbai where it has a state-of-the art hospital at Malad West.” “Winning this award reinforces our resolve in aligning with the mission and vision to continue being world-class and providing quality eye-care for all,” he further added. EH News Bureau

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MARKET

AERB to conduct surprise inspections of X-ray facilities Stricter actions will be taken against those who grossly violate the AERB norms

Raelene Kambli, Mumbai THE ATOMIC Energy Regulatory Board (AERB) recently ordered the shutdown of X-ray facilities at three private hospitals and two diagnostic centres in Mumbai owing to non-compliance of requisites specified by the authority. Following this move, AERB plans to have more surprise inspections of facilities in Nagpur, Pune, Nashik, Chennai, Kolkata and Delhi. The AERB also plans to conduct more

surprise inspections across the country. According to Dr AU Sonawane, Head-RSD, AERB, “The Board last year revised the safety code for X-ray facilities and its compliance. Also, AERB came up with a rule for compulsory registration of Xray facilities for which they started off a web-based registration service. As per AERB, the major requisite for registration and compliance include, patient safety, good quality imaging and less radiation exposure.” Dr Sonawane further

informs that after the launch of their online registration service around 20 thousand X-ray facilities have been registered in a span of eight to nine months. The Board has also issued several advertisements for the same. However, expressing his worry about many unregistered X-ray facilities still functioning within the country he said, “On April 8, we started off this surprise inspection to check on whether these X-ray facilities functioning within the city of Mumbai are registered and

are compliant with our safety code. During our inspection we found that medical institutions including Pt Madan Mohan Malviya Hospital, Healthcare Diagnostic Lab, Metro Care Diagnostic Centre, Millennium Life Line Hospital, and New Millennium Multispeciality Hospital seriously violated our norms. Therefore, we ordered a complete shutdown of these institutes. Further, we have also issued warnings against operating X-ray equipment without AERB registration to Lok-

manya Tilak Municipal General Hospital, Sion, Dr VT Shah Dignostic Centre and Clinic, Matunga, Navi Mumbai Municipal Corporation Hospital, Vashi, Insight CBCt, Vashi, Health Spring, Vashi and Neway Hospital, Sanpada.” In the next three to four months, many more surprise inspections will be conducted and stricter actions will be taken against those who grossly violate the AERB norms. raelene.kambli@expressindia.com

Artemis Hospitals and Ministryof Public Health of Afghanistan sign MoU Plan to set-up telemedicine services and promote medical tourism ARTEMIS HOSPITALS has signed a memorandum of understanding (MoU) with the Ministry of Public Health of the Islamic Republic of Afghanistan. The MoU envisions quality healthcare service provisions for all the Afghan nationals through collaboration with Artemis and strengthening human resource management and development in Afghanistan. Through this MoU, Artemis Hospital will extend its distinguished expertise to the Ministry of Public Health

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and help in setting up the following services: ◗ Telemedicine ◗ Capacity building of Afghan healthcare professionals ◗ Medical tourism ◗ Public private partnership The MoU will promote and reinforce cooperation, mutual exchange of views and exchange of experts and researchers. Dr Devlina Chakravarty, Executive Director and CEO, Artemis Hospitals; Dr Ferozuddin Feroz, Minister of Public Health of the Islamic Republic of

The MoU will promote and reinforce cooperation, mutual exchange of views and exchange of experts and researchers Afghanistan and Shaida Mohammad Abdali, Ambassador, Embassy of the Islamic Republic of Afghanistan, spoke about the various pointers of the MoU and

expressed their zeal to work towards a same goal. The event also witnessed the presence of Dr (Col) Manjinder Sandhu, Medical Director & Director Cardiol-

ogy, Artemis Hospitals; Naveen Kapoor, President (International Business Division) and Whole time Director of Apollo International; Ahmad Jawad Osmani, Director, International Relations of Ministry of Public Health of the Islamic Republic of Afghanistan; Sayed Mujtaba Ahmadi, Economic Counselor of the Embassy of the Islamic Republic of Afghanistan; Abdul Alim Atarud and Hedayatullah Stanekzai. EH News Bureau

MARKET

Deakin University and MAX Healthcare collaborate It’s a health data mining project to develop a predictive model to better healthcare management

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resultant model will be jointly held and shared by the teams at Deakin and Max healthcare

as a prototype programme. Once successful, the model would be subsequently piloted

at Max Healthcare on prospective cases over a period of one year and the predictive

accuracy would be calculated and shared with Deakin team. EH News Bureau

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DEAKIN UNIVERSITY has signed a partnership with Max Healthcare for a project that will focus on data analytics for healthcare. Both partners are bringing ‘big data’ to work for medicine with its huge records of patient history - with data on admissions, diagnosis and outcomes, spanning a huge inventory of images, computerised records and registries and the consequent untapped potential to identify critical safety issues, as well as service and clinical efficiencies. As part of the agreement, Max Healthcare and Deakin University will jointly address this pressing need by leveraging state-of-art and verified techniques in data analytics to support clinical decisions. The outcomes are critically important from economic, patient safety and systems perspectives. The immediate project will focus on heart disease, specifically on patients with index admission [symptoms] of acute myocardial infarction (AMI) or stroke. Prof Svetha Venkatesh, Director, Pattern Recognition and Data Analytics, Deakin University said, “The primary objective of the project will be to search through the existing data sets for hidden patterns of both the predictable and preventable events in managing the healthcare of individuals. This will be done by building sophisticated predictive models, utilising machine learning techniques derived from anonymised hospital patient records from diverse hospital data sources. This paradigm is novel, since it is capable of both hypothesis generation and testing, whilst being agnostic and unbiased to prior assumptions.” A joint team will analyse the data, extract relevant features and build a validated machine learning model for specific prediction task. The

MARKET I N T E R V I E W

‘Product innovations are the need of the hour’ With the growing need for health insurance penetration in India, both government and the private sector are keen on bringing in new, innovative products to the market. Sandeep Patel, MD and CEO, Cigna TTK speaks on the changing scenario within the health insurance sector in India, in an interaction with Raelene Kambli

Can you give an overview on the current insurance scenario in India? At present there are 24 life insurance and 28 non-life insurance players in the market. Among the noninsurance players there are five standalone health insurance players and CignaTTK Health Insurance is one among them. The insurance penetration in the country is at 3.9 per cent way below the world average of 6.3 per cent. Recently, the Insurance Bill was amended and the FDI limit was increased from 26 to 49 per cent. This move was welcomed by the industry and is expected to further support development of the insurance industry with infusion of capital. For health insurance the Bill made more sense as it can now operate as a separate line of business. Is the insurance market in India still fragmented? The market is dominated by public sector insurance companies, both in life and non-life business. But the private sector is catching up as they offer wide range of products. With FDI opening up, it’s expected that infusion of capital will give a push to the products in terms of innovation and reach. What has been the impact of

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added emphasis on health insurance in the Union Budget 2015? The increase in the tax deduction limit on health insurance premium to Rs 25,000 from Rs 15,000, and to Rs 30,000 for senior citizens under section 80 D, was a positive step forward to help increase penetration in, and awareness of health insurance products. This move is likely to provide much needed momentum to the health insurance industry by incentivising the end consumer and encouraging them to set aside more money for insuring themselves and their families for their health and well-being needs. How will this move help improve the health insurance scenario in the future? People in India don’t take up health insurance since there are no returns. The move will bridge tax incentive gaps between health insurance and other long term insurance, pension, and investment based products. Why are Indians reluctant/lagging to invest in health insurance? The awareness about health insurance is very low in India. Even much aware people avoid buying health insurance as the thought of falling sick don’t cross their

At Cigna TTK we believe in offering immediate gratification to our customers, hence we offer health maintenance benefits immediately after buying the policy mind. It is need of the hour for insurance companies to spread awareness on health insurance and ease the claim process so that customers can have a seamless and pleasant

experience. At Cigna TTK we have attempted to take care of these nuances by training right and deploying trained medical practitioners to assist our customers. We have made considerable technology innovations like Cigna TTK distributor portal and a Cigna TTK mobile app for the first time in the health insurance space. This is an on-the-go facility for our distributors to enable policy purchase online with greater ease and convenience. How much health insurance cover does an individual need? The health insurance cover varies from individual to individual. For an adequate cover the important parameters to be considered are age, gender, city of residence, pre-existing diseases, family history and financial reserves. If one has a group health insurance cover from the employer, top-up covers are useful in such situations, as the cover may not be sufficient. What are the myths associated with the Indian health insurance sector? There are a few myths associated with the health insurance sector because of ignorance. The common ones are that claims get settled only against hospitalisation, one

does not need health insurance if healthy, have a group health cover and hence don’t need separate policy. I think it’s important to address such issues and create awareness on health insurance. How does Cigna TTK add value to its customers? Cigna TTK is the latest entrant in the market as a standalone health insurance company. We assist our customers in living healthy through our ProActiv Living Program. We promote health and wellness, by partnering various prominent marathons across the country and provide complete assistance to our customers in illness and in wellness. At Cigna TTK we believe in offering immediate gratification to our customers hence, we offer health maintenance benefits immediately after buying the policy. What are the new innovations by Cigna TTK? Product innovations are the need of the hour. At Cigna TTK we have pioneered few innovations like Cigna Global Health Plan, Worldwide Emergency Cover, Sum Insured upto 1Crore etc. We continue to bring more innovations as we believe one size does not fit all. raelene.kambli@expressindia.com

EVENT BRIEF JULY - OCTOBER 2015 INTERNATIONAL MUSCULOSKELETAL ULTRASOUND CONFERENCE

MEDICALL 2015

INTERNATIONAL MUSCULOSKELETAL ULTRASOUND CONFERENCE

MEDICALL 2015 Date: July 31, Aug 1 and 2, 2015 Venue: Chennai Trade Centre, Nandambakkam Summary: Medicall brings the latest, appropriate and affordable technologies, for the benefit of all hospitals including smaller hospitals, clinics, nursing homes and physicians setting up group practice. Visitorsâ&#x20AC;&#x2122; profile include doctors, hospitals owners, diagnostic centres, medical directors, biomedical engineers, medical colleges, healthcare services, investors for healthcare industry, and purchase managers. Exhibitorsâ&#x20AC;&#x2122; profile include hospital equipment, surgical equipment, hospital furniture, diagnostic/laboratory equipment, dental/ophthalmology equipment, medical disposables, facility management and support services, hospital design and construction, hospital staffing service, IT provider for hospital, communication equipment, medical waste management, medical textiles, financial and health insurance services, office automation, equipment and accreditation agencies. Contact Medexpert Business Consultants, 7th Floor, 199, Luz Chruch Road, Mylapore, Chennai Tamil Nadu, India Phone: 91 44- 24718987

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Date: October 8-11, 2015 Venue: Vivanta by Taj, Dwarka, New Delhi,

Summary: The event would focus on the application of ultrasound to the entire range of musculoskeletal imaging. It would dispense information on the anatomy, techniques and interventions applicable

to the musculoskeletal system using ultrasound, while continually defining its role as a major modality in musculoskeletal imaging

Contact Conference Secretary Dr. Nidhi Bhatnagar, E-7, East of Kailash, New Delhi Mobile: +91 - 9810884378. E-mail: nidhibhatnagar63@gmail.com.

MARKET I N T E R V I E W

â&#x20AC;&#x2DC;We are the first company in the world to get a patent for pooled stem cell technologyâ&#x20AC;&#x2122; Recently, Stempeutics observed the First Stem Cell Awareness Day in India with a public event to explain stem cell therapy options and sought to dispel misconceptions about the use of stem cells as therapy. M Neelam Kachhap spoke to BN Manohar, CEO, Stempeutics to know more about its novel products and business plans

How is the partnership with Cipla shaping up? Stempeutics had entered into strategic alliance with Cipla for marketing its products in 2009. We are pleased with the partnership and hope that it will bear fruits soon. Cipla and Stempeutics were founded by great visionaries who have realised the potential of India to take on the world in healthcare and education. Both the organisations share common ideals and values of their founders. Cipla brings to the table its expertise in terms of go to market strategies, marketing and sales. They also follow good manufacturing practices and lead us through the regulatory pathway. While we are very strong in basic science and research they bring expertise in other fields. Can you throw some light on the recently received patent for your stem cell product? We are the first company in the world to get a patent for pooled stem cell technology and process to make a novel stem cell entity called stempeucel. It is derived from allogeneic

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pooled mesenchymal stromal cells extracted from the bone marrow of healthy, adult voluntary donors. Our process has a unique advantage. Stem cells are already available, there is no innovation there. The innovation is in the new biological entity. We pool multiple donor cells to create the end product. It is the way in which we isolate and bank it and we are the only company that uses pooling technology. The companyâ&#x20AC;&#x2122;s proprietary pooling approach allows an efficient manufacturing process with minimum wastage of resources in order to provide the product at an affordable cost to patients. We can create more than a million patient doses from a single set of master cell banks which is unique in regenerative medicine. This means that life-cycle of our cells line is much longer than our competitors. We can produce a number of batches with consistent characteristics that are very critical for good therapeutic effect. Our product has better immuno-modulatory properties and broader array of cytokine production capacity. Our technology

produces a unique investigational medicinal product (IMP) which is characterised using a variety of parameters necessary to establish the sterility, identity and potency of the product.

Our product has better immunomodulatory properties and broader array of cytokine production capacity

How is this pool of stem cells used? What are the indications it can be used for? It can be used for a number of diseases but we have conducted trials and will market the product for Thromboangiitis obliterans and critical limb ischemia. Thromboangiitis obliterans is an autoimmune disorder with recurring progressive inflammation and thrombosis (clotting) of small and medium arteries and veins of the feet. It is strongly associated with use of tobacco products primarily from smoking, but also from smokeless tobacco. Patient experiences severe pain. Critical limb ischemia (CLI) is a progressive form of peripheral arterial disease, which blocks the arteries in the lower extremities, resulting into reduction of the blood flow. Peripheral arterial disease is caused by

atherosclerosis, the hardening and narrowing of the arteries over time due to the build-up of fatty deposits called plaque. It is a debilitating disease which affects patients with severe pain in the feet or toes. Insufficient supply of blood flow results into the development of sores and wounds in legs and feet. If left untreated, patients may finally have to undergo amputation of the affected limb as the last treatment option. In the US, most common current treatments for CLI are characterised by high rates of primary amputations, multiple procedures and high rates of procedure-related complications. In such cases, the disease not only affects the quality of life but also increases the economic burden of patients. Stempeucel drug is expected to address the root cause of the disease through anti-inflammatory and immune-modulatory mechanisms. It is expected to induce angiogenesis through release of vascular endothelial growth factors, epithelial growth factors, angiopoietin and improve the perfusion and help the repair

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EMA has granted Advanced Therapy Medicinal Product classification for our novel stem cell drug stempeucel which will be used for treatment of Thromboangiitis Obliterans (TAO) in the European Union and regeneration of the ischemic muscle tissue. Tell us about the clinical trial being conducted for this product. We are at an advanced stage of a clinical trial for CLI. We have completed phase-2 trial and are going for phase-3. Being an unmet medical need or what we call orphan indication where no treatment is available to cure the disease, only symptomatic relief is provided, we have proposed our product to be used as investigational medicinal product (IMP). Stempeutics has already submitted its applications to Drug Controller General of India (DCGI) to obtain marketing authorisation approval for Stempeucel. The availability of the product in the market is subjected to DCGI approvals. We have trial sites at12 hospitals across India. These include AIIMS, KEM, MS Ramaiah, CMC Vellore, PGI Chandigarh and Stanley Medical College, Chennai to name a few. What are your plans for this product launch? It will be launched first in India. India first, global next. Our motto is win locally, play globally. So, first we will make the drug available in India then only we will take it to other geographies. Tell us about the investments into this product. We have been spending money (investing) for the past nine years, so far investment of about Rs 200 crores has gone into the company through various stakeholders. We believe that by next year we will start earning as this drug goes to

the market. What is the size of Stempeutics today? Stempeutics is based at two locations in India and has a manpower strength of 40. We have 65 patents filed, 8 granted, 62 peer review articles published. Our innovative stem cell product is patented in US, Australia, New Zealand, South Africa, Singapore and recently in China. The European Medicines Agency (EMA) has granted Advanced Therapy Medicinal Product classification for our novel stem cell drug â&#x20AC;&#x2DC;Stempeucelâ&#x20AC;&#x2122; which will be used for the treatment of Thromboangiitis Obliterans (TAO) in the European Union. And hopefully we will have good news from DCGI soon. So what does 2015 look like for you? Well, we have put in a lot of hard work and I hope we can enjoy the fruits of our labour now. We believe that the benefit of regenerative medicine should go to the people. It is too premature to talk about the revenue for Stempeucel but there are a many patients suffering with CLI in India. The market is easily worth $100 million every year. Tell us about your product pipeline. For this product, we are looking at CLI as an indication, but besides this we are also looking at osteoarthritis, liver cirrhosis, etc. Since the drug is working on the vascular cite we are looking at expanding it for peripheral artery disease and most importantly, diabetic foot ulcer. mneelam.kachhap@expressindia.com

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May 2015

MARKET POST EVENT

DY Patil University hosts 6 National Conference - Career Conclave-2015 th

The event elicited a good response from the delegates

THE 6 TH National Conference 'Career Conclave-2015' was recently held at DY Patil University, Navi Mumbai, Belapur campus. Hospital promoters, directors, hospital administrators, CEOs, owners of nursing homes, laboratories and radiology centres, healthcare management consultants and medical students shared their experiences on how to gradually climb the career ladder at the event. The conclave was well received by the students and their parents. More than 240 delegates comprising medical interns, paramedical students and parents took part in the event. Dr R Gopal, Director and Head of Department, DY Patil School of Management inaugurated the event and Dr A Velumani, Chairman and Creator, Thyrocare and Nuclear, the Chief Guest, lit the lamp. Speakers who attended the event were Balaji Cuddapah, Country HeadTechnical, Liberty Videocon General Insurance and Rahul Bajpai, Regional Head, HCG — Oncology, Mumbai. The session started with an inaugural address by Dr Gopal who gave an idea about the courses being offered and the activities conducted by the university and how students would benefit from them. Dr Velumani's session was very interesting and interactive. He gave insights on how to plan for the future and why one should toil hard now to get the desired results in the future. Cuddapah spoke about the opportunities available in the insurance sector and on

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India's position in providing insurance to all. Dr Nitin Sippy, Associate Professor, Health and Hopsital Management, DY Patil University and national convener said, “Such conclaves brings the aspirant students and the industry personnel together on one common platform. The high attendee list merely portrays the need and value of such conclaves. We are delighted to serve knowledge to the delegates by this platform.” Post lunch session witnessed two panel discussions. The session on 'Career Opportunities in Health & Hospital Management' was moderated by Dr Sippy. The session was attended by Rahul Bajpai, Shrabani Basu, VP – HR, Sir HN Reliance Foundation Hospital; Tasnim Fidvi, Sr Manager Administration, Saifee Hospital Trust and Neeraj Kumar, GM – Human Resources, Gleneagles Khubchandani. All the panel members spoke about the challenges they come across in the hospital management process, attrition rates and selecting the right candidates for the right job. The session also threw light on the growth and career opportunities in hospital management and public health administration at all levels. The second panel discussion stressed on 'Career Opportunities in Banking & Insurance'. The session saw participation from Sukesh Bhave, Assistant VP– Claims, SBI General Insurance, who was the panel moderator. The panel members were Richi

Panel discussion on ‘Career Opportunities in Health and Hospital Management’

Panel discussion on 'Career Opportunities in Banking & Insurance'

Healthcare industry experts shared their experiences on how to gradually climb the career ladder. More than 240 delegates took part in the conclave Sontakke, Assistant VP, Raksha TPA-Operations, Peeyush Agarwal, Head Operations, Tata AIG General Insurance,

Binu Krishna, VP, HDFC Standard Life Insurance and Padmanabhan Iyer, Manager, Kotak Life Insurance.

The panelists highlighted the various job opportunities provided by the insurance sector and the TPA market in India. The session ended with a vote of thanks by Mangesh Jadhav, Assistant Professor, Banking and Insurance. Jadhav said, “As the sun of this year's conference sets, we promise a new era of healthcare reforms and initiatives and a bigger, better and brighter conference in the coming years.” EH News Bureau

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Mumbai hosts ULTRAFEST 2015 The theme of this yearâ&#x20AC;&#x2122;s conference was 'Urogyanecology and Obstetrics' ULTRAFEST, one of the biggest conferences on sonography in India, was held in Mumbai recently. Organised by Maharashtra State Branch of Indian Radiological and Imaging Association (MSBIRIA), it was held at Renaissance Convention Centre, Powai, Mumbai. The organisers have informed that this year they had record breaking footfalls and the event was attended by more than 950 delegates from all over India. The conference also saw participation of young fellow teaching residents and more than 146 papers and posters with scientific and educational content were presented. The theme of this year conference was 'Urogyanecology and Obstetrics.' The conference had eminent international and national speakers of repute giving scientific lectures and imparting their experience and knowledge to fellow delegates through didactic lectures and workshops held on all three days of the event. The interna-

tional faculty was from US and had several renowned women professionals such as Dr Shweta Bhatt, Dr Sheila Sheth and Dr Paula Woodward. A giant 40-feet LED screen, put up for displaying lectures for delegates and for live direct relay of interventional procedures done at Seven Hills Hospitals into the conference

main hall, was a unique feature at the event. The conference also saw great trade participation with reportedly more than 18 trade companies showcasing their products and ultrasound machines over the three days at various stalls outside the conference venue. EH News Bureau

EXHIBITORS SPEAK U

ltrafest allows a huge interaction between companies and delegates where we have access to understand the requirements and offer the best suited critical power solutions. In Ultrafest, we participate through our partner Upasana Enterprises of Mumbai. This year we received quality audience from the healthcare segment.The participants displayed a lot of interest in our critical-power solutions.We will continue to be part of Ultrafest in future to extend the reach of our innovative solutions, specially in the healthcare segment.

Arunabh Ghosh National Head- Sales, Socomec Innovative Power Solutions

ltrafest offers a great platform for doctors to stay updated about the latest trends in ultrasound. BPL had a fantastic experience by showcasing our E-CUBE range of products. Ultrafest gave us an opportunity to showcase our products and technologies to a large audience from all over the country.We felt that BPL-Alpinion's Ultrasound systems have created a great impact which we were able to experience from the doctors who visited our booth at Ultrafest 2015.

Sajiv Subramanian Director of Ultrasound Business, BPL Medical Technologies

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May 2015

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Despite being riddled with several bottlenecks, nursing in India is growing, strength to strength. India is slowly waking up to the reality that the nurses are key to resolving several healthcare issues and are strong partners in any growth and development programmes of the healthcare industry. A positive change is bound to come BY M NEELAM KACHHAP

ebating on the importance of nursing to healthcare delivery is like asking who came first, the chicken or the egg? It is widely recognised that nursing is an integral part of healthcare delivery. It is also true that nurses and nursing have been marginalised within the health system in India. But a change

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in their status cannot be brought about without their participation. It is not the time to dwell on the notion of nurses as victims, but rather emphasise the possibilities for nurses to take their place and seize the new opportunities being presented to them. This acknowledgement provides a unique opportunity for nurs-

ing to demonstrate leadership by developing clinical nurse leaders to collaborate with the multidisciplinary care team in driving evidence-based, safe quality, cost-effective healthcare services. â&#x20AC;&#x153;The nursing role is rapidly evolving as nurses are tasked with an even wider range of healthcare responsibilities. Todayâ&#x20AC;&#x2122;s nurs-

es aren't just caring for the sick; they are being considered as equal partners in the continuum of patient care,â&#x20AC;? says Dr Harish Pillai, CEO Aster Medicity, Kochi. There is a significant growth in the number of nursing educational institutions and the number of nurses in India, yet the numbers are woefully inadequate.

Strength in numbers By no means is the number of nurses small in India. About 23 lakh nurses is a big number, however the availability of nurses is a big issue as we are nowhere close to a nursepatient ratio of 1:4. As per the report of the Steering Committee on Health for the 12th Five Year Plan of the Planning

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Today’s nurses aren't just caring for the sick; they are being considered as equal partners in the continuum of patient care Dr Harish Pillai Chief Executive Officer Aster Medicity, Kochi

Certified ACLS, BLS courses are conducted for skill enhancement of nurses and various educational programmes, workshops, etc are conducted on timely basis Dr Alok Roy Chairman, Medica Group of Hospitals, Kolkata

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Commission, India has 19 health workers (doctors-six, nurses and midwives – 13) per 10,000 people in India. WHO norms provide for 25 per 10,000 people. According to yet another estimate the strength of nurses in India is currently 0.8 nurses per 1000 citizens. This, compared to the world average of three nurses per 1000 is quite low. To come closer to the world average, our healthcare system would need to add about two million more nurses to its numbers. There are approximately 5000 nursing schools in India with varying intake capacity producing about 20,00025, 000 nurses annually. There are many unregistered schools that also function in India but the quality of training and the number of nurses produced by these institutes are not known for sure. Since nurses are the largest workforce in any healthcare organisation, their leadership and empowerment is the foundation on which the quality of care and safety of the patients rest.

Nursing leadership In the recent years, many nursing leaders have emerged in India. Every year the National Florence Nightingale Nurses Awards recognise the meritorious services rendered by the nurses and nursing professionals in the country. "Our nurses have received numerous awards and recognitions for their excellent performance in their respective fields, both internal and external," says Dr Alok Roy, Chairman, Medica Group of Hospitals, Kolkata. "Some of the noted recognitions are NABH Excellence Award for Nursing Services and Best Nurse Award of the state government," he informs. Speaking about outstanding nurses at the hospital, Valsa Thomas, Director Nursing, Dr LH Hiranandani Hospital, Mumbai says, "The Nursing Department at the Dr L H Hiranandani Hospital continues to be a strong team in this prestigious institute. They do not stop at being ordinary but try to excel at the task assigned to them, may it be at the

India has 19 health workers per 10,000 people in India. India has 0.8 nurses per 1000 citizens. The world average is three nurses per 1000. To come closer to the world average, our healthcare system would need to add about two million more nurses patient care end or in picking up the trophy for an extracurricular activity. "The nurses who show attributes of knowledge and skill with the right attitude are nominated for Best Employee Award on a monthly basis. There is an annual award function where nurses get nominated and awarded for the ‘Most Valued, Most Improved and the Care Award’. The nurses thus feel appreciated and motivated to become a source of inspiration for others," she adds. In addition, the state government also recognises meritorious nurses with state awards. Besides these, many nurses have proved their mettle in developing best practices at their hospitals, securing academic and travelling grants, partnering in research and publishing peerreviewed papers. "Jinumol M Varghese, being a staff nurse, got involved in the evolution of our EMR project and today she is an overall champion for the Nursing Informatics and EMR," informs Dr Pillai. In 2011, Shanti Teresa Lakra, an auxiliary nurse midwife working among the Ongees tribe in Andaman & Nicobar Islands, became the first nurse to receive Padma Shri, the fourth highest civilian award in India. She is recognised for her exceptional services to the tribes during the devastating tsunami of 2004. Lakra’s determination, dedication and courage to provide health and psychologi-

cal care to the primitive tribes in distress was recognised and appreciated, for which she was also conferred the prestigious National Florence Nightingale Award in the year 2010. She has also received the Catholic Health Association of Andaman & Nicobar Islands (CHAANI) – Best Nurse of the Year – 2010 Award. Dr Jothi Clara J Micheal, Group Nursing Director, Global Hospitals' Group is a well known academician. She was the recipient of the International Travel Award from Midwest Nursing Research Society 2008 (MNRS), US, and the Eta Pi Research Award for the Annual Eta Pi Chapter Research Day held in 2005 at the University of Wisconsin Oshkosh, Gruenhagan.

Emerging technology and nursing Technological advancements challenge the nurses to be at par with the current times and stay competent. “The nursing practice has to match the rapid pace of advancements in technology,” says Dr Pillai. Nurses today handle technology, starting from a basic cardinal sign assessment to higher level of life-saving technological gadgets. “These type of gadgets have made the nursing professionals more predictive and proactive in detecting the life threatening complications to life taking issues,” informs Partha Das, Group Head, HR, Global Hospitals, Chennai. Large to small, portable, gadgets help nurses during long

stressful working hours. Several emerging and existing technologies help the specialised nurses in accurately detecting and diagnosing minor to major aliments in many primary care settings where the nurse forms the first point of contact to the patients. “It’s not just that nursing is becoming a broader field; it's becoming deeper, too. It's more than knowing how to perform tasks and procedures; it’s about being a more effective member of the healthcare team and navigating clinical systems. To become more effective, nurses need more time for direct patient care and this is possible with emerging technologies that will help to change the practice of nursing,” says Dr Pillai. In addition, there are technologies that support nurses with fingertip information and knowledge for appropriate decision making based on evidence. Robotics, genomics and digital technology are all knocking on the doors of nursing.

Electronic health records The concept of electronic health records (EHR) constitutes a wide range of information systems, from files compiled in single departments to longitudinal collections of patient data. "Electronic health records make the nurses aware of all the patients information at a glance. This timely and user-friendly technology has always been welcomed and cherished as a treasure of innovations," says Das. Although many nurses find dealing with EHR cumbersome and problematic they know and fully appreciate its values. "Its effective because its time saving and data can be fed and analysed easily," explains Neelam Dhawan, Nursing Superintendent, Bhatia Hospital, Mumbai. Today, EHRs are used in primary, secondary and tertiary care although its penetration in the Indian market has been slow. "As patient safety is of prime importance the hospital is in the process of incorporating EHR and the first phase has been incorporated in the OPDs for consultants,"

( informs Thomas. Several data components are documented in EHRs: daily charting, medication administration, physical assessment, admission nursing note, nursing care plan, referral, present complaint (symptoms), past medical history, lifestyle, physical examination, diagnoses, tests, procedures, treatment, medication, discharge, history, diaries, problems, findings and immunisation. In future it will be necessary to incorporate many types of standardised instruments, electronic interviews and nursing documentation systems in EHR systems. “Its advantages include a single consolidated record for each person; capacity for data interfaces and alerts; improved interdisciplinary communication; and evidence-based decision support. Well-designed and well-implemented computerised provider order entry (CPOE) systems can streamline nurses' work and will help to reduce medication errors and ensure patient safety,” says Dr Pillai. Critical care environment where nurses generate a massive amount of data and the total command of all available information is imperative, they often find it difficult to provide undivided attention to the patient. “Digital charting helps nurses to simplify nursing work flow by eliminating tedious and time consuming job of hourly monitoring of vital signs, infusions and ventilator settings etc. and enable them to focus on what matters most,” says Dr Pillai. The ability of nurses to use an EHR effectively is critical to patient safety, decreased facility expenditures for training, and reduced healthcare costs. To use EHRs effectively, nurses must have the required knowledge and skills.

Skill enhancement Learning is a continuous process for nurses. Both clinical skill and technological skill enhancement are part of their life. “Privileging nurses to handle technological challenges from simple to complex demands investment from HR and nursing service departments of the hospital. It is a

SEVEN STEPS FOR CONTINUOUS QUALITY IMPROVEMENT (CQI) ◗ Identify standards of nursing care excellence set by accreditation body. ◗ Explore gaps by matching existing practice with identified standards: ◗ Categorise gaps and identify relevant measures and metrics: ◗ Refine SOP’s/policies identifying strategies to fill gaps and prepare quality task force: ◗ Monitor quality indicators/conduct CQI, nursing care and multidisciplinary clinical audits ◗ Raise the bar of quality indicator to reach higher level of excellence ◗ Benchmark care excellence

continuous process as far as our learning and development activities are concerned. We ensure that all our nurses are imparted both functional and behavioural training. Each nurse undergoes the specified number of training man days (eight hours per month). The training policy for nurses is structured and objective specific,” says Das. Each hospital has its own collection of high-end technology which they like to talk about. “At Aster Medcity, we are giving due preference to technology familiarisation session conducted for the new nursing staffs as a part of their 14-days mandatory Nurses Induction Training Program,” says Dr Pillai. Knowledge of computers is widely recognised as a must have quality in nurses today. “Candidates with computer knowledge are preferred,” says Dr Roy. “The nurses are inducted to use the computer as all the process involved in patient care are online e.g. procurement of medicine, access to laboratory reports, radiological reports and hospital intranet,” informs Thomas. Nurses recognise the need for updating their knowledge and implementing evidencebased practice for improving the quality of the nursing care. Hence, due importance is given to continuing education programmes. “Continuing education programme is conducted by all the superiors in the nursing field from time to time and also by those nurses who are handling the updated

technology throughout their patient care,” says Dhawan. “Regular classes on advancement of patient care, new installation of electronic biomedical instruments and about inter-departmental communication through system is provided at our hospital. Certified ACLS, BLS courses are conducted for skill enhancement of nurses and various educational programmes, workshops, chart preparing, quizzes are conducted on timely basis,” informs Dr Roy.

Accreditation and certification Accreditation and certification programmes improve the process of care provided by healthcare services and are much sought after in India today. Nurses are key to the accreditation and certification programmes. "They play a very important role and help us in achieving optimum level of competency in the healthcare system," says Dhawan. "In the hospital, the nursing team is critical to a quality programme, due to the significant number of professionals and their direct and permanent practice with internal and external clients. The nurse interacts with all the areas of support, with autonomy and co-responsibility. Furthermore, since the academic formation the nurse is familiar with management issues, leadership, and the clinical audit, being an educator and a researcher they have the unique ability to assist the multidisciplinary team dur-

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ing the implementation and monitoring of a process of accreditation," says Pillai. There are various measures of nursing efficiency related to accreditation. "The role of nursing in accreditation is integral to ensure quality of care to the patient, which can be measured through the length of hospital stay of patients, hospital acquired infections, bedsores, bed fall and medication errors," says Thomas. However, nurses do not work in isolation and a broad array of departments need to work in tandem for the nurses to succeed. "Nursing care excellence in any healthcare setting is difficult to achieve without the support of the medical and operations team. Hence a Trio (Medical - OperationNursing) concept approach is introduced by the support of the management. Nursing leadership team along with the nursing initiative team is empowered to implement continuous quality improvement steps within through puts," says Das. "Excellence, in this framework is perceived as a dynamic concept involving, raising the bar, defining inputs, strategising processes, and benchmarking outcomes,” he adds.

On the success path The success and professional excellence of nurses can be achieved by developing a clear universal framework where all aspects of patient care are taken into account. Experts believe that one approach for nursing success is standardising the entry-level education for nurses and developing a uniform professional development and career advancement trajectory with appropriate incentives to encourage participation. Various organisations like the Nursing Council of India and the Trained Nurses Association of India is also lobbying for it. The thrust in enhancing the state of nurses in India should be centred around clinical excellence, continuous quality improvement, preventive and proactive approach, evidence-based practice and error prevention ethical culture. mneelam.kachhap@expressindia.co

We ensure that all our nurses are imparted both functional and behavioural training Partha Das Group Head, HR, Global Hospitals, Chennai

The role of nursing in accreditation is integral to ensure quality of care to the patient Valsa Thomas Director Nursing, Dr LH Hiranandani Hospital, Mumbai

Continuing education programme is conducted by all the superiors in the nursing field from time to time Neelam Dhawan Nursing Superintendent, Bhatia Hospital, Mumbai

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cover ) INSIGHT DR SANJU THOMAS ABRAHAM Director â&#x20AC;&#x201C; Indian Dental Nursing, Coimbatore

DENTALNURSING IN INDIA Dr Sanju Thomas Abraham, Director â&#x20AC;&#x201C; Indian Dental Nursing, Coimbatore, gives a rundown on the dental nursing sector in India

he demand for quality health care is driving the transformation of the healthcare sector in India. In India, oral health is not given its due diligence. According to a Frost and Sullivan report around 40-50 per cent of Indian population has never visited a dentist even though, nearly 70 per cent of population is suffering from dental diseases. Even then the scope for the Indian dental care services market is huge. It was estimated to be $739 million in 2010 and is expected to reach $1302.5 by 2015 at a CAGR of 12 per cent. Dental nurse is a common term used in dentistry but unfortunately India lacks a professional group of dental nurses. Dental nurse is an integral part of the dental team but unfortunately this segment is occupied by different sets of people from non qualified individuals to professionals like registered nurse. The reason behind this discrepancy is lack of standardis-

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ation and non-availability of proper training and certification of dental nurses. The healthcare sector in India has been growing rapidly in recent years and is estimated to reach a value of $280 billion by 2020. Consequently, the sector is also experiencing an incremental demand for human resources from doctors and nurses to allied health professionals and technicians. With reference to the recent Public Health Foundation of India (PHFI) report, India has a shortfall of six million allied health professionals. Within this context there is an increased need in the healthcare setting for qualified dental nurses with the highest standards of professionalism, skills and expertise to provide high quality patient care and support for the dental clinician. As the practice of dentistry changes, the need for qualified dental nurses increase. This need is also attributed to patientsâ&#x20AC;&#x2122; demand for skilled and qualified staff; dental

There is an increased need in the healthcare setting for qualified dental nurses with the highest standards of professionalism, skills and expertise to provide high quality patient care and support for the dental clinician nurses requiring to be familiar with a range of routine and non-routine dental procedures; the need for the highest

standards of quality assurance; and continual changes in health and safety guidance and legislation. Consequently,

demands and responsibilities have become greater for dental nurses working within a variety of dental

(

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environments. The professional group of dental nursing is in its infancy, however it is widely recognised that improving oral health will have a positive impact on the general health and wellbeing of any population. The development of this suite of qualifications has been triggered from the dentists themselves who are looking for professional and quality services to serve the best interests of their patients. The dental nurse is an essential member of the dental team. Dental nurses work within a variety of dental environments and provide support to dental clinicians, patients and the dental team. The range of duties performed by dental surgery nurses include; preparing and maintaining the dental clinic/surgery; prevention of infection and cross infection; recording information provided by a dental clinician relating to the patients dentition, periodontium and soft tissues; preparing mixing and handling a range of dental materials; providing chairside support to the clinician during a range of dental procedures; maintaining full contemporaneous dental records; preparation of equipment, materials and patients for dental radiogra-

phy; communicating, supporting, monitoring and reassuring patients; providing advice within their own capabilities; supporting patients and colleagues if there is a medical emergency and providing patients with oral health advice prescribed by the dentist. In a general dental practice environment the dental nurse may work in several areas of the surgery including: reception duties (making appointments), payments and banking, and getting involved in the administration of the practice. The varying roles that a dental nurse might undertake will depend upon the practices' particular requirements.

What qualities are essential for a dental nurse? A dental nurse is usually the patients' first contact on entering the dentist's surgery. People are often very nervous while visiting dentist and a dental nurse must be able to put the patient at ease - a dental nurse needs good people skills. In the surgery a dental nurse needs to be able to work quickly and keep calm. As some of the chair-side work can be very precise, a dental nurse is expected to have a high degree of manual dexterity.

Course pattern of dental nursing

1924 FIRST DENTAL COLLEGE OF INDIA WAS ESTABLISHED IN CALCUTTA BY DR R AHMED

1933 THE NAIR DENTAL COLLEGE & HOSPITAL, BOMBAY, CAME INTO EXISTENCE

1938

THE GOVT. DENTAL COLLEGE; BOMBAY, WAS STARTED AND THEREAFTER THERE WAS NO LOOKING BACK

Students undergo continuous assessment throughout the training programme, both at the training centre and at the dental practice. Regular meetings between the dentist and tutor is held to discuss students progress and commitment to the course. Homework, class work and work placement reports will be used at these meetings.

know-how of basic life support and the ability to support the dental team during a medical emergency. With increasing awareness more people would be willing to spend on dental health creating demand for more dental clinics. This demand cannot be fulfilled without the support of dental nurses Hence, in coming years, dental nursing will be a sought after profession.

Objective of dental nursing studies programme

Who should opt for a dental nursing career?

Any course or programme that aims to prepare students for the profession of dental nursing must demonstrate the role of a dental nurse within a variety of dental settings. It must teach how to prepare and maintain the clinical environment for a range of clinical procedures. Also demonstrate the recording of information presented to them by a dental clinician relating to the patients dental and oral tissues. In addition the course must discuss how to maintain patient confidentiality and patient data protection and show how to maintain health and safety for self, members of the dental team, patients and visitors. Professionalism and acting within own field of competence is required as well as

If oneâ&#x20AC;&#x2122;s calm, good with people, interested in dentistry and keen to train on the job, becoming a dental nurse could be a good option for them. Being a dental nurse will provide one with an opportunity to work in a dental setting and to be a part of dental team. The challenges for a dental nurse will be having to work with people who are scared of the dentist so one has to know how to put people at their ease. The ideal dentist : dental nurse ratio should be 1:1. With 25,000 graduate dentists passing out each year and a vast pool of registered dentists, there is huge scope for those who seek to make a career as a dental nurse.

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cover ) OPINION

NURSING IN INDIA: AWAITING A BRIGHTFUTURE Anita A Deodhar, President, TNAI, gives an overview on the future of nursing in India and recommends several measures to improve the current scenario in nursing

n ancient India, the medical care was provided only by doctors and physicians. Though Sushruta, the father of medicine had mentioned about nursing while describing few essential qualities of nurses, there has been no mention about female nurses in India till the Mughal period. Nursing in India started and developed only after invasion by the British. The first nursing training school was sanctioned by the British government during 1854 in Madras in the lying-in hospitals. Initially, a two-years' course for nurses training was started at St Maryâ&#x20AC;&#x2122;s hospital at Tantaran in Punjab. The recommendations of Bhor Committee (1943-46) acted as the foundation for development of nursing services in India. In postindependence period, various committees were formed to study the position/situation of nursing profession in the country. Various changes were brought from time to

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time in education and service system as well as in the rules and regulations. Trained Nurses of India (TNAI) was formed in the year 1908 and the Indian Nursing Council (INC) was established in the year 1947, which the reafter upgraded the basic educational qualification requirement for candidates desiring to undergo nursing education. In the past, nursing profession was considered to be an occupation for Hindu widows and/or deserted women as a self-supporting measure. Women from the Christian community undertaking the nursing profession were more in number than the women from other communities, since, as a profession,

nursing did not have a proper status in the eyes of society. After establishment of the INC, most of the states in India established their State Nursing Councils (SNC). The SNCs were responsible for maintaining the standard and uniformity in nursing education. Main function of SNCs was to conduct examinations and the registration of qualified nurses to permit them to practice. Those days courses in Auxiliary Nurse Midwife (ANM), (one year and six months) and General Nursing and Midwifery (GNM) (three years and six months) were mainly conducted. BSc and MSc Nursing courses were introduced subsequently and very few colleges were conducting

these programmes. Now many universities are even facilitating M Phil and Ph.D programmes successfully and the achievers of these qualifications are holding the highest positions in nursing all over India. Periodic revision of all these programmes is being done from time to time, to improve the educational standard. It was noticed that there is great disparity between the available and required number of nurses as per the population and the set INC norms in the nurse/patient ratio. Shortage of nursing personnel, between 1980-1990s, might have been due to migration of trained nurses to overseas countries, especially in the Gulf countries

TNAI, along with other associations in specialised nursing fields and unions, provide collective professional identity to contribute to development of the nursing profession

for higher salary and perks. Nursing profession, being entirely job-oriented, there is great demand for qualified nurses all over the India. Since many corporate hospitals are being established and any more avenues like medical tourism, home nursing, industrial nursing etc. are available to better qualified and efficient nursing personnel. Number of men entering this female dominated profession have been increasing in the last few years. It is a clear indication of increased demand for nurses. Standard of education and code of ethics is regulated by the INC and SNC. The colleges and universities do play an important role in maintaining quality and standard of education. TNAI, along with other associations in specialised nursing fields and unions, provide collective professional identity to contribute to development of nursing profession. They play a major role in collective advocacy and safeguard welfare of nurses. Legal

(

FOCUS:NURSING

1854

1943-46

The first nursing training school was sanctioned by the British government in Madras

The recommendation of Bhor Committee acted as foundation for development of nursing

1908

1947

Trained Nurses of India (TNAI) was formed

Indian Nursing Council (INC) was established

provisions and government control over the nursing practice ensures good and conducive working environment. All these combined efforts from different institutions would play an effective role in establishing professional status and autonomy in nursing. However, in reality, nursing and midwifery profession is not honoured as an autonomous body in spite of the fact that they are fully developed, qualitatively and quantitatively. The services rendered by them to ailing patients do not receive proper recognition from other health professionals in the medical field and even by the society at

large. They are not accepted as leaders or administrators in their own fields without assigning any justifiable reason for such lack of recognition for the nursing profession. In the years to come, many changes are expected even in the National Health Policy regarding funding, education, specialisation, creation of a permanent nursing cadre, better salary structure etc. With respect to womenâ&#x20AC;&#x2122;s empowerment the nurses are already empowered and they only need freedom to use their powers. There is a great need for the society to recognise the rights and responsibilities of nurses and midwives and

There is a great need for the society to recognise the rights and responsibilities of nurses and midwives therefore they should insist for having only qualified nurses whereever they get admitted for medical treatment. It is necessary that man-

agements of government and public sector hospitals should think on the lines of administrators of corporate hospitals and improve working and image of health services, including efficient patient care rendered in the public hospitals. One way of improving health services in the public sector is to maintain the INC prescribed nurse:patient ratio (1:3), at least to some extent in certain departments to give better service. If that is adopted by government hospitals, it would help the government-managed hospitals to gain public confidence. Adoption of NABH accreditation shall certainly improve

the quality of nursing care, which will be more patientoriented even in public sector and government hospitals. Proper and controlled use of information technology is playing wonderful role in raising their performance standard. In future, the concept of a 'nursing practitioner' and research in nursing, need to be encouraged more along with evidence-based nursing practice. All these changes shall definitely give appropriate respect and position to nurses in the society, but would also bring financial stability to this noble profession of nursing.

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‘Building green is an opportunity to use our resources efficiently’ Kohinoor Hospital, Mumbai has been one of Asia's first hospitals to receive the LEED Platinum Rating for its green hospital structure. Raelene Kambli interacts with Dr Rajeev Boudhankar, VP, Kohinoor Hospital to understand what is LEED certification and how Kohinoor Hospital has managed to stay green

How important is it, in your view, to 'build green'? ‘Green’ or ‘sustainable’ buildings use resources like energy, water, materials and land more efficiently than the regular standard buildings. With more natural light and better air quality, green buildings typically contribute to improved employee health, comfort, and productivity. Generally, buildings account for 1/6th of the world’s fresh water withdrawal, 1/4th of its wood harvest and 2/5th of its material and energy flows. Hence it would be justifiable to say ‘building green’ is an opportunity to use our resources efficiently while creating healthier buildings that improve human health, build a better environment and provide cost savings.” What is LEED certification and how does a hospital go about getting one? LEED stands for The Leadership in Energy and Environmental Design. The LEED Green Building Rating System developed by the US Green Building Council (USGBC), provides a suite of standards for environmentally

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sustainable construction. Since its inception in 1998, LEED has grown to encompass more than 14,000 projects in the US and 30 countries covering 1.062 billion sq ft (99 sq km) of development area. The hallmark of LEED is that it is an open and transparent process where the technical criteria proposed by the LEED committees are publicly reviewed for approval by more than 10,000 membership organisations that currently constitute the USGBC. The certifying authority for Kohinoor Hospital is the Indian Green Building Council (IGBC). The intent of LEED India – IGBC New Construction is to assist in the creation of high performance, healthful, durable, affordable and environmentally sound commercial and institutional buildings. Green building ratings are classified into four categories, namely, LEEDs-certified, Silver, Gold and Platinum. The project must satisfactorily document achievement of all of the pre-requisites and a minimum number of points to attain the LEED ratings as listed in the table.

We should know the importance of green buildings to have a healthier life tomorrow Is the LEED programme a valid way to encourage green design? The LEED India Green Building Rating System is a voluntary, consensus-based, market-driven building rating

system based on existing proven technology. It evaluates environmental performance from a whole building perspective over a building’s life cycle, providing a definitive standard for what constitutes a ‘green building’. The rating system is organised into five environmental categories: ◗ Sustainable Sites ◗ Water Efficiency ◗ Energy & Atmosphere ◗ Materials & Resources and Indoor Environmental Quality and an additional category ◗ Innovation & Design Process What are the benefits in building a green hospital? Green buildings provide financial benefits that conventional buildings do not. These benefits include energy and water savings, reduced waste, improved indoor environmental quality, greater employee comfort/productivity, reduced employee health costs and lower operations and maintenance costs. By going green, we can achieve energy savings up to 35 per cent over the ‘Ashrae standard’ which is the base of building design standard.

Studies of workers in green buildings has reported substantial productivity gains of up to 16 per cent including reduction in absenteeism and improved work quality based on ‘people friendly’ green design. In other words, green building design has environmental, economic and social elements that benefit all building stakeholders including owners, occupants and the general public. How did you manage to get a Platinum rating? The prime driving force was that we aspired to make Kohinoor Hospital the first hospital/healthcare institution in the world or at least in Asia to achieve Platinum Rating. The second reason was that Platinum is the highest rating in the green rating category and we wanted to go for the best! I would specifically wish to add, that it was not only the ratings, the name and fame that prompted us to go for Green – Platinum. It is our CMD Unmesh Joshi’s dream that all Kohinoor projects will be green. It is also his foresight that green is the future of all the

LEED – INDIA CERTIFICATION LEVELS commercial projects to come, in a sense that it helps in the industry to save on the resources of the world which are slowly getting depleted. If we can be make a difference even by a small percentage of the benefits to the world, Kohinoor benefits so to say. Also, it takes only a small increase in the initial cost over their conventional counterparts, but the benefits are multi-fold as compared to the original investment in green features. Productivity, health benefits, reduced operation costs, energy, emission, water and waste benefits are just a few of the added benefits that Kohinoor has got by going green. What are the challenges you face? There is no challenge in

Certification

New Construction

Core & Shell

LEED Certified

26 - 32

23 - 27

LEED Certified Silver level

33 – 38

28 - 33

LEED Certified Gold Level

39 - 51

34 - 44

LEED Certified Platinum Level

52 - 69

45 - 61

CREDIT POINTS ARE DISTRIBUTED AS PER THE ENVIRONMENTAL BENEFITS UNDER THE BELOW MENTIONED AREAS OF ACTIVITIES S No Credits

New Building

Core & Shell

Prerequisites

Sustainable Sites

Water efficiency

Energy and Atmosphere

Materials and Resources

Indoor Environmental quality

Innovation and Accredited Professional points

Total

maintaining a green hospital/green building but the challenge is in making one. Green building projects cost more than regular projects. However, in terms of patient welfare providing better medical services it helps in the long run and proves more beneficial to society. There's a belief that one has to choose between building green and building beautiful. Can you combine aesthetics and sustainability? Yes! One can certainly combine aesthetics and sustainability while running a green hospital. We have done it. Which are the other hospitals that have received LEED certification? Dell Children’s Medical

Center of Central Texas in Austin has been honoured as the first hospital to be awarded Platinum Leadership in Energy and Environmental Design (LEED) status by the US Green Building Council. The 169-bed facility, which encompasses nearly 500,000 sq ft received a score of 54 out of a possible 69 total points, putting it two points over the threshold for platinum status. The facility which had a construction cost of $130 million opened in June 2007. We are the first in Asia. What will take to make a real, substantive change? Society plays an important role in this. As responsible citizens, we should know the importance of green buildings to have a healthier life tomorrow. raelene.kambli@expressindia.com

KAVISH eneRGY

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‘There are basically no challenges in maintaining a green hospital’ Ruby Hall Clinic, Wanowrie, Pune received a LEED cerification with a gold rating last year. Bomi Bhote, its CEO, talks about the measures undertaken to create and maintain a green hospital, in an interaction with Lakshmipriya Nair

Ruby Hall Clinic, Wanowrie has received IGBC's LEED certification with a gold rating. What were the parameters under consideration? The following parameters were considered: ◗ Sustainable Site ◗ Water Efficiency ◗ Energy & Atmosphere ◗ Indoor Environmental Quality ◗ Innovation in design ◗ Material & Resources What are the measures/steps implemented at the hospital which serve to make it a green hospital? We undertook the following measures under each parameter to make Ruby Hall, Wanowrie a green hospital. Sustainable Sites ◗ Appropriate site selection with all basic amenities and services within the range of half mile from the site ◗ Reduced pollution and land development impact from automobile use ◗ Three per cent of parking place with electric charging facility ◗ Total suspended solids (TSS) removal strategies implemented at site ◗ Helped reduce TSS in roof and surface runoff water ◗ Erosion and sedimentation traps were laid at site during construction ◗ Directed the water into the pond and reduced erosion Water Efficiency ◗ Reduced potable water

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consumption for landscaping through using native and drought tolerant plants, drip irrigation system ◗ Recycled (STP) water is used for more than 50 per cent of cooling tower water requirement to limit the use of potable water for AC make-up ◗ 100 per cent of waste water are treated on site with tertiary standards by using sewage treatment plant ◗ Use of high efficiency fixtures such as ultra flow water closet, sensor based urinals and tap to reduce fresh water demand Energy & Atmosphere ◗ HFC 134a is used in water cooled chiller which is CFC and HCFC free and hence it helps reduce ozone depletion ◗ Highly efficient HVAC systems with continuous monitoring of the performance by temperature and RH sensor connected to BMS system ◗ Energy efficient lighting fixtures and occupancy sensors are used which reduces electricity consumption ◗ Use of energy and water meters to verify energy and water consumption for proper measurement and verification Material & Resources ◗ More than 75 per cent waste reused or recycled ◗ Construction debris reused in other project sites ◗ Building materials and products used have been extracted and manufactured within 400 km from Pune

Ruby Hall Clinic is designed for a comfortable thermal environment by maintaining temperature and relative humidity that promotes productivity and well being

◗ Waste segregation at source was adopted at the time of construction and separate bins were provided to collect the same ◗ Unused waste was segregated separately and sold to waste recycler for reuse Indoor Environment Quality ◗ Campus declared as ‘Smoking Free Zone’ and is being followed religiously ◗ Fresh air designed as per ASHRAE standards have been adopted. CO2 sensors placed at appropriate locations to monitor indoor air quality ◗ Green products used such as low VOC content paints for interior work and low VOC content sealant, adhesive for flooring, glazing, HVAC duct etc. ◗ Designed for a comfortable thermal environment by maintaining temperature and relative humidity that promotes productivity and well being Ruby Hall Clinic has been able to optimise its life cycle cost by 20 per cent YOY with a slight increase in capital expenditure. What are the challenges involved in creating and maintaining a green hospital on a day-to-day basis? There are basically no challenges in maintaining a green hospital. It is similar to running a regular hospital. It is just necessary that you engage with a qualified

operations and maintenance partner. What are the major benefits accrued out of being a green hospital? Being a green hospital has several benefits such as: Economic ◗ Lower operating costs through Energy and water savings ◗ Increased property value ◗ Decreased infrastructure strain ◗ Improve competitive position ◗ Secure its own funds Environment ◗ Reduced emission levels and reduced risks to human health ◗ Water conservation ◗ Storm water management ◗ Temperature moderation ◗ Waste reduction ◗ Open, clean and green spaces Social ◗ Quicker patient recovery ◗ Increased access to quality healthcare for society ◗ Increase volunteers or donations ◗ Increased brand identity People ◗ Increased employee attendance ◗ Increased employee productivity ◗ Improved safety and security ◗ Reduction in attrition rates ◗ Very good recognition in society lakshmipriya.nair@expressindia.com

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Need of the hour: Energy efficient hospitals Dhawal Patel, Founder and Promoter of Kavish Energy, speaks about the amount of energy and cost that can be saved in healthcare industry infrastructure, by making them energy efficient facilities

HEALTHCARE INDUSTRY today faces high energy cost challanges that continue to rise, creating many difficulties to manage the facility's operating budget. Hospitals and clinics have high energy demands due to 24x7 operations, HVAC, lighting, medical imaging equipment, and special requirements for clean air and disease control. Acute and extended care facilities must manage energy consumption to achieve optimal patient care, comfort and safety as efficiently as possible. Hence, there is a serious need for taking new and creative steps that put these rising energy costs in check, both for regulatory compliance and sustainable business goals. Kavish Eco Energy Solutions, an emerging firm in the field of energy management, provides total cost effective solutions for all energy-related services to consumers through adoption of:â&#x2014;&#x2014; Energy conservation techniques â&#x2014;&#x2014; Efficient technologies â&#x2014;&#x2014; Renewable energy sources With a team comprising a mechanical engineer, IGBC AP architect and building industry professionals, Kavish Energy helps one access their building project's greatest potential. The firm identifies opportunities to improve the built environment, operations and occupant behaviour. By executing each project with thorough energy analysis and assessment, Kavish Energy helps consumers to optimise their consumption and reduce the excess energy usage.

Kavish Eco Energy Solutions, an emerging firm in the field of energy management, provides total cost effective solutions for all energy related services to consumers As per a study, lighting contributes 18-25 per cent of total electrical consumption in hospitals. The flagship service of Kavish Energy - Illumination Analysis and design helps healthcare industry to choose the appropriate lighting for

given location as per standards thereby saving cost on lighting bills and also reducing labour, re-purchase charges and charges on installation of lights. Not only old buildings which can be audited and assessed, even new hospitals can be

designed and built as a green building infrastructure. Kavish Energy is one of the leading consultants in green building architecture, planning and designing. Their sustainable building solutions, which incorporate usage of renewable

energy (wind and solar) equipment, water re-cycling; rain water harvesting and filtration combined with advanced control techniques increases the level of energy saving automation. The concept of green building encompasses ways of designing, constructing and maintaining buildings to decrease energy, water usage and operating costs, improve the efficiency and longevity of building systems, and decrease the burden that buildings impose on the environment and public health. With the use of sustainable energy equipments like Solar water heaters for hot water requirements, LED Lights for lighting needs, Solar power plants for in-house power generation, Motion Sensors for Automation etc , can change the energy consumption pattern of many high rise multifunctional hospitals, clinics and other healthcare institutions. Contact dhawalp@kavishenergy.com for any further assistance

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‘Social innovation technology to hospitals like AIIMS would lead to a better health condition’ Hitachi India has been recently selected by the New Energy and Industrial Technology Development Organization (NEDO) to undertake a feasibility study in India for an ICT-based green hospital demonstration project which facilitates hospital’s energy saving. Naotoshi Nishida, VP, Infrastructure Systems Company, Hitachi India speaks about the concept of ICT green building and their demonstration project in India, to Raelene Kambli. Excerpts

How does ICT green concept contribute to the public sector, such as healthcare? The rapid growth of the healthcare services demand does not complement the supply even with so many efforts made by the public sector hospitals like AIIMS within the metropolitan cities like Delhi. Hitachi conducted its initial site survey prior to the proposal and found that ICT green concept would benefit and contribute to this demand gap situation with the overall energy/utility management. The effort made so far in this area lacks vision and intention to improve the energy management and data maintenance including its storage. Hitachi’s objective is aimed at contributing to the welfare of the patients by enhancing the overall efficiency in such hospitals leading to the healthcare services being provided to more number of patients compared to the present scenario. This would also lead to a single doctor attending to more number of patients thereby reducing the energy cost and providing quality health services by analysing the stored data effectively. Our aim would be to

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achieve a quality aspect at AIIMS. What does it mean to be a ICT-based green hospital in the Indian context? With regards to the Indian context, most of patients who line up at the out-patient department (OPD) of a public hospital like AIIMS are exempted from making the actual payment which is contrary to the fact that social expenses for such services are increasing dramatically. If the government extends its support and pledges to provide quality healthcare services to everybody in India, it would cater to the current patient demand and projects for large hospitals can be taken up incepting such green hospital concept everywhere. It would also be wise to have more efficient operation within the existing facilities in order to increase the number of patients being treated everyday. Tell us about your ICT-based green hospital project in India? In order to make the ICT-based green hospital project a reality especially at AIIMS in Delhi, Hitachi will be

ICT green concept would benefit the demand gap situation with the overall energy/utility management

conducting an energy conservation management system demonstration which would include renewable energy, high efficiency utility equipment, hospital ICT system integration/ consolidation and data centre facility with energy saving technology. The energy management system that would be installed will have the capacity to visualise energy thereby optimising its management at AIIMS, Delhi. What are the benefits associated with it? As a prelude to this project, Hitachi would be considering replacing the current energy management equipment like chillers and replacing them with high energy efficient chillers for better energy consumption in the area of air conditioning. Hitachi would also consider setting up solar generation system at the roof top of the hospital with a more efficient back up system (DG and battery) in order to reduce energy consumption per patient. This would hugely lead to a reduction in the social expenditure for the government.

What are the challenges in creating a ICT-based green hospital? We believe it is the first-ofits-kind project where energy management and IT Systems will be integrated at the same time. It is a challenge in itself to initiate this project. AIIMS on a daily basis gets unlimited number of patients, with the hospital running beyond its capacity, therefore replacing the current energy management and IT system with the more efficient one would be a challenge in itself. What should be the way forward? After successful implementation of this project at AIIMS Delhi, Hitachi would like to explore and extend this project to other such large hospitals in India. Our thought is to integrate all AIIMS within the country with this concept so that facilities can be utilised commonly and more efficiently. Hitachi firmly believes that providing this social innovation technology to hospitals like AIIMS would lead to a better health condition for the patients. raelene.kambli@expressindia.com

HOSPI INFRA I N T E R V I E W

‘We have ensured that our OT abides by the NABH standards’ Dr Anand Kumar, Owner, ARS Hospital and Bhavesh Bhatt, GM – MSW Business, Maquet talk about the need for a separate hospital for orthopaedics industrial injuries and trauma and the role of technology in aiding treatment at these set-ups

Tell us about your new hospital which got inaugurated on 22 April, 2015 Dr AK: We are a 50-bedded medium sized orthopaedic hospital located at the heart of the industrial hub in Tirupur that has many garment factories and workers. We felt the need for a specialised hospital to cater to the daily needs of industrial injuries and trauma cases. Thus we began this hospital as an advanced centre for joint replacement, orthopaedics and trauma care. Our success from our year of establishment in 2007 has been driven by our expertise in offering specialised care with state-of-the-art equipment and team of doctors to treat injury and trauma patients to help them get back to their normal lives. We have ensured that we have the best of technology and medical equipment in the hospital. This alone has helped us achieve 10,000 surgeries till today of which more than 500 were complex procedures involving knee and hip replacements. Our specialities include total knee replacement, total hip replacement, accident and trauma care, shoulder, foot and ankle surgery, spine surgery, arthroscopy and sports medicine. What kind of diagnostic and treatment facilities would be offered at your hospital? Dr AK: As our hospital caters to primarily the orthopaedic and trauma

procedures, we realised that to ensure high quality patient care, ease of surgery for our doctors and success rate of the procedures offered by the hospital required a state-ofthe-art operating room (OR) as a critical infrastructure. We have invested in VARIOP Most advanced Modular OR from MAQUET which offers exceptional functionality and flexibility for all our disciplines. This is the first installation in South India. Developed in-line with real world OR requirements, the modular table Alphastar PRO ensures optimum results for all orthopaedic and trauma interventions. Modular components allow for quick and easy configuration and adjustment, creating more efficient and cost-effective operating rooms. It also offers surgeons exceptional stability and ergonomic design for precise patient positioning and optimal access to the surgical

We began this hospital as an advanced centre for joint replacement, orthopaedics and trauma care

Maquet offers complete design concepts that take today’s needs and tomorrow’s growth into account

site along with VOLISTA lights and pendants. We are also the first hospital in Tamil Nadu to have Orbic 3D highend C-arm with 3D functionality that is best suited for intra-operative use in orthopaedic, trauma and spine surgery. It helps for precise imaging and perfect visualisation with integrated intraoperative 3D imaging. We have ensured that our OT abides by the National Accreditation Board for Hospitals & Healthcare (NABH) standards and for that we have ensured a bacteria free environment with seamless walls, laminar flow and air pressure standards maintained at all times. Tell us about the tie-up that you have with medical device manufacturers like Maquet for state-of-the-art technology? Dr AK: ARS Hospital has installed two VARIOP, modular OTs developed by MAQUET Germany. MAQUET India provided a complete solution in conceptualising and designing of our OT complex. These modular OTs follow guidelines provided by NABH for setting up any hospital. These modular OT provides a very modern looks with bacteria free environment that includes laminar flow, air extraction elements in maintaining clean air. We will be using the most advanced trimano, 3D support

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HOSPI INFRA arm which is the surgeon’s third hand for various surgical procedures mainly used for shoulder arthroscopy and can also be used for holding camera in laparoscopic procedures. We also intend installing their very advanced Digital Integration solution called TEGRIS in the near future. Could you tell us about the new intelligent room designs technology? BB: Maquet offers complete design concepts that take today’s needs and tomorrow’s growth into account. Intensive discussions with clients, medical technicians and architects help Maquet to develop intelligent room designs. The long-sighted planning efficiently makes use of all

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Whether investing in a new building, a modernisation or expansion, individual solutions are always necessary in order to take precise account of all aspects of complex planning and medical technologies. Selecting the right partner is critical when it comes to the smooth implementation of sensitive areas of a building

resources while leaving plenty of space for future changes. Whether investing in a new building, a modernisation or expansion, individual solutions are always necessary in order to take precise account of all aspects of complex planning and medical technologies. Selecting the right partner is

critical when it comes to the smooth implementation of sensitive areas of a building, such as operating rooms, intensive care units or central sterilisation departments. We understand these needs, and meet the technical and economic requirements and expectations of the hospital.

The patient, personnel and instrument flow in OR departments are subject to intensive analysis. In this way, resources can be employed more efficiently and cost-effectively. What begins with intelligent and forwardthinking planning results in comprehensive solutions that

optimise the long-term workflow. MAQUET is thus able to offer its clients workflow designs that not only keep up, but stay ahead instead. Daily workflow should be well-organised, both in terms of structure and throughput. While VARIOP structures the OR workspace for optimum ergonomics and workflow, INSIGHT Clinical Logistics software provides relevant real-time information to increase patient throughput and cross-departmental collaboration. Together, VARIOP and INSIGHT effectively streamline clinical workflows to help hospitals improve clinician and patient satisfaction throughout the lifetime of the OR. mneelam.kachhap@expressindia.com

ASK A QUESTION Brief us on some of the functions of the healthcare technology management professionals. NITISH Baroda

Equipment control and Asset management, equipment inventories, work order management, data quality management, equipment maintenance management, personnel management, quality assurance, patient safety, risk management, hospital safety programmes, radiation safety, medical gas systems, in-service education and training, accident investigation, analysis of failures, root-causes and human factors are some of the basic functions of technology management professionals. What is green building concept? LEELA Pune

Green building refers to a structure and processes that is environmentally responsible and resource-efficient throughout a building’s lifecycle from sitting to design, construction, operation, maintenance, renovation, and demolition. In other words, green building design involves finding the balance between home building and the sustainable environment. This requires close co-operation of the design team, architects, engineers and the client at all project stages. What is the importance of

rural market penetration through telemedicine? DR AJAY LULLA Udaipur

The advances in medical science and bio-medical engineering on one hand and telecommunication and information technology on the other are offering wide opportunities for improved healthcare in India. The factors that are likely to drive the growth of telemedicine in India are the following: ◗ Inaccessibility of care for majority of the population ◗ A severe shortage of skilled and qualified doctors in the rural areas ◗ High cost of healthcare, particularly for secondary and tertiary care ◗ Very high patient volume in the rural areas compared to the number of doctors, hospital beds and trained medical staff ◗ Problem of retaining doctors in rural areas ◗ Specialist doctors cannot be retained at rural areas as they will be professionally isolated and become obsolete ◗ Widespread availability of mobile network What are the main challenges to set up a healthcare facility in rural areas? MANISH JHA Ranchi

Main challenges that we face while setting up in rural areas are: ◗ Funding of healthcare projects ◗ Day-to-day operation facilities ◗ Affordability of care

◗ Availability of healthcare staff ◗ Access to essential drugs and medicine In which places do we require toilets for the handicapped in a hospital? NILESH SHAH Surat

As per NABH norms, toilets for the disabled is compulsory in the OPD area. IPD doesn’t require handicapped toilets as such because wards have separate toilets for patients. Still if you want to place it in IPD and in other sections you can do so but it is not mandatory. What will be the benefits of Electronic Medical Record system in India? LEENA BAHAL Mohali

The benefits that an EMR is expected to bring in are: ◗ Paperless medical history ◗ Reduced healthcare costs ◗ Empowering the stakeholders to be able to deliver right treatment at the right time ◗ Promote the practice of evidence-based medicine ◗ Accelerate research and building effective medical practices ◗ Usher in ease in maintaining health information of patients ◗ With proper backup policies increase life-span of health records of individuals that is from conception to cremation ◗ Safety with access, audit and authorisation control mechanisms ◗ Faster search and update

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

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Gourangaa Consulting: Enhancing healthcare efficiency Gourangaa is able to partner with clients to reduce long-term operating costs, while maximising revenue and client satisfaction

Al Kafeel Hospital Karbala. Driven by its experience of providing practical solutions to diverse clients, Gourangaa Consulting looks forward to forming beneficial partnerships with leading hospitals from across the world.

What we do? ◗ Kitchen design and planning ◗ Laundry design and planning ◗ CSSD design and planning

Kitchen design and planning GOURANGAA CONSULTING is one of the leading Indian consultancies with a proven track record of implementing and executing innovative projects across India and the globe. With proven expertise spanning a wide range of offerings to help leading and upcoming healthcare facilities increase efficiency, Gourangaa’s major focus areas involve the design and planning of CSSD, kitchens and laundries. By utilising state-of-the-art technology to design and implement products that perfectly balance cutting-edge sensibilities with practical efficiency, Gourangaa is able to partner with clients to reduce long-term operating costs, while maximising revenue and client satisfaction. Since its incorporation in 2007, the healthcare division has spearheaded projects of leading hospitals — including India's largest hospital, Vadilal Hospital in Gujarat, which houses over 3000 beds. Other healthcare projects include Asian Bariatric’s, MAS Hospital Udaipur, Rukmani Birla Hospital Jaipur, Adani Medicity, Ahmedabad as well international projects in Iraq – Al Kafeel Hospital, Babylon and

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The reason why kitchen consultants are required is because they can predict the number of staff, bring equipment cost down and most importantly design around the ability of a kitchen to last a lifetime. Gourangaa uses the most efficient combination of equipment from around the globe to reduce operational and manpower costs. They design as per the region and the clientele, who will be consuming the food. The first step is getting a questionnaire duly filled by the client which gives information on the type of cuisine, number of courses, dietary requirements etc. Then, the company calculates the area allocation and workflow analyses, which helps design the facility in an ergonomically efficient manner. All their designs are based on Hazard Analyses Critical Control Point (HACCP); they

ensure that there is adequate separation between different cooking areas. Each kitchen designed by them has the following designated areas: meal preparation, meal service, dish and pot wash, cleanup and storage. The design aspect needs to start during the schematic design phase of the project because aspects of a building like sunken floor, ceiling height, placement of grease trap etc. need to be taken under consideration so that the final product is operational at its best.

Laundry design and planning Medical laundry is one of the most integral parts of a healthcare facility. Its smooth and hygienic function guarantees the well-being of the healthcare facility’s staff and patients. A well designed laundry that would include proper pre-wash area, barrier washers and well placed dryers and ironing can reduce manpower and operational costs with a huge margin at the same time ensuring the best deliverability. Also, a lot of facilities depend on outsourcing the laundry, which increases operational costs and at the same time increases the risk of contamination. This happens because the chemicals/wash cycle used does not adhere to clinically specified standards, therefore having an in-house laundry is advantageous.

A very crucial part of a healthcare laundry is the placement of the machinery that affects the directional flow of work, which separates the soiled linen and clean linen. Before Gourangaa Consulting undertakes any design built project, they perform a load calculation sheet, which provides us the exact laundry generated by all departments in the facility. Based on the specific calculation, they are able to recognise the exact combination and size of the machines required. The company strongly propagates the use of barrier washers which allow the laundry to be designed in such a manner that there is an input and an output through a barrier meaning that dirty and contaminated linen is put in from one side, which is then processed and the clean linen is extracted from another side. Their designs incorporate every individual aspect of a healthcare facility laundry i.e. pre-wash, sorting tables, soiled linen input, clean linen extraction, drying, ironing, storage and dispatch. The designing of a laundry needs to be incorporated in the early stages of schematic design phase after understanding the load of linen that will be passed through it on a daily basis, as it requires adequate space and equipment placement for it to be functional at its highest capacity.

Gourangaa Consulting looks forward to forming beneficial partnerships with leading hospitals from across the world

CSSD planning and design The responsibility of the Central Sterilisation Supply Departmen (CSSD) in a healthcare facility is to receive, process, sterilise, store and then issue equipment that is used during operations in an operation theatre. It is responsible for the entire cycle of the equipment starting from the dispatch from the storage unit, its return in its soiled condition and its sterilisation. The department is required to have sterile equipment ready to dispatch at all times. To achieve the level of accuracy required for this department to run it is essential to incorporate the correct design, correct equipment, well-trained operators and most importantly a good flow of work separating soiled area from the sterile and rest of the areas. Many hospitals outsource the sterilisation process of their equipment, which increases cost in the longer run of business. Gourangaa provides design solutions that are unique for each facility wherein it calculates the load that will be put through the department and at the same time considering the expansion plans of the facility for the future. The company’s designs are based upon a varied number of factors including area required per bed, the distance from the location where the equipment will be transported for usage, work flow direction in the department etc. While designing they also take into consideration dirty corridors, clean corridors and also ensure that there is no cross contamination while processing. The planning of the CSSD needs to begin with the schematic designing stages after understanding the load that will be taken by the department on a daily basis.

HOSPI INFRA

Automated patient transfer lift: Comfortable patient lifting devices West Coast Corporation appointed exclusive distributor for India, Bangladesh, Sri Lanka and Nepal

THE AUTOMATED Patient Transfer Lift is a revolutionary new product in the patient lift, transfer and accessibility fields. By incorporating patient lift along with transportablity the lift is truly an all-in-one tool in patient and mobility healthcare. Originally designed and manufactured in Korea, it has swept across the US, Australia and finally made it here to India, Nepal, Sri Lanka and Bangladesh by Westcoast

Corporation, Mumbai. Now, Indians too can share this innovative concept for patient mobility and freedom by making patient care as convenient and simple as possible. Working as a patient lift, the seat slides easily underneath the patient and attaches simply to remote control, the person is quickly and comfortably lifted out of their bed and transported. From this point, the patient may be quickly and easily transported to another

nearby location, like a restroom, vehicle, wheelchair or other testing facility. Speaking on the occasion, said Vijhay J Shetty, MD & CEO – West Coast Corporation, “Suffering patients who need dedicated assistance 24x7, find great relief when they are offered ‘transfer lift’ device, thus reducing their dependency on others. With battery operated, easy manoeuvring, transfer lift automated chairs are available in various

models offering chest rest, torso support, knee rest, IV drip stand, brake pedal, safety belts, with remote control to modulate height, weight, inclination, position etc. suiting the patient’s need. We feel delighted to meet with those patients who subscribe to transfer lifts devices and feel encouraged.” Patient transfer lifts provide complete safety while transferring patients and hence avoid any untoward accidents that

take place while using conventional manual methods to transfer patients. The conventional manual methods not only cause patient discomfort but are also risky and can cause injury to patients during the process of transfer. For further details contact: Vijhay Shetty Mob: +91-9322676992 / 8097091722 Website: www.westcoastcorpn.co.in

EXPRESS HEALTHCARE

May 2015

STRATEGY

WAGING A WAR AGAINST

TOBACC Slamming the Central Government's decision to delay the deadline of increasing the size of pictorial warnings on tobacco products, healthcare providers, health activists and public health groups put forth arguments and facts to link tobacco consumption with cancer. They also question the government's commitment to ensure good health for its citizens and recommend the way forward BY RAELENE KAMBLI

EXPRESS HEALTHCARE

May 2015

M I L L I O N D E AT H S due to tobacco consumption by 2030 in India

ast October, the health ministry under the leadership of the then Union Health Minister, Dr Harsh Vardhan issued a notification requiring cigarette manufacturing companies to devote at least 85 per cent of the surface areas of cigarette packets on both sides to graphically and literally represent the statutory warning. According to the notification, every cigarette packet would carry pictorial depiction of throat cancer and a message in English, Hindi or

any Indian language on both sides. Originally, the notification was scheduled to kick off on April 1, 2015. However, just few days before the mandate would be effected, the Centre revoked its decision after a parliamentary panel looking into the guidelines for sale of tobacco recommended that the proposal be kept in abeyance until its socio-economic ramifications were evaluated. Some of the members of the panel including BJP MPs, Shyam Charan Gupta, a

5500 YO U T H

initiate tobacco use in India each day

beedi baron and Dilip Gandhi claimed that there was no Indian scientific evidence that links smoking with cancer and that this move would affect employment prospects of beedi and tobacco industry which employs 1.3 crore people in the country. The health ministry's inappropriate decision to defer the implementation of a notification for increasing the size of pictorial health warning on cigarette packets and various other tobacco products has trig-

2500 INDIANS

consumimg tobacco die daily

gered an outrage among various healthcare stakeholders. In a letter to the Prime Minister, various tobacco control experts have urged for introduction of new warnings without any further delay.

Facts about tobacco and cancer in India Dissenting the claims made by the regulatory panel members, experts provide enough evidence that proves the link between tobacco consumption and cancer. Dr Monika Arora,

Director, Health promotion and Associate Professor, Public Health Foundation of India, informs that as per the publication 50 years of Cancer Control in India under the National Cancer Control Programme, available on the Ministry of Health and Family Welfare, Government of India website (last updated April 13, 2015) tobacco is the most important identified cause of cancer and is responsible for about 40 to 50 per cent of all cancers in men and about 20 per cent of

EXPRESS HEALTHCARE

May 2015

STRATEGY

all cancers in women. These figures have been estimated from the National Cancer Registry Programme of the Ministry of Health and Family Welfare, Government of India”. “Tobacco is the only legal product that kills more than 50 per cent of consumers who use it the way it is intended. The best public health evidence that has accumulated in the last 50-75 years is with regard to the dangers of tobacco. Tobacco causes not just cancer, but a whole host of cardiac, respiratory and other problems,” reveals Dr Pratima Murthy, Professor of Psychiatry, Centre for Addiction Medicine, NIMHANS, Bangalore. Giving more statisics from the government's official reports, Bhavna B Mukhopadhyay, Executive Director, Voluntary Health Association of India says,“The Government of India has published several evidence-based reports which include Report of Tobacco Control in India 2004, Bidi Smoking and Public Health, 2008 and Global Adult Tobacco Survey, India 2010. All these establish the close link between tobacco and cancer as well as other tobacco-related diseases. There are several other studies available in the public domain. Each day 5500 youth initiate tobacco use, 2500 Indians die daily due to tobacco-related diseases and 10 lakh Indians die annually due to diseases caused by tobacco. Economic Burden of Tobacco Related Diseases in India (2014) commissioned by Ministry of Health & Family Welfare states that the total economic costs attributable to tobacco use from all diseases in India in the year 2011 for people aged between 35-69 years amounted to Rs 1, 04,500 crores. The total revenue from all tobacco products in the same year constituted only 17 per cent of the estimated costs of tobacco.” Experts also point out that not only smoking tobacco causes cancer but also smokeless tobacco has the equivalent risk. Says Dr Sapna Nangia, MD, Radiotherapy, Sr Consultant & Clinical Coordinator, Ra-

EXPRESS HEALTHCARE

May 2015

Photo Courtesy: Voluntary Health Association of India

diation Oncology, Apollo Cancer Institute, Indraprastha Apollo Hospital, New Delhi, “There are many studies that confirm the strong association between cancer and tobacco. Gajalakshmi et al I ( Asian Pac J Cancer Prev. 2015;16(3):1201-6.) interviewed 80,000 families in Tamil Nadu and found that ever having chewed tobacco increased a person’s risk of dying due to cancer by 50 per cent and of dying early by 30 per cent.” Binoy Mathew, Media Officer, Voluntary Health Association of India, reveals, “At least 28 chemicals in smokeless tobacco have been found to cause cancer. According to a health report by the Ministry of Health and Family Welfare in consultation with National Institute of Health and Family Welfare on the ill-effects of chewing tobacco, there are over 3095 chemical components in chewing tobacco products (including gutkha), among them 28 are proven carcinogen. The major and most abundant group of carcinogens is the tobacco-specific N-nitrosamines (TSNA). The report reveals that rampant use of chewing tobacco is associated with high prevalence of oral cancer in India, and almost 90 per cent cases are linked to tobacco. India has the highest prevalence of oral cancer globally, with 75,000 to 80, 000 new cases of

oral cancers being reported every year.” The menace of tobacco smoking just doesn't stop there, it harms even people around. “Passive smoking or environmental tobacco smoke (ETS), is an important risk factor for occurrence of lung cancer among never smokers. A strong association was observed between ETS exposure during childhood and lung cancer. In relation to adult life, the increased risk due to ETS exposure from a smoking spouse was observed only in case of cigarette smoke. Exposure to ETS inside vehicles was also detected to be a risk factor,” points out Dr Pradyut Waghray, Sr Consultant Pulmonologist, MD, Kunal Institute of Medical Specialities. Hyderabad and HOD and Prof of Pulmonary Medicine, SVS Medical College, Mahbubnagar, Telangana. With several evidences to back our claim that tobacco does cause cancer, what should be the way forward to curb this menace? Do we have proper regulations in place? The Government of India enacted ‘Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA) to prohibit the consumption of cigarettes and other tobacco

products, which are injurious to health. To strengthen the implementation of the tobacco control provisions under COTPA and policies of tobacco control mandated under the WHO Framework Convention on Tobacco Control (FCTC), the Government of the India piloted National Tobacco Control Programme (NTCP) in 2007–2008. In spite of these regulations the number of tobacco users and producers are constantly on the rise. Then, can smoking bans be an option?

To ban or not to ban? Several countries worldwide have introduced smoking bans public policies that include criminal laws and occupational safety and health regulations, which prohibit tobacco smoking in workplaces and/or other public spaces. In India, a nationwide smoke-free law pertaining to public places came into effect from October 2008. Moreover, as per the rule anybody violating this law will be charged with a fine of Rs 200. The sale of tobacco products within 100 yards of educational institutions is also prohibited. This has been a bit beneficial in some areas. Dr Kunal Saxena, MD, Rusan Pharma cites an example from a study done by the Ministry of Health and Family Welfare. “A recent study compared air nicotine levels in public

places in Ahmedabad, India, before (June 2008) and after (January, 2010) the implementation of a comprehensive smoking ban which was introduced in October 2008. Second-hand smoke, exposure was significantly reduced in public places after the smoke-free legislation came into force. Smokers need to be made aware that passive smoking in their official/personal spaces can cause health risks to their loved ones and should refrain from exposing them to the smoke. It is also a brilliant way to try curbing the urge to smoke which can help reduce ones intake,” he says. However, this particular rule is ineffective in many areas and just by having few smoke free zones we cannot help curb this ill- omen. So can a complete ban on sale and production of tobacco be a solution? Giving a perspective of the laws associated with tobacco production and use, Dr Arora, informs, “Banning tobacco is not mandated either in WHO FCTC or in COTPA. Both FCTC and COTPA aim to regulate tobacco products. In India ban has only been imposed on gutkha products under Food Safety and Standard Authority of India’s (FSSAI) Act, as one of its provisions prohibits addition of tobacco or nicotine to any food product. The Supreme Court of India had declared, gutkha to

be a food product in one of the earlier cases. Some states have expanded the net of this ban to include all smokeless tobacco products (chewable forms), as manufacturers of gutkha had started selling tobacco powder and other gutkha ingredients separately, to circumvent the FSSAI Act that bans use, sale, storage and manufacture of gutkha. It is justified to enforce such a ban, if the law cannot be enforced in its letter and spirit.” The Indian law may not permit a complete ban, yet there are some industry experts who strongly believe that banning tobacco in India is the solution. Dr Ranga Rao, DirectorDepartment of Oncology at Max Super Speciality Hospital, Shalimar Bagh, feels, “Very strict implementation would be a problem but possible with strong personal, national, social and political determination. That is undoubtedly the best that can happen to humanity in this world. It will do much good to the society. No single measure would have helped humanity so much. The benefit measured in terms of money is unimaginable and the present world can be "a step nearer to heaven.” Agreeing to the same, Dr Vedant Kabra, Director, Department of Surgical Oncology Fortis Memorial Research Institute expresses, “It will significantly curb the menace. Some of our politicians claim that a ban on tobacco will lead to loss of employment of a large number of people. I think they are more concerned about their own earnings and not that of these poor people because almost whole of the beedi industry of our country is controlled by politicians. These people can be put to much better use and can contribute in a much more positive way in nation building rather than promoting national destruction.” There are very few countries in the world that have completely banned the sale and production of tobacco. Bhutan is one of them. However, survey's show that a complete ban on tobacco sale and production in

these countries gave rise to smuggling and illicit production and sale of tobacco products. Moreover, some studies conducted by Cancer Epidemiology Biomakers & Prevention journal on examining the history of the cigarette controversies happening in different countries reveal that tobacco companies fund scientific research that was intended to obfuscate and prolong the debate about smoking and health These studies also point out that today, tobacco companies acknowledge that smoking is a cause of disease, but they have not materially altered the way they do business. Can such a plot be possible in India? In such circumstances will a complete ban lead to black marketing in India? Says, Dr Lancelot Pinto, Consultant Respirologist, P. D. Hinduja National Hospital and Medical Research Centre, “Prohibition has historically been proven time and again to be an ineffective means of curbing a social problem. It moves the market underground, thereby making it even more unregulated and dangerous, besides creating a whole new avenue for criminals to generate a tax-free revenue. I do not think a ban can solve the problem.” “No ban has worked 100 per cent in India or anywhere else. In fact, an outright ban may turn out to be counterproductive and result in illegitimate consumption of tobacco. So what is required is restricted access and educating the masses on the ill-effects of the tobacco consumption. People should be made aware of the ill-effects of tobacco at an early age so that they know the risks beforehand before getting themselves acquainted to the habit of smoking,” Dr Anil Heroor, Consultant Oncosurgeon, Fortis Hospitals, Mumbai. Speaking about a possibility of black marketing of tobacco and tobacco-products Dr Achal Bhagat – Senior Consultant, Psychiatrist and Psychotherapist, Indraprastha Apollo Hospitals, Delhi, states, “While a ban might be reassuring at one level, it only generates a secondary market. Access be-

Article 11 of FCTC on packaging and labelling prescribes that PHWs should be 50 per cent or more of the principal display areas but shall be no less than 30 per cent of the principal display areas comes slightly difficult but not impossible. It is important for government to inform people and decrease access to products that could be detrimental to their health. Tobacco dependence is a cluster of behavioural, cognitive and physiological phenomena. Very few tobacco users can successfully quit the habit in their first attempt. But the evidence is strong that it can be done. From quit smoking helplines, mobile applications to counselling to prescription medicines, there are numerous effective ways to make people quit. In my opinion, a scientific way of controlling any drug use is decreasing the source of supply and creating effective strategies to reduce the demand.” Dr Vikram Kekatpure, Senior Consultant and Head of the Department of Head and Neck Oncology and Reconstructive Surgery, Narayana Health City, Bangalore chips in saying, “It should be adequately taxed and access to tobacco products should be restricted.”

Role of social advertisements and pictorial warnings Well, if banning is not an option

and the current regulations are not enough, will there be another solution? Dr Arora has an answer. Citing examples from different countries, she urges India to take lessons from these solutions. “India needs to note that FCTC provides only the floor (bare minimum) that should be achieved by countries to protect their citizens from dangers of tobacco, and not the ceiling. Realising the public health benefits of larger warnings, countries like Australia, Thailand and many others, have gone beyond the minimum prescribed size of pictorial health warnings (PHW) in FCTC. Article 11 of FCTC on packaging and labelling prescribes that PHWs should be 50 per cent or more of the principal display areas but shall be no less than 30 per cent of the principal display areas. Indian Tobacco Control Law- COTPA 2003 is on the lines of FCTC for most of the articles, however, falls short in certain areas, such small size of PHW. India’s current 40 per cent on one side of the pack, translates to 20 per cent on both sides and India does not meet the minimum prescribed size for these warnings. Originally, India ranks 136th in the world due to small warnings on one side of the pack only, while other countries like Brazil have 100 per cent of one side of the the principal display area devoted to PHW. This policy intervention in India has not been able to make full impact and is a lost opportunity for providing health education to consumers and youth in particular, who can be dissuaded from experimenting by putting effective warnings on tobacco product packages,” she avers. “India demonstrated global leadership when it announced its new 85 per cent pictorial health warnings in October 2014. Following the Oct 15, 2014 notification on 85 per cent pictorial warnings on both sides of tobacco products, India’s position jumped to second from 136 (of 198 countries). Taking the cue from India, countries like Nepal, Pakistan, Sri Lanka, dramatically increased the size

of their pictorial warnings to 90, 85 and 80 per cent respectively. India has received immense support for implementation of 85 per cent pack warnings from victims of tobacco use, doctors, cancer hospitals, national and state levels health organisations, wellknown public health experts, beedi workers unions, women and youth groups and 50,000 signed petitions from general public. Some eminent MPs from across different political parties such as Supriya Sule, Rajeev Chandrasekhar, PK Sreemathy, Baijayant Jay Panda, Prahlad Joshi, among others, have also written to the Health Minister, JP Nadda in favour of 85 per cent larger pack warnings in public interest,” reckons Mukhopadhyay. Further on Arora says, “Apart from PHW, India needs ban on loose sale of cigarettes, as the whole purpose of PHW on packs is lost, if cigarettes are sold loose. PHW are only on pack and not on individual cigarettes, thus sale in pack is essential to target messages to the consumers. Similarly, surrogate advertising, brand stretching, point of sale advertising and on-pack advertising are areas that still need to be strictly regulated under comprehensive ban on advertising. Tobacco taxes need to be substantially raised, across all tobacco products to be able to influence demand and thus see any public health benefit of this tobacco control strategy in India.”

Lastly... In a country like India, where more tobacco users are coming on board, larger pictorial warnings is the need of the hour. It is not right to put a billion lives at stake in order to save the occupation of those employed by the tobacco industry. The government if really bothered of these poor people can certainly provide them with an alternate occupation. It is time that all stakeholders of public health raise their voice and join in the war against tobacco. raelene.kambli@expressindia.com

EXPRESS HEALTHCARE

May 2015

STRATEGY INSIGHT

Thank you MPs, but what are you smoking?

GIRIDHARA R BABU Associate Professor, PHFI

Giridhara R Babu, Associate Professor, PHFI; member on the NCD surveillance leadership workgroup of the International Society for Disease Surveillance (ISDS), and Wellcome Trust-DBT fellow debunks the claims of some Loksabha MPs that there is no clear link between tobacco consumption and cancer

alileo Galilei said, “We cannot teach people anything; we can only help them discover it themselves”. He was reprimanded and troubled by the Church till his death. His fault was that, he said that the earth revolved around the sun, not a mere hypothesis but he backed it with telescopic evidence. The Pope apologised several eras after Galileo's death. India has lost several such lives due to using tobacco. This time, it is some members of parliament who doubt the otherwise obvious evidence. They might have been guided by instinct and less by science, but each of their utterance has to be denounced. Otherwise, it might have dreadful longstanding upshots on the health of Indians. But, thank you MPs. I say this with deep gratitude, as it is parliamentarians who created attention regarding misconceptions about tobacco. This provides a perfect opportunity to explain that MPs are absolutely mistaken like most folks on tobacco use. In epidemiology, bias is a systematic deviation of results from truth. Let us examine some statements of the MPs and understand whether these are based on truth. "I can produce a lot of peo-

EXPRESS HEALTHCARE

May 2015

Ther stud e is no In y dian betw to show the l een t ink oba and c cco usa ge ance r Dili who p Gandh is i, the p the hea d of arlia m pane entary l

etes diab ar, rice, t e g You ing sug 't you n at e y do ese to e u . Wh or all th d s e f to pota arnings well s w e gs a writ thin am Shy upta, G P ran Cha Sabha M ad Lok Allahab from

ple in front of you who are chain smokers of beedi and till date they have had no disease, no cancer," said Shyam Charan Gupta, Lok Sabha MP from Allahabad. “Whether or not smoking causes cancer is debatable. I know two elderly people who drank a

lot uce a you d o r f p I can in front o rs of e l k p o e o of pe chain sm they ate are who i and till d ease, d dis bee d no r a h e nce hav no ca m Shya upta, G n a rom Char ha MP f b a ad Lok S Allahab or no Whether t sm canc okin er is g cau elde d ebat ses rly p a alcoh eople w ble. I kno ho d w tw ol a ever nd smok rank a bo o y day e . One d 60 cig ttle of ar is sti othe ll aliv ettes r die e , the d at 8 6

PrasadRam arma BJP MS P from h, Assam

bottle of alcohol and smoked 60 cigarettes every day. One is still alive, the other died at 86,” said Ram Prasad Sarmah, BJP MP from Assam. No doubts here, MPs indeed might have observed few chain smokers who have not yet got cancer. However, for every surviving smoking

male in 100 people, 19 other smoking men would have died. Those who have got cancer and/or have died earlier, won't be noticed by the observer. Instead, if the MP examines elderly population in each age group, it would not be a surprise that most of this group would be composed of non-smokers (as smokers would have died of cancer or other diseases). This is survivor bias. There is another problem termed observer bias, wherein the observer (MP)s biased of consequences of tobacco, arising from financial stakes or conflicts of interest. In the finite sample the observer (MP) has seen, he has observed chain smokers,who have not yet got cancer. However, he is not following people temporally to see whether they get cancer or not. Cancers take at least a decade to develop and mere observation wouldn’t diagnose the condition. We cannot be sure of the diagnostic ability of the MPs as the cancers and other non-communicable diseases (NCDs) are asymptomatic for a long time till they get complications such as heart attack or stroke. “There is no Indian study to show the link between tobacco usage and cancer,” said Dilip Gandhi, who is the head

STRATEGY of the parliamentary panel. In a nationally representative survey of 1.1 million homes, Prabhath Jha and others found that smoking reduced median survival of women by eight years and six years for men. This was published in prestigious New England Journal of Medicine (2011). A search of smoking and lung cancer in Google scholar finds 25300 articles, with more specifics pointing to 196-9870 articles. At least 1000 epidemiological studies show large relative risks 20:1 suggesting that risk is 20 times or higher for those who smoke. Tobacco is the single largest avoidable cause of premature death, a recognised carcinogen and the largest source of particulate indoor air pollution. It is a major cause of deaths and diseases due to second-hand smoke. A dose-response relationship indicates the higher propensity to get

lung cancer with each extra cigarette smoked. In India, NCDs account for 60 per cent of all deaths, making them the leading cause of death. Tobacco use is the chief risk factor for causing NCDs. Resulted by smoking and other shared risk factors such as physical inactivity and unhealthy food, India’s NCDs burden results in 40 per cent of all hospital stays and roughly 35 per cent of all recorded outpatient visits. With increased proportion of ageing population in India, we are going to be in a precarious state. You get diabetes due to eating sugar, rice, potatoes. Why don't you write warnings for all these things as well," says Gupta. Those who have diabetes are advised not to eat high sugar containing foods and not vice versa. This shows the despondency to use unfounded state-

De toba aths due cco a re lik to more ely to than be eigh annu t millio ally b n y 20 30 Two effec of the si x tiv cont rol p e tobacc o olicie the h s ealth lie with sect care or!

Tobacco is the single largest avoidable cause of premature death, a recognised carcinogen and the largest source of particulate indoor air pollution. It is a major cause of deaths due to second-hand smoke

ments to defend the use of tobacco, a tactic used by tobacco moguls to engage more people to use tobacco in low and middle-income countries such as India. Tobacco provides instant euphoria, causes diseases over a period of time and results in premature death. Tobacco industry propagates wrong information to target non-users, they support activists who advocate that tobacco use is a matter of individual choice and state should not interfere. Tobacco is very potent as the users hook on to it after taking few puffs. The adverse marketing and surrogate advertisements influence teenagers and young adults to start using tobacco and they would never be able to quit. The honourable MPs should desist from making such statements and instead work on curbing tobacco use, and win the overly prolonged war against tobacco.

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EXPRESS HEALTHCARE

May 2015

STRATEGY INSIGHT

Riding the PE/VC wave in healthcare

DIPEN VIJAYKUMAR TRIVEDI Healthcare Management Consultant

Dipen Vijaykumar Trivedi, Healthcare Management Consultant, gives his insights on what the PE investor/Venture Capitalist are looking for while souring for healthcare projects to invest

f you happen to be the first-generation doctor turned entrepreneur, who having negotiated the tough initial years, wishes to expand one’s practice at a larger scale then, arranging for capital is extremely critical. Any debt financing envisages serving a collateral security which may always not be feasible, at early stages of one’s practice career. But capital is certainly available for the deserving ones who muster the courage of making it large and chase their dreams till they turn real. Healthcare has been riding a wave of private-equity (PE) investments and specialised services such as dentistry, fertility, pathology labs, eye care, family clinics (consultation, diagnostics, pharmacy, all under one roof model) etc. have already benefitted from this surge. (Check table) Let us try and explore certain fundamental questions which a venture capitalist or a private equity investor seeks to explore while setting out to shop for promising and profitable medical ventures:

What is the focus of the business model? A business model focusing on a ‘specialised medical service’ has been preferred over and above a multi-speciality hospital chain in which the management is possibly aiming to do too many things and spreading too thin.

Is the business idea initiator an ‘early mover’

EXPRESS HEALTHCARE

May 2015

Year

Deals

Value $ Million

2011

463

2013

1262

2013

1359

2014

*80

*1450

(Source: Extracts from several Reliable Public Domain websites)

or a ‘laggard’ in the current market context? An early mover advantage in an unorganised space, is the ideal opportunity that venture capitalists or the private equity investors look out for.

What is the CAGR potential? What is the growth potential (compounded annual growth rate) of the ‘specialised medical service’ in context of the Indian healthcare market. Is there a clearly identifiable market? The basic concern is not whether it will grow, but at what ‘rate’ and ‘pace’ will it grow?

Depth and conviction in the business plan The business plan should explain the nature of the company's business, what it wants to achieve and how it is going to do it. The entrepreneur/ doctor should prepare the plan and should set challenging but achievable goals. Venture capitalists expect the business plan to include detailed market size analysis. Market sizing should be presented from the ‘top down’ and from the ‘bottom up’. That means providing third-party estimates found in market

research reports should be equally complimented with a feedback from potential customers, showing their willingness to buy and pay for the offered services.

Capability to execute business plans Demonstration of the capability (in terms of experienced management team, screening systems, policies, processes and a sound administrative structure) in creating as well operating franchisee clinics, which maintain uniformity in service delivery standards, quality and customer experi-

Entrepreneurs who devote significant efforts in choosing the apt technology often get picked up by venture capitalists

ence across its chain of clinics, irrespective of their geographical location.

Cost effective and practical acquisition of customers Venture capitalists and PE investors often come across entrepreneur/doctors who are often by nature very passionate about their practice. In itself this is a good thing, but unfortunately that passion often blinds them to some important issues: ◗ They don’t focus on how they are going to acquire customers in a cost effective way especially in unknown territories, as they believe that people will either beat a path to their door owing to their goodwill in an erstwhile tried and tested locality, or that their service will go viral as everyone will love it so much they will tell all their friends. ◗ They fail to look at whether their erstwhile (local) goodwill or their service is enough to get the customer to overcome inertia and experience it, with other competitors around especially in an unknown/new territory.

A competitive advantage through ‘niche’ services, for a better market penetration and an assured market share Products and services that customers can't do without because they are so much better in terms of ‘experience’ or because they are so much ‘cheaper’ than anything else in the market. VCs look for a

competitive advantage in the market. They want their portfolio company to be able to generate sales and profits before competitors enter the market and reduce profitability. The fewer direct competitors, the better. This is one of the core principles of the venture capitalists and its application is no different in terms of the healthcare industry.

A capital-light model VCs often judge the wisdom and the manner of spending in the initial stages of the setup. They appreciate a ‘capital light’ model, to start with (i.e. a low intensity ‘capex’ per unit of the proposed chain).

Choice of healthcare IT and technology Entrepreneurs who devote significant efforts in the choice of apt technology (keeping in mind the technology redundancy factor) often get distinguished and picked up by the venture capitalists at the time of decision making.

Is the business model scalable? How soon is an ‘exit’ possible? The business model should have a potential for a rapid scaling up in terms of units for the chain. The ‘exit’ by means of an Initial Public Offering (IPO), will require a substantial amount of scaling up. ‘speed of scaling up’ is directly proportionate to the ‘nearness of exit’ through an IPO route. The faster is the potential to scale up, the more convincing is the investment.

IT@HEALTHCARE CASE STUDY

Remedinet Solutions and Manipal Hospitals: Partners in progress

MUNISH DAGA CEO Remedinet Technologies

Munish Daga, CEO of Remedinet Technologies gives a rundown on how the deployment of a Remedinet solution helped Manipal Hospitals streamline their health insurance claims

HEALTHCARE IN India is experiencing phenomenal growth and development. Cashless health insurance schemes have witnessed remarkable adoption across sectors, including at the grass root level. To ensure profitability and efficiency of operations, it is crucial for all the participants in the health insurance claim settlement process to maintain transparency, accuracy and a quick turn-aroundtime (TAT) during the entire process. However, dependency of these participants on manual methods for data capturing and record maintenance is detrimental to the overall efficiency of the claim settlement and adjudication process as well as the growth of the healthcare sector in India.

Challenges faced by Manipal Hospitals A key player in the healthcare ecosystem is the provider â&#x20AC;&#x201C; the hospital. Without the right hospital infrastructure, it will not be possible to cater to the

needy. To cater to the rising demands and to continue providing services as well as ensuring customer satisfaction, it is crucial for hospitals to con-

stantly evolve and adopt latest innovations. While India is at the forefront in adopting latest technology for medical devices and equipment, adoption of

technology at the back end, particularly for health insurance claim adjudication is required. Manipal Hospitals, a lead-

ing integrated healthcare service provider in India, is focused at providing quality healthcare services with facilities and infrastructure on par with global

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IT@HEALTHCARE

R standards. As a trusted name in the healthcare sector, Manipal witnesses a huge inflow of patients and thus, health insurance claims on a day-today basis to seek the best medical services. To avail of cashless insurance, upon getting admitted to the hospital, the patient must produce a cashless health insurance card. They are required to fill a form provided by the hospital staff. This form has details of their policy and the treatment recommended by the doctor. Based on the information disclosed in this form, the insurance company/ TPA decides the amount of expenses they would cover for the treatment. This information is then communicated to the hospital. At the end of the treatment, the hospital communicates the final amount to the insurance company/TPA for reimbursement. Thus, to handle the influx of cashless claims, ensure a hassle-free experience for the patient, maintain transparency, accuracy and efficiency, undoubtedly, a standard platform facilitated by technology connecting all the players of the healthcare insurance ecosystem would prove beneficial. To make the health insurance claim settlement process fluid, Manipal had to address the following issues regarding the current claim settlement process: ◗ The information shared by patients in their form is typed manually and fed into computers by data operators. This information is then shared with the TPAs/ insurance company in the form of PDFs/JPEGs. Inaccuracies while keying in this information often results in the form being sent back to the hospital for corrections ◗ Data entered at different stages is also open to subjective human interpretation, increasing the possibility of errors ◗ The entire process of collecting and sharing the relevant data becomes a time-consuming exercise adding to the patient’s discomfort ◗ Real time tracking and monitoring the progress of a

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emedinet has provided the technology support that we needed to handle the huge influx of health insurance claims and thus, helped us to ensure customer satisfaction.Their EPM and ECM solutions have made it possible for us to get pre-authorisation approvals from TPAs/ insurance companies within 2/3 hours and reduce the time taken to process a discharge by half.The entire process has become faster and accurate, enabling us to emerge as one of the best in the business.

Dr Niranjan Rai Head, Patient Support Services, Manipal Hospitals

By using ECM, Manipal has been able to track the details of each case at each stage, identifying gaps or errors and rectifying them to speed up the process claim proved to be difficult due to the absence of a webbased software that can facilitate instantaneous flow of information ◗ Owing to the delays in processing claims, patients had to go through additional waiting time after discharge

Remedinet to the rescue Remedinet team offered Manipal simplistic solutions for the challenges faced by them during pre-authorisation and claim management. In 2006 they started using Electronic Preauthorisation Manager (EPM), a web-based electronic form for entering all relevant information at the time of hospitalisation. This helped in reducing the instances of incomplete data entry and brought down the TAT for processing pre-authorisation requests significantly. This web-based platform also provided an overview

of all the transactions, their status and past history to keep a track on the progress and thereby, define the accountability of the staff members. In 2014, Manipal Hospitals started using the Electronic Claims Manager (ECM). ECM helps in easing out the most critical phase of the entire cashless insurance claim process. It allows hospitals to submit claims electronically by using the standard IRDA compliant claim and bill formats and soft copies of all supporting documents required by various insurance companies. By configuring mandatory fields and documents at pre-authorisation phase, ECM significantly reduces queries from insurance companies/TPAs regarding incomplete claim forms and missing documents. ECM also makes it possible to track the status of a claim settlement process. Thus, by using ECM,

Manipal has been able to track the details of each case at each stage, identifying gaps or errors and rectifying them to speed up the process. With their simple solutions and value added services Remedinet has emerged as a key technology partner for Manipal.

Impact A technology platform makes it possible to identify lags or delays and fix the error in real-time. Quick responses to queries raised, real time tracking of the claims process, and retrievable archives become possible too. Making the process faster, error-free and reliable thus, improves the overall efficiency of claims adjudication process. Remedinet solutions enhanced the efficiency of the claim settlement process and benefitted the hospital and insurance

companies/TPA as well as the patients in the following ways:

Benefits to the hospital ◗ Accuracies in maintaining records improved as the manual process of filling forms was done-away with ◗ A transparent dashboard showed all relevant details for monitoring the claim settlement process ◗ Inconvertible platforms for exchanging information were eliminated to make room for electronic readable platforms ◗ As all patient records were maintained electronically, the time involved in the claim settlement process was reduced drastically ◗ The time required for preauthorisation reduced from 6/8 hours to 3/4 hours ◗ Real-time monitoring of claims made it possible for hospitals, TPAs and insurance company to expedite the settlement process ◗ Assured delivery of all crucial information to various participants in the claim settlement process

Benefits to the patient ◗ The time taken to process a discharge reduced from 3/4 hours to 1/2 hours ◗ Faster claim settlement process resulted in minimising the waiting time for patients, enabling them to manage bed utilisation and other resources better ◗ Archive of treatment history made it possible for patients to refer this information for further treatment without actually furnishing the report copies To be on par with global best practices and be prepared for the current as well as the future demands of Indians for healthcare services, a healthcare provider’s focus on delivering efficient healthcare services using cutting-edge technology will go a long way in ensuring customer satisfaction and thus, customer loyalty. Remedinet has supported Manipal in enhancing the overall experience of the patients.

IT@HEALTHCARE REPORT

VC funding in health IT/digital health drops with $784 mn raised in Q1 2015 The Mercom Capital Group Report reveals that Health IT/Digital Health companies have now raised almost $10 billion in VC funding since 2010

MERCOM CAPITAL Group, a global communications and research firm, released its report on funding and mergers and acquisitions (M&A) activity for the healthcare information technology (IT)/ digital health sector for the first quarter of 2015. Mercom’s comprehensive report covers deals of all sizes across the globe. Venture capital (VC) funding in the health IT/digital health sector dipped by about 35 per cent, coming in at $784 million in 142 deals compared to $1.2 billion in 134 deals in Q4 2014. Announced debt and public market financings in the sector amounted to $975 million in seven deals in Q1 2015 including one IPO, bringing the total corporate funding raised in the sector for Q1 2015, to almost $1.8 billion. Health IT/digital health companies have now raised almost $10 billion in VC funding since 2010. “Funding fell across the board with the exception of Mobile Health (mHealth), which was the bright spot this quarter. There was also significant M&A activity in the first quarter for mHealth companies. We have already seen 10 M&A transactions in Q1 compared to 21 in all of last year, which bodes well for exits in Mobile Health,” commented Raj Prabhu, CEO and Co-Founder of Mercom Capital Group. Healthcare practice-centric companies raised $347 million in 44 deals in Q1 2015 compared to $568 million in

288 investors and four accelerators/incubators participated in Healthcare IT deals this quarter. 11 investors participated in multiple rounds. Investors with the most funding deals this quarter included GE Ventures with four, followed by Rock Health and Kaiser Permanente Ventures with three each 43 deals in Q4 2014. Areas that received the most funding under this category were Data Analytics companies with $92 million, Data Warehousing companies with $70 million, Health Insurance Exchange companies with $38 million, EHR/EMR companies with $36 million, and Practice Management Solutions companies with $34 million. Consumer-centric companies raised $437 million in 98 deals this quarter compared to $643 million in 91 deals in Q4 2014. Mobile Health companies continued to attract the most VC funding bringing in $282 million in 56 deals, most of which went to mHealth Apps with $220 million. Telehealth companies secured $65 million while Rating and Comparison Shopping companies brought in $47 million. There were 65 early-stage deals under $2 million, including 16 accelerator/incubator deals in Q1. Seed stage accelerator/incubator deals have slowed with only six deals last quarter and 16 this quarter compared to 35 in Q1 2014.

Top VC funding deals in Q1 2015 were the $70 million raise by Health Catalyst, a provider of healthcare data warehousing, the $55 million raised by Ayasdi, a big data analytics company, the $40 million each secured by Advance Health, a provider of a mobile patient data capture application for managed care providers, and ClassPass, a mobile membership app offering fitness and wellness classes across multiple gyms and studios, the $38 million raised by Collective Health, a cloud-based employer self-insurance platform, and the $30 million raised by Practo, developer of a physician search engine to book appointments and rate providers. A total of 288 investors and four accelerators/incubators participated in Healthcare IT deals this quarter. There were 11 investors that participated in multiple rounds. Investors with the most funding deals this quarter included GE Ventures with four, followed by Rock Health and Kaiser Permanente Ventures with three each. Globally, US companies

raised $716 million in 123 deals. Eleven other countries: India, Israel, Canada, Australia, Serbia, Spain, Finland, Singapore, Germany, Austria and the UK recorded deals this quarter. In the United States, 38 deals came out of California, followed by New York which recorded 13 deals, Massachusetts and Texas with 12 and eight deals respectively, and Wisconsin with five deals. There were 56 M&A transactions (14 disclosed) in the Health IT sector in Q1 2015 compared to 52 transactions (nine disclosed) in Q4 2014. Practice-focused companies lead M&A activity with 42 of the 56 transactions. Consumercentric companies had 14 transactions in Q1 2015. Mobile Health companies were acquired this quarter followed by seven Practice Management Solutions companies, five EHR/EMR companies, three Medical Imaging and three Data Analytics companies. In terms of disclosed transactions, Mobile Health came out on top with $578 million, led by two acquisitions from Under Armour. The largest

disclosed M&A transaction was the $475 million acquisition of MyFitnessPal, a nutrition and fitness platform that allows users to track their health goals and provides nutritional information, by Under Armour. This was followed by the $325 million acquisition of Studer Group, a provider of healthcare consulting services and software, by Huron Consulting. Performant Financial Corporation acquired Premier Healthcare Exchange, a provider of advanced cost management solutions for commercial health plans and third party administrators, for $130 million. HealthStream acquired HealthLine Systems, a provider of credentialing and contact center quality management software to the healthcare industry, for $88 million. Under Armour also acquired Endomondo, a developer of a mobile app and website that provides users a fitness community and allows them to track their workouts, for $85 million. Announced debt and public market financing in Health IT rose to $975 million in seven deals this quarter compared to the $299 million in eight deals in Q4 2014. There was one Digital Health IPO in Q1 2015: Invalon, a data analytics solutions company, which raised $600 million. There are a total of 546 companies and investors covered in this comprehensive report.

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IT@HEALTHCARE CASE STUDY

Digital imaging for document management

SUSHEEL JOHN MD, Information Management, Asia Pacific Region, Kodak Alaris

Susheel John, MD, Information Management, Asia Pacific Region, Kodak Alaris gives a rundown on applying digital imaging’s lessons to document management

HEALTHCARE PROFESSIONALs worldwide have witnessed first-hand technology migration from radiology film and laser film printers to diagnostic digital imaging and communications in medicine (DICOM) digital devices and picture archiving and communications systems (PACS). This transition has had an extensive impact on patient care, efficiencies and diagnoses. Healthcare organisations and professionals are facing a steep learning curve and the need to build network and IT infrastructure, along with external communication capabilities, ensuring interoperability and facilitating the efficient exchange of images for viewing and interpretation. Initial adoption and migration to the electronic health information exchange negatively impacted clinical productivity. This caused resistance, frustration and financial challenges. Healthcare professionals were more focused on patient care than evolving technologies, especially dealing with hybrid environments of medical films and digital images.

Improvements with electronic healthcare processes As India’s healthcare system continues its migration towards electronic health communication and interoperability, the objective is to encourage physician-wide

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adoption of electronic healthcare processes. This will help facilitate immediate access to information and reduce the instances of lost information. Examples of technologyenabled process improvements include: ◗ Use of unilateral electronic health records (EHR), physician entries and information exchange between doctors, practices, facilities and patients ◗ Closed loop e-prescriptions to improve patient medication adherence ◗ Proactive patient engagement for wellness management and better patient outcomes We can take advantage of lessons learned from the film-to-digital evolution to relate these lessons to the transition from paper-to-electronic health information exchange, some of which are already in practice today: ◗ Utilising upfront planning to choose systems that meet your needs and ensure a successful transition ◗ Managing user introduction through new systems and process implementations, since initial and on-going perception can make or break a project ◗ Identifying and accepting the gaps and realities upfront to be better prepared

Paper-to-electronic data transition The thought of change to new electronic processes can

The healthcare industry often looks for a single ‘fix’ to process issues, and EHRs were perceived to be that single ‘fix’

cause much anxiety, especially due to the familiarity and comfort with current manual practices. Even in today’s culture, where nearly everyone uses digital communications in their everyday lives, there is still the dread of change, together with cost and implementation challenges. Organisations need to identify a methodical migration plan before moving away from film – this includes a structured conversion plan for back file paper documents and charts. Options include outsourcing the complete conversion project, converting paper files and charts prior to the next patient visit, or to adopt a hybrid approach of scanning prior to visit, along with converting back file charts when on-site availability permits. Determine a day-forward

process of converting paper documents that may present themselves, from patient orders to test results received. Planning out whether the information would be stored as part of the EHR or in another system is critical to knowing where and how to access pertinent information. Decide whether to store and manage documents as part of an EHR system, taking into account whether a dedicated, integrated and accessible document management solution is more appropriate for handling all document types – not just patient health information. Always check ease of use and compatibility.

Realise hybrid environments The healthcare industry often looks for a single ‘fix’ to process issues, and EHRs were perceived to be that single ‘fix’. Healthcare organisations need to simultaneously research and compare current and new technology compatibility gaps and identify best practices that include effective ways to work in hybrid environments. Healthcare has recognised that between providers, facilities, patients and associated businesses, there will always be: ◗ Some information in paper form ◗ Data in various formats (structured and unstructured) ◗ Technology integration and

compatibility issues ◗ Information security

concerns ◗ Communication and

exchange challenges ◗ Care providers who will not

implement electronic systems or electronic communication methods ◗ User adoption struggles

Looking forward Once electronic information is interoperable and accessible, applied clinical and business intelligence and analytics will become important tools, enabling the next level of transformation in healthcare. This added dimension of ‘intelligent’ information, which provides the ability to receive immediate clinical feedback and trigger treatment suggestions, will result in better outcomes. This will also ultimately aid in readmission reduction while optimising patient care and satisfaction, with expectations of assisting in population health management. We will also see greater operational efficiencies related to staffing and resource allocation, coding and billing guidance and information process enhancements, which all lead to increased productivity and reduced costs. Ultimately, if we learned well from previous technology migrations, there will be enormous opportunities for IT leaders and providers to make an impact on the healthcare industry.

LIFE PEOPLE

Dr Ashok Seth conferred with Padma Bhushan for his contribution to cardiology Dr Seth has received the Padma Shri in 2003, the National Award of Republic of Spain ‘Officer’s Cross Order of Isabella the Catholic’ in 2010, and ‘Mason Sones Award’ from SCAI (US) in 2010 DR ASHOK SETH, Chairman of the Fortis Escorts Heart Institute (FEHI) has been conferred with Padma Bhushan, the prestigious national award and civilian honor for his contribution in the field of cardiac care by the President of India. Dr Seth’s contribution to the growth of cardiology, especially interventional cardiology, has been notable. Over the past 26years, he has pioneered numerous angioplasty techniques for India and Asia Pacific region like directional atherectomy, angioscopy, stents, thrombectomy devices and drug eluting stents, use of impella heart support device failing heart, bioabsorbable stents and TAVI. His other achievements include being a part of the focused Advisory Group and seminal studies for development and clinical

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Dr Seth has more than 250 publications to his credit in prestigious Indian and international medical journals and has been bestowed with honorary doctorates from four prestigious universities in India

applicability of bioresorbable scaffold stent (BRS), which is recognised internationally. Dr Seth has been honoured with Padma Shri by the President of India in 2003, the National Award of Republic of Spain ‘Officer’s Cross Order of Isabella the Catholic’ in 2010, ‘Mason Sones Award’ from SCAI (US) in 2010 among numerous other awards. He also has more than 250 publications to his credit in prestigious Indian and international medical journals and has been bestowed with honorary doctorates from four prestigious universities in India. Congratulating Dr Seth on the honour of the award, Ashish Bhatia, COO, Fortis Healthcare said, “The teams at the FEHI and at Fortis Healthcare are extremely proud to have a charismatic, yet humble man who leads by example as their leader. This award, among the numerous awards he has received, is a reflection of his commitment and dedication towards his passion in cardiac care. We are proud to be associated with such a luminary and wish him greater success.” On being congratulated for the award, Dr Seth said, “I am thankful for the honour. The award makes my mission to work tirelessly in this field of medical sciences more resolute. As the Chairman of this Institute, my endeavour will always be to lead my colleagues to many more victories and strive towards more solutions to give a ray of hope for numerous patients dying of failing hearts. "

International Achievement Award 2015 from ICN for Dr Subadhra Devi Rai The award accords worldwide recognition of the recipient’s achievements and contribution to nursing internationally DR SUBADHRA DEVI RAI, a nurse and senior lecturer at the School of Health Sciences (Nursing) at Nanyang Polytechnic, Singapore, has received the International Achievement Award 2015 bestowed by The International Council of Nurses’ (ICN) Florence Nightingale International Foundation (FNIF). The ICN is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. ICN works to ensure quality care for all and sound health policies globally. The award is given every two years to a practicing nurse with at least 10 years of nursing experience in one of the following domains of nursing: direct care, education, management or research. The award accords worldwide recognition of the recipient’s achievements and contribution to nursing internationally. The Indian-origin nurse, Dr Rai’s career began in Singapore where she worked in an intensive care unit following her

general nursing training. She continued her education in Canada where she also worked as a researcher at the Edmonton Centre for Survivors of Torture and Trauma. In 2005, she became a women’s health coordinator at Women’s Education for Advancement and Empowerment (WEAVE) in Chiang Mai, Thailand. In 2014, Dr Rai received a grant for a project on the health of repatriated refugees from the ThaiMyanmar border back to Myanmar. She volunteered with AWARE SAB in Singapore where she offered support to and advocates for victims of sexual assault. Dr Rai holds a PhD in Population Health from the University of Alberta. “Subadhra Rai has shown dedication in providing nursing care to vulnerable populations since the beginning of her career,” said Judith Shamian, President of the International Council of Nurses and the Florence Nightingale International Foundation in a press release. “Her special focus on issues such as gender-based

violence, sexual health and reintegration of refugees is particularly topical,” she added. The International Achievement Award will be presented to Dr Rai at a special FNIF Luncheon to be held on June 21, 2015 at the ICN Conference in Seoul, Republic of South Korea. Past recipients of the award have included Liisa Hallila, a Finnish nurse-entrepreneur for her work in nursing education and management; Anneli Erikkson, a Swedish nurse and President of Médecins Sans Frontières in Sweden, who worked with endangered communities during catastrophes; Carol Etherington, an American nurse working on community based programmes for people living in the aftermath of war and natural disaster; Susie Kim, a Korean nurse whose major contributions to nursing education and practice have earned her international recognition; and Margaret Hilson, a Canadian nurse working in international health programmes.

Vikram Patel from PHFI named in TIME magazine’s list of 100 most influential people Prof Patel is the Co-Director of the Centre for the Control of Chronic Conditions at the Public Health Foundation of India and has led research for the development of the field of global mental health and improved care for those with mental disorders in resource-poor countries

TIME MAGAZINE has named Prof Vikram Patel, Psychiatrist and Professor of International Mental Health among the TIME annual list of the 100 most influential people in the world. Prof Patel is the Co-Direc-

tor of the Centre for the Control of Chronic Conditions at the Public Health Foundation of India. He is also the founding and Joint Director of the Centre for Global Mental Health, a partnership between the London School of Hygiene & Trop-

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LIFE ical Medicine and Kings Health Partners, UK. He is a Wellcome Trust Senior Research Fellow and is also Co-founder of Sangath, a mental health research NGO-based in Goa. Prof Patel played a lead role in synthesising evidence that has shaped the foundation of the field of global mental health and promoted its dissemination by editing key journal series and textbooks that form the basis of teaching and practice in the field. Prof Patel has conducted

ground-breaking epidemiological research that revealed the burden of mental disorders in low- and middle-income nations and showed a strong link between mental disorders and poverty. His research focusses on how to bring better mental healthcare to low-resource communities, where around 90 per cent of people affected by mental illness go untreated because psychiatrists are in such short supply. His studies have looked at the burden of mental disorders and suicide in young

people; the association of poverty and gender based violence with depression and suicide; adolescent health, HIV/AIDS and maternal and child health. He also carries out research on chronic diseases which seeks to integrate mental healthcare with that for other chronic diseases, and on using mhealth innovations in improving access to and quality of care. His research also demonstrated that evidence-based treatments for mental illness can be delivered effectively in these coun-

tries by non-specialist healthcare workers. Commenting on the announcement, Prof Vikram Patel said, “Being named on this list is a recognition for the tireless efforts of so many people around the world to use science and advocacy to enhance the quality of life of people affected by mental health problems, easily the most neglected of all global health issues, in the poorest communities of the world”.

Strand Life Sciences names Scott Storrer as Global President, introduces US management team US team focused on National Launch of StrandAdvantage - company’s pancancer genomic profiling service

STRAND LIFE Sciences announced the appointment of Scott Storrer to the position of Global President. In this new role, Storrer, who joined Strand in July 2014 as President of North America, will oversee the company’s operations worldwide with a focus on strategy and business expansion. In addition, Strand introduced its US management team, which is focused on the national launch of StrandAdvantage. Available now to physicians, StrandAdvantage was designed to accelerate the analysis of therapeutically actionable cancer genes and match them to relevant FDAapproved targeted cancer therapies and open clinical trials without the need for multiple tests. Utilising proprietary

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advanced analytics and interpretation expertise, StrandAdvantage provides oncologists with clinically actionable results in days instead of weeks to enable more timely decisions about the besttargeted therapies for patients. “Scott has been an integral member of the team bringing StrandAdvantage to market in the US. The team we have appointed will support his efforts to deliver precision medicine to more oncologists and pathologists,” said Dr Vijay Chandru, Chairman and CEO, Strand Life Sciences. Storrer is a 20-year healthcare industry veteran. Prior to joining Strand, he was President and CEO of Genomind, a personalised medicine company. Before this, he held several leadership positions with Cardinal Health, where he advanced to Group President of Cardinal’s $81 billion pharma segment. Earlier in his career, Storrer was Executive VP, Service and Information Technology with CIGNA Corp. Storrer said, “The team we are putting in place enables Strand to continue to lead advances in NGS approaches to genomic testing and to offer physicians the most advanced care options through precision medicine.”

The company’s US management team appointments are: Dr Preveen Ramamoorthy GLOBAL HEAD OF DIAGNOSTICS

In this position, he leads next generation sequencing test validation, clinical operations, regulatory compliance and quality assurance of Strand’s India and US reference laboratories. He also holds an adjoint faculty appointment at the University of Colorado School of Medicine’s Division of Personalized Medicine and Bioinformatics. Prior to joining Strand Life Sciences, Ramamoorthy was the founding head of the molecular diagnostics department at National Jewish Health, Denver, where he led the launch of high complexity molecular diagnostics laboratory-developed tests spanning oncology, immunology, genetics and infectious diseases.

Dr Harsha Rajasimha VP OF GLOBAL BUSINESS DEVELOPMENT

He focuses on corporate strategy to expand Strand’s personalised medicine Smartlab business and to forge strategic alliances across vertical markets and around the world. Rajasimha is cofounder and board member of the Organization for Rare

Diseases India and is an affiliate faculty member of systems biology at George Mason University. Since beginning to explore the intersection of computer science, genomics and medicine more than a decade ago, he has authored 14 peer-reviewed articles and worked on some of the largest interdisciplinary genomics projects at the Virginia Bioinformatics Institute, National Cancer Institute, and National Eye Institute.

Doreen Korba VP OF GLOBAL MARKETING

An experienced marketing executive and brand innovator, Korba directs Strand’s diverse global marketing initiatives. Her responsibilities include corporate branding and messaging, product marketing, demand generation, public relations, website management, online marketing, social media and events. Prior to joining Strand, she served as VP of Marketing at Genomind, where she built a successful brand from the ground up and helped to establish the company as a leader in personalised medicine for mental health.

Caely Cusick VP OF PERSONALISED MEDICINE SALES

She is responsible for the direc-

tion and management of all sales and business development activities. Cusick is a top-performing sales professional with expertise in business development, account management, marketing strategy and event production. She previously served as director of business development for Burrill & Company, a San Francisco financial firm specialising in biotechnology and life sciences investing; as director of national sales for Bloomspot; regional event sales manager for The Economist; and campaign manager for The Leukemia & Lymphoma Society.

Cheryl Abrantes MANAGER OF CLIENT SERVICES

Abrantes has more than 15 years of customer service and public relations experience. Prior to joining Strand, she served as the head of client services for the Advanced Diagnostic Laboratories at National Jewish Health (NJH). In 2009, she built the client services team for the US-wide launch of the age-related macular degeneration genetic test named Macula Risk in partnership with ArcticDx. While at NJH, she also managed the laboratories’ highest revenue-generating account, LabCorp.

LIFE INSIGHT

Healing the healers with employee engagement DR RAJANI TEWARI, HR Head, Wockhardt Hospitals

Dr Rajani Tewari, HR Head, Wockhardt Hospitals, speaks on the measures that can be implemented in hospitals to improve employee engagement and enhance the workplace environment

“To win in the marketplace you must first win in the workplace.”

- Doug Conant, CEO of Campbell’s Soup

n today's economic world, while everything is driven by numbers, it has now become a mandate to focus on a softer yet hard-hitting aspect of organisational functionality - the engagement level of the employees on whose performance the survival and thriving on the entire organisation depends. An ‘engaged employee’ is one who is optimally enthused and captivated in his/her work, while at the same time has a positive attitude which directs action when furthering his/her organisation’s goals and reputation. This involves going above and beyond the call of duty and applying one’s ‘discretionary’ effort to take his/her task (and organisational goal) to its fruition. All organisations have admitted that engaged employees can make or break the bottom-line performance of the organisation by increasing productivity and innovation levels and by reducing expenses associated with high employee turnover. Employee engagement is, thus, the term given to the approach employed by organisations to ensure commitment of employees to the values and objectives of their organisation and motivation to align their personal goals with those of the

organisation. Employee engagement is about creating the right culture and working conditions for employees to offer more of their capability by tapping into their latent potential. Employee engagement, by its definition, has its roots in the ‘Internal Generator Theory’ and ‘Herzberg’s 2 Factor Theory’ which talk of ‘hygiene’ and ‘motivation’ factors at work which eliminate employee dissatisfaction (like working conditions, pay, etc) and generate employee satisfaction (like recognition, de-

velopmental opportunities etc.) respectively. Most practices employed by organisations revolve around this theory and most of the efforts are spent to eliminate dissatisfaction and hardly any, if at all, to increase satisfaction / motivation to deliver one’s best at the workplace. In the wake of the increased need for employee engagement for employees in a healthcare setting, we at Wockhardt Hospitals have adopted a 360o engagement model that espouses a holistic approach towards

employee engagement. It involves a combination of strategies to eliminate the dissatisfiers and increase the satisfiers. The 360o model resides on three engagement pillars - creative engagement (fun at work), intellectual engagement (career enhancement initiatives) or social engagement (corporate social responsibility and industry connect). The model comprises four quadrants – each of which focus on different levels of hygiene and motivation. The

first quadrant focuses on basic hygiene – this involves knowing your payslip, benefits, policies, tax rules, etc. The second quadrant focuses on personal growth – this involves personal grooming, personal finance management, exploring your creative side, health and wellness programmes, etc. The third quadrant focuses on fun at work – this involves festival and birthday celebrations, talent hunt competitions, inter-departmental team building programmes and so on. The fourth quadrant focuses on professional growth and learning. This involves creation of a platform for learning where one gets the right blend of technical, behavioural and other soft skills to enhance one’s skills in the current role and also upskill himself/herself to the next rung of the corporate ladder. As one can note, the first two quadrants focus more on hygiene factors whereas quadrant three and four increasingly focus. Thus, the model holistically addresses both functions that need to be addressed by any engagement strategy – minimising the dissatisfiers and maximising the motivators. Each of the engagement pillars has specific activities/ initiatives that were lead by the HR department. Creative engagement comprises associate –family connect, HR payroll helpdesk, concierge desk, talent hunt contests etc. Wockhardt Hospitals is associated with Partners Harvard Medical

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LIFE International (PHMI), an international arm of Harvard Medical School, US. We also have a robust nursing leadership programme designed to develop nurse leaders and help them move up the clinical and corporate ladder. Knowledge enhancement activities for better clinical care involves doctors and nursing managers visiting Harvard Associated Hospitals to learn the global best practices in healthcare and help implement the same back at Wockhardt. We also sponsor higher education for associates and even our senior leadership go through various internal and external management development and leadership development programmes. We don’t believe in restricting development to internal associates – we also have progammes that

foster the importance of the ‘power of dialogue in crucial situations’. These programmes received excellent participation and feedback from the topmost medical consultants in India who are associated with Wockhardt Hospitals. The result – all round intellectual engagement of Wockhardtians. We also cater to the newer trend among the working population worldwide- to find the higher motive of life – which brings us to the third pillar – social engagement. A number of initiatives like the Swachch Bharat Abhiyan, Wockathon and Medical Partnering with the ISL in 2014 for all football matches held in Goa help our associates to give back to the community as well as network within the organisation and the environment outside. In order to ensure that our

ENGAGEMENT PILLARS

◗ Creative engagement (fun at work) ◗ Intellectual engagement (career enhancement initiatives) ◗ Social engagement (CSR and industry connect)

initiatives are in line with the need of the hour, we keep ourselves abreast with the pulse of the organisation. We place a lot of importance on ‘listening’ and ‘speaking practices’ within the organisation. As part of the 360o engagement model, a workplace engagement (WE) survey was rolled out function wise to check the engagement levels of

the associates on four parameters – role engagement, supervisory engagement, environment engagement and aspirational engagement. Post data collection, the results were analysed and that was followed by a one-on-one dialogue with each respondent by the Wockhardt Hospitals Corporate HR to discuss issues, if any, and to discuss the career aspirations of the associates. This was done to create a culture of candour and to encourage feedback not just top down but also from the subordinate to the superior. Other similar practices involve activities like focus group discussions, voice of Wockhardt (VoW) suggestion box, coffee with HR, biannual employee satisfaction surveys, Town Hall meetings and so on. All aim at ensuring

that the engagement strategies are aligned to the organisation and associates as well as to course-correct if necessary. The value proposition of the innovative, internally-developed 360o engagement model is three-pronged: internal customers are happy and hence are more engaged on the job. Also, engagement brings multidisciplinary teams together, leading to greater team building/bonding. They, in turn, deliver better service to the external customers – leading to better customer service scores and more recommendations to other prospective customers. This leads to greater satisfaction among the management because of greater associate productivity, better team-work, better service and improved bottom-line.

GE South Asia and Wipro appoint Milan Rao as President and CEO of Healthcare Business Rao will build on Wipro GE’s expansion plans and continue to strengthen the company’s ‘In India, for India’ proposition GE SOUTH Asia and Wipro announced the appointment of Milan Rao to lead GE’s Healthcare business as President and CEO, GE Healthcare South Asia and MD, Wipro GE Healthcare. Milan will build on Wipro GE’s expansion plans and continue to strengthen the company’s ‘In India, for India’ proposition of innovating disruptive technology and business solutions to enhance access to high quality, affordable healthcare solutions. He replaces Terri Bresenham, who has been leading GE Healthcare’s South Asia business since September 2011. Milan will report to Azim Premji, Chairman, Wipro and Banmali Agrawala, President and CEO, GE South Asia. Terri, a 25-year veteran at

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GE, will move to a global role. In the last three years, she has led GE Healthcare to launch winning initiatives like skill building programmes, industry partnerships and breakthrough products such as Discovery IQ and Revolution ACTs, informed a press release. Agrawala said, “Milan will take GE’s mission of a Healthier India forward through development of disruptive technologies and business models in India, for India. Our Healthcare business reinforces our philosophy of creating localised and affordable solutions. I thank Terri for her contribution and am confident that Milan will carry forward GE’s legacy of striving to develop solutions that meet the needs of the Indian healthcare

sector.” “Wipro and GE have enjoyed a strong and enduring partnership lasting over 25 years that has made an indeli-

ble mark on India’s healthcare industry. I am confident Milan will further strengthen this relationship and give an added impetus to our mission to build a healthier India,” said Premji. Milan joined Wipro GE Healthcare in August 2013 as COO. He has over 20 years of senior management and leadership experience in several industries including Telecom, Financial Services and FMCG. Milan brings a wealth of experience in driving business strategy, sales, marketing and general management at multinational and Indian companies such as Bharti Airtel, Morgan Stanley, Citibank and Seagram. As COO of GE Healthcare South Asia, Milan has built and driven strategies to successfully take GE’s healthcare solutions closer to healthcare providers across all parts of South Asia and has integrated systems and processes that have helped to build a differentiated customer experience.

Prior to Wipro GE Healthcare, Milan was the CEO for the Enterprise Business at Bharti Airtel, where he was responsible for a business serving 2500+ corporate and government institutions in India and globally. Milan Rao, GE Healthcare’s new President and CEO for South Asia and MD of Wipro GE Healthcare said, “Wipro GE has achieved several milestones on the promise of delivering affordable and accessible healthcare. I am looking forward to expand our leadership in the market, accelerate innovation and distribution capabilities to continue enhancing customer centricity and technology adoption for quality healthcare diagnosis everywhere. We hope to build on our successes in local innovation, partnership with all governments and healthcare providers to achieve our vision of a healthier India and also help transform lives world over.”

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

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TRADE & TRENDS

Carestream Health to develop 3D orthopaedic imaging system Company is working with orthopaedic, sports medicine specialists on Design for New Cone Beam CT System CARESTREAM IS partnering with leading orthopaedic and sportsmedicine specialists to develop a new three-dimensional medical imaging system (investigational - not available for commercial sale) for capturing images of patient extremities (knees, legs, feet, arms and hands). Initial clinical studies will focus on the advantages of using cone beam CT (CBCT) technology in the diagnosis and treatment of knee injuries. This system is designed for use by orthopaedic surgeons, who are meeting this week at the annual

American Academy of Orthopaedic Surgeons conference. Imaging systems based on CBCT technology can be used in treating orthopaedic conditions. Carestream’s new CBCT system is designed to provide weight-bearing images of knees, legs and feet, which are difficult to obtain. “We are focused on applying CBCT technology for extremity imaging because it offers excellent visualisation of soft tissue and bone with systems that are smaller and more affordable than CT systems,” said Diana L

Nole, President, Digital Medical Solutions, Carestream. Carestream’s new extremity system may be adopted for use in urgent care facilities

and clinics, athletic training facilities, and orthopaedists’ and other specialty practice offices. “This system could make it

easier to obtain diagnostic exams immediately following an injury and help improve evaluation and treatment,” Nole explains. Nole adds that Carestream is working with top orthopaedic care providers and leading sports medicine experts to help guide current and future product development initiatives. The company’s development efforts include an agreement forged two years ago between Carestream and the Buffalo Bills with the goal of aiding Carestream’s understanding of the use of advanced medical imaging technology in early detection and monitoring of player injuries. This partnership continues to focus on the need for new technology to help address key concerns in sports medicine.

Reducing neonatal and maternal deaths in India Hitex Healthcare proposes usage of sterile ready to use disposable delivery set during delivery

INDIA ACCOUNTS for more than one fourth neonatal global death figures. A neonatal death is defined as a death during the first 28 days of life (0-27 days). Early neonatal death refers to a death between 0-6 days after birth. Late neonatal death refer to a death between 7-27 days after birth. Maternal death can be defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to

or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Pregnancy-related and infant deaths in the country has been a cause of concern according to the latest data released by the Registrar General of India. The figures of maternal mortality rate (MMR) vary across the country. There are states which have reacted to the situation and implemented measures in bringing down the MMR. Kerala and Tamil Nadu have surpassed the Millennium Development Goals

(MDG). The figures not only vary across different state, the situation in districts of same state also differ. For example, in Bihar the lowest is in Patna and double the figure is in Madhepura. Women need not die in childbirth. We must give a young woman the information and sup-

port she needs to control her reproductive health, help her through a pregnancy, and care for her and her newborn well into childhood. The vast majority of maternal deaths could be prevented if women had access to quality family planning services, skilled care during pregnancy, childbirth and after delivery, or post-abortion care services and where permissible, safe abortion services. Over a period of time, the percentage of institutional deliveries has been going up steadily. The schemes launched by government through NRHM has been instrumental in spreading awareness. State governments also have been taken initiative in reaching out to the remotest corner of the state. Hitex Healthcare will like to

propose usage of sterile ready to use disposable delivery set during delivery. The set has been developed under the guidance of experienced and leading gynaecologists. The fabric used is non-woven SMMMS, bi-laminates, tri-laminates etc which has been accepted world-wide as a barrier product. The proposed sets have all basic items needed for both types of deliveries and are very simple to use. As the sets are sterile, it can be used in remote areas as well where sterilisation facilities do not exist. Workshops and initial training for nurses and midwife needs to be conducted throughout each district. It will ensure hygienic conditions during delivery and will go a long way in bringing down the rate of mortality during delivery.

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TRADE & TRENDS

Haemostasis testing â&#x20AC;&#x201C; the way forward The diagnostic segment today comprises a wide array of specialties. With the availability of high-end technologies, it is possible to conduct an in-depth analysis of just about any parameter

COAGULATION REMAINS ONE of the most important parts of diagnosis in pathology and is routinely suggested as a first line test for disease detection. Ironically, the assay is still restricted to only PT/ ATT. Evaluation of even the fibrinogen level (FIB) is considered as a special test. Analysers available in the market offer nothing more than the clot-based tests (PT/ ATT) and FIB assays. Moreover, all analysers available in India work on the principle of either mechanical or optical detection. Mechanical detection is an age-old technique based on viscosity. It is an indirect method and is performed with a metal stirrer/bar/bead in the reaction cuvette. The latest direct measurement method is based on the optical scatter light (nephlometry) principle and makes use of clear reagents. This method offers much more information on clot formation than its predecessor.

Opening doors beyond routine coagulation Transasia Bio-Medicals has committed itself to offering the latest, highest quality systems across the globe for over 35 years now. Understanding the customer needs and going beyond limitations to provide the best solutions, has been its forte, earning it credibility globally. Transasia, alongwith its subsidiary ERBA Diagnostics, France, has developed a new semi-automated systemECL series. ECL 105 (single channel analyzer) and ECL 412 (four channel analyser)

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are capable of performing all clot, chromogenic and immunotubidometric assays (haemostasis). These systems employ the most advanced

and trusted nephlometry principle for detection. The innovative ECL 412 is the only system of its kind to perform the complete haemophilia and

thrombophilia panels. The wider test menu provides an edge over all the routine systems. The measurement of clots at 640nm is the first of its

PAUL FRANCIS PREM Sr Manager â&#x20AC;&#x201C; Business Development, Transasia Bio-Medicals

kind to measure HIL samples. Moreover, the multi-channel operations on ECL 412 enhances the parallel run of either the duplicate or fresh assays, thereby increasing the throughput. The system is capable of providing better calibration data for every parameter, resulting in higher accuracy of reporting. The large graphical display aids in viewing the reaction curve for the assay and analysing the data in correlation with the results. The system uses half the volume of reagents required, thereby making it cost effective with better precision. Today, most laboratories are accredited and have started using LIS. ECL provides for LIS compatibility and data export system. Vis-Ă vis its counterparts, it offers a wider data storage capacity, an expandable memory and provision for interface and transfer of information. The system is complimented with a validated, high quality, economically priced range of reagents provided by Transasia. By far, the most advanced, the ECL series along with its reagent range, provide much beyond the clot-based assays, offered by all other semi-automated analysers in the market. With its unmatched services, the system is best suited to serve not just standalone labs but corporate hospitals, chain labs and referral labs as well. All in all, the system offers all test features of a fully automated coagulation analyser on a semi automated system.

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