Express Healthcare (Vol.9, No.6) June, 2015

VOL.9 NO.6 PAGES 68

www.expresshealthcare.in JUNE 2015, `50

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CONTENTS MARKET Vol 9. No 6, JUNE 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

HEALTHCARE MARKETING

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CHANGING PANORAMA Healthcare players have woken up to the need of engaging their customers effectively to stay ahead of the competition.As a result, they are opting for marketing strategies which are innovative and nonconformal in nature | P41 P18:INTERVIEW: DR MOHAN THOMAS Senior Cosmetic Surgeon with Breach Candy Hospital

P36:INTERVIEW: DR RAJAN DATAR

GENETIC DIAGNOSTICS SPECIAL

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ETHIOPIA OFFERS 100% FDI TO INDIA HEALTHCARE SECTOR

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BLK HOSPITAL SIGNS PACT WITH UZBEKISTAN GOVT

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NABH, WORLD BANK RELEASES PRE-ACCREDITATION GUIDEBOOK FOR SHCOS

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RESEARCHERS DISCOVER WAYS TO BLOCK SIGNALS INVOLVED IN BRAIN DISEASES

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NH’S OVERSEAS HOSPITAL, HEALTH CITY CAYMAN ISLANDS GETS JCI ACCREDITATION

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INTERNATIONAL SOS LAUNCHES LEGAL FRAMEWORK ON DUTY OF CARE

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SEMINAR AT SYMBIOSIS ON HOSPITAL & HEALTHCARE MANAGEMENT, MEDICO LEGAL SYSTEMS & CLINICAL RESEARCH

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HSSA CONDUCTS STERITECH 2015

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Founder, Datar Genetics

P39:INTERVIEW: DR VIJAY CHANDRU Chairman and CEO, Strand Life Sciences

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

Making a living

T

he cloak of altruism does not quite fit the blood transfusion value chain in this country. The theme of this year's WHO World Blood Donor Day campaign, which is marked every June 14, is ‘Thank you for saving my life’. By thanking voluntary blood donors and highlighting how they have saved patients' lives, WHO hopes to motivate more voluntary blood donations. Its final goal is that all countries receive 100 per cent blood supplies from voluntary unpaid donors by 2020.

But, blood supplies is a billion dollar business and in countries like India, the skewed demand-supply gap makes it well nigh impossible to envisage a day when the country can achieve WHO's 2020 target. As the cover story in this issue highlights, the cloak of altruism does not quite fit the blood transfusion value chain in this country (See story: License to bill, pages 20-25). Spanning donation to disbursement, including all the steps of collection, testing, processing and distribution; the blood supplies industry could do with a strong dose of regulation so that patients can get guaranteed access to safer, more affordable blood supplies, when they need it most, wherever they need it. This is a distant dream for most patients and their relatives today. With the size of India's population, it is only to be expected that not much remains philanthropic but limits must be set for the greater public good.

Genetic diagnostics, also called molecular diagnostics, is another area where India is considered one of the fastest growing markets.

Globally projected to be worth $7.9 billion by 2018,

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The cloak of altruism does not quite fit the blood transfusion value chain in this country

a MarketsandMarkets report predicts a CAGR of 9.7 per cent during the forecast period (2013–2018), with Asia slated to be the most promising region for molecular diagnostics in the coming five years, as it plays catch up with the rest of the world.

But the path for genetic diagnostics and the resulting practice of personalised medicine will not be smooth. As the lead story in the genetic diagnostics section analyses, the euphoria surrounding the medical genetics revolution has been tempered by major analytical and interpretative challenges that have emerged in recent years. (See story, Tracing the trends in genetic diagnostics, pages 28-31).

India is not the only country where genetic diagnostics has a promising but challenging future. A PwC report on 'The Science of Personalized Medicine: Translating the Promise into Practice', calls it a disruptive innovation that will create both opportunities and challenges for traditional healthcare and emerging market participants. For instance, as the report points out, the growing direct-to-consumer (DTC) diagnostic market is convenient for consumers but also controversial.

And as India lacks skilled counsellors to interpret these results, patients and their relatives could end up taking the wrong decisions.

India is nowhere close to ensuring equitable access to these and other healthcare facilities and services. As the euphoria of PM Modi's first year wears off, let us hope that he and his team get down to bridging the gaps and converting slogans into reality.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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LETTERS QUOTE UNQUOTE

MAY 2015

We forget that health requires a holistic view of being one with nature,adopting healthy lifestyles and avoiding excesses.While taking pride in a fair amount of success in meeting the health-related Millenium Development Goals,we need to redouble our efforts to surmount the ever-increasing public health challenges, which include,among others,communicable diseases,non-communicable diseases,anti-microbial resistance,impact of climate change on health and universal health coverage

A GOOD READ

T

hank you for the wonderful story that you did.

(Ref: Waging a war against tobacco, EH May 2015 issue) It came out very well.

JP Nadda

Binoy Mathew Media Officer Tobacco Control Voluntary Health Association of India

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

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Union Health Minister, India (In his speech after assuming presidency of the 68th World Health Assembly in Geneva)

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MARKET NEWS

Ethiopia offers 100% FDI to India healthcare sector Land will be offered to Indian entrepreneurs besides other incentives and tax facilities to set up hospitals and other healthcare facilities

ETHIOPIA OFFERED 100 per cent Foreign Direct Investment (FDI) facility to India for setting up hospitals and other healthcare facilities in Ethiopia.

The host country will acquire land for Indian entrepreneurs and offer other incentives and tax facilities as well.

Addressing a summit on 'India: The Future Global Healthcare Hub' under the aegis of PHD Chamber of Commerce and Industry, Ambassador of Federal Democratic Republic of Ethiopia Gennet Zewide said, “Many patients travel from Ethiopia and other African countries for super critical care facilities.” He also informed that Ethiopia intends to explore the country for setting up of a host of medical services including concessional land and bunch of incentives including holidays schemes to suitably protect the Indian investments in the health sector.

The summit also saw a vast majority of African diplomats

The summit was also attended by a vast majority of African diplomats from countries such as Republic of Rwanda, Zimbabwe, Egypt, Gambia from countries such as Republic of Rwanda, Zimbabwe, Egypt, Gambia who were also participating in summit, demand that facilitation centres for visiting patients and their relatives from African countries be set up in Indian metropolis with super critical facilities to ensure that they are not fleeced by hospital owners due to excessive over invoicing. They allege that visiting patients in need of best of medical facilities fall prey to touts, middle men and brokers who recommend nursing homes making false claims.

Apart from Ethiopia other diplomats such as High Commissioner of the Republic of

Rwanda Ernest Rwamucyo; Ambassador of the Republic of Senegal El Hadj Ibou Boye; Ambassador of Zimbabwe Mawxell Ranga; Minister Commercial Bureau, Embassy of Arab Republic of Egypt Mongy Badr; Counsellor, High Commission of Gambia Alieu Bah, also raised the issue.

Mongy Badr, Minister Commercial Bureau, Embassy of Arab Republic of Egypt, hailed the approach of the Modi government towards promotion of India’s service sector since it contributes the largest share to the nation’s GDP. Among others who also endorsed the demand for creation

of such facilitation centres were Director, Fortis Organ Retrieval and Transplant and Gastroenterology and Hepatobiliary Sciences Dr Avnish Kumar Seth; Senior Consultant Renal Transplantation Department, Gangaram Hospital Dr H Jauhri; Medical Director, Indian Spinal Injuries Centre Dr H S Chabbra; Unit Director, Rockland Hospital Navneet Bali.

The Chairmen of International Affairs Committee for Africa and Health Committee of PHD Chamber, Sanjeev Sardana and Nishant V Berlia including the Secretary General of the Chamber, Saurabh Sanyal assured the participants that the chamber would take up the issue of setting up of facilitation centres for visiting African patients in India with the Ministry of External Affairs and other departments of the government so that fleecing of patients are stopped.

EH News Bureau

Tribeca Care to expand its operations to Delhi-NCR and other metros TRIBECA CARE is expanding its operations to New DelhiNCR and gradually to other key metros. Tribeca Care provides medical, non-medical and emergency services for elder care services.

Tribeca Care Managers work with families and healthcare providers to provide home care to older, chronic patients.

According to Tamojit Dutta, Founder and Co-CEO, Tribeca Care, “In the US, Long Term Support Services (LTSS) is a $400 billion industry that benefitted from enormous public and private investments over many years. With 110 million senior citizens, India has the largest aged population in the world. However, managing elder care in India is a major challenge for most busy and nuclear families. Lack of professional care infrastructure makes elder care both stressful and difficult to manage – especially at home. We, at Tribeca Care, are endeavoring to make it easier for adult children, who sometimes live in another city or even country, to manage day-to-day care of their older loved ones.”

EH News Bureau

BLKHospital signs pact with Uzbekistan Govt DELHI-BASED BLK Super Speciality Hospital has signed an MoU with Republican Research Center of Emergency Medicine (RRCEM), an Association of Emergency Physicians at Uzbekistan, to establish cultural, educational, scientific and medical cooperation in various spheres

on the basis of equality and mutual benefit. RRCEM is reportedly the biggest emergency care provider in Uzbekistan. Among others, this shall pave way for development of joint international projects and research.

The MoU was signed by BLK Super Speciality Hospital Direc-

tor Naresh Kapoor and Dr AM Khadjibayev from RRCEM. This pact will enable both hospitals to organise an exchange programme for undergraduate and post-graduate students, informs a press release.

BLK Super Speciality Hospital will help in training and develop-

ment of doctors for emergency care at the hospital in Uzbekistan. These trained doctors can then avail advanced training and observership in emergency care at the BLK Super Speciality Hospital in Delhi. BLK Super Speciality Hospital shall also offer residency training programme

for graduate and postgraduate students in the areas of cardiology, oncology, neurology, orthopedics, bone marrow transplant, at its premises in India subject to the rules and provisions prescribed by Medical Council of India and other authorities.

EH News Bureau

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MARKET

NABH, World Bank releases preaccreditation guidebook for SHCOs SHCOs that aspire to improve the quality of their care but lack the internal capacity to achieve this on their own, will benefit from this document

THE ‘GUIDEBOOK for PreAccreditation Entry-Level Standards for Small Healthcare Organizations’ was recently released by NS Kang, Additional Secretary and Director-General, CGHS, Ministry of Health and Family Welfare, Govt of India, in the presence of senior government officials from all over the country. The guidebook is a product of a collaboration between the National Accreditation Board for Hospitals & Healthcare Providers (NABH) and the quality collaborative initiative

of World Bank. Reportedly, a team of renowned experts in healthcare quality, with considerable experience in accreditation and quality assessments, led by Dr Alexander Thomas (President, CAHO), Dr Somil Nagpal and Dr Abha Mehndiratta (both of the World Bank) developed this document.

Currently, there are around 300 NABH-accredited hospitals in the country. With the introduction of the pre-accreditation entry-level standards for SHCOs published by NABH, quality is within the reach of

It an important milestone in an effort to standardise healthcare at the grassroots and will have far-reaching effects

smaller hospitals, nursing homes and healthcare organisations of India. The IRDA, RSBY and many state governments are considering the entry-level standards as a requirement for empanelment within the next few years.

NABH claims that this guidebook is, therefore, an important milestone in an effort to standardise healthcare at the grassroots and will have far-reaching effects across the country. It contains comprehensive information with tools and templates on 27 selected entry-

level standards for small healthcare organisations (hospitals under 50 beds), out of the 41 standards published by the NABH. SHCOs that aspire to improve the quality of their care but lack the internal capacity to achieve this on their own, will benefit from this document. Dr K Kalra, CEO, NABH, has commended this document as a piece of ‘excellent work.’ The guidebook will be made available online on the NABH website.

EH News Bureau

Researchers discover ways to block signals involved in brain diseases The researchers hope that continuation of their work could lead to improved treatments for neurological conditions such as stroke and chronic pain, depressive and anxiety disorders

A RESEARCH team based at the University of Eastern Finland and the Turku Centre for Biotechnology have found new ways to block a pathway that may be responsible for several brain disorders, which could open the door to developing better treatments.

The protein NOS-1 generates nitric oxide, a chemical signal that is linked to neurological disorders from neurodegeneration, stroke and chronic

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pain sensitivity to anxiety and depressive disorders. These are now among the most common causes of disability and mortality, but decades of efforts have not led to a safe drug that controls NOS-1.

The researchers involved in the new work previously found that neurodegeneration or brain lesions caused by NOS-1 requires it to bind another protein called NOS1AP (or CAPON). They asked if dam-

age can be reduced by preventing binding of NOS1AP to NOS1, as NOS-1 cannot directly be controlled by drugs.

The researchers now reveal NOS1AP binds to NOS-1 in a surprisingly complex manner, and developed two separate ways to prevent it. By studying precisely how NOS1AP binds to NOS-1 they found two separate sites of interaction, by demonstrating that two different parts of NOS1AP are re-

quired for binding to NOS-1 on separate sites. Each site could be blocked, one by a peptide previously developed by the team and the other by a new synthetic protein generated for this study. The second site was completely unexpected as no similar interaction had been previously described and so nobody had known to look for it before. Blocking either site by itself reduced the damaging signals caused by NOS1 in

brain cells. The results were replicated in several regions of brain tissue that are sensitive to degeneration caused by NOS-1. This means that it is now easier to design drugs that control damaging signals from NOS-1 in the brain because it can be done in two different ways or both ways may be combined.

(Source: University of Eastern Finland)

MARKET

NH’s overseas hospital, Health City Cayman Islands gets JCI accreditation It is only the second hospital in the region to have received a JCI approval

NARAYANA HEALTH’S Health City Cayman Islands (HCCI) has received the Joint Commission International (JCI) Gold Seal of Approval.

Launched in February 2014, this recognition is received just over a year of Health City Cayman Island’s operations.

Reportedly, it is for the first time that an Indian healthcare chain has set-up a hospital in the western world and it is only the second hospital in the region to have received a JCI approval.

Dr Devi Shetty, Founder and Chairman, Narayana Health said, “It is rewarding to see our efforts recognised with the accreditation by JCI which has expanded our credibility worldwide. JCI’s endorsement of our state-of-theart clinical facilities and of medical treatment further reinstates the Narayana Health commitment.”

Narayana Health is associated with Ascension Health Alliance, one of the largest private, non-profit healthcare networks in the US, to provide quality services at HCCI. Dr Ashutosh Raghuvanshi, Vice Chairman, MD and Group CEO, Narayana Health, “HCCI has continued to demonstrate how the group’s high-quality, low-cost model can be successful and impactful in the western world as well. It has completed over a year of operations and received a JCI approval. The majority of Health City's team members come from institutions where quality has

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become a way of life, allowing the hospital to achieve this important accreditation in such a

short time.”

The Joint Commission International Hospital Standards

aim to stimulate continuous, systematic and organisationwide improvements in daily

performance and in the outcomes of patient care.

EH News Bureau

MARKET

Industry urges for stringent tax policy for tobacco-products Globally tobacco will kill over 8 million people every year by 2030- WHO Raelene Kambli, Mumbai TOBACCO IS one of the major cause of cancer and cardiovascular diseases in India. According to WHO, around six million people each year globally die due to tobacco consumption. Moreover, the epidemic will kill over eight million people every year by 2030 and more than 80 per cent of these preventable deaths would occur in low and middleincome countries.

On the occasion of World No

Tobacco Day, experts highlight the need for stringent tax and pricing policy for tobacco-products in order to reduce its consumption in India.

Says Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region, “Countries are constantly defining ways to curb tobacco consumption. Tax and price policies are widely recognised as most effective for reducing demand for and consumption of tobacco products. These measures together with strong pictorial warnings have brought substantial health care gains.”

Dr K Srinath Reddy, President, Public Health Foundation of India, opines that raising taxes on tobacco is the most effective way to reduce its consumption.

He urges to take lessons from countries like Mexico and elabo-

rates, Mexico had raised taxes on tobacco products and have sucessfully reduced to number of deaths caused by it within the country. He further explains, “This strategy will lead to significant improvement in public health. Rising taxes will lead to high prices of tobacco products which inturn will make it difficult for poor people especially women and youth to purchase these products and use it. This will lead to a positive health impact and will also help in generating revenue for the country through these taxes.”

Not just Mexico, even Philippines has adopted this strategy to bring down the tobacco menace within the country. According to a WHO report, in 2012 the Government of Philippines sucessfully raised taxed on tobacco despite strong opposition

from the tobacco industry. They called it the 'Sin-Tax Reform Bill' and believed that this important piece of legislation will buttress the Philippines government’s health agenda and address the high prevalence of smoking in the country. The Departments of Health and Finance joined forces to communicate, through a powerful media strategy, the health benefits of the tax reform bill.

So should India, follow suit?

“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”, feels Dr Monika Arora, Director: Health promotion and Associate Professor, PHFI. Like Dr Arora and Dr Reddy, many industry leaders also be-

lieve that a stringent tax policy for tobacco-products will work in favour of India. However, there are some who feel the need to also ramp up the awareness drives for the same.

Amol Naikawadi, JMD, Indus Health Plus says, “An increase in taxation on tobacco products reduce the consumption of tobacco among youth and mid age group. To encourage people to quit smoking, other than increasing the prices of tobacco, the rule of no public smoking should be strengthened and people should follow the same stringently. It is imperative to spread awareness amongst masses about the consequences of tobacco consumption. Self-realisation will drive an individual from quitting tobacco and leading a healthy life.” raelene.kambli@expressindia.com

International SOS launches legal frameworkon Dutyof Care The paper provides a guideline for Indian companies on protecting their workforce travelling within and outside India, by mitigating health and travel-related risks INTERNATIONAL SOS, leading medical and security services provider, has launched a paper on Duty of Care, to help Indian companies ensure the safety and security of employees while at work, locally and abroad.

In partnership with Nishith Desai Associates, a researchbased Indian law firm, the paper provides a guideline for Indian companies on protecting their

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workforce travelling within and outside India, by mitigating health and travel-related risks.

Reportedly, the paper covers a broader concept of the workplace - which according to Indian law is considered to be out of the conventional premises of the company – and includes deputations abroad.

Endorsed by the Employers Federation of India, the paper: ◗ Compiles the main national

regulations related to the management of work health and safety responsibilities of employers when deputing employees abroad ◗ Highlights implications employers face when duty of care is breached. These include direct costs (such as evacuation, repatriation and post incident medical costs) and indirect costs (such as litigation costs, salary costs, administrative costs, pro-

ductivity losses and damage to company reputation) ◗ Provides business travel and security advice and recommends risk mitigation programmes, such as pandemic preparedness plans as well as emergency and crisis response plans Nicolas Bertsche, General Manager, International SOS India said, “The recommendations in this paper will help

Indian companies achieve a return on prevention, through the compliance of applicable regulations and best practices with respect to employee health and safety. We are confident it will deepen our relationship with our existing clients, and help Indian companies carry out their Duty of Care obligations in a structured approach.’’

EH News Bureau

MARKET POST EVENT

Seminar at Symbiosis on Hospital & Healthcare Management, Medico Legal Systems & Clinical Research Two day seminar brings together all stakeholders in the healthcare industry SYMBIOSIS INSTITUTE of Health sciences (SIHS), a constituent of Symbiosis International University (SIU) organised a seminar on “Hospital and Healthcare management, Medico-legal Systems and Clinical Research� held at its Lavale campus in Pune recently. The event was inaugurated by Dr Rajiv Yeravdekar, Dean, Faculty of Health and Biomedical Sciences; Dr Vidya Yeravdekar, Principal Director, Symbiosis, Dr Rajani Gupte, Vice Chancellor SIU, Anjan Bose, Director General, NATHEALTH, Dr Santosh Shetty, Executive Director, Kokilaben Dhirubhai Ambani Hospital-KDAH; Dinesh Lodha, Country Manager & Business head, Samsung and Anand Deshpande, President, Persistent.

Dr Yeravdekar set the pre conference symposium in motion by delivering a

The seminar covered issues like branding and advertising in healthcare, careers in public health, patient safety, and medical laws EXPRESS HEALTHCARE

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MARKET key note address on successful healthcare models. Bose anchored a session that saw various stakeholders share their views. Dr Shetty shared his experience while Lodha gave insights into the trends, opportunities and innovations in various verticals of Indian

healthcare industry with special reference to medical devices industry.

Pharma industry's growth was outlined

by Dr Abdoos Farooqui, Assistant Professor, SIHS while Anand Deshpande mulled on IT in healthcare. Adheet S Gogate, Partner and Head,

Philips Healthcare, India spoke about entrepreneurship in healthcare.

This was followed with sessions that discussed branding and advertising in healthcare, careers in public health, patient safety, diagnostics industry, medical

laws among others. The valedictory ceremony was graced

by Chief Guest, Suneeta Reddy, MD, Apollo Hospitals Enterprise. The Guest of Honour for the ceremony was Advocate Ram Jethmalani, Former Union Law Minister.

The star alumnus award

was presented to Dr Sunil Bandekar, Medical Superintendent, Breach Candy Hospital Trust Mumbai and Dr Mahesh Karajgikar, CEO, Waleed Pharmacy and Stores, Muscat, Sultanate of Oman, for their stellar contributions in healthcare industry.

HSSA conducts STERI-TECH 2015 The seminar aimed to be an initiative to collectively ensure stringent level of sterilisation and highest quality of patient care in the healthcare industry

HOSPITAL STERILE Services Association (HSSA) recently organised a full day seminar 'STERI-TECH 2015' in Mumbai. More than 200 participants attended this seminar and 45 vendors displayed their products.

The seminar was able to stride ahead with an initiative to collectively ensure stringent level of sterilisation and highest quality of patient care in the healthcare industry. HSSA continues its efforts to create awareness and keep every stakeholder updated on the latest trends and knowledge in critical CSSD activities and patient care. The seminar had presentation and discussion regarding CSSD techniques and other affiliated issues with latest updates on international standards.

The seminar started with a welcome speech by Neena Kulkarni, Secretary, HSSA and introduction speech by SP Gaonkar, President, HSSA. The seminar was inaugurated by Dr Ramesh M Chaturvedi, Dean, Cooper Hospital, Mumbai.

Felipe Mejia, Director of Project Planning CSSD, Belimed, gave a presentation on 'Planning and Designing of CSSD.' He highlighted the need for a unidirectional flow of AHU system. He emphasised the ‘must’ demarcations in the department and also pointed out those which could be given a low pri-

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ority in case of constraint of space and other resources.

Dr Vithal Kamat, Executive Chairman and MD, Kamat Hotels India, gave tips on how to reach the level of excellence in any industry, hospitality or healthcare. He shared his own experiences to communicate his basic theory of excellence and success.

Dr Aruna Poojari, Sr Microbiologist in Breach Candy Hospital, spoke about the challenges caused by biofilms in the sterilisation process. This area was more or less getting neglected in the cleaning science which is a pre requisite for the success of sterilisation.

Richard Bancroft, Development and Technical Service Director of Albert Browne spoke about international standards and quality assurance in CSSD. His involvement in standardising EN standards in Europe made his presentation more authoritative and understandable.

Dr Hrishikesh Vaidya, Medical Director of Horizon Hospital, based in Thane, expressed his views about how the CSSD should function to realise the requirements of a nursing home type of hospital. This presentation was useful for small hospitals to work in line with right practices of CSSD with limited resources.

Karnik Parikh, Director, Pharmalab India took the dele-

HSSA committee members (L-R): RD Bhogle, SP Gaonkar, Jayakrushna Nayak, Netra Vaidya, V Murlikrishnan, Neena Kulkarni, BP Singh and Jay Singh

gates through the anatomy of steam sterilisers in a very simple way. As most of the CSSD staff action is limited to only operation of the sterilisers, there was a gap of understanding of basic minimum know-how about the technical aspects of the sterilisers.

Sarbajit Dey, Service Manager, STERIS INDIA gave a detailed illustration about the recent innovation of hydrogen peroxide sterilisation. Although these types of sterilisers have become a common asset in most of the Indian CSSD, it is still unknown to a huge volume of the CSSD personnel.

Shine Anil, Dy Chief of Nursing at Wockhardt Hospitals, made a change in the concept about service to operation theatre through CSSD by highlighting CSSD and OR

Token of appreciation to Dr Vithal Kamat for his presentation by Netra Vaidya (Treasurer-HSSA) and SP Gaonkar (President-HSSA)

collaboration. Quite a few points were discussed on how CSSD can develop a better image in customer care issues although it is a back operation.

The seminar ended with a quiz competition and all the delegates were awarded with participation certificates.

EVENT BRIEF JUNE - OCTOBER 2015 20

EVOLVING HEALTHCARE INVESTMENT LANDSCAPE

EVOLVING HEALTHCARE INVESTMENT LANDSCAPE Date: June 20, 2015 Venue: Taj Gateway, Kolkata, Summary: A conference on scope of VC & PE funds, debt funds and angel funds in healthcare

31

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MEDICALL 2015

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June 2015

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‘100 per cent FDI permission in medical equipment sector will facilitate M&A transactions’ Ever since Indian industries have started globalising their business, M&As have played a significant role in corporate restructuring and expansion. Anand Bhageria, Partner at Singhi Advisors and Narayan Shetkar, Director at Singhi Advisors talks about the M&A activities within the pharma and healthcare industry, in conversation with Raelene Kambli

How many M&A deals were closed in healthcare last year?

Shetkar: In 2014, 22 deals were closed totaling $150 million. In 2015, eight deals were closed till date totalling $150 million.

What is the current state of M&A deals within these two sectors?

Shetkar: Consolidation will accelerate with: ◗ Single state/regional players will enter other regions to gain presence/entry ◗ Large healthcare groups will eye speciality chains to fulfill the service offerings ◗ Strategic tie-ups (like Apollo – Sanofi for Sugar Clinics diabetes) will increase ◗ Multinational companies are continuing to collaborate with Indian pharma firms to develop new drugs ◗ Indian players are focussing on entering new markets with new opportunities. For e.g.

Lupin is making inroads into new markets such as Latin America, Russia and other East European countries. ◗ Foreign generic companies are looking for acquisitions in India

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After the Ranbaxy-Daiichi deal went through a lot of hitches, deals in the pharma sector decreased. Are there any signs of improvement?

Bhageria: To our mind, even though the volume of pharma deals that happened in 2008 could not be touched till 2015, Indian pharma sector has seen consistent and numerous deals since 2008-2015 and the deal outlook is positive for the coming years. The reason for the spurt in deals in 2008 could be the pre subprime levels.

Thus, inspite of the issues which surfaced in the RanbaxyDaiichi deal, there have been other large ticket deals like Mylan-Famy, Ranbaxy-Sun, Elder-Torrent, Agila-Mylan, Ascent-Watson, PiramalAbbott Shantha-Sanofi etc. post the Ranbaxy-Daiichi deal which further confirms the good health of the Indian pharma sector.

Is the Indian pharma industry expected to witness major consolidations in the API sector?

Bhageria: Yes, we expect consolidation owing to the following reasons: ◗ Financial distress amongst independent API players.

blocks of the pharma chain and yet account for less than 10 per cent of the pharma industry globally. We believe that Indian pharma players wanting to expand/augment their API manufacturing capabilities would actively look to pursue such opportunities. Larger industry players would also help in meeting stringent regulatory compliance requirements of these units.

We expect growth momentum to sustain in the near-tomedium term ANAND BHAGERIA, Partner at Singhi Advisors

Several of these companies have acquired critical skills/regulatory approvals.

However, they are reeling under huge debt and long working capital cycles; and have poor ROCE levels. Large players, working with banks and the existing promoters,

Diagnostics players will tap the IPO market and acquire speciality diagnostics like molecular and genomic testing NARAYAN SHETKAR, Director at Singhi Advisors

could revive these units by providing necessary capital injection and aligning debt. ◗ APIs are the critical, building

What is the news in the healthcare sector? Which are the major deals that happened last year?

Shetkar: Diagnostics players will tap the IPO market and acquire speciality diagnostics like molecular and genomic testing. Regional diagnostics players will expand their geographic reach further The majore deals are as follows: ◗ Manipal Group entered Rajasthan by acquiring the 250-bedded Soni Hospital. ◗ Narayana Hrudayalaya entered East India by acquiring 325-bedded West Bank Hospital for Rs 200 crores ◗ Sun Pharmaceutical Industries acquired Ranbaxy Laboratories for a total

MARKET

consideration of $4 billion (Rs 240 billion) from Daiichi Sankyo Company in an all stock transaction. Upon closing, Daiichi Sankyo received 8.9 per cent stake in Sun Pharma. ◗ Japan-based Meiji Holdings acquired 100 per cent stake in Medreich for Rs 1,750 crores ◗ Strides Arcolab acquired 100 per cent stake in Shasun Pharma for Rs 1,300 crores ◗ Aurobindo Pharma acquired commercial operations of Actavis Group for total consideration of $ 40.76 million (Rs 240 crores). ◗ Aurobindo Pharma acquired US-based Natrol Inc for approximately $132.5 million (Rs 814 crores) ◗ Torrent Pharma acquired branded formulations business of Elder Pharma in India and Nepalfor a total consideration of $ 322 million (Rs 2,000 crores).

Which are the big deals in the offing for the pharma and healthcare sector in 2015?

Shetkar: They are: ◗ Parkway Hospital of Singapore has acquired 51 per cent stake in Hyderabad-based 750-bed Continental Hospital for Rs 250 crores ◗ There are deals under progress in Seven Hills Hospital (Mumbai), Global Hospitals (Hyderabad), MedPlus (Pharmacy Chain) ◗ Daiichi Sankyo sold its entire 8.9 per cent stake in Sun Pharma for $3 billion ◗ Torrent Pharma is planning to acquire the dermatology business of Mumbaiheadquartered Encore group in a deal size of Rs 350 crores ◗ Mylan Inc entered into a definitive agreement to acquire women's health business in Mumbai-based Famy Care for $ 800 million (Rs 4,956 crores).

How will the tax proposals announced during Budget 2015 help both in-bound as well as out-bound M&As in theboth industries?

Shetkar: Increase of insurance cover will boost health insurance and indirectly benefit delivery providers and 100 per cent FDI permission in the medical equipment sector

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June 2015

will facilitate M&A transactions.

What are your predictions for the coming months?

Bhageria: With steady demand being witnessed across therapy segments and price hikes taken by companies in line with Drug Price Control

Order (DPCO) guidelines, we expect growth momentum to sustain in the near-to-medium term.

One important industry move that you would like to highlight?

Shetkar: The national drug

pricing regulator, National Pharmaceutical Pricing Authority (NPPA) intensified its bid to control prices of medicines in order to make them affordable. In a move aimed to bring down prices of some of the key medicines, NPPA fixed the price of 108

non-scheduled formulation packs of 50 anti-diabetes and cardiac medicines. However, it had to withdraw internal guidelines for further such price control actions issued under Para 19 of the DPCO, 2013 later. raelene.kambli@expressindia.com

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‘The estimated size of the overall cosmetic surgery industry is worth $110 million’ India is considered to be a hub for cosmetic surgeries. Dr Mohan Thomas, Senior Cosmetic Surgeon with Breach Candy Hospital, Mumbai speaks about the growing market, the opportunities and challenges in the industry and laws associated with the practice in India, in conversation with Raelene Kambli

What is the current size of the cosmetic surgery market in India?

Indian cosmetic surgery market is anticipated to witness remarkable growth in the coming years. The reason being increasing consumer awareness, direct marketing and advertising campaigns and technological advances in surgical and non-surgical procedures, resulting in high growth of cosmetic surgery market in India. Growing disposable income of middleclass households and a gradual shift in people’s desire to look presentable and more beautiful for a longer period of time is the driving force behind the cosmetic surgery industry. Today, anti-ageing surgeries and cosmetic procedures are rapidly gaining popularity in India.

The estimated size of the overall cosmetic surgery industry is worth $110 million (around Rs 460 crores) with the maximum revenue by invasive or surgical procedures as their costs are comparatively higher than the non-invasive procedures. With the growing anti-ageing industry, that is three per cent of the entire skincare segment

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in India, offering solutions to large numbers of women, it’s never been easier to eradicate the lines and wrinkles that make you look older than you actually are. This has given rise to the growth of non-invasive procedures in comparison to the invasive procedures.

What are the new trends in this field?

Due to the rising obesity epidemic, men are increasingly getting breast reductions. Dermabrasion, a type of skin polishing, has nearly doubled. Among other things, the procedure helps people get rid of acne scars.

With an increasing number of people going in for weight loss on their own or aided by bariatric surgery, deflation syndrome causing very loose skin has become very common. The procedures that have gained popularity are the ones that snip away excess skin, such as arm lifts, breast reductions and tummy tucks.

Buttocks have also gained prominence among females with many of them wanting perky butts.

Newer entrants in cosmetic treatments include:

Cosmetic procedures and methodology should be subjected to rigorous research protocols

Botox therapy: The therapy is considered as an alternative to botulinum toxin to treat wrinkles. Rather than causing temporary paralysis of muscles with botulinum toxin, the nerves to the muscles are frozen causing a similar effect. Research shows that the treatment lasts for several months and has similar effects to botulinum toxin.

Vampire facelifts: Another innovation in cosmetic treatment is the use of a patient’s own plasma (the protein rich liquid component of blood) to enhance facial features. It is said to reduce wrinkles, improve facial volume and rejuvenate the face. The procedure is said to be at a very nascent stage and there is no substantial research to prove the benefits gained from reinjecting a patient’s own blood products into their tissues and any effect is likely to be temporary.

Fractional laser: Many talk of the ideal treatment that lessens the time of the procedure. Fractional laser can resurface the skin to rejuvenate the areas such as the face or hands. Although recovery is much quicker, this

is because a small total area has been treated as compared to conventional lasers and repeat visits are often needed.

Non surgical fat loss: Use of radiofrequency and magnetic therapy to help shrink the skin and destroy the fat cells to achieve good results.

What are the opportunities and deterrents for the industry?

Cosmetic procedures in India and across the world are treated as a commodity. False and misleading promotions flourish in conventional and online media in the fight for a share of the market and the patients’ welfare becomes secondary as gimmicks are promoted in the name of scientific development. Such kind of promotion leads to commercialisation of the speciality and is contrary to the efforts to make the discipline a legitimate medical practice.

To maintain the ethics of the speciality, it is quite essential that the cosmetic procedures and methodology should be subjected to rigorous research protocols before they are used on

MARKET

patients. Any surgical initiative in cosmetic surgery must adhere to the highest standards of research for subject protection. It is quite essential to safeguard the health and welfare of the patients opting for cosmetic procedures.

What about regulations?

There is very little regulation of the use of specific products for cosmetic purposes. There is relatively very little monitoring of the efficacy and safety of cosmetic procedures and treatments.

Use of limited mechanism makes it difficult to prevent the use of demonstrably harmful procedures. Use of injectables, applicables and the technology should be FDA approved, preferably US FDA approved.

What are the current laws for cosmetic surgeries and aesthetics procedures in India?

A plethora of surgical and non-surgical treatments are provided in the aesthetics industry. Surgeries are usually performed by well-trained cosmetic and plastic surgeons.

However, the number of cosmetic procedures performed in India is rapidly on the rise. What is alarming is that the legal regulations surrounding the use of cosmeceuticals are surprisingly lax. The problem with the cosmetic industry is

The medical community needs to initiate steps to improve the ethical practice of cosmetology in India. Scientific evidence of the safety and efficacy of cosmetic procedures and devices is needed to assure the public that the interventions being offered have been evaluated properly that in terms of laws and regulation, it is not at all treated like a separate branch of medicine. It is important to make people understand the need to choose the right premises and practitioners, both private and public, that are directly involved in the performance of a procedure.

For e.g. It is not possible to have control on sex to prevent AIDS but the only way forward is to educate and sensitise people about AIDS. Similarly, the end user needs to take an educated call on the procedures that are good and apt for his or her concerns. He or she should not fall prey to dreams in a bottle.

The centre he chooses should have adequate facilities and the practitioner should be well qualified to carry out the procedure.

People should understand that these are medical procedures and should be conducted with the same care and diligence in an adequately

equipped facility.

The demand for cosmetic surgery is on the rise, and it is an industry that can possibly generate profits. However, the profit motive should never be allowed to interfere with the delivery of healthcare and the trust that patients place upon the practitioners.

Currently who certifies these procedures?

The American Board of Cosmetic Surgery along with the American and International Board of Aesthetic Plastic Surgery and American Academy of Dermatology is the certifying board devoted solely to examining a surgeon’s skill in cosmetic procedures of the face and body. It is an independent sub-speciality board that examines and certifies physicians in general, facial and dermatological cosmetic procedures.

In India, individual societies that are under the medical

board control and grant certifications in broad based specialities. The surgical procedures performed are all standardised and part of published literature in the peer reviewed journals and no experimental surgery is conducted.

The government intends to introduce regulations for cosmetic surgeries. What is your opinion about this? How will this impact the industry?

Currently, it’s important to regulate the poor and unsafe practices carried out in the cosmetic sector and particularly, the non-surgical interventions that are almost entirely unregulated. The requisite medical boards and authorities are already present to have checks on the extent of this practice and they do have regulations to improve the quality of training and patient care. I would like to point out that this is a significant area of medical practice which has

grown enormously in the recent years. We need to make sure that patients are protected and that the doctors and others undertaking cosmetic procedures have the training and skills needed to undertake this work. Not newer regulations but adequate education is going to help in that direction.

How can we curb malpractices in this field?

The medical community needs to initiate steps to improve the ethical practice of cosmetology in India. Scientific evidence of the safety and efficacy of cosmetic procedures and devices is needed to assure the public that the interventions being offered have been evaluated properly. Hands-on training of medical practitioners and non-medical personnel should be carried out and certificates provided.

The procedures initially should be carried out under the guidance of an expert and patients should insist on having a qualified, experienced professional conduct the procedure in a medical facility which has been certified for the requisite purpose.

Instead of policing cosmetic practitioners it is advisable to bring them to the same standard by adequate education and hands-on training and workshops. raelene.kambli@expressindia.com

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cover )

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FOCUS:BLOOD BANKING

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A blood bank is halfway between a pharma manufacturing unit and a healthcare service provider Dr Gautam Wankhede Director-Medical Affairs/Marketing, Alliance Transfusion, Gurgaon

The blood banks run by the government come out to be the worst.

The blood banks run by corporate sectors are by far better in maintenance and administration Dr Jyotsna Codaty HOD – Transfusion Medicine, Fortis Malar Hospital, Chennai

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M

ost people working in the healthcare sector understand that the term 'blood bank' is a misnomer. It neither functions as a bank nor stores blood indefinitely. It is more like a manufacturing facility that converts raw materials into finished goods. “A blood bank is halfway between a pharma manufacturing unit and a healthcare service provider. Blood components are manufactured in the blood banks and as with all manufacturing units, so raw material is the key,” explains Dr Gautam Wankhede, Director-Medical Affairs/Marketing, Alliance Transfusion, Gurgaon.

As blood banking activity happens behind the cloak of philanthropy, people seldom talk about revenues generated by selling blood and its components. As Dr Nabajyoti Choudhury, Secretary General, Asian Association of Transfusion Medicine wrote in an article 'Management in Indian Blood Banking System: True Reality,' blood banking in the real sense is a production industry with all the components of a business built into it.

Unlike 'Matrix' where machines use humans as a power source, cultivating humans and harvesting power from them; blood banks rely on voluntary blood donation. However, whole blood, as collected from donors, is not used as such. It first needs to be tested for infections like HIV, Hepatitis etc. Then the

blood is separated into useful components. Apheresis is a process by which blood is separated into different components, through centrifugation and membrane separation technology. Blood is collected from volunteers so it is free; but the testing, storing and apheresis cost money. To understand the scope of blood banking one needs to know the market size.

Need for blood At any given point there is scarcity of blood in India.

According to a World Health Organisation (WHO) report, India needs 12 million units of blood annually, whereas annual collections are just nine million units. If we consider a simple scenario where one unit of blood costs around Rs 1500, the probable market size of blood in India (1500x12) would be Rs 18000 million (Rs 18 billion/1800 crores) market. Blood and blood components have generated billions of dollars in revenue

for entities that deal in nonprofit blood supply even though profiteering is not one of the things associated with blood banking.

There are upwards of 3000 blood banks in India.

"There are about 2760 registered blood banks in India as per the records of the Central Drugs Standard Control Organization (CDSCO), the national regulatory body for blood banks in India. However, the number of active blood banks may be lesser than this," says Dr Wankhede.

However, Dr Shanta Ghatak, Director, Public Welfare Trust Organisation and Bhoruka Research Centre for Haematology and Blood Transfusion, Kolkata has a different view. “There are around 3042 blood banks in India, mostly in the public sector,” she informs. “A huge black market for blood operates when epidemic diseases like dengue break-out or when rare blood groups are sought,” she adds.

Other than the govern-

According to WHO report, India needs 12 million units of blood annually, whereas annual collections are just nine million units. If we consider a simple scenario where one unit of blood costs around Rs 1500, the probable market size of blood in India (1500x12) would be Rs 18000 million

ment, the Indian Red Cross Society (IRCS) is a well known organisation involved in blood collection and supply. Other blood banks are owned and operated by charitable trusts, NGOs or private players. According to Dr Choudhury, about 55 per cent blood banks are operated by the government, five per cent by the IRCS, about 20-25 per cent are run by the NGOs and the rest 15-20 per cent are run by private players. "There is a huge difference when it comes to the ownership of the blood bank. By far, I am sorry to say, the blood banks run by the government come out to be the worst. The blood banks run by corporate sectors are by far better in maintenance and administration as they are conscious of providing better services and do not wish to get into any legal conundrums. Whereas, NGOs are more budget-friendly and generally stick to all rules,” says Dr Jyotsna Codaty, HOD – Transfusion Medicine, Fortis Malar Hospital, Chennai and NABH Assessor for Blood banks, Quality Council of India.

Understanding blood banks Blood banking in India is a highly unorganised sector with many players and unique characteristics. "In India, like in England, blood banks originated in and around hospitals," explains Mahesh Mohatta, MD, Prathama Blood Centre, Ahmedabad. "But, as blood remained short all through, various types of blood banking operations started in the country. Looking at government hospital-based blood

(

FOCUS:BLOOD BANKING

KEY FACTS BLOOD DONATION RATE

banks; private hospitals also started their blood banks.

Later on, seeing the scarcity, pathology labs also added blood banks. With continuous pressure on blood supply, independent, not-for-profit blood banks also started appearing in the country" he informs.

Currently, most of India’s blood banks are hospitals’ in-house blood banks. However, a full-fledged blood bank is not required to be a part of any hospital. Blood banking can be a self-sustained activity wherein blood is collected, processed and supplied to the hospitals and nursing homes of the area. "Normally, a multi-disciplinary hospital with about 500 beds requires 5000-7000 units of blood per year of blood, split into its components like red cells, platelets and fresh frozen plasma. An economically viable blood bank should have collection of 100,000 units of blood per year," says Mohatta.

"That means a big blood bank should meet about 15-20 hospitals' requirement of blood. If each hospital tries to accommodate a blood bank, then their in-house blood banks are bound to be inefficient and a burden on the hospital," he further observes.

than 95 per cent voluntary blood donors and the rest are direct or autologous donors.

No patient is ever asked to organise for the replacement.

HIGH-INCOME COUNTRIES 36.8 donations per 1000 population

MIDDLE-INCOME COUNTRIES

108

LOW-INCOME COUNTRIES 3.9 donations per 1000 population

11.7 donations per 1000 population

M I L L I O N blood donations collected globally

2760

registered blood banks in India as per the records of the Central Drugs Standard Control Organization (CDSCO)

50-60%

9-10

M I L L I O N

blood in India is collected by replacement and professional donors

The minimum cost of processing one unit would be in excess of Rs 2200

IN INDIA

units of blood are collected annually, while the need is in excess of 12 million units

Processing charge is recommended to be about Rs 1050 (government blood banks) and Rs 1450 (non-government blood banks) for a unit of whole blood

Blood components derived from whole blood: The most common blood components are Packed Red Blood cells, Platelet and Plasma (Fresh Frozen Plasma).

Cryoprecipiate and Platelet Rich Plasma (PRP) can also be prepared

Blood donation paradox Blood is collected from three types of donors; voluntary, replacement and paid. One would assume that most of the blood collected in India is voluntary but in reality, people are forced to arrange for blood through replacement donors when they require blood.

"This is one of the biggest reasons for failure of Indian blood banks," opines Mohatta.

"Indian blood banks ask the

patient to replace a unit of blood for every unit one wants. This is a sort of barter where fresh blood is available only against blood donated.

By banking mainly on replacement donors, blood banks have become complacent and are not motivated to go out and collect blood from voluntary donors," he adds.

Around the world, most countries encourage voluntary blood donation. Blood is a life-saving medicine and should be available in-stock whenever required. Moreover, a country with a large adult population like India should have no dearth of blood, if collected pro-actively. However, there is little effort to

educate and popularise the culture of blood donation in India. "It is the blood bank's responsibility to collect blood sufficient for their area’s requirement. By asking for replacement they indirectly encourage professional blood donors," laments Mohatta.

Most of the developed nations like Europe and US have more

Thinking outside the blood Blood as collected from donors is whole blood.

Advancement in the field of transfusion medicine has led to processing of this whole blood to make different lifesaving therapeutic components. About 10 different life saving products can be made from one unit of blood. "The most common components made from blood is packed red blood cells, platelet and fresh frozen plasma; cryoprecipiate and platelet rich plasma (PRP) are also prepared," informs Dr Wankhede. Plasma can be further fractionated into proteins and immunogloblins.

“Cryo-poor plasma can be fractionated into about five main plasma fractions in a complex plasma fractionation factory,” says Mohatta.

“The main plasma fractionation products are Albumin, Immunoglobulin, Factor 8, Factor 9, Fibrinogen and some other life-saving products as well,” adds Mohatta.

It is now a well known scientific fact that there is no need for whole blood transfusion in medical science. Still an estimated 50 per cent of blood in India is used as whole blood. It is a waste of precious resource which otherwise can go in making plasma fractions and making India self-sufficient in plasma products. "It is world wide accepted fact, also recognised and strongly recommended by National Blood Transfusion Council (NBTC), that the practice of usage of whole blood should

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cover ) be abolished. Yet, there are no concrete steps to eliminate usage of whole blood. Government should have put a fiveyear ultimatum to switch to the practice of blood components to all blood banks," opines Mohatta.

Investing in safety Infectious diseases continue to be transmitted through blood transfusion and remain one of the main concerns in transfusion medicine today. According to National Aids Control Organisation (NACO), around 1,000 people contracted HIV infection in Maharashtra in 2014 due to blood transfusion and on account of violation of blood donation guidelines during voluntary blood donation camps. Another report said that in the same year a state-run hospital had to throw away 717 units of whole blood due to lack of proper storage facility. "The blood donation drives are usually held on holidays, Saturdays, Sundays and during Republic days and Independence days etc., mostly for politicians to gain mileage; but too much and too many blood bags are wasted due to this utter atrocious practice and mismanagement across the blood banking segments in India," says Dr Ghatak. In practice, two per cent of the collected blood is discarded annually. "The figures may vary in different blood banks, but it may range from three to ten per cent depending on the screening tests carried out for infectious markers. The most common cause of discarding donated blood remains positivity of infectious markers. However, there are other reasons for discarding the blood components, especially platelets, because of expiry of utilisation date. At times, some units show signs of haemolysis, or fail to meet quality criteria in terms of volume and functionality.

These have to be discarded too," says Dr Wankhede.

Traditionally employed enzyme linked immunosorbent assay (ELISA) techniques and chemiluminescence (CLIA)/ enzyme-linked fluorescence assay (ELFA) are used by

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blood banks to screen donors.

However, the onus of providing safe blood lies with the blood bank, and knowingly or unknowingly, the testing is not 100 per cent accurate. Quality control is unheard of in most blood banks and the lapse in safety is only talked about when a patient contracts infection after the transfusion.

Novel methods of screening are expensive but can further guarantee safety. In addition to transfusion transmitted infections (TTI) testing, red cell antibodies screening, nucleic acid testing (NAT) and the newer gel/bead techniques are being adopted by blood banks. Experts believe that blood processing techniques like leukoreduction, irradiation and pathogen inactivation are expected to play an increasingly important role in enhancing blood safety in future.

An economically viable blood bank should have collection of 100,000 units of blood per year Mahesh Mohatta MD, Prathama Blood Centre, Ahmedabad

Ground realities It is clear that blood banks need to upgrade and have a stringent quality process, more in terms of GMP to be able to provide blood. "Blood banking system in India is decentralised, while in Western countries it is centralised.

Therefore, we see that blood banks have varied practices of blood manufacturing and using different technology. As the technology advances, the cost of blood components go high," explains Dr Annapurna Ramesh, HOD, Department of Transfusion Medicine and Blood Bank, Fortis Bengaluru.

Investments in this regard have been almost non-existing. Capital cost of setting up a blood bank is very high. "It depends to a large extent on the type of tests and procedures that are to be implemented in a blood bank. The most basic set up would cost anything in the range of Rs 75 lakhs to a crore, whereas the more advanced blood banks with NAT tests and automatic blood grouping and infectious disease testing instruments can cost in excess of Rs four crores to set up," shares Dr Wankhede. Along with this, there is huge operational cost.

By banking on replacement donors, blood banks are not motivated to go out and collect blood from voluntary donors Dr Shanta Ghatak Director, Public Welfare Trust Organisation and Bhoruka Research Centre for Haematology and Blood Transfusion, Kolkata

“A major expenditure is on the blood banks staff which includes doctors, counselors, camp organisers, lab technicians, phlebotomists, IT personnel, drivers and other workers who need to be well-trained and available 24 hours. Multiple teams are required to carry out simultaneous blood donation camps and run the blood bank at the same time. The heavy machin-

ery requires annual maintenance, regular calibration and breakdown support, besides the electricity and water bill.

Most expensive equipment such as refrigerated centrifuge, refrigerators, automated equipment, apheresis machines, etc. have a life of four to five years and have to replaced after this period,” shares Dr Wankhede. Apart from these, there are recurring costs of blood bags, apheresis kits, haemoglobin testing kits, kits for testing infections, blood grouping reagents, glassware, disposables, red cell antibody screening reagents, leucodepletion kits and QC testing reagents. Refreshments for donors are also a part of the recurring cost. “We spend about Rs 1000/unit of collected blood in fixed cost and Rs, 600/unit in direct variable cost,” reveals Mohatta.

With such overheads, it’s very difficult to operate blood banks without investors stepping in. “A reasonably modern blood bank might cost Rs nine to ten crores without the cost of land and building. Only self sustaining blood banks which can recover the cost can dream of such an investment," says Mohatta. "Internationally, a blood bank collecting, processing and distributing about 100,000 units of blood per year is considered economically viable. World’s biggest blood bank, New York Blood Centre (NYBC) collects, processes and distributes more than 600,000 units of blood per year. There are more than 100 blood banks in the world, collecting, and processing above 100,000 units of blood per year. In contrast to international blood banks which collects 100,000 units of blood per year, India’s biggest blood bank collects about 25,000 units/year. At a low level of operations, it is difficult to sustain and afford modern equipment," laments Mohatta. For blood banks to be self-sustainable and be able to provide affordable and safe blood it is important to increase the number of units processed. "Internationally, blood banks are mainly run by

'not-for-profit' organisations.

The initial investment comes from grants and loans, then they continue to grow with their own income. Blood banks can go for forward with integration and start plasma fractionation. Higher level of activity at a given fixed cost can make it possible for them to distribute very high quality blood components at a service charge of about Rs 400-500 per component in India, without asking for replacement," shares Mohatta.

Regulatory woes In India, blood is categorised as a life-saving 'drug' and comes under the purview of the Drugs and Cosmetic Act (D and C Act), 1940 and Drugs and Cosmetics Rules, 1945.

CDSCO is the national regulatory body for blood banks in India. However, NACO/NBTC play the advisory role and are main technical body to frame guidelines for the practice of transfusion medicine. "CDSCO, headed by the Drugs Controller General (India), is the authority that enforces regulations at the central level, while every state has a regulatory body to oversee the blood banks in their territory. NABH has a set of standards for granting accreditation basis which they award a certificate to a blood bank," informs Dr Ramesh.

The National Blood Policy (NBP) was published by the Government of India in in consultation of NACO in 2002.

Many experts feel that CDSCO may need more partners to regulate and monitor blood banks as it is only equipped to look at legal aspects pertaining to infrastructure, equipment, spacing and staff neglecting the medical and quality aspects of transfusion medicine.

Accreditation for blood banks is a new and voluntary step taken to assure quality.

Talking about NABH’s involvement in accreditation of blood banks, Dr Codaty says, "NABH monitors all quality systems. Though its primary concern is that all government

(

FOCUS:BLOOD BANKING

With the help of associations like Indian Society of Transfusion Medicine and Asian Association of Transfusion Medicine along with federation of Indian, non-government blood banks, the industry must push for reform, mostly in improved testing

regulations are abided in letter and spirit and it further adds checks and balances, working on their set of standards to plug any loopholes where an error is likely to happen. Presently, there are only about 60 NABH accredited blood banks in the country but they are doing sterling work."

Making way for centralised banking Centralised blood testing is the norm internationally, as they successfully ensured quality, economy and bulk processing of blood samples. "Central blood testing centres should have highly automated environment of bar-code, ERP, NABH/NABL accreditation and ability to collect blood samples from across the country and electronically transfer the results in the shortest possible time. Central blood testing centre should again be a 'not-for-profit' centre, preferably a part of RBTC with a permission to accept blood samples from any blood centre," opines Mahatta.

In fact, the government was also in favour of centralised blood banking.

"At one time, the centre had mooted a high-tech, fully component, central blood bank for each state with licenses only for storage centres. These storage centres could give blood to people who need it. Later, these storage centres can submit their requisition and draw from

the central blood bank. This is an international system and has been functioning well in most advanced countries," shares Dr Codaty. "Having mooted it and allocated space for infrastructure, it came to naught and a good idea was wasted. Today, the government issues licences for whole blood even after knowing that the need of the hour is its components," she laments.

Change is inevitable There are winds of change in the blood banking and transfusion medicine sector. With the help of associations like Indian Society of Transfusion Medicine and Asian Association of Transfusion Medicine along with federation of Indian, nongovernment blood banks, the industry must push for reform, mostly in improved testing.

Increased participation in National Haemovigilance Program of India, which seeks to monitor recipient adverse transfusion reactions, should be encouraged by peers. All the stakeholders must join hands to advocate uniform pricing and highest safety standards for blood and components along with safe transfusion practices.

The emphasis should be on adopting IT in blood banking.

And lastly, pre-operative autologous blood donation (PABD) in elective surgeries should be popularised. mneelam.kachhap@expressindia.com

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cover )

BLOOD BANKING IN INDIA:

AT PAR WITH GLOBAL STANDARDS? Express Healthcare garners views from industry experts on the accreditation guidelines for blood banks in India. They also highlight the areas where we lag in terms of blood safety measures

DR ANAND DESHPANDE Consultant Transfusion Medicine & Hematology, PD Hinduja Hospital & MRC

A

ll blood banks should be encouraged to go for NABH accreditation. Abiding by the guidelines laid out by NABH will automatically ensure quality and safety of blood.

This will also ensure much better patient safety. The most important aspects to be

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considered: + Encourage repeat voluntary donors: The more the number of times a person has donated blood, it’s directly proportional to safe blood.

Most of the times, we have first time voluntary donors.

This also means we need to have more awareness pro-

grammes held for people to donate further. The benefits of blood donation should be highlighted better. + Pre-donation counselling: Whenever a person is readied to donate, the donor medical history should be noted down well. There should be a good counselling session provided

to the donor to fish out any medical problems he or she is facing. This is a very important exercise. + Proper use of blood and blood components: It is necessary to administer the right amount of blood or blood components to a patient. Indiscriminate use of

blood products should be curtailed. + Proper EIA testing should be undertaken. + NAT Testing: Once NAT testing is administered, rest assured you have received the best blood. Hinduja Hospital is one of the early adopters to NAT testing.

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DR RAJEEV NIKTE HOD-Blood Bank, Global Hospitals, Mumbai

B

lood transfusion is one of the necessary modalities in patient care. Blood is a biological material and carries inherent risks. Blood transfusion is ‘error-prone’ by virtue of the process involving a chain of events done at different locations, by different personnel, happening simultaneously or in series. Some errors can be life threatening.

'Accreditation Canada'

defines patient safety as ‘prevention and mitigation of unsafe acts within healthcare system’.

Blood is a ‘drug’ and hence covered in India under Drugs and Cosmetic Act. The law has framed stringent requirements to operate a blood bank. By providing technical requirements like premises, personnel, equipment, QC, etc., it mandates conformance to standards of strength,

quality or purity.

Regulatory standards state what is required to operate a blood bank, whereas accreditation standards elaborate on how to achieve quality and safety in a product/ service.

In India, accreditation standards were developed systematically i.e. National Blood Policy (2003), Standards for Blood Banks by NACO (2007), Accreditation

Standards for Blood Banks and Transfusion Services by NABH (2007). Accreditation standards cover technical as well as quality requirements, and span its scope to the clinical side of transfusion. This was a major step to assure safety in blood transfusion.

Accreditation standards in India are comparable to those of well established accreditating bodies world over. Emphasis is on continual quality

DR VIJAY D'SILVA

DR CHARU PAMNANI

Director - Medical Affairs & Critical Care, Asian Heart Institute, Mumbai.

Head – Laboratory Medicine and Quality for Wockhardt Hospital

T

ur guidelines are comparable to global standards; however, where we fall short when it comes to good monitoring mechanisms. We also see a huge disparity between blood banks in the urban areas and those at district levels. Laws regarding blood transfusion services are part of Drugs and Cosmetics Act. Blood is under the regulatory control of Drug Controller (General) of India, the Central licensing authority which is assisted by the State Drug Controllers. The NBTC and SBTC are advisory in nature. Despite availability of consensus guidelines inappropriate blood transfusions happen, and not all collected units are converted into components, reporting of adverse events after transfusion is poor and donor deferral system is practically nonexistent. So, despite multiple agencies there is poor monitoring and control. We should consider a single autonomous agency

he blood banking practice in Maharashtra is under the guidelines and control of the FDA and they have certainly laid down stringent policies.

They are adequate to prevent any problems with blood banking.

The assessment of blood in the window period can be

improved by NET testing.

There is a high possibility of infection in the window period. It has not been mandatory till now for the assessment of blood in the window period and hence infection is missed during the incubation period. So, it has to be made mandatory for assessment of blood in the window period.

DR MAHENDRA SINGH CHAUHAN HOD – Dattaji Bhale Blood Bank, Dr Hedgewar Hospital, Aurangabad

T

he recent guidelines

by NACO for medical officers and lab technicians and separately for nurses are by and large appear to be adequate.

We have around 2609 blood banks across India in different sectors such as government hospitals, private hospitals, trust run banks and private standalone blood banks of which around 100-110 are accreditated. We have the NACO, QCI and NABH which have laid down adequate guidelines; however governance is a huge problem.

We lag in terms of commitment, type of blood bankers, intentions and mentality of the

receivers and the customers’ i.e. doctors, needs to be addressed .

I have noticed that implementation of these guidelines are different in various blood banks. Moreover, at many blood banks nearly 40 per cent of the standards for blood safety is not been met. If you take a look at the government hospitals, the methods for blood grouping is not up to the standards.

Additionally, there are many blood banks that still use the manual methods which should be avoided. Automation in blood banking has reduced errors ; however this needs to be further reduced.

O

manned by people with experience in transfusion medicine.

The biggest challenge is a steady supply of safe blood.

Also, recruitment of voluntary donors who are committed and will be repeat donors. Information, communication, and education to first time donors, so that they overcome their fears and prejudices cost a lot in terms of time, effort and funds, which are often scarce. There is unfortunately no centralised system to co-ordinate services and stocks so the deficit can be anywhere between 20-40 per cent. It also leads to wastage of blood or components in a few setups.

The control on pricing deters the industry from implementing latest technologies as the cost implications would be high. We also need to find ways to increase longevity of blood and at the same time ensure that the clinicians are willing to accept that blood.

WE HAVE AROUND 2609 BLOOD BANKS ACROSS INDIA

improvement. Apart from technical requirements, standards demand conformance to quality aspects like training, supplier evaluation, documentation, records, and more importantly on performance improvement through internal audits, CAPA, and management reviews, etc.

A well developed system based on accreditation standards can ensure topnotch quality and safety.

DR NARINDER NAIDU Medical Director, Indian Red Cross Society

T

he accreditation guidelines for the blood banks are adequately framed, but for blood safety we lack our focus on getting a safe donor. Pre-donation counselling of the blood donors is not carried out, blood donors are not adequately educated on the various illnesses and diseases that can be transmitted through blood so that they can go in for self deferral. They should be made to understand their responsibility in answering the donor questionnaire honestly.

Therefore, safety will remain a concern until and unless we get truthful and honest replies from the donors about their lifestyle and the illnesses they have suffered.

This is only possible if they have been counselled before blood donation.

A number of tests are now available which intend to reduce the window period of the infections. But until and unless proper counselling of the blood donors is done prior to blood donation it is not possible to increase blood safety.

Accreditation guidelines are laid down and mandatory but how much of it is actually followed and done remains to be seen.

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GENETIC DIAGNOSTICS SPECIAL

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TRACING THE TRENDS IN

GENETIC

DIAGNOSTICS Clinical diagnostics took a big leap with the advent of medical genetics but has it found its footing in India?

Amid the euphoria surrounding this diagnostic revolution, can India overcome major analytical and interpretative challenges that have emerged in recent years?

BY M NEELAM KACHHAP

C

ure of an ailment is no longer magical or mystical in today's time. In fact we know that accurate diagnostic is the key to right therapy. And genetic diagnostics has been able to take accuracy to a new level of truth. “With a population of 1.26 billion and 26 million births every year the burden of genetic diseases is very high. Many diseases can be predicted with great accuracy, prevented if genetic testing is done at the appropriate stage and some of the diseases can be cured or managed better if we know the precise genetic defect,” shares VL Ramprasad, CEO, MedGenome, Bengaluru.

The widespread awareness and recognition of

rising incidence of congenital and hereditary genetic diseases in urban India has led people to seek genetic testing and counselling services. “In the urban population, congenital malformations and genetic disorders are the third most common cause of mortality in newborns,” reflects Seemant Jauhari, CEO – Research and Innovations, Apollo Hospitals.

Market for genetic testing Due to explicit benefits related to rapidity, high sensitivity and specificity and scope for detecting diseases and disorders in early stage, today molecular/genetic testing scores over the traditional methods. “Globally and in India, genetic

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GENETIC DIAGNOSTICS SPECIAL

90 100 5 INDIA RANKS

TH

testing and molecular diagnostics have made notable inroads into medical practice, particularly for infectious disease testing. However, more complex and advanced testing approaches (for cancer and other complex genetic diseases) may only be in the early stages,” says Dr BR Das, President - Research and Innovation, Mentor - Molecular Pathology and Clinical Research Service of SRL Diagnostics.

“India holds the 5th rank after US, Europe, China and Japan in global molecular diagnostics market with double digit growth rate,” he adds. Quoting a WHO case study on genomics, Jauhari says, “Genetic diagnostics market is based on physician referral, although there is about 10 per cent self-referral by the patients.

Today, after 15-20 years of frantic pace of development, molecular diagnostics is universally acknowledged as the modern face of pathology and more poignantly, as the pathology of the future. And with the arrival of new technology genetic testing has become more viable option for patients today. “With the new DNA sequencing technologies it has become practically feasible in terms of cost and time to do genetic testing,” says Ramaprasad. “There are about 9000 well-characterised genetic diseases (Mendelian diseases) and even though individually they are rare, collectively they account for 20 per cent of infant mortality or paediatric hospitalisation in the non-communicable disease segment,” he adds.

How many centres and what tests?

A decade ago there were about a handful of centres offering cytogenetic services, with only a few clinics providing advanced cytogenetic, biochemical, prenatal diagnostic services and counselling. The Department of Genetic Medicine at Sir Ganga Ram Hospital, New Delhi established in 1997 is one of the pioneer genetics centre in India.

The Genetics Unit, Department of Paediatrics, AIIMS, New Delhi; Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical

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%

IN THE GLOBAL MOLECULAR DIAGNOSTICS MARKET WITH DOUBLE DIGIT GROWTH

OF INDIA’S MEDICAL COLLEGES DO NOT PROVIDE TRAINING AND EDUCATION IN CLINICAL GENETICS AND GENETIC COUNSELLING

LABORATORIES INCLUDING BIG REFERENCE LABORATORIES AND REGIONAL, MEDIUM SIZED LABS MOLECULAR GENETIC TESTING ACROSS INDIA

20

%

OF INFANT MORTALITY OR PAEDIATRIC HOSPITALISATION IN THE NON-COMMUNICABLE SEGMENTARE CAUSED BY ABOUT 9000 WELL-CHARACTERISED GENETIC DISEASES (MENDELIAN DISEASES) COLLECTIVELY

Sciences (SGPGI); Centre for DNA Fingerprinting and Diagnostics, Hyderabad; Indian Council of Medical Research, Mumbai; Department of Medical Genetics, Kasturba Medical College, Manipal are some of the notable institutes with good clinical medical genetics practice.

Private labs like SRL Diagnostics are also doing exemplary work. A number of new companies like Bengaluru-based MedGenome, NutraGene and Eurofins Genomics, Genotypic Technology, Strand Life Sciences; Hyderabad-based Mapmygenome, DNA Labs India; Mumbai-based Datar Genetics, Positive Biosciences; Chennaibased X-code LifeSciences are bringing genetic diagnostics closer to people. “Over 100 laboratories, including big reference laboratories as well as regional medium-sized labs across India, offer molecular genetic testing,” informs Dr Das.

One of the gray areas in genetic testing is the absence of adequate regulations and framework.

There is no official framework for assessing new genetic tests that become available in India

These centres receive samples not only from different parts of India, but also from Bangladesh, Pakistan, SriLanka, and Middle East and Africa.

Range of tests India is at par with any other country in the world in terms of availability of genetic tests.

“Currently, worldwide estimated 1000–1300 genetic tests are available for approximately 2500 conditions, both for rare and common. Considering the health priorities, disease prevalence and affordability, molecular/genetic diagnostic tests pertaining to infectious diseases and cancer are more commonly available,” informs Dr Das. A number of genetic tests are available in India to look at prenatal and postnatal anomalies. “The key focus areas of genetic tests are: diagnostic tests; prenatal, familial and risk assessment,” says Jauhari.

Regulations One of the gray areas in genetic testing is the absence of adequate regulations and framework. There is no official framework for assessing new genetic tests that become available in India, nor any formal system for approving which tests may be used in a clinical setting.

“Presently there are no specific regulations pertaining to molecular/genetic diagnostics in India,” says Dr Das. “PCPNDT Act regulates the practice of invasive and noninvasive prenatal tests so that they are used only to detect the genetic defects but not revealing the gender of the foetus,” informs Ramprasad. Talking about prenatal genetic testing, Jauhari says, “There is a mandatory registration system for all the laboratories that provide prenatal diagnostic services in India. As per the Act, all the genetic laboratories, clinics and counselling centres offering prenatal diagnosis should be registered under the Pre-conception and Prenatal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994. The government passed this Act to prohibit the use of prenatal diagnostic techniques for sex selective abortion.

Registration requires that these organisations comply with a range of quality assurance requirements.”

New diagnostic methods and interventional strategies for genetic conditions that are prevalent in India are developed and validated under the guidance of Indian Council of Medical Research (ICMR) through a task force on human genetics and by the Genetic Research Centre (GRC), a permanent national centre under the umbrella of ICMR. Accreditation is one of the ways to preserve quality and safety of the process in genetic testing. “National Accreditation Board for Testing and Calibration Laboratories (NABL) has recently modified its scope for inclusion of specific guidelines related to molecular testing. Besides few major laboratories in India voluntarily follow guidelines mandated by College of American Patholo-

gists (CAP), US, thereby ensuring services of global standards,” informs Das.

Training and education Healthcare in India is plagued by the short supply of adequately trained personnel.

Clinical genetics is no different.

According to a report appearing in the Indian Journal of Human Genetics over 90 per cent of India’s medical colleges do not provide training and education in clinical genetics and genetic counselling, contributing to lack of professionals specialising in these fields. “Genetics literacy in India is sorely lacking even in the current medical training curriculum. There is an urgent need for awareness and education regarding the use and interpretation of these advanced

Today, after 15-20 years of frantic pace of development, molecular diagnostics is universally acknowledged as the modern face of pathology and more poignantly, as the pathology of the future. And with the arrival of new technology, genetic testing has become more viable option for patients today molecular tests,” says Dr Das. “SRL Mumbai is the only Maharashtra University of Health Sciences recognised centre in India which offers Fellowship Course in Molecular Pathology for post graduate doctors,” he adds.

Dr Shubha R Phadke, Professor and Head, Department of Medical Genetics, Sanjay

Gandhi Postgraduate Institute of Medical Sciences, Lucknow; and President, Indian Academy of Medical Genetics opines, “We need to impart an understanding of the clinical applications of medical genetics to undergraduate and postgraduate students.

Training of committed medical college teachers from various specialties like paediatrics,

obstetrics, pathology, anatomy, biochemistry, internal medicine, oncology, etc. and helping them to collaboratively set up genetic units in each medical college is the only way to take clinical genetics to all clinics. Training of teachers will have rapid, long term and multiplying effects. We need to take the fruits of research in genetics to

the masses through clinicians from all specialties.”

“The Indian Council of Medical Research has initiated plans for creating a network of genetic centres in medical colleges and I hope this initiative proves to be successful in achieving its goal of disseminating the knowledge of genetics to all medical practitioners,” she adds.

Today, genetic testing has grown from a niche speciality for rare disorders to a broad scope of applications for routine, complex diseases and personal use. However, there is an urgent need for all stakeholders to step-up and uplift genetic diagnostics, making it available, accessible and safe. mneelam.kachhap@expressindia.com

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GENETIC DIAGNOSTICS SPECIAL EXPERT SPEAK

Genetic diagnostics: pushing the frontiers of diagnostics in India Anu Acharya, CEO, Mapmygenome, elaborates on the growing importance of genetic diagnostics in healthcare delivery

ANU ACHARYA CEO Mapmygenome

H

istory teaches us that innovations in science and technology have the potential to revolutionise the practice of medicine. The most promising game changer for this century is genetics. Translational science and precision medicine are trending domains pursued by governments, industry, academia, and the medical fraternity. Pioneering medical practitioners across the globe are harnessing the power of genetics to add value to their practice. As medical science is gearing up for this paradigm shift, the question for tomorrow is not about accepting genetics, but about making sure that we are all prepared to ensure best clinical utility of genetic tests.

After the usual hype and hyperbole for a decade or so, genetics has become part of clinical practise worldwide and has

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the power to revolutionise healthcare.

The reasons for this change are shown by examples of recent studies like the one published in New England Journal of Medicine that has shown effectiveness of genomic testing for detecting lung cancer to be less invasive compared to traditionally used invasive bronchoscopy tests that have proven to be inconclusive.

What has captured the fancy of most physicians is that they can now actually help patients on their treatment choices using pharmacogenetics. Several instances have been cited where medications given to two differ-

ent individuals elicits different responses. About two to three per cent of people cannot metabolise clopidogrel. Genetic testing can identify individuals and can help doctors make more informed decisions.

In this article we will go through some historical background, the future, clinical utility and a couple of case studies before concluding remarks.

Opportunities and misses In mid-19th century, cholera often became pandemic, causing a significant dent in population across cities and even countries. In spite of Dr John Snow (Father of Modern Epidemiol-

ogy) demonstrating the link between contaminated water and the origin of cholera, medical fraternity continued to ignore this and the disease continued to flourish and wreak havoc. On the other hand, just six months after the discovery of X-ray in 1895, doctors in armed forces were using this technique on wounded soldiers to locate bullets. Along with the discovery of tubercle bacilli in 1882, X-rays paved way for early diagnosis of tuberculosis. While one is a case of missed opportunity, the other is an example of human resourcefulness.

When Angelina Jolie announced news of her double

mastectomy and later surgery to remove her ovaries and fallopian tubes following genomic testing, there was mixed reaction. While some hailed her for encouraging women to be proactive about her health, others criticised her for triggering an avalanche of genomic tests sans medical consultation and genetic counselling. However, the fact that she has contributed a lot more to the spread of awareness about genomic testing than any educational campaign can even aspire for is universally acknowledged. For Mapmygenome, it is heartening to see many doctors who are keen on learning more about genetic tests and their clinical utility.

A paradigm shift In 2012, Melanie Swan of Futures Group predicted a new perspective to healthcare by 2050, where gaps between medical practice, healthcare, and personal health will be bridged. Another prediction is the predominance of preventive healthcare, where individuals take charge of their health, harnessing the power of technology. Genomic tests – single

nucleotide polymorphism and whole genome sequencing – are among the key catalysts to this change.

With Health 2.0, we have seen the beginning of this change. Wellness was once a fancy word. Today, it is part of every hospital’s business strategy to engage a new generation of customers, who are actively pursuing wellness using social apps for various reasons - right from fitness and diet to finding the best doctor.

The cost of genomic testing has also witnessed a steep decline. The complete sequencing of the first human genome was an expensive project.

Today, whole genomes can be sequenced at a fraction of the cost. Targeted gene sequencing and SNP analysis bring a further reduction to the costs. Advances in technology can bring down these costs further, making these tests more accessible and affordable. Powering this trend are other factors like advances in cloud computing, big data, secure electronic medical records and laboratory information management systems.

Clinical utility of genomic tests Genomic tests already find clinical utility in many key areas – disease prevention, diagnosis, and treatment. Translational medicine, where doctors work in tandem with geneticists, bioinformaticians, and genetic counsellors, is a reality today.

Some prominent medical institutions in India and abroad have their own research facilities that are working on genetics. Many have strategic partnerships with molecular diagnostics companies such as Mapmygenome.

Early detection It has been proven beyond doubt that early detection can enhance the efficiency of treatment while reducing healthcare costs. In cases where there is a strong familial history of a particular disease, a genetic test is advised. Even if the patient tests positive, there is a greater chance of survival. For e.g., genetic screening is a powerful tool for hereditary forms of

colorectal cancer - Lynch syndrome and Familial Adenomatous Polyposis (FAP). A large percentage of colorectal cancer cases are hereditary and preventable. Genetic tests can identify causal mutations to diagnose the condition even before tumorigenesis, paving way for better treatment. This helps check if other blood relatives are at risk too.

Predictive testing and prevention The biggest advantage with genetics is that people can take charge of health by preventing or delaying the onset of many health conditions. Standard tests do not predict predisposition to high cholesterol, diabetes and other conditions. Genetic tests can be used as ‘predictive testing’ to determine chances of a healthy individual to developing a condition, or ‘presymptomatic testing’ to determine if a person with a family history for a disease but no current symptoms have causative gene alterations for the condition.

The consulting physician can recommend further tests, treatment, or prophylactic measures. Angelina Jolie’s case is a classic example. She had undergone the BRCA genetic test for breast cancer [Example 1].

Treatment Another key role of genetics in medicine is to determine drug response. The efficacy and sensitivity of a drug varies from person to person.

It may work wonders for some, cause an allergic reaction in others, and show no effect in yet others. Finding drug response through a genetic test can help patients save time and money while increasing the credibility of healthcare providers [Example 2].

EXAMPLE 1: CLINICAL UTILITY OF BRCA1/2 FULL GENE TESTING

EXAMPLE 2: GENETIC TESTS FOR DRUG RESPONSE – CLOPIDOGREL

BRCAgene testing is done using blood sample to identify harmful changes (mutations) in either one of the two key breast cancer susceptibility genes BRCA1 and BRCA2.

Women who have inherited these genes have higher risk of developing breast risk and ovarian cancer compared with the general population.

BRCAtest is offered to people who have a personal or family history,or who have specific types of cancer and these people are more likely to inherit these mutations.

Inherited BRCAgene mutations are responsible for about five per cent of breast cancer and 10-15 per cent for ovarian cancer.

Apositive result implies that there is a pathogenic mutation in one of the breast cancer genes and there is high likelihood of developing breast cancer or ovarian cancer relative to the normal population.However,the positive result does not mean that the patient will develop cancer.

Clopidogrel is a common drug majorly prescribed for cardiovascular diseases and usage of this drug is high among patients.For this drug to work,enzymes in liver (predominantly CYP2C19) must convert (metabolise) the drug to its active form.

Therefore,patients who cannot metabolise the drug efficiently are called poor metabolisers.This effect of metabolism depends on certain alterations in genes.

Using a genetic test,doctors who are prescribing this test can find if their patients can metabolise the drug.

Family health Couples planning a family can undergo genetic testing to determine if they are carriers of a particular disease. Similarly, prenatal diagnosis is routinely used to diagnose genetic conditions in developing foetuses.

Newborn screening is equally important to detect genetic disease for early diagnosis and treatment.

Rare diseases

Costs

Clinical utility of genomics in rare diseases is beyond measure. Often in families with rare diseases, the journey from onset of symptoms to diagnosis and treatment can take an emotional, physical and economic toll. With a genetic test, diagnosis and treatment becomes easier.

In many conditions, before the right diagnosis is made, there are additional psychological and economic costs on the patients, family, and healthcare providers. Genetic tests, with their non-invasive nature, simplicity, accurate diagnosis and analysis of the causative factors, can help alleviate these

costs largely. For healthcare providers, this in turn translates to cost-effective healthcare.

genomics, which can add value to nearly all domains of medicine. Pioneering medical practitioners are keenly following advances in genomics, especially in domains relevant to their clinical expertise. Some are even collaborating with the industry for path breaking research in genomics. Physicians in India need to be educated on the pros and cons of genomic testing, which can be used as a complementary diagnostic tool along with the traditional biochemical tests.

Government boost In the United States, the latest Obama budget has allocated significant resources for the development of precision medicine. A similar boost from the Government of India can go a long way in empowering genetics and enhancing healthcare.

Regulatory structure Regulatory structure is a cornerstone for the practice of any discipline of medicine. A strong regulatory framework keeping in mind the conclusions from genomic tests is essential.

Empowering clinical trials Research in medical science is forever ongoing, which helps physicians to stay ahead of causative agents of a disease. A key field of research is clinical trials, where the burden of finding the right sample group often falls on industry or academia for want of right diagnosis.

With genetic tests, finding the right sample group becomes easier. Using genetic tests to analyse response to drugs can also save on costs.

Handling output from a genetic test Genomic tests give information regarding the presence or absence of causative variations in DNA for a disease. It is essential that a qualified professional with sound knowledge of genes and their impact on the human body give patients the right interpretation of the report. Genetic counsellors can be an integrated part of hospitals to offer counselling along with doctors’ recommendations.

The road to future For an innovation to scale up to its potential, all stakeholders need to power up and focus. In the West, genomic testing has become part of the healthcare lexicon. Genomic tests in India are an evolving territory that requires the right nurturing.

The learning curve The best and most sought after medical practitioners are those who keep abreast with advancements in their domain and internalise new findings in their practice. The same goes for

Conclusion Genetic tests are here to stay.

The clinical utility of these tests are reason enough for their acceptance by all. For the medical community, now is the right time to act – to take this giant leap into tomorrow. In a few years, the entire healthcare scenario is likely to change to individual-centric, with strong focus on prevention rather than cure. Education, government support, and regulatory structure will be of great help in implementing this technology.

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GENETIC DIAGNOSTICS SPECIAL I N T E R V I E W

‘We offer tests in a sub-set area of genetics, called as metabolomics’ Abhimanyu Kumar, Founder and CEO and Susheel Singh, Co-Founder, Director and CTO, Preventine speak about genetic diagnostics in India, the market for preventive tests and their strategy to reach out directly to the end users, in an interview with Raelene Kambli

Is the concept of genetic testing well received in India?

Abhimanyu Kumar: India is a complex country with a lot of disparity, not only within its economic aspects but also with respect to knowledge, awareness and mindset. The health needs can be broadly classified in two parts – ‘responsive testing’ (after a disease occurs), and preventive testing (before the onset of a disease or its conditions). While a significant portion of the Indian population opts for getting tested only when the disease and associated conditions surpasses all other priorities; yet there is a small but growing percentage of population which has woken up to the concept of prevention. This is the population which is at the intersection of education, awareness and most importantly, affordability. An indirect indication of the concept of ‘prevention’ picking up is the growing number of gymnasiums, nutrition clinics and increasing number of health insurance customers. And simultaneously, as the education and income levels rise, a higher percentage of population moves in this

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bracket of prevention. Within this bracket lies the concept of genetic tests because these tests have mostly to do with ‘prevention’.

In 2008, when we went operational, we were one of the first movers in a sub-area of genetics called as metabolomics. It was almost impossible to connect with the medical fraternity, let alone with common people about the concept of preventive tests, even if it was for newborn or young children.

However, within a span of few years, we have been seeing a change in the mindset. Today, especially the new generation of parents are much more willing to pick preventive tests for their children.

In addition, a certain percentage of adult population which is aware of hereditary diseases, mostly the common ones like diabetes, obesity, cardiac diseases etc. are now willing to pick up preventive tests which can give early signals of health problems associated with such diseases.

Since the economy is doing good, education, awareness and income levels are rising, it is just logical that more of such preventive genetic tests shall be picked up by a significant percentage of people in India. The only

We believe the genetic tests are likely to be adopted quite a bit in India

Our tests help manage the conditions at early stage and avert fateful outcomes on health

ABHIMANYU KUMAR

SUSHEEL SINGH

Founder and CEO, Preventine

Co-Founder, Director and CTO, Preventine

variable that remains for a sustained growth is – how useful are the tests actually?

is considered today to be a growing consumer market for even the most premium products and there are plenty of early adopters of the latest gizmos, SUVs and high-end housing. Observing this and our simultaneous experience with consumers, we believe

What is your opinion about the genetic testing market in India? What are the opportunities in this field?

Abhimanyu Kumar: India

the genetic tests are likely to be adopted quite a bit in India.

However, one risk area is whether the genetic tests can match up to the expectations of consumers.

Consumers in India are known to have high expectations, more so when it is about premium products.

Now, it is a fact that most genetic tests give a ‘probabilistic finding’, which in my personal opinion does not meet the expectations of the consumers in India. A testresult which sounds like, ‘you have a 41 per cent risk to a certain disease against a population risk of 38 per cent’, does not connect well with a consumer who expects something really concrete about his future health. In addition, the genetic tests findings need to be simplified enough to be understood by a consumer with minimal efforts. Giving complex matrix or data does not go too well with the buyer, whichever way you package it. The reports also need to go beyond obvious recommendations like ‘lifestyle change’. This is something too basic and the consumers may feel that the expense into buying a genetic test went underused.

The opportunities therefore will be only for those

tests which meet specific criteria like: Deterministic results, easily interpretable reports by the way of risk-graphs and conclusive statements; and associated information about management of the identified condition(s). It goes without saying that the management should be routed through a qualified health practitioner.

For other tests, I think they have to wait for some time.

How different is the Indian market from the global one?

Abhimanyu Kumar: Indian market is more diagnostics oriented, whereas genetic tests are mostly preventive tests and hence have yet not made it to the mindset of the larger Indian population.

Secondly, we are used to starting a line of treatment even based on a hypothesis. In the sense that, if there is a physiological indication or there are tests which give only superficial findings, we consider it enough to support a hypothesis behind the medical condition and start a treatment. Whereas, in most advanced countries, forget treatment of illness, people tend to get examined first even before taking steps towards ‘wellness’. It is a practice to first drill down to reach the specific cause behind health conditions which may have general symptoms. Only then a line of treatment is picked.

There are many deterministic genetic tests which help drill down to the root cause behind general health conditions. But they are not tried in the Indian market because just a ‘sense’ or ‘hypothesis’ is enough to initiate a treatment, so why to go for something which is expensive and also not too easily available with local laboratories. We mostly look at the immediate problem and not the long term consequences of an underlying medical condition.

So, working with pathological findings to find immediate relief suffices somehow.

For example, in a disease

like diabetes which affects over 6.5 million people, the standard approach is to manage sugar levels and at best have some physiological parameters read or tracked.

Whereas, genetics and more specifically, metabolomics has made it possible to pick very early signs before diabetes affects the neuropathy or liver functioning, and thereby helping personalise a treatment plan which works for the diabetic. However, the uptake is yet less because life just goes on even with preliminary measures and other reason being lack of awareness about such class of tests.

Which class of genetic diagnostic testing do you cater to? What are the areas that these tests cover?

Susheel Singh: We offer tests in a sub-set area of genetics, called as metabolomics. We are yet to get confident about the value proposition offered by the conventional genetic tests and hence have chosen to concentrate on metabolomics since it gives excellent findings, very early indications of effect of disease on functioning of vital organs and helps give a clear, unambiguous recommendation on the line of treatment to the consumer.

The chief area which we cover are chronic diseases like diabetes, obesity, cardiovascular disease, autism and inborn errors of metabolism. Our tests help manage the conditions at early stage and avert fateful outcomes on health.

You say that one day preventive genetic tests are going to be available in the superstores. So are these direct-to-consumer genetic tests ?

Abhimanyu Kumar: Few years back there were not too many health-centric stores.

Today, we have huge chains of stores which sell only health products, but also weight management diets and special foods. In certain countries there are kits available for

even HIV testing on a do-ityourself basis. In fact, there are companies in the US, which have introduced even pathology tests under a ‘do-ityourself’ model, in which the consumers collect the blood sample themselves through lancet or capillary action, and send it to the laboratory. The kits for these tests are to reach the hands of the consumer and he would do the rest. Logically, the superstores are a distribution point and it is quite likely that someone who has a high cholesterol or a family history of cardiac problems will pick a test for ‘trans fats’ directly

There is a market for ‘preventive’ tests based on concrete or deterministic findings, provided the industry players are able to market the value locked in such tests from the health store, collect his sample by a small painless prick on the finger, send the sample to the laboratory, get the results and if high trans fats are detected in his blood, will go to see his family doctor.

With the direct-toconsumer tests, the direct part is primarily about the mode of sample collection, which can be done at home without any technical assistance. For our category of tests, the sample requirement is a dried blood spot and urine sample. Both are self-doable.

However, most of the tests coming to us are routed through clinicians. The good thing is that this category of

tests are being appreciated by the clinicians, because without the approval of those who are going to treat the illness, it is unfeasible to offer the tests to consumers.

What will be the benefits and drawbacks of these kind of predictive tests? And are these tests in any way predictive? If yes, what are the risks involved in predictive testing?

Susheel Singh: ‘Preventive’ is a better word rather than ‘predictive’. They pick definitive signs of disease progression and help initiate a preventive regime of treatment. The benefit with this category of tests is that quality of life can be managed to a great extent, the high emotional, physical and commercial loss because of diseases can be reduced.

On the other hand the ‘predictive’ genetic tests for several hereditary diseases including cancers, may not give concrete findings, thereby causing unnecessary worry to consumers. Just having some ‘chance’ of contracting a disease in future will leave one with unnecessary paranoia.

What are the regulations related to direct-toconsumer genetic tests?

What is the code of conduct you follow in India?

Susheel Singh: Unfortunately there are, as of now, not too many regulatory requirements for direct-toconsumer genetic tests. And why genetic tests, in fact there are not many requirements even for general medical tests in India. Any lab can go operational with just a shop and establishment license, and this is fatal. More so if it comes to genetic tests whose results shall be apparent only over a long period of time, the unaccredited laboratories can easily get away with even sub-optimal results.

We follow strictest quality norms, maintain the international ISO15189 for medical laboratories and have a 100per cent EQAS compliance with at least five

international laboratories.

Can these kind of genetic tests be misused by patients? How can you curb the misuse of such tests, especially if they are predictive?

Susheel Singh: Theoretically, if a person knows about an impending disease or condition may get himself insured at a lesser premium and there can be a reverse scenario of being charged a heavy premium for disease he is not even suffering from. There have been continual debates on this and similar issues, because of which genetics and insurance are yet to come together.

There are other scenarios wherein genetic tests can be misused by employers or even prospective parents who intend to adopt a child.

One and the only way to not let such practice flourish is by some strict guidelines by the government. I hope that our government realises the momentum of upcoming genetic tests and comes up with very clear guidelines on genetic tests.

What will be the way forward in this segment of genetic diagnostics?

Abhimanyu Kumar: The only way forward for ‘predictive genetic’ tests is to firstly get the results validated. There are billions of base pairs you get while decoding a DNA. Basing a conclusion on limited analysis is not too reliable lest the results are validated over a period of time.

There is a market for ‘preventive’ tests based on concrete or deterministic findings, provided the multiple players in the industry are able to market the value locked in such tests properly without overpromising and maintaining utmost quality and ethics. The most potent area of work is going to be ‘personalised medicines’ based on preventive or earlyidentifier tests. raelene.kambli@expressindia.com

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‘We are aggressively pursuing research in the field of molecular pathology and genetic analysis’ Rajan Datar, Founder, Datar Genetics explains to Raelene Kambli, on the opportunities and challenges in genetics for India and also talks about Datar Diagnostics's partnership with Apollo Hospitals Educational and Research Foundation (AHERF)

What is the scope for genetic diagnostics in India? Which areas of genetic testing has prospered in India so far?

Molecular genetic diagnostics is still in its infancy in India. It may take another three to five years before this speciality matures.

If you compare with the West or Far East, India is lagging behind when it comes to imbibing molecular genetics in clinical practice.

Cytogenetics so far is still considered the bench mark.

The reason being limited laboratories with availability of sequencing platforms and lack of exposure to clinicians regarding molecular diagnostics. The same can be inferred by comparing Indian cancer patient survival data with that of the West.

There is tremendous potential in the molecular diagnostic market in India, particularly in oncology.

However still a lot of awareness and education is needed. Cytogenetic methods like Fluorescence in-situ Hybridization (FISH) and Immunohistochemistry (IHC) have a limitation of sensitivity and specificity, almost 20 per cent grey zone exists and if you were to decide your chemotherapy based on such

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In India, genetics invariably limits itself only to the reproductive medicine part. Fields like pharmacogenetics, oncogenetics are yet unheard of RAJAN DATAR, Founder, Datar Genetics tests for patients with breast cancer, colorectal cancer, then definitely we need to relook into the evidence. Even American Society of clinical Oncology (ASCO) acknowledges this fact.

In India, genetics invariably limits itself only to the reproductive medicine part. Fields like pharmacogenetics, oncogenetics are yet unheard of. There are not many specialised clinicians in this field. Newly introduced liquid biopsy tests like CTC and ctDNA need to be familiarised and utilised appropriately.

These are novel tests, the platform for which has been developed by DGL. The oncology practice will definitely benefit from such novel tests.

It’s time we move on from cyto to molecular genetics.

What are the opportunities and challenges associated with this field in India?

Medical genetics is a neglected field in medical sciences. Today, we have several scientists working on genetics but the major hindrance is their lack of clinical knowledge, as the majority come from life sciences background. Very few medical universities are imparting medical genetics knowledge to medical graduates and post graduates, though this scenario has begun to change.

Hence in this field it’s a dual task, to educate the clinicians and create opportunities by inculcating and imbibing molecular genetic tests in practice. For instance, almost every physician treats heart patients. Anti-coagulants and anti-platelets are some of the most commonly prescribed drugs. Yet over informal interactions with numerous physicians, we found that almost 80-90 per cent were unaware of pharmacogenetic

tests for such drugs, forget about prescribing these tests.

We need to look at the current guidelines and evidence. Definitely there’s an argument that there is no Indian data, isn’t it? We need to emphasise on whatever evidence we have as of now and develop where there is meagre. But that ain’t no excuse we need to start somewhere. We need to exploit the newly available testing platform for the best.

Cost is another factor for such tests. But one fact needs to be highlighted, some laboratories are doing FISH and IHC based tests for Rs 12,000 to 18,000/- , DGL is providing pharmacogenetic testing for Oncology drugs for Rs 8,500/-, similarly other pricing are also reasonable.

Yet we should acknowledge that technology comes with a cost.

What are the trends in this field? What kind of research

is underway in this field?

The field of molecular genetics is very promising, a lot of research is going on at the international level. What is striking is that India contributes to less than five per cent of such research, a lot of data comes from west and Far East. China has made tremendous progress in this aspect. The current need is however to focus more on the translational part of research.

If any amount of evidence is to remain in the lab then it’s pointless. As much we adapt in clinical practice, there is bound to be new learning.

In India, lot many public sector and private sector enterprises are conducting research in this field. It’s time we have conclaves and interactions amongst these research scientists and clinicians across various specialties for the better. The question of Indian data will broadly be addressed in such a way.

Which areas of genetic testing do you cater to?

DGL desires to be the pioneer institute when it comes to Molecular Genetics.

Presently DGL offers genetic tests in the following specialities

◗ Oncology: Tumour genome sequencing, tumour exome sequencing, tumour and paired transcriptome sequencing, tumour tissue molecular characterisation, liquid biopsy - circulating tumour DNA, circulating tumour cells, pharmacogenetics for chemotherapy drugs, hereditary cancer testing. ◗ Cardiology: Pharmacogenetics for cardiology drugs, hereditary cardiac conditions testing ◗ Diabetes: Pharmacogenetics for diabetes drugs, genetic test for neonatal diabetes and maturity onset diabetes of the young ◗ Neuro-psychiatry: Pharmacogenetics for neuropsychiatry drugs ◗ Reproductive medicine: Non-invasive pre-natal testing, pre-gestational diagnostic testing, preconception/marital genetic screening, neonatal and new born genetic screening ◗ Geriatric: Pharmacogenetics for osteoporosis and nutrigenomics testing Are there any ethical issues that plague the genetic diagnostic sector in India?

Ethical issues are indeed there. But what’s more important are the legal issues.

With such a hue and cry regarding PCPNDT going on, it’s time we make known that

Datar Genetics' strategic collaboration with Apollo Hospitals Educational and Research Foundation (AHERF) will help us establish a liquid biopsy platform for detecting Glioblastomas (GBM). AHERF will provide Datar Genetics the necessary technical and clinical support for co-validation of the assay. For the same, AHERF has assembled a consortium of Apollo Hospital’s neuro-oncologists to conduct collaborative research to understand brain tumours molecular genetic tests are larger than just reproductive genetics. If you leave apart NIPS and PGD, still there are pharmacogenetics for various specialities, oncogenetics etc. much beyond the purview of PCPNDT. There are different takes on incipient findings of the genetic tests, also patient privacy and confidentiality.

Here decisions need to be taken on case to case basis, also medical ethics need to be remoulded into medical genetic ethics. A lot of literature evidence and legalities are being developed, we need to promptly update ourselves.

Right from patient consent to test, to confidentiality while sample processing, analysis and reporting, issues need to

be addressed at every level.

Again genetic counselling is a very important issue which needs to be addressed.

What is the business approach adopted by you to reach out to the masses?

How have you benefitted by this approach?

I wouldn’t really say that we have a business approach to this. Doctors have been very appreciative of this technology- as it enables them to treat their patients better.

What are your plans for Datar Diagnostics in the coming months?

We are aggressively pursuing research in the field of molecular pathology and genetic analysis to offer wholesome service from

pre-disposition assessment to post-diagnosis management and recurrence monitoring.

Our area of focus is cancer, reproductive genetics, cardiovascular disease and transplant genetics.

You have also tied-up with Apollo Hospitals, can you throw some light on this partnership?

Datar Genetics' strategic collaboration with Apollo Hospitals Educational and Research Foundation (AHERF) will help us establish a liquid biopsy platform for detecting Glioblastomas (GBM), one of the most aggressive malignant brain tumours in humans.

Management of GBMs remain challenging as there are no current curative

treatments and therefore, mortality rates continue to stagnate at high levels. This research is critical, from the point of view of effective treatment as well as pharmacogenetics.

The global market size for diagnosis of brain tumour is about Rs 500 crores. The Indian market is estimated to be roughly eight per cent of this. The real cost, however lies in the amounts spent post mis-diagnosis. A trial and error based approach can lead to much heartburn and high costs. Only 15 per cent of the existing incidences worldwide are diagnosed correctly at present.

Datar Genetics, by virtue of a state-of-the-art facility at Nashik and a specialised team of scientists, has undertaken the challenge to translate this liquid biopsy technology into a clinically applicable diagnostic platform which will immensely help the neurooncologists to stratify tumour patients in real time for disease progression and therapy response.

AHERF will provide Datar Genetics the necessary technical and clinical support for co-validation of the assay.

For the same, AHERF has assembled a consortium of Apollo Hospital’s neurooncologists to conduct collaborative research to understand brain tumours. raelene.kambli@expressindia.com

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Awareness of genetic diseases is significantly increasing Dr Shailesh Pande, Genetic Counselor Metropolis Healthcare speaks on the trends in genetic diagnostics and the way forward in this field, in an interaction with Raelene Kambli What are the latest trends in genetic diagnostics? ◗ Micro array:With an increasing trend for high quality healthcare testing, microarray is the fastest growing segment in diagnostics. Evolution and development of microarrays by biotech companies have dealt with the market requirement of speedy results based not only on high resolution and coverage but by providing an easy and robust data analysis system.

In clinical genetics there has been a transition where chromosomal microarray is the first-tier diagnostic test for individuals with developmental disabilities, multiple congenital anomalies, intellectual disabilities and autism spectrum disorders as per the guidelines by American Society of Clinical Genetics.

Microarray technologies have explored the field of cancer genetics with an aim to give faster cancer diagnosis and management. Treatment decisions in cancer are offered based on cancer profiling and biomarkers. ◗ Next generation sequencing (NGS): An NGS test gives tremendous throughput and speed and allows researchers to study and analyse at a micro level that was not possible earlier. These tests are rightly filling the void with DNA sequencing tests and are giving answers to many questions.

With NGS it has become possible to refine diagnosis, individualise treatment, and prevent drug effects and development of new therapies.

NGS will be a very valuable

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asset in genetic diagnostic in coming years. ◗ Non-invasive prenatal testing (NIPT): NIPT is a new technology by means of which prenatal screening for common aneuploidies in pregnant women can be done from peripheral blood i.e. by non invasive techniques rather than invasive techniques like CVS and amniocentesis and can be carried out much earlier than invasive techniques. One can overcome the possibility of procedure related miscarriages (though small) associated with invasive methods. Basically it is carried out in circulating cellfree DNA in maternal blood.

NIPT falls in between being a screening and a diagnostic test.

Abnormal result in NIPT has to be confirmed by invasive test like chorionic villus sampling (CVS) or amniocentesis.

Is genetic diagnostic a booming market in India?

India is experiencing a shift towards prevalence of noncommunicable diseases. As per recent studies, India has secured third position in congenital malformations and genetic disorders as the commonest cause for neonatal mortalities in cities.

Awareness of genetic diseases is significantly increasing in India and there is a dire need for adequate and effective genetic testing and genetic counselling services.

There are multiple reasons for upsurge in genetic diseases in India; some of them can be summarised as consanguineous marriages, high birth rate, late marriages,

We offer the full scope of cytogenetic and FISH tests as well as genetic counselling and availability of improved diagnostic facilities. Today, very few clinics and labs are providing advanced cytogenetic, biochemical/metabolic, molecular and prenatal diagnosis services and genetic counselling under one roof.

There is tremendous scope for genetic testing in India.

Metropolis has been at the forefront in adopting global practices and will continue to make the right investments to provide the very best.

What are the opportunities and challenges?

The biggest challenge is in creating awareness of the significance of genetic tests and to make people understand that many of the genetic problems are now treatable. If not treatable they are certainly preventable. Lack of accredited and authorised genetic labs across the nation and counselling services is proving to be a huge impediment to spread the right kind of awareness.

At Metropolis, we have a set protocol that we follow for genetic tests. We send a detailed counselling letter to patients whose samples have come to us for genetic testing if a face to face meeting is not possible. Metropolis is also well positioned with its network of labs across India, collection centres and a seamless logistics team that makes it possible for samples to reach us in the stipulated time. Once the analysis and reporting of the sample is complete, every opportunity is taken to discuss the case with referring clinician and after obtaining detailed medical history, counselling letter addressing to the doctor is issued What doesMetropolis Cytogenetics offer?

We offer the full scope of cytogenetic and Fluorescence In-situ Hybridisation (FISH) tests as well as genetic counselling under one roof.

There is a wide range of cytogenetic and FISH tests for different indication on different tissues like blood, bone marrow, product of conception, prenatal and solid tumours. There are

some common conditions and diseases wherein genetic tests are followed or a couple with molecular diagnostic tests.

Metropolis is one of the few labs offering prenatal diagnostic tests. We have also developed Sperm FISH for repeated pregnancy losses with aneuploidies and cases with abnormal semen analysis reports.

Metropolis is the only lab in India to offer genetic counselling services to its customers. It is an education and training initiative which aims to spread knowledge about genetic aspects of illness in terms of risk analysis, presence of heritable disorder or of chances of passing it to their unborn offspring with following principle elements: diagnostic and clinical aspects, documentation of family and pedigree information, recognition of inheritance patterns risk estimation, scientific communication and empathy in those seen, information on available options and further measures, support in decision making and discussion on cost effectiveness.

Genetic counselling can be offered to large number of genetic disorders for different conditions and different age groups such as: ◗ Pre-conceptional, prenatal genetic counselling ◗ Postnatal (paediatric, pubertal, adults) genetic counselling ◗ Premarital genetic counselling Continued on page 40

I N T E R V I E W

Genetic testing can help in choosing the right drug and the right dose for a patient Dr Vijay Chandru, Chairman and CEO, Strand Life Sciences, gives a rundown on the genetic diagnostics market in India, its future prospects, his company's share in this fledgling market and how genetic diagnostics would impact healthcare in the coming years, in an interaction with Lakshmipriya Nair How big is the market for genetics diagnostics in India?

What is your share in it?

The overall molecular diagnostics market is perhaps at about three to four thousand crores. In genome sequencing based diagnostics, Strand has perhaps a 30 per cent market share today in India. We work with about 100 hospitals and clinics in the country and over 200 physicians use our tests for their patients on a regular basis.

How far can the information received through genetic testing be reliably used as the basis for healthcare decisions?

There are two types of genetic signatures that are useful for healthcare decisions.

Mendelian variants in specific genes are the source of risk of various inherited disorders and these genetic tests can confirm a diagnosis and trigger preventive measures. As an example, Angelina Jolie has now created a great awareness about the risks associated with genetic markers for breast and ovarian cancer.

There are also pharmacogenomic variants that can be indicative of how effective or adverse a specific therapy (drug) can be in treating the patient. Selection of specific chemotherapies, targeted therapies and the dosing for

cancer treatment based on genetic variants is now considered as an emerging new guideline for standard of care.

What are the opportunities and challenges associated with this sphere?

In personalised and precision medicine, genetic testing can help with choosing the right drug and the right dose for the individual patient.

This has been effectively demonstrated in the care of many cancer patients. There are also great opportunities in preventive care of people whose risks for diseases can be estimated from genetic dispositions and appropriate preventive measures including many lifestyle changes can be effectively brought to bear.

Cardiac disease, neurodegenerative and cardiovascular disease are particularly significant in adults and seniors.

The challenge is that we have only learnt to interpret about 20 per cent of the genes in human DNA. So there is a lot of signal from genetic testing that we simply do not know how to interpret. Knowledge is expanding rapidly and highly trained and large scale knowledge curation is required to address this challenge.

Strand has a very special approach to this which has made us a global leader in

We will continue to be the market leader in the space of complex multigenic testing in India interpretation.

Tell us about your offerings in this arena? How do they help in effective healthcare delivery? How have they been received?

We have the market lead in the following areas ◗ Multi-genic NGS panel for

solid tumour profiling ◗ Multi-cancer familial risk panel ◗ Clinical exome panel for rare disease diagnosis ◗ Specialised panels for cardio and eye related inherited disease Strand Centers for Genomics and Personalized Medicine provide exceptional genetic counselling both at a pre-test and post-test stage. We have counsellors spread across the nation and we strongly believe that genetic testing should be inter-mediated by medical professionals. Genetic testing done ‘direct to consumers’ and overt advertising to consumers is fraught with ethical problems since these are highly technical and yet life changing diagnosis, and there are possibilities of misunderstanding by patients and their families. Our quality of tests and particularly our interpretations are deeply appreciated by physicians who can use them as decision aids in selecting treatment options.

What's your way forward in this area? Any significant tieups with other players which would help you gain a firmer foothold into this market?

In India we already have corporate relationships with hospital networks like Max, Narayana Health, HCG, Apollo, and also a number of smaller

specialist groups. We work with many of the key opinion leaders in the medical specialities that we serve.

In the US, our CLIA lab at Aurora, Colorado is up and running and we are in the market with direct to physician sales. We have an exceptional scientific advisory board with leading oncologists and clinical biologists from Dana Farber, National Jewish, LV Prasad Eye Institute, Duke University, Boston University, etc.

We believe that we will continue to be the market leader in the space of complex multigenic testing in India and will grow the market for the whole field. This is an emerging area of personalised and precision medicine which is happening now in India just as it unfolds in the West as well.

How affordable are these tests for the Indian market?

We have taken affordability as a key driver of innovation in order to address the Indian market but more importantly to take on the global market with the advantages of a lower cost base. Even in the West and in health systems like the US there is tremendous downward pressure on reimbursements for molecular diagnostics and Strand will be better prepared than its competitors to deal with this pressure because it is ‘Made in India’. As our board

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GENETIC DIAGNOSTICS SPECIAL member, Ravi Venkatesan (former Chairman of Microsoft India) has written ‘Win in India, Win Everywhere’.

In India, we are driving towards pricing that is on the same order of magnitude as a PET scan which is perhaps one of the most expensive diagnostic tests that has become a standard of care. So these tests are not cheap but they are affordable. We believe that the value provided to patients by enabling physicians make better decision based on

deeper insights justifies the price. But the market will speak.

What is the scope for personalised medicine in India? What role does Strand Life Sciences envisage for itself in this sphere?

Strand is participating in bringing personalied and precision medicine to the Indian healthcare establishment in a responsible, ethical and scientifically validated manner. We are

working with the medical establishment to define new guidelines of bringing this practice into the mainstream of medical practice, and are carrying out exceptional translational research with our partners in Mazumdar-Shaw Medical Center at Narayana Health which will put personalised and precision medicine in India on the global map. India has been a global leader in affordable medicines, affordable surgeries and affordable hospital care. There

is no reason why we cannot be a global leader in affordable personalised and precision medicine.

What aboutsecurity of the information you provide?

How do ensure that it does not get misused?

Our technology platforms follow the best practices and are certified to be HIPAA compliant. If labs and diagnostic companies follow the regulatory regimes of NABL, CAP and ISO in a

genuine way, these will automatically ensure security and ethical use of data. At Strand we have an internal Institutional Ethics Review Board that oversees and clears all our processes as well as the specific tests that we launch.

It is time for a national legislation along the lines of a ‘genomic information nondiscrimination act’ (GINA was passed in the US in 2009) that would protect citizens from misuse of their genetic data. lakshmipriy.nair@expressindia.com

Continued from page 38

Awareness of genetic diseases... ◗ Counselling in cancer genetics.

Can you elaborate on some of the studies you are working on?

Currently we are conducting the following studies: ◗ Prenatal: Karyotyping and FISH from amniotic fluid ◗ Postnatal: Karyotyping and FISH from blood in various paediatric cases, infertility, BOH, products of conception ◗ Cancer genetics: Karyotyping and FISH in various blood cancers ,solid tumours like breast cancers ◗ Sperm FISH: In males with abnormal semen analysis report and repeated pregnancy losses with foetal aneuploidies.

Why is counselling an important aspect of providing genetic diagnostics at Metropolis?

When the doctor suspects some responsible genetic factor then he refers the patient to a genetic counsellor. Genetic counselling is a process of communication and education to increase understanding of genetic disease, discuss disease management options, and explain the risks, benefits and limitations of tests.

After obtaining detailed family, medical, and obstetric

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history, genetic counselling gives clear, accurate information to make an informed choice of option for the patients, to know what test to be conducted and what is best for them.

In which areas of genetics diagnostics counselling should be offered and why?

Here are some indications where genetic tests and genetic counselling can be offered.

Some of the examples where genetic testing and counselling is offered: Infants/Children ◗ Ambiguous genitalia ◗ Dysmorphism ◗ Syndromic appearance ◗ Congenital abnormalities ◗ Suspected metabolic disorders ◗ Growth retardation ◗ Deaf mutism/blindness ◗ Prepupertal/pubertal Pubertal disorder ◗ Underdevelopment of secondary sex character, short height, gynecomastia, hypospadias, genital abnormalities USG abnormalities ◗ Absent/rudimentary UT or absent/streak ovaries ◗ Primary and secondary amenorrhea ◗ Mental retardation ◗ Fragile X syndrome (previous baby)

Reflex strategies and optimisation of test and test panels for benefit of patient is one of the way forward ◗ Epilepsy, autism, muscular disorders Preconceptional and prenatal ◗ Consanguineous marriage ◗ Members of high risk ethnic group ◗ Maternal disease (eg. diabetes, Phenylketonuria) ◗ Single gene disorder (thalassemia, Duchenne muscular dystrophy) ◗ Infertility or patient on ARTs ◗ Two or more pregnancy losses ◗ Previous child or family with H/O genetic/birth defect. ◗ Positive Minimum Spanning Tree ◗ Abnormal ultrasound ◗ Adverse maternity age Premarital genetic counselling

◗ Assist an individual or family to decide whether to proceed and choose appropriate genetic testing. ◗ Confirmation of clinical diagnoses or rule out a genetic disorder. ◗ Identify at risk group. ◗ Support family members and provide information about support groups and local service agencies.

How does accreditation impact the genetic testing labs?

Accreditation is important because these tests are specialised tests and requires the right kind of automation, skilled technicians, trained team and moreover the hands and eyes of an experienced team. It is important that the laboratory adheres to protocols and follows global standards.

These tests are important because it could be life changing for the patient and then there is absolutely no room for technical or manual error. Error free diagnosis is critical because doctors depend on diagnostics reports for disease management diseases.

At Metropolis quality is a way of functioning, simply because it guarantees accurate and reliable results. Because we insist on pin-point precision even on routine tests, there is

no compromise in upholding highest standards of quality.

Every process and every technician in cytogenetic is oriented towards quality. Apart from our stringent internal quality programmes we are following norms of PCPNDT, National Accreditation Board for Testing and Calibration Laboratories (NABL), and College of American Pathologists (CAP).

What is the way forward for genetic diagnostics in India? ◗ Increased awareness of genetic tests and its applications ◗ Proving genetic counselling services to tertiary level by building strong network for logistics ◗ Detailed counselling letters and tele-discussion of reports and assistance can help change the existing situation. It will also help the population choose a proper genetic test ◗ Reflex strategies and optimisation of test and test panels for benefit of patient ◗ Mass screening for most common genetic diseases prevalence in certain geographic locations or tribal populations with the help of government bodies and healthcare insitutions E.g. beta thalassemia raelene.kambli@expressindia.com

STRATEGY INSIGHT

H E A LT H CA R E IN India is in state of flux and poised on the threshold of a transformation.

Touted as a sunrise industry, it is apparently teeming with opportunities. Hence, it has become vital to send out the right communication to the customers and engage them fruitfully to stay in the lead and optimise the potential available.

As a result, healthcare providers and vendors, both are looking for newer approaches and fresh strategies to harness this growth prospects. One of the players who have come up with a new strategy is Becton Dickinson (BD). Varun Khanna, MD, Becton Dickinson opines, “Healthcare delivery in India is at crossroads where specialised, protocol-based and integrated care is essential to cater to the next level growth.”

Alchemy to attain progress BD has adopted a new mode of reaching out to its customers called ‘Alchemy – Together for Transformation.’ The company informs that it is a joint strategy session to deliver a level of collaboration which was unheard of earlier in the healthcare industry.

The initiative is an attempt by the company to discover the priorities of their customers.

BD launched the first chapter with its key customer, the Fortis Group. Recently, they conducted their second session

HEALTHCARE MARKETING

CHANGING PANORAMA A

Healthcare players have woken up to the need of engaging their customers effectively to stay ahead of the competition.

As a result, they are opting for marketing strategies which are innovative and nonconformal in nature

BY LAKSHMIPRIYA NAIR AND RAELENE KAMBLI

with Thyrocare, a leading diagnostics provider in India.

Through Alchemy, BD intends to introduce its new products, new services as a preview to the customers and to reiterate the message that BD is at the forefront in delivering the right products and services to its customers.

Khanna explains, “The private healthcare sector

providers are looking at forging partnerships that will help them achieve their top priorities. Alchemy is BD’s flagship customer centricity initiative that is targeted to identify synergistic partnerships in areas that are relevant to BD and our key customers through a joint strategy session between the leadership teams of the two organisations. Each Alchemy ses-

sion is being seen as a new opportunity to learn more about our customers.” Thus, as the word alchemy refers to ‘a seemingly magical process of transformation, creation, or combination’; BD’s new strategy of reaching out to its customers seems to be aptly named.

Khanna also informs that Alchemy has helped them on three fronts.

◗ Understanding their customers better, on account of an elevated degree of customer engagement at the C- suite level ◗ Speed to action and catalysed decision making ◗ Ability to elevate the healthcare ecosystem to a different level where all energies are channelised towards improving healthcare outcomes and quality of care But, have its customers also found such an approach novel and beneficial? What are their views on it?

Synergising for success Daljit Singh, President, Fortis Healthcare has a very positive feedback to offer. He says, “We believe today we are moving beyond managing ‘buyer-seller contracts’ to a whole new level of engagement that leverages each other’s strengths to provide both organisations a competitive advantage in the market. From a buying-selling arrangement, the relationship must now transcend into a strategic partnership that drives mutual success.”

He further informs, “Alchemy was a perfect platform that underscored collaborative thinking; I believe it was a great way to strengthen relationships and, most importantly, an essential building block for trust. Fortis, along with BD, was able to identify themes and projects that have the potential to help the community and country at large.”

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STRATEGY promotion effectively He also informs, “Leading pharma companies and also some of the medical device companies offering O2C devices to customers for chronic diseases like diabetes, kidney ailments, etc. can greatly benefit from our offer.”

Healthcare delivery in India is at crossroads where specialised, protocol-based and integrated care is essential to cater to the next level growth Varun Khanna

Digitally yours

L-R: Dr Velumani, CEO, Thyrocare and Varun Khanna , MD, BD at the Alchemy session held recently

MD, Becton Dickinson

From a buying-selling arrangement, the relationship (Fortis and BD) must now transcend into a strategic partnership that drives mutual success Daljit Singh President, Fortis Healthcare

I see a lot of synergy in the thought process between both the organisations (BD and Thyrocare) Dr A Velumani CEO, Thyrocare

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Khanna summarises the outcome of the session with Fortis and says, “Some of the synergistic work themes that evolved out of Alchemy with Fortis were infection control, diabetes and oncology. We launched a platform called Signature Solutions with Fortis that will help in benchmarking practices in insulin injection techniques, infusion and blood collection practices in improved infection control and patient experience.” He also informed, “Oncology being a large focus area for Fortis Healthcare, we are evaluating a collaboration in that space. Through SRL, we are actively focusing on improving the access to TB diagnostics in the hinterlands.”

The second session with Thryocare too seems to have yielded good results.

Dr A Velumani, CEO, Thyrocare, updates, “The importance of healthcare workers safety in addition to patient safety was the highlights of the session. The need for awareness, knowledge about disease transmission, training of healthcare workers, safety measures, tools and strategic plans to achieve it in the years to come were discussed (at the Alchemy session).” He further reiterates, “I see a lot of synergy in the thought process between both the organisations and I am sure this synergy is going to amplify our targeted goal of establishing good pre-analytical laboratory practices across India.”

Offering his feedback on the outcome of the Alchemy session with Thyrocare, Khanna says, ‘Thyrocare as an organisation is focused on high throughput of high value tests.

They do this brilliantly by investing in technology and processes that bring in high degree of efficiency across the value chain of diagnostics and the savings are passed back to their customer. Cervical cancer, leukaemia and lymphoma are areas of common interest for both of us and could be potential areas of collaboration.

In our endeavour to strengthen laboratory practices in India, we are exploring skill enhancement in phlebotomy with Thyrocare.”

Dr Velumani adds, “We are looking ahead to put our best effort towards creating awareness amongst healthcare professionals by implementing safe and good laboratory practices in both pre-analytical and analytical phase.”

Thus, the new approach seems to have set BD on a rejuvenated growth path. However, BD is not the only one to move away from traditional and conventional methods of reaching out to customers and opt for a less trodden path.

A gem of a stratagem DHL, a renowned integrated logistics service provider, has devised a Direct to Market (D2M) solution that connects manufacturers directly with their end customers and usually involves an integrated

logistics and Order to Cash (O2C) solution. Samee Patel, Life Sciences & Healthcare Director, DHL Supply Chain informs, “It aims at reducing the layers within the distribution channel thereby having better control on inventory flows, visibility and control on fund flows within the distribution chain.”

Explaining the rationale behind adopting such a tactic, he says, “Our aim is to offer logistics services in a manner that would provide better control, visibility and predictability to the complete distribution function.”

Patel also gives a rundown of the advantages of their stratagem: ■ DHL becomes an extended sales arm ◗ Ability to up-sell products/ inform customers on promotion ◗ Close the gap of lost sales and out of stock situation ■ Enhanced relationship with the end customer ◗ End customers will have the impression that they are engaging with the manufacturer instead of a third party ◗ Possibility of co-branding with manufacturer - call agents will identify themselves as representatives of the manufacturer ■ Complete visibility of sales supply chain ◗ End of day inventory, sales, delivery information is readily available through DHL system ■ Increased adaptability ◗ Activity-based pricing provides visibility to improve productivity. ◗ Ability to do tier-based pricing which would help in handling

These two players have already started capitalising their strengths through unconventional methods of marketing. What about the rest of them? Is it time for the others too to devise their own, unique ways of engaging their customers?

Mitish Chitanvis, Cofounder, Health5C, a digital health management company answers this question affirmatively and says, “Absolutely, conventional marketing methods are good, however, not effective to reach out to masses and create a top of mind recall.

Consistently measuring an RoI on the marketing activities is essential.”

He recommends digital media as an effective mode of communication and hence a great marketing tool. Elaborating, Chitanvis says, “Mobile marketing/advertisements, social media, using google effectively etc are playing a major role in today’s brand building world. Then comes the service/culture that needs to be excellent for the customer to back up the branding and marketing effort that the healthcare service providers are using. Finally, the healthcare industry works on word of mouth, customer reference or friends’ reference business, hence excellent customer experience is also a must. Innovative tools on ‘How to make a patient’s life simpler’ by using mobile and web technology is a must.”

According to Chitanvis, “Content and inbound marketing are some of the biggest strategies that are coming up.

Hybrid marketing strategies utilising the power of social media and conventional methods is a lethal combination.”

#Socialmedia: Trending in healthcare marketing Several brands have started

utilising social media to good effect. Max Bupa is a case in point. The leading health insurance provider chose to engage their consumers and drive an education campaign through social media to bust the prevailing myths of health insurance industry. Two fictional characters, Satya and Mathya, educated the consumers about health insurance through quirky and engaging conversations built through comic strips, puzzles and tips. The campaign was very successful in creating brand recall for Max Bupa and also served to spread awareness about the need for health insurance. The brand has also engaged in several other social media activities as part of their marketing strategy.

Another example of good media marketing could be Lifecell’s Facebook strategy which sought to communicate with their target audience i.e. pregnant mothers and expecting parents, to reassure them about stem cell banking.

The brand decided to use Facebook from a social perspective, and decided to make parents who are already registered with LifeCell become their brand ambassadors and speak on behalf of the brand by expressing their parenting emotions.

The brand also created several timeline contests with photos and videos, to engender great fans’ engagements around days like Parent’s Day, Mother’s Day etc. Each competition targeted one specific category of people: ‘mothers to be’, ‘fathers to be’, ‘fathers’ and ‘mothers’. These engagements served to make the brand very popular and increased their footfalls. As Malorie Lucich, Facebook Spokesperson says, “People share, read and generally engage more with any type of content when it’s surfaced through friends and people they know and trust.”

Narayana Health, a leading healthcare institution, helmed

by Dr Devi Shetty, has also utilised digital media to position itself as a leading brand and become a success story in healthcare marketing. It has chosen a variety of digital

tools such as interactive websites, search engine optimisation/marketing, online reputation management, social media and other tools such as emailers, news portals, and portals with medical content.

The objectives were to seed positive content about Narayana Hospitals, its credentials, success stories, doctors, etc on various forums and relevant sites, address queries about the hospital on forums, defuse negative feedback on review portals and avert spread of bad word of mouth.

The activities have reaped great results and helped in improving brand recall. The stories of technological advancement in healthcare, cure, prevention, CSR activities, etc have helped the hospital in build strong brand loyalty as well.

Thus, integrating social media into the healthcare marketing mix have enabled these organisations to share accurate, timely information about their brand and build a positive image in the minds of their target audiences. Other healthcare marketers too can embrace this medium to generate positive online communication for managing their reputation since social media has emerged as one of the most powerful tools of digital communication.

Winds of change There are evidences galore to prove that many have started shifting towards unconventional ways of reaching out to their target audience with the help of technological advancements in the healthcare space.

As Dr Biranchi Jena, Director, IIHMR, Bengaluru, a healthcare management institute in the country, says, “Across various industries, marketing methods have been changed significantly with the advent of

information technology and I can foresee that the healthcare industry would not reinvent the wheel with conventional methods. A blend of conventional and emerging methods is expected to do the trick.”

Challenges to tackle However, the entire industry has not caught on to these new-fangled means of marketing. Dr Jena also informs, “Apart from the pharmaceutical sector, other sectors like hospitals, insurance and other allied services have not witnessed a very structured way of marketing.”

Chitanvis agrees and enumerates the challenges which have hindered the advent of structured marketing in healthcare: ◗ There are very few vendors who understand healthcare marketing and consumer acquisition ◗ Healthcare marketing is not like marketing in any other industry ◗ Healthcare marketing is also about content marketing and specifically around medical content ◗ Cannot play the emotional card in marketing strategies, since health is already a sensitive and emotional subject Elaborating on the same theme, Dr Jena states that marketing is the instrument which facilitates out-of-box innovative methods to expand the markets. He also says that however, we often misinterpret the marketing efforts with sales activities and hence we are still not able to tap the huge market in rural and semi-urban areas.

In the future So, what’s the way forward?

How can healthcare players surmount the impediments to propel their growth trajectory

Integrating social media into the healthcare marketing mix have enabled organisations to share accurate, timely information about their brand and build a positive image

through effective marketing practices?

Probably by being in-sync with the changing trends in marketing and by realising the fact that healthcare, as any other business, needs to be promoted as a product and a service. Dr Jena believes that this would happen in the near future. He says, “While effective communication has been a major issue in healthcare marketing, I expect a significant change in the awareness and communication led marketing to improve customer intimacy. Consumerism is therefore coming a big way in healthcare marketing. This generates demand for healthcare as a product.” A retailfocused mindset might very well drive healthcare marketing strategies in the future.

Many have already started learning from the marketing methods used in other industries and it is to be expected that the rest of them will follow suit. Healthcare marketers will begin to take note of altered consumer preferences and buying decisions, including medical care. Good content will play a pivotal role moving forward, and enable healthcare marketers to start conversations and control the messaging on a micro level.

Moreover, it is also likely that healthcare marketers would opt for building long-term relationships with smaller, targeted audiences, than creating generic content. Thus, outdated concepts like “one size fits all’’ will die a natural death and the above mentioned examples demonstrate that the process has already begun.

Thus, the healthcare marketing space would be redefined with the players vying with each other to stay ahead of the curve, and consistently deliver fresh and creative campaigns that set themselves apart from their competitors. And rightfully so, because as Seth Godin, renowned American author, entrepreneur and marketer puts it, “How dare you settle for less when the world has made it so easy for you to be remarkable?” lakshmipriya.nair@expressindia.com raelene.kambli@expressindia.com

Our aim is to offer logistics services in a manner that would provide better control, visibility and predictability to the complete distribution function Samee Patel Life Sciences & Healthcare Director, DHL Supply Chain

Hybrid marketing strategies utilising the power of social media and conventional methods is a lethal combination Mitish Chitanvis Co-founder, Health5C

Apart from the pharma sector, other sectors like hospitals, insurance and other allied services have not witnessed a very structured way of marketing Dr Biranchi Jena Director, IIHMR, Bengaluru

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LIFE PEOPLE

Lt Gen Vimal Arora (Retd) is the new Chief Clinical Officer of Clove Dental Earlier he was heading the Dental Branch of the Army, Navy and Air Force as the Director General of the Armed Forces Dental Services (DGDS) CLOVE DENTAL announced the appointment of Lt General Vimal Arora (Retd) as its Chief Clinical Officer. “Dr Arora will play a key role in ensuring that the Clove continues to deliver affordable and high quality oral healthcare in a transparent and ethical manner” said Amarinder Singh, CEO of Clove Dental.”

“I look forward to being a part of the Clove Dental team, said Dr Arora. “Clove Dental is doing an excellent job of building the modern dental infrastructure for India and I look forward to playing a crucial role in the bringing best dental practises from my

experience as the Director General of the world’s largest dental services,” he added.

Prior to joining his assignment at Clove Dental, Dr Arora was heading the Dental Branch of the Army, Navy & Air Force as the Director General of the Armed Forces Dental Services (DGDS). He has received the Presidential Award four times for distinguished services. He was also the Honorary Dental Surgeon to the President of India. He has been awarded Lifetime Achievement Awards by the Indian Prosthodontic Society, Indian Dental Association and he is also the recipient of the ‘Order of the Special

Royal Emblem’ from the Sultan of Oman and also the ‘Sushruta Award’ from Dr APJ Abdul Kalam in 2015 for professional excellence.

He has been conferred the Honorary fellowship of the International College of Dentists and is the Founder Member of the International Congress on Oral Cancer, World Assembly on Tobacco Counters Health and the Indian Dental Association, Defence Branch. He is on the Board of the Governing Council of the ‘Maulana Azad Institute of Dental Sciences’, New Delhi. He is also the Member of the Dental Council of India.

Satish Reddy takes over as National Safety Council Chairman Reddy takes over the Chairmanship from Venu Srinivasan, who steered the workings of the Council since July 2011 SATISH REDDY, Chairman of Dr Reddy’s Laboratories has been appointed as the new Chairman of the National Safety Council (NSC). Reddy takes over the Chairmanship from Venu Srinivasan, who steered the workings of the Council since July 2011. The National Safety Council is the apex body set up by the Govt of India, Ministry of Labour and Employment, to generate, develop and sustain a volun-

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tary movement on safety, health and environment at the national level.

As a part of its mandate to make safety in India a way of life, the council conducts specialised courses and workshops across the nation, carries out safety audits and risk assessments, facilitates awareness camps in organisations and so on.

On his appointment as the Chairman, NSC, Reddy said,

“It is an honour and privilege to be nominated as the Chairman of the National Safety Council. The apex body has been doing commendable work since its inception. I look forward to working with my fellow council members in carrying forward key initiatives on health, safety and environment. Safety continues to be a critical factor in contributing to India’s positive growth trajectory”

KEM nurse Aruna Shanbaug passes away She had been in a vegetative state after her rape in 1973 by the hospital’s ward boy LESS THAN a week after International Nurses Day, Aruna Shanbaug, former junior nurse at KEM hospital, finally breathed her last on May 18, 2015.

67-year old Shanbaug had been brain-dead and in a vegetative state since 27 November 1973, when she was sexually assaulted by a ward-boy who also choked her with a dogchain. This cut off blood supply to the brain, resulting in brain stem contusion and injury to her cervical cord, which also left her cortically blind. She was artificially kept alive by doctors and nurses at Mumbai’s KEM Hospital.

Shanbaug was diagnosed with a bout of pneumonia a week before her demise and was admitted in the medical intensive care unit (MICU).

Though the hospital had communicated that she was recovering and all her other medical parameters were fine, she suffered a sudden attack on the day of her death and could not be saved.

Shanbaug's case had posed many uncomfortable questions about euthanasia and right to life, about the right of hospitals and healthcare institutes to block resources for patients who stood no chance of recovery. Her demise will probably raise all these questions once again and hopefully lead to a more humane solution, within the legal system, for dealing with patients like Shanbaug as well as taking steps to protect the nursing fraternity from such incidents in the future.

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Advertise in

Business Avenues Please Contact: ■ Mumbai, Ahmedabad: Kunal Gaurav 91-9821089213 ■ Delhi: Ambuj Kumar 91-9999070900 Delhi Associate: Dinesh 91-9810264368 ■ Chennai: Arun J 91-9940058412 ■ Bangalore: Khaja Ali 91-9741100008 ■ Hyderabad: E.Mujahid 91-9849039936 ■ Kolkata: Ajanta 91-9831182580 50

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Advertise in

Business Avenues Please Contact: ■ Mumbai, Ahmedabad: Kunal Gaurav 91-9821089213 ■ Delhi: Ambuj Kumar 91-9999070900 Delhi Associate: Dinesh 91-9810264368 ■ Chennai: Arun J 91-9940058412 ■ Bangalore: Khaja Ali 91-9741100008 ■ Hyderabad: E.Mujahid 91-9849039936 ■ Kolkata: Ajanta 91-9831182580 54

June 2015

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Capturing physical assessment and vital signs data is routine.

Accessing them should be too.

Connect your patient vitals with Welch Allyn Connex®.

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

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

ASK A QUESTION What are the evacuation tasks for ICU-based staff?

representatives from inpatient units.

DR PARASHAR Allahabad

How are standard operating procedures important in hospitals?

A disorganised evacuation can result in confusion, injury, and property damage. While developing your emergency action plan, it is important to determine the following: ◗ Clinical engineering ◗ Facilities management ◗ Hospital volunteers ◗ Housekeeping ◗ Pharmacy ◗ Patient transporters/escorts [Intra-facility] ◗ Transport team if available on site [Inter-facility] ◗ Social work What are the benefits of forming a patient’s flow team?

DR PREMPRAKASH Bhopal

The importance of creating multidisciplinary teams is to plan quality improvement interventions. One of the benefits of a multidisciplinary team is that members will bring different perspectives and knowledge about problems, their underlying causes, and potential solutions. We recommend that, at a minimum, your team include a team leader (day-to-day leader), senior hospital leader (e.g., the chief quality officer), individuals with technical expertise related to the strategy, ED physicians and nurses, ED support staff (e.g., clerks, registrars), a research/data analyst, and

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DR RAJNI Ranchi

Standard operating procedure, if realised and materialised as a component of an effective management system, helps cultivate transparent functions, implement error prevention measures and facilitate corrective actions and transfer knowledge and skill. When it comes to the practice of medicine and pharmaceutical care, its relevance and importance becomes critical to ensure safety. SOP helps to provide an efficient and quality service and having an efficient SOP in place minimises errors, clears the way forward by avoiding uncertainties, and serves as a vital tool to transfer knowledge and skill.

What is the difference between medical marketing and medical practice management?

SHAMA Chennai

They are related terms, but they have quite different roles in practice. Broadly defined, Medical Practice Management embraces operational matters such as coding, payer selection, accounts receivable, staffing, HIPAA, software, cost cutting, and about a million other issues

that are the day-to-day business of the business/practice. In its purest form, Medical Marketing is about building a positive reputation, getting your phone to ring, getting people to come in for a first appointment and converting them into patients.

Practice Management is largely about the wheels that turn inside the practice. And Practice Marketing is the planned process of communications that goes on with individuals who, for the most part, are not yet aware of or part of the practice.

What are the steps for equipment planning in a new hospital?

DR SWAMINI. Bengaluru

Healthcare technology management professional's functions are: ◗ Equipment Control & Asset Management ◗ Work Order Management ◗ Data Quality Management ◗ Personnel Management ◗ Quality Assurance ◗ Patient Safety ◗ Risk management ◗ Hospital Safety Programmes What are nurses to patient ratios?

KAMAL Thane

Patient ratios are based on matrices developed in accordance with local and national benchmarks for ratios as well as established discipline guidelines.

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

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

TRADE & TRENDS

Carestream earns highest rating for DRX-Revolution Mobile Systems and Room-Based DRXSystems Customers praise performance, reliability and installation of company’s DRX family of products and detectors CARESTREAM EARNED the top rating in MD Buyline’s Market Intelligence Briefing (2015 Q1) for both portable and room-based DR systems.

Carestream’s DRX-Revolution Mobile X-ray System and its DRX-Evolution and DRXAscend systems earned high marks from customers for system performance, reliability, installation and service repair quality. The DRX-Revolution was the highest rated portable system and Carestream’s DRX room-based platform tied for the highest rating in the DR room category.

MD Buyline reports for imaging systems are based on user satisfaction ratings in the following categories: system performance, reliability, installation/implementation, applications training, service response time and service repair quality.

According to MD Buyline, “the DRX-Revolution boasts a unique system design with a collapsible tube column, tube/line visualisation software, grid alignment, high kW power capacity, built-in caddies … and other progressive design features.”

The report notes that many hospitals are adding Carestream’s small-format DRX 2530C cesium iodide

The DRX-Revolution optimises imaging for inpatients and critical care areas with a small footprint and a long tubehead reach that provides easy access to patients in rooms crowded with bedside medical equipment detectors to meet the need for high-resolution imaging in the neonatal intensive care unit (NICU), as well as orthopaedic surgery and other applications.

It also stated that “users praised Carestream’s customer service, troubleshooting and knowledgeable staff.”

MD Buyline’s report on DR

rooms commended Carestream for “adding an increased level of system flexibility and the ability to be more creative when tailoring an X-ray system to a specific site’s needs.” In addition, technologists stated that Carestream’s DRX detectors provide flexible solution with both retrofit kits

and new systems.” The report also spotlighted excellent performance and customer satisfaction with Carestream’s family of DRX-1C and DRX 2530C cesium iodide detectors and the DRX-1 detector. Customers also commended Carestream for its “longstanding reputation for stellar service and support.”

Carestream offers a full portfolio of in-room and mobile X-ray imaging systems as well as the ability to retrofit existing equipment. The DRX-Revolution optimises imaging for inpatients and critical care areas with a small footprint and a long tubehead reach that provides easy access to patients in rooms crowded with bedside medical equipment.

Carestream’s room-based systems offer automated, motorised overhead tubes for positioning convenience and productivity or non-motorised tubes for greater economy.

Software and hardware features accommodate specialities such as paediatrics, orthopaedics and trauma care.

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TRADE & TRENDS

New age hematology analyzers from Transasia Kanchan Jeswani, Product Manager – Hematology, Transasia Bio-Medicals elaborates how hematopoietic progenitor cells (HPC) is emerging as a novel parameter in hematology analyzers

KANCHAN JESWANI Product Manager – Hematology, Transasia Bio-Medicals

PERIPHERAL BLOOD stem cells (PBSC) are increasingly used to restore hematopoiesis as an alternative to bone marrow transplantation. It is important to determine the precise time for HSCs (hematopoietic stem cells) to be collected for a reliable, rapid and successful haematological recovery.

HPC and HSC express high levels of the cell surface glycoprotein, adhesion receptor CD34.

The levels of CD34 expression decreases with cell maturation and differentiation. Expression of CD34+ is thus a defining hallmark for hematopoietic stem cells (HSCs) and progenitor cells (HPCs) in bone marrow (BM), peripheral blood (PB) and cord blood. An accurate quantification of circulating CD34+ stem cells is important to decide the optimal time for collection.

Flow cytometric enumeration of CD34+is the standard method of counting. The International Society of Hematotherapy and Graft Engineering (ISHAGE) gating strategy isused for CD34+ cell detection.

An alternate method for quantification of circulating HSC minimises the number of CD34 determination, thus saving important resources. Since the introduction of the HPC software in 1997 in the high end Sysmex analyers, many studies of HPC determination versus CD34+ cell enumeration have been performed. The HPC parameter serves as an inexpensive and fast alternative for quantification of the circulating HSC Cells.

Sysmex Corporation, Japan offers the latest and best

intermediate products during apheresis, can be used to predict the final amount of collected CD34+ cells.

The detection and number of HPC in the peripheral blood could possibly provide a standard and rapid alternative for predicting the yield of stem cells collected by apheresis.

HPCs may also be a good indicator to know the optimal timing for collection of the peripheral blood stem cells.

The HPC count can thus be a useful potential parameter in optimising timing for CD34+ enumeration prior to leukapheresis.

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Figure 1: No HPC detected

technology in hematology analyzers. Marketed in India, exclusively by Transasia BioMedicals, Sysmex offers a whole range of systems ranging from 3 to 6 Part Differential Analyzers. Infact the newly launched Sysmex XN series is equipped with a White Precursor Cell (WPC) channel to differentiate abnormal lymphocytes and blasts by using the optical detection system and Fluoroscence flow cytometry.

A study (published in December, 2013, in the International Journal of Laboratory Hematology) conducted by the scientists at the National Cancer Center Hospital (Tokyo, Japan) concluded that the HPC count obtained on a Sysmex XN analyzer correlates accurately with the enumerated CD34 cells. Cells expressing the CD34+ and hematopoietic progenitor cells (HPCs) were compared in 76 granulocyte colonystimulating factor (G-CSF)

Figure 2: HPC detected

The Sysmex XN analyzer can carry out an HPC enumeration without the use of monoclonal antibodies

product was estimated from HPCs in pre apheresis peripheral blood (PB) or mid apheresis product. This count was found to correlate well with the total number of CD34+ cells in the final products. Moreover, the change in HPCs in PB closely resembled that of CD34+ cells during mobilization. Further, studies using immunomagnetic beads suggested that majority of CD34+ cells existed in HPCs, and vice versa.

Conclusion mobilised blood or apheresis samples taken from 18 healthy donors and 6 patients undergoing autologous PBSCT. CD34+ cells were isolated using MACS magnetic cell separation kits (MiltenyiBiotec – BergischGladbach, Germany).

The investigators found a strong correlation between the numbers of HPCs and CD34+ cells. The expected total number of HPCs in the final

The Sysmex XN analyzer can carry out an HPC enumeration without the use of monoclonal antibodies Sensitivity of flagging of blasts is enhanced in the WPC channel of the instrument. It gives a clear demarcation between the blasts and the abnormal lymphocytes.

The total number of HPCs in the final products, as well as from pre apheresis PB and

References 1.Bali Medical Journal (Bali Med. J.) 2014, Volume 3, Number 3: 112115\P-ISSN.2089-1180, EISSN.2302-2914 www.balimedicaljournal.org or www.ojs. unud.ac.id 112 HEMATOPOIETIC PROGENITOR CELLS AS A PREDICTIVE OF CD34+ ENUMERATION PRIOR TO PERIPHERAL BLOOD STEM CELLS HARVESTING1Zefarina Zulkafli, 2Rapiaah Mustaffa, and 2Shafini Mohammed Yusoff 2.Hemopoietic Progenitor Cell (HPC) Enumeration: A Comparitive Study betweenFlow Cytometry and Sysmex XE2100Hematology AnalyzerSalem H. Khalil, Barbara GengJournal of Appplied Hematology 2010 3.http://www.bloodjournal.org/c ontent/122/21/2032November 15, 2013; Blood: 122 (21) 4.December 27, 2013, in the International Journal of Laboratory Hematology

TRADE & TRENDS

Technology trends in flow cytometry Advances in the field of flow cytometry have been tremendous, and even now there are many developments day-by-day, says Rohit Chakravorty, Application Specialist – Flow Cytometry, Sysmex India

IT ALL started when Prof Dr Wolfgang Göhde, launched the world’s first Fluorescence Flow Cytometer in 1968. The original name of this technique was Pulse Cytophotometry, and he named it as ICP-11 (Immuno Cytophotometer). 10 years later in 1978, at the Conference of the American Engineering Foundation in Pensacola, Florida, the name was changed to flow cytometry. Since its inception, this technique has started developing interest in many scientists thereafter. Advances in this field have been tremendous, and even now there are many developments day-by-day.

Initially, flow cytometers were used as experimental

devices in research institutes only. However, the uses and application of this instrument gained great momentum, and other industries have started to explore this technique too, and now it has become a major market. Today’s flow cytometers sport multiple lasers and fluorescence detectors, which aid users in labelling multiple antibodies and in identifying precisely a target population by its phenotype.

Apart from research segment, flow cytometry is now being applied in clinical, industrial, essential healthcare, agriculture, aquaculture, microbiology, etc. and the list goes on. People have now understood the importance of

Today’s flow cytometers have multiple lasers and fluorescence detectors, to aid users to label multiple antibodies and in identify a target population by its phenotype

this technique, and are now improvising on its existing technical aspects. Advances in laser sources, sample preparation automation, detection sensitivity, digital-signal processing speed, rare-event analysis, and cell-sorting performance, coupled with a broad portfolio of reagents with a varying spectrum of dyes and fluorochromes, provide the tools necessary to answer questions in immune monitoring, immunophenotyping, stem-cell analysis, cell-signaling, and signal transduction.

Partec GmbH (pioneers of Flow Cytometers), has been acquired by Sysmex Corporation, Japan. Worldwide, there

ROHIT CHAKRAVORTY Application Specialist – Flow Cytometry, Sysmex India

has been a tremendous boost to the clinical segment of flow cytometry. Partec (now Sysmex) being in the market since last 47 years, now along with the pioneers in clinical field, Sysmex would be soon launching a dedicated clinical flow cytometer for all the clinical application along with the reagents kit. There are some great innovations expected in the coming years when we see the association of flow cytometer with the best of hematology analysers, creating a haemat-flow technology. Already imaging flow cytometry has created a boom in the industry, and people are eyeing for new technologies and advances.

Dickies launches range of medical uniforms and footwear Dickies medical uniforms are designed keeping in mind the requirements of the professionals in the industry, who work long hours and are exposed to tough conditions GLOBAL WORK wear brand, Dickies launched its medical and healthcare uniforms and footwear lines in India. The range of medical uniforms is affordable and durable.

Dickies, which began operations in India in November 2013, intends to bring quality and affordable workwear across industries in the country. The range of medical and healthcare uniforms is a part

of the first phase of operations of the company.As the medical and healthcare industry in India continues to grow at a steady pace, there is a severe need for quality workwear for professionals across the board that ensures uniformity, quality and safety.Dickies medical uniforms are designed keeping in mind the requirements of the professionals in the industry, who work long hours and

are exposed to tough conditions. The uniforms, which include lab coats, scrubs and footwear, have easy-care fabric; cotton/polyester fabric that provides breathable, all day comfort and gender-specific sizing and styling. “There is a severe need for quality workwear in the Indian medical industry. The healthcare industry in India is expected to reach $160 billion by 2017,

which means several thousand more people involved in servicing in this industry. Every industry needs durable, safe, affordable workwear – for safety, for better performance. Dickies hopes to fulfill this massive need for quality workwear in the Indian medical industry,” Ravi Karthikeya, CEO, Dickies India said. Williamson-Dickie is the world’s leading provider of authentic work uniforms,

specialising in innovative performance work wear since 1922. The company offers premium quality products at an unmatched value across a vast assortment of uniforms, work and safety footwear in more than 100 countries.

Williamson-Dickie operates in India through exclusive license with ID Overseas (A Group Company of India Designs Exports)

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TRADE & TRENDS

Academy of Hospital Administration, a pioneer institute

MAJOR GENERAL MUNINDRA SRIVASTAVA, VSM ** (RETD) President-AHA

AHA is a pioneer in development of quality standards for hospitals and healthcare organisations

ACADEMY OF Hospital Administration (AHA) is an autonomous professional body of highly qualified and experienced hospital and health system administrators from across the country. It is registered under Society Registration Act 1860, in 1987 at Delhi.

AHA is a pioneer institution of the country known for quality education, training, planning designing, consultancy and research public health, in the field of hospital and healthcare management, quality and accreditation, research, health technology assessment, policy formulations and health system quality assurance and disaster management education.

AHA is located in Institutional Area, Sector 62, AHA House, Noida. The Institute of Healthcare Management, Training and Research has been established by AHA for conducting various courses, training and research programmes for central and state government hospitals, institutions and private healthcare sector.

Success stories AHA has a proven track record of around 27 of high quality education, training, professional consultancy to central, state and public sector organisation in hospital and health sector planning, operational management, quality and accreditation, health systems research, policy formulation, biomedical

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AHA was the first institution in India to start hospital and health systems management training courses.AHA has trained more than 4000 hospital and health administrators equipment management and health technology assessments.

Core competencies ◗ It was the first institution to start hospital and health systems management training courses in India in 1987 ◗ First institution in the country to start PG and certificate programmes in quality management in healthcare in the country. ◗ Pioneers in development of quality standards for hospitals and healthcare organisations, which were later further developed into NABH Standards by NABH, Quality Council of India. ◗ Empanelled with National Health Services Resource Centre (NHSRC), Ministry of Health & Family Welfare, Govt of India for : (a) Training in health systems quality (b) Health systems research ◗ Provided professional consultancy for quality and accreditation project for facilitating hospitals for being eligible for

NABH Accreditation of public sector medical college hospitals, dental colleges, district hospitals, CHCs, PHCs in states of Delhi, Gujarat, J&K and Haryana. ◗ AHA took the initiative for capacity building of trained certified hospital operations senior and middle level managers/executives in the country, a cadre highly deficient but in great demand. AHA has trained more than 4000 hospital and health administrators including few from neighbouring countries e.g.

Nepal and African countries. ◗ AHA is study centre for an UGC-recognised university for conducting MBA/PG Diploma Courses in Hospital Administration through Distance Learning–Duration 2-years, 1-year Prog [Lateral Entry], and 1-Yr PG DH&HM. ◗ AHA also conducts programmes for PG Diploma in Healthcare Operations and Quality Management [PGDHO&QM] and PG certificate Programme in Quality Management and Accreditation of Healthcare Organiza-

tions [QM&AHO] apart from various short-term programmes for healthcare professionals. ◗ AHA has an empanelled team of more than 300 health systems, hospital architects, hospital engineering systems, TQM. It also comprises domain expert consultants and academicians in various fields of health, hospital and allied sectors all over the country in different states, for providing advisory and consultancy support to the public and private sector. It consists of: ◗ Hospital project management and feasibility assessment experts ◗ Hospital operations management consultants ◗ Hospital planning and designing and making DPR experts – greenfield and brownfield both ◗ Hospital and health systems architectural design consultants ◗ Single speciality hospitals (eye hospital/maternity hospitals/ children’s hospital/joint transplant centres) ◗ Clinical services planning experts for OPD, IPD, ICU, OT,

NICU, poly trauma and emergency services centre, dialysis centre, maternity and paediatric units, cardiothoracic centre, organ transplant centres ◗ Supportive services:CSSD, laundry and linen services, dietary and nutrition services, medical records dept, gas supply systems, HVAC System. ◗ Health systems quality management experts, NABH Accreditation System for hospitals, CHCs, PHCs, allopathic clinics. Accreditation of imaging system and empanelled consultants for NABL certification for laboratory services ◗ Large pool of academicians and senior faculty staff — MHA/MD Hospital Administration)/MD (PSM)/MD (CHA), MS (Obstetrics & Gynaecology),/B Arch/TQM consultants, clinical faculty staff — for training, education, expert professional advice /consultancy in the field of hospital planning and management, health administration, TQM, Six Sigma, Lean Healthcare, ISO 9000; 2008 System. AHA has more than 1500 members all over the country.

Contact details AHA House, C-56/43, Institutional Area, Sector-62 Noida- 201 301, UP Email : ahaindia@ahaindia.org ahaindia1987@gmail.com Tel: 0120-4233761/62/63 Website: www.ahaindia.org

TRADE & TRENDS

RubyHall Clinic installs Philips IngenuityElite 128 Slice CTScanner Completing a whole body scan in under twenty seconds, the machine produces high definition images which enables doctors to see even the smallest and thinnest vessels in any part of the body RUBY HALL Clinic has announced the installation and launch of its new CT Scannerthe Philips Ingenuity Elite 128 Slice CT which offers high resolution imaging coupled with a significantly reduced radiation dose and lower noise. The launch of this cutting-edge technology - a first in India further strengthens the hospital’s commitment to provide the highest standards in patient care along with world class equipment.

Inaugurated by Dr Cyrus Poonawalla, Chairman and MD, Serum Institute of India the Philips Ingenuity Elite 128 Slice CT scanner has set a new standard in digital imaging.

Completing a whole body scan in under twenty seconds, the machine produces high definition images which enables doctors to see even the small-

Ruby Hall Clinic believes that this new scanner will provide the hospital’s patients with the very best service available, as well as providing clinicians with outstanding visual referencing est and thinnest vessels in any part of the body. The technology also allows for faster scanning time. Dr Joshita Singh, Head of Department-Radiology explains, “The scanner is of tremendous benefit to our patients. We're able to scan the patients from head to toe in a matter of seconds, reducing their time on the table, stress and anxiety. This particular scanner also creates high resolution images at low radiation dose to patients thus

aiding clinicians with the diagnosis and also allows for low dose paediatric imaging.”

The Philips CT scanner is excellent for neurology, cardiac, spinal and abdominal scanning as well as peripheral angiograms. Improved contrast enhancement helps view minute details such as cardiac bypass grafts and vascular structures in the lungs. CT coronary angiogram provides excellent visualisation of the coronary arteries which will

enable doctors to effectively diagnose coronary artery disease. The scanner also comes with software such as liver segmentation analysis, orthopaedic metal artefact reduction, bone removal, virtual colonoscopy and perfusion imaging.

With the ability to produce high-end imagery, Philips has been rated the number one imaging equipment vendor.

The CT scanner also has the advantage of offering a much

lower radiation dose - upto 80 per cent lower as compared to conventional CT scanners with the iDose4 technique.

Ruby Hall Clinic believes that this new scanner will provide the hospital’s patients with the very best service available, as well as providing clinicians with outstanding visual referencing.

Bomi Bhote, CEO Ruby Hall Clinic states, “Every month, the hospital conducts approximately 750 CT scans. The launch of this state-of-the-art technology will help fulfil our endeavour of providing our doctors and their patients with the finest cardiac, neuro and body CT imaging, reported by our team of experienced specialist radiologists. It is indeed a moment of pride and rest assured, there will be many more to come.”

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I N T E R V I E W

There is no tight legislation in India for mandatory use of HMS in hospitals Srinath Bettadpur, Founder & CEO, Spigot Software talks about the HMS market in India, existing health IT solutions, and his company's offerings in this sphere, in an interaction with Express Healthcare

Tell us about the HMS market in India?

HMS market, according to me, is still in the initial stages due to various factors.

Currently in India, specifically, tier II and tier III cities, does not have appropriate infrastructure in terms of stable electricity, backup power, internet availability at high speeds etc. This may be true in some of the tier-I cities as well. Also, there is no tight legislation in India for mandatory use of HMS in hospitals. This has led to huge price variations across vendors and no standardisation. However, the healthcare market itself is growing at a very rapid pace in India and therefore, expectation is that the above scenario is due to change sooner or later. Therefore, the HMS market in India is bound to be huge and every vendor who has the perseverance to stay put will definitely get a good pie and a say in the market.

How is Spigot Software's products different from the existing health IT solutions in the market?

Spigot Software is one of the young entries into the

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HMS market. Spigot’s products are intuitive, has easy to use GUI, covers all aspects of the workflow in a hospital, all modules are plug and play on top of core HIS module, all modules have similar UI thereby reducing the time for training, company is small and highly agile, customer gets personalised attention and get quick responses. The plug-and-play products can be either used in the integrated mode with HIS or can be used in the standalone mode. Our products from day-one are completely web-based and can be adapted easily into a cloud environment. Also, as a company we are very much open to customisations.

What is the benefit of using Spigot HMS? There are several benefits that the customer can reap by using Spigot’s HMS solution.

Some of them are: ◗ Highly scalable architecture that is future proof, there are different product variants that cater to all kinds of health care units on the spectrum.

Thereby, making it easy for the customer to have a same vendor across different solution.

The HMS market in India is bound to be huge and every vendor who has the perseverance to stay put will definitely get a good pie and a say in the market ◗ Small and a very agile company with easy access to technical support and very less turnaround times in terms of responses and resolutions ◗ Spigot is a technology and technologist-driven company ◗ Use of Spigot’s solutions

offer better ROI and economy of operations. ◗ Spigot’s pricing of the solutions are very competitive and give value for money Can you inform us about your product pipeline, future products etc.

Spigot has several products that support the main product in the pipeline for the future, of these some important are, offerings for the cloud space, more mobile interfaces, enhanced support for accounts and finance etc.

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