Express Healthcare (Vol.9, No.7) July, 2015 by Indian Express

VOL.9 NO.7 PAGES 84

www.expresshealthcare.in JULY 2015, `50

Programme Overview

Focus Areas

Healthcare Executive Management Development Programme is designed with a focus on imparting essential skills and competencies to senior healthcare professionals holding administrative positions in their organizations. The programme aims to â&#x20AC;&#x153;enhance healthcare leaders' abilities to plan, organize, control, and lead their organizations and enable them discover new ways to handle issues, seize challenges and take their organizations and people to new directions.â&#x20AC;? The programme is fully residential and consists of experience sharing, case studies, problem-based learning, lectures and interactive sessions.

Who should Participate? The programme is designed for professionals occupying or likely to occupy leadership positions in government / private organizations with atleast 15 years of progressive experience in the field of healthcare. Those involved in policy formulation, project management, programme development and implementation at hospitals / medical colleges / healthcare organizations and responsible for healthcare capacity building, efficiency and excellence in medical service delivery, etc. would be the ideal candidates to attend this coveted programme.

Programme Dates th

4 - 10 October, 2015

Venue

Ramoji City, Hyderabad

* Includes delegate kit, hotel accommodation, all meals & airport transfers at Hyderabad.

The programme capacity is 50 participants only For further info & updates please visit :

www.hxmdpaiims.com

Key Resource Faculty Dr Shakti Kumar Gupta Medical Superintendent, AIIMS (RPC), Delhi & Prog. Director (HxMDP) Dr D.K. Sharma Medical Superintendent, AIIMS, New Delhi Dr Sidhartha Satpathy Prof. & Head, Dept. of Hospital Administration, AIIMS, New Delhi Maj Gen Pawan Kapoor, VSM Army Medical Corps. Dr Sharon Kleefield Harvard Medical School, USA Dr Rubin Pillay Collat School of Business and School of Medicine, University of Alabama, USA Dr Pieter S. Stepaniak Professor, Health Operations Management, Medical University, Poland Dr K.V. Ramani Centre for Management of Health Sciences, IIM, Ahmedabad Dr Sanjeev Singh Medical Superintendent, AIMS, Kochi Brig. Sunil Kant, VSM Army Medical Corps. Dr A Venkat Raman Professor, Faculty of Management Studies, University of Delhi Dr R Chandrashekhar Advisor-HLL Lifecare & Chief Architect (Retd), Ministry of Health, GoI

Dr Deepak Aggarwal Chairman, Computerization & Addl. Professor, AIIMS, New Delhi Dr Angel Rajan Singh Assistant Professor, Hospital Administration, AIIMS, New Delhi Mr Ajay Gupta Executive Director, KGD Architecture, Bangalore

Correspondence Address: Programme Coordinator - HxMDP, Room No. 6 A, Dept. of Hospital Administration, AIIMS, New Delhi-29 Tel/Whatsapp: +91 9013956633, 9582222521, Email (Preferred): info@hxmdpaiims.com Website: www.hxmdpaiims.com

CONTENTS MARKET Vol 9. No 7, JULY 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 Harit Mohanty - East & 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

THE

SMARTWAYOFHEALING

Though Indian healthcare providers are introducing a slew of measures to enhance efficiency and optimise their resources for best outcomes, they have a long way to traverse before metamorphosing into truly smart hospitals | P34

P20:INTERVIEW: ASHISH DHAR

STRATEGY

NATHEALTH, INDIA SIGNS MOU WITH TASK FORCE HEALTH CARE

PHILIPS INDIA AND IBA SIGN AN EXCLUSIVE ALLIANCE

TECH MAHINDRA AND CIRCLE HEALTH SIGN 10YEAR STRATEGIC DEAL

GNRC LAUNCHES FREE AMBULANCE SERVICE

BD INDIA AND DR LAL PATHLABS LAUNCH COE IN PHLEBOTOMY

DOCTORS URGE AMENDMENTS IN PCPNDT ACT

AROGYA FINANCE LAUNCHES PREAPPROVED MEDICAL LOAN CARD

LIFE

Founder Director, GrandOpinion

P50:INTERVIEW: SHIPRA DAWAR Founder & CEO, ePsyClinic

P52:INTERVIEW: ISABELLE CUOC CEO, Kallistem

TAKING A BIG LEAP

SEXUAL HARASSMENT: A GROWING CONCERN IN INDIAN HEALTHCARE

Express Healthcare® Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045. Printed for the proprietors, The Indian Express (P) Ltd. 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 © 2015 The Indian Express (P) 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

Physician, heal thyself

uly 1 was designated as Doctor's Day by the Government of India in 1991 to honour the memory of Dr Bidhan Chandra Roy, a legendary who also became the second chief minister of West Bengal. The day generally sees a slew of functions to honour members of the medical profession but this year, over 4000 resident doctors from Maharashtra, affliated to the Medical Association of Resident Doctors (MARD), chose to go on an indefinite strike from this day, presurise the state government's alleged apathy towards their demands. In any other profession, their demands would seem legitimate. For instance, asking for at least two months paid leave for pregnant lady doctors as well as those contracting TB on the job seems a fairly reasonably expectation. Or even the demand that post-graduates specialising in a particular field have to be posted in the same department during their bond service. Media reports suggest that the state government has now agreed to most of MARD's 10 demands after talks with the striking doctors but there are massive trust issues on both sides. On June 12, MARD representatives met the Maharashtra Medical Education Minister, Vinod Tawde and were given a verbal assurance that their demands would be met. However, they later realised that only four of their 10 demands were listed in the minutes of the meeting and hence were forced to carry out their threat to go on strike from July 1. The strike is sure to inconvenience patients and their relatives, who will be in no position to appreciate the larger issues at stake: the scarcity of trained medical staff, especially in rural areas, etc. This will only add to the perception that practitioners of what was once considered a noble profession, nay calling, have today morphed into extortionists, accused of first judging the purse and then the pulse of a patient. Incidents like these have pushed modern day medical practitioners and in fact anyone associated with the healthcare sector, off their pedestal, with the halo exchanged for horns. Today, every section of the healthcare delivery chain – doctors, hospitals, diagnostic chains – are seen as cesspools of corruption. Every touch point is perceived to be tainted. Which is why we chose to focus on the dark side of India's healthcare sector in Express Healthcare's July issue, the Doctor's Day Special issue. The good news is that the introspection has started from within. At least some doctors seem to be practicing the adage: Physician, heal thyself. The most famous recent example is Dr Arun

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July 2015

Accused of judging the purse rather than the pulse of their patients,members of the medical profession seem to have trulyfallen off their pedestal in India

Gadre, Coordinator, Support for Advocacy and Training to Health Initiatives (SATHI) who published the testimonies of 78 like-minded doctors, in his book titled, 'Voices of Conscience from the Medical Profession.' Luckily, Dr Gadre is not alone. Dr Debal Sen, a Kolkata- based independent consultant, who has also spoken out against his fellow doctors, is one more example of a band of doctors who have stuck to their principles while weathering personal hardship. For sure, there is another side to this story. Dr Ramakant Panda, Vice Chairman and MD, Asian Heart Institute raises equally valid points of defense, citing the high capitation fees for medical college, the long years of study, the high cost of building a practice, etc. Do read more of this debate in our cover story, 'God incarnate or fallen angel?' (pages 24-29) as well as two hard hitting guest articles: 'Is it truly ‘test’ worthy?', by Sunil K Pandya from the Department of Neurosurgery at Mumbai's Jaslok Hospital & Research Centre (pages 30-31) and 'Sickness industry and corruption' by Professor BM Hegde, renowned physician and former Vice-Chancellor of Manipal University (pages 32-33). Mainline media has of course done their bit, offering a ready platform to aggreived patients and their relatives. In fact, international journals like the British Medical Journal seem to have chosen India as the poster boy of corrupt practices within the medical/pharma industry. This is part of a larger pan-country campaign, probably in the hope that the solutions too must come from the same ecosystem. Here's the link to a BMJ blogpost on Doctor’s Day: (http://blogs.bmj.com/bmj/2015/06/30/doctors-dayin-india/). The two authors have shown the way forward, pinpointing a few areas which they feel are important for medical professionals in India to contemplate and respond. As I write this, The Indian Express Group launches a new branding campaign with the tag line: The Indian Express. For the Indian Intelligent. I am sure Express Healthcare addresses this section of the audience within the healthcare fraternity. Because we believe that our readers do not want to be on a pedestal, but want to find lasting solutions. Not a pat on the back, but a mirror to the faults, all the better to correct them; an informed analysis, based on sustained and close interaction with practitioners themselves. Do tell us how we can continue to live up to our tagline. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

LETTERS QUOTE UNQUOTE

JUNE 2015

INTERESTING ARTICLE

A GOOD READ

our recent article on blood banks is very interesting and good. (Check story: License to Bill in EH June 2015 issue) However, considering the fact that in India 80 per cent of rural population is dependent on government blood banks, it covers a minor portion of landscape. We suggest you to cover government blood bank gaps in a sequel as that is the area which is gray and requires urgent attention.

he story on innovative marketing strategies is a good read. (Check story: Healthcare marketing: A changing panorama in EH June 2015 issue)

Diana Mary John Adfactors PR diana.john@adfactorspr.com

Prashant Tewari Independent Healthcare Consultant prashanttewari1@gmail.com

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MARKET NEWS

NATHEALTH, India signs MoU with Task Force Health Care The MoU will remain effective for a period of three years

NATHEALTH SIGNED a Memorandum of Understanding (MoU) with The Task Force Health Care (TFHC) Working Group India. This collaboration is intended to improve healthcare and the life sciences and healthcare sector in both countries through a strong cooperation between the two organisations and its members. The present MoU will remain effective for a period of three years. Anjan Bose, Secretary General, NATHEALTH said, “Our key objective of signing the MoU is to promote cooperation and exchange of information, knowledge and expertise between NATHEALTH and TFHC in the field of life sci-

ences and health, on the basis of equality, reciprocity and mutual benefit, taking into account the applicable laws and legal provisions in each country.” Len de Jong, Task Force Health Care, Chairman, Working Group India, said, “The Task Force Health Care is an innovative Dutch platform for the medical sector, which combines the expertise of companies, NGOs, knowledge-institutes and the Dutch government. The Netherlands are keen to share their knowledge and experience with that of India. Together we will be able to provide excellent medical healthcare in India as well as in the Netherlands.” Sushobhan Dasgupta, President, NATHEALTH,

This collaboration is intended to improve healthcare as well as the life sciences and healthcare sector in both countries said, “Through this alliance NATHEALTH and TFHC will develop and strengthen cooperation and exchange in

hospital building and infrastructure, healthy aging including rehabilitation, health systems strengthening including e-health and management, medical devices, equipment and medical technology, education and training, best practice sharing and alignment with National Health Policies of the respective countries.” Sander Vorselman, Task Force Health Care, Vice-Chairman, Working Group India, said, “I am looking forward to learning more about Indian healthcare possibilities, while sharing our Dutch knowledge on infrastructure, buildings, and hospital planning. This MOU will provide the opportunity for strong cooperation and

will prove mutually beneficial.” Rahul Khosla, Senior VP, NATHEALTH, said, “India can draw learning from several countries (developed and developing) around the world on how they have progressed in building the backbone of infrastructure (physical and social) for the growth of their economies. This association is a step forward towards that. The coordination of all activities under this Memorandum of Understanding will be done by the Secretariat of Healthcare Federation of India (NATHEALTH) and the Programme Management of the TFHC Working Group India. EH News Bureau

Inspirata to launch R&D facility in Bengaluru To invest up to three million dollars to set up and operate the facility, will hire 50 product development engineers, scientists and informaticists with healthcare domain expertise INSPIRATA, A cancer diagnostics solution provider with a digital pathology solution is launching its India operations with a research and development facility in Bengaluru. This facility is an extension of their US operations and will be set up and run at cost of around $3 million. Inspirata intends to hire 50 software product development engineers, scientists and informaticists from the healthcare domain in the next two months.

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The Indian development centre aims to support all three of its business units, i.e. digital pathology work-flow solution, companion diagnostics and the cancer information data trust, and also will work on data mining, data analytics and predictive software algorithms. Satish Sanan, CEO, Inspirata said, “The Indian R&D centre will play a very strategic and vital role in our endeavour to help speed up cancer diagnosis, research, teaching and

most importantly provide doctors and patients with predictive data that will change the way cancer is diagnosed and treated. Bengaluru has the right ecosystem to support our plans and hence our decision to locate one of our key initiatives here.” Inspirata has developed a digital pathology workflow solution that scans glass pathology slides, making the digital images available for high-resolution viewing and

sharing anywhere in the world. Reportedly, Inspirata’s pathology cockpit employs advanced computational image analytics algorithms called Companion Diagnostics that pre-screen and highlight suspicious cells on the digital images of glass pathology slides, helping pathologists to more rapidly diagnose cases. These novel detection and diagnostic algorithms are expected to shorten the turnaround time for cancer detec-

tion and diagnosis from 12-13 days to two to three days. Additionally, patients will have more rapid and affordable access to second opinions and consultations from a worldwide pool of pathologists who specialise in specific forms of cancer. The company also intends to develop a Cancer Information Data Trust—a database of cancer signatures cross-referenced to clinical treatment protocols and patient outcomes. EH News Bureau

MARKET

Philips India and IBA sign an exclusive alliance To enhance access to proton therapy in India ROYAL PHILIPS and IBA have signed an exclusive agreement to enhance access to proton therapy in India. The alliance aims combines Philips’ expertise in clinical informatics and innovative imaging techniques for therapy planning and guidance and IBA’s strengths in proton therapy. This agreement builds upon the collaboration between Philips India and IBA, which started in 2013, to build the Apollo Proton Therapy Center. Sameer Garde, President, Philips Healthcare said, “We are very pleased to announce that Philips India and IBA are introducing the best-in-class proton beam therapy for cancer patients in India. We are confident that the future launch of the first proton therapy center in Apollo Hospitals, Chennai, will mark the beginning of a new phase in cancer treatment in the country and also the subcontinent”. Olivier Legrain, CEO, IBA, added, “We are privileged that Philips India is supporting us in bringing cutting edge proton beam therapy to India. We are certain that this initiative will be a significant step in improving the quality of cancer treatment in the country. ” The exclusive Philips-IBA agreement for India follows the framework agreement that Philips and IBA signed in September of last year. The framework agreement comprises research and development, marketing and sales of imaging and therapy solutions in oncology. The collaboration also enables both organisations to mutually leverage technologies and solutions: IBA benefits from Philips diagnostic imaging products offered to oncol-

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ogy care centres, while Philips will leverage IBA proton therapy solutions within its offering for

customers in select markets around the world. As part of the framework agreement,

Philips and IBA have already signed multiple country-specific collaboration agreements, each

optimised for the local market needs. EH News Bureau

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MARKET

Tech Mahindra and Circle Health sign 10-year strategic deal

GNRC launches free ambulance service

Reportedly, the deal is worth a projected £50 million over the 10 years

TECH MAHINDRA has been selected by Circle Health after a competitive procurement process to become their chosen technology partner for the next 10 years. The project will be delivered by nth Dimension, a newly formed wholly owned subsidiary of Tech Mahindra in the UK. Reportedly, the deal is worth a projected £50 million over the 10 years. As per the partnership, Circle will provide access to its hospitals, clinicians and experience of running healthcare, allowing Tech Mahindra to develop and adopt new technologies that improve patient care, operational delivery and to reduce costs for all parties. Tech Mahindra will develop

new IT solutions for Circle’s hospitals and NHS management contracts - giving its facilities access to state-of-the-art technologies. Both Circle and Tech Mahindra have ambitious growth plans for the healthcare sector, focusing in the first instance on the creation of a new hospital in Birmingham that will reportedly allow for a wide range of innovations to be adopted within the design phase. Additionally, Tech Mahindra will support Circle in developing its innovative MSK service across Bedfordshire, providing patients with the ability to book their MRI appointments from their mobile phones and GPs viewing scans

and reports from their mobile devices. Steve Melton, CEO of Circle said, “This deal is a sign of the times. Healthcare has yet to see the tech-led disruption that we’ve seen in other sectors, but we think that is about to change.” He also added, “We’re absolutely delighted our partnership with Tech Mahindra will support us to grow our business and improve our competitiveness through the adoption of new technologies.” Rajib Bhattacharya, VP, Tech Mahindra said, “We are delighted to partner with Circle who have a proven track record of innovation in healthcare delivery. Our plans are to focus on creating and adopting

new technologies from around the world into the UK healthcare market which is facing unprecedented pressures on its finances and we felt that Circle were the best partner to work with. We will support them in improving their current infrastructure and cocreating new applications that will allow for patients to take more control of their healthcare. Circle are also building a new hospital in Birmingham and we will be embedding our technologies into the build so that the hospital will benefit from mobile solutions that will allow for the clinical staff to operate at the highest levels of productivity and quickly.” EH News Bureau

Nightingales Home Health Services partners with DaVita for nephrocare Come together to launch pre and post dialysis continuum of care and home hemodialysis for patients of end stage renal disease NIGHTINGALES HOME Health Services, an enterprise of Medwell Ventures is associating with DaVita, a leading global provider of dialysis services. They come together to launch pre and post dialysis continuum of care and home hemodialysis for patients of end stage renal disease (ESRD) with the entire setup

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of dialysis being installed at the patient’s home. Under this partnership, Nightingales would provide a specialised nephrocare plan which will include screening of patients for kidney related medical issue, initial clinical assessment, nursing care for pre and post dialysis continuum of care, dietary consul-

tation, diagnostics and physical therapy. In addition for the home hemodialysis programme, DaVita would be responsible for the infrastructure setup including dialysis machine, reverse osmosis ultrafiltration water plant, consumables, etc. Through its technological infrastructure, the DaVita Command Centre

will be able to monitor the patient on real time basis, check for alarms, etc. and the staff will be able to converse with the patient via videoconference facility. Nephrologists associated with DaVita will also be available for home consultation for chronic patients with end stage renal disease. EH News Bureau

GNRC HAS launched a fleet of ambulances, to complete GNRC’s emergency services portfolio. Dr Nomal Chandra Borah, Chairman cum MD, GNRC Hospitals, informed that the fleet of 100 ambulances will aim to provide basic life support instantly after receiving a call for an ambulance and will have on board a paramedic and a pilot – both trained in basic life support and safe medical evacuation procedures. Speaking on the occasion, Dr Borah, said, “A recent report in the world’s most esteemed medical journal Lancet has stated that over 95 per cent of the world’s population has health problems — with over a third having more than five ailments. Several ‘State of Health’ reports formulated by GNRC over the last several months have demonstrated indubitably that the state of health and care in Assam and North-East India lags way behind the rest of the country and the world. We can well imagine, therefore, how acute the situation is in this part of the world. To address the pressing need for a solution to the rising number of emergency medical situations in the region, such as stroke, heart attack and road accident, we have been building an emergency services portfolio that overcomes several access barriers – financial, awareness-related and now, transportation.” Free emergency services for the first 24 hours provided by GNRC to all patients include waiver of doctor’s consultation fee, bed charges, charges for essential investigations, medicines and life support. In addition, GNRC’s Accident Card provides medical care to members of the programme in the unfortunate event of an accident befalling them. EH News Bureau

MARKET

BD India and Dr Lal PathLabs launch COE in phlebotomy

BD AND Dr Lal’s PathLabs inaugurated a Centre of Excellence in Phlebotomy (blood collection, sampling). This initiative will provide certified phlebotomy courses to healthcare professionals, laboratory technicians, assistants and nurses, and support them in driving best practices in preanalytical processes for accurate and reliable diagnosis. Reportedly, BD will impart intensive training on fundamental principles of safe blood collection; specimen handling and sample preparation that will help develop the critical capacity of maintaining firstrate specimen quality and protect the safety of patients and medical staff. It also aims to strengthen laboratory services by improving the quality of patient specimens and reducing incidence of pre-analytical errors, thereby improving safety for both patients and healthcare workers. “Studies have indicated that nearly 68 per cent of all errors in laboratory testing are associated with the pre-analytical phase – phlebotomy being a major component of this phase. There is immense potential to enhance the skills of laboratory technicians in line with the growing healthcare needs of the Indian population. With this Centre of Excellence, BD will continue its commitment toward sharing knowledge and enhancing clinical practices in creating sustainable improvements in healthcare,” said Varun Khanna, MD, BD – India. “Speaking on the occasion,

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July 2015

(Hon) Brig Dr Arvind Lal, Chairman & MD, Dr Lal Path

Labs said, “This initiative to provide training for labora-

tory staff and clinicians will help in the long term for

India’s healthcare.” EH News Bureau

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MARKET

West Bengal to have nine more medical colleges To add 17000 new beds, signs MoU with SingHealth IN A major bid to improve healthcare infrastructure in West Bengal, the state government plans to add 17,000 new beds soon. Disclosing this to Express Healthcare, Malay Kumar De, the state's Principal Secretary, Department of Health & Family Welfare said, “We plan to operationalise 17000 new beds soon”. "The number of beds will be upgraded from an existing 67,000 to 80,000 by this year itself,” informed De. On the medical education front, the State plans to set up nine new medical colleges taking its tally to 26, which De claims will be one of the highest in the country as per the given parameters. MCI stipulates that there should be one medical college for a population of five million, West Bengal, with a population of 95 million, will have 26 colleges, which is much above the stipulated mark.

Five out of these nine colleges will be government colleges and the rest four will be set up under the private-public-partnership (PPP) model. The nine medical colleges will be established in Cooch Behar, Bhangar, Raiganj, Dhubulia, Rampurhat, Kurseong, Purulia and Diamond Harbour. For the government medical colleges, the district hospitals will be upgraded to full-fledged medical colleges. The State government's total investment in this project will be to the tune of Rs 1,000 crores, De informed. De said that the State government would be soon setting up a Public Health Institute at Kalyani in Nadia district of the state. Kolkata has a Central Government run All India Institute of Hygiene & Public Health. De also said that the government is heavily investing in the State's health infrastructure

Five out of these nine colleges will be government colleges and the rest four will be set up under the PPP model and the scope of cardiac care and cancer care would be enhanced in the State-run hospitals in the coming months. “The Chief Minister has already announced free treatment for the EWS section of the society at State-run hospitals,” De said. He said that infrastructure

for cardiac and cancer care and surgery would be upgraded in the State-run hospitals and the government would be procuring medical equipment like linear accelerators, cath lab, surgical implants, etc to the tune of Rs 250 crores. De explained that West Bengal has a very healthy total fertility rate (TFR) which is the lowest in the country at 1.6, while it is 1.2 in Kolkata. Hence, the population growth in the State is very low. He added that post 2031, the State’s population will start decreasing which will make the health infrastructure sufficient. However, consequently there will be a larger percentage of senior population and providing geriatric care to these senior citizens would be a challenge in the coming days. He informed that the efforts by the government towards better 'mother & child

care' facilities has culminated in a substantial drop of MMR (113) and IMR (35). De urged private investors to come and invest in the State. and assured them all possible help and speedy clearances of their proposals/projects under the State's 'Clinical Establishment Act'. He said that the Act will be amended and a new Act will come into force shortly, which will further benefit private healthcare units in the State. In another major development, the Department of Health & Family Welfare, Government of West Bengal has signed a MoU with SingHealth of Singapore for technical support and training of its healthcare personnel like doctors and nurses. SingHealth has a network of two hospitals, five national specialty centres and nine polyclinics. EH News Bureau

Doctors urge amendments in PCPNDTAct A joint initiative by AHPI and IMA THE NATIONAL Steering Committee on the PCPNDT Act, comprising experts from the major national medical societies, came together in Bengaluru to deliberate on the plight of the girl child and steps to improve the altered sex ratio in India. The committee expressed grave concern over the declining sex ratio despite the existence of the PCPNDT Act for over twenty years, and felt that a review of the Act was in order. Voicing collective opinion, Dr Alexander Thomas, the

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Executive Director of AHPI and co-chair of the committee, said, “The purpose for which this Act was promulgated has not been achieved. In its current form, the implementation of the PCPNDT Act has deprived the poor and needy population (especially women and children) of life-saving and essential ultrasonography.” As noted in a joint statement released by the by OHCHR, UNFPA, UNICEF, UN Women and WHO, “Communicating the sex of a foetus can be done discreetly, even

silently, and prosecuting offenders is therefore practically impossible.” The committee noted that doctors who perform these crimes are rarely caught, and that the Act was being used to punish doctors for minor offences such as clerical errors in the filling of forms, thereby resulting in doctors being prosecuted and ultrasound machines being seized and sealed. The committee also took cognizance of the fact that doctors and other medical professionals were being put to

extreme hardship while performing routine and essential scans to the extent of denying the facility of life-saving ultrasonography to patients. Due to this, many qualified doctors are opting not to do PNDT scans, thus creating a shortage of experts trained in ultrasonography. The control of ultrasonography and harassment of the medical professionals through the PCPNDT Act has not resulted in the improvement of the falling sex ratio. The committee agreed that

it was time to consider additional methods to improve the sex ratio including social change. The proposed amendments will help make ultrasound more easily available to those in need and would make the law less rigid towards the medical fraternity. The National Steering Committee will take these proposed amendments to Government (Ministry of Health and Family Welfare and Ministry of Law and Justice) over the next few weeks. EH News Bureau

MARKET

Arogya Finance launches pre-approved medical loan card Facilitates loans of upto Rs two lakh for the financially weak AROGYA FINANCE has launched the Arogya Card in Mumbai. It has a pre-approved medical loan of upto Rs two lakhs for the cardholders and their family members. “Unexpected healthcare shocks are leading over forty million Indians into poverty every year. Arogya Finance has taken a step to bridge this gap by launching the Arogya Card that offers pre-approved loans at reasonable terms by making it available at the right time and place of need to those who lack collateral or formal income proof. We are providing a onestop financial solution for people in need whenever and wherever there is an unforeseen medical emergency.” said Jose Peter, Co-Founder and CEO of Arogya Finance. The Arogya Card does not require collaterals or formal income proof which are mandatory in other forms of finance. Reportedly, Arogya Finance offers a pre-approved loan and makes it easily available within 24-hours. The card offers medical loans to the traditionally un-bankable, using a psychometric tests as an innovative risk assessment tool, which enables evaluation of the credit risk profile of people outside the formal banking system. The borrowers can repay the loans in easy monthly installments of upto 36 months and is calculated in a way that it does not exceed 25 per cent of the total family income. Dheeraj Batra, Co-Founder and VP of Business Development at Arogya Finance said, “With the launch of the Arogya Card, we are creating a lifeline for millions of people in India facing poverty due to high expenses incurred on healthcare.

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Our Cumulative Collection Ratio is very high at 96 per cent and

shows the robustness of our methodology”.

Arogya plans to implement the concept of Arogya Card

across the nation. EH News Bureau

MARKET I N T E R V I E W

We are looking for strategic tie-ups with healthcare institutes GrandOpinion is a new platform for patients seeking a second opinion before taking medical decisions. Raelene Kambli speaks to Ashish Dhar, Founder Director, GrandOpinion to understand the concept and the company’s prospects in India What is the relevance of a second opinion service in the Indian context? India is positioned very similar to other developing nations when it comes to healthcare industry. Some of the essentials that drive this market and overall tele-consult model are listed below: ◗ Medical misdiagnosis ranging from 24per cent in US alone to upto 65 per cent in developing countries ◗ Lack of speciality care: People have to travel a long way to seek quality care and medical attention. Not easily accessible ◗ Unnecessary surgeries: Mostly applicable to developing countries where there is no accountability and lot of surgeries and procedures are recommended to patients that are not required ◗ Distrust in the medical system and lack of confidence in the system due to past background and history Tell us about GrandOpinion, how will it help patients? We solve the above problems by: ◗ Shortening the time span to deliver quality medical consult and outcome. ◗ Reducing misdiagnosis by over 20 per cent and reduce the amount of unnecessary surgeries if they were not needed to begin with. ◗ Enabling our members to access the best in class and chosen doctors for most conditions at a click of a button and a phone call away. ◗ Reducing the turn around

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time and bringing efficiency and transparency in the system in a cost effective way. Our strong panel of over 200+ specialists, catering to all types of cases in acute and chronic conditions, whom we pick and choose is what differentiates GrandOpinion from anyone out there. We are quality-centred and not quantity-centred. GrandOpinion enables you to access medical care and consult in a most convenient, fast and cost effective way. We have built a web-based, mobile based digital platform that connects a unique panel of specialists and doctors on one end and users on the other. All cases and reports are handled at the back-end are processed before it hits the specialists and an opinion is delivered. People currently go to a doctor and take appointments which takes weeks and months at times. They also have to figure out if their insurance will cover this or not and have to be within that limit. Do you think Indians would like this concept? Absolutely. We are very sure that India would absorb and get used to this concept. They would love the features. The concept of GrandOpinion works for everyone, irrespective of the healthcare situation and economics of that market. It is about ease and convenience alongwith quality for best and right outcomes. In an age when we have seen an increase in life spans as well as

results in reduced health plan benefits and coverage to make up for higher costs. Healthcare fraud and abuse prevention will be extremely critical in an emerging market like India.

The concept of GrandOpinion works for everyone, irrespective of the healthcare situation and economics of that market an increase in chronic and other diseases with billions spent on care, hospitalisation and medications; GrandOpinion is an effort to improve the standard of healthcare without leaving homes and access the best services without geographical boundaries . In addition, obtaining a second medical opinion may assist in detection and prevention of healthcare fraud and abuse. Everyone pays the price for healthcare fraud through higher plan dues and out-of-pocket costs. It also

What are your business prospects? GrandOpinion is looking to break into corporate and health insurance markets. Our strategy is very clear and it works. We have done our math right and run figures as to how much can we save and help increase productivity and outcomes, including retention of talent in a company. For health insurance, which is still at a nascent stage in India, we have developed a very unique business model. We would encourage the insurance providers to talk to us so that we can assist them to reduce malpractices and unnecessary claims which cost them millions. Approaching direct customers and general public is big move for us. We have taken a holistic approach and are very cautious from both, price and time standpoint. Healthcare outcomes and decisions that GrandOpinion assists cannot wait and time is an absolute factor in such conditions. Our turn-around time is less than 48 hours for an opinion and less than two hours for a tele-consult. Insurance companies see value of offering cover for a medical opinion service as part of their claims and policies. Individuals and families aligned with such

policies are able to avoid misdiagnosis and unnecessary surgeries or treatments. It is now necessary, especially in case of diagnosing major ailments and chronic conditions like diabetes, heart attacks, kidney failure, organ transplants etc. What is your business strategy? We are looking at very key and strategic tie-ups with healthcare institutes. Working with corporates and health insurance companies is big for us. The target audience in India is quite diverse and comes from various economic backgrounds. We have made sure that GrandOpinion serves the interests of all. Expert teams, knowledge base and best practices combined with on-ground activities and partnerships shall enable us to reach and offer the services onthe-go. Fast, easy and convenient at the best price! What are your plans for the coming 3-5 years? GrandOpinion is looking to scale up and diversify in other healthcare sectors. We will focus on Big data and providing analytics on chronic and other medical conditions. We also seek to raise investment to push our growth and expansion in India specifically. Company is very bullish about India’s growth looking at the present and future medical and healthcare conditions across the nation. raelene.kambli@expressindia.com

MARKET POST EVENT

CII Evolving Healthcare Investment Landscape conference held in Kolkata The conference deliberated on strategies to facilitate increased flow of investments in tier II and III cities CII EASTERN Region organised the 3rd edition of the Evolving Healthcare Investment Landscape to explore the emerging scopes for venture capital, PE funds, debt and angel funds in the healthcare industry, in Kolkata recently. Malay Kumar De, Principal Secretary, Health and Family Welfare, Government of West Bengal shared with the audience what the West Bengal government aims to achieve in this crucial sector. De announced that the state will add 17,000 operational beds in government-managed hospitals in the next one year. De also stated that an MoU has been signed with the Government of Singapore to set up a training module in the healthcare sector. Five medical colleges in the state will be upgraded while four more will be set up through the PPP model. Cardiac care and cancer treatment will subsequently available free. De also spoke of the stateâ&#x20AC;&#x2122;s move to set up 14 mother and child care hubs, tertiary care units and 68 critical care units. Sanjay Prasad, Chairman, CII Healthcare Subcommittee ER, dwelt upon the phenomenal scope available for both industry and fund managers to take advantage in the immediate future. He also mentioned the role that regional players can play in providing service at

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MARKET very affordable cost, without compromising on the quality of services. Later, Ananta P Sharma, MD and CEO, SIDBI Venture Capital, said SIDBI was contemplating setting up a West Bengal Fund which will look for investment opportunities in the State. According to Dr Rupali Basu, President and CEO, ER Apollo Hospitals Group, the government spending in healthcare is too little to meet the growing demands. Medical devices, much of which is imported today, needs to be manufactured at home for making them available at low costs. The session concluded with a vote of thanks by Rupak Barua, Group CEO, AMRI Hospitals.

Plenary I : Options & Opportunities The session, featuring healthcare experts and fund managers, discussed various funding options and opportunities in healthcare. In his opening remark, Barua, moderator of the session, said that there are two key reasons why PE investors prefer the healthcare sector. First, being an emergency service provider, growth in business is constantly growing; and second, expectations from the industry are growing exponentially. According to Skanda Jayaraman, President and Head of Investment Banking, Spark Capital Advisors, investment decisions depend on the scale and horizon of projects, making tailor-made investments for each. Investment opportunities in e-commerce projects will be preferred in the future. Mahesh Anaokar, Director, Germinacion Capital, said investors look for projects and services that touch the masses in tier-II and III cities and rural India. Sectors which will elicit increased attention are home care health services, birth care and cosmetology. On the future of PE, VC and Angel investments in healthcare sector, Pradeep K Jaisingh, Chairman, HealthStart, said the thrust is rather on projects and services for tier-two and three cities than the metro cities. Projects on lifestyle ailments, oncology and remote ICU managements attract investors as they touch many lives at the

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(L-R) Dr Saugata Mukherjee, Sanjay Prasad, Malay Kr De, Ananta P Sarma, Dr Rupali Basu and Rupak Barua

grassroot level. Angel investors prefer to look for projects in home care and elderly care, wellness and modern disease management. Sudhakar Jayaram, Country Head, and Group CEO of BR Life Hospitals and Strategic Advisor NMC Group, UAE said entrepreneurs should not only learn how to move away from investments made, but also work towards it to grow in future. With market pressure shifting towards the outcome of businesses, costs of businesses will be the governing factor where pricing of products and services will be very important. He also said that there has to be a technology outburst to detect and change traditional treatments in the medical world.

Plenary II : Managing Mismatch Although a number of start-ups have appeared in the healthcare sector of the Eastern region, there are no forums to discuss and debate the issues faced by entrepreneurs. Dr Rana Mukherjee, MD & Principal Consultant of Mediplanners,

Audience at the conference

moderated this session which sought to assess the degree of difficulties for regional players to PE, VC or Angel funds. Dr Mukherjee suggested that there could be an “ongoing interactive platform” set up to facilitate investors and entrepreneurs alike. According to him, venture capital managers are often forced to downscale their investment targets because of a mismatch between fund size and fund requirements in the East. Risk capital appetite is low here, and as a result, many entrepreneurs look for a comfort zone in debt financing. Ayanabh Debgupta, Cofounder, Medica Synergie, shared his experience of working with a fund manager, saying that “one cannot do without the other. He also mentioned the stringent norms followed by fund managers who adhere to a very strict audit system. Debgupta also called for creation of “value for customers” in the long run. Presenting a first-hand view of what smart investments can do to a business, Somenath Mukherjee, Chairman, Hearing

Plus, recounted his experience of handholding by Brand Capital. Within a year, Hearing Plus has been able to scale up business to 47 centres across India. Advising budding entrepreneurs to focus on products and strive for constant improvement, Dr Sabahat Azim, Founder and CEO of Glocal Healthcare, urged entrepreneurs to “build for prosperity” and not cut corners in meeting compliances and rules by the government. Vrinda Mathur, Partner, Grant Thorton India, spoke of the options that could be available in Eastern India. Providing an investor’s point of view, she stressed on the scalability of business models.

Plenary III : Stratagem & Strategy The third plenary session discussed the strategies that healthcare units could adopt while utilising PE, VC, debt and impact utilisation funds. While introducing the panel of speakers, the moderator, PL Mehta, Whole time Director of Neotia Healthcare Initiative,

said that he would be glad to help set up the fund and even suggested that CII Eastern Region look for fund managers who could help set up the fund. Social impact funds are selective in choosing enterprises that have products and services that affect social changes. Unitus Seed Fund, based out of Bengaluru and Seattle, funds projects that change the lives of masses at the smaller cities and the rural level, informed Vikram Duggal, Consultant of the company. “There is not just a social angle but also a commercial aspect to the project,” Duggal said. Unitus is looking to spread across the country, particularly in tier-two and three cities. While highlighting a few success stories of the eastern region, he pointed out that there is no dearth of talent in cities like Kolkata, but what they still lack is enough incubation skills needed to become a a bigtime entrepreneur. Duggal also mentioned what seed funds look for while making their investment decisions and how they help partners scale up in volume and profitability before exiting. Soumitra Ghosh, CEO, Wadhwani Initiative for Sustainable Healthare, (WISH), said that his organisation offers help and handholding to innovators who have products or services that aim to strengthen primary healthcare in the country. It has already started working in States with high populations. He said working with State governments is not impossible. However, a combination of government’s involvement with private entrepreneurs makes for a success story. WISH provides seed capital from Rs three lakhs to Rs three crores. According to Ravichandran Natarajan, Senior VP, Narayana Health Group of Hospitals, the experience of having gone through two PE fund investments has been different with the second being more strategic and long-term that assesses the social impact and financial sustainability. Entrepreneurs should understand that there is enough money to tap, provided you have a good product and a clear concept of how to return. Thus, the conference offered valuable insights for healthcare entrepreneurs.

EVENT BRIEF JULY - OCTOBER 2015 31

MEDICALL 2015

MEDICALL 2015 Date: July 31, Aug 1 and 2, 2015

INTERNATIONAL MUSCULOSKELETAL ULTRASOUND CONFERENCE

ing its role as a major modality in musculoskeletal imaging

Contact Conference Secretary ,

Dr Nidhi Bhatnagar, E-7, East of Kailash, New Delhi

Mobile: +91 - 9810884378. nidhibhatnagar63@gmail.com

Venue: Chennai Trade Centre, Nandambakkam Summary: Medicall brings the latest, appropriate and affordable technologies, for the benefit of all hospitals. Visitorsâ&#x20AC;&#x2122; profile include doctors, hospitals owners, diagnostic centres, medical directors, biomedical engineers, medical colleges, healthcare services, investors for healthcare industry and purchase managers. Exhibitorsâ&#x20AC;&#x2122; profile include hospital equipment, surgical equipment, hospital furniture, diagnostic/lab equipment, medical disposables, facility management and support services, hospital design and construction, hospital staffing service, IT healthcare providers, medical waste management, financial and health insurance services, office automation, equipment, accreditation agencies etc.

www.hmdhealthcare.com

Safety I.V. Cannula with

While you take care of patient safety, We wish your safety.

Contact Medexpert Business Consultants, 7th Floor, 199, Luz Chruch Road, Mylapore, Chennai Phone: 91 44- 24718987

INTERNATIONAL MUSCULOSKELETAL ULTRASOUND CONFERENCE Date: October 8-11, 2015 Venue: Vivanta by Taj, Dwarka, New Delhi,

Summary: It would focus on the application of ultrasound to the entire range of musculoskeletal imaging. It would dispense information on the anatomy, techniques and interventions applicable to the musculoskeletal system using ultrasound, while defin-

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for harp njury revention

Reduce the chances of Infections from Used Cannulas

cover )

GOD INCARNATE OR FALLEN ANGEL

The taint of corruption in healthcare has forced us to ask whether doctors are god incarnate, fallen angels or merely flawed mortals like the rest of us? BY RAELENE KAMBLI

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cover )

emocracy does not support corruption. However, the irony is that most democratic societies of the world report a high level of corruption. Ideally, democracy provides equality to all people coming from different backgrounds and competencies. But the freedom central to democracy also seems to give opportunity to play around with several loopholes, giving rise to malpractices and corruption. As an act, corruption is an insidious plague which not only corrodes moral values but also impairs the functioning of an economy. It defeats the purpose of democracy and causes the entire society to suffer. Corruption has an adverse impact on the long-term economic growth of a nation. As per a study conducted by Transparency International, a global movement working against corrupt practices, corruption affect economic development in terms of economic efficiency and growth. It also affects equitable distribution of resources across the population, increasing income inequalities and undermining the effectiveness of social welfare programmes, ultimately resulting in lower levels of human development. According to a World Bank study, the infant mortality rate in countries with higher corruption is about three times higher and the literacy rate is 25 per cent lower. In fact, World Bank statistics also reveal that the level of corruption in countries with emerging market economies is much higher than it is in developed countries. Despite the knowledge that corruption hampers the overall welfare of an economy, no country has been able to completely eliminate it and India is no different.

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Concept of corruption in healthcare Although India claims to be the tenth largest democratic economy in the world, corruption has consumed every sphere of its public life. There is no single institution or sector in India that remains corruption free. However, in recent times corruption within the healthcare sector in the country has caught the international eye. Scores of articles published in various national and international publications bear witness to the growing nepotism in Indian healthcare. Even as Prime Minister, Narendra Modi and the Union Health Minister, JP Nadda claimed that there would be a crackdown on corruption, scams continue to surface across every aspect of the healthcare system in India, spanning from medical education to patients being looted through unnecessary procedures and diagnostics tests in large and reputed corporate hospitals.

Monsters behind the mask What are the reasons for the entrenched corruption within India's healthcare system? Dwindling morals, high medical education fees or vulnerability and peer pressure? Replies Dr Arun Gadre, Coordinator, Support for Advocacy and Training to Health Initiatives (SATHI), “The reason is the unequal power equation between the patient and the doctor. However smart, empowered and educated the patient may be, she or he would never feel equal in power with the doctor when suffering from an illness. The patient would never be able to dictate terms as any other consumer can.” Dr Gadre, who has interviewed 78 doctors and has

published their shocking testimonies of corruption in a book titled, 'Voices of Conscience from the Medical Profession' furthers avers, “Healthcare is now a predominant marketplace. With dwindling moral standards, most doctors have ceased to take the interest of the patient into account as they should. The rot has been compounded by growing influence of medical technology industry, pharmaceuticals, vaccine industry and private medical colleges. Here, we depart from the moral standards and now the main culprit is systemic rot.” Dr Debal Sen, a Kolkatabased independent consultant informs that some of his compatriots in white coats - as well as other healthcare workers and medical authorities - are engaged in corrupt practices. Some are extremely iconic figures within the industry while others are leading corporate hospital chains in India. Dr Sen states that around 40-60 per cent of medical doctors registered under the MCI have no proper documents to support their qualifications. He informs that in Kolkata itself 50-60 per cent doctors practice without a DM qualifi-

In recent times, corruption within the healthcare sector in the country has caught the international eye

cation. He also claims that corruption is prevalent in various sectors such as defense, forestry, and the judiciary but in healthcare we can call it medical terrorism. Dr Sen has given up practising in corporate hospitals as he witnessed too many malpractices within these so-called torch bearers of healthcare in India. “It is a known fact that doctors accept kickbacks from pharma companies and hospitals but the bigger criminals are corporate (hospitals who) under the guise of providing care, pressurise doctors to convert general check ups into surgeries to add to their revenues. Government-run hospitals are no less. A premier government-run healthcare institution in Delhi has cases where poor patients need political help to get a bed for treatment,” he shares.

In defense of doctors Referring to an article written by Dr Samiran Nundy in the British Medical Journal (BMJ) Dr Ramakant Panda, Vice Chairman and MD, Asian Heart Institute, Mumbai says that this article has raised several questions about ethical values among Indian doctors and has sparked a fresh debate within the healthcare community and policy makers. “Dr Nundy in his article mentions about corruption being all pervasive in healthcare delivery in India, starting with capitation fees for the entry into medical colleges,” he states. "First, let’s understand that errant doctors and hospitals are reflection of the moral norms of the society, and not a problem that pervades the entire profession. There are black sheep in every profession, representatives of post-independence generations that have grown up in an environment of scarcity, taxevasion and corruption and

hence have not known better ways to survive. In future, this will change," says Dr Panda. He elaborates, “Here's what’s happening on the ground. After 10-12 years of study and work, most doctors are well into their 30s before they begin earning. They start with Rs three to five crores capitation fee debt on their balance sheet, at 32 years of age. Add to this, the cost of a house, which could range upwards of Rs one crore. Their peers in other professions have started earning a full decade earlier. Time and money is invested amidst stiff competition. After becoming qualified doctors they must bear the high costs of setting up a practice, space, equipment and running an establishment. This means borrowing, which in turn, means repayment with interest. Moreover, the environment of medical practice has changed significantly in recent decades. Physicians providing patient care have experienced reduced autonomy and increased administrative burdens. Absence of regulation in private healthcare has its effect on the cost, quality and transparency in the healthcare industry. Cuts, therefore seem essential to build a quick profitable practice. And every holiday offered by a pharma company seems like a reward for the long years of hardwork. All this 'hand-inglove' practice makes the patient suffer.” Dr Panda certainly has a point when he says that high capitation fees in private medical colleges is one of the root causes of corruption in India's healthcare system. As part of this Express Healthcare story, the correspondent spoke to parents whose children had recently given the medical entrance exam. They showed snapshots of SMS messages

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SMS received by a parent in Mumbai. The messages assure a direct admission to medical colleges for a certain amount

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cover ) sent by agents claiming to represent various medical colleges in and around Mumbai. As per these messages, colleges have quoted capitation fees that range anywhere between Rs 30-50 lakhs. (See image on pg 27) Moreover, these parents also informed that they receive calls from various agentswho claim to hold seats in government as well as private medical colleges. It was also revealed that agents quote around Rs five crores for a post graduate seat in Navi Mumbai’s premium medical college. “One of the agents told us that our ward need not appear for the entire question paper during the entrance exam. If he could answer just 20 marks of the paper, the rest would be done by their sources within. All we would have to do is pay him money. Now I have lost faith in this profession and have asked our child to choose another career,” reveals a disillusioned parent.

The dividend on medical devices Apart from this, Dr Anant Pandhare – Medical Director – Dr Hedgewar Hospital, Aurangabad reports on the nexus within the heart stent industry. Dr Pandhare informs that hospitals charge around Rs 1-1.5 lakhs for a high standard stent that costs anywhere between Rs 25,000-40000 “This is my own experience . I, once, personally negotiated with vendors of medical products and equipment for my hospital. Once while purchasing stents, one of the vendors quoted Rs one lakh per stent. Knowing that that stents do not cost so much, I questioned his quotation. On this the vendor replied saying that this would include my cut. Thereafter, I decided that I will personally keep a track of all purchases of such products for my hospital so that no one in my hospital would ever be tempted by such offers.” If this is the state of health-

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care in most parts of our country, are our laws adequate to hold these wrong doers accountable for their misdeeds?

Lack of regulation India does have an anti-corruption act – the Prevention of Corruption Act 1988 – enacted to combat corruption in government agencies and public sector businesses in India. However, there are many loopholes to maneuver around it. Where the private sector is concerned, there are no regulations and accountability mechanisms. Referring to the most talked about and sordid tale of disgrace, about how ex-MCI president, Dr Ketan Desai caught red-handed by the CBI while taking a bribe from a private medical college in 2010, is still running Indian medical education and regulatory system sitting behind the curtain, Dr FD Dastur, PD Hinduja Hospital & Medical Research Centre, points out that money, power and political patronage has allowed MCI to be run by the wrong type of individuals who corrupt the profession for personal gain. Commenting on the lack of

proper regulations and laws for corruption within the healthcare sector, Dr Gadre shares, “In 2010, the government had introduced the Clinical Establishment Act. It is a welcome step, as due to it, at least now we are having a discourse on regulation of the private healthcare sector. But if you search the entire document; an important word is missing i.e. the patient. It does not talk about patients’ rights. It is bureaucratic. We doctors have (our) worst nightmares when we imagine any regulation. It only means that there is one more tool in the hands of a few corrupt (government) babus to exploit. Jan Arogya Abhiyan has come out with a draft of the model act. However, the government must adapt it. In its present form, there is a great danger that it would not be implemented on the field as it should be and in that scenario, both patients and ethical doctors would suffer.” Dr Dastur opines, “The government’s Central Drugs Standard Control Organization (CDSCO) does not have the stringent rules of the US FDA. It is woefully understaffed with

a mere 1500 inspectors compared to 14,500 of US FDA. Furthermore, the relationship between certain plant officials and inspectors has at times been reported as ‘too cordial’ and quality control issues have arisen. Thus, three leading Indian companies in 2013-14 have had their manufacturing plants banned from exporting drugs to US on account of poor quality control. In August 2014, the Bombay Municipal Corporation reported a sudden outbreak of 38 adverse drug reactions (ADRs) in two of its city hospitals. The drugs responsible appeared to be two antibiotics, namely Ceftriaxone and Cefotaxime. Those affected developed convulsions, breathlessness and vomiting. One patient died. An investigation is ongoing.” Dr Dastur also recounts last year’s botched sterlisation camp and says, “In November 2014, in a sterilisation camp in Chhattisgarh, 28 women became acutely ill within hours of surgery and died, provoking worldwide condemnation. Adulterated antibiotics from a Mumbai company are suspected to have contributed to these fatalities. Such incidents demoralise pub-

lic confidence in government healthcare schemes and in Indian drugs in the market.” These testimonies indeed paint a very dark picture of the healthcare system within India. So, has any one raised the alarm? What have been the consequences so far?

Fight for justice Dr Kunal Saha, a US-based professor and private consultant in HIV/AIDS, is known for his struggle against a case of medical negligence in which his wife, Anuradha Saha lost her life. She died at the age of 36 at Kolkata-based Advanced Medicare Research Institute (AMRI) on May 28, 1998. Since then, Dr Saha has been waging a tireless war against corrupt practices. “Corruption in the medical regulatory system is the root cause of the present abysmal condition of healthcare in India. I established “People for Better Treatment” (PBT) in 2001 primarily to spread awareness about medical negligence and to stop the rapidly spreading evils of medical corruption. Over the past 14 years, PBT has brought major changes in the flawed Indian medical system through numerous public interest litigations (PILs) in the High Courts and Supreme Court of India. For example, our PIL in the Supreme Court (W.P. No. 317/2000) made the shocking discovery that not only different state medical councils were deliberately keeping silent for decades on complaints against negligent doctors, no medical councils were even established in a large number of states across India, more than 50 years after independence. As a result of this historic PIL, sections 8.7 and 8.8 were enacted into the MCI “Code of Ethics & Regulations, 2002”, mandating a six month timelimit to dispose of complaints against doctors (section 8.7) and also giving right to appeal against the decision of the state medical council (section 8.8).

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PBT is also fighting numerous legal battles against the disgraced ex-MCI chief, Dr Ketan Desai and deep-rooted corruption in the medical councils,” he states. Describing his personal legal battle he goes on to say, “Although a more personal legal battle against ‘eminent’ Kolkata doctors and AMRI hospital in Kolkata, the recent verdict and highest-ever compensation in Indian medical history (Rs 11.5 crore including interest) by the Apex Court in the case for the wrongful death of my wife, have rekindled hope for countless victims of malpractice in India. This historic judgment by the Supreme Court has sent a strong deterrent signal to the errant and unethical doctors and hospitals across India. The Apex Court has declared in an unequivocal manner that an innocent patient’s life must (be) worth a lot more than what was given until now. It has also awarded ‘exemplary or ‘punitive’ damages for the first time in a case of medical negligence underscoring the point that reckless treatment is an act against the society at large. Until the Anuradha Saha case judgment by the Apex Court, consumer courts across India were awarding measly amounts as compensation to the tune of Rs one or two lakhs for loss of a human life even on the rare occasion when a doctor was found guilty for medical negligence. The Indian medical community and Indian Medical Association (IMA) have received a strong message for the first time against medical negligence through the historic judgment in my wife’s case. This was reflected with the filing of a desperate and unprecedented ‘review’ petition by the IMA seeking to reduce the quantum of compensation in the Anuradha case even though IMA was not even remotely connected with this personal litigation against Kolkata doctors/AMRI hospital. However, the review peti-

IMA had demanded a ban on Akshay Kumarstarrer film ‘Gabbar is Back' because the movie highlighted some corrupt practices in healthcare. However, it is undeniable that several unethical practices are prevalent in the healthcare industry. So, why are industry bodies turning a blind eye to such happenings? Do we need a Gabbar in healthcare too? tion by IMA was promptly dismissed by the Supreme Court.” The Apex Court judgment in Dr Anuradha’s case and Dr Saha's movement has served as a corner stone in starting a social campaign against corruption. How effective can such social crusaders be in making a difference or holding people accountable? Dr Annirudha Malpani, Aniruddha Malpani, Medical Director, HELP - Health Education Library for People, challenges the success of social campaign. “The problem with the campaigns against medical corruption is that while they do a good job of documenting the problems, they fail to provide effective solutions. Most of the solutions are impractical after all, preaching to unethical doctors that they need to start practising medicine ethically by refusing to take cuts and kickbacks is hardly going to help! What's worse is that these crusades just drive the wedge further between doctors and patients. Patients start treating all doctors with suspi-

cion - and this lack of trust will prevent doctors from being able to provide high quality medical care to their patients,” he believes. Agreed Dr Malpani, a social crusader perhaps does not have the capacities and capabilities to bring about a renaissance. However, we cannot turn a blind eye to the malfeasance flourishing within the healthcare system. We need to take a stand. At least for patients who become victims of such malicious crimes and for those medical professionals who still practise with all ethical values. Certainly there is always light at the end of the tunnel. We only need to find proactive measures and execute them; the rest will fall in line.

Transparency is the key Dr Panda suggests some reform areas. “We need to increase the number of post graduation seats for medical sciences in India. Look at the recent AIPMT cheating case6.3 lakh children are competing

for 3700 medical seats: the inequality is the problem. AIPMT is the gateway for admission to 15 per cent of seats in all central government medical colleges and participating state government medical colleges. Inequity sends law breakers ahead of law makers. The government has to allow private players to start off PG courses within their hospital setting. Also, we need to reduce the nuisance of cut practice by way of making medical education less expensive. Public investment in new medical colleges, liberalising infrastructure norms for setting new medical colleges and encouraging participation from private hospitals will help. Furthermore, a better pay package for teachers will enhance the quality of faculty, thereby incentivising them and ensuring limited private practice for teachers. It is also crucial to make it mandatory for hospitals to go for accreditation,” he recommends. Dr Sen adds, “We can take some lessons from the US,

where they have a medical audit committee. Likewise, we need to commission a hospital review committee wherein hospitals will be audited at regular intervals. We also need to alter the current patent laws and make them more patient-friendly. Lastly, we need to define the meaning of brain death in our medical books, to curtail the growing organ market.” Another suggestion comes from Dr Pandhare who urges hospitals to opt for full time doctors, paying them good salaries. On the other hand, Dr Malpani speaks of empowering the patient. “Information therapy has an important role to play. If every doctor had their own website, patients would be able to reach out to them directly, so there would be no need for specialists to pay referral fees. Also, hospitals would be able to maximise their bed occupancy, so they would not need to incentivise specialists to refer patients to them,” he sums up.

Wanted: A Gabbar for healthcare? Corruption in healthcare that begins with high capitation fees for medical seats and many more such practices only raise questions about the next generation of doctors. In a recent incident, the IMA demanded a ban on Akshay Kumar-starrer film ‘Gabbar is Back', only because the movie’s hero highlighted some corrupt practices in healthcare. However, it is undeniable that several unethical practices are prevalent in the healthcare industry. So, why are industry bodies turning a blind eye to such happenings? Do we need a Gabbar in healthcare too? It is time that PM Modi's government comes through on their electoral campaign promise to cut down corruption. Similarly, it is time for the many healthcare professionals in India to recall their Hippocrates oath and live by it. raelene.kambli@expressindia.com

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here is a public perception that the medical profession is growing increasingly avaricious and unscrupulous. The defendants of the profession take refuge in the explanation that medical doctors are merely reflecting social mores. As corruption worsens in the society at large, doctors find reasons to follow suit. A common argument put forward by doctors is: ‘When I search for a consulting room for my practice or a flat for my home, I have to pay a considerable sum as black money. Likewise, when I try and enroll my child in a reputable school, I need to pay a huge sum under the table. Where am I to get these sums? Willy-nilly, I too must use avenues to collect unaccountable funds.’ Such thought flies in the face of the fact that the doctor is a highly educated and privileged person who cannot and should not justify unethical and unscrupulous acts under any circumstances. Discussions on this topic have been in progress over decades. Indian Journal of Medical Ethics, published from Mumbai, features several essays criticising current trends and suggesting corrective measures. The topic of unethical practices in performing medical tests (among other instances of unethical behaviour) has been brought into international focus by an essay written by a gynaecologist Dr Arun Gadre from Pune and published in the British Medical Journal (BMJ) on February 24, 2015. Particular emphasis has been placed on the excessive use of expensive tests for pecuniary motives.

The role of tests Tests are requested after the doctor has obtained a detailed account of the origin, duration and progress of the illness from patient and family. The record-

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IS ITTRULY ‘TEST’ WORTHY? Sunil K Pandya, Department of Neurosurgery, Jaslok Hospital & Research Centre, Mumbai examines the factors driving unethical practices in healthcare, including prescription of unnecessary medical tests and gives insights on prevention of such malpractices

ing of this history is followed by a careful, detailed clinical examination of the patient. On completing the examination and reviewing the findings in the light of the history, the physician arrives at one or more possible diagnoses. In many instances, where the diagnosis is unequivocal, the physician may not require any tests and may proceed to treatment. When the diagnosis is not clear and may be one of several possibilities, the doctor requests tests that will eliminate the unlikely possibilities and focus attention on what ails the patient. These tests may be in the form of examination of the blood, urine, sputum or other body fluids or tissues or some form of imaging ranging from X-ray films to sonography, isotope scans, computed tomography (CT), magnetic resonance (MR) scans and positron emission tomography (PET) scans. Accurate and appropriate treatment can now be recommended. So far, so good.

Unethical practices The problems under discussion arise from greed in the two parties – the doctor requesting the tests and those performing them. The latter individuals and groups, attempting to garner a greater share of the business, offer incentives – financial and otherwise – to the referring doctor for each test ordered. The ethical doctor disregards such offers. The most effective and least expensive tests are requested from reputable centres near the patient’s residence or workplace. However, those swayed by lucre, request as many tests as they can, concentrating on those that are the most expensive as these guarantee the maximal returns in terms of commissions from the laboratory or imaging centre. Other compulsions may also play a part. Doctors who have secured appointments as consultants in reputed private hospitals are, at times, under pressure to boost the income of laboratories and imaging units in these hospitals by sending all their private patients there.

Some hospitals monitor the income generated by each doctor for such departments periodically and penalise those not sending ‘adequate’ referrals for tests. Why are these practices not in the interest of the patient? ◗ Unnecessary tests are a drain on the patient’s purse. Worse, they may result in a chain reaction that can, at times, be disastrous. For e.g. an unnecessary X-ray film of the chest may show a doubtful abnormal shadow near the heart. This shadow is in no way connected with the patient’s illness but since it has come to notice, it elicits a recommendation that a further test – angiography – be performed. This adds to the patient’s costs. Angiography involves threading a large artery in the thigh and the injection of a chemical that renders blood vessels in and around the heart opaque to X-rays and thus clearly visible on films. Angiography shows a variation of the normal that requires no treatment. Unfortunately, the patient suffers a complication at the site of arterial puncture in the thigh that results in blockage of the artery. An operation is required to restore the flow of blood through it. The patient undergoes physical hardship, inability to work for a fortnight and considerable additional and unnecessary expense. ◗When incentives in the form of kickbacks from laboratories or imaging centres play an important part in the decision by the doctor to order tests, the temptation is to send the patient to the laboratory or imaging centre that offers the largest sums. These are usually not the most competent or reliable laboratories and imaging centres. ◗ The sum paid by the laboratory or imaging centre to the referring doctor is included in the charge levied on the patient. The patient is thus paying an added sum, unaware that he is rewarding the referring doctor. How can patients avoid being victims of such unethical practice? Since we are unaware of the extent to which such unethical practices are in vogue it is best

( to be on guard against them. Tests ordered after a cursory recording of the history of the patient’s illness and physical examination are questionable. The doctor has not taken the pains to learn details of the evolution of the disease that has caused the patient’s illness or determine where it is located in the body. A battery of tests cannot compensate for a good clinical examination. Such tests can be compared to the use of a shotgun that fires innumerable pellets in different directions. Since they are not focused, they may miss the target and despite considerable expense, the patient may be none the wiser about the cause of his illness. When you are told to get the test done only at a specific laboratory or imaging centre without being given a rational justification for this recommendation, your antennae should quiver. There are centres and laboratories with special expertise and referrals to them for specific tests are in the best interests of the patient but this must be explained to the patient. Most simple tests can be performed at a variety of labs or imaging centres without any dilution of the information elicited. Likewise, when you are asked to get tests done at a particular private hospital to which your consultant is attached and he dissuades you from getting it done at a centre near your home even when getting it done at the hospital causes considerable inconvenience, you should question the choice of the laboratory or the imaging centre. Why is the onus on avoiding such malpractices thrust on the patient? Beset with a multitude of anxieties – about the symptoms experienced, doubts of the gravity of the illness causing them, expenses that may have to be met, interruption of work at home or in office – why should the patient have to shoulder the additional responsibility of detecting and frustrating unethical doctors and centres? As a nation, we are poor at enforcing ethical practices. Agencies such as the Medical Council of India and the state medical councils were created to

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each test requested and for any other information you may need. ◗ Friends and relatives you trust can, at times, guide you based on their earlier experiences with doctors and hospitals.

Plight of doctors

maintain standards of ethical medical practice. They have dismally failed to do so. Several efforts have been made to ensure probity and accountability in their functioning but these have failed so far. We lack accreditation agencies that study the performances of individual doctors, laboratories and imaging centres and rate them by excellence, ethical standards and other useful criteria. The lay individual is thus sailing in an uncharted sea. Over the past few years, there are groups that claim to rate agencies. The little I know of them is not conducive to confidence in their ratings as they solicit doctors, laboratories and imaging centres and do not perform rigorous, independent assessments. So, is the current situation hopeless? How can you make the best of this state of affairs? Well, the following steps may help: ◗ Public teaching hospitals such as the King Edward VII Memorial Hospital in Parel, Sir Jamsetjee Jejeebhoy Group

Excessive medical tests are being demanded by private practitioners for pecuniary motives Sunil K Pandya, Department of Neurosurgery, Jaslok Hospital & Research Centre, Mumbai

of Hospitals in Byculla, Lokmanya Tilak Memorial General Hospital in Sion and the Bai Yamunabai Nair Hospital at Bombay Central in Mumbai are generally devoid of unethical practices though caution when dealing with individual doctors remains advisable. ◗ If you are fortunate in having a trustworthy family physician, he can prove an excellent guide to the specialised tests and treatment you may require. Unfortu-

nately, such physicians are dwindling and can be almost categorised as endangered species. ◗When you see a doctor for the first time pay attention to the time and effort he devotes to you. A friendly and cheerful attitude, concentration on what you are saying, the making of copious notes whilst he listens to you, a detailed physical examination are encouraging findings. On the other hand, the doctor watching the second hand of his watch as he sees you, handling innumerable telephone calls whilst you are trying to narrate your woes and the termination of his consultation within minutes of your arrival are disconcerting warning signals. ◗ As you have gathered from the text above, beware of the doctor ordering a multitude of tests after a cursory examination and of one insisting that you get them done at a particular centre. ◗ At all times, do not hesitate to insist on your rights – on the time spent by the doctor with you, a proper examination, explanation of the rationale for

This group deserves help, sympathy and encouragement. Many doctors graduating from the public sector teaching hospitals are motivated towards excellence and ethical practice. They enter the arena with aspirations and enthusiasm. The need to add to existing medical knowledge through research also inspires them. But, disillusionment strikes them hard as they encounter obstacles. It is difficult for them to get attachments to reputed private hospitals. Referral of patients are few and far between. Making ends meet is a recurrent dilemma. At such times they become vulnerable to unethical practice and lures set out by laboratories and imaging centres. What can I, at the fag end of my career, say to them? I can point out examples of those who have resisted temptations of the unethical kind and have risen to the highest ranks of medical practitioners. Names like Dr Noshir Wadia, D Farokh Udwadia and Dr Homi M Dastur from the older generation and Dr Anil Karapurkar, Dr Sanjay Nagral, and Dr Shekhar Bhojraj from the younger generation will inspire them. There is much to learn from their perseverance and endeavour. I appeal to the conscience of medical practitioners by quoting the great physician, Sir William Osler, “My message is chiefly to you … since with the ideals entertained now your future is indissolubly bound. The choice lies open, the paths are plain before you. Always seek your own interests, make of a high and sacred calling a sordid business, regard your fellow creatures as so many tools of the trade, and, if your heart's desire is for riches, they may be yours; you will have bartered away the birthright of a noble heritage, traduced the physician's well-deserved title of ‘Friend of Man’, and falsified the best traditions of an ancient and honorable Guild.”

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cover ) "Power does not corrupt men; fools, however, if they get into a position of power, corrupt power." - George Bernard Shaw Modern society, with the influence of the western education, has come to revere money and power as the most vital part of human existence on this planet. Even as far back as 1802, the romantic British poet, William Wordsworth, became so sad when the first industry came up in England, what is now called the Industrial Revolution. He wrote a beautiful poem, ‘The world is too much with us’: “The world is too much with us; late and soon, Getting and spending, we lay waste our powers;— Little we see in Nature that is ours; We have given our hearts away, a sordid boon!” The poem tells it all about today’s scene in modern medical practice, which unfortunately has percolated to even all modalities of sickness care. Even in the name of ayurveda, homeopathy and what have you; people have started making money in a big way. Today, one can have a week’s ‘ayurvedic’ treatment for $25,000 in bigger cities like Bengaluru and Mumbai, so the contagion of greed is not restricted to Western medicine alone. That brings us to the crux of the problem. It is not modern medicine that is at fault, it is the greedy practitioners of modern medicine who are at fault. Any industry, including the sickness industry, needs to sell its wares. But, this has led to a new speciality in modern medicine; i.e. disease mongering. Along with that, we have obliging epidemiologists who can create epidemics at the drop of a hat, if you need it. One example would suffice: Coronary artery disease was not a very common disease even when I was a student in the 50s. And the diagnosis was purely clinical, based on the patient’s story. No investigation can clinch the diagnosis of coronary artery disease. Naturally, the

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SICKNESS INDUSTRY AND CORRUPTION Professor BM Hegde, renowned physician and former Vice-Chancellor of Manipal University, highlights the growing incidences of nefarious and unethical practices in healthcare

incidence of coronary artery disease was not very high. Today, we have transformed the scenario. We have started a new business called ‘routine checkup’ of the apparently healthy, based on the faulty premise that early diagnosis in the pre-symptomatic stage is better for prevention. This is scientifically untrue, no disease will benefit in the asymptomatic stage by outside intervention. However, the myth perpetuated by the screening industry, aided and abetted by heavy advertisement through the electronic and print media in our present “health scare” system nets in almost 75 per cent of the healthy population, who have blocks seen in the epicardial large coronary arteries. These are seen even in children. These intraluminal blocks are just a bandaid put by nature on injured vessel endothelium. The latter is not a disease, as the intraluminal blocks gradually increase, nature provides plenty of collaterals to feed the distal part of the heart muscle. The real coronary artery disease is due to hot inflammatory intramural blocks, which are not seen in the coronary angiogram. These hot blocks can attract a clot producing the various presentations of coronary artery disease, viz: angina of effort, unstable angina, intermediate coronary syndrome and heart attacks. Consequently, there has been an epidemic of coronary heart disease in the last couple decades with the availability of coronary bypass surgery and angioplasty. So today, coronary interventions are done not to help the patients who are asymptomatic anyway but to collect, “billions of dollars in cash for the doctors, hospitals and instrument manufacturers, social status and respectability for the star performers”, as Harlan Krumholz, the Chief of Cardiology in Yale University wrote in an editorial a few years ago, in the New England Journal of Medicine. The story is the same in every other field, leading amongst which is the cancer industry. This is a trillion dollar industry. Linus Pauling, a scientist

who got two Nobel prizes, emphatically wrote that cancer research has been a fraud. This idea has been reaffirmed by many studies since then. John Iaonnidis, a Stanford professor has found out that almost 85 per cent of the cancer research data cannot be replicated independently. Most cancer research is funded by the cancer industry. Billions of dollars of cancer research are poured into animal studies, which cannot be replicated in human beings. There has not been a serious effort to prevent cancer as other industries are pouring in thousands of cancer producing chemicals into human food channels. We live in the midst of carcinogens, which is a good idea because we want more cancer patients to cater to the expensive cancer industry. One example would make the point: Imitanib, a tyrosine kinase receptor inhibitor is the latest darling of the cancer industry. In India, a course of this drug might make even the reasonably rich people paupers, what the industry does not want is for the world to know that many such powerful tyrosine kinase receptor inhibitors are there in our kitchen turmeric powder, which can be bought for almost nothing. Mark Twain was right, when he wrote, “A lie can travel half way around the world while the truth is putting on its shoes.” How true. So corruption is an integral part of the healing arts in the 21st century. Around this nucleus of corruption grows an industry of corruption. Family doctors in the olden days were friends, philosophers and guides of their patients. Today, they are slowly transforming themselves into a supply chain for the greedy corporate hospitals. With each referral, the man gets 10 per cent kickback from the final bill, that too in cash, making them quite rich overnight. The pharma industry, the motivator of all this, thrives on falsehood, half truths and blatant lies. In the name of having poured in billions for fundamental research to discover a chemical molecule, they claim they have a right to claim a

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patent over the drug and sell it at an enormous cost. One will be shocked to know the various methods they adopt to influence the prescribing doctors. With all the strict laws in place, they still bribe doctors and find their way through. They create multiple indications for each drug, while the true science says that any reductionist chemical molecule will not be accepted by the human body’s wisdom. Other overt and covert methods of corruption in this arena are: drug companies doling out millions of dollars to the so called, ‘thought leaders’ to sit on guideline committees and invent new diseases to sell drugs. Couple of examples come to mind: one is the famous JNC committee on blood pressure management, the so called normal blood pressure started coming down from 160/100 when I was a student to almost 110/70 in the JNC 7 report. The only conceivable reason why the so called normals came down could be that the drug pushers invented newer chemical molecules to lower blood pressure. Such ridiculously low blood pressures may push the blood pressure further down in sleep, helping elderly patients to meet their maker in heaven prematurely. Sanity has seemed to prevail on the committee now, and thank God, JNC 8 has now gone back from the original level of 160/100 to a nicely camouflaged 159/99. I am sure millions must have changed hands, although I have no proof of that. Every reductionist chemical molecule introduced into the human system is first rejected by the human body’s wisdom and sent to the liver for destruction [first pass effect], creating a new epidemic of non-alcoholic cirrhosis. Studies have also shown that whatever good comes out of medical treatment is exclusively because of the placebo effect. The unfortunate fallout

of all this has been an epidemic rise of adverse drug reactions [ADRs]. The latter has now been found to be one of the leading causes of death in all those countries where medical audits exist. A recent study of the medical world since the advent of the journal, The Lancet, in 1823, to scientifically rectify the corrupt and incompetent practices of London doctors in 1823. James Wakeley, the founder of The Lancet, a doctor himself, thought that the doctors in London in 1823 were a bunch of corrupt, nepotistic, incompetent lot who had become an abscess on the human body, eating into the flesh. He called his journal The Lancet, and thought it could open the abscess and drain out the pus. Unfortunately, nearly 175 years after the advent of The Lancet, an audit showed that what was in 1823 an abscess on the human body has transformed itself over the years into a corporate monstrosity. All because of the greed for money by the people concerned. The only way we can see an end to this nefarious practice is by a change of heart of doctors. I hope it is possible. Society is changing, thanks to the information overload, patients are becoming wiser and I hope, sooner than later, doctors will have to practise the essential part of medicine, enunciated by the Father of Modern Medicine, Hippocrates: “Cure rarely, comfort mostly, but console always.” I hope this day will not be far off. A good doctor must basically be a good human being and a good human being should be an authentic human being. Corruption as a disease will die a natural death when mankind becomes altruistic. “The surest way to corrupt a youth is to instruct him to hold in higher esteem those who think alike than those who think differently.” - Friedrich Nietzsche

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HOSPITAL INFRA

THE

SMART WAYOFHEALING Though Indian healthcare providers are introducing a slew of measures to enhance efficiency and optimise their resources for best outcomes, they have a long way to traverse before metamorphosing into truly smart hospitals BY LAKSHMIPRIYA NAIR

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To have a complete 'smart hospital', the infrastructure and technology has to support each other Barun Pal Chowdhury Director - Design Build, Shapoorji Pallonji

A 'smart' hospital has to be: patient experience focused, employee focused, organisation focused, and innovation focused. Anil V Pillai Director, Terragni Consulting

atient-centricity is slowly gaining prominence in Indian healthcare and has led to the emergence of a new concept called 'smart hospitals'. But, how is it defined? Succinctly put, it is about creating streamlined, optimised healing environments for best outcomes. “Smart hospitals are those that effectively and efficiently use and leverage technology and data to ensure high quality medical care which is sensitive, proactive, consistent, repeatable and sustainable,” says Anil

V Pillai, Director of Terragni Consulting, a healthcare management firm. Explaining the concept further, he states, “The fundamental tenet of being a 'smart' hospital is that it has to cover four essential dimensions. It has to be: patient experience focused, employee focused, organisation focused, and innovation focused.” Pillai elaborates on the smart hospital concept: ◗ All its clinical, data and technology systems are integrated seamlessly ◗ The hospital has invested

in technology and maintains these technologies to ensure that three key challenges of patient care are met: ■ Alleviate patient and caregiver anxiety ■ Ensure patients play a participatory role in their own healthcare ■ Connectivity, information and data flow between hospital medical systems, patients, care givers, medical, nursing teams are seamless. Talking about the benefits offered by a 'smart hospital', Barun Pal Chowdhury, Direc-

tor - Design Build, Shapoorji Pallonji informs, “Smart hospital can lead to higher efficiency of doctors and other support staff. Additionally, security and patient safety gets more prominence while building high level of patient satisfaction. This will bring transparency, reliability and efficiency in the growing healthcare industry.”

Dapper and dynamic designing So, how do we go about designing a smart hospital? Well, the key is to design set ups that are

Hospitals are now turning into health preserving entities and are teaming up with a network of interdisciplinary teams Dr Satish Prasad Rath Chief Innovation Manager, Healthcare Research, Xerox Innovation Group (XIG)

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HOSPITAL INFRA

The approach towards surveillance has changed from analog to digital surveillance Sudhindra Holla Country Manager, Axis Communications

The realisation of the need for a safe and secure environment in healthcare has gained ground Col Sunil Sharma Head Physical Security Practise, MSSG

The idea of a centralised laundry can reduce operating costs at a very large scale for many hospital operators Aditya Sinh Jhala Director, Gourangaa Consulting

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dynamic and engaging, combining architecture and technology. Thus, while creating smart hospital spaces, the design should enable hospital environments to be interactive as it would aid the hospital staff to do a superior job, more swiftly. The infrastructure should cater to the individualised needs of patients and amplify the opportunities to expand treatment options. They must also have a distinct focus on connectivity, communication, and access to information to enhance the quality and safety of patient care, reduce inefficiencies and ensure improved management and administration within the hospital. As Dr Satish Prasad Rath, Chief Innovation Manager, Healthcare Research, Xerox Innovation Group (XIG) underlines, “Hospitals are now turning into health preserving entities and are teaming up with a network of interdisciplinary teams to maintain the health of a community. Investment will be needed in upgrading infrastructure to new age patient centric health record systems. The hospitals need to co-create this new era of medicine in participation with patients, technology firms, medical devices firms and pharmaceuticals. Chowdhury explains, “To have a complete 'smart hospital', the infrastructure and technology has to support each other. An integrated system is the requirement of the day. Systems need to ‘talk’ to each other and share information. An intelligent healthcare infrastructure builds efficiency across an organisation.” He further informs, “The most important criterion of a smart hospital is seamless and paperless communication between various departments, personnel and communication devices. This translates into high level of infrastructure and technological support.” Thus, a smart hospital should be characterised by:

Avant-garde technology The last decade has witnessed a burgeoning romance between IT and healthcare. The marvels of IT are fast revolutionising healthcare delivery. Dr Rath opines that gone are the days

The most important criterion of a smart hospital is seamless and paperless communication between various departments, personnel and communication devices. This translates into high level of infrastructure and technological support when healthcare was reactive and confined to hospitalcentered episodes. He says, “Nowadays, with technological advances, we can understand an individual’s personalised profile by analysing his pedigree, his social profile, his genomic profile, his past medical encounters from electronic medical records (EMR) and his quantified self view from his personal health record (PHR).” “The healthcare industry is increasingly reliant on technology for the delivery of services to patients which has led to an increasing amount of intelligence within hospitals,” claims Subhasish Gupta, Country Manager – India & SAARC at Allied Telesis, a company providing networking infrastructure and interoperable network solutions. “The network has become a critical factor in the landscape of patient care. Quality care and affordable healthcare services can only be delivered profitably by utilising digital technology connected by a secure and reliable IP network,” emphasises Gupta. Agreeing with this view, Chowdhury states, “Systems integration and systems design are the critical elements in designing a smart hospital. Various departments, such as the nurse call station, the radiology dept, the pathology labs, the scanning centres, etc., have to be seamlessly integrated keeping in mind the workflow of the clinicians so that they can work more efficiently. Elements such as mobile devices, smart boards, and wireless protocols have to be incorporated. Network connection is also something which is vital in this kind of design.

Flexibility of IT infrastructure has to be kept in mind so as to accommodate and adapt to technology advancement.” He further informs, “Some innovations such as tracking devices and smart boards can be important elements of a smart hospital. Patients can be tagged with tracking devices and these can also be synced with the electronic or 'smart boards' which can allow the caregivers as well as the relatives of the patient to know the whereabouts of the patient, e.g. when they are in the scanning centres or out of the OT, etc. Cloud support can also be incorporated in the design of a smart hospital. A patient's records, lab reports, doctor's notes can all be stored in the cloud so that no matter where the patient is, the attending doctor can call up the information at the tap of a button. This means that information is available ‘just-in-time’ when and where required!” Looking at the growing potential for intelligent IT in healthcare, companies like Allied Telesis and Xerox are offering innovations aimed at making healthcare delivery simple yet effective. Gupta highlights that Allied Telesis offers include intelligent wireless networks which enable clinicians to move among patients with a tablet-type technology for rapid access to all manner of information and IP telephony that enables staff to be contactable anywhere in the facility, rather than only at their desks. He says, “Allied Telesis has a number of innovative technologies that deliver the performance, intelligence and se-

curity required within smart hospitals. We have couple of deployments in KPC Medical College, MGM University (Medical College and Hospital) and KIMS-Hubli. With our network security technology, the organisations can access operational data from the same place. Besides, security is enhanced as access to the network is limited to personnel with the appropriate rights. The organisations achieved high performance, security and greater network efficiency at a low cost. The solution greatly increased network efficiency.” Dr Rath too highlights, “Xerox is working on analytics driven intelligent tools that will work for employee wellness, ICU admission prediction, post discharge readmission prevention and personalised care plans. These intelligent tools will empower existing hospitals to increase their services and care delivery without physically increasing their beds and take care of menace of chronic diseases through home monitoring.” Blackberry sees a lot of potential in the healthcare sector as well. It is investing in NantHealth, a healthcare platform. In an interview with Express Computer, Annie Mathew, Director, Alliances and Business Development, BlackBerry says, “Technology and mobility will play a crucial role in revolutionising the healthcare system and propelling the next phase of growth in India.” (Read more at http://computer.financialexpress.c om/interviews/blackberrys-prescription-for-success-in-healthcare/12604/) Hospitals too are eagerly adopting new-age technology and integrating them into their infrastructure. For instance, Aster Medcity, a quaternary care hospital based in Kochi, was recently in the news for introducing a system called 'Bill Buddy'. It helps to update patients regarding their treatment expenditures and on the spot payment. A hotline number is provided to each patient, bystander or relative, which can be used by them whenever they want to avail of this facility. The portable bill counter will then reach the patients

room post which, the bill settlement and payment can be undertaken on the spot. This will eliminate the difficulty faced by the patients and bystanders of hunting for the right counter, waiting in long queues during payment. Col Sunil Sharma, Head Physical Security Practise, Mahindra Special Services Group (MSSG) informs how the ‘Internet of Things’ have enabled healthcare set ups to amalgamate IP-addressable communications and medical devices, sensor systems, building systems, and hospital information systems like EMR with the aid of an enterprise service bus. It permits these distinct systems to exchange information with each other, and with patients, healthcare providers, and staff. This, in turn, has made it easier to deliver the right information and resources at the right time to the point of care and opened up new avenues for the emergence of healthcare processes that are smart, efficient and effective.

Stress on security and surveillance Another predominant aspect while constructing a smart hospital is safety and security. Sudhindra Holla, Country Manager, Axis Communications informs, “Security is a big concern for hospitals as it is accessible to the public. Healthcare industry is being attacked by unauthorised intruders, cyber criminals and others. This industry is facing challenges in protecting the privacy of their patients and securing their infrastructure. Therefore the industry should opt for integrated security solutions that will be easy to maintain. This will allow the management to monitor and address specific areas of concern. ” “The healthcare sector looks for surveillance solutions, which can give them a 360° view. Hence, the approach towards surveillance has changed from analog to digital surveillance. Health industry has also adopted this change. This has added benefits to the healthcare industry and also helps in remote monitoring and robust storage capabilities,” he states. Col Sharma also says that the realisation of the need for a safe

and secure environment in healthcare has gained ground, leading to change in perception towards safety and security. “Healthcare providers understand the importance of patient and their relatives’ healthcare experience during the time of medical emergencies or services. However, the providers also understand the sensitivity of the healthcare environment and therefore focus more on prevention and fast resolution to ensure a safe and peaceful environment. This requires robust and optimal processes and constant periodic trainings of staff and review of processes and incidents to optimise processes. Top managements are seized by the importance of safety and security. Therefore, they are intimately involved in ensuring safety and security, infra up-

and statutory requirements immediately and guarantee long term sustainability. N Santhanam, CEO, Breach Candy Hospital Trust informs, “It is approximately fours years since MSSG has been associated with us and there is a marked improvement in our physical security posture and fire safety. The focus has been on prevention rather than responding and MSSG team has duly supported us in the planning and implementation of the accepted plans.” Thus, a proactive approach towards safety and security would indeed be an important step towards becoming a smart hospital.

Emphasis on energy efficiency Energy efficiency is another

ergy efficient building envelope real time monitoring and control of energy and environment parameters, 100 per cent waste water treatment and re-use as well as 100 per cent rainwater harvesting and 100 per cent organic waste composting onsite. Being smart would definitely include taking a leaf out these hospitals’ strategy and opting for similar tactics to become energy efficient. A lot of innovations in several other spheres like lighting, modular operation theatres, space management and even CSSD can be implemented for optimal results. For instance, as Aditya Sinh Jhala, Director, Gourangaa Consulting a company offering CSSD and laundry solutions informs, “The idea of a centralised laundry can reduce operating costs at a very large

It is evident that the healthcare industry has woken up to the fact that it is time to discard outdated approaches towards healthcare delivery and adopt new-age ideas to improve and enhance healthcare delivery grades, process optimisation and staff trainings to achieve and improve upon the patient healthcare experience,” he adds. Giving an insight on the offerings by his company, he says, “MSSG ensures that the technology component of physical security is open source and therefore future ready for integration in any smart hospital solution, as and when undertaken. MSSG IT Security services ensure data security by recommending adoption of best IT security practices to achieve patient and medical data security. The integrated services of physical security and IT security create a safe infrastructure environment for efficient and optimal medical services delivery.” Breach Candy Hospital, Mumbai chose to opt for MSSG’s solutions. MSSG was given the role of planning, designing and implementing a risk mitigation strategy for fire safety and security within the existing set-up. The approach had to include the compliance

aspect which would be crucial in the making of a smart hospital. Hence, many healthcare set-ups like Ruby Hall Clinic, Wanowrie in Pune and Kohinoor Hospital, Mumbai have opted to be 'green hospitals'. Both are LEED certified hospitals for their measures in energy conservation. Kohinoor Hospital has a LEED Platinum Rating, the highest under LEED India Green Building Rating System. It endorses a wholebuilding approach to sustainability and has implemented an array of energy efficient measures to decrease energy consumption, lessen greenhouse gas emissions and enhance the quality of patient care. Ruby Hall, Wanowarie has received a Gold rating by the IGBC focused on 42 specific actions in the areas of sustainable sites, water efficiency, energy and atmosphere, materials and resources, indoor air quality and innovation in design to get a gold rating. Reportedly, the hospital uses ecologically friendly building materials, en-

scale for many hospital operators. The idea is to create a centralised plant that is not physically attached to any hospital but is a separate location and will have the capacity to serve large number of hospitals . It will be mutually advantageous for facilities to work together in creating such laundry plants to reduce their costs and increase efficiency.” So, it is evident that the healthcare industry has woken up to the fact that it is time to discard outdated approaches towards healthcare delivery and adopt new-age ideas to improve and enhance healthcare delivery with optimal utilisation of the available resources. Santhanam informs, “We have identified technology and technology infrastructure as the priority area to be addressed to establish seamless communication and access to information. In the first phase we have identified IT infra upgrade as the priority area. We have already initiated the process of upgradation

and hope to be future ready by 2016. In parallel, we plan to integrate our services data to enable addressing of individual needs of patients by various platform independent of location i.e. in or out of hospital premises. Security of patient data is also of paramount importance and will be given due priority and investment.”

A long way to go Thus, looking at the changing attitudes and the slew of measures being introduced, is it safe to deduce that the concept of ‘smart hospitals’ is fast growing in India? Are the Indian hospitals transfiguring into smart ones? Pillai doesn't think so. He opines, “The focus is to approach being 'smart' with a rather disintegrated approach. There are hospitals that will put in smart panels in patient rooms, a kiosk here and a wi-fi there. The roll out of these technologies is rarely the outcome of a well thought strategic initiative. The ones that do so focus on driving operational efficiency and reducing costs. Patient experience due to the demand exceeds supply paradigm is at best seen as an aesthetic add on which enhances 'marketability' of the hospital and at worst given the short shrift. The other two dimensions of employee and innovation do not seem to figure currently in the larger scheme of things.” He adds, “Indian healthcare has just commenced on its journey to be smart. To that extent, they all have some way to go yet. Having said that there are hospitals who have invested considerably in the path of being ‘smart’, examples like Fortis, Apollo come to mind.” Chowdhury has a similar view to offer. He says, “The smart hospital concept is being adopted by some hospital chains but not in totality. The healthcare industry is progressing slowly but steadily.” Yet, the concept has definitely taken root in the healthcare scenario and healthcare providers have been taking several steps to implement measures which would lead towards making them smart. The journey has begun. It is only a matter of time before reaching the destination. lakshmipriya.nair@expressindia.com

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July 2015

HOSPITAL INFRA CASE STUDY

Efficient, effective and affordable healthcare with HP solution

M LAKSHMI NARAYAN RAO Country Leader – HP Future Cities, CTO – Technology Services, HP India

M Lakshmi Narayan Rao, Country Leader – HP Future Cities, CTO – Technology Services, HP India elaborates on how HP’s eHealth Care Center addresses the health needs in India

THE HEALTH of a nation is judged by the health of its citizens. Great nations have been built on the framework of exemplary citizen healthcare. Healthy citizens form the core of a vibrant prosperous city that grows constantly and spurs the economy of the nation. The challenges of providing effective healthcare to citizens is a common one across the world, particularly in developing nations and India is no exception. Inorganic growth of new cities has exacerbated the problem due to the vast influx of migrant populace that arrive looking for better opportunities and better life. There is a need for mass rapid deployment of healthcare infrastructure that is effective, efficient and is responsive to the needs of the citizens at point of need. This gap needs to be addressed as it falls in the ambit of basic necessities of citizens. Skill and scale are of essence in this healthcare prerogative.

HP eHealth Care Solution The solution called HP eHC eHealth Center initiative is a disruptive innovation that combines the best of health and IT domains. By providing

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July 2015

underserved populations with access to quality, affordable healthcare, the initiative plays a critical role in contributing to healthy, vibrant communities and spurring economic growth. The solution is envisaged to assist government efforts to maintain and expand local and national healthcare initiatives. Designed and developed in India, the eHC solution reportedly combines the values of several current technologies. ◗ Cloud technologies for re-

mote access and ubiquitous delivery ◗ Mobility for pervasive access ◗ Big Data for real time, purpose-built analytics ◗ Dashboards for real time data representation and trending analysis. The HP eHC (E-Health Care) solution is built on a framework that leverages leading concurrent technologies to provide the best of healthcare infrastructure at affordable costs to citizens. It is simple, easy to deploy and

can scale rapidly.

Key outcomes

Delivering 21 st -century healthcare to underserved populations: The eHealth Center initiative is transforming public healthcare access in resource-poor locations. Designed to fit in a standard shipping container or pre-existing clinic, the eHealth Centers are fully equipped with essential medical diagnostic equipment, HP workstations, and cloud-enabled technology, and then placed in com-

munities where people live without access to clinics, electricity, or the Internet. Now people who may not otherwise have access to basic medical services are able to receive quality preventive care from trained nurses and healthcare workers for themselves and their families, as well as proper medical assistance for serious, life-threatening illnesses. Leveraging the power of the cloud to transform access to quality, affordable

HOSPITAL INFRA healthcare: The eHealth Center initiative showcases the ability of HP cloud-enabled technology solutions to increase the accessibility, quality, and efficiency of healthcare provisioning around the world. The fully functional mobile facilities are quickly and cost-effectively customised with HP workstations equipped with software networking capabilities, an open and accessible web-based electronic medical records system, and essential diagnostic equipment integrated into the cloud. These cloud-enabled technologies provide the tools necessary for on-site staff to perform routine diagnostic tests, and make the results available online so that physicians hundreds of miles away can provide a remote diagnosis, reducing the need for highly skilled medics on-site. Assisting governments with community-wide health monitoring and management: The eHealth Center initiative provides the tools and technology governments need to collect, track, and analyse big data—such as disease patterns and risk factors—to facilitate real-time disease surveillance. Governments can also use this highly secure, protected patient health information to analyse for patterns and trends, and develop healthcare policies and programs to benefit the entire community. By doing so, governments are able to bring quality healthcare to people living in resource poor locations—a critical contributor to building healthy, vibrant communities and strengthening local economies. The initiative provides the tools and technology that government entities and communities need to proactively mitigate the threat of an epidemic with real-time disease surveillance. It also helps policy makers understand the big picture from aggregated health data so they can better shape future healthcare policies

Ensuring efficiencies The role of the paramedics at site is a very crucial one is ensuring a smooth, efficient and

effective operation. Bearing in mind the importance of this aspect, HP has designed an online training system that ensures that paramedics are trained on technology usage skills, domain skills and softskills to help them do their jobs better. Using technologies and tools such as the award winning HP VideoBook that provides video-based learning and on-line assessment, the training module forms a critical cog in running the entire

eHC operations smoothly.

Mobile health workers To enhance the reach of the eHC, HP has designed the Mobile eHC unit that provides similar care to citizens who are in far flung remote areas or are immobile. The Kit is highly portable and works in conjunction with a tablet computer and is capabkle of working off-line via Blue tooth LTE/USB connectivity. The data thereafter is automatically uploaded to the health

cloud. This ensures an integrated approach and a system that is unified and free of human errors.

Analytics and dashboard The initiative provides the tools and technology that government entities and communities need to proactively mitigate the threat of an epidemic with real-time disease surveillance. It also helps policy makers understand the big picture from aggregated health data

so they can better shape future healthcare policies. ◗ Analytics for healthcare policy formulation ◗ Early epidemic detection ◗ Preventive healthcare and intervention ◗ Disease surveillance in real time Thus the solution from HP leverages the best of developments in the healthcare domain and IT technologies to addresses the varying health needs of Indian cities, towns and villages effectively.

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July 2015

HOSPITAL INFRA

Medicall gets bigger th and better in its 13 edition In its 13th edition, Medicall has become a truly international show, with over 600 exhibitors expected from more than 20 countries and professional visitors exceeding 11,000

edicall, reportedly India’s largest B2B medical exposition is organised by Medexpert Business Consultants, promoted by Dr Manivannan, Joint MD of Kauvery hospital a 750-bedded Hospital group in South India. Early in his career, he identified that nursing homes, small clinics and hospitals in tier II and III cities faced a distinct disadvantage in the market while procuring consumables and equipment for their business. They neither had the choice nor the price advantage enjoyed by the biggies. While talking about the motivation behind starting this show, Dr Manivannan says, "Small and medium sized hospital owners from tier II and III cities cannot afford to have qualified purchase managers. Equipment companies also do not have adequate sales force to meet all these hospital owners. Since I have undergone the difficulty for my hospital, I thought Medicall will bring in all equipment manufacturers under one roof." Medicall serves as a marketing platform wherein the equipment companies showcase their products to hospital owners and decision makers. Thus, Medicall was born. Medicall is a pocket edition of Medica, Düsseldorf. Its shows are held at Chennai, Mumbai, Delhi, Ahmedabad, Kolkata and Colombo.

Rise over the years 2006: The first Medicall exhi-

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Medicall provides a cost effective and accessible opportunity for healthcare entrepreneurs, management professionals and physicians of India, as compared to a visit to Dusseldorf or Dubai, with more relevant group of products and services bition was introduced as a small medical equipment expo and was hosted at Chennai. It was very well received by the industry and there were more than 100 exhibitors and 3000 visitors. 2007: Medicall 2007 was bigger and better than its first edition. There were more exhibitors and visitors at the event. 2008: The third edition of Medicall attracted 5,400 visitors from across the country. Apart from hospital owners, hospital administrators, and people from other segments like dealers, architects, hospital consultancy, nurses, and biomedical engineers, exhibitors dealing with hospital flooring, lighting, energy saving equipment, storage solutions, ambulance fabricators, etc., also participated for the first time in this show. 2009: With more than 5700 visitors attending Medicall 2009, the expo bridged the gap between the buyers and users and managed to bring them together on one single platform. In this

three-day expo, more than 250 exhibitors from all over India and China displayed their latest equipment. Medicall became a pan-India event than just a regional expo in Chennai. 2010: Availability of unique products, choice of products, international exhibitors were the USPs of Medicall 2010. It was bigger and more incisive in terms of content and participation. International participation increased and over 400 exhibitors from China, Germany, Taiwan, England and India displayed their latest medical equipment. It grew to become India's largest and Asia's third largest medical equipment expo. 2011: Around 7500 visitors from India and other countries like Sri Lanka, Nigeria, Nepal, and Taiwan visited the three day show. The Healthcare Innovation Awards, instituted for first time in this edition of Medicall, attracted several applications from across the country. More than 430 exhibitors from India, Germany, China, Taiwan,

Korea, Japan and Iran participated in the show and displayed A-Z requirement of hospitals. 2012: Medicall 2012 was again a year to remember with huge participation from healthcare industry experts and professionals as well as several new and innovative segments like fashion show on hospital garments and “Hospital Property Mela”. Over 500 companies exhibited at Medicall. It also saw an increase in exhibit space. Representatives from Germany, China, Taiwan, South Korea, Pakistan, Malaysia and more participated in Medicall events that year. 2013: With 530 exhibitors and more than 10500 visitors, Medicall 2013 grew in terms of quality and quantity. BrainStormMedicall conferences attracted more than 850 delegates with eight parallel thematic healthcare conferences. 2014: Medicall 2014 involved approximately 630 companies from across the globe who participated in the exhibition. Most of the

exhibitors substantially increased the size of their stall and showcased more products during the threeday exhibition. It was a true bazaar for hospital equipment and supplies, ranging from surgical gloves to the most sophisticated medical equipment used worldwide.

Highlights of Medicall 2015

In its 13 th edition, Medicall has become a truly international show, with over 600 exhibitors from more than 20 countries and professional visitors exceeding 11,000. The international pavilions will include Bavaria, Germany, China, Taiwan, Malaysia, South Korea, Portugal, Italy, UK, US, Indonesia, and Nigeria Exhibitors profile include: ◗ Building automation and facility management ◗ Consumables ◗ Electrical and lighting solutions ◗ Endoscopy equipment ◗ Healthcare consultants ◗ Healthcare IT solutions ◗ Hospital beds, furniture and floorings ◗ Housekeeping solutions ◗ HVAC and medical gas ◗ Implants ◗ IVD equipment ◗ Laboratory equipment ◗ Laundry equipment ◗ Life support systems ◗ Mannequins and teaching equipment ◗ Medical disposables ◗ OT and ICU equipment ◗ Patient monitoring systems

HOSPITAL INFRA ◗ Physiotherapy and orthopaedics Radiology equipment ◗ Recycling and hospital waste management ◗ Refurbished equipment ◗ Rehabilitation products ◗ Sterilisers ◗ Surgical instruments ◗ Telemedicine ◗ Wound care products

A must attend event Come August, the medical fraternity embarks on its journey to Chennai, the ‘Mecca’ of the medical legion. It is a perfect getaway to meet one's peers, to compare and choose equipment and best of all to refresh the knowledge base in the intellectually stimulating BrainStorm Medicall. A favourite with many international prod-

The show stoppers of Medicall are its seminars and workshops. Much care is put into this section to ensure they are not didactic and uni-directional but highly interactive and responsive.The healthcare intelligentsia at BrainStorm Medicall dishes out nuggets of wisdom in a nutshell. At Medicall, medicine meets management uct companies, they visit Medicall to widen their dealer and distributor base. Diversity is a given in this expo. Medicall provides a cost effective and accessible opportunity for healthcare entrepreneurs, management professionals and physicians of India, as compared to a visit

to Dusseldorf or Dubai, with a more relevant group of products and services.

Brainstorm Medicall workshops and seminars The show stoppers of Medicall are its seminars and workshops. Much care is put into this section to ensure

they are not didactic and unidirectional but highly interactive and responsive. The healthcare intelligentsia at BrainStorm Medicall dishes out nuggets of wisdom in a nutshell. At Medicall, medicine meets management. A wide range of topics have

been discussed over the years. Topics ranging from costing of hospitals to succession planning, lean six sigma and HR in hospitals. Close to 12,000 footfalls are expected. The profile of visitors will include: ◗ Doctors ◗ Hospital Owners ◗ Hospital Administrators and various stake-holders ◗ Diagnostic Laboratory Owners ◗ Pathologists ◗ CEOs ◗ Dealers & Distributors ◗ Manufacturers ◗ Importers ◗ Purchase Managers ◗ Bio-Medical Engineers ◗ Academicians ◗ Para Medical staff ◗ Consultants.

TOPICS PLANNED FOR MEDICALL 2015 Seminar Title

Date

Timing

Cost

Description

Costing for hospitals

Friday,July 31, 2015

10 am to 1 pm

Rs 500

Rising healthcare cost is a major problem both for the hospitals and the patients. Entry of Government sponsored insurance schemes and CGHS has forced the hospitals to cut down the insurance package prices dramatically. Rationalisation of costs is essential for survival of many small and medium hospitals. Successful ones are those who understand this and manage their costs. Doctors are uncomfortable with numbers.This seminar breaks the ice and makes medical professionals number savvy and financially literate

Workshop on NABH Pre Accreditation entry level for Hospitals

Friday,July 31, 2015

10 am to 1 pm

Rs 500

Workshop on NABH pre accreditation entry level for ospitals

Succession planning

Saturday,August 1, 2015

10 am to 1 pm

Rs 500

Family owned and closely held hospitals must compulsorily attend this seminar. Corporatisation and professionalisation of healthcare management makes succession planning a sine qua non.With more children of physicians opting out of medical profession even small clinics need to plan on passing the baton.A step-by-step lay person walk through of succession planning will keep you glued to the seminar.

Lean Six Sigma

Saturday,August 1 2015

2 pm to 5 pm

Rs 500

The world has embraced Lean Six Sigma in every industry but India is lagging behind in almost all industries, most notably the healthcare industry. Lean practices helps in reducing wastages inside the hospital and six sigma practices help in reducing errors. Leading practitioners and industry experts will talk about the benefits, methodology and adoption techniques.

HR in Hospitals

Sunday,August 2 2015

10 am to 1 pm

Rs 500

Acute shortage of manpower is the bane of the hospital industry. Sourcing, selecting, hiring, training, grooming the leaders and the led will be discussed in great detail. Most significantly interesting inputs will be shared on retaining talent and reducing attrition. Hospitals must understand the aspirations of the young and focus on talent transformation to attract the very best.

IT :Workshop in Social Media, SEO and Mobile Apps for Healthcare

Sunday,August 2, 2015

10 am to 1 pm

Rs 750

E-commerce has become pervasive. Everything is happening online and mobile applications are ubiquitous. Digital hospitals which have adapted to ecommerce and mobile applications have enhanced customer satisfaction and profitability.The workshop will impart skills on how to use social media effectively : Facebook, LinkedIn ,Twitter and also how to get the best out of SEO, mobile apps and popular applications like Gmail , Skype etc.

EXPRESS HEALTHCARE

July 2015

HOSPITAL INFRA

Akhand Enterprises: One-stop shop for servicing medical equipment Akhand services and repairs a large variety of medical and laboratory equipment

hether in a bustling emergency room or a secure medical laboratory, the medical equipment used in a hospital can help save lives. This is why the sensitive medical equipment must work at all times. If a system is down for even a minute, it can mean huge risks. This thought, Jatinder Pal Singh and Mohanjit Singh paved the way for Akhand Enterprises. They felt the need for a one stop shop to service and repair of all emergency medical equipment. In the year 2006, they ventured out on their own with Akhand Enterprises which provides sale, service, repair and maintenance solutions in the fields of: ◗ Cardiology ◗ Critical care ◗ Anesthesiology ◗ Emergency and OT equipment ◗ Ambulance equipment ◗ Medical accessories and batteries “Akhand sells and repairs all

Jatinder Pal Singh and Mohanjit Singh

types of ECG machines, foetal monitors, ultrasound machines, anaesthesia machines, cardiac monitoring systems, colour doppler, CT scan, MRI, C-arm, defibrillators, syringe pump, pulse oximeter and their accessories. Our working territory is Delhi-NCR, Haryana, Punjab, Jammu, Rajasthan, Gujarat, Lucknow, UP and other states. Our mission is to be a call away for any medical equipment repair anytime anywhere,” says Singh. Akhand services and repairs

a large variety of medical and laboratory equipment. “Our biomedical technicians are experienced and factory trained. We provide quick repair turnaround time and warranty our workmanship. Our service repairs are performed by qualified and certified technicians. Our company prides itself in the quality and honesty of our work practices. We strive to provide a quick turn–around times and customer satisfaction,” says the young entrepreneur. Akhand has a state-of-the-

art workstation with most modern test and service equipment and other facilities along with a pool of qualified trained technicians ready to take the plunge for the fastest and convenient service. Akhand has displayed outstanding service and results in cases where the product's respective companies have pull their hands in the matter of cost effective repairing. As the reward, the best hospitals and nursing homes are Akhand’s loyal clients in Delhi and other cities. The technical and educated staffs are always dedicated to provide their best services to fulfill the customer’s satisfaction. Akhand is a specialist in the repair of medical equipment and surgical instruments that meet the exacting requirements of the healthcare industry professionals and medical service practitioners. The company offers a comprehensive range of technical advisory and repair services and prides itself on its high standards of workmanship and exemplary ongoing and

after-sales service. Key features: ◗ India's most popular medical equipment company, for service and support ◗ Major installations for medical equipment in the private and public sector ◗ Service backup of qualified and trained service engineers ◗ Team of qualified and talented engineers ◗ Provides online services for all 24 hours and 365 days ◗ Undertakes AMCs and CMCs of life saving medical equipment ◗ Upgrades itself for awareness of new technologies ◗ Professional, trained service engineers Akhand Enterprises is also actively engaged in advanced research and development studies and soon plans to introduce new products under the company banner. Akhand Enterprises aims to become the most admired Indian medical company through service, repair manufacturing, wide-ranging product solutions and world class customer service support.

The latest healthcare IT solutions and key challenges in Indian healthcare systems EHR system is the one piece of health technology that has received more attention than any other over the past several years THE LATEST solutions introduced in the market for managing hospital operations: One of the latest emerging solution is Web based HIS to

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July 2014

manage hospital operations. It can be hosted on cloud. The benefit of web based HIS is that it allows the application to run on multiple servers and at vari-

ous locations suitable for chains of hospitals, clinics, diagnostic centres and pharmacy. It’s designed is based on service-oriented architecture

(SOA) allowing applications to bind to services that evolve and improve over time without requiring modification to the applications that consume them.

EHR system is the one piece of health technology that has received more attention than any other over the past several years. Now days in India de-

HOSPITAL INFRA mand of EHR is increasing rapidly. Various renowned hospitals like Aster Medcity (Cochin), Apollo Hospital (Dhaka),Shanti hospital (Bangalore), BLK Hospital (Delhi) etc. are using EHR developed by Akhil Systems and we handle enquires almost every day. Over the past several years, the omnipresence of smart phones, tablets and their applications has been one of the biggest cultural shifts in the hospital setting, as well as society at large. Doctors nowadays are preferring tablets for maintaining their patient records, it’s also being used for surgeries. The iPad, which has almost become a default tablet, has countless popular apps for physicians and executives, ranging from medical calculators and medical Spanish to clinical presentations and actual EHRs. Patient portal is an online

Over the past several years, the omnipresence of smart phones, tablets and their applications has been one of the biggest cultural shifts in the hospital setting, as well as society at large. Doctors nowadays are preferring tablets for maintaining their patient records, it’s also being used for surgeries tool for patients is also one of the latest technologies now available in market. Through this patient can get online test results, access their clinical records etc. Key challenges in integrating IT into the Indian health care system: ◗ Lack of standards in Healthcare IT due to varied functionality requirements in hospital to hospital ◗ Lack of in-house IT domain

knowledge ◗ Integration and cost effectiveness ◗ Reluctance of medical, nursing and other staff to adjust to change ◗ More reliability on paper based systems ◗ Lack of proper vendor support ◗ Akhil Systems has faced almost all of the above challenges in past two decade’s enriched experience in healthcare only.

It has tackled these challenges in very effective manner. For example; there is lack of standardisation in healthcare IT but through 20 years of experience, the company has almost included all the technical and functional requirements learning from the hospitals (especially in India) itself and above all the company’s solution is so flexible that it can provide customisation as much as possible as per hospital re-

quirement. Akhil also provides champion training to hospital IT staff to master the application. Till date, it provides almost all major integrations through HL7 compliance. It prepares a plan in such a manner that would enable it to be implemented in a very short period as much as possible and in an effective way, which provides cost effectiveness. Akhil also trains and educates hospital staff to get used to the system as much as possible and they learn easily as well from the most user friendly interface. This slowly changes the mentality of using paper based systems as they realise the benefits of using the system. Even doctors are also started using EMR in various hospitals in India and other countries. And for support it provides dedicated team to tackle support issue 24x7 to give the best support throughout.

Enhancing healthcare with Rossmax International The company offers diagnostic products in the fields of fitness, obesity, hypertension, inhalation, fever and hot-cold-pain therapy ROSSMAX INTERNATIONAL manufactures and sells medical and home healthcare products worldwide. It offers diagnostic products in the fields of fitness, obesity, hypertension, inhalation, fever, and hot-cold-pain therapy. The company provides monitor products for walking, fitting, and jogging activities; body fat monitors and obesity products. It also offers monitoring products for hypertension, such as sphygmomanometer, wrist watches, stethoscopes, calibration managers, manager software, upper arm automatic and semi-automatic

products, and accessories; and infrared ear, digital, and noncontact thermometers, as well as portable thermometer calibration products for fever. In addition, the company provides infrared heating wraps for ankles, elbows, foot, knees, shoulders, thighs, waists, and wrists; and mesh and piston nebulisers and nebuliser testers, as well as blood pressure monitors. Rossmax International was founded in 1988 and is based in Taipei, Taiwan. The company has branches all across the world like Switzerland, Japan, China, India and the Americas.

“Our business fields are prevention, monitoring, therapy. Our product and service portfolio consists of diagnostic products in the field of fitness, obesity, hypertension, inhalation, fever as well as hot and pain therapy. Our products are distributed in more than 50 countries and are clinically validated and approved based on latest quality standards. With the only fully integrated factory in the industry, we pride ourselves on world class manufacturing capabilities and end-to-end process controls,” says Aashish Zutshi, Director

Aashish Zutshi, Director Rossmax International

Rossmax International (Indian subcontinent market). From pioneering research and product development to highly efficient manufacturing, shipping and logistics, operational excellence is a crucial key to the success. Above all, accuracy, safety, stability and reliability of blood pressure monitors reflect upon the value of a brand. Both customers and consumers alike must be comfortable with the product selected. All Rossmax products are CE certified and vigorously tested and clinically validated before reaching customers.

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July 2014

HOSPITAL INFRA

HMD launches Cathy Safety IV Cannula with SIP CLIP Invested over Rs 100 crores for setting up new plant for manufacturing next generation safety infusion IV cannulas (catheters)

industan Syringes and Medical Devices (HMD), manufacturer of SMART (auto disable) syringes, has launched the next generation Cathy Safety IV Cannula with SIP CLIP, for preventing needle stick injuries. According to WHO, if safety cannula are made mandatory in hospitals, then around 80 per cent of all hospital staff can be saved from needle stick injuries. HMD invested over Rs 100 crores in setting up of a new manufacturing facility at Ballabhgarh, to manufacture the next generation ‘Safety IV Cannula with SIP CLIP’. The new plant is spread on an area of 5.5 acres and will have the capacity to initially produce 36 million units of ‘Safety IVCannula’ to meet the rising export demand to Europe which is expected to be around over 50 per cent and balance for domestic demand for its new revolutionary technology, designed to prevent needle-stick injuries which is very common among health workers and nursing staff. According to Rajiv Nath, Joint MD of Hindustan Syringes and Medical Devices (HMD), “We are particularly excited about the prospects of our latest offering ‘Safety IV Cannula with this Sharps Injury Prevention SIP Clip’, which will certainly boost our export profile. We soon will be exporting this product to more than 20 countries by 2017. We have already shipped over 1.5 million I.V Cannulas to Scandinavia re-

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If safety cannula are made mandatory in hospitals, then around 80 per cent of all hospital staff can be saved from needle stick injuries- WHO

cently and have received excellent feedback and clinical acceptance. For one, this patented design greatly minimises the chances of needle stick injury to a nurse after she attaches a IV Catheter and removed the blood infected needle from a patient which results in numerous unfortunate infections and even deaths, particularly in developing countries like India. Most of these accidents are not reported. This product will greatly enhance health safety of our hospital staff and health workers and they deserve this protection. Our next generation cannula is designed to help bring down substantially the overall cost resulting from treatment of diseases like Hepatitis and

HIV due to needle stick injuries and resultant nosocomial infections but also address the stigma against treatment of HIV patients,” added Nath. He expressed hope and optimism that government will make use of indigenous ready availability of ‘Safety Cannula’ and make it mandatory for treatment of people especially those affected with serious blood borne infections like Hepatitis and HIV. Some of the innovative features of Cathy+Safety IV Cannula with SIP CLIP include: ◗ Automatic passive safety ◗ SIP - Sharps Injury Prevention. ◗Injection molded in one piece – cost advantage

◗ The first needle protection device in a pure polymer, which is integrated inside the catheter adapter ◗ Safe, simple and customer – friendly ◗ Ease of insertion without peel back ◗ Minimal trauma ◗ Ultra sharp, ultra polished needles ◗ Electro polished and backcut point It may be pointed that needle-stick injuries are common among healthcare staff and workers. Nurses are the largest single victim group, and have high rates of injury. According to WHO, 80 per cent of all hospital staff have personally experienced needle stick injuries. There are two million reported needle

stick injuries per EU and US, plus more than 1 million unreported injuries. Out of 35 million heathcare workers nearly 10 per cent receive percutaneous exposure to blood borne pathogens like Hepatitis and HIV annually and 90 per cent of these accidents occur in developing countries. Needle stick injuries also result in high financial and human costs and cause considerable distress to nurses and doctors. To mitigate the risks, within EU, safety devices are mandatory as of May 11, 2013 (EU Council Directive 2010/32 of May 10, 2010) and US passed the Needle Stick Safety and Prevention Act (NSPA) in 2000. India is yet to bring in policy or legislation on this.

HOSPITAL INFRA

Inventions for a better environment from ASCO ASCO is ready to launch its new range of orthopaedic power tools under their banner Starlite Power Tools

pothecaries Sundries Manufacturing Company is a leading provider of quality medical and hospital equipment to doctors, hospitals, and health service agencies worldwide. The company, simply known as ASCO in the global market, manufactures and markets a wide variety of high quality hospital equipment. The brand has gained recognition worldwide as a high quality premier brand, and, in recent years, has made its mark into the European marketplace where it continues to be recognised for its exceptional quality. ASCO, has been in the field of supplying quality surgical/hospital appliances and allied products for almost six decades now. It is also credited with setting the benchmark of excellence in quality, R&D and customer service. ASCO is a Government of India recognised Star Export House. The company has various accreditation and international certifications including ISO9001, ISO13485, GMP, CE, FDA (India) approval. The company was founded in the year 1948 by HR Narang who had a vision to create a premier surgical instrument manufacturer in India. It’s his single minded devotion to work, vast knowledge and insight that went on leading the organisation until 'ASCO' became a known name worldwide for quality medical and hospital equipment. Today, the company managed by the next generations of family members has grown tremendously in

tion, enabling effective placement and minimising trauma to surrounding structures and soft tissue, and rigid support for fracture healing. This will result in faster healing time, improved patient recovery, and greater patient satisfaction. The doctor’s demand of high power, autoclavability, flexibility and convenience to use have been considered while designing these products.

various medical fields and markets. Today, the ASCO brand is associated with trust, quality and dependability. “We are proud of our relationships with the hospitals and medical practitioners across the world. We believe that a successful surgery cannot be accomplished without the right hands and right tools. ASCO instruments are trusted by thousands of doctors around the globe,” says Aseem Narang, young entrepreneur and the International Marketing Director of ASCO. “Medical science has made significant progress in research, disease treatment and improvement in overall quality of cure in the last few decades and today more help is avail-

able to cure ailments. ASCO strives hard, not only to keep pace with the advancement in medical technology but also to contribute to the growth of the field by focusing on innovation. The company also keeps a control on the product cost so that high quality equipment are offered at affordable prices for the benefit of many,” says Narang. Today, ASCO is ready to launch its new range of orthopaedic power tools under their banner 'Starlite Power Tools'. The products include: ◗ Bone Drill ◗ Acetabular Bone Drill ◗ Oscillating Saw ◗ Cannulated Drill ◗ Cranial Drill ◗ Cranial Mill

◗ Sternum Saw ◗ Plaster Saw The new orthopaedic power tools are fracture fixation and correction devices that will allow orthopaedic surgeons to quickly and easily repair bones with difficult geometries. Today’s generation demand a greater need for operative treatments to repair fractures and return patients to work and activity sooner. Traditional treatments for fractures, in particular, have had mixed results and long recuperative periods. 'Starlite Power Tools' uses technology which can be used in least-invasive surgical procedures to provide fixation for fractures at the core of the bone. The equipment provide flexibility for ease of inser-

The products of ASCO that are currently available or are soon to be launched in India are: ◗ Orthopaedic battery operated power tools ◗ External fixators ◗ Orthopaedic Implants ◗ Orthopaedic Instruments Innovation echoes in every brick of ASCO and it is the foundation on which new types of surgical instruments and implants are designed and manufactured that will help medical professionals across the world to act with more precision, thereby serving the community better. The hallmark for the success of ASCO has been the persistent efforts taken to understand the needs of the surgeons and focus on research and development to provide better solutions. ASCO has a record of accomplishment for bringing innovative medical products to the market that provide prominent clinical solutions for patients and allow them to resume a healthier life. The company endeavours towards building a healthier world.

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July 2015

STRATEGY

TAKING

ABIG LEAP Sagar Healthcare and Diagnostics unveils expansion plans, looks to roll out new venture next year M NEELAM KACHHAP

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July 2015

rivate healthcare landscape in India is dotted with family-owned businesses. Some of the most successful FOBs have successfully transited into tier I organisations and some even completed an IPO and became a PLC. Sagar Healthcare and Diagnostics, a prominent player based in Bengaluru is set to take it a step further by taking their business global. The big leap is going to happen by the end of December 2015, with new service offering spanning the GCC region where they already have a small presence. "We want Sagar Healthcare to be a responsible, ethical and research-based healthcare pro-

viding organisation that is appreciated at an international forum," says Dr D Premachandra Sagar, Vice-Chairman – Sagar Group who is at the helm of these changes. A resilient family owned business, Sagar Healthcare and Diagnostics is a part of the Sagar Group instituted by R Dayananda Sagar and Dr Chandramma Sagar that has interests in education, healthcare, hospitality, automobiles, technology and infrastructure. The group ventured into healthcare services in 1960 under the aegis of Dr. Chandramma Sagar with Chandramma Nursing Home. When the private healthcare wave hit India. Dr D Hemachandra Sagar, Chairman – Sagar Group

and Dr D Premachandra Sagar, Vice-Chairman – Sagar Group inked a pact with Apollo Hospitals Group to help establish a 250 bed hospital in Jayanagar, heart of Bengaluru. The hospital became functional in 2002. Within a few years they, gained enough confidence to go solo and moved forward without support from Apollo. "Apollo came as project manager and we became their franchise. In subsequent years, we gained sufficient expertise in managing and operating the hospital and we ended the partnership amicably," says Dr Sagar. It was around that time that they felt the need to be innovative and started work on the second hospital. The Sagar Hospital Banshankari is astate-of-the-art

415- bed multi-speciality hospital that came into existence in 2009. With 700 operational beds in Bengaluru, more than six clinics and a chain of pharmacies, Sagar Hospital was in good shape and looking to grow and conquer its share in the growing healthcare market.

The dream By 2008, the company had augmented a strategic plan to grow quickly and spread fast. They had identify low hanging fruit opportunities to drive transformation immediately. Accordingly, the company was to setup 300-bed secondary care hospital in Bengaluru and 200 bed tertiary care hospitals in Mysore, Hubli, Davangere, Shimoga and Mangalore in Kar-

nataka and in other parts of India at a project cost of about Rs 50 crores for each hospital. The Group had planned to set up a chain of 50 to 100 pharmacies and a chain of polyclinics in Bengaluru and other parts of Karnataka by the end of 2012. However, the economic slowdown crept up on the world by the end of 2008 and the company like many of its contemporaries put most of the plans on hold. "Global slowdown hampered our growth plans," shares Dr Sagar. "We took a step back to analyse the situation and realised that healthcare in India did not perform as expected. Healthcare investments does not give you that kind of yield. We realised that hospitals cannot be build

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STRATEGY

SAGAR HEALTHCARE AND DIAGNOSTICS PLANS TO SPEND RS 600 CRORES IN THE NEXT FIVE YEARS AS IT RENEWS FOCUS ON ITS HOSPITAL ARM AFTER A FIVE-YEAR INERTIA AND EXPANDS BUSINESS IN NEW TERRITORIES for profit generation alone but hospitals should be build as institutions delivering cuttingedge treatment along with research," says Dr Sagar. "We also did not want to go for private equity investments before we had consolidated our business," he adds.

The beginning of change This was the time that Dr Sagar brought Ishiqa Multani on board as Executive Vice-president, Strategy and Innovation and President, Sagar Healthcare, Overseas Projects in 2013. The first non-owner, nonmedico member to hold the title, Multani was tasked to introduce innovative operational strategies for improving operational efficiencies throughout the company. She had a Herculean task cut out in front of her. "Corporate restructuring at Sagar meant destroying old paradigms, creating an overall impact on the internal organisational culture, flow of authority, responsibility and information across the organisation,' reveals Multani. "As a first step, we had to put a conscious effort to restructure policies, programmes, processes and people. We had to do the de-layering of the pyramid to thin out the top, unproductive, highly paid layer. This ensured shorter and effective decision making," she adds. Business process re-engineering was another area that Multani worked on intensively. Hiring the right personnel for the right job can sometimes be very challenging, but extremely crucial in competitive environment. "We had to change our criteria to hire people for preparing the discharge summaries wherein they are required to have qualifications in

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Ishiqa Multani, Executive VP, Strategy and Innovation, and President, Sagar Healthcare, Overseas Projects

agement by objectives is encouraged among all key line managers and department heads. “We, together, set goals that are tangible, verifiable and measurable. These goals are revisited every month, and a checklist of expectations and achievements is maintained,” Multani says. She believes that management by walking around is the key to know the ground realities and take corrective actions on time. “I believe that all employees and customers likewise, have something to suggest, right or wrong, constructive or not, and we have to listen to them. To be an effective leader one has to know the unfiltered, real-time information that never reaches the formal environment of a board room.” she opinies.

Finding the best fit either medical transcription or a BSc degree as against the previous method wherein anyone who required a “patient care staff” job was hired and put on to do this work. This change worked in our favour as it meant lesser revisions, lesser turnaround time and higher patient satisfaction," shares Multani. "We also introduced a preadmission process, which is located in the OPD. This is for patients who opt for elective surgeries, and can undergo all the tests before getting admitted. This saves time for both the doctor and the patient. Likewise, there are a few other areas that were looked in the and improved in a similar fashion by putting benchmarks in place," she adds.

Playing on strengths Leveraging her global management skills ( a management de-

gree from Exeter university and a PR firm in UK), Multani set about to rework the management style that is the hallmark of FOB hospitals in India. “Every organisation, and every leader has a different style of management. For me, it was very important to engage each and everyone in the organisation. One size fits all cannot be applied in this case, hence, I have a participative management style with my fellow colleagues, and a few other key personnel across the organisation. It is ensured that they are all motivated and told the true worth of their knowledge and skills, which they have to exploit to facilitate a strong, efficient, operational environment. This, I feel, has given us better output from the same people. We never changed heads just because we saw lesser productivity earlie,.” she informs. At Sagar Healthcare, man-

New management also meant new growth plans. Since, Sagar Healthcare was a family-owned business they were wary of outside investors. "Being a conservative, family owned business, we believed in organic growth for all these years," says Dr Sagar. However, today he seems ready for the inorganic route, having studied the market and its potential. He is betting big on the new territories and innovative healthcare delivery model. "We are looking at various strategic mixes to grow in times to come. M&A, strategic alliances, franchising are now considered by the group, which wasn't the case earlier," he adds. Dr Sagar further says, “The company is geared for growth because we are a debtfree facility so we have access to capital. We are equipped to handle the phase of growth and bring in growth capital.” Sagar Healthcare and

Diagnostics, a striking debt free healthcare company, plans to spend Rs 600 crores in the next five years, as it renews focus on its hospital arm after a five-year inertia, and expand business in new territories. “In the past 12 years we have invested Rs 500 crores in the company. Further, we plan to invest another 600 crores, combination of debt and equity in the next five years," Dr Sagar reveals. "The organisation has been cautious in its investments as we needed to figure out how to weather the current storm in the industry and still be wellpositioned to take advantage of the next upswing," says Multani. "The corporate assets are redeployed to look at expansion. Moving forward, we are looking at M&As, strategic alliances, and starting green field projects in the country and outside," she adds.

Setting a trajectory for growth "After slowdown we now have a new strategic plan which again entails expansions in Southern India,” says Dr Sagar. He believes that South is a good region because it compliments their larger tertiary care facilities. “We have to move. We need to focus on territorial expansion to drive business. So, NCR is a good bet as North has good prospects of growth. From there we can penetrate across India.” says Dr Sagar. After pondering some more he says new hospitals have to be started after a lot of due diligence. “It is not only about starting a facility but also understanding the gap analysis. In recent years, lots of facilities were flagged off. As a result, over capacity was created in one domain while there was lack of facility in

another region. So this is due diligence as far as strategic expansion is concerned.” he says. Sagar's next hospital will come up at Davangere by August next year. The hospital will have a capacity of 50 beds extendable to 100. A similar hospital will come up in Shimoga soon after. The hospital in Hubli is also on the cards. “We have commissioned one hospital in Davangere and Shimoga and the Hubli hospital is on the drawing board,” says Dr Sagar. The company is in talks with strategic partners to expand to key territories like the NCR. “We would announce strategic alliance to create 50 bed units pan India soon,” says Multani. The company also has plans to increase its polyclinic base in Bengaluru to 10 units by December 2015 and increase it to key locations across South India within the next two years. Over the next two years, Sagar Healthcare will focus on bringing its hospital, clinics and pharmacy projects on stream and consolidate the company. Recently, the company strategically re branded Chandama Nursing Home to Sagar ChandrammaHospital and upgraded the facility. The company is also in the middle of re-branding its polyclinics. “The polyclinics will be re-branded and new brand identities will roll out in next two months,” informed Multani. Dr Sagar said that the re branding will help support further growth aspirations by helping connect the company to new consumers. He said ,”It’s something that reinforces our consumer promise 'with you for life”.

Creating new markets Sagar Healthcare and Diagnostics, will be the first India based company to spread its wings in the Middle East and North Africa (MENA )region beyond token presence. The company currently operates two polyclinics in GCC region one in Oman and another at Dubai healthcare city. “GCC is a big market for us,” says Dr Sagar. “We currently operate in one location in UAE and Oman and we are working on increasing our presence there,” he adds. “We are in the process of

acquiring a few clinics there. We will complete five brownfield acquisitions by Dec 2015,” Multani adds. “We will have a chain of 10 polyclinics in UAE by June 2016,” she adds. “To become a comprehensive player with critical size, presence in certain strategic locations becomes important. But the most important challenge is to create a strategy that is innovative. That was our play when we started,” says Dr Sagar. Indeed, Sagar Hospital is one of the best examples of the first wave of innovation in hospital design in India. “We changed the look-and-feel of the hospital,” he says.

Conquering emerging markets The company has its sights set firmly on the planned launch of its polyclinics in GCC next year. “This will serve as a stepping stone to enter the African market, which is an emerging market,” says Dr Sagar. “There is a huge unmet need for healthcare delivery in Africa,” Dr Sagar says. “Consider this, in 2012, 47 per cent of Nigerians visited India for health reasons. Other countries like Kenya also sends patients to India,” he adds. “We see Africa as an area not only for engaging as a solution provider but creating jobs and bring abut a holistic development,” says Dr Sagar. “There has been growing political momentum in developing healthcare facilities in some African countries and we are actively participating, in those discussions,” Dr Sagar informs. On its investment plans for Africa, he said that Africa would be a “major growth engine for its business” in the coming years. “In the MENA region clinical facilities have to have lot more focus on primary and secondary care. However, overseas expansion will have to be done at a point where we need to understand the most important part is assimilation of human resources,” Dr Sagar states. No wonder then that the Sagar Medical College is to be rolled out simultaneously.

Pet project - academic medical centre Sagar Medical College is

Dr D Premachandra Sagar, Vice-Chairman – Sagar Group

Dr Sagar's pet project. He envisions a world class academic medical centre which not only provides clinical and hospital care but is also a leader in research and education. “When I talk about medical school I refer to a place where high level of intervention goes on. There are different group of people involved in medical schools who are able to do cutting edge research. This does not happen in India,” says Dr Sagar. “When you look elsewhere, say US and look at the big boys of healthcare, be it Cleveland Clinic, Mayo Clinic, Johns Hopkins they are all part of a university system. This is what I want to bring to India,” Dr Sagar says. “In future, a school of technology will have to partner with school of medicine to device frugal technology for healthcare. That is the only way forward,” says Dr Sagar. He also says that this can only

happen if there is an exponential change in attitude and mindset of the regulatory body. “As part of the Dayananda Sagar University we are working to create an environment where doctors and engineers work together to solve healthcare problems. Of course, there are regulatory challenges but India will have to wake up to the globalised education system and do away with archaic medical education system,” he says. The work on the medical school is already underway. Multani, who is also Advisor, Dayananda Sagar Institutions and Dayananda Sagar University, says, "Total investment for the new medical college is estimated around Rs 350 crores; out of which Phase 1 will see an investment of Rs 250 crores and Phase-II will have an additional investment of Rs 100 crores."

"There is no doubt that healthcare in India is comparable to the Western world. Having said this, young India needs to now look in to creating value in health IT, biomedical engineering, technical writing, research, management and complement healthcare industry. Dayananda Sagar University’s proposed medical college project has a vision that looks into creating such valued and innovative personnel who go on to enhance the overall worth of healthcare industry in India," points out Multani. Looking to reap full benefits of these investments from 2016-17 onwards, Dr Sagar said Sagar Healthcare will have a unique portfolio of globally competitive business with a new age, India-centric service with very high growth potential. mneelam.kachhap@expressindia.com

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STRATEGY

I N T E R V I E W

'There is still a huge untapped market for mental wellness services in India' ePsyClinic.com is a new concept for dealing with mental health problems. Shipra Dawar, Founder & CEO, ePsyClinic.com shares the concept behind her business model and plans for the company in India, with Raelene Kambli

What is your opinion about the mental health scenario in India? How well is it dealt? There is a staggering gap between the demand and supply of mental health services in India. There is an exceptionally high need for “an all acceptable, acountable and accessible” structured mental and emotional wellness (not illness management) service designed for today’s India and yet there is a near vacuum at the supply side. Today, over 50 per cent of all working people in India face chronic stress. Over 42 per cent people working in the private sector face depression or anxiety. India also has the maximum number of people who have suffered at least one major depressive episode. About 80 per cent of all Indians at least once go through a major life stressor that often throws them off-balance emotionally and leaves them in a prolonged state of unhappiness. Yet, less than five per cent of people facing these issues seek help. Apart from stigma, there are three supply side reasons for this. First and foremost, the providers of mental health care are speaking the language of symptoms to generate awareness. Nothing wrong here as this is fairly

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the regular practice. However, with issues of mental and emotional wellness, the knowledge of the symptoms alone is not enough, because the person facing these issues often cannot understand that he/she is experiencing these symptoms and more so at the initial level. Second, there is a gap in terms of lack of accountability for positive mental wellness outcomes. Third gap is of accessibility. People often wish to consult and work with a mental wellness professional at night/early morning, while they are at home or at work and that too in a private and completely confidential setting, but they can't. What is the need of the hour in this area? As I was discussing, the triple ‘A’ gap has to be dealt with. We need to have mental wellness services that are acceptable, accountable and accessible to the person in need of these. We need a more open, dialogueenabling and client (not patient) centric approach for mental wellness. Mental wellness should in no way be different than physical fitness and wellness. We are seeing young talented people taking away their lives. That’s a very sad state and we need to change that. In

order to do this, we need to reach out at the time of the beginning of an issue, with accountability and accessibility so that we are able to make a difference. And this Triple ‘A’ goal is what precisely formed the basis and the inspiration for developing and launching ePsyClinic.com.

We need to have mental wellness services that are acceptable, accountable and accessible to the persons in need of these

Tell us about ePsyClinic.com and its offering? ePsyClinic.com is India's leading and largest completely online and positive emotional and mental well-being mega clinic. We, at ePsyClinic.com, are speaking the language of not just symptoms but also of life situations, triggers, emotions that the person can easily connect with. We are training our providers extensively for positive mental wellness outcome delivery, we research extensively on issues of our target audience to devise services, thus making our mental wellness services accountable. We are online with all possible modes (video, audio, text chat, telephone) so we are accessible at any place, at any time in a completely private and anonymous setting. We are here to make people truly happy and in a

state of well-being, using scientific and world class therapy, counselling, positive wellness focused psychiatry and psychology services. Anybody facing major stressors in life due to work, relationships, caregiving, loss of loved one, parenting, sexuality, pregnancy etc. and/or facing anxiety or depressive symptoms can consult and avail complete online management of the issue from India’s and world’s top mental healthcare providers at the comfort of their own locations, and in a completely private and anonymous setting. Our providers are intensively trained in-house by ePsyClinic.com for delivering positive emotional and mental wellness and health outcomes. ePsyClinic.com only cares about one bottom line and that is complete well-being of its patrons. Speaking about technology for delivery of our mental and emotional wellness services, ePsyClinic.com has instant, one-click and later online consultation through secured and in-built video call, audio call, text chat and in-mailing service along with proprietary and exclusive real-time shareable online planners, thought diaries, record and alert system to manage client’s complete

STRATEGY

wellness process. Unlike other online health providers world-wide, we don’t just aggregate mental healthcare providers and their clients (mostly with very few direct client visitors) by providing a technology platform. Rather, we hire best of mental health care providers, train them extensively for superior online delivery and positive outcome, develop specialised mental wellness services and concepts, software and online tracking programmes and market our services as well as our providers, directly to larger customer base while taking full accountability of the care and therapeutic services provided. Can you explain how the concept of an interactive platform using audio, video, chat and messages work in the Indian context? Online technologies like video, audio and chat are powerful but to use them for healthcare delivery requires a different skill set and this is true in the global context. Video, audio chat or messages can become the basis of forming a connection between the provider and the client in an ongoing manner just as face-to-face visits. However, cues present in online conversation, be it video, audio or chat are different from face-to-face physical cues. Hence, the providers have to be separately trained in gauging a client's online cues to formulate an effective management/treatment strategy. ePsyClinic.com is a leader in this regard. We have a very tough hiring process and we test a candidate specifically for online healthcare delivery skills along with larger clinical skill set. We also have a three-week training programme, developed in-house, for perfecting use of impersonal mediums of psychiatry and counselling services. Until and unless a provider passes this internally, they do not

Our providers are intensively trained in-house by ePsyClinic.com for delivering positive emotional and mental wellness and health outcomes. ePsyClinic.com only cares about one bottom line and that is complete well-being of its patrons appear on portal. Technology is an enabler in the real sense only when the use of it is mastered for delivering quality care. Also the real value of being an online mental wellness provider is beyond the communication technologies. The online planners, diaries, client situation intake and record, real time communication in between sessions are the real value generators. ePsyClinic.com has devised many of these proprietary tools and is working to create more such tools with feedback and knowledge flowing from the market. Speaking of the Indian context, India today is globally recognised as an early adopter of new technologies, new processes and new business models. The only dampener is the connectivity issues that we have to face, especially in tier II, III and IV cities. But with 4G and other advances, these issues will be sorted in the near future. What are the business prospects that you see in India? India is a huge potential market as there is a real dearth of services like ours that could help people effectively deal with life stressors, mental stressors, performance and emotional issues. Over 50 per cent of all working people in the private sector in India face either chronic stress, depression or anxiety. About 30 per cent of their family members face similar issues. So out of around 30 million

people (employed in private sector and their families), 12.5 million people are dealing with major mental stressors and issues. However, less than five per cent of these 12.5 million ever seek help due to lack of awareness, issues of accessibility, lack of specialised services and last but not the least- prevalent stigma. This is our core client base for the first year. And the latent but strong need for wellness services is the underlying opportunity around which ePsyClinic.com’s core offering has been structured. Beyond this, there is still a huge untapped market for mental wellness services in India (it has the highest number of people with chronic stress, irrespective of their profession and location). We will expand to the larger mass market with the right set of services and channels as we grow. How do you plan to market your product? Our main goal for the first year is to make people aware that our services exist and that they can truly help them in becoming happier, healthier mentally and emotionally. We already know that there is a huge demand out there, so if people know, they are going to reach out to us. So to achieve this we are following a CCCC plan i.e. content, communication, connection and creativity to market our service Content: We are creating and distributing a lot of free content through our web

portal, social media, other print magazines and our own booklets. The content is in the form of self-help articles on themes of daily stressors, life situations. We also are constantly developing webinars, relaxation audio therapies, educational videos and positive brain stimulating activities. Communication: The essence of our service is honest dialogue. To actively market our services, we have to initiate these conversations. So we are doing a lot of live experiential events at corporate parks, select malls in metros. We, of course, also do a lot of social media based activities to communicate and reach out. Connection: Whether at the live events, or through our content or a 24x7 quick free live consultation with the mental wellness providers, or paid consultation on our web portal, we are making honest, well-meaning and resonating connection with our client base. This connection drives more people to us and also is generating a positive word of mouth for our services. Creativity: Our marketing strategies are always unique and we try to come up with things unheard of in this industry. Live experience events for a service like mental wellness were unthinkable. There have been workshops, but asking people to come and experience how therapy and consultation could help them deal with their issues at their work places and at malls hasn’t been done

anywhere else in the world. We could cut stigma fair and square through these events. Like this, we will continue to adopting new, creative and exciting marketing strategies. What are your immediate plans? In the next few months we will be doing many things to woo our clients and increase our user base. To do this, we have the following action plan: On the tech side: ◗ ePsyClinic.com’s android and iOS app development is nearing completion and will be launched soon. ◗ We are also creating specialised self-help monitoring and solution providing apps. ◗ We are improving and doing R&D in-house for making our video call services also available on lower bandwidths, keeping focus on connectivity issues that our clients in India could face especially in tier II, III and IV cities. That will be our focus. ◗ Ours is a very complex technical product. It is not just an e-commerce platform, it is an ecommunication, e-solution and e-management platform. So we are working to improve our technology, make it more user-friendly and scalable. ◗ We are also introducing automated and one-click telephonic consultation facility for people who do not have advanced phones and/or who are more comfortable with telephonic consultation. On the retail side: Online yet offline emotional wellness places (Stay tuned for our retail strategy with a twist!) On the service improvement side: Now that we are getting real feedback, we are incorporating that to consistently improve the quality, delivery and end value of our service. raelene.kambli@expressindia.com

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STRATEGY I N T E R V I E W

Non-obstructive azoospermia is medically unmanageable, so no treatment options are available Recently, Kallistem, a French biotech company working in the area of male infertility became the first in the world to develop a technology to produce fully-formed human spermatozoa in-vitro. In an email interview, Isabelle Cuoc, CEO of Kallistem tells M Neelam Kachhap about the ground-breaking technology and her plans for taking the technology to market

What is the prevalence of male infertility today? The average estimate through occidental region is an average of 15 to 17 per cent of couples suffering from infertility with a prevalence of 30 per cent ; within those 15-17 per cent for men, 30 per cent for women and 33 per cent for an indetermined reason (both sexes probably together). For non-obstructive azoospermia, our estimations as of today is a prevalence of 120 000 adults in the world as a minimum. Non-obstructive azoospermia, is medically unmanageable, so no treatment options are available. What are the available treatment options? Methods of managing infertility depends of the type of infertility. For example, hormonal dysfunctions are treated with hormonal treatment or an obstructive azoospermia can be managed by surgery. Similarly in some non-obstructive azoospermia cases a biopsy is performed to look for one spermatozoa to perform intracytoplasmic sperm injection (ICSI) the average success rate for this is about 50 per cent. However,

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for non-obstructive azoospermia without testicular spermatozoa, which appears in 50 per cent of the cases today, there is no treatment. These patients have to look for a sperm donor. The technology developed by Kallistem addresses â&#x20AC;&#x2DC;non obstructive azoospermiaâ&#x20AC;&#x2122; only if the patient has primitive germ cells in the testes. Tell us about your innovation for the treatment of male infertility? Today, if a patient does not produce mature spermatozoa but has only immature germ cells in his testes for any reason (mainly related to sertoli cells which are the nurses of germ cells), it is not possible to use those cells for ICSI because genetic and epigenetic transformations have not been completely achieved. The solution of Kallistem is to use the biopsy to perform a culture of up to 72 days to allow the full maturation of the spermatozoa in vitro with the same physiological conditions as possible than the one in the body. The innovation lies in the bioreactor which has been designed to perform this

development timeline for this technology? If we succeed with fund raising, we could start clinical studies in 2017 as I told you, and commercialisation from 2020.

The technology developed by Kallistem addresses non-obstructive azoospermia only if the patient has primitive germ cells in the testes culture plus the know how to cultivate the male germ cells. What is the significance of the ability to make viable sperms in vitro? The significance is that earlier it was not possible but now we can have viable sperms. However, these sperms can be used for ICSI and not IVF (cannot work as it needs motile spermatozoa) to get babies. But it needs to be accepted by regulatory

agencies and governments to make sure that everything is safe for the patient. Could you talk about the clinical trials for your product/technology? Yes, clinical trails are in plans. We plan to do it in 2017. We do not have a precise study plan right now. We are in a process of looking for investors to help us in our endeavour. Can you share the product

Would you tie-up with infertility clinics to bring the technology closer to people? Yes we would. This is definitely the plan. We are doing our best to get the best development for the patient in term of safety, accessibility and availability as soon as possible. You have given hope to millions of couples worldwide, India is eagerly awaiting for your technology. How and when can patients in India avail of this medical breakthrough? Today, it is more an issue of fund raising for us. The scientific team has been working since 20 years on it and is impatient to go through the regulatory process. We still have some development to do but it is development, not research. Itâ&#x20AC;&#x2122;s only a matter of time. So, we cross our fingers. mneelam.kachhap@expressindia.com

LIFE OPINION

Sexual harassment: A growing concern in Indian healthcare

VISHAL KEDIA, Founder & Director, ComplyKaro

Vishal Kedia, Founder & Director, ComplyKaro throws light on the problem of sexual harassment in healthcare and emphasises that it is essential to comply with the The Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 to address this issue

HEALTHCARE HAS emerged as one of the largest service sectors in India that employs approximately 1.25 million women or about 1.1 per cent of all working women. At the same time, the problem of sexual harassment of women at the workplace has assumed serious proportions, with a meteoric rise in the number of cases. Surprisingly, however, in most cases women do not report the matter to the concerned authorities. The government enacted The Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 on December 9, 2013, but unfortunately most organisations do not seem to be aware of it. This unawareness and ignorance can no longer continue as all organisations are now required to comply with this Act whether they have women employees or not. In a study “Sexual Harassment at Work Place: Experiences of Women in the Health Sector”, conducted by a researcher, Paramita Chaudhuri, sexual harassment in hospitals, of women doctors and nurses, seem to have become a common practice in India. What’s worse, most of the employees have not heard of an Internal Complaints Committee (ICC) for redressing their grievances. Further, they can be sexually harassed by not only their co-workers but also by patients and their relatives and even employees of service providers like technicians of medical equipment etc. There have also been instances wherein ward boys and

doctors have sexually harassed patients, their relatives or visitors to hospitals and medical facilities. In all such instances, the sexually harassed woman has a right to make a sexual harassment complaint to the ICC for redressal since the accused is one of its employees. In case of organisations dealing with medical devices, clinical trials, outsourcing, telemedicine and health insurance, their employees interact with a lot of women during their sales and/or operation outcalls. If there is occurrence of any untoward incident during such interactions even outside the organisation’s premises, such organisations are responsible for providing redressal mechanism in the form of ICC to such victims. Failure to comply with the law could lead to hefty penalties, imprisonment and even closure of business. The law is crystal clear and non-compliance of this

law can invite trouble for the management to the extent of facing charges of abatement of the crime and facing criminal prosecution. Further compliance with the said act needs to be mentioned in the Annual Report to be filed by organisations. Instances when no such annual report needs to be prepared, organisations have to file a report with the District Officer each year. The law provides for penalty up to Rs 50,000 for such non disclosure and double the penalty and closure of business on successive defaults. In the report to be submitted to the organisation and the District Officer each year, the ICC has to disclose the training sensitisation programmes arranged by organisation(s) during the year amongst other facts. Organisations with ten employees or more need to have a written sexual harassment policy in place. The policy should be

made known to all personnel and affirm that the organisation will not tolerate sexual harassment, and will take disciplinary action when such harassment is discovered. It is imperative that the reduction of sexual harassment in healthcare is important because it is a major social issue. In organisations employing 10 or more workers as a whole, the organisation has to mandatorily constitute an ICC at each location to redress grievances. The committee is headed by a Senior Woman employee apart from two other employee members and an external representative who may be an NGO member or an advocate. Minimum 50 per cent of the said members must be women. In case of organisations that employ up to nine workers or where the complaint is against the senior management/business owners, such complaints are heard and decided by the Lo-

cal Complaints Committee (LCC) constituted in each District by the local authorities. Hence a redressal forum has been provided with respect to every organisation, big or small. All employees of the organisation must necessarily undergo sensitisation training each year as the entire emphasis of the law is prevention of instances of sexual harassment. Even the ICC members need to undergo skill building training as they are a fact finding body which needs to adhere to principles of natural justice with powers of the Civil Court whilst hearing and deciding the complaint(s). Further recommendations of the ICC are challengeable before the Industrial Tribunal. Setting up a mechanism does not mean that there is sexual harassment in your workplace. Prevention is better than cure, and being proactive always helps. Along with performance, change in employees' behaviour patterns also deserves employer's close scrutiny. The act complained about must be unwelcome to the aggrieved woman. Hence, what may be sexual harassment in a normal situation may not be construed as sexual harassment in a consensual and romantic relationship. By the compliance of the mentioned law the management of organisations can shield themselves from any legal consequences and ensure that prompt remedial action is taken against the perpetrator i.e. accused in case of genuine complaints and the complainant in case of false and malicious complaints.

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LIFE PEOPLE

Analog Devices announces winners of Anveshan Design Fellowship 2014-15 IIT Mumbai wins with a baby wellness monitor, RV College of Engineering for its ‘bionic arm’ and VIT for its ‘psycho-physiological training approach for amputee rehabilitation’ project A BABY wellness monitor, a bionic arm and a new approach for amputee rehabilitation took top honours at Analog Devices' Student Design Fellowship, Anveshan 2014-15. The first prize was bagged by Indian Institute of Technology, Mumbai for its ‘Baby Beats: A Baby Wellness Monitor.’ The winning team, represented by Neeraj Babu C, Vineesh V S, Riyaz Mohammed, Apurv Mittal, Anjaly TR, received a cash prize of Rs 200,000 and also demonstrated their solution pitch to industry stalwarts at the awards ceremony. The second prize was bagged by R V College of Engineering, for its ‘Bionic arm.’ Vellore Institute of Technology, was awarded the third prize for its ‘psycho-physiological training approach for amputee rehabilitation’ project high-end engineering design and innovation. This edition of the fellowship

saw 314 registrations from over 120 universities across India. Anveshan is designed to mentor budding engineers to enhance their system design skills by actually developing prototype products under the guidance and mentorship of industry experts. The selected projects are executed on similar lines as in the industry for a period of nine months, with regular architecture reviews, component selection reviews, interim deadlines and finally a complete presentation and demonstration of the prototype. After two rounds of extensive review of proposals, 12 finalists were shortlisted and the projects were started in summer of last year. A mid-project evaluation was conducted in January 2015, where the competing teams presented their projects to Peter Real, Analog Devices’ Senior VP and Chief Technology Officer.

Anand Madanagopal, MD of Cardiac Design Labs, congratulating IIT Mumbai participants, the winners of Anveshan 2015

The winning teams, which incidentally were all focused on innovative and affordable healthcare solutions for India and emerging markets, were honoured in a felicitation ceremony attended by Vikram Damodaran, Director of Healthcare Innovation at GE India, Anand Madanagopal, MD of Cardiac Design Labs and Venkatesh Kumaran, VP, Strategy and Operations, India

Electronic Semiconductor Association (IESA). Commenting on the programme, Somshubhro (Som) Pal Choudhury, MD, Analog Devices India said, “There is an incredible enthusiasm by the student community in India to apply technology to solve challenges that they see every day, which we are trying to nurture through our Anveshan Design Fellowship Program. We are

thrilled with the energy that we witnessed during the course of Anveshan 2014-15. These systems built by the student teams are focused on addressing key market needs, are affordable and very well thought out. I strongly encourage the student teams to take them on to the next level.” Anjaly TR, a member of the winning team from IIT, Mumbai commented, “Working with Analog Devices has been a profound learning experience for all of us. Our journey from creating a literary survey to building the prototype has been magnificent. Presenting our interim and final prototypes and receiving the feedback from the industry stalwarts was an exhilarating experience for the team. This Fellowship has played a decisive role in shaping our careers and would like to wholeheartedly thank Analog Devices for this opportunity.”

Hisao Masuda to head OMRON Healthcare India business Masuda has been associated with Omron for last three years OMRON HEALTHCARE India, a player in the home health monitoring segment in the country has appointed of Hisao Masuda as the new MD of its India operations. Masuda succeeds Shinya Tomoda who completed his successful over-

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seas term of three years in the organisation in March, 2015. Masuda has been associated with Omron for last three years. Prior to coming to India, he was at Shanghai leading Omron Healthcare business’ growth and development for China region from 2012 to 2014. Welcoming Masuda, Jose Maria Salazar, MD, Omron Healthcare Singapore said, “I am extremely positive that under Masuda’s leadership, Omron Healthcare India will continue to grow and will be

able to live up to the stakeholders’ expectations.” He brings with himself a vast managerial foundation from the health, pharma and chemical sectors. He has served as COO with LTT Bio-Pharma, Japan where he helmed the planning and execution of fund raising and M&A initiatives and was associated with JFE Shoji Trade Corporation (Japan) where he laid a strong standing ground for the organisation to grow in the South East Asian region.

Commenting on his appointment, Masuda said, “I am honoured to lead the healthcare business in India. I look forward to working closely with the Indian talent pool to contribute towards making Indian people enjoy a healthy and comfortable life through our wide range of healthcare products. As a team, we will also strive to live up to the expectations of all other stakeholders through the successful execution of our business operations.”

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TRADE & TRENDS I N T E R V I E W

Every Dickies product comes with 'satisfaction guaranteed' commitment Ravi Karthikeya, CEO & Director, Dickies India talks about his company's offerings and its plans for the Indian market, in an interaction with Express Healthcare

What is the demand of medical work wear in India? What is the size of the market? The Indian healthcare Industry, which was estimated at $40 billion in 2010, is expected to reach $280 billion by 2020. The healthcare industry is defined as hospitals, medical infrastructure, medical devices, medical equipment, medical uniforms and foot wear, health insurance etc. The biotechnology sector alone has around 340 companies which employ more than 25,000 technologists currently. The healthcare industry are likely to grow at a rate of around 18 per cent per year and this growth will be further boosted by the opportunity presented by $ 300 billion worth of drugs set to go off-patent in next five years, resulting in the industry needing bulk professionals in various areas. Such massive growth in the healthcare industry is expected to create about 21 lakh jobs by the year 2020. In the hospital sector alone, about 1.8 million beds are required by the end of 2025. Additionally, 1.54 million doctors and 2.4 million nurses are required to meet the growing demand in hospitals. To meet the increasing competition, hospitals and other healthcare facilities are differentiating themselves with the fringe benefits they can offer in the medical facilities. 'Patient experience' is the top priority of healthcare organisations, where providing medical services is not enough to engage customers. Hospital wards are being redesigned to

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not resemble the traditional wards. The rooms are equipped with the latest television sets, Wi-Fi availability. Could you tell us about the range of your products? All new Dickies uniforms are for medical professionals who wants classic styling paired with soft, easy-care fabric. Dickies' legendary durability and quality remain, while the new, cotton/polyester fabric provides breathable, all day comfort. In Dickies, our range consists of medical scrubs, lab coats, nursing uniforms and medical footwear. Dickies brand scrubs comes with cushion tapes on the inside waist band and back neck for confront and long hours wearing, While wide range of fifteen seasonal colors offer variety and multiple mix-andmatch possibilities with a choice of unisex, men’s and women’s fits, ranging from official issue uniforms to custom made, whether by corporate hospital or by a independent practitioner. Dickies medical clothing is made gender-specific sizing and styling is just one of our distinguishing features. Best fits comes in short, regular and tall lengths which need no alteration or resizing. Dickies lab coats are made from comfortable crisp cotton/polyester fabrics with easy care and stain release finishes and features modern lapels, exquisite pocket detail and clean finishing on all seams. The coat confers a sense of doctor’s authority and cleanliness and we offer consistent whiteness across

keeps its original promise while delivering more style, value and features that – like all Dickies medical uniforms are – 'Made to Work'. 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.

Dickies uniforms are for medical professionals who wants classic styling paired with soft, easy-care fabric Dickies offers sensible footwear for discriminating medical and healthcare professionals with fashion styling for today’s young doctors. Dickies offers medical foot wear with washable leather, breathable linings for high moisture absorbing, light weight, mid-sole provides long wear and stability for long hour standing and slip resistant What is the USP of your company? Every Dickies product comes with 'satisfaction guaranteed' commitment and unconditional warranty. Dickies signature

What is your goal for this financial year? Considering that there is no brand in this space makes our performance and durable standards unique and new to the Indian medical and hospital uniforms. But there has been a positive acceptance and orders to try better quality and performance uniforms. We are primarily focused to cater South India for the first year of our business as over 50 per cent of national medical and healthcare activity is in the South. We are building relationships with corporate hospitals and medical centres with world’s best performance and service standards to offer. We will be looking to achieve business associations with all major medical centres of South India by the end of this year and take it from there to rest of India. How do you see this market growing in India? The concept of healthcare is just entering the mindset of the average Indian society. But with a population of over one billion, the healthcare industry naturally becomes one of the most watched in the country, with a high growth potential. India has also emerged as a preferred destination for

medical tourism owing to its cost advantage and explosive growth of private hospitals, equipped with latest technology and skilled professionals. This means that hospitals need to match international standards in their offerings The hospital industry accounts for about 80 per cent of the total market, according to a report by RNCOS. The promise of a large, growing market has lured several international healthcare players like Columbia Asia Group and Pacific Healthcare have set up operations in India. These foreign firms are setting up hospitals, R&D centres, clinics etc. The possibility of such growth translates to a corresponding rise in demand for the infrastructure, facilities for employees and benefits. Anything else you would like to add. We accomplish this globally by designing and producing high quality, durable, fashioninspired, comfortable medical uniforms and footwear. We create a warmer, friendlier, and healthier medical environment by providing dynamic, unique, and state-of-the-art products and concepts to help. Healthcare workers and their patients. Dickies medical and healthcare uniforms provide outstanding value, uncompromising quality, industry-leading style, and compassionate customer service in ethically produced and competitively priced for India.

TRADE & TRENDS

XP 100- Leading from the forefront Divya Munshi, Product Management-Hematology, Transasia Bio-Medicals elaborates on the advantages of Sysmex XP-100 distributed solely by Transasia in India

THROUGH ITS quality products and services, encompassing the entire array of diagnostics, Transasia Bio-Medicals has been leading the in-vitro diagnostic industry for over three decades. With an aim to provide innovations that aid in timely and accurate disease detection, Transasia regularly introduces the latest and most advanced technology based on the end user’s needs. Haematology is one of the fastest growing segments of the Indian IVD Industry. It’s been more than 20 years that Transasia and Sysmex Corporation, Japan have partnered together to create a benchmark in haematology. Transasia is the sole distributor of Sysmex products in India and markets a varied range of their haematology systems right from the 3PDA Sysmex XP-100 (a basic requirement of every lab) to an upgraded 5 PDA Sysmex XSseries and the latest 6PDA Sysmex XN-series. The accurate, precise and clinically relevant parameters reported by Sysmex analyzers have contributed in a huge way to the betterment of Indian preventive and curative healthcare industry. Key highlights/features of Sysmex XP-100 are:

Hardware ◗ Easy to operate LCD touch screen graphical display ◗ Auto probe cleaning facility ◗ Auto clog detection facility ◗ Inbuilt robust thermal printer ◗ Easy sample and reagent entry through handheld bar-

code reader ◗ Easy connectivity through LAN, barcode, serial and graphical printer port ◗ Equipped with sample rotor valve technology to ensure precise sample aliquoting in every measurement

Parametric and Software ◗ Reports 20 clinically useful parameters plus four WBC research parameters to provide easy and accurate diagnosis of clinical condition. ◗ The analyzer is equipped with

floating discriminator technology to reduce the interference among WBC sub-populations and the intervention of microcytes in PLT count during the cases of microcytic hypochromic anaemia. ◗ The analyzer reports true neutrophil count which helps in differential diagnosis of neutrophilia and eosinophilia. It also provides screening of iron deficiency anemia and beta thalassemia through simultaneous reporting of RDW-SD and CV.

✦ XP100 INS

◗ The analyzer provides screening of the cause of thrombocytopenia with the help of PLCR, PDW and MPV reporting. ◗ The analyzer reports measured HCT through the ‘Cumulative pulse height detection’ principle to aid in profiling of anemic condition and present a betterco-relation with other RBC parameters in cases of RBC abnormality. ◗ The analyzer ensures volumetric cell measurement to

DIVYA MUNSHI Product ManagementHematology, Transasia Bio-Medicals

The accurate, precise and clinically relevant parameters reported by Sysmex analyzers have contributed in a huge way to the betterment of Indian preventive and curative healthcare industry reduce the need of frequent calibration and to ensure precise sample reporting. ◗ Keeping In mind the accreditation requirement of laboratories, it has X-bar and LJ QC program. ◗ It is one of the only three-part systems to provide online QC programme named Sysmex Network Communication System (SNCS). With all its advanced features, Sysmex XP-100 is the latest three-part fully automated haematology system giving its end-users an effective, easy, accurate and precise sample analysis.

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TRADE & TRENDS

JKAnsell launches calendar, workshops on hand mudras An initiative to promote International Day of Yoga

THE JOURNEY began when the United Nations declared June 21 as International Day of Yoga, adopting a measure proposed by Indian Prime Minister Narendra Modi who said Yoga lets people "discover the sense of oneness with yourself, the world and the nature." Since then JK Ansell's team put in dedicated efforts to aid such a great achievement at the international level. The team introduced a special calendar for 2015 with an annual objective to create awareness about hand mudras, which is a part of Yoga. The calendar reached thousands of healthcare professionals across India, most of which was requested through online and print media campaign. The objective was to commmunicate an important message – “quality of life for

The entire campaign is built on the fact that our health is literally in our hands, because hand mudras can really lead to a healthier life. Vision is to touch millions of patients through thousands of healthcare practitioners in next few years healthcare professionals”. This was just the beginning. The team’s aim was to reach more and more healthcare practitioners and make a larger impact on the first ever International Day of Yoga. The video on hand mudras video was developed as an awareness tool. The objective was to reach more and more healthcare practitioners on the D-day. To meet this objective, the following digital

channels were adapted: ◗ Email campaign – reached more than 100,000 healthcare practitioners ◗ YouTube Channel – More than 25,000 views by people in healthcare industry ◗ Google Display Network Hundreds of mail started pouring in, appreciating the concept/initiative and requesting a DVD. To take the campaign to next level, print

campaign has also been designed wherein in healthcare practitioners can watch hand mudras video on YouTube by scanning QR code and request a DVD by writing an email to the organisation. To continue building this story, Hand Mudras Workshops are also being planned across country where healthcare practitioners will be given two hours' session on hand mudras by experts. Cost of these work-

shops will be borne by JK Ansell. The entire campaign is built on the fact that our health is literally in our hands, because hand mudras can really lead to a healthier life. Once healthcare practitioners in India know the basics, patient can also be educated by them, spreading the great Vedic science across the masses in the country. With this practice we’ll ensure that we create awareness about our prestigious ancient science and making our community better. These activities will surely result in improved socio-economic and quality of life. Vision is to touch millions of patients through thousands of healthcare practitioners in next few years. Being an expert in hand barrier protection, we always care for the hands that care.

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TRADE & TRENDS

Carestream’s DRX-Evolution Plus System adds innovative features to DR platform Company continuously updates DRX-Evolution to expand options, enhance performance; new Plus System to ship later this year

CARESTREAM HEALTH’S newest DRX imaging system— the CARESTREAM DRXEvolution Plus—adds several major software and hardware enhancements to meet the changing radiology needs and budgets of healthcare providers worldwide. Carestream has steadily expanded the capabilities of the DRX-Evolution platform since it was introduced and the new DRX-Evolution Plus will begin shipping later this year. The system’s modular components, including fully automated systems, have gained wide acceptance among radiology professionals in leading hospitals and clinics. The new DRX-Evolution Plus offers: ◗ A sleek new design with LED lighting for enhanced functionality and aesthetics ◗ Greater flexibility in high-ceiling rooms via an extended tube column ◗ A new high performance generator designed by Carestream ◗ An optional table to accommodate patients up to 705 pounds (320 kg); and ◗ Forward-looking design specifications to embrace future advanced imaging applications from Carestream as they become available. “The DRX-Evolution has earned the trust of radiology

professionals around the world, largely due to continuous improvements in functionality that help technologists quickly and easily capture complex exams that previously required greater effort,” said Helen Titus, Carestream’s Worldwide Marketing Director for X-ray Solutions and Ultrasound. “We have developed more new software features that can boost productivity and enhance the visualisation of anatomy, while simultaneously helping to reduce radiation dose.”

Advanced capabilities of the DRX-Evolution Plus include: ◗ An innovative wall stand Bucky-angulation feature that expedites cross table and other complex X-ray exams ◗ Tube touch screen that allows a technologist to change techniques and view images from the tube ◗ Pediatric capabilities including automatic technique and image processing for seven pediatric body size categories ◗ Bone suppression software for optimised viewing of soft tissue ◗ Fast, secure log-in process using RFID badges ◗ A transbay option that enables fast tube movement across multiple trauma bays, which helps expedite treatment while minimising move-

ment of critically ill or injured patients ◗ Automatic acquisition and stitching for long-length and supine imaging exams; ◗ IHE Dose Reporting to facilitate data sharing with a facility’s dose management system.

DRX-Evolution Plus offers modular components The DRX-Evolution Plus also offers modular components and configurations and supports a choice of three DRX detectors, including two cesium iodide detectors (35 x 43 cm and 25 x 30 cm) for highquality imaging. For maximum productivity, the DRX-Evolution Plus can be configured with a 43 x 43 cm fixed detector in the wall stand, and one or two additional wireless detectors that can be used for table Bucky and tabletop exams. The CARESTREAM DRXEvolution Plus is a versatile digital radiography system that can perform a wide range of general radiographic exams with remarkable convenience,

productivity and patient comfort. Like other members of the company’s innovative family of DRX systems, the DRX-Evolution Plus is based on

Carestream’s X-Factor design that enables each DRX detector to work with all other DRX systems within a provider’s environment.

EXPRESS HEALTHCARE

July 2015

TRADE & TRENDS

Regulatory framework for medical devices Rajiv Nath, Forum Coordinator,Association of Indian Medical Device Industry (AIMED) opines that there should be a separate law book and separate regulatory authority or a revamped CDSCO as Indian Healthcare Products Regulatory Authority

n traditional mode of regulations worldwide earlier, government was the regulator. It prescribed requirements for manufacturing, directly checked compliance through inspectors and directly punished errant manufacturers thereby creating conflict of interest and a breeding ground for corruption. As regulators worldwide are getting increasingly stretched for resources and the required technical expertise, various components of a regulatory framework are getting unbundled. India needs to imbibe similar best practices and bring in regulatory reforms Regulations in India need to be layered to separate the role of legislature from that of a regulator, and those of a supervising accreditation body to assist the regulator from those of third party conformity assessment bodies who will audit the manufacturer in lines with principle of subsidiarity, our key policy principle (3.2): Minimum Government – Maximum Governance

Minimum Government – Maximum Governance In India there has been no onus on manufacturers to demonstrate compliance. There is a need to provide this layer whereby manufacturers voluntarily use accredited, third party conformity assessment bodies to verify and certify their compliance level to

EXPRESS HEALTHCARE

July 2015

regulations. This will also create higher international acceptance for Indian products. Systems need to be created to do market surveillance and monitor adverse events as well as enable needful systemic action to prevent reoccurrence of such incidences for ensuring greater patient safety. While we have been assured that this will be taken care of in rules, ideally the law should give sense of direction of framework for rules, which is missing. ◗ In the proposed Bill, govern-

ment policies will strangely now legitimise pseudo manufacturing whereby marketing and trading companies declare themselves as manufacturers! We are already over 70 per cent import dependent. The manufacturing sector is already weakened and challenged to create Indian brands for Indian consumers. Users and consumers will endorse Indian products made by actual manufacturers. However, the government should not confuse consumers by giving them access

to products from pseudo manufacturers which may be imported from China and just packed or sterilised in India. Even the Consumer Protection Act does not allow traders to label themselves as manufacturers so why does the Bill propose this? World over, regulations are used strategically as a non tariff barrier to protect domestic industry, in addition to protecting the interest of the consumers and patients. We should reconsider the decision permitting the definition of manufacturer to

EMERGING STRUCTURE

Government legislation

Regulatory authority sector-specific to enforce law

Accreditation body (NABCB) - Supervises technical competence of CAB Conformity Assessment Body (CAB)- Support regulator by verification and certification

Manufacturer - Demonstrate compliance with standards/regulations

Consumer

include sub contracting of a complete product to a third party. It is against Make in India vision of our Prime Minister ◗ Adulteration: - This definition may be deleted from proposed Bill as it relate to drugs, food and chemicals, not to devices. ◗ Considering the diversity of medical devices as engineering and consumer goods it is imperative to encourage existing manufacturers of engineering goods to diversify into medical devices with a similar technology base e.g. Hospital beds by furniture producers, under pads and clinical diapers by baby diaper producers etc. It is imperative to have a separate law book and a separate rule book (other than pharmaceutical based D&C Act) and not only a separate chapter without cross referencing, as is being proposed, to encourage this. The steps taken in the past to regulate medical devices as pharmaceuticals have made India increasingly import dependent and a decreasing desire for investment in manufacturing is evident. Such small Industries may not afford to hire a pharmacist or even a professionally qualified regulatory expert. Do we need an MNC, large industry dependent supply chain environment by creating an entry barrier?

REGD. WITH RNI NO.MAHENG/2007/22045. REGD.NO.MH/MR/SOUTH-252/2013-15, PUBLISHED ON 8th EVERY MONTH & POSTED ON 9, 10 & 11 EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE.