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

VOL.9 NO.9 PAGES 80

www.expresshealthcare.in SEPTEMBER 2015, `50

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CONTENTS MARKET Vol 9. No 9, SEPTEMBER 2015

THE

Chairman of the Board Viveck Goenka

MOHFW LAUNCH NATIONAL HEALTH INNOVATION PORTAL

RAVI SHANKAR PRASAD LAUNCHES HEALTH INITIATIVE ‘SEHAT’

MPHASIS AND IIITB PARTNER TO SUPPORT INCUBATION OF SOCIAL ENTERPRISES

Overuse and over pricing of stents in cardiac care procedures has been a hot topic for discussion lately.An analysis delving into the factors driving these issues and measures to mitigate them| P41

SOCIETY OF REGENERATIVE MEDICINE LAUNCHED IN INDIA

NEW DELHI TO HOST ADVANTAGE HEALTH CARE - INDIA 2015 IN OCTOBER

P18:INTERVIEW: GURUPRASAD S GM, Robert Bosch Engineering and Business Solutions

MUSCULOSKELETAL ULTRASOUND SOCIETY TO ORGANISE MUSOC 2015

THIT 2015 CONFERENCE TO BE HELD IN BENGALURU

OPPI CONCLUDES 4TH HEALTHCARE ACCESS SUMMIT IN MUMBAI

Sr Vice President-BPD Neil Viegas

STENT

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

SAGA

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

P20:INTERVIEW: SAM SANTHOSH CEO, MedGenome

Artist Vivek Chitrakar, Rakesh Sharma

P33:INTERVIEW: SATYENDAR JAIN

Photo Editor Sandeep Patil

Minister of Home, Health, Power, PWD & Industries

P46:INTERVIEW: PROF SOUMYA JANA

MARKETING Regional Heads Prabhas Jha - North Dr Raghu Pillai - South Harit Mohanty - East & West

Dept of Electrical Engineering, IIT Hyderabad

Marketing Team Douglas Menezes G.M. Khaja Ali Ambuj Kumar E.Mujahid Arun J Ajanta Sengupta

P48:INTERVIEW: DR KEWAL KRISHAN

PRODUCTION General Manager B R Tipnis Manager Bhadresh Valia

P47:INTERVIEW: DR ANVAY MULAY Chief Cardiac Surgeon, Fortis Hospital, Mulund

MUSCULOSKELETAL IMAGING: COMING OF AGE

LIFE

Program Incharge, Heart Transplant & Ventricular Assist Devices, Senior Consultant Cardiac Surgeon, Max Heart & Vascular Inst, Saket, New Delhi

P54:INTERVIEW: DR NIDHI BHATNAGAR Organising Secretary, MUSoc 2015

STRATEGY

HEALTHCARE MARKETING RISK MANAGEMENT

PREVENTIVE & PREDICTIVE HEALTHCARE

Scheduling & Coordination Mitesh Manjrekar CIRCULATION Circulation Team Mohan Varadkar

IN IMAGING

DR TAKUO AOYAGI RECEIVES 2015 IEEE MEDAL

PROF ANUPAM SIBAL RECEIVES BAPIO AWARD 2015

TERARECON APPOINTS JEFF SORENSON AS PRESIDENT

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

The rockstar of cardiac care

uthors of a recent study published in PLoS ONE questioned the use of two commonly prescribed presurgical tests in the US. They somewhat predictably found that while prothrombin time (PT) was ordered unnecessarily in 94.3 per cent of the cases, activated partial thromboplastin time (aPTT) was unnecessary in 99.9 per cent of cases. The authors, Capoor et al., point out that these tests were intended primarily to be diagnostic and there is no rationale to indicate their use in routine screens. The sample was quite extensive, as it included 1,053,472 consecutive patients from 27 medical facilities enrolled from 2009 to 2012, with complete data gathered for 65 per cent of those patients. Thus, these findings have significant weight, considering that the US, and for that matter, all governments are striving to rationalise healthcare costs. The authors of the PLoS ONE study conclude that over-diagnosis of disease seems to be a modern epidemic in high-income countries. But there is clear evidence of symptoms of this epidemic in India as well, spanning not just over-diagnosis but for instance, medical implants like heart stents. Timed with World Heart Day on September 29, our lead story in the Cardiac Care special examines this controversial topic (See story, The Stent Saga, pages 42-45). While stent manufacturers tend to refute this allegation, cardiac surgeons weigh in on both sides of the debate. There are already signs of regulation. For instance, cardiologists from AIIMS formed the Society for Less Investigative Medicine (SLIM) last year, and with growing support, the initiative went national this May. Globally too there is a move towards relooking practices and procedures, evolving towards a more rational healthcare model. Medical practitioners will feel that to ‘test is best’, simply to avoid medico-legal consequences but there has to be a balance between evidence and experience-driven clinical practice. The man on our cover in this issue, Dr Naresh Trehan, too has very strong views on achieving this fine balance. Sample this quote, a more colourful one back from the days when he was still at Escorts Heart Institute: “There is a difference between medicine and commerce. It's the difference between a wife and a whore.” A decade later, as Chairman of his brainchild, Medanta-The Medicity, he still doesn't believe in mincing his words. Driven by a dream to “create a distinct identity of healthcare delivery that

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Our cover storydetails not just Medanta's rise as the Mecca of cutting edge,high end cardiac care,but also Dr Naresh Trehan's efforts as the health sector lead in various industryassociations and as advisor to policymakers

India provides”, the good doctor has often courted controversy, like his unceremonious exit from Escorts to being slapped with a medical negligence charge when former Chief Justice of India JS Verma died of multiple organ failure at Medanta. But I believe history will be kinder to this US-returned Lucknow boy than his peers. In the final analysis, his larger than life personality will have done more good than harm for India Healthcare Inc. Our cover story details not just Medanta's rise as the Mecca of cutting edge high end cardiac care, but his efforts as the health sector lead in various industry associations and as advisor to the policy makers. His detractors say he is moulding policy to suit his agenda, while others say that healthcare needs a rockstar personality to get ‘government babus’ to listen. (See story, The Sapient Surgeon, pages 26-32) One policy maker who does seem to listen is Satyendar Jain, Minister of Home, Health, Power, PWD and Industries, in Arvind Kejriwal’s Aam Aadmi Party. His vision to transform Delhi's healthcare system could be driven by politics but one year from now, if Delhi's mohalla clinics can truly form an ATM-like network to serve the basic healthcare needs of the population, will the means justify the ends? Juggling media queries on the death/alleged murder of an inmate in the Tihar Jail to fielding queries on Delhi’s plans for the homeless aged, Jain appeared more than capable of talking into the night to me on his party’s vision to correct past mistakes. (See interview: ‘Our govt’s focus is first on quality healthcare’; pages 33-36) In the coming issues, we hope to feature the views of more state governments on their plans to implement healthcare schemes. Some states have announced schemes which prove that at least they are not afraid of trying out new models. For instance, take Rajasthan’s announcement that it would run its primary health centres in a publicprivate-partnership mode. Such initiatives may have teething problems like the Chhattisgarh government’s move to outsource diagnostic services in health facilities in 2013 which was put on hold pending a ‘fresh look’ at the gaps but today, we have some guidelines in place for the free diagnostics initiative under the National Health Mission as well as operational guidelines for mobile medical units. As policy evolves, there is also the sense that health is finally on the political agenda. Thanks no doubt to rockstars like Dr Trehan who take it upon themselves to champion the cause. More power to them. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

QUOTE UNQUOTE

DR POONAM KHETRAPAL SINGH

NARENDRA MODI

Regional Director,WHO South-East Asia Region

Prime Minister of India

“India has achieved a momentous public health feat – the elimination of maternal and neonatal tetanus. Maternal and neonatal tetanus is reduced to less than one case per 1 000 live births in all 675 districts of the country”

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MARKET NEWS

MoHFW launch of National Health Innovation Portal The portal aims to be a platform to boost innovations in public health MINISTRY OF HEALTH & Family Welfare (MoHFW), Government of India has launched a national initiative for innovation recently. Inaugurating the National Summit on Healthcare Innovations at Shimla, Union Minster for Health and Family Welfare, JP Nadda launched the national innovation portal. It has been made to facilitate the innovators to boost innovations in public healthcare. National Health Innovation Portal is being launched to serve as a platform in the public domain to facilitate collection and dissemination of good practices and innovations that are found to be replicable. Reportedly, this portal would serve as a gateway for integrating innovations into mainstream healthcare and has the potential to bring about transformative improvements in healthcare delivery by accelerating the uptake of successful innovations of products, processes and programmes. It is an attempt to poolin and showcase innovative programmes designs, practices, technology solutions and products across the public and private healthcare sector of India. These solutions have either demonstrated abilities to address health systems challenges in specific contexts or hold a promise for future. This platform is expected to act as an inspiration to health entrepreneurs as well as provide newer programme designs, devices and approaches to cover those in greatest need of healthcare. EH News Bureau

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MARKET

Ravi Shankar Prasad launches new health initiative ‘SEHAT’ Launched in association with Apollo Hospitals, the venture would expand the reach of telemedicine in the country RAVI SHANKAR Prasad, Minister of Communications and Information Technology, and Minister of Law and Justice recently launched the government’s latest health and IT initiative called Social Endeavour for Health And Telemedicine (SEHAT) at the India Habitat Centre in Delhi. This venture with the Apollo Hospitals is expected to connect 60,000 common service centres (CSCs) across the country to a common network and provide healthcare access to millions of citizens irrespective of geographical location or connectivity. Dr Prathap C Reddy, Chairman Apollo Hospitals said, “This initiative of ‘SEHAT’, shall connect the largest population of our country on a

Dr Prathap C Reddy, Chairman, Apollo Group of Hospitals with Ravi Shankar PrasadMinister of Communication and IT, and Minister of Law and Justice

common network to avail telehealth services. Apollo Hospitals has always been committed to providing the DIGITAL DIVIDEND to all Indians. We are very proud to have launched India’s first telemedicine centre in 2000 which was

launched in Aragonda and it was inaugurated by the then President of the United States, Bill Clinton. Through our PM’s ‘Digital India’ initiative more Indians shall get access to eservices and we are delighted to be a partner with

the GOI in this path breaking endeavour to link SEHAT to 60,000 CSCs. Sangita Reddy, Joint MD, Apollo Hospitals said, “Telemedicine can provide rural population access for basic, specialty and super speciality consultations. Since 80 per cent of conditions do not require a doctor’s physical presence immediately, they can be dealt with through telemedicine. Most lifestyle and communicable diseases fall into this category. It is indeed a privilege for us to work with the Government of India and the Minister in making history by starting the world’s largest telemedicine programme in the world today.” EH News Bureau

Myriad Genetics partners with Positive Bioscience Offer molecular genetic testing in India, especially to assess cancer risks MYRIAD GENETICS has announced a strategic partnership with Positive Bioscience to offer molecular genomic testing in India. These tests will help screen for cancer risks and enable families of cancer patients to take various preventive measures. All testing will be carried out at Myriad’s labs in US and Germany. Through this partnership, Positive Bioscience will provide world-class molecular genetic testing for cancer patients and their families. The tests also provide physicians

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with information to personalize treatment for their cancer patients. Genomic tests are available for nine cancers: breast, pancreatic, ovarian, endometrial, melanoma, prostate colon, lung and gastric. “We are pleased with our strategic partnership with Positive Bioscience through which Myriad can bring our 25 years of experience in clinical genetic testing to India,” said Gary King, Executive VP of International Operations, Myriad Genetics. King further added, “Indian patients can now access world

leading tests such as BRACAnalysis to identify the risk of developing breast and ovarian cancer, Colaris for hereditary colorectal cancer and the myRisk test, which assesses the risk of developing eight cancers. Our prognostic tests such as EndoPredict for breast cancer and Prolaris for prostate cancer will help to avoid both the overtreatment and under-treatment of patients and personalise patient care while reducing the economic burden of treatment. We intend to work closely with Positive Bioscience to

make these tests available to Indian clinicians and patients.” Speaking on this partnership, Samarth Jain, CEO of Positive Bioscience said, “Positive Bioscience is pleased to work with Myriad to offer molecular genetic testing in India. With our wide reach, thousands of Indians will instantly have access to world-class testing. These tests will help patients by providing insights into potential healthcare challenges they may encounter and improve the quality of their lives.” EH News Bureau

Fortis Escorts launches Liver and Digestive Diseases Institute THE FORTIS Escorts Liver & Digestive Diseases Institute (FELDI) was inaugurated by the Union Minister for Health & Family Welfare, Jagat Prakash Nadda recently. The team at the Institute will be led by Dr Ajay Kumar, Chief & Executive Director, Fortis Escorts Liver & Digestive Diseases Institute and the liver transplant team is led by Dr Vivek Vij, Director, Liver Transplant & GI Surgery. Reportedly, a range of comprehensive diagnostic and pathological tests will be available at the Institute. Dr Kumar said, “This Institute, with its state-of-theart facilities in form of world class infrastructure, state of the art equipment and backed by the leaders in the profession will strive to provide state of art care to patients suffering from gastrointestinal, pancreaticobiliary and liver disorders. While dealing with daily mundane disorders like diarrhoea, GERD, etc, it will also provide care of international standards for complex disorders like GI cancers, pancreatitis and cancers and liver transplant.” Dr Somesh Mittal, Zonal Director, FEHI said, “There is a definite need for an institution of excellence of the calibre of the Fortis Escorts Liver and Digestive Diseases Institute. We are proud to announce an exceptionally skilled team with expertise in liver and digestive diseases especially as these diseases are increasing in epidemic proportions in India. Our goal is to deliver excellent healthcare of global standards to patients .” EH News Bureau

MARKET

Mphasis and IIIT- B partner to support incubation of social enterprises Have signed a MoU by which IIITB would leverage portion of Mphasis’ CSR funds to support social enterprises MPHASIS, A GLOBAL technology services provider, announced its partnership with The International Institute of Information Technology (IIIT-B), a deemed university, to support and nurture deserving social enterprises. The two organisations have signed a memorandum of understanding (MoU) wherein IIIT-B would leverage a portion of Mphasis’ corporate social responsibility (CSR) funds for supporting social enterprises. IIIT–B will invest and nurture social enterprises that are in line with Mphasis’ CSR focus areas such as education, employability and entrepreneurship. In addition to funding, IIIT-B will also provide focused mentoring services, logistics support and business network support for the incubatees. Reportedly, IIIT-B has so far incubated 12 ideas and currently supporting six companies in the areas of education, healthcare and energy. “In keeping with our brand promise of ‘Unleash the Next’, we are relentlessly looking for opportunities to support promising, disruptive social enterprises through reputed incubators. We believe that this partnership with IIIT-B, approved incubators by the Government of India, will enable us to realise this vision,” said Dr Meenu Bhambani, AVP and Head, CSR and the Office of Diversity at Mphasis. “IIIT-B works in partnership with the corporate sector on education and entrepreneurial initiatives. Through

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this partnership with Mphasis we look to provide technology, management and financial

inputs to help inspire innovators to bootstrap their technology ventures. With the innova-

tive and inclusive CSR policies of Mphasis, we look to reach out to more eligible and aspiring

people,” said Prof S Sadagopan, Director at IIIT-B. EH News Bureau

MARKET

Med device industry call upon govt to empower domestic manufacture Demand regulatory clarity, fiscal incentives, innovation hubs and correction of inverse import duties INDUSTRY LEADERS, participating FICCI Heal 2015 have called upon the government to take strong measures to drive the consumption of medical devices in the country, bring clarity to regulatory policy, correct inverse import duties and provide fiscal incentives to give the domestic manufacture of medical devices a strong impetus for growth and turn India into a global innovation hub for medical technology. Varun Khanna, MD - BD India, said, “Make in India’ campaign must be aligned with key government initiatives to create a strong impact on public health and provide safe medical care accessible to all. Therefore, it is important for the stakeholders in the medical devices and larger healthcare ecosystem to constructively engage in a dialogue to facilitate ‘Make in India’ for the country. The government should strengthen entrepreneurship and innovation to fulfil the clinical unmet needs leading to better patient outcomes.” Ajay Pitre, Co-Chair of

Experts were unanimous that the medical devices industry is poised to grow significantly in the coming years due to the huge unmet need, and it is no longer sustainable to continue with the current 80:20 import-export ratio FICCI Medical Devices Forum & MD, Pitre Business Ventures, said, “The need for quality healthcare services is going to rapidly expand as the Indian economy evolves. A strong domestic medical technology industry is very much possible, considering India’s strengths, to help meet the country’s needs for medical devices meaningfully and cost effectively. From a net importer, India can transform itself into a provider of cost-effective medical technology solutions to the whole world; provided an enabling ecosystem is put in place by the government.” The experts were unanimous that the medical devices industry is poised to grow

significantly in the coming years due to the huge unmet need, and it is no longer sustainable to continue with the current 80:20 import-export ratio. They called upon the government to focus on the following initiatives: Market expansion: The current market of medical technology in India is an insignificant fraction of the global market. The government needs to facilitate access and drive consumption by increasing spending in healthcare from current one per cent of GDP to at least three per cent. Regulatory clarity: The Act separating medical devices from drugs needs to quickly come into force. It should

enforce risk-based classification and allow ease of clinical trials. Also, a nodal ministry has to be made responsible for end-to-end facilitation of the medical technology industry. Fiscal incentives: To create a global supply chain and manufacturing in India, the government needs to provide fiscal advantages to investors on the lines of countries like Ireland and China. Said Probir Das, MD, Terumo India, “It is very important for the Government to address the issue of inverse import duties and formation of manufacturing clusters. The import of components is often more expensive in India than the import of finished goods.

Zero duty or very low levels of duty on component imports will facilitate local assembly/ production of medical devices.” Added Sunil Khurana, Chairman, FICCI Medical Electronics Forum & CEO, BPL Medical Technologies, “The ‘Make in India’ campaign coupled with 100 per cent FDI in this sector will provide a huge impetus in growing the medical devices sector in India. Indian medical devices companies must try attract international majors for their participation in the form of funds, technology and manufacturing partnership. Local manufacturing will help in development of custom products suited better to our disease pattern and patient demography thereby reducing the overall cost of delivery. Manufacturers would also benefit through government purchases giving preferential treatment for domestic production. Further, we also need to develop our own quality control standards specific to Indian context.” EH News Bureau

Societyof Regenerative Medicine launched in India The Society will work to guide the regulatory framework for regenerative medicine A GROUP of doctors, life sciences companies and academic researchers have come together to launch the Indian Society of Regenerative Medicine to advance regenerative therapies in India. Currently registered in Uttrakhand, the organisation aims to work towards development of safe and effective re-

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generative medicine technologies in India. The Society will also work to guide the regulatory framework for regenerative medicine. Dr Himanshu Bansal, the main convener of the society, said, "There is a need for unified and coordinated advocacy representing the interests of the patients, doctors, re-

Aims to develop of safe and effective regenerative medicine technologies

searchers and investors that comprise the entire regenerative medicine community." A revised set of guidelines on stem cell research was released in 2014 by the Indian Council of Medical Research and the Department of Biotechnology, however there are no guidelines for other types of regenerative medicine

in India. Apart from Dr Bansal Dr Mayank Jain, Bhopal and Dr Neeti Khunger, Delhi are the founding members and are working on the bylaws for the society, election of officers and an executive committee at its first official meeting at Delhi in December 2015. EH News Bureau

MARKET I N T E R V I E W

‘Affordable and accessible care is part of our mission’ Bosch Healthcare is extending its reach in India. Guruprasad S, General Manager, Robert Bosch Engineering and Business Solutions, talks to M Meelam Kachhap about technology as an enabler to drive efficient healthcare system, especially in the rural sector

Why did Bosch foray into healthcare? Bosch’s tagline is ‘Invented for Life.’ We have been around for the last 130 years and have made significant contributions to make life better. We would want to be the technologyenabler partner to bring about a change in healthcare which is needed. Bosch can bring about this change in a very strong and intimate way. How is healthcare a good fit for an engineering-driven company? Till date, healthcare mostly has been a service where a close relationship exists between a doctor i.e. the caregiver and another human being i.e. the patient. But, we find that existing doctors or trained care givers are insufficient to cater to the exploding population on earth and this is where a technology player like Bosch can help. There are various areas where Bosch can make a difference. We spoke about doctor-patient ratio that is heavily skewed. Bosch is an active part of a concept called ‘connected world’ which is basically our network. We believe that the connected world will be inhabited by connected life, which means billions of people who are connected to each other. In this concept, we believe that our technology solution can bring in the fourth multiplier effort to bridge the gap between the physical non-availability of a care giver and sort of virtualise

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him to make him available to the needy patients. Can you give us a few examples? Let’s take the example of healthcare capital investment. Most of the capital investments in countries like India or China is heavily concentrated around an urban establishment i.e. tierI cities. This automatically means that no investments are possible in areas which are located in semi-urban, rural or remote areas. So, Bosch wants to introduce solutions where compact portable devices, as an addition to capital infrastructure of the city, could somehow help in extending healthcare services to rural setups. Last but not the least, all of us are aware that healthcare costs only seems to be going up with no possibility of it being affordable to the masses. Bosch wants to bring about an integrated healthcare system. It believes that an integrated healthcare system will enable healthcare services to reach the masses at affordable costs. Again, it would rely on the new emerging concept of Internet of things where billions and billions of devices start talking to each other, exchanging information and bringing the world closer and closer. How will the healthcare business affect your top line? Bosch has already made significant investments for research and development on health technology and

healthcare solutions to emerging economies like India. We are also taking it across the BRIC countries with the vision that ultimately we can bring about some reverse innovation and some of our products will start making inroads into developed countries.

Bosch has competencies which are far more deeper and wider than just as an IT solution provider precision engineering which is required to manufacture these compact sensors. We have made significant headway in bringing this technology to product form. So, investments have already been made, the mind share already exists, all the way from Bosch Board of Management in Germany up to our local management in India and other emerging economies. We believe that this will definitely bring about a change which will add to our volume, ie. our top line and make significant contributions to our bottom line. I’m responsible for taking

How many people work exclusively for healthcare business in India? We have the principle company called Bosch Healthcare Systems GMBH in Germany which was found in January 2015. This is a young, entrepreneurial-driven organisation where we have a research and development pool along with the delivery function. In alignment to that, we have a business domain healthcare practice in Bosch India. Today, we have a staff strength of more than 100. Most of them are high-end engineers and research staff. We also have partners who have assisted us in our journey. Why did you choose eye-care to enter the healthcare market and not IT service solutions? Bosch, apart from being a technology powerhouse and an engineering powerhouse, has competencies which are far more deeper and wider than just as an IT solution provider. Now, in the business domain healthcare, our team has very clearly designed our solution around leveraging these competencies like embedded hardware and near hardware

software. We have the competence to develop application, software on top of it, even to the extent of web, mobile and cloud-based solutions and we want to package the whole thing as one offering, which a typical IT company cannot even dream of. At the lower end of the spectrum, when you are nearing hardware, many of these IT companies have no competence whatsoever to come out with or evolve such solutions. So for example, say a fundus camera which was launched by Bosch India has a physical hardware, physical electronics powered by lowlevel software are interfaced with various IT applications and information is able to go on the cloud to become accessible wherever it is required. Could you give us a sense of the market you are looking at in India? Numbers are still under works. We want to make small inroads in the emerging markets and developing countries. We foresee that by 2020 or 2022 a significant share of Bosch’s total revenue will be contri buted by this business domain. Could you tell us about the products you have developed? There are a set of problems that we are working on. We want to address healthcare’s burning issues. Affordable and accessible care is part of our mission. We have significant focus on non-invasive technology to deliver

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Could you tell us about your product pipeline? In India, anaemia has emerged as a manifestation of malnourishment. We are developing a non-invasive haemoglobin monitor which can be a valuable enabler to detect anaemia. We are working on a cutting-edge optimal sensor into a product to make it marketable. There are several products in the market but many do not address the core problems of accessibility and affordability. We are working with research establishment on this. Are you manufacturing your own products or re-branding existing products as Bosch? We are not acting as a reseller to any company. We source components from our global channels. As far as whether the gadgets we sell is a rebranded product of some other company, I don't think so. The fundus camera is a Bosch product. Where is this fundus camera manufactured? Any product that is branded as Bosch goes through all the processes, quality checks, mandatory certifications, etc.

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Again, with Bosch being a large multinational company, we have our partners who can give a set of components so that the fabrication can be done at a different location. Many products of Bosch are produced at multiple locations. The sourcing of the components can be done from anywhere in the world. Is it true that the fundus

camera is not made-in-India? The product per say is conceptualised, designed and sold in India. As Bosch is an MNC, the subcontracting and channels can be world wide. Yes, it does have components coming from various partners, but I’m not aware of the exact fabrication location. I'll have to check on that. Are you selling this product

in markets other than India? Currently, we have taken the first steps in India. We may in the future make such forays into other markets but now we are focusing solely on the Indian market. Has Bosch Healthcare US shut down? Bosch Healthcare US, basically was an acquisition made by

Bosch. Its function was in telemedicine with a specific focus on North America. As of July 1, that organisation has been shut down. We are in the ramp down phase and all further healthcare activity will be under the GMBH umbrella. Bosch has a dedicated focus in healthcare. mneelam.kachhap@expressindia.com

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healthcare through smart healthcare solutions. We recently partnered with Apollo Cradle to launch a maternal and paediatric mobile-based application. Similarly, we are trying to bring out solutions for geriatric care. We have got good traction for it. We are working together with research institutes, have established a chair at IIS and working closely with them to take cutting-edge research to the market. We believe that these are directions to bring about newer technology to resolve problems of future. Robert Bosch India is a core member of NATHEALTH and one of the active participants in Digital India task force which is underway at NATHEALTH and other industry bodies. We try to give direction to policies for the betterment of people. Currently, our fundus camera is the only device with the customers, but many more products are lined up to be launched in the coming quarter.

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‘Our aim was to provide a complete, one-stop solution for diagnostic testing’ Recently Bengaluru-based Medgenome, a genetic diagnostics and research company raised Rs 130 crores ($20 million) from Sequoia Capital in series B funding. Sam Santhosh, CEO, MedGenome shares the plans for the growth of the company, with M Neelam Kachhap

You started Medgenome in 2013. How has the journey been so far? We started as a ‘Multiomics Diagnostics Lab’ with an initial investment of $five million (Rs 30 crores). Our aim was to provide a complete, one-stop solution for diagnostic testing of every aspect of a disease at the molecular level from the DNA to RNA to protein biomarkers dynamically. And we have been able to do that and more. Our mission is to make this testing available and affordable to people with cancers or genetic conditions and their families, thereby actively working towards guarding health. Last year, we raised Rs 24 crores ($ four million) in Series A Funding, So I think we are on the right track. What was your revenue last year and what are expectations in future? Last year, our revenues were around Rs 25 crores and this year we are expecting around Rs 50-60 crores. The market is opening up as more and more doctors are getting aware of genetics implementation and are getting excited to know that such facilities are available in

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India. We envision that the adoption will be faster now. What are your current plans? The idea is to scale up. MedGenome’s core lab of 10,000 sq ft is based at Narayana Health City, Bengaluru on the third floor of Narayana Nethralaya building. We will take up another floor to expand our lab with more machines. This is for the clinical diagnostics part. Our second revenue stream is paid research, either from academic institutions which get funding and use our services as partners or pharma companies based in US. We have a US office at San Francisco, but there the lab is small because we do not do diagnostics there. It is a technology office cum lab. We want to scale it a bit more, maybe get a bigger lab.

Last year, our revenues were around Rs 25 crores and this year we are expecting around Rs 50-60 crores

What will be the driver of the new momentum at Medgenome? Last year we entered into an exclusive agreement Natera, a global leader in noninvasive genetic testing, to bring non-invasive prenatal testing (NIPT) to India. Natera’s test, known as Panorama, is a non-invasive

prenatal screening test that examines foetal DNA in the mother’s blood to screen for abnormality in the chromosomes. Panorama is the only screening test in the world that detects triploidy status in the foetus (69

chromosomes rather than 46 chromosomes), and reports whether a 'vanishing' twin was present, i.e. there was a twin but it got absorbed, and is no longer detectable by ultrasound. For the last two years we have been offering this test in the US now it is available in India. So doctors won't need to send samples to China or US, it is exclusively available with us and its cheaper. Then there are issues with shipping. So, we see a lot of growth in this segment. We will start carrier testing soon as there is a lot of demand for carrier testing here for diseases like thalassemia. We will keep the prices of our services as low as possible. Which areas in India are you looking at for growth? Most of our sales come from North. Our sales office is located in Delhi. We have a 40 member sales team and are looking to add 20 more this year. We get samples from all over India and a few neighbouring countries also but we have not yet started aggressive sales. We have different MOUs with 35-40 hospitals at present for catering to their genetic testing requirement. We

will involve more hospitals this year. What are the challenges you face in this segment? One of the biggest challenge is creating awareness among healthcare providers. We hold symposiums and minisymposiums on a regular basic and also have conferences and try to get our message across to the target audience. But, we need more effort on this front. Also you need to understand the sample flow in this business. A lot of tests may be required before the genetic tests and these are either done in-house by the hospital or are done at a different location. Then the sample comes to us. So, sample flow management is a big challenge. Also people think genetic testing is very expensive. The tests cost Rs 1.5 lakhs in the US or Europe we offer here at Rs 20000. We do not offer concessions on this rate but if the treating physician recommends a economically weaker patient we try to work out a better offer for them. At present we do not have any tie-up with the insurance sector. We will take this up soon. mneelam.kachhap@expressindia.com

MARKET PRE EVENT

NewDelhi to host Advantage Health Care - India 2015 in October To promote India as a premier global healthcare destination INDIA IS emerging as a preferred healthcare destination for patients across the globe. Growing at a compounded annual growth rate (CAGR) of 27 per cent, the inflow of medical tourists in India is likely to cross 3.2 million in 2015. ‘Advantage Health Care India 2015’ aims to showcase India and its immense pool of medical capabilities as well as create opportunities for healthcare collaborations between the participating countries. Slated to held from October 5-7, 2015, in New Delhi, the objective of this summit is to promote India as a premier global healthcare destination and to enable streamlined medical services exports from India. This underlying objective is a unique conglomeration of the ‘5 – Ts’ - talent, tradition, technology, tourism and trade. The event features are: ◗ Reportedly, first ever international summit on medical value travel being organised in India for promoting services exports from India ◗ Exhibition with focus on hospitals, healthcare centres, AYUSH hospitals, educational institutions, medical devices and electronics, pharma companies, pharma machinery and packaging, and associated infrastructure – medical tourism facilitators, hotels, airlines, tour and travel companies and TPAs ◗ Present and promote exclusive medical services and expertise ◗ Opportunity for state governments to showcase

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MARKET their healthcare and wellness industry ◗ Provide excellent brand visibility to the exhibitors ◗ Knowledge sharing programme where renowned Indian doctors and AYUSH experts will deliver lectures on different topics ◗ International conference on medical value travel ◗ Reverse Buyer Seller Meeting and planned B-2-B sessions with hosted buyers from more than 60 countries ◗ Visitors and hosted buyer delegations from 60 countries ◗ Organised hospital visits by state governments for the visiting foreign delegations to provide exposure of the Indian hospital infrastructure ◗ Health Ministers’ round table session, with Health Ministers invited from the selected 60 countries to discuss issues encompassing medical value travel and formulating a way forward. ◗ Indian healthcare providers and global healthcare stakeholders on one platform ◗ B2B meetings and tie-ups with hospitals and healthcare centres ◗ Showcase medical devices sector - opportunity to encourage foreign companies to start manufacturing in India with local partners ◗ Showcase pharma sector bulk drug manufacturers, pharma machinery and packaging industry strengths for the opportunity to tie up with pharma manufacturers for JVs, services exports and export of machinery ◗ Showcase training capabilities of India in medical, pharma and nursing sector. Engage with international partners for imparting training courses and short education programmes ◗ Training and development of programmes for allied medical staff through Indian medical universities and skill development missions ◗ Opportunity to get into business tie up for clinical research and trials ◗ Establish global business contacts and connects ◗ Sign business cooperation agreements with international stakeholders sending patients to India.

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Musculoskeletal Ultrasound Society to organise MUSoc 2015 It aims to intends to spread knowledge about the vast scope of musculoskeletal ultrasound in clinical practice

MUSOC 2015, an international conference on musculoskeletal ultrasound is being from held 8-11 October, 2015, at the Taj Vivanta, in Dwarka, New Delhi. It is being organised by the Musculoskeletal Ultrasound Society, dedicated to the application of ultrasound to the entire range of musculoskeletal imaging. The event's objective is to teach the anatomy, techniques and interventions applicable to the musculoskeletal system using ultrasound, while constantly defining its role as a major modality in musculoskeletal imaging.

The event seeks to constantly define its role as a major modality in musculoskeleta l imaging The highlights of this conference would be: ◗ Over 20 international faculty apart from renowned national faculty ◗ Dedicated, single focus

educational programmes ◗ Live demonstrations on all joints following each session ◗ Interventional techniques on animal models ◗ Hands-on-workshops each day ◗ One to one interactive session between faculty and delegates to help step into the international arena of teaching and learning ◗ Introduction to world class authors of various books ◗ International accreditation of the conference from America, Europe, UK and India ◗ Companies' support to show-

case the best tools to help delegates get introduced to optimal technical resource ◗ Assurance in form of information on many training programmes for future growth and hand holding Thus, MUSoc 2015 intends to spread knowledge about the vast scope of musculoskeletal ultrasound in clinical practice, teach the right techniques and learn to use the modality judiciously. Apart from radiologists, it is also pertinent for rheumatalogists, pain management consultants, sport medicine experts, orthopaedicians etc.

Transforming Healthcare with IT conference to be held in Bengaluru It offers an opportunity to meet, discuss and disseminate the latest happenings in the field of healthcare IT THE 6TH INTERNATIONAL Conference on Transforming Healthcare with IT promises to be an exciting confluence of minds from the field of healthcare and information technology. It offers an opportunity to meet, discuss and disseminate the latest happenings in the field of healthcare IT. Organised by the Apollo Hospitals Group, the conference is being held on 16-17 October, 2015 at The Lalit Ashok, Bengaluru, India. This edition of the confer-

THIT-2015 intends to spark a breakthrough in collective thinking on usage of Smart ITfor smarter healthcare delivery across the globe ence will focus on the impact of information technology in healthcare, on the theme ‘Today & Tomorrow’. It will reportedly bring together 60 speakers from different

countries addressing over 750 delegates. The conference attracts a focused audience which includes leaders from hospitals, CEOs of healthcare units, CIOs and CXOs, senior

healthcare professionals, domain experts from IT companies, start-ups and venture capitalists among others. THIT-2015 intends to spark a breakthrough in collective thinking on usage of Smart IT for smarter healthcare delivery across the globe. This conference is being held along with “The 5th International Congress on Patient Safety” at the same venue. For more information on the event check: www.transformhealth-it.org

MARKET POST EVENT

OPPI concludes 4 Healthcare Access Summit in Mumbai th

Healthcare Access Award 2015 announced

ORGANISATION OF Pharmaceutical Producers of India (OPPI) recently organised its fourth ‘Healthcare Access Summit’ in Mumbai. The day-long event registered key industry stakeholders and policy makers who discussed various measures which need to be taken in order to improve healthcare access in India. During the inauguration, Dr VK Subburaj, Secretary, Department of Pharmaceuticals spoke about the current state of healthcare scenario in India. He began his address by recalling the evolution of the global and Indian pharma industry and the importance of medicines. He talked about the growing disease burden worldwide, and especially in India. He went on to say, “India is becoming the capital for CVD, diabetes and cancer. Globally, cancer cases are increasing and it is highly recommended that the Indian population should go for routine check ups. The solution for all this lies in adopting the prevention approach.” He also pointed out that India has several health days to commemorate, however, the advocacy for prevention and awareness about these diseases remain constrained to only those days. He stressed upon the fact that India lags behind in addressing disease burden. Highlighting the immunisation strategies, he went on to say, “I think there is a need to have a separate

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MARKET agency which will create awareness among the masses to prevent diseases.” Speaking about the scarcity of doctors in our country, Subburaj pointed out that we have less medical colleges that can provide seats to the number of students applying for medical studies. He added that we need to make adequate arrangement to increase the number of doctors in India. While speaking on Tamil Nadu government’s initiative towards healthcare, he encouraged the public private partnership model and mentioned that wherever good healthcare practices are available in the country, other states should adopt it as the sector needs innovation for the betterment of the society. Hansraj Gangaram Ahir, Minister of State for Chemicals and Fertilisers, Government of India requested the healthcare industry to become self reliable on things where we are dependent on other countries. Ahir said that the core objective is to work for the betterment of the country’s population. He also mentioned that the government wants to increase the production capabilities of the industry and provide affordable medicines to the needy people of the country. “Our ministry is constantly working on this space and I request the industry to work along with the government,” he said. Speaking on the sidelines of the event, Ahir also expressed his views on the recent ban of 700 pharma products by EU. He said, “I am confident that very soon this ban will be revoked as Ministry of Commerce, Government of India is working on it.” Dr K Srinath Reddy, President, PHFI, highlighted the need for a technology-enabled public healthcare system and centralised government’s drug procurement systems. Reddy also questioned the government’s will to successfully implement the National Health Policy. He suggested that to build an productive healthcare system, we need to approach states for more resources. “India needs a

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(L-R) Hansraj Gangaram Ahir, Minister of State for Chemicals and Fertilisers, Government of India, Ranjana Smetacek, Director General, OPPI and Ranjit Shahani, Vice Chairman and MD, Novartis

The event registered key industry stakeholders and policy makers who discussed various measures needed to improve healthcare access in India combination of investment, innovation and integrity to build a strong healthcare system,” he said. During the event, OPPI also announced the Healthcare Access Award 2015 which was bagged by Narayana Health. Dr Devi Shetty, Chairman, Narayana Health, who spoke to the audience through a video call, urged the government to equalise UG and PG seats for medical colleges in India. He said, “The US has 19,000 undergraduate seats and 40,000 post graduate seats whereas here in India, we have 50,000 undergraduate seats and only 14,000 postgraduate seats. Due to this, we are desperately falling short of specialists to tackle NCD and other conditions that need specialised care.” Receiving the award on behalf of Shetty, Arunesh Punetha, Zonal Director, Narayana Health spoke about

their corporate plans, “We will soon establish our hospitals in Jammu, Lucknow, Bhubaneshwar and Mumbai. Nitin Goel, MD, IMS Health Information and Consulting Services India presented the gaps in Indian healthcare infrastructure limits especially in rural areas. He also released their latest report on the healthcare system. He informed that seeing the present scenario, we need three lakh qualified doctors in the system to provide quality healthcare to the Indian population. He also pointed out that no comprehensive survey has been done to know where the healthcare infrastructure has been created. There have been funds created but it’s not being used. Healthcare spending needs to be increased to six per cent of GDP, primarily driven by increase in public spend, he added. (With inputs from Raelene Kambli)

(L-R) Dr Shailesh Ayyangar, President, OPPI and Managing Director, India and Vice President, South Asia, Sanofi, Dr VK Subburaj, Secretary, Department of Pharmaceuticals and Ranjana Smetacek, Director General, OPPI

EVENT BRIEF OCTOBER 2015 05

ADVANTAGE HEALTH CARE - INDIA 2015

ADVANTAGE HEALTH CARE - INDIA 2015 Date: October 5-7, 2015

capabilities as well as create opportunities for healthcare collaborations between the participating countries.

Venue: New Delhi Summary: Jointly organised by Ministry of Commerce & Industry, Govt of India; Federation of Indian Chambers of Commerce and Industry (FICCI); and Services Export Promotion Council (SEPC), Advantage Health Care - India 2015 is an international summit on medical value travel. It aims to showcase India and its immense pool of medical

Contact Federation of Indian Chambers of Commerce and Industry Federation House, Tansen Marg New Delhi - 110001 Tel : +91 11 2370 5468, +91 11 2348 7579 Fax : +91 11 2335 9734 sandip.mukherjee@ficci.com

INTERNATIONAL MUSCULOSKELETAL ULTRASOUND

INTERNATIONAL MUSCULOSKELETAL ULTRASOUND CONFERENCE CONFERENCE Date: October 8-11, 2015 Venue: Vivanta by Taj, Dwarka, New Delhi, Summary: It would focus on the application of ultrasound to musculoskeletal imaging. It would dispense information on the anatomy, techniques and interventions applicable to the musculoskeletal system using ultrasound, while defining its role as a major modality in musculoskeletal imaging Contact

TRANSFORMING HEALTHCARE WITH IT

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

latest happenings in the field of Healthcare IT. This conference is being held along with the 5th International Patient Safety Congress

TRANSFORMING HEALTHCARE WITH IT

Contact Suresh Kochattil Conference Secretariat, Transforming Healthcare with IT, ATNF, 9th Floor, Health Street Building, Apollo Health City, Jubilee Hills, Hyderabad Ph: 040- 23606868 / 09849011006 E: mail@transformhealth-it.org

Date: October 16-17, 2015 Venue: The Lalit Ashok, Bengaluru Summary: Organised by te Apollo Group of Hospitals, the conference aims to bring together experts from both healthcare and IT to meet, discuss and disseminate the

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FOCUS:LEADERSHIP

THE SAPIENT SURGEON Medanta - The Medicity is a testimony to Dr Naresh Trehan's chutzpah and endurance. Now, the cardiothoracic surgeon-cum-entrepreneur has a fiveyear plan for his four-year old business. Will his strategy help him scale greater heights and usher a new era in India’s the healthcare sector? BY NEELAM KACHHAP

t’s a hive of activity outside Dr Naresh Trehan's office in Medanta Medicity, Gurgaon. I am awaiting my turn along with secretaries, patients, executives, department heads, and VIP guests for an audience with one of the most influential men in the Indian healthcare arena. Dr Trehan (69), a cardiothoracic surgeon and the Chairman of Medanta-The Medicity, is a known face at the state banquet and Delhi's high life. He is known to command most of the dialogue in healthcare policymaking in India. Be it industry bodies like CII or PHFI or any committee influencing public policy, his presence is almost mandatory. Dr Trehan's efforts have been appreciated with highest civilian awards like Padma Shri and Padma Bhushan by the government and Dr BC Roy Award by peers. Back in his office, Dr Trehan expresses his dissent when I ask him about his influence on the healthcare sector. "I'm not influential in the sense that I can ensure favourable treatment from someone, especially using my wealth or contact," says Dr Trehan. "I paid every penny for this land (Gurgaon), Rs 84 crores and Rs 150 crores for Noida," he emphasises. “I've been working with the CII National Committee on Healthcare as Chairman since 2000. We have done a lot of progressive work. From starting point when there was no knowledge, the only thing we knew was

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cover ) PADMA SHRI

that we were far behind in the basics. Interacting across the board with all stakeholders of healthcare system we have created know-how for healthcare development,” explains Dr Trehan. “I head the Healthcare Sector Skill Council, which is funded by the National Skill Development Council. We know skilling healthcare professionals in the allied healthcare space is required and we are doing that now." he informs. "I may have shared the dais with the health minister or the Prime Minister on several occasions, but that does not mean I'm influential. My life's philosophy has simply been to work hard with dedication towards my profession, everything else follows," he adds. Dr Trehan has dedicated his life to cardiac surgery and today is known as one of the most accomplished surgeons in the world. Although he does not come from a deprived background, his parents were physicians themselves, and he represents a generation of people who had enough fire in their bellies to make a mark for themselves despite difficult circumstances. Originally from Pakistan, Dr Trehan relocated to Delhi with his family after the partition and grew up with reinforced patriotism and new found enthusiasm just like the young India he represented. "When we were growing up, India was called underdeveloped. A few years later it was called a developing nation. Then a few years later, India was called almost developed and today it is known as an emerging mar-

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PADMA BHUSHAN

DR BC ROY AWARD

ket,” he recalls. He earned his education from King George's Medical College in Lucknow and shifted to NewYork for a better future. In 1973, cardiology was all the rage, most exciting and adventurous. And Dr Trehan wanted it. He wanted it so bad that he fought his way up the residency ladder and snatched the most coveted cardiology training of the time - under the legendary surgeon Dr Frank Spencer at the The New York University School of Medicine. Dr Trehan honed his surgery skills for seven years under Dr Spencer’s tutelage. He worked there till 1988 as Assistant Professor of Surgery. "I had a successful practice in New York. Every year around 300 patients would come from India for treatment. At that time I knew that for every person who could afford to come to New York there were hundreds who could not afford. It propelled me to bring my practice back to India," says Dr Trehan. My thought process said that to have your own identity one must be masters of its own destiny," Dr Trehan reflects. "And that is why I came back to India to create a distinct identity for healthcare delivery that India provides," he says. "However, at that time, private healthcare was not evolved and I did not find any hospital that had the infrastructure to support my work. That's why I built Escorts Heart Institute and led it to be the largest heart centre in this part of the world," he adds. But fate had its way, and Dr Trehan, after falling out

with his business partner, decided to build his own hospital. The very public dispute between him and Shivinder Mohan Singh, MD, Fortis Healthcare resulted in Dr Trehan’s exit from the project he created. In 2003, Dr Trehan started dreaming of an integrated centre of medicine which

would produce new knowledge for people in India. "I was musing over the fact that India was missing institutes like Harvard, Mayo Clinic, Cleveland Clinic and Hopkins in US and Imperial College in London. These institutions are not only the providers of highest end of care in their part of the world but also the

fountain heads of all new knowledge and therapy," explains Dr Trehan. "But this new knowledge was related to their own country and would therefore not be conducive for our people. So we needed an institute that could enhance science by fundamental research and work on minimising costs," he

WE NEEDED AN INSTITUTE THAT COULD ENHANCE SCIENCE BY FUNDAMENTAL RESEARCH AND WORK ON MINIMISING COSTS

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MY LIFE'S PHILOSOPHY HAS SIMPLY BEEN TO WORK HARD WITH DEDICATION TOWARDS MY PROFESSION, EVERYTHING ELSE FOLLOWS

explains. This is how Medanta was born. Dr Trehan found a co-dreamer in entrepreneur, Sunil Sachdeva and set up Global Health, which owns and operates hospitals under the brand name Medanta.

DNA of Medanta - The Medicity Spread over 43 acres, the integrated healthcare facility, houses six centres of excellence which provide medical intelligentsia, cutting-edge technology and state-of-the-art infrastructure with a well-integrated and comprehensive information system. It has 1250 beds with over 350 critical care beds and 45 operation theatres catering to over 20 specialities. "There's never been a hospital built of this variety before, we created an infrastructure in 2.4 million sq ft and matched it with highest technology to make it possible to do research along with treatment. We got human capital of the calibre that is matched anywhere in the world or better than anywhere," claims Dr Trehan. So, what is Medanta's advantage over other facilities? "There is a leader in medicine in each department of equal quality of the world's best benchmark," says Dr Trehan. And rightly so. Be it Dr AS Soin, liver transplant surgeon or Dr Ashok Rajgopal, orthopaedic surgeon; each doctor is an expert in his/her own right. They have all been brought together at Medanta. "We can tackle diseases together,

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cover ) that is what we do. We have a tumour board concept for every disease. We deliberate on all cases together and take a decision. This brings two things, quality and honesty. This is the difference we offer to our patients. This is our advantage," beams Dr Trehan. In four years, he has worked to establish Medanta as the place for superlative medical care. "My dream is that we have the highest standard of healthcare, not only in India but this part of the world. So, if a problem cannot be treated somewhere else then the patient can be sent to us and we will do our best. Medanta is positioned as a destination for complicated cases," he says. "We give the best chance in the world. If you look at the kind of procedures we have developed you will be surprised. We do bypass for patients with 10 per cent ejection fraction and we do it every day. So, today we have gained that reputation that any body who cannot be fixed anywhere else can be fixed here. If you have complications we are the last stop," divulges Dr Trehan. Maybe this was the kind of enthusiasm that led Dr Trehan to take up former CJI, JS Verma’s case. However, not all lives can be saved. The patient died of multiple organ failure at Medanta and the family alleged negligence. The case was dismissed by the Delhi Medical Council and is now being appealed at the MCI. Yet, Dr Trehan is very passionate about upholding ethics in the medical profession. He says, “The subject of ethics in medicine is very close to my heart. We are forming a body called 'Doctors for Ethical Practice' within the IMA with help from Dr KK Agarwal. We will take it national very soon.” So what is next? He says, "We should be able to do primary research here. We should be able to work on development of molecules, looking at disease processes.” In February 2011, Dr Trehan partnered with Duke Medicine, an academic health

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sciences system based in Durham, North Carolina, US, to conduct early phase clinical research at Medanta. Medanta Duke Research Institute (MDRI) was instituted as a new joint venture company where Duke Medicine was to providing scientific, clinical research, and Medanta was to fund the creation and operation of the facility. "The aim was to develop new therapies for a large number of diseases. By performing “proof of concept” studies, the MDRI would have provided opportunities for Indian physicians and patients to participate in the clinical research process in ways that have not been previously possible,” says Dr Trehan. The 60-bed facility was to open in April 2011, but the project never took off. The clinical trial industry in India took a hit when reports of unethical practices surfaced and the Supreme Court, taking a stern view on the death toll associated with clinical trials, recommended the government to re look at the laws governing clinical trials in India. "We have put in a huge amount of resource

MEDANTATHE MEDICITY: ATA GLANCE Spread over

ACRES

1250 BEDS

350 45 20 CRITICAL CARE BEDS

OPERATION THEATRES

SPECIALITIES

into that (MDRI) it is a very costly business. But unfortunately so far we have not been able to progress. We lost a lot of money because of this but we haven't lost hope," says Dr Trehan. In the last two years, the entire regulatory framework pertaining to clinical trials was overhauled. "It disrupted the whole research in all international galaxy. But in a way it’s very good because now we have a regulatory policy, clinical trials were being abused before. As much money as we have lost, I still feel it was a good thing. This was imminent. It should have happened and it did,” informs Dr Trehan. “We will have to refine it (regulations) because we have, on one hand abuse going on, but as a knee jerk reaction, we have become holier than thou. Americans have a very mature system, the Europeans have an equally mature system for clinical trials. We should learn from those experiences and create a policy that is progressive,” opines Dr Trehan. The partnership with Dukes Medicine is still on.

“Actually, last year we slowed it down, but the partnership is still there. We are waiting for the policy to be finalised," he adds. Dr Trehan has not thrown in the towel as yet, he is still hopeful of integrating traditional medicine research with modern medical practice. "In addition to practicing modern medicine, we decided to leverage the strength of traditional medicine, basically Ayurveda and others, and see how we can combine the power of the two for creating therapies which will then become equally or more effective, less traumatic to human body and imminently less costly. We are engaged in frontier research, trying to combine Ayurveda and modern medicine and we have got some early success," Dr Trehan informs. Dr Trehan's effort to create new knowledge is also gaining momentum. “Our clinical outcomes today are as good or better than anybody in the world mostly better,” says Dr Trehan. He says, “There are new things that we have done in all the different specialities, especially in robotics. Dr Rajesh Ahlawat and his team are doing robotic kidney transplant. We have done a lot

(

FOCUS:LEADERSHIP

TODAY, I CAN SAYTHAT I INTRODUCED MODERN CARDIAC SURGERY INTO INDIA. NOW CARDIAC SURGERIES ARE AVAILABLE MORE EASILY IN INDIA in stem cells. We are doing some research on hepatocytes and on liver failure. So, the effort that we have made to create new knowledge across all specialities is happening now.” It has been four years since the hospital opened its doors to the patients and it has already achieved break even. Medanta was started with an initial investment of Rs 1,000 crores, raised through a mix of equity and debt. "We had loan from banks, and investors like Punj Lloyd and Avenue Capital. We achieved fast break even and have paid back all our loan. We have seen a 20-25 per cent year-on-year growth,” says Dr Trehan. “We are growing organically. My principle is, for every facility we can take 50 per cent debt. Today, we are moving at a pace that we can self finance ourselves, but our philosophy on debt is 50-50. So, we will have 4000 more beds in three to four years, financed 50 per cent by us,” he divulges. Recently, Singapore's stateowned investment firm, Temasek bought Punj Lloyd's shares and invested about Rs 700 crores in Medanta. Earlier in December 2013, Avenue Capital sold its shares to private equity major Carlyle Group for an undisclosed sum. Talking about his expansion plans, Dr Trehan says, “I'm not after number of beds. If we have created a system which is producing this kind of result then it should be available to people. I want to take that knowledge to places where it does not exist, so that everybody around can benefit from it. Today, I can say that I introduced modern cardiac surgery into India. I did it and I'm happy in 25 years we have

started a movement. Now cardiac surgeries are available more easily in India. Now, the movement is in multi-speciality and quality, as well as collectively doing research in all this. My plan is to create more institutions like this.” New facilities are already under construction at different locations in North India. “We already have one under construction in Lucknow. With 1000 beds it will be like Medanta,” shares Dr Trehan. Lucknow has always been close to his heart. “Utter Pradesh is undeserved. I'm from Lucknow, I studied at King George’s Medical College. There is a lot of knowledge there but they need a platform to participate in the new development of medicine. There are many practitioners of Ayurveda and Unani medicine which we will leverage,” he discloses. “The second facility we are planning is in Noida because there is need in that area of this standard. Then another facility is coming up in Patna. These are the big ones with 1000 beds,” shares Dr Trehan. “We have taken over Abdur Razzaque Ansari Memorial Weavers' Hospital, Ranchi in Jharkhand and a hospital in Indore. We will upgrade the place and bring Medanta's standard to these undeserved areas so that highest standard of healthcare can be provided to all at reasonable cost,” shares Dr Trehan. “What I would like to do is disseminate knowledge and provide services to people. We will train people in cardiology, orthopaedics, neurology and everything else they need. And we need to multiply. If you were to see how knowledge proliferates, today most of the cardiac surgeons in these cities or the vicinity are

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cover )

trained by me. A lot of people doing liver transplant are trained by Dr Soin,” reveals Dr Trehan. “I'm not going to Chennai. I'm not going to Mumbai. Over capacity does not worry me. It exists here (Gurgaon) also. You can do better than most but that does not mean you are serving peopl Undeserved areas need that quality of medicine. Disseminate knowledge and provide services to other people, that’s what I'm after,” says Dr Trehan. Besides this, Dr Trehan has other plans. “My biggest obsession today is to build a children's hospital of the cali-

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My biggest obsession today is to build a children's hospital of the calibre of Boston Children's Hospital or Great Ormond Street Hospital; not from profit but from my family funding and funding from other philanthropies bre of Boston Children's Hospital or Great Ormond Street Hospital; not from profit but from my family funding and funding from other philanthropies,” discloses Dr Trehan. “I see children are suffering

today as their parents do not have the money or knowledge to provide good treatment. I want to create one of the best hospitals for children in this region. I want to offer subsidised to full free service, but

with a good 500-bed hospital with world class infrastructure,” says Dr Trehan. He wants this children's hospital to be close to the present day Medanta hospital. Looking back at his life, Dr

Trehan says, “Everybody chooses their own space. Mine is basically from the highest end of medical care to improved knowledge to create new medicine in India.” Reflecting on the healthcare scenario in India, Dr Trehan says, “My aim is to bring in new capacity building for India and try to bring everybody together to take every resource that is on the ground and use for Indians. If we do that and build trust between the government and the private sector, everybody will have to perform to keep up that trust. I think then people of India will benefit.” mneelam.kachhap@expressindia.com

STRATEGY I N T E R V I E W

‘Our govt’s focus is first on quality healthcare’ An architect by profession and a founder member of Arvind Kejriwal’s Aam Aadmi Party, Satyendar Jain is Minister of Home, Health, Power, PWD and Industries. He may seem an unlikely choice to handle the health portfolio but he has managed to make a fair bit of progress on the AAP’s promises on the health front. In a frank discussion, he explains to Viveka Roychowdhury that Delhi’s healthcare system needed a revamp and why he is betting on an ATM-like master plan for ‘Anytime, Anywhere Health’

What are the priorities of the Aam Aadmi Party (AAP) when it comes to securing the health of Delhi’s citizens? What are the initiatives you have taken on this front so far? We have increased the health budget by one and a half times in this year. Our first priority is quality healthcare for all. Both conditions are compulsory. It is not acceptable that there is no quality, nor that if we give quality healthcare, it is

available to only some people. Why do we have to choose to give quality healthcare to only, say, five per cent of the population? And then showcase it as an achievement? Even if that five per cent is at the bottom level, it still means that the rest of the 95 per cent are out of this loop. Suppose that of 50 people injured in a bus accident, you decide to give compensation to only two of the injured people, and disregard the other 48 people.

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STRATEGY

We are looking at how we can achieve maximum quality and efficiency, in the least possible time and at the least cost. If you visit the first mohalla clinic, you will see that it has been planned so well that in a small space we are able to fit in a lot Is that right? So our government’s focus is first on quality healthcare and then providing this to everybody. AAP recently launched Delhi’s first Aam Aadmi mohalla (neighbourhood) clinic this July. Isn't this a revamped version of a primary care centre (PHC)? What is the rationale behind this initiative? The concept of the mohalla clinic is that it should be close to people’s homes, within walking distance. This will be the first level of intervention for any health problem they have. Till today, our system has never thought of providing the first level of healthcare within walking distance of people’s homes. The existing clinics are quite far from each other and as a result, people most often have to travel two, three or even five kilometres to reach them. So that’s not a ‘neighbourhood clinic’ in the true sense, because it is not within a locality the patient is familiar with. Our Aam Aadmi mohalla clinics are designed to serve the needs of a particular mohalla (neighbourhood). Each mohalla clinic will have a doctor, an auxiliary nurse midwife (ANM), a pharmacist as well as a lab technician for performing diagnostic tests. The doctor checks the patient, prescribes medicines, (most of which are available within the mohalla clinic) as well as, if needed, asks the lab technician to do the required tests. We plan to offer around

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50 tests within the mohalla clinic, which will cover most of the basic and common illnesses. During our trial runs, we thought that we could attend to 80 per cent of patients’ illnesses at the mohalla clinic and would need to refer the remaining 20 per cent (with more serious illnesses) to hospitals. But now our experience shows that 95 per cent of patients can be treated at the mohalla clinic itself and less than five per cent need to be referred to hospitals. This has two benefits. Firstly, people get quality healthcare close to their homes. They do not have to spend on bus tickets or auto to travel to the clinic. Neither do they have to spend too much time to get their health check up done. Normally they would first spend on travelling to the hospital, then wait for upto two or even three hours for their turn. After meeting the doctor, they’d have to either buy medicines or go to a clinic to get lab tests done. They would get the test done the next day and the test reports the third day, then again wait a few hours to show the reports to the doctor, and only then the treatment actually starts. So for one illness, big or small, the patient has already spent two to four days. But in the mohalla clinics, the patient gets a token number when they visit the clinic. They can either wait or go home because they can judge when their turn will come and they stay close to

the clinic. At the next level, we are creating an app which will alert the patient when his turn has come. Then they can take appointments via cell phones through the app. So we aim to give the same services as already available for other tasks. If you can book flight tickets over the Internet or cell phones via apps, so why not here? The advantage of technology is that it smoothens the process as well as makes it cheaper. Today, we make manual entries in a registry, and each entry is done multiple times. Secondly, we will make a health card for every citizen of Delhi and connect all health services online. A patient will be able to use this at a mohalla clinic, a polyclinic, a multispeciality or super-speciality facility, all with the same health card. There is no need to carry the test reports, X-rays, etc. All the person needs to do is swipe the card, key in the number and since it will be biometrically enabled, give the thumb impression. The doctor can access all the health records of the patient at once, with graphs charting out his health indicators like blood sugar levels, blood pressure readings, previous medicines taken, current medication etc. By when will the health card system be in place? We are targeting for a year but it might take more time as this is a very tight deadline. But we are taking on tough targets because we believe that we

have to aim for the highest level. So, we are looking at how we can achieve maximum quality and efficiency, in the least possible time and at the least cost. So it could be that while we aim for 100 per cent, we might achieve 95 per cent. Another advantage of taking everything online is that we will be able to understand exactly what is happening where, and track everything. For instance, if stocks of a particular medicine in the mohalla clinic are depleting, it will trigger a restock request. So supply chain issues will also get sorted out. We are not reinventing the wheel as most of these systems and processes are already being used in the private sector. The third advantage of the mohalla clinic system is that it will reduce the crowds in hospitals. Right now, it is becoming difficult to differentiate between crowded railway platforms and hospitals. Each bed is shared by two, sometimes three patients. If you don’t have space for patients, how can you treat them? And even if you do manage to get treatment, you will not be able to rest physically or mentally due to lack of space, so how will you get cured? So, we have to increase our capacity. Right now, after 68 years of Independence, we have 10000 hospital beds in Delhi. We are going to add the same number of beds in the next two and a half years, meaning that we are aiming to

double our capacity. We hardly have any capacity when it comes to emergency. ICU or accident beds are hardly 1000 beds of the total 10000 beds. Once this is increased to 20000 beds, around 70008000 beds will be for emergency/ICU beds. You have set a deadline of launching 1000 mohalla clinics within one year, by July 2016. Will you have the staff to man these clinics? As I said before, we are looking at how we can achieve maximum quality and efficiency, in the least possible time and at the least cost. If you visit the first mohalla clinic, you will see that it has been planned so well that in a small space, we are able to fit in a lot. It is air-conditioned, looks good but without an extra inch of space. It may be small but it is well-designed for maximum utilisation of each and every inch. If everything is compactly designed, the running expenses too will be less. That is our target. So we are also looking at the future maintenance of such units when we design and set them up. What about the criticism that the existing 200-odd clinics are mostly defunct and are not staffed? We are upgrading them into polyclinics where each one will have four to five specialists. In a recent interview to

STRATEGY

Indian Express, Union Minister of Health and Family Welfare Jagat Prakash Nadda, in response to the question that the health budget had been reduced, had said that the states have been given the funds, but they do not have the plans. When the AAP campaigned for the Delhi elections, the party manifesto had 17 points related to health. So, what is the progress on each of these promises? We’ll try to achieve all of these in these two and a half years, barring one or two and also expand these 17 promises to 70. I’ve already said what we are doing on the mohalla clinics, increasing bed capacity and computerisation fronts. Budget allocation (for health) has already been increased. We said we would fill existing vacancies of 4000 doctors and 1500 paramedics, while abolishing contractual postings. This is already under process and will happen in a year’s time. We’ve already recruited 1500 paramedics. Are the doctors employed in the mohalla clinics permanent employees? We are studying many models so it’s difficult to comment

inertia.

My speed and the speed of my government is fast, but the system has not yet caught up! There is always resistance to change but now they have realised that our announcements and plans are well thought through and backed by a lot of planning right now. The APP manifesto had also promised free 100 per cent immunisation of infants and young children. What is the status on this? We have already started this initiative, where we run an immunisation camp for seven days each month. Our target is to complete 100 per cent of the immunisation population in one year or one and a half years. The manifesto also said that special eye and dental care clinics would be set up in all public hospitals in Delhi. We are opening 250 dental clinics and this will also happen in the same time span. What about plans to set up a 24-hour helpline manned by well qualified staff in every government hospital in Delhi? In one year’s time, by July 2016.

What about the promise to centralised the procurement of pharmaceutical drugs and equipment? This has already happened. What about plans to provide a free ambulance service across Delhi, even for patients from private hospital? This will take another six months, by February-March 2016. My speed and the speed of my government is fast, but the system has not yet caught up! There is always resistance to change but now they have realised that our announcements and plans are well thought through and backed by a lot of planning. I am seeing a slow change in attitude. We have proved that we can achieve what we promise. For instance, we have increased the number of beds in the government hospital at Burari from 200 to 800. The

cost of setting up the first 200 beds was Rs 90 lakh per bed but the cost of the additional 200 beds was just Rs 15 lakh per bed. So, now they realise that intentions are more important than the cost. And this is not the only example, we are doing the same in the (public) hospitals in Ambedkar Nagar and Dwarka. We will change all of Delhi’s (public) hospitals and you will not feel that you are in a public hospital. Of course, it won’t be like a private hospital but if we are today at the D or C level of infrastructure, we will move up to the B then A level. The biggest thing is that now we have proved that this is doable, easily. And now everyone also feels that it should happen. There was the intial disbelief that this could never happen. Anyone’s first reaction to change is to resist it. That is Newton’s law of inertia: to resist change, to remain in the same position. We have to push away this

Moving on to the promise to open more pharmacy shops to dispense generic drugs? We will be starting this on a trial basis and will roll this out as well in the next year or two year’ time. Another promise was to increase outpatient hospital hours to include early morning and late evening timings to facilitate office going residents. We’ll do this more through the mohalla clinics going forward because even if OPD hours in hospitals are increased, people would still need to travel to them, whereas the mohalla clinics will be more convenient. The manifesto had also promised that while 38 hospitals had diagnostic centres, their testing and diagnostic services would be bolstered and 10 new diagnostic centres would be opened. What is the progress on this front? We are changing this scheme to offer diagnostic services in all 1300 mohalla clinics. Currently, we aim to offer around 50 tests, which will be increased to around 100 tests. Are these services provided

The first Mohalla clinic in Delhi. It’s small but designed for maximum utilisation

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STRATEGY

We have enough policies in our country but there are gaps in the implementation of these policies. We need the experts to study the implementation gaps and tell us how to fix them by private players? We are conducting a trial run and are looking at various models to see which one works best. Either the lab, equipment and staff are of the private player and they provide us the service or we buy the lab and equipment from them and run it with our own staff. We are studying both models right now to decide which one will give us maximum efficiency and quality at minimum cost. But we have gone beyond the APP pre –election manifesto. In addition to the points already mentioned, we are doing a lot more. For instance, we are opening 70 panchkarma and naturopathy clinics, meditation centres, physiotherapy centres. The list is endless. What are your future plans and initiatives? Before we started our work in Delhi, we studied the health systems of the US, where even after spending 16 per cent of GDP on healthcare, many US citizens still face a problem. They are able to provide free services to only 45 per cent of their citizens. OECD spend nine percent of GDP on healthcare. Whereas in India, including the private sector, it’s only four to five per cent. We’ve also studied the health systems of Canada, Latin America and specifically Brazil, Cuba; few countries in Europe and the UK’s NHS. But we realised that we would have to make our own system because our demography and needs are different. We have of course

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incorporated the good aspects of their systems. We have many health policy experts from other countries offering to study our system and help us set policies. We have enough policies in our country but there are gaps in the implementation of these policies. We need these experts to study the implementation gaps and tell us how to fix them. We know where we stand today and where we want to be in two years, but help us to solve the problems along the way. We’ve been preparing for this from December 28, 2013 (the day Arvind Kejriwal took oath as Delhi Chief Minister). It’s like APJ Kalam’s quote: Dreams are not those that you see in your sleep but those that will not let you sleep. My wife jokes that this applies to me! The dreams that we dreamed

of on December 28, 2013 will not allow us to sleep; we will stay awake and fulfill these dreams. It’s been 19 months now (since the APP took office) and we have done many things. We are confident that we will change Delhi’s healthcare system. We will have to make our own healthcare system for Delhi. The existing healthcare system of primary healthcare centre, a secondary hospital and tertiary specialty care hospital system does not suit Delhi’s needs. It was designed for a larger area, a state whereas the NCT has different geographical constraints. Therefore we’ll have to refashion it into a system with many mohalla clinics, then larger polyclinics, followed by a few multi and super speciality hospitals. For example, take eye care. Today, there are around 33 eye

Dr Alka Choudhary, Medical Officer, Aam Aadmi Clinic treating a patient

care facilities in all Delhi’s public facilities with two to three eye doctors but none of them offer the full spectrum of eye care. So we will consolidate these to just seven or eight fully speciliased eye care centres of excellence (CoEs) with 10-12 doctors. Govind Ballabh Pant Hospital is well known for ortho care so we will designate it a CoE and then make four more like it. We’ll do the same in liver and biliary sciences. Today, we have islands of success; we will replicate these islands of success. We will repeat what is right, and fix what is wrong. We’ve divided Delhi into five zones: north, south, east, west and central Delhi. Each unit will be self-contained. No one will have to go to another zone for multi- or super speciality care. All this calls for some reorganisation but it will allow

us to make better utilisation of the resources available to us. How will the mohalla clinics evolve in future? Today, we avoid going to a hospital for upto 10 days even though we may be running a fever. We prefer to selfmedicate. It is better that people get treated early and avoid coming to hospitals because hospital care can get expensive. These mohalla clinics will be particularly helpful for aged patients because these are almost at their doorsteps, they can go twice a week to check their blood pressure, sugar levels, etc. These visits cost a fraction of what would have to be spent if they need hospitalisation. These mohalla clinics will later double up as preventive healthcare centres once we start health awareness drives on Sundays. We will use a lot of technology. This has never been done before so we are starting on a clean slate. This is good because we can directly use the latest and the best technology, rather than making do with obsolete systems. We are bypassing desktops and laptops and directly putting all our (health related) technology and apps on tablets. Just as banks have opened ATMs everywhere to avoid overcrowding their banks, I want the mohalla clinics to be ATMs for health services: i.e. ATH, AWH: any time health, anywhere health. viveka.r@expressindia.com

STRATEGY INSIGHT

Healthcare marketing risk management: An objective approach DR KAPIL MOHAN Healthcare Management Professional

Dr Kapil Mohan, Healthcare Management Professional, speaks about how healthcare providers can manage marketing risk by way of synergising overall business operations

TEN MOST COMMON CONCERNS FOR MARKETING FUNCTION

Assess

◗ Insufficient knowledge of customer’s attitude and behaviour

Measure

Many a times this leads to replacing the associated agency/ vendors or reassigning responsibilities via organisational changes, where responsibility for driving top line revenue is assigned amidst complex operating environments. Typically, these are all too narrowly focused and many a times lead to additional complications. Progressive marketing organisations recognise that managing risk is the responsibility of the entire marketing organisation. It is not compartmentalised within different functions or assigned to a single position but rather seen as a key practice for developing and executing the marketing plan. Until recently, this idea of end-to-end risk and performance management as a key activity in the marketing organisation has been practically unheard of. But, increasingly, senior management is looking to marketing to enable, if not drive, short and long-term business growth, while improving accountability, transparency, and speed to market. Effective risk management allows marketing to take on the myriad go to market obstacles necessary to facilitate business growth within this complex environment, to achieve business objectives. Properly configured and executed, it provides an opportunity to improve business returns with greater quality, resilience, and predictability across the enterprise.

◗ Failing to segment the market in the most advantageous way

Risk Management

Evaluate

ORGANISATIONS FACE internal and external actors and influences that make it uncertain whether, when, and the extent to which they will achieve or exceed their objectives. The impact this uncertainty has on the organisation’s objectives is ‘Risk’. Healthcare provider organisations today face significant challenges when contemplating change to their strategies, execution processes, information and people. Operations, logistics, finance, human resource, sales and marketing environment is increasingly more complex as they strive to position for changing consumer tastes and preferences, channel proliferation, demands of innovation, accelerating technological breakthroughs and the increasing intensity of competition. This necessitates a change of attitude and direction by some companies to incorporate more attacking and defensive measures in the planning and implementation of their marketing efforts. Managing this complexity gets more expansive and costly by the day in comparison to gross revenue, which results in a wide range of uncertain factors or risks when changes threaten the organisations’ ‘goto-market’ strategy. Additionally, as a healthcare organisation seeks answers for failed initiatives and/or lost opportunities, it leads to assignment of blame and costly changes.

◗ Lack of marketing planning process ◗ Cutting price rather than increasing value ◗ Failing to have market-based product evaluation

Manage

◗ Misunderstanding the company’s marketing strengths and how they relate to market ◗ Narrow, short-term view on advertising and promotion

Effective risk management allows marketing to take on the myriad go to market obstacles necessary to facilitate business growth within this complex environment, to achieve business objectives Risks and controls – marketing Performing risk assessment requires defining and consistently applying an approach that is tailored to suit the organisation. A multi-tiered platform of business objectives, key result areas

and/or key performance indicators, risk factors, and control factors should be developed in concert with the traditional marketing process of strategy development, marketing planning, execution and evaluation. Responsibilities in the risk as-

◗ Tendency to view marketing as only advertising or sales ◗ An organisation structure incompatible with marketing structure ◗ Failing to invest in future, particularly in human resources and technology

sessment process are assigned to those parties who can provide meaningful perspective on relevant risks (not only line management but also crossfunctional representation). Sources of input are determined based on available information (such as prior assessments, KRAs, lessons learned). Output requirements are established based on the specific re-

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STRATEGY

! Process Step / Activity

occurs at

Risk

Business Objectives

is reduced by

Key Result Areas (KRAs)

Key Risk Indicators (KRIs)

Key Control Indicators (KCI’s)

Control

C is monitored by

KRAs

KRIs

Standardisation

R1: Inconsistent and/or sub-optimal decision-making and operations resulting in adverse operational efficiencies/effectiveness/governance issues

Organisational structure

R2: Sub-optimal utilisation of resources due to lack of clarity in organisation structure, work flow, authority matrix, expectations and deliverables, potentially leading to excess costs/financial loss and/or operational disruptions

Budgetary controls

R3: Non-budgeted expenses/expenses potentially exceeding budgets, leading to adverse cash flow

Business strategy

R4: Lack of clear direction as to where marketing efforts should focus, lack of understanding of what marketing methods are going to reach customers in the exact manner that organisation was hoping for, may result in deviation from marketing objectives/goals

Revenue and profitability

R5: Non-collection of amounts for services and goods availed by patients.

Test

quirements of sponsors and other stakeholders (senior management, the board, regulators, stockholders, or business partners). This platform connects the marketing strategy with multi-functional execution within the company. The tiers of indicators reflect the cascading of top level management objectives with the day to day management of marketing programmes and supporting operational activities. Understanding of the business objectives relevant to sales and marketing function, in scope for risk assessment, will provide a basis for subsequently identifying potential risks that could affect the achievement of objectives, which reflect the core strategy that the organisation is adopting with respect to each Key Result Area (KRA), wherein performance has a critical impact on the achievement of the overall strategic mission. Although there may be a variety of objectives any healthcare organisation may have defined, major KRAs of sales and marketing function comprise of standardisation, organisational structure, budgetary controls, business strategy, revenue and profitability, brand and communication, differentiators and innovation.

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Based on KRAs assigned, the designated owners should develop a preliminary inventory of key risk indicators (KRIs) that could impact the achievement of the organisation’s objectives. ‘KRIs’ refers to prior and potential incidents occurring within or outside the organisation that can have an effect, either positive or negative, upon the achievement of the organisation’s stated objectives or the implementation of its strategy and objectives. KRIs must be identified from the information obtained through interviews, workshops, surveys, process flow reviews, documentation reviews, questionnaire/s, self-assessment exercises, industry practices etc. or a combination of such data-gathering techniques. Through facilitated workshops, risk practitioners can guide line management and cross-functional staff through the process of analysing objectives, discussing past events that impacted achievement of those objectives, and identifying potential future events having such impact. There are many more such (classes of) risks, so a comprehensive risk identification needs to be done; after the risk is identified, it should be cate-

R6: Absence of legally vetted agreement, or expired or incomplete agreement, may lead to potential financial loss and/or lack of adequate legal recourse when needed. R7: Potential financial/profitability loss due to--absence of/inadequate marketing programme feasibility and post execution evaluation-failure to meet budgeted annual and channel-wise sales targets

Brand and communication

R8: Weak branding leading to--loss of sales/attraction for new customersdilution of brand equity-loss of customer loyalty and/or-stagnated business growth

Differentiator

R9: Undistinguished products and services from those available in a crowded marketplace, which may lead to potential financial loss due to lack of uniqueness in the minds of customers.

Innovation

R10: Potential stagnation in services could lead to commoditisation and hence loss of premium.

gorised and prioritised and key controls for each risk should be defined and implementation of such controls monitored. The overall business objectives and the functional objectives should be clearly defined/identified and then key risks for the concerned domain

would need to be factored in, to ensure we plug all significant gaps. Formulation of risk and control for marketing function, is in itself a complex affair as one size doesn’t fit to all. Nevertheless synergising overall business and functional objective with an agile and measure-

able marketing plan/strategy is the big challenges and critical successes factor. It is always better to take a professional help than to be penny wise and pound foolish. Finally, the efficacy of such defined controls should be tested on a regular basis.

STRATEGY INSIGHT

Preventive and predictive healthcare

INTEGRATION OF TECHNOLOGIES In India, the primary goal of PPH will be, to develop tools for early diagnosis of the risks and initiate appropriate preventive strategies, says Gundu H R Rao

outh Asians ( I n d i a n s , Bangladeshis, Pakistanis and Sri Lankans) have a very high incidence of cardiometabolic diseases, such as hypertension, metabolic syndrome, abdominal obesity, Type-II diabetes, ischemic heart disease and stroke. Preventive and Predictive

Healthcare (PPH) uses stateof-the-art diagnostic tools, to identify the patients who may be at high risk for hospitalisation or developing acute events, leading to morbidity and mortality. Once identified, the system will proactively contact the patients, to initiate positive behavioural changes, to improve better management of their health.

GUNDU H R RAO, PHD Emeritus Professor, Laboratory Medicine and Pathology, University of Minnesota, USA. Founder CEO, South Asian Society on Atherosclerosis and Thrombosis (SASAT).

By integrating predictive modelling with early diagnosis of the risks, behavioural changes, life style management, medical management, pharma management and personalised empowerment services, PPH provides a unique healthcare service platform. Ayurveda scholars have been debating and using this logic for centuries. Tri-dosha classi-

fication of Prakriti has been used by the Vaidyas, to determine the state of health and predisposition of individuals to various metabolic diseases. According to this theory, each individual has a certain ratio of Vata, Pitta and Kapha (the three doshas) that is unique to him or her. Sharma and Chandola (2010) conclude in their article, that the complex set of

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STRATEGY

disorders identified as Prameha in Ayurveda, correlates in many ways with obesity, metabolic syndrome, and diabetes. Neither the Emory University (USA) Predictive Health Initiatives nor the Ayurvedic studies on Prakriti, have developed significant clinical evidence, to support their concept and as such, cannot be effectively used for risk profiling, risk prediction, management of observed risks and disease prevention. Having said that, can we give this ancient science a critical validation at least? Of course we can design appropriate population-based studies, to test this system of classification of metabolic risks and diseases. A large randomised study can be initiated to test the dosha system of classification of the health status. Various cardio metabolic diseases such as pre-hypertension, hypertension, visceral obesity, metabolic syndrome, pre-diabetes, type-II diabetes, ischemic heart diseases and stroke are, after all manifestation of alteration in the metabolic functions. For the sake of simplicity, we can administer Internet-based Deepak Chopra’s Dosha quiz (www.doshaquiz.chopra.com) to 10,000 individuals of ages between 30 to 60 and further evaluate this selected cohort, with another of Deepak Chopra’s survey or some other standardised test (www.doshaquiz.chopra.com/dos ha_part2.asp) or an independent test developed by the experts in this field and further classify this population into the basic 3-doshas (Vata, Pitta, Kapha) or into six or nine subtle variants of the doshas. Then we can investigate these selected cohorts, with a second set of interviews, and identify the type of diseases which are prevalent or the observed risk factors they have for various metabolic diseases, and generate clusters of “at risk” individuals or diseases. We can further evaluate this population for altered activity of metabolic enzymes. In a country like India,

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with an epidemic of cardiometabolic disorders, the primary goal of PPH will be, to develop tools for early diagnosis of the risks and initiate appropriate preventive strategies. Currently, India has 65 million type-II diabetics and an equal number of pre-diabetics. In addition, there is cooccurrence or co-morbidity of other cardio metabolic risks such as hypertension, visceral obesity, metabolic syndrome, ischemic heart disease and stroke. All of these risks are, in some way or the other interrelated and plays a critical role in the development of acute vascular events. If we just look at type-II diabetes as an example, then from the management perspective, we will have to start with early diagnosis of the risks for hyperglycemia, as well as alterations in blood vessel-wall pathology. One of the gold

circulating blood components produce vasoconstrictors. Alterations in the production of these vasoactive molecules will result in changes in the vascular compliance and initiate a condition called, endothelial dysfunction (ED). This is the earliest vascular pathology that we can detect currently, for risk assessment. There are many tools available for assessment of this condition. Examples include, Periscope (Genesis Medical System, Hyderabad), CV Profilor (HDI Diagnostica, Minneapolis, MN) and TM-Oxi system (LD Technologies, Miami, Florida). The software generates impressive diagnostic reports with some recommendations. Risk factors chart includes; marker for Autonomic Nervous System (ANS) activity, ANS balance, fat mass, markers of lipidemia, markers of endocrine

cussed in this article, power of prediction mainly comes from analytic validity, clinical validity and finally clinical utility. The point of concern when considering the power of prediction will be, the selection of parameters that provide the most accurate and reliable risk prediction. We also have to consider, whether we are discussing prediction of a risk for disease, for an interventional procedure, for hospitalisation or for acute events. Therefore, risk prediction tools have to be developed keeping these various stages of the risk and disease management strategy in mind, and come up with appropriate assessment tools. In view of the fact, that there is a tremendous activity in the development of risk and disease management applications, it should seriously consider the best use of the

One of the gold standards to monitor hyperglycemia would be to monitor postprandial glucose levels, two hours (2HPPG) after a meal. This risk assessment will get a great boost, if we develop a non-invasive glucose monitoring system standards to monitor hyperglycemia would be to monitor post-prandial glucose (PPG) levels, two hours (2HPPG) after a meal. This risk assessment will get a great boost, if we develop a non-invasive glucose monitoring (NIGM) system, as there will be little resistance for risk assessment using this novel technology. Similarly, early detection of altered vessel-wall pathology will provide us great opportunity to initiate behavioural changes and integrate holistic preventive management strategies. Vascular physiology and pathology are modulated to a great extent by the endogenously produced vasoactive molecules. Endothelial cells lining the vessels produce a variety of vasodilators and

disorder, insulin resistance, insulin production, microcirculation; C-fiber density, sympathetic failure score, parasympathetic failure score, blood pressure control score, cardiac performance score, and endothelial function score. The developers of the original non-invasive diagnostic system (LD-Technologies) claim, that the system detects 14 cardio-metabolic risk markers. Some major questions that arise in the mind when you hear, such claims is, how can a simple device, with three well-tested components such as pulseoximeter, blood pressure monitor and galvanic skin response monitor, provide information on 14 vital cardiometabolic health indicators. As we have already dis-

smart phone, tablets, big data and cloud computing, for enhancing our diagnostic and predictive capabilities. We should also consider what are the best diagnostic parameters needed for use in a risk assessment tool to get optimal results. With the rapid advance in the development of medical devices, data collection, computing, big data storage and analytics, genetic risk assessment, and the availability of a variety of non-invasive diagnostic technologies, now it is possible, to use multiple technologies, utilise the collective strengths and build a comprehensive risk assessment and risk prediction platform. To create awareness, develop educational and preventive programmes, I started a

professional society, SASAT (www.sasat.org) at Minnesota, USA, in 1993. We have organised over 15 international conferences on this subject in India, under the aegis of SASAT and published several books related to this topic. During the SASAT-2006 conference in Bangalore, we organised a round-table conference to discuss how we can develop a seamless platform for developing affordable healthcare for all. Experts who met at this conference suggested that we should bring in practitioners of traditional Indian medicine also on to this platform. The purpose of this essay was to articulate the possibilities, create awareness about the priorities, describe current status, stress on challenges, and opportunities, initiate robust discussions related to the immediate need for the creation of a “National Platform” for addressing the prevention and management of cardiometabolic diseases. When it comes to preventive healthcare, the modern medicine has failed to develop robust preventive strategies for the prevention of cardiometabolic diseases. Whereas, the ancient art of healing, Ayurveda has been promoting holistic approach for a healthy disease-free life. Modern medicine on the other hand, has been advocating early detection of symptoms or risks for various disorders and better management of the risks for prevention of acute events from occurring. We are of the opinion, that integrative approach to healthcare, taking the best of the ancient medicine and the best of the modern medicine would be ideal for a country like India. We should also take advantage of the rapid progress in emerging technologies, like biotechnology, bioengineering, biomedical sciences and information technology, to develop a seamless integration of these technologies, for developing an easily accessible, widely acceptable and relatively affordable healthcare.

CARDIAC CARE SPECIAL

THE

STENT SAGA

Overuse and over pricing of stents in cardiac care procedures has been a hot topic for discussion lately. An analysis delving into the factors driving these issues and measures to mitigate them BY RAELENE KAMBLI

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CARDIAC CARE SPECIAL

n the last five years, the coronary stent market in India has been growing at an impressive rate due to rise in coronary angioplasties which have resulted from a surge in cardiovascular diseases (CVDs). According to the National Interventional Council (NIC), coronary interventions in India have increased from 117420 since the year 2010 to 248152 in the year 2014. The NIC report discloses that India is one of the few countries where percutaneous coronary intervention (PCI) are growing at 14.5 per cent rate over 2013 (Check table on NIC statistics on CVDs, PCI and Stents implants). The total number of stents implanted last year was 3,10,190, out of which approximately 60 per cent of the market is shared by multinational companies such as Abbott, Medtronics, Meril Lifesciences, Boston Scientific etc. As per a report published by Ace Business and Market Research Group (ABMRG), a research and consulting company, the coronary stent market in India, which comprises drug eluting stents (DES), bare metal stents (BMS) and bio-absorbable stents (BVS), was valued above $400 million in 2012. The report further states that the stent market in India would triple in numbers by 2021. However, in the last few months, the success of the stent market in India has been constantly under the scanner by various government agencies and the media. The industry is presently battling against two major accusations- over pricing and over use. Express Healthcare chose to dig deep and examine this situation.

of stenting and the other concern is restenosis (or reocclusion), the recurrence of abnormal narrowing of an artery or valve after corrective surgery. The percentage/incidence of closure/restenosis was very high in balloon angioplasty, depending on the lesion length and size - sometimes as high as 30-40 per cent. This meant the failure of the procedure. A number of factors (methods/procedures?) such as i.e. drilling, laser, cutting, radiation were tried as a solution of this problem, but nothing was so successful between 1988 and 1996.” Stents entered the Indian market during the 90s in the form of bare metal stents which proved to be one of the most useful and beneficial devices for patient of coronary artery blockage undergoing angioplasty at that time. “Early stents solved the main problem of acute closure markedly and also the restenosis problem to a certain

extent, which resulted in the percentage of closure/restenosis coming down from 30-40 per cent to around 15-20 per cent. Subsequently, the drug-eluting stents, which became available in 2005-06, addressed the problem of restenosis successfully with the percentage of restenosis coming down sharply from 40 per cent to less than 10 per cent and in some cases, no restenosis at all, depending on the size and length of lesion,” informs Dr Ravat. Talking about the initial prices of stents in India, Dr Praveen Chandra, Chairman- Division of Interventional Cardiology Heart InstituteDivision of Cardiology, MedantaThe Medicity mentions, “Initially, (in 1992-1993), none of the stents were manufactured in India. Since these bare metal stents were imported to India the cost of these stents were around Rs 80,000-95,000 in those days. At that time there

were around 25-30 cath labs in India. Soon, with the upsurge in CVDs, the demand for stents and cath labs increased. In 2004, drug eluting stents entered the Indian market whose costs ranged between Rs 80,000127,000 . Today, there are around 10,000 cath labs in India that performed around three lakh stent implants last year”. Facts provided by the NIC, a data registry for the cardiologist and people associated with cardiac care), proves that there is a growing demand for cardiac interventions, especially in terms of stent implants. But, does this mean that all these CVD patients require stents? Why is the industry being accused of overuse of stents? Let’s understand this aspect first.

US stent market vs India If we take a look at the global scenario, the increasing numbers of PCIs has been ques-

tioned worldwide by several research agencies. Take the example of the US, where in the last 10 years several studies published by association such as American Medical Association, the Joint Commission and reputed publications such as New York Times, Reuters etc., show that there is a constant misuse and overuse of stents. In January 2006, an article published in the journal Circulation observed that although there has been a dramatic increase in artery-opening procedures to prevent heart attacks, over the last 10 to 15 years, the rate of heart attacks stayed relatively constant. In the year 2010, a stent scandal broke out after the arrest of Dr Mark Midei, a star cardiologist at St Joseph Medical Center in Townson, Maryland. The New York Times published a head-turning tale about this well-acclaimed cardiac surgeon who was found

Dr Hasmukh Ravat, Cardiologist, Fortis Healthcare, Mumbai remembers the way angioplasties were performed earlier and says, “In the evolution of angioplasty as a procedure, two factors (and limitation) have always remained matters of concern. First, the acute closure happening within a few hours to the day

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Source: NIC

Beginning of the story

CARDIAC CARE SPECIAL to be taking illegal kickbacks from a leading multinational stent making company that operates in India as well. After this incident, leading cardiologists in the US confessed that some doctors were overusing heart stents in an effort to make up for lost revenue due to health revenue cutbacks and also because of kickbacks received from multinational stent makers. The multinational stent maker who was involved in the scandal is still freely doing and growing its business worldwide and enjoys a huge market share in India's thriving stent market. Episodes similar to what happened in the US have been reported in other parts of the world as well. So, what’s the scenario in India?

Over use of stents in India: Decoding the issue

Source: NIC

Looking at the alarming rise of CVDs in India, it won’t be hard to believe that the increasing number of stent implants can be justified. Still, how many of these stenting procedures are medically advisable and how many doctors put patients at unnecessary risk and make them bear unnecessary procedure costs? A well-read daily recently published a study by interventional cardiologists in the country which revealed that 50 per cent of patients who have been advised stents to remove heart blockages do not require it! The study further states that every heart block does not need a stent and can be managed with medical treatment. And again, every block does not need a drug eluting stent or the latest technology of absorbable stents (costing between Rs 1.5 to Rs 2 lakhs). Renowned cardiologists also fear overuse of stents in India. “In India, there is no audit for the medical procedure, so claiming misuse of stents can neither be validated nor dismissed,” says Dr Praveen Kulkarni, Consultant- Cardiologist, Global Hospitals Mumbai. Adding to this, Dr Ravat, says, “There have been instances of misuse of stents in India. Stents can be misused in some cases where they are not required, i.e. in case of a small vessel or not-significant size of vessel or less severe or significant lesion, there is a possibility

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CARDIAC CARE SPECIAL

At my hospital, I get around 30 per cent patients who have been advised stent implants or bypass procedures by their doctors and who actually do not require these surgeries Dr Ramakant Panda Vice Chairman and MD, Asian Heart Institute

Prices of stents have been coming down in India. With the availability of stents manufactured in India and regulatory bodies keeping a close watch, they are expected to come down further Dr (Prof) Harsh Wardhan HOD-Cardiology, Primus Hospital, New Delhi

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India DES sold in private hospitals

Imported DES sold in private hospitals

Govt prices for DES (under the CGHD and other govt schemes)

70,000-80000

75,000-90,000

23625

Average cost 70,000

Average cost 75,000

that instead of one long stent, a number of small stents are used. There is no evidence that lesion will be of any benefit in case of total damaged heart wall muscle.” “With no standardised regulations, misuse or overuse is ought to happen. At my hospital I get around 30 per cent patients who have been advised stent implants or bypass procedures by their doctors and who actually do not require these surgeries. I treat them with just medication,” reveals Dr Ramakant Panda, Vice Chairman and MD, Asian Heart Institute. Dr Prafulla Kerkar, HOD Cardiology Department, KEM Hospital, and Consultant Interventional Cadiologist, Asian Heart Institute explains how this overuse or misuse happens. He says, “Stents are most useful in saving lives while dealing with acute problems of the heart, like heart attack or pre-heart attack symptoms. Implanting a stent in a 100 per cent blocked artery after 24 hours of a heart attack in a stable patient is useless. It should be implanted before the golden hours. So when cardiologists do not test the viability of the heart muscle before implanting the stent in this scenario, the actual misuse happens.” While there are a few cardiologists who agree that there is overuse to certain extent, there are a few who spurn this allegation. Dr Lekha Pathak, Executive President, Heart Foundation of India is one of them who denies this accusation. She says, that this issue is overhyped and people should remember that stents are used to save lives of patients and that there is no misuse or overuse. “There is a misconception about this problem,” Dr Chandra asserts. But, he agrees that there are some grey zones within the industry as well. Giving the view of a multinational stent maker, Milind Shah,

MD and VP-South Asia, India, Medtronic points out, “India has a very low usage of stents. The recently published NIC registry data suggested that only 0.02 per cent of the coronary artery disease (CAD) patients in India go through angioplasty whereas in the US, 3.24 per cent of the population undergoes angioplasty every year. Interestingly, NIC registry data also reflected a trend contrary to the claims of overuse, with the rate of growth of angioplasties going down from 22 per cent in 2013 to 14 per cent in 2014. The reduction of growth rate in procedure points towards reducing treatment adoption of angioplasty. These data points may not suggest an overuse.” Though the growth rate of PCIs may have gone down as per the NIC, the fact that the issue of over use of stents in India can only be dealt with effectively and curbed if the government brings in stringent regulations for such high risk procedures.

The cost issue... The other and the most talked about issue around the use of stents in India is the problem of high costs associated with these procedures. Once again, if we compare the Indian cost with the rest of the world, we are far more affordable. Our healthcare costs are lower compared to that of our neighbouring countries, Europe and the US. Dr Chandra informs that nearly 30- 35 per cent of patients from the US, Europe, Africa and some Asian neighbours seek cardiac treatment in India. Dr Panda also reveals that India's healthcare costs are cheaper than those of even Pakistan and Bangladesh. However, coming back to the costs of stents in the US, in 2010 the price of a stent was less than $1000 but the cost of procedure for implant would range anywhere from $30,000 to more than $100,000. Today, the cost would vary only

by a small margin. However, in India there is an assumption that the cost of stent implants is high due to the high cost of the device and also because cardiologists still choose imported stents over local ones. To understand the real cost difference between imported stents and local ones. We further spoke to some cardiologists and some distributors of stent both local and imported stents after which we derived at the average prices of stents sold in India. But before this it is important to note that, the Union health ministry has fixed Rs 23,625 as the price of a DES under various government schemes. (See the table above) While speaking to Dr Panda, he admits that there is no huge difference between imported and local stents. He says, “In fact we expect that local stents should be around 50 per cent cheaper than imported ones. But that’s not the case.” Dr Chandra also complies with the fact that there is no huge difference. He says there is a difference of around Rs 10-15 thousand only. Now the question that arises is why do cardiologists prefer imported stents? Dr Panda explains, “The simple reason is that Indian stents are not clinically proven to the extent that we can recommend it to patients.” On the same lines, Dr Chandra explains, “Imported stents become an obvious choice because these FDA-approved stents have gone through several clinical trials. For any stent to get an FDA approval, manufacturers will not only have to conduct many clinical trials but they also will have to conduct two to three compound studies on the device before undergoing certification. So, since these stents have gone through so many trials and are acclaimed worldover, we prefer these stents.” Giving the stent manufacturers the benefit of doubt, Dr

Praveen Kulkarni, ConsultantCardiologist, Global Hospitals Mumbai, speaks about the rationale behind the high cost of stents and the reason why patients pay so much for such procedures in India. “Speaking economically, actual production price of any product is always dramatically different from the cost of the product to the end users. Stents costs are expensive because the research and development costs are very high. The companies who invest heavily into R&D have to recover their costs and hence the cost is high. These expenses are always borne by the end users that are patients. Also, India has one of the highest ‘out-of-pocket’ expenditure on healthcare. This directly burdens the common man, especially in high-end procedures,” he accounts. We acknowledge that more investment in R&D will increase the overall cost of the product. That does not mean we can ignore the affordability part of these procedures for Indian patients. Studying the US market on this aspect we derive that even if the price of stents and the procedures in this part of the world are higher than that of India yet insurance and government funding does relieve maximum burden of their medical expenses. Nonetheless in India, we have approximately 15 per cent people having medical insurance and our government funding in this area is around 37 per cent, as per NIC reports. So, still a large amount of CVD patients who undergo PCIs have to pay out of pocket. Well, the good news is that the government has taken initiatives in this regard to bring prices under control by capping the amount of DES stents under various government schemes. And, taking this as opportunity, stent makers are leaving no stone unturned to grab a share of the pie by bringing down the cost of their

CARDIAC CARE SPECIAL products. Informs, Dr Nilesh Gautam, Senior Interventional Cardiologist, Asian Heart Institute, “As new players are entering the angio-device industry, the competition to grab the maximum market share is increasing. Hence, every player is trying to provide the best quality equipment at the lowest possible price, leading to an overall reduction in the device prices. For example, the price of bare metal stents and drug eluting stents has been slashed by approximately 15 per cent. The price of angioplasty balloons, catheters, and wires has fallen by almost 40 per cent.” Dr (Prof) Harsh Wardhan, Head of Department of Cardiology, Primus Hospital, New Delhi, opines, “The prices of stents have been coming down in India over the years. With the availability of stents manufactured in India and regulatory bodies keeping a close watch on stent prices, they are expected to come down further, making it more affordable for patients. Some state governments have taken the initiative to provide free PCI procedures and stents to poor patients. Clinical research and trials of indigenously manufactured stents will go a long way in developing the confidence in these indigenously produced devices and reducing the cost of procedures.” However, if stent prices are dropping, why is the patient paying a huge price for angioplasty procedures? An industry source who

prefers to be anonymous informed that in a private set up in New Delhi, the average angioplasty package has moved from 1.5 lakhs in 2001 to Rs 2.25 lakhs in 2015. Which is about Rs 75,000 rise in the last 15 years, notwithstanding inflation. “In the present scenario where the cost of stents to a hospital have dropped by around eight per cent CAGR over last decade, yet the price of a stent to the patient has not seen much reduction,” the source questions. He further says, private hospitals offset the losses on the angioplasty package (which they incur because of higher infrastructure costs, salaries, etc) by cross-subsiding it with what they gain through negotiating a reduction in prices with stent companies.” We tried to find out from some patients about their experiences.

implant and Rs 46,000 for hospitalisation, including doctor's fees and other expenses, the break-up for which was informed to him well before hand. However, Basu also informed that he would had to cough out Rs 2,00,000 for the implant if he would have done the operation at Kolkata's leading heart care institute as the hospital had quoted them this sum. Despite the price war that Basu faced, he still seems to be visibly happy as he leads a normal life now. “I am leading a normal life after the stent implant and there were no complications after the procedure,” he informs.

The companies (stent makers) print liberal MRPs; so the effective price for stent to the patient depends on how much profit margin the hospital wants to maintain on the ‘trading’ of the It’s a long way to go.... stents Clarifying why hospitals charge Dr Hasmukh Ravat Cardiologist, Fortis Healthcare, Mumbai

Patients’ view Arundati Shah, a 56-year old woman has had a stent implant done in 2013. Although she leads a normal life now, she has bitter memories of the time when she suffered a heart attack back then. She recounts, “My family was told by the hospital, which is a leading private healthcare institute in Bandra, that they required to implant a stent when I suffered a massive heart attack in June 2013. However, the price of the procedure was Rs 2.5 lakhs and they had to deposit half of the amount before the operation. Since they could not

shFift me to another hospital they went through a tough time arranging the amount.” She further questions why hospitals have this system of first depositing money and then operating on the patients? “Are they institutes to save lives or mint money?,” queries an irate Shah. On the other hand, Anup Kumar Basu, a 65-year-old resident of Chandannagar, a distant suburb in Kolkata, underwent a stent implant in 2014. The implant took place at a mid-sized hospital in Kolkata. He incurred Rs 75,000 for the

so much for stenting procedures, Dr Ravat says, “Difference in the purchase and sale price of stents by hospitals depends on a number of factors. Corporate hospitals often buy or assure use in bulk, so their actual purchase price is generally less than the listing price of the stents. The companies (stent makers) print liberal MRPs; so the effective price for stent to the patient depends on how much profit margin the hospital wants to maintain on the ‘trading’ of the stents.” Dr Kerkar, drawing attention to another important issue on this aspect, says, “In Maharashtra, under the RGJAY scheme, cardiac patients who require stent implants are provided with

approved well-researched DES however at some private hospitals patients are still implanted with bare metal stents in order to earn profits out of the RGJAY scheme,” he discloses. Moreover, he goes on to say that under such government schemes there should be special packages with immediate sanctions for stenting procedures on heart attack patients so that more lives can be saved.” Further, pointing out the DCG(I)'s intent to bring stents under essential medicines, he says, “Stents according to me, are not essential medicines. Nowhere in the world are they treated as essential medicines. They need to be put under price control but stents are life saving only in times of acute heart problems. Otherwise, they only control symptoms and recurrence of blockages. So, they need not be put under essential medicine.” All said and done, the price war, the over use and the blame game will continue unless the government brings in some stringent norms for use of such life saving devices. The government's move to bring stents under price control is certainly welcome; however the government also needs to create a cap for prices on performing such procedures in the best interest of patients. raelene.kambli@expressindia.com (With inputs from Sanjiv Das)

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‘It will be a boon to people in rural India who don’t have access to basic medical care’ In a bid to provide reliable healthcare delivery in remote areas at low cost, faculty from IIT Hyderabad has recently proposed a two-tier, telecardiology framework, where ECG records can be transmitted even when available resources such as power and bandwidth are limited. Prof Soumya Jana, Department of Electrical Engineering, IIT Hyderabad, shares the idea and ideology behind this cardiology framework, with Raelene Kambli

Tell us about the two-tier telecardiology framework that you have developed? Typically, a patient is transferred to the diagnostic centre where experts look at the signal, evaluate it (if the signal is normal or abnormal) and make a recommendation. So that’s kind of a one-step process and doesn’t take into account any resource constraint (like power or bandwidth shortages). However, in remote areas, people may not be on the power grid and may not have access to a large bandwidthphone or internet. In such cases, this framework may not be suitable for remote locations. We have addressed this using the two-tier framework. As a first step, we picked 20 per cent of the samples. These samples helped us reconstruct the original signals. With reasonable accuracy of 95 per cent, the reconstruction helped us save power in two ways: by collecting 20 per cent signal (requiring 20 per cent of total power) and second by transmitting these signals we cut the process by 1/5th. In this way, we essentially can operate with 20 per cent of capacity. In the second step, we transfer the signal directly to the local sub centre (instead of the diagnostic centre) for classifying the signal into normal and sub normal

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categories. If the signal is normal, the signal is not transferred any further. Only sub normal signals are transferred, saving a lot of time and resources. How is it developed? What is the mechanism used to develop it? What we are doing now is we are giving mathematical approval that works. For example; something needs to be transmitted; we transmit only the relevant part of it. That partial part is good enough. This is called comparative sensitive technique, it actually demonstrates that this is indeed possible. Now, basically we demonstrate the mathematical terms and delegate it using some of the standard database that is available. We have used one of the databases hosted in the MIT, MIT BE database, to demonstrate the proof of concept. Has it been tested so far? By whom? Testing actually needs to happen at several levels. First level of testing is algorithmic level. We have to demonstrate the algorithm correct, that part has already been done. The second level of testing is against the VL database to show that your algorithm is correct and works with real signals. So, that part has been

done only using MIT BE data set. The third thing is to take it to the field to test. This is not yet been done by us as the field version is in the process of manufacturing. One version of the system has already been manufactured, but not the field version. As soon as the product is ready, we will test it on field.

For this solution, we are making further innovations on the algorithm, the technology behind it.We are constantly improving the enabling technology

What are the benefits of this technology? This system has been developed for the population in the remote parts of India and the world that cannot take advantage of regular healthcare. For example; somebody who lives in remote Arunachal Pradesh may not have access to medical services. Typically, the most basic healthcare system they have may be a health centre or a sub-centre. In some other places they may not have a doctor but only a trained medical worker. So, we analysed the published data from government on Arunachal Pradesh; we found that people travel 9 km to access a sub centre. They do not have a doctor or proper treatment; they only have access to medical workers and some basic medicines. In addition, they do not have access to power or adequate communication systems like landline or internet facility.

We can overcome these issues as we minimise using both power and communication bandwidth. Who all are involved in developing this technology? What motivated you to develop it? We have a team at IIT Hyderabad. Dr Shastri, a colleague from the mathematical department and I are from the facility side. Research scholar, Dr Sandeep Chandra and Rupak Tandoli have been instrumental in working out the integrity of technology. This is the core team. The other faculty members like Swamy Dutt help in manufacturing the device and chips. This team is completely dedicated to translating this vision into actual product prototype. How does it work? As mentioned above, the device has the capability of verifying sample signals as normal or abnormal. Using minimal power and bandwidth, the signals can be transmitted to the local subcentre. The sub-centre will evaluate this data according to the algorithm. If the signal is abnormal, it will be sent to the diagnosis centre. The technicians at the diagnosis centre can look at the reconstructed signal acquired Continued on page 50

CARDIAC CARE SPECIAL I N T E R V I E W

Recipient list (for heart transplants) is ever increasing while donor numbers are dwindling Recently, Fortis Hospital, Mulund conducted two successful heart transplants following concentrated and speedy coordination between airport authorities, hospitals, government officials and traffic constables to create green corridors. Dr Anvay Mulay, Chief Cardiac Surgeon, Fortis Hospital, Mulund narrates the sucessful events and talks about the challenges involved in heart donation in India, in an interaction with Raelene Kambli

Why is heart the least donated organ? Reasons behind the dismal number of heart donations in India? Heart donation is only possible after brain death of a patient – a living person cannot donate his heart, making heart donation very scarce. In India, people are declared dead once their heart stops functioning, then their heart is not good enough to be transplanted. Only a small segment of those dying patients who have been declared ‘neurologically critical’ and are brain dead, can donate organs. Among those who are suitable for heart donation, not many patients and their families are ready to progress with organ donation – further building scarcity.

What transformation have you seen in the field of heart transplants in India and world over? In India, heart transplant programme is now gaining momentum but there is a long way to go; abroad, heart transplant statistics are on the decline or are rather static. Reiterating what I said previously, the recipient list is ever increasing while the donor numbers are dwindling. As informed earlier, increased life longevity and drop in the percentage of road traffic accidents are key reasons for the decline of heart transplants abroad. Brain dead patients are getting lesser and lesser whereas the recipient list is ever increasing.

What is the rate of heart donation in India vs the West? It’s not comparable. The heart donation numbers were very high in US and UK, but the numbers are now on the decline, not because people don’t want to donate but for the following two reasons – increased life longevity and drop in the percentage of road traffic accidents, whereas the list of recipients is on a sharp incline. In India, the donation rate in itself is so meagre that donation rate comparison cannot be made.

Tell us about the green corridor which was laid out for two consecutive heart transplant surgeries? Green corridor means a VVIP corridor created when there is need for a heart to be transported from point A to point B in record breaking time. Unlike liver and kidney transplants, which allow a little more ischemic time, green corridor is an absolute must for heart transplant, which has to be conducted in a stipulated time. Primarily, a green corridor is created to avoid any lapse in the ischemic time of the organ.

In India, heart transplant programme is now gaining momentum but there is a long way to go; abroad, heart transplant statistics are on the decline or are rather static

What are the basic parameters required for an heart transplant; for donation and for the hospital to conduct the surgery? Parameters for the recipient are: ◗ Should be less than 70 years of age ◗ Should not have cancer that has spread all over the body ◗ Should not have diabetes, which would have caused damage to the kidneys or gangrene of the foot ◗ Should not have lung pressure issues Patient having intractable angina (chest pain) inspite of angioplasty; patient who has got intractable arrhythmia (irregular heartbeats) requiring multiple shocks repeatedly and patients who suffer from severe heart failure are suitable candidates for a heart transplant. Parameters for the donor are: ◗ Should be less than 65 years of age ◗ While determining the cause of death we have to ensure that the heart is not damaged or the patient doesn’t have a previous history of heart damage. An echocardiography is done, blood grouping and cross matching of the recipient and the donor is done. Body surface area, weight and

height of the donor is also mapped against the recipients stats ◗ If the donor is over 50 years old, coronary angiography is done to understand if the patient has any coronary artery disease and if the heart is good enough to be transplanted into a recipient, or not. Once this detailed study is done, then the decision of going ahead with the transplant or not, is made Parameters for the hospital: ◗ Zonal Transplant Coordination Centre (ZTCC) has authorised some hospitals where heart transplants can be done, these are called transplant hospitals or recipient transplant hospitals. Other hospitals where there are no such facilities, liver and kidney transplants can be conducted and a donor heart can be retrieved. If a donor patient is critically ill in any such facility, which is equipped with ICU and operation theatres but there is no set up for heart surgery/ transplant – such facilities are also recognised by ZTCC for retrieval of the heart. In such scenario, our team of expert doctors go to such facilities and retrieve the heart ◗ Nursing homes/smaller facilities, where ICU and Continued on page 50

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CARDIAC CARE SPECIAL I N T E R V I E W

Government has to make certain rules and specify the steps to simplify donation Heart transplants in India face many challenges. Right from finding a donor to arranging the logistics for the transplant, these roadblocks have taken many lives. However, in the past few years, experts see some winds of change. Dr Kewal Krishan, Program Incharge, Heart Transplant & Ventricular Assist Devices, Senior Consultant Cardiac Surgeon, Max Heart & Vascular Institute, Saket, New Delhi, explains the present scenario in the heart transplant field, to Raelene Kambli

When was the first heart transplant done in India? The first successful heart transplant was done in August 1994 at AIIMS. What kind of transitions have you witnessed in the field of organ donation, especially when it comes to heart donation? Post the first heart transplant there was a lot of enthusiasm within the medical fraternity and a few heart transplants were conducted in next three to four years. However, after that the interest waned and almost nothing happened for more than a decade in this area. Other organs like liver and kidney continued to rise in number as live donors were a possibility. The limitation of heart transplant is that only a deceased donor can be used so no activity happened for almost 14 years. Then in Chennai, because of the kidney donor racket, rules were amended for deceased donation procedure to make it more simplified. This increased the donor pool in Tamil Nadu and heart transplants have started happening more frequently since 2012. Approximately, how many people in India are awaiting a heart transplant? What are the reasons behind the dismal

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numbers of heart donation in India? Though there are more than 10 lakh people suffering from end-stage organ failure, most of those who manage to make it to the list eventually donâ&#x20AC;&#x2122;t survive the wait. This scenario proves to be especially fatal for those who are battling with end-stage heart failure. The reason for this could be lack of awareness amongst the public to donate organs. Less interest of intensivists to declare brain dead to avoid hassles after that. Though Human Organ Act 1994 (HOTA) has been amended to simplify brain dead related procedures there are still many hiccups. What is the difference between total artificial heart transplant and left ventricular assist device (LVAD) procedure? Which is a better option and when? Total artificial heart is when you remove the native heart and put a total mechanical heart, i.e. both the left side and right side of heart are now mechanical. In LVAD, the native heart remains in place, a pump is put in the left ventricle and then connected to aorta. Only left side is now mechanical and right side is still native heart. Total artificial heart is used when

both sides of the heart are severely damaged. LVAD is used only when left side is severely damaged and right side can still function which happens in most of the cases.

It used to be difficult to transport heart from one place to another but nowadays with green corridors it has been made easier to transport a heart

What is the longevity and survival with an artificial heart? Longevity of LVADs is around 15 years. Survival with LVAD is around 67 per cent at many centres. As these long term devices have come for clinical use in 2002, time will tell how long they can make patients who are on these devices survive. Total artificial hearts are used as a bridge to transplant only when both ventricles are severely damaged and LVAD will not give them survival advantage. How easy or difficult is it to conduct a heart transplant in India? It used to be difficult to transport heart from one place to another but nowadays with green corridors it has been made easier to transport a heart. Procedure itself is not very cumbersome though one should know how to transplant smoothly and in a scientific manner for good outcome. Recently, we successfully conducted the first heart transplant at Max Super Speciality Hospital, Saket in the history of Max

Hospitals. The transplant for free of cost for the EWS patient who was awaiting the heart for past seven months. What are the legal and ethical laws governing heart transplant in India? HOTA controls all the legalities and ethical issues related to transplant. Health is a state subject so every state has its own rules and regulations to control deceased organ donation. This is one the reasons why in one state donation rate is higher than in another. What are the latest developments you see in the concept of heart transplants? One is easing up in Human Organ Act. Other, communication is better through mobile phones and scientific meetings. Government and NGOs are playing vital roles to spread the word and help to make things happen where nobody from private or government existed and lag was there. Young generation is quite receptive to organ donation of their brain dead family members when convinced. What has been the reaction of the masses, influencers, donor families, and recipients towards this Continued on page 50

CARDIAC CARE SPECIAL Continued from page 48

Government has to make certain rules... concept of heart transplant? Reactions of masses have changed with time. More awareness and advertisements related to organ donation have changed the whole perspective in the community so that people are coming forward and asking if they can donate organs of their loved ones when they are declared brain dead. Recipient families feel quite happy that their patient would get a new heart and a new lease of life. They are going to get relieved of the disease and thankful to the donor family even if they do not know any

details of the donor. What is your view on government policy and efforts towards organ donation in India? Government is also making lot of efforts for organ donation to happen by encouraging government and NGO officials. There is a website for registry by every state. Government is also helping to train transplant coordinators who are the key persons. What are the main challenges and issues in the

People are coming forward and asking if they can donate organs of their loved ones when they are declared brain dead

private healthcare segment? In private healthcare, internal infrastructure is not a problem but there is no common network to help each other if brain dead is declared at any centre. Moreover, logistics related to expenditures of harvesting and maintaining donor till organs are harvested is also a challenge. How can the various stakeholders work together to improve the situation for organ donation in India? Government has to make

certain rules and specify the steps and logistics to simplify the donation as it’s happening in Tamilnadu. Government should make it mandatory to notify the braindead. Though it’s there in the rules it’s not happening in reality. NGOs, especially MOHAN Foundation, are making remarkable difference in increasing the donation rate by convincing the families of potential donors and coordinating with different hospitals where organs are required. raelenekambli@expresssindia.com

Continued from page 46

This system has been.... by other devices. After this, it’s easy to diagnose the issue and send back the diagnosis through SMS. This saves a lot of time so that patients with serious issues can immediately meet a doctor to get treatment. How can it be utilised to increase access to cardiac diagnoses, even in rural India?

It will be a boon to people in rural India who don’t have access to basic medical care. This solution will give them access to quick diagnosis and medical treatment if needed. Are you planning to tie-up with the government to take this technology to the hinterlands of India? This project is funded by the Ministry of

Communication and Information Technology (MCIT) under the Department of Information Technology. We are also tying up with healthcare providers and companies. We are still working out the way we would like to take it to ground on a large scale. What are your future plans for this product?

We are exploring more government support and generating industrial interest so that this actually can be made operational and sustainable. Are there any more innovations in the pipeline? Yes, there are many innovations, but in terms of cardiology we need to ensure that the targeted functionality

is fully realised. For this solution specifically, we are making further innovations on the algorithm, the technology behind it. We are constantly improving the enabling technology. Our entire focus is on realising the functionalities, reducing cost, and reducing utilisation of resources like power and bandwidth. raelene.kambli@expressindia.com

Continued from page 47

Recipient list for .... operation theatre facilities are not available, the patient has to be moved to a suitable facility that is recognised by ZTCC and the heart is retrieved Any special permissions required to conduct such procedures?

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Yes, the ZTCC panel interviews the recipient, ensures that the facility is equipped and available for the transplant, only then is the recognition and license to conduct a heart transplant given. What were the challenges

The ZTCC panel gives the recognition and license to conduct a heart transplant

you faced in organising the entire heart transplant exercise in both the cases? I and my team are very passionate towards the cause of organ transplantation hence we faced no challenges.

treated differently? How different? There is no difference in treatment or management of both the patients – both have steadily recuperated and have come out of the ICU.

Were these two cases

raelene.kambli@expressindia.com

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MUSCULOSKELETAL IMAGING

Pic used for representational purposes

COMING OFAGE Musculoskeletal imaging is gaining prominence in diagnostic radiology and has seen several momentous advancements in the recent years, abetted by growing research BY LAKSHMIPRIYA NAIR

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An evolving sphere The first X-ray, taken by Wilhelm Conrad Roentgen, of his wife’s hand, set the foundation for diagnostic radiology and marked the beginning of musculoskeletal imaging as well. Yet, recognition and progress as a sub-speciality, especially in India, came to the sphere only around two decades ago. Dr Bhavin Jhankaria, Radiologist and Partner, Picture This by Jankharia, enlightens, “From being a non-speciality up to 10 years ago, now it is being accepted as a separate sub-speciality. Many radiologists spend more than 50 per cent of their time doing only musculoskeletal imaging.” Reiterating this point, Dr Lavakumar says, “The importance of musculoskeletal radiology as a standalone speciality in India has begun to gain prominence only recently. The Musculoskeletal Society of India, dedicated to imaging, was formed just two years back albeit we’re making rapid progress in this speciality.” However, since then, musculoskeletal radiology has witnessed significant advancements which have been instrumental in enhancing diagnostic sensitivity and specificity and enhanced the scope of image-guided treatment options. Research and growth of cross-sectional imaging like CT and MR imaging have also played pivotal roles in furthering the evolution of musculoskeletal radiology as a separate sub-speciality.

Revolutionising healthcare delivery So, how has the sphere affected healthcare delivery over the years? What have been the major benefits? Dr Zambre informs, “Musculoskeletal imaging has also allowed the clinicians to use the plain old X-rays to the maximum effect. When coupled with the size standardisation, it now allows the doctors to accurately get bone measurements, facilitating surgical planning for plac-

Pic used for representational purposes

edical imaging has transformed the way healthcare is delivered in modern times. It has also seen rapid progress in the past few decades, spurred by the growing emphasis on evidencebased medicine. One of its branches which has seen increased implementation in the recent years is musculoskeletal imaging. Defined as the imaging of the bones, joints, and connected soft tissues using an extensive array of modalities such as conventional radiography, computed tomography (CT), ultrasonography and magnetic resonance imaging (MRI), it is a field which is constantly evolving to offer timely and useful information about musculoskeletal anomalies to experts for enhanced continuum of patient care, from detection and diagnosis to post-treatment supervision. As Dr Swapnil Zambre, Consultant Arthoscopy and Joint Replacement Surgeon, Fortis Hospital Kalyan, ascertains, “Musculoskeletal imaging, which essentially means getting various kinds of images or pictures of bones, muscles and nerve tissues that are facing disorders, has seen rapid but cumulative advances in terms of quality of information one can gather from these images.” Adding to this, Dr Rajesh Lavakumar, Senior Consultant and MSK Lead, Columbia Asia Radiology Group, informs, “The speciality is vast and it encompasses diagnosis and imageguided therapy for all kinds of ailments affecting the musculoskeletal system ranging from congenital deformities, infections - bone/soft tissue, cancers, rheumatological diseases and trauma both accidental/sport related. The speciality includes interventional/therapeutic radiology pertaining to the musculoskeletal system in the form of ultrasound, fluoroscopy and CT-guided procedures which range from biopsies to injecting therapeutic drugs at specific targeted locations.”

Research and growth of crosssectional imaging like CT and MR imaging have also played pivotal roles in furthering the evolution of musculoskeletal radiology as a separate subspeciality ing various metal implants in patient by accurately predicting the required size and shape even before the surgery. This has resulted in faster, minimally invasive surgery and rapid patient recovery.” As Dr Lavakumar highlights, musculoskeletal imaging has aided early and accurate diagnosis, which in turn has been instrumental in: ◗ Avoiding unnecessary diagnostic/ exploratory procedures ◗ Less extensive and more appropriate surgery ◗ Use of interventional radiologic techniques have led to focused delivery of medication which improves outcome ◗ Prevention of late disabilities ◗ Eventual cost saving for patient — less days in hospital, treatment at early stage of

disease, more productive years in career etc Dr Jhankaria opines, “Subspecialists provide better quality of reads of MRIs and X-rays and this improves healthcare delivery overall.”

Contemporary trends Thus, the experts unanimously agree that musculoskeletal imaging has brought significant advantages to healthcare delivery. So what are reigning trends is this area? Dr Lavakumar answers, “The current trends in MSK imaging are cartilage imaging, PET CT, diffusion weighted sequences on MRI, MR arthrography, 3 Tesla MRI for small parts and high resolution ultrasound. These have greatly improved diagnostic capabilities and accuracy when

compared with traditional MR sequences and ultrasound that we limited ourselves to - till fairly recent times. If studies like MR arthrography becomes integral and common practices, it will add immense value to patient care.” On the other hand, Dr Zambre says, “The single biggest advancement in the field of musculoskeletal imaging, which has not only bought down costs, but is also environment-friendly, has been the advent of digital X-rays. If properly implemented, one no longer requires the X-ray plates, which can fade and get spoilt with time. With digital X-rays, all information can be stored on a USB drive. However, the biggest advantage is, perhaps, the ability to play around with the digital X-ray images by way of ability to zoom-in and zoom-out various areas of the image, and the ability to change contrasts, which has allowed the clinicians to get better insights into picking up diagnosis for problems such as hairline fractures, which they would have missed before due to small image size and poor quality. He further opines, “Another trend in musculoskeletal imaging that is emerging is that of portable ultrasound. Advances in the field of electronics and constant cost cuts have put more sensitive and advanced, and laptop-sized ultrasound machines in the hands of surgeons. These are now being used in one-stop sports medicine clinics where surgeon can – immediately after a patient exam – perform an ultrasound to confirm a diagnosis, thus preventing delay in the treatment. Since it is performed by the same surgeon who has been intimately aware of the anatomy of the body part being examined, the accuracy of ultrasound diagnosis gets magnified, overcoming the operator dependency in this modality to a large extent.” Dr Zambre also highlights, “Advances continue in the field of musculoskeletal imaging. One

IN IMAGING such development is the 3D MRIs, which will allow us to assess in detail in three dimensions the nature of injuries, especially in the soft tissues where the CT scans fall woefully short. When coupled with 3D printers, musculoskeletal imaging could allow us to print patient specific implants and synthetic tissues in near future. Another trend is the even more detailed 9 to 21 Tesla MRIs, which may not necessarily have direct clinical use as of now, are currently allowing us to study cellular metabolism better and to look at effects of newer drugs on cells, speeding up the launch of newer drugs. However the most exciting anticipation about the future is that of the Dynamic CT.” He further enlightens, “In orthopaedics, quite a few problems manifest themselves only when the patients move and work. Until recently, the doctors had been hemmed in by static imaging, where the patient lays still either in X-ray or MRI or CT, and one is not able to appreciate pathology due its dynamic nature. Dynamic Fast CT machines which are already a niche reality, will change that and allow doctors do not only carry out the better diagnosis, but will also enable them to tailor surgeries more precisely.” Dr Jhankaria feels that the modality’s rise as a major subspeciality itself is a significant trend. He opines, “The main trend is the fact that young radiologists are taking this up as a sub-speciality. It is a multimodality and musculoskeletal radiologists often read X-rays and MRIs as well as perform ultrasounds and USG-guided procedures.”

Challenges to conquer Thus, the modality has seen significant progress in recent times. It is undeniable that it’s making an indelible mark in the advances made by medical imaging. Yet, it has not yet achieved its true potential. Challenges continue to dog its growth trajectory. As Dr Lavakumar says, “The fact that high quality musculoskeletal radiology is not widely available in India is a reflection of the country’s priorities. We’ve

Musculoskeletal imaging has undergone several transformations, aided by increasing research on new imaging techniques and application of the proven techniques in novel fields been a developing country for long and have been focusing on life and death issues so far. Only recently we’ve begun to look at quality of life as well. India has only in the recent years been seeing a steady rise in sports and fitness interests. Whilst it improves the general health of our nation, today’s radiologists are also challenged to help solve complex injuries.” He further informs, “There continues to be a lacuna in formal teaching of ultrasound and MRI skills pertaining to diagnosis of musculoskeletal pathology.” Dr Zambre also explains, “In India, in major metropolitan and town areas, newer X-ray and MRI modalities have made an amazing penetration across the board, and are now at par with most of the developed nations. However, the necessary expertise that is required in radiology, to interpret these more detailed images, has been somewhat patchy and varies from excellent to adequate.” Dr Lavakumar also states the steps being taken by his hospital to mitigate these issues. He says, “To address this, we at Columbia Asia Radiology Group have been attempting to create awareness about current trends in musculoskeletal imaging by organising workshops in collaboration with musculoskeletal specialists from Leeds University, UK and also ‘Radiology Contact Programs’ for global and Indian radiologists to hone their skills while rising to the upcoming healthcare demands. The most recent batch came all the way from Indonesia.” Events like MUSoc 2015, an event which promotes musculoskeletal ultrasound, also seek to meliorate the domain. Dr Nidhi Bhatnagar, MS-USG Consultant, Max Panchsheel,

Sanjeevan Hospital and General Secretary, Muskuloskeletal Ultrasound Society says, “At MUSoc 2015, we will be teaching all seven major joints e.g. shoulder, elbow, wrist hand, hip, knee, ankle and foot. It has topics of interest for not only the radiologists but also for rheumatologists, orthopaedicians, sports medicine consultants and pain management physicians. There will be hands-on, teaching workshops to impart focused training. We will be emphasising each aspect of musculoskeletal ultrasound .”

The way forward So, what does the future hold for this sub-speciality? Answering this query, Dr Lavakumar says, “Injuries in contact sports like football, hockey, kabbadi, wrestling, boxing or even non-contact sports like golf, cricket, tennis, cycling, badminton, track and field professionals need high quality specialist care, be it orthopaedic surgery, sports medicine or physiotherapy. Correct diagnosis is crucial for good quality care - that is where musculoskeletal radiology as a speciality plays a pivotal role. Suboptimal care has drastic implications on one’s career which impacts quality of life both physically and financially. In today’s technology driven world, easy and quick access to musculoskeletal sub-speciality radiologist should be possible.” He adds, “Hence, educating radiologists and clinicians alike would play a key role. I see a dramatic increase in musculoskeletal radiology educational programmes throughout India and internationally. A short stint internationally will certainly add perspective and value to one’s practice.”

Dr Zambre states, “The diagnostic accuracy will continue to improve in surgeons with time, as they continue to get direct feedback of their diagnostic accuracy when operating on the patient subsequently, thus correlating the findings. Ultrasounds in clinics are not only proving a useful diagnostic assistance, but are also allowing doctors to deliver ultrasound-guided injections into the body areas safely and accurately, thus greatly increasing their efficacy. Patients, who previously had either blind injections or needed to wait for the availability of a radiologist, can have it done straightaway, thus decreasing the cost with faster treatments. Improvements in images obtained by the newer 3 Tesla MRI machines have also had a significant impact not only on the diagnosis (pretty much invalidating diagnostic arthroscopy), but also on the patient’s treatments. Newer machines have been able to show cartilage and ligament injuries in far greater detail, allowing tailor-made treatment for injuries which might previously have been missed. On the whole, the above advances, coupled with better surgical training and newer treatment modalities, have allowed us to treat and restore functions in pathologies, previously simply left untreated.” Thus, it is evident that musculoskeletal imaging is finding accelerating usage in varied areas including imaging of tumours and tumourlike lesions, cases of trauma, vertebroplasty and other spinal interventions etc. Moreover, as a constantly budding speciality, it has undergone several transformations, aided by increasing research on new imaging techniques and application of the proven techniques in novel fields. So, as Dr Jhankaria concludes, “It is here to stay and as time passes, the depth of knowledge will increase and help patients and doctors understand and treat disease better. lakshmipriya.nair@expressindia.com

From being a non-speciality up to 10 years ago, now it (MSK) is being accepted as a separate sub-speciality Dr Bhavin Jhankaria Radiologist and Partner, Picture This by Jankharia

The importance of MSK radiology as a standalone speciality in India has begun to gain prominence only recently Dr Rajesh Lavakumar Sr Consultant and MSK Lead, Columbia Asia Radiology Group

Musculoskeletal imaging has seen rapid but cumulative advances in terms of quality of information one can gather from these images Dr Swapnil Zambre Consultant Arthoscopy and Joint Replacement Surgeon, Fortis Hospital Kalyan

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MUSoc supports a standalone crosssectional modality in the vast field of radiology Dr Nidhi Bhatnagar, Organising Secretary, MUSoc 2015 talks about the highlights of the event, its objectives and more in an interaction, with Lakshmipriya Nair

What preparations have been underway for MUSOC this year? Musculoskeletal (MSK) ultrasound is a cross-sectional modality ready to break all barriers and mindsets working against its already established applications in evaluation of bones and joints in India. MUSoc 2015 is the most significant event India is embarking upon as a dedicated teaching programme in this field. With our dedicated organising team and strong handholding from associations like Delhi Orthopaedic Association, we have approximately 300 registered delegates from all parts of the world. At least 60 participants are from 17 countries across the globe. This event, to be held at VIVANTA by Taj, Dwarka, will also address the need for accredited training programmes in this field with international affiliations. What will be the focus and key topics to be covered under the scientific programme? India today is standing at the edge of a marvellous revolution and we are ready to absorb all that comes our way like a sponge. At MUSoc 2015, we will be teaching all seven major joints eg shoulder, elbow, wrist hand, hip, knee, ankle and foot. It has topics of interest, not only for the radiologists but also for rheumatologists, orthopaedicians, sports medicine consultants and pain management physicians.

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There will be hands on teaching workshops with delegates to impart focused training. Twenty three international faculty and many national level MSK USG specialists will be there to engage in interactive sessions with the delegates. We will be emphasising on each aspect of MSK ultrasound like its ease of work-ability, scope for patient interaction, point tenderness and symptoms evaluation by radiologist, dynamic real time feature which gives us information about the functionality of the tissue under observation, colour doppler features which in most cases acts like contrast studies of MRI and CTs, and last but not the least, evaluation of multiple systems in the same sitting, should our clinical judgement indicate so. What is new for this edition and what are your expectations? Most important- An exclusive international conference has never to have been organised before in India on musculoskeletal ultrasound or given the due respect and position this modality deserves in the sphere of diagnostic radiology. ◗ MUSoc chose New Delhi to celebrate their 25th (Silver) anniversary meeting ◗ We have nearly 300 registered delegates with participation from 17 different countries ◗ 23 hands on workshops will be running at the same time on all four days ◗ All seven joints will be a part

At MUSoc 2015, we will be emphasising on each aspect of MSK ultrasound of the scientific session: shoulder, elbow, hand and wrist, hip, knee, ankle and foot. ◗ 23 luminaries will be sharing the same platform from the world of musculoskeletal ultrasound- a never seen before occurrence ◗ Declaring Musculoskeletal Ultrasound Academy (MUA) for training in MSK USG with international accreditations ◗ Declaring 10 October, 2015 as Musculoskeletal Ultrasound Day India ◗ For the first time ever, five major international accreditations from Royal College of Radiologists (RCR), European Society of Skeletal Radiology (ESSR), University

of Murcia (Spain), and Henry Ford Health Systems (US), American College of Physicians. At national level , we have credits from DMCDelhi Medical Council (24), National Board of Examinations (NBE) (26) ◗ First time ultrasound-guided training on animal phantom models As an Organising Secretary, my expectations do not just surround the desire to see a resounding victory for MSK USG by way of convincing the practising physicians but to see the concept trickle down to the level of masses as an option they have when suffering from ailments of bones and joints for diagnosis. At the same time, I also hope to showcase the potential India holds in terms of educational and business opportunities to the world. What is the message you would like to give the participants, exhibitors and visitors at MUSOC? To the delegates who are majorly radiologists, I wish them all the best and urge them to zealously learn all the techniques at MUSoc 2015 from these masters, go out there and just sweep the orthopaedicians off their feet with accurate diagnosis. Also knowing where to apply and where not to is a very important part of learning and in making a success of this modality. To the nonradiologist participants, I congratulate them for their futuristic approach of coming

to this conference and orienting themselves to a new field of application in medical practice. To all the exhibitors, first and foremost, I thank them for placing their faith in this modality and extending a strong handholding to this conference by providing technological support. Also, I would dearly request the ultrasound companies to promote the concept of MSK USG to the new buyer so that they can at sometime offer this service too to the patients at their institutions. How does an event like MUSoc help to shape the trends in musculoskeletal imaging? MUSoc has been unique in its approach to support a stand alone cross-sectional modality in this vast field of radiology. One cannot draw comparisons between any two investigative modalities since all have their own advantages and limitations. Ultrasound, till not so long ago, was considered analogous with the foetal scan, in India. MUSoc has brought into the focus yet another application for the modality, which has immense benefit not only to the patients but also to the clinicians and the radiologists. It's a highly technical and specialised offshoot of radiology but the results that it is capable of churning out with dedicated teaching programmes such as MUSoc can only be marvelled at and should seriously be encouraged at all levels. lakshmipriya.nair@expressindia.com

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Kaustubh Enterprises A-6 Nutan Vaishali, Bhagat Lane, Matunga (West), Mumbai - 400 016. INDIA • Tel.: (022) 2430 9190 • Telefax: (022) 2437 5827 • Mobile: 98204 22783 • E-mail: rujikon@rediffmail.com / rujikon@gmail.com • Website: www.rujikon.com

ICONIC AMERICAN MEDICAL UNIFORMS BREATHABLE & ALL-DAY COMFORT

Medical Scrubs

Lab Coats

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September 2015

MEDICAL EXPRESS HEALTHCARE

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Priceless purity

to guarantee your reputation Pharmalab, a name synonymous with quality and technology in the areas of sterilisation, washing, process equipment, sterility and water purification, now introduces total solutions for hospitals. Manufactured indigenously and in collaboration with world leaders.

Ultrasonic Washer

Washer Disinfector

Arcania Bedpan Washer

Steam Sterilizer

Vertical Chamber Autoclave

Pharmalab India Private Ltd. Kasturi, 3rd Floor, Sanghvi Estate, Govandi Station Road, Govandi, (East), Mumbai - 400 088.  Tel no: 91-22-66 22 9900  Fax: 91-22-66 22 9800  E-mail: pharmalab@pharmalab.com  www.pharmalab.com  CIN No. U29297MH2006PTC163141 EXPRESS HEALTHCARE

Sterilizer Test Kit

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FEBRILE ILLNESS DIAGNOSIS

WEIL-FELIX TEST

BRUCELLOSIS

SALMONELLOSIS

Febrile antigens for the detection of antibodies to Proteus OX-2, OX-K or OX-19 as an aid in the diagnosis of rickettsia infection.

Febrile antigens for the detection of antibodies to Brucella abortus and Brucella melitensis as an aid in diagnosis of Brucella infection.

Febrile antigen set for the detection of antibodies to Salmonella as an aid in the diagnosis of Salmonella infection

The combination of results can be used as an aid to identify the disease.

Individual febrile antigens are available for Brucella abortus and Brucella melitensis.

Antigen suspensions for S.typhi (OD and Hd) and S. paratyphi (OA, OB, OC, Ha, Hb and Hc)

Individual febrile antigens are available for Proteus OX-2, Proteus OX-K and Proteus OX-19. ●

Stained Febrile antigens in convenient dropper vials.

●

Suitable for both slide and tube test protocols.

●

Individual antigens and kits are available with different combinations of febrile antigens with Positive and Negative controls*

508, 5th Floor, Western Edge-I, Kanakia Spaces, Opp. Magathane Bus Depot, Western Express Highway, Borivali (E), Mumbai-400066 T: +91-22-28702251 F: +91-22-28702241 E: info@omegadiagnostics.co.in W: www.omegadiagnostics.com www.omegadiagnostics.co.in A subsidiary of Omega Diagnostics Group PLC ODX/SEP015/FEBIL/EXPHEALTH/V3.0

EXPRESS HEALTHCARE

CIN :U51909MH2011FTC219692

*please inquire for the various combinations available in kit form.

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Capturing physical assessment and vital signs data is routine.

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

Visit www.welchallyn.com/connex to learn more today. Wirelessly transmit patient vitals to your EMR right from the bedside with Connex® vital signs devices

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Non Glare

Surgical Instruments

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www.tufftinstruments.com 64

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LIFE PEOPLE

Nihon Kohden’s Dr Takuo Aoyagi receives 2015 IEEE Medal for innovations in healthcare technology Selected for his pioneering contributions to pulse oximetry which have had a profound impact on healthcare DR TAKUO AOYAGI, Senior Manager, Nihon Kohden has received the 2015 Institute of Electrical and Electronics Engineers (IEEE) Medal for innovations in healthcare technology. The IEEE is a renowned technical professional organisation dedicated to advancing technology for the benefit of humanity. Each year, this prestigious honour is awarded to an individual, a team of individuals, or multiple recipients for outstanding contributions or innovations in engineering within the fields of medicine, biology, and healthcare technology. Dr Aoyagi was selected for his pioneering contributions to pulse oximetry, which have had a profound impact on healthcare. Dr Aoyagi’s invention, first published in 1974, has helped improve patient safety during anaesthesia and is recognised as the standard of care for the assessment of oxygenation, spanning virtually every domain of medical practice. In 2007, the World Health Organization (WHO) recognised pulse oximetry as the most important lifesaving practice during surgery. Since then, WHO has initiated the ‘Global Pulse Oximetry Project’ to ensure that every patient undergoing

Dr Takuyo Aoyagi (second from left) joined by (L-R) IEEE PresidentElect Barry Shoop, IEEE EMB President Andrew Laine and IEEE President Howard Michel

surgery is monitored with pulse oximetry. “With the brightest minds in medical technology, Nihon Kohden has helped shape the face of the medical device market, and continues to do so. Dr Aoyagi’s accomplishment is but one example of Nihon Kohden’s legacy of innovation and the positive impact we have on healthcare delivery worldwide,” said Wilson Constantine, CEO, Nihon Kohden America. Dr Aoyagi joined Tokyo-based Nihon Kohden Corporation in 1971 as a manager of the development department and was promoted to general manager in 1985. He has served as a Senior Manager of his namesake, the Aoyagi Research Laboratory since 1991. In his current capacity at Nihon Kohden

Corporation, Dr Aoyagi continues to explore oxygenmonitoring technologies for the advancement of diagnosis, treatment, and improved patient safety. “Dr Aoyagi invented one of the most important technologies for patient safety. All of us at Nihon Kohden congratulate him on this well-deserved honor. We continue to develop innovative technologies that lead to improvements in healthcare quality,” said Kazuo Ogino, Chairman of the Board, Nihon Kohden Corporation. Dr Aoyagi formally received the medal from IEEE Howard Michel, President and Barry Shoop, PresidentElect at the IEEE Honors Ceremony at the Waldorf Astoria, New York.

Prof Anupam Sibal receives BAPIO award 2015 He was recognised for promoting excellence in patient safety and quality PROF ANUPAM Sibal, Secretary General, Global Association of Physicians of Indian Origin (GAPIO), Group Medical Director, Apollo Hospitals Group, was conferred the British Association of Physicians of Indian Origin (BAPIO) Award for promoting excellence in patient safety and quality. The award was presented by Dr Virander Paul, Deputy High Commissioner of India recently at the BAPIO conference in Leicester UK. BAPIO is a national voluntary organisation established in 1996 in UK that represents doctors of Indian origin from Indian sub-continent. Dr Prathap C Reddy, Chairman Apollo Hospitals

(L-R) Prof Anupam Sibal receiving the award from Dr Virander Paul

Group and Founder President of Global Association of Physicians of Indian Origin (GAPIO), Dr Sanku Rao, President GAPIO, Dr Ramesh Mehta, President BAPIO and VP GAPIO and many more distinguished doctors were present at the award ceremony.

TeraRecon appoints Jeff Sorenson as President Sorenson joined the company in 2004 and was most recently SVP of sales and marketing TERARECON recently announced leadership changes to strengthen the company and position it for the next phases of growth and solution development. Venkatraman Lakshminarayan, who served as CFO since 2005 and CEO since 2014, has stepped down to pursue other interests. He is succeeded by Jeff Sorenson, who will lead the company as President. Sorenson joined the company in 2004 and was most recently SVP of sales and marketing. "TeraRecon is unique because it offers a complete and truly vendor-neutral 3D advanced visualisation suite

which can be extended to serve the medical image viewing needs of the entire health enterprise," Sorenson stated. He continued, "I am excited to serve our valued customers and to drive innovation in this new capacity as President." On the heels of three large enterprise, iNtuition advanced visualisation wins in early August alone. The company also reported a marked increase in iNteract+ interoperability and enterprise imageenablement projects. In addition, the anticipation of the feature-rich iNtuition software release is driving an increase in software maintenance renewals.

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September 2015

TRADE & TRENDS

JKAnsell,India recognised as best medical glove company of the year The organisation aims to grow in healthcare barrier protection domain as this has been Ansell’s strength for over 100 years now

JK ANSELL, India has been recognised for the second time as best medical glove company of the year. The team was recently felicitated during the 5th grand edition of CIMS Hospital Management Conference and Healthcare Excellence Awards. CIMS Healthcare Excellence Awards is a practice to honour centres of excellence and quality-driven healthcare delivery institutions. JK Ansell is a forerunner of powder free medical gloves segment in India. “We remember the days when we started talking about this novel concept to surgeons and they welcomed and adapted it. Today, we feel proud that surgeon’s always expect new solutions and innovation from Ansell. Within latex powder free range, we’ve well defined surgical specialty wise protection solutions so as to offer maximum comfort and dexterity to the surgeons. This facilities better surgical outcomes indirectly,” says a senior company official. The organisation aims to grow in healthcare barrier protection domain as this has been Ansell’s strength for over 100 years now. To build on core strengths, the organisation has introduced radiation attenuation gloves and is also evaluating innovative propositions like antimicrobial technology. Ansell medical glove brands enjoy strong equity among target group in India. JK Ansell is a 50:50 joint venture of Ansell Group Australia and Raymond Group India. The organisation operates in segments pertaining to sexual wellness and medical gloves in India.

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September2015

JK Ansell team was recently felicitated during the 5th edition of CIMS Hospital Management Conference and Healthcare Excellence Awards

‘Patient data safety and security is our primary focus and responsibility’ Dr Ashendu Pandey, CEO, CK Birla Hospitals speaks on the new HIS implemented at CK Birla Hospitals, in an interaction with Express Healthcare

What is this new HIS in CK Birla all about? How will it benefit the patients? New HIS at CK Birla is about streamlining processes, increased transparency, and enhanced operational efficiency resulting in improved patient care and experience. The HIS implemented is interfaced with Laboratory Information System and lab analysers are interfaced with radiology information system and imaging modalities, e-mail gateway and sms gateway is also integrated with back office ERP which is SAP. Going forward we will integrate the system with other clinical/ non-clinical solutions to provide best possible experience to our patients. The software solution invariably helps caregivers to follow best practices and closed/improved processes, helping in minimising clinical errors and improving patient care. How will this system will benefit the doctors? Doctors are always concerned about providing best treatment to their patients. Best treatment depends upon many factors which include timely availability of investigation reports and medicines. The new system will make sure that Doctors have information on their patients when it is required, right from critical values to investigations which will help in taking immediate corrective treatment irrespective of their location. What are the benefits of

going paperless for a hospital? Hospitals can derive immense benefits from going paperless as dissemination of information becomes faster as it is then available in real time helping doctors and other stake holders to take quick decisions in order to improve patient care. Other benefits which hospitals can derive is lower operational cost which could be passed on to customer as a bonus, in addition to improved services. Going paperless not only helps hospitals and its patients, it also helps vendors/partners in bringing in efficiency and reduction in cost in providing services to the hospitals. It’s a win-win situation not only for hospitals and patients, but for vendors/partners as well. In a nutshell all the entities which are linked in this chain may get benefitted. We often hear that there is no medical data about many diseases or procedures. Can you elaborate how this HIS can bring a transformation in clinical procedure and disease? Going forward, the system will capture vital information on diagnosis, treatment and outcome, which is stored for future reference and research. This information will be available to our consultants at the click of a button, helping them take clinical decisions for best and sure outcomes in treating patients with similar medical conditions. This repository will increase in size with each passing treatment and help more and more patients get best and sure treatment in future.

to the consultants immediately after acquisition of images and reported. This quick dissemination of clinical information helps consultants take the right course of treatment without waiting to be available at the patient bedside.

The software solution invariably helps caregivers to follow best practices and minimise clinical errors In the diagnostic arena, how will this system work? Diagnostics play a vital role in treatment. Correct values of laboratory tests and their quick availability to doctors helps patients in getting the right treatment at the right time. The system is highly interfaced with other entities, be it other clinical solutions or medical equipment or other non-clinical solutions. The system captures results from the laboratory analysers without any human intervention making sure that the values captured are correct and are available immediately after these are certified. Similarly radiology studies also shall be available

How will this HIS deal with emergency? This HIS has a separate and unique workflow for emergency which can handle patients efficiently and in the quickest possible manner. It also has a separate disaster management module which is effective while handling large number of patients in case of natural or manmade calamities. How will this HIS build up efficiency where medical condition of each person differs? The beauty of the software lies in building up efficiency when caregivers have to deal with different patients and each of them have a different medical condition. The software keeps track ofeach patient’s in course of treatment individually and provides the information on each patient without any mix up. Do you think this system will do away with long admission, discharge and appointment queues with doctors? The system is helping us reduce the wait time at various touch points, whether it is taking appointments with doctors, admission or discharge. We follow the policy of one UHID for life in which

patient demographics are always available in the system giving away the need for registering the patient at every encounter or episode thus reducing the wait time at admissions. Patients can be seamlessly moved from emergency to patient wards and in getting treatment in continuation with emergency. Discharge process is simplified where all the discharge activities are completed before a patient could be sent for financial discharge. System locks the beds after each discharge for housekeeping clearance, making sure that all the patient beds/rooms are properly cleaned and sterilised without nurses following up with housekeeping after each discharge. Is there any other hospital using this system? How is it different from the rest of the hospitals? The solution is used in over 100 hospitals in the Middle East and at hospitals of Narayana Health in India. Most of the hospitals in India implement the only billing solution which captures services and materials from billing perspective only. Our approach is different wherein we shall be using clinician physician order entry, nurse care plans and electronic medical record. We are using high degree of integration with other clinical and nonclinical systems to exploit and drive maximum benefit out of the system. Our focus was to have clinical at the core of our implementation. We should Continued on page 72

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TRADE & TRENDS

Carestream's new R/F systems available for order worldwide These radiography/flouroscopy systems can enhance workflow and perform contrast exams using fluoroscopy that can be associated with a radiography image CARESTREAM HEALTH entered the radiography/ fluoroscopy (R/F) market with two systems that deliver high-quality, cost-effective imaging. They are Carestream DRX-Excel and Carestream DRX-Excel Plus. These systems can enhance workflow and perform contrast exams using fluoroscopy that can be associated with a radiography image, in addition to specialised contrast procedures that record both fluoroscopy and radiography sequences and interventional procedures. Carestream’s DRX-Excel systems are configured with a table and a tube in one system. An optional integrated flat panel detector produces high-resolution images for general radiography as well as fluoroscopic sequences. The DRX-Excel platform also is available as a conventional R/F system that uses either CR cassettes or DRX-1 detec-

Carestream DRX-Excel Plus

tors with an image intensifier. “We are expanding our radiography leadership to include fluoroscopy, which is performed by many of the hospitals and imaging centres we serve,” said Jianqing Y Bennett, President, Digital Medical Solutions, Carestream. “This is a natural extension for both our company and our customers, and enables healthcare providers to benefit from purchasing these systems from a single supplier

with a strong reputation for outstanding service and support.” Both DRX-Excel systems offer a source-to-image detector distance of 180 cm, an ergonomic design and the ability to select an image intensifier for fluoroscopy or use the optional flat panel detector. The DRX-Excel Plus has an elevating table that tilts for fluoroscopy exams and can be lowered or raised to provide flexible, comfort-

Carestream DRX-Excel

able imaging for patients. Table weight capacity is 265 kg (584 pounds). The DRX-Excel has a fixed table with a weight limit of up to 200 kg (440 pounds) and has the tilt capability for fluoroscopy exams. Both systems feature productivity-enhancing capabilities including a positioning pedal that allows the operator to have their hands free, which is helpful for interventional exams, and a remote

control that can move the table from anywhere in the room. Other options include integration of a Carestream DRX detector, four-way float top table movement; and the ability to stitch multiple images together for long-length exams. These systems support Carestream’s X-Factor approach, which enables a DRX detector to be shared among an R/F room and other DRX mobile or room-based radiography or R/F systems. In the US, only the DRXExcel Plus model will be available. Both systems will be available in Europe, Asia, Latin America and other countries. Carestream currently offers a wide range of diagnostic imaging systems to healthcare providers worldwide and the company recently began accepting orders for its new Carestream Touch Ultrasound systems in the US.

Continued from page 71

Patient data safety and security is our primary focus... focus on patient care, billing automatically falls in place if we follow the steps involved in patient care. By going digital in healthcare are we not losing the traditional method of staying connected and maintaining records of a patient? In fact, going digital is helping us stay connected and maintaining patient records in an efficient manner. The system takes care of keeping

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September2015

doctors and patients connected, patient records are available to clinicians without getting into manual retreival of patient files. Going forward, our home care portal will even allow patients to maintain their health records at one place and sharing these with their doctors as well. We are creating a space which shall be used by both doctors and patients. Can this system be exposed to a threat of invasion of

privacy, which is another concern since India does not have a comprehensive law in place or sufficiently updated policies to regulate personal information in the medical or health context? Patient data safety and security is our primary focus and responsibility. We have implemented information security policies to make sure that patient data remains safe and secure and is available only to who should have access to it. Patient data in the

system is only available to treating doctors and to caregivers. Sensitive/confidential information related to patients has another level of security and remains between the doctor and their patients. Will such a system increase the healthcare cost to the patient? CK Birla Hospitals is committed to provide the best outcomes and experience to its patients. We have invested

substantially in the implementation and will keep on investing in technology which will help in the best outcomes. In the long run, patients will get benefitted as they will get the best treatment which shall be guided by the patient history and the medical conditions they have undergone in the past. We never pass on any of the development or enhancement cost to our patients.

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.