Express Healthcare (Vol.10, No.6) June, 2016 by Indian Express

VOL.10 NO 6 PAGES 68

www.expresshealthcare.in JUNE 2016, `50

CONTENTS Vol 10. No 6, JUNE 2016

Chairman of the Board Viveck Goenka

SCALEV/S SUSTAINABILITY: WHATWILLYOU CHOOSE?

MARKET

Sr Vice President-BPD

Neil Viegas Editor Viveka Roychowdhury* Chief of Product

‘COCHLEAR NOT ONLY RESTORES HEARING BUT IT BRINGS BACK CONFIDENCE’

HITS 2016 TO BE HELD IN BENGALURU

NAYATI HOSPITAL, MATHURA CELEBRATES WORLD HYPERTENSION DAY

Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bengaluru Assistant Editor Neelam M Kachhap DESIGN National Design Editor Bivash Barua Asst. Art Director Pravin Temble

18TH & 19TH NOVEMBER 2016

Senior Graphic Designer

Renowned Speakers Major Tracks Published Papers & Abstracts

Rushikesh Konka Senior Designer Rekha Bisht

Artists Vivek Chitrakar, Rakesh Sharma

Registrations CALL- 9535942460 MR.KANAGARAJ

Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - East & West Marketing Team

INTERVIEWS P14: DEEPIKA T GRANDHI Business Development Head, Cleveland Clinic

KNOWLEDGE

SOCIO-ECONOMIC IMPACT OF NCDS A SILENT CRISIS FOR INDIA

IT@HEALTHCARE

WHY HEALTHCARE INDUSTRY SHOULD INVEST IN DIGITISATION?

Douglas Menezes Ambuj Kumar E.Mujahid Arun J Debnarayan Dutta Ajanta Sengupta

P22: SANJEEV VASHISHTA

CEO, SRL Diagnostics

PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia

42: DR SHILPA LAD Specialised radiologist in breast imaging and interventions NM Medical Center, Mumbai, India

Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

P45: PRASHANT JHAVERI Head, Products and Strategy, Medi Assist

Express Healthcare® Regd.with RNI no. MAHENG/2007/22045,Postal Regd. No. MCS/162/2016 – 18,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 © 2016 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

Regulating the regulators

he Supreme Court’s decision in end May to mandate a single national entrance exam for UGH and PG medical seats from next year, has merely postponed the debate on medical education. Many state governments, some emboldened by recent poll wins like in Tamil Nadu, have already made it clear that they would oppose implementation of the National Educational Eligibility Test (NEET) as it put students from their states at a disadvantage, both from a syllabus as well as linguistic point of view. It was the Medical Council of India (MCI) that first suggested the idea of a NEET. But the MCI has been fighting a battle of credibility for many years. The latest salvo was a hard hitting Standing Committee Report (SCR) submitted on March 8, focussing on the functioning of the MCI. The changes recommended by the SCR are so sweeping that many experts have called for a scrapping of the MCI and a fresh start. The report itself recommends that the Ministry should take measures to amend the present statute or 'enact a new legislation' which allows the government to intervene in matters of corruption. With a three member committee now in place to oversee the functioning of MCI till it is reformed, the end is still nowhere in sight. In most such cases, public interest dies a natural death, but could it be different this time? The clamour for change shows signs of escalating since the SCR was tabled in the Parliament. An editorial in the British Medical Journal (BMJ) lauded the report "for its thorough analysis of the state of healthcare in the country and paving the way for radical reform" but also warns that it overlooks "the complicity of ruling politicians, many of whom own private medical colleges." (BMJ 2016;352:i1731) In an acknowledgement that political will must flow from the top, former policy makers and doctors have now joined forces to request Prime Minister Modi's direct intervention in the revamping of the MCI. In a letter to the PM, the group reportedly asks him to implement the SCR's recommendations without delay and that the current MCI be replaced by a "transition team of experts.” According to media reports, the letter suggests that this transition team would work out the reform agenda over the next two years and enable the implementation of a revised architecture of a new body whose creation will require a bill to be enacted by the Parliament. The fact that the letter is signed by five former health secretaries (Sujatha Rao, Keshav Desiraju,

EXPRESS HEALTHCARE

June 2016

Former health secretaries and doctors have written to Prime Minister Modi,requesting his direct intervention in the revamping of the MCI

Javid Choudhury, Prasanna Hota and K Chandramouli) and leading doctors like Dr Samiran Nundi, Dean of Sir Ganga Ram Institute for Postgraduate Medical Education and Research and senior gastrointestinal surgeon (one of the authors of the BMJ editorial cited above), Dr Srinath Reddy, cardiologist and President, Public Health Foundation of India, Dr Maharaj Kishan Bhan, paediatrician and Former Secretary, Department of Biotechnology, Dr Gautam Sen, cardiothoracic surgeon and founder of Healthspring, a chain of clinics focussing on family health, and clinical immunologist Dr Sita Naik speaks for itself. Some of these doctors have served on the Board of Governors of the MCI so they probably have first hand experience of the misgovernance and corruption in the Council. In fact, Rajendra Pratap Gupta, President & Board Member, Disease Management Association of India goes a step further and calls for reform of all regulatory bodies in the healthcare sector, like the Pharmacy Council of India, Nursing Council of India, Homeopathic Council etc. His letter dated May 9 to the Chief Justice and the bench of five Supreme Court Judges hearing this matter points out that all these bodies exist to 'protect their own turfs, and no one ‘really’ cares for the ‘patient’ for whom the entire healthcare system should operate.' He has offered to meet the Chief Justice or the bench to discuss his ideas of going beyond 'doctors' and a ‘treatment based’ healthcare system rather than focusing on 'Population Health’. There will be no doubt many more such requests and offers of help to the government and the bench of judges. Which prove that there is no dearth of advisors and experts available to help the government. It is high time that there is a new blueprint for healthcare regulatory bodies which have not evolved in tune with current socio-economic and industry realities. But, how long will this process take? Dr Arvind Panagariya, Vice Chairman, Niti Aayog who heads a panel looking into the reform of the MCI, has gone on record to say on May 28, that major changes would happen in the next few months. With the BJP government using its second anniversary to remind the electorate of its achievements, with an eye clearly on the 2019 polls, will healthcare finally become one of the top three election issues? Or will it be swept under the carpet, yet again? VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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LETTERS QUOTE UNQUOTE

MAY 2016

WELL WRITTEN ARTICLES

have read your May issue and found that the articles covered in this issue were well written; especially the article titled, “Will IPOs in Healthcare sink or soar?”. Dr Prateek Rathi, Special Executive Officer-ESI Scheme, Department of Public Health, Maharashtra

HEAD OFFICE Express Healthcare® MUMBAI Douglas Menezes The Indian Express (P) Ltd. Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821580403 Email Id: douglas.menezes@expressindia.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express (P) Ltd. Business Publication Division Express Building, B-1/B Sector 10 Noida 201 301 Dist.Gautam Budh nagar (U.P.) India. Board line: 0120-6651500. Mobile: +91 9999070900 Fax: 0120-4367933 Email id: ambuj.kumar@expressindia.com Our Associate: Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com

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June 2016

Tobacco use continues to be a major public health issue across the WHO South-East Asia Region with nearly 246 million people in the region's 11 countries continuing to smoke tobacco and just below 290 million using it in smokeless forms

The government is committed to bring about transparency in medical education and remove malpractices JP Nadda

Dr Poonam Khetrapal Singh

Union Health Minister, India

Regional Director for South-East Asia,WHO

(Speaking at the state health ministers’meet on NEET)

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MARKET I N T E R V I E W

‘Cochlear not only restores hearing but it brings back confidence’ In India, three out of 1000 people have moderate, severe or profound bilateral hearing loss. This handicap is often treated as a low profile disability (as it cannot be seen), which leads to very low awareness about this sombre issue in the society. Former international cricket icon and Cochlear’s Global Hearing Ambassador, Brett Lee and ENT specialist, Dr Shankar B Medikeri, speak to M Neelam Kachhap, about the social responsibility towards people with hearing disabilities and the solutions to tackle this issue Dr Medikeri what is the incidence of hearing impairment in children in India today? Shankar B Medikeri (SBM): In India for every 1000 children born, four to five will have profound degree of hearing loss. I’m talking about sensorineural hearing loss and these children may not be benefited by a hearing aid. They require implanted devices. Actually over five per cent of the world’s population – 360 million people – have disabling hearing loss out of which 328 million are adults and 32 million are children.

but can also trigger hearing loss. Other than these a tumour on the hearing nerve can cause the rarer neural hearing loss.

What are the causes of disabling hearing loss in children? SBM: There are many causes of hearing loss among children, which mainly are congenental or birth defects or post birth. Congenital hearing loss is present at birth and is the most common problem seen in newborn babies. It can be either inherited or caused by abnormal development in the foetal stages of life. These can be because of birth injuries, anoxia during birth, severe infections, severe jaundice. Other causes could be trauma, presbycusis (age-related hearing loss), noise exposure from machinery or firearms, Meniere’s disease and meningitis. Then there are ototoxic drugs which may be necessary to treat some lifethreatening medical conditions

At what age do parents seek help for hearing implant? Who has been your youngest patients so far? SBM: I have been practising in this field for the past 13 years and my youngest implanted patient was nine months old at the time of implant. Parents seek help in first year of life onwards. We need to have more new born screening as its not one of the mandatory screening at birth. Infant hearing screening programmes can improve the linguistic and educational outcomes for the child. Early detection and intervention are crucial to minimise the impact of hearing loss on a child’s development and educational achievements.

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Tell us about the genetics of hearing loss. SBM: Hereditary hearing loss can be inherited in an autosomal dominant, autosomal recessive, or Xlinked recessive manner, as well as by mitochondrial inheritance. In India, consanguineous marriages are the main cause of hereditary hearing loss. Mutation in GJB2 and GJB6 are used for molecular genetic testing.

Hereditary hearing loss can be inherited in an autosomal dominant, autosomal recessive, or X-linked recessive manner, as well as by mitochondrial inheritance. In India, consanguineous marriages are the main cause of hereditary hearing loss

What are the benefits and risks of cochlear implants?

MARKET SBM: Cochlear implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants bypass the damaged hair cells of the inner ear (cochlea) to provide sound signals to the brain. Earlier, we used to do Cochleostomy with round window enlargement techniques for cochlear implant which resulted in some amount of trauma. Now, the latest technique uses thin soft electrodes and minimised initial intracochlear trauma and preserve residual hearing. Why have you associated with Cochlear? Brett Lee (BL): I’m very proud to be associated with Cochlear as their first Global Hearing Ambassador. I have seen some of the recipients ‘switched on’ for the first time, when they suddenly hear sound! I saw their sheer joy at being able to hear life. It really affected me. This is something I have always wanted to do giving back to society. And it feels incredible. What has been your experience in the past year working with Cochlear? BL: It has been incredible to see the work Cochlear does around the world. As Cochlear Ambassador, I lead ‘Sounds of Cricket’ campaign to raise awareness of the significant medical, social and economic impacts hearing loss can have on individuals and their families. It is very important to promote social inclusion of people with disabilities. I feel like I'm part of a big family and raising awareness is fun. I learn new things everyday. Cochlear not only restore hearing but it brings back confidence. Do you have a personal connection with the cause of hearing loss awareness? BL: I understand the agony and anxiety a parent has when the kid has hearing loss. My son had a fall and had diminished hearing for a year but lucky his hearing came back to normal range. It is coincidental that I got involved with Cochlear.

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What does your work with Cochlear entail? BL: My work entails primary advocacy to raise awareness about hearing loss and cochlear implants and promoting social inclusion of people with disabilities. Also, for economically weaker people affected with hearing

loss, I hope the government will come with initiatives for affordable hearing aids, cochlear implants and services. People with hearing implants face social prejudice. Do you think implants could one day be as

common and affordable as reading glasses? BL: Yes, I see that people with hearing implants face a lot of social prejudice and stigma in all walks of life. I believe education and awareness will change this in future. It will become as easy going as spectacle. Earlier people used

to frown upon spectacles, now it is a fashion accessory. Cochlear has worked on a sleeker design and different colour implants for people to choose from. Cochlear is working on a new technology to create totally invisible implant. mneelam.kachhap@expressindia.com

MARKET I N T E R V I E W

â&#x20AC;&#x2DC;Our focus is to raise Cleveland Clinic's brand awareness to every nook and corner of Indiaâ&#x20AC;&#x2122; US-based Cleveland Clinic is looking to provide liaison services to patients in India. Deepika T Grandhi, Business Development Head, Cleveland Clinic, spoke to M Neelam kachhap on Cleveland Clinicâ&#x20AC;&#x2122;s plans in India Tell us about Cleveland Clinic's association with India? Cleveland Clinic supports the diverse needs of patients, medical professionals and healthcare organisations around the world. Cleveland Clinic has collaborated with persons across the globe who serve as liaison points to create a seamless process to assist patients in coordinating their medical needs with medical professionals. Cleveland Clinic recently finalised plans to provide liaison services to patients in India who are seeking treatment from Cleveland Clinic specialists.

Cleveland Clinic connects with international patients from approximately 125 countries. In the year 2015, one per cent of the total international patient population came from India.

What percentage of patients treated at Cleveland Clinic come from India?

How do you plan to promote the Cleveland Clinic brand in India? We are a premier healthcare

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Tell us about the services offered by Cleveland Clinic in India? Although at present Cleveland Clinic is focused on providing patient liaison services, we would be happy to consider any opportunity to support healthcare delivery process in terms of consulting, providing access to second opinions from our specialists and education services.

Cleveland Clinic connects with international patients from approximately 125 countries

organisation with top-level rankings in multiple specialties. As such, our brand is extremely well recognised in many parts of the world, including India. But our focus is to raise the brand awareness to every nook and corner of this country, not just the major metros. We plan to utilise social and print media to promote our services across the country. Our primary objective is to create awareness, not just for the brand, but also for the widearray of services that Cleveland Clinic has to offer. Additionally, we plan to utilise key medical conferences to get our message out to the medical leaders and the healthcare community in general.

like to add. Cleveland Clinic, a non-profit multi-specialty academic medical centre based in Cleveland, Ohio, US, was founded in 1921. Today the 3,000 physicians at Cleveland Clinic represent more than 120 specialties and subspecialties. Cleveland Clinic is committed to better outcomes for patients, and on innovation in their diagnosis and treatment. This commitment now extends to colleagues across global medical community. Our presence in facilities ranging from Nevada to Florida in the US, and from Canada to Abu Dhabi in the United Arab Emirates internationally makes access to Cleveland Clinic services easier than ever before.

Anything else you would

mneelamkachhap@expressindia.com

Sometimes Iâ&#x20AC;&#x2122;m blunt. But never pointless.

Creativeland Asia

The Indian Express. For the Indian Intelligent.

#IndianIntelligent

MARKET PRE EVENT

HITS 2016 to be held in Bengaluru The event will address new challenges and opportunities that arise from information technology in healthcare HEALTHCARE INNOVATION and Technology Summit (HITS 2016), will be held at JW Marriott in Bengaluru on July 2, 2016. The event will be an exclusive platform where emphasis will be given on top quality hospitals, laboratories and surgeons who want to be at the forefront of providing quality healthcare by ‘Enhancing Smart Healthcare Delivery’ into their systems. These doctors are the change makers and trendsetters who will get to develop different benchmarks on healthcare delivery. They are not only

from major cities but the larger most essential Tier II and Tier III cities across South India. The platform will help strategically to identify the most technologically advanced solutions that can be integrated. It will focus on how to engage healthcare providers to develop and use technology and innovation with a futuristic approach. Government ministries and departments, hospital directors, CEOs and chairman, procurement heads / purchase managers, medical directors, CMIO’s & Head HIM’s, surgeons and doc-

tors, CIO's & CTO's, senior IT leaders, general managers, senior vice presidents etc., are likely to participate in the event. HITS-2016 is proud and propitious to associate with Express Healthcare who together would manifest enhancements in delivery of healthcare through targeted hospitals, laboratories and clinics. HITS-2016 will address the new challenges and opportunities that arise from information technology in healthcare. It will showcase the latest innovations, trends and technologies; facili-

tate new collaborations and partnerships to generate new ideas and taught process. It is also a one-stop shop bringing the entire eco-system together under one roof. Healthcare strategies will be explored and executed accurately with the right understanding on the following subjects. They are Technology-enabled care (TEC), Electronic medical records (EMR), mHealth / eHealth, digital health, telemedicine/ telehealth/telecare, portal technology, remote monitor-

ing tools, sensors and wearable technology, wireless communication, real-time locating services, nuclear medicine, robotic technology, IoT/ IoE, 3D printing, big data/ data analytics/ data aggregation, Hospital Management Information Systems (HMIS), Picture Archiving and Communication System (PACS), Remote Installation Services (RIS) and hybrid technology. A series of keynote presentations, round table and panel discussions will be held during the summit.

POST EVENTS

The President confers Florence Nightingale Awards to 35 nurses Health Minister commends selfless dedication, handwork and compassion of nurses THE PRESIDENT of India, Pranab Mukherjee conferred the Florence Nightingale Awards to 35 nurses from across the country on the occasion of International Nurses Day at the Rashtrapati Bhavan, in the presence of JP Nadda, Minister for Health and Family Welfare. The President congratulated the award winners and said that nurses play a vital role in all aspects of healthcare, be it national health campaigns like polio eradication, mid-wife services and community education. Their level of commitment and care are much valued in both urban and rural areas, including remote areas of the country. The President added that their contribution is critical in the

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The President, Pranab Mukherjee addressing at the presentation ceremony of the Florence Nightingale Awards 2016, on the occasion of the International Nurses Day, at Rashtrapati Bhavan, in New Delhi

achievement of the nation’s healthcare goals. Their inputs into health sector policies are equally important for they help in creating the necessary supportive work environment for their practice, he added The President while commending all the nurses for their compassion, discipline and commitment to healthcare said that developing resilient health systems is a key to realise the United Nation’s Millennium Developmental Goals. Emerging global threats such as microbial resistance, new pandemics, infections, and natural disasters have added to the pressure and demands on healthcare services. The services of nurses are crucial for a response system that a

MARKET government creates to meet these challenges, the President said. Nadda also congratulated the award winners and appreciated their exemplary services. Acknowledging the strong caring and compassionate attitude of the nursing community, the Health Minister said that nurses play a pivotal role in providing healthcare at the primary, secondary and tertiary level. He added that through the competence they have demonstrated themselves to be role models for the young generation. He elaborated on the various schemes and initiatives taken up by the Ministry for strengthening and upgrading the infrastructure and human resource in the nursing sector. Nadda also informed that the Ministry has undertaken a number of initiatives for strengthening the nursing cadre. Some of them are establishment of ANM/GNM Schools, upgradation of institutions from school of nursing to college of nursing, training of nurses, and development of nurse practitioner courses for critical care and primary healthcare services. The Minister further added that the National Nursing and Midwifery Portal is being developed to bring out all nursing related information like Government of Indiaâ&#x20AC;&#x2122;s initiatives in the field of nursing, information regarding nursing and midwifery education and human resource availability in the country, circulars, notifications, job opportunities and e-learning modules at a single platform. Speaking on the occasion the Health Minister stated that work on creating an Indian nurses live register will help in getting the latest, correct and real-time information of the current human resources in the field of nursing in India. A technology platform called the Live Register has been initiated to include, capture and up-date the latest information of currently practicing nurses. The Florence Nightingale awards are given to the outstanding nursing personnel employed in central, state/UTs. Nurses working in government, voluntary organisations, mission institutions and the private institutions can apply with the due recommendation of concerned

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National Nursing and Midwifery Portal is being developed to bring out all nursing related information like Government of Indiaâ&#x20AC;&#x2122;s initiatives in the field of nursing, information regarding nursing and midwifery education and human resource availability in the country etc

state government. The Florence Nightingale Awards carries Rs 50, 000 cash, a certificate, a citation certificate and a medal. Also, present at the award ceremony were BP Sharma, Secretary (Health and Family Welfare) and senior officers from the Ministry of Health and Family Welfare along with invitees.

MARKET

Nayati Hospital, Mathura celebrates World Hypertension Day Organises free health check-up camp for cardiac and neuro patients NAYATI MULTI Super Specialty Hospital, Mathura recently celebrated World Hypertension Day with an objective to create awareness and engage with the community to educate them on early detection and prevention of hypertension. The theme for World Hypertension Day 2016 was ‘Know your numbers.’ Nayati Hospital, to mark World Hypertension Day, organised a free health checkup camp in Mathura for cardiac and neuro patients. The checkup included free consultation by the cardiologists, haemoglobin, Random Blood Sugar (RBS) and blood urea nitrogen serum creatinine test and tests on TMT, echo and

Dr Sunil Kumar Gupta giving a lecture on the effects of hypertension

lipid profile. Dr Venugopal Ram Rao, Chairman, Cardiac Sciences and HOD Department of Cardiothoracic and Vascular Surgery, Nayati Multi Super Specialty Hospital stated, “More awareness is needed to ensure people, who suffer from this condition, that they are accurately diagnosed and know about the available treatment

options. In many cases, there are no symptoms until it causes complications such as heart attack, stroke and chronic kidney disease. So, it is important to realise that you may have high blood pressure and the only way to find out is to get your blood pressure checked at regular intervals. India is on the brink of a cardiovascular disaster and needs urgent measures to con-

trol blood pressure levels.” Dr Sunil Kumar Gupta, Head of neuro-interventional surgery and minimally invasive neurosurgery, Nayati Multi Super Specialty Hospital stated, “Hypertension is one of the important causes of Cerebro Vascular Accident (CVA) or stroke. Damage to the nervous system has long been known to be a common manifestation of hy-

pertension in the form of stroke or CVA. If we control our blood pressure in normal range then we can reduce the risk of stroke /CVA.” Dr Krishna Mohan Sahu, Director, Department of Nephrology, Nayati Multi Super Specialty Hospital stated, “High blood pressure and kidneys are intimately related. While high blood pressure can damage the kidneys and lead to chronic kidney disease (CKD), kidney disease can lead to high blood pressure. High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more. It's a dangerous cycle. It is imperative that we practice healthy living and seek the help of doctors whenever needed to keep blood pressure below 120/80.”

Hospitals celebrate International Nurses Day The theme for this year’s celebration was ‘Nurses: A Force for Change: improving health systems – Resilience EACH YEAR, May 12 is commemorated as International Nurses Day across the world. The day is celebrated in memory of Florence Nightingale, the founder of modern nursing. Hospitals in India celebrated the day with great fanfare. This year the theme being Nurses: A Force for Change: improving health systems — Resilience, recognised the growing importance of nurses in improving the healthcare system in India. Wockhardt Hospitals or-

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June 2016

ganised a cultural programme and award ceremony across all the facilities of Wockhardt: Vashi, Mira Road, Rajkot, Nagpur, Nashik, Surat, Goa. At Wockhardt hosptials, nurses who had served these hospitals for five to 10 years were rewarded with gold coins and an ‘Excellence certificate’ with medal was awarded to outstanding performance by ‘Florence Nightingale Club’ of Wockhardt Hospital. Various programmes like

nursing team pledge; cultural events like five minutes skit and dance performance, cake cutting etc were organised at all Wockhardt Hospitals for

the nursing team. The initiative was a gesture from the hospital for nurses who care for their patients. Apart from this, the group organised a Nursing Leadership Programme- a unique way to recognise the managerial dimensions in nursing to train potential leaders and train them in key competencies. Likewise, PD Hinduja Hospital & Medical Research Centre also recognised and commemorated the diverse roles played by nurses in im-

proving the healthcare system’s resilience and enhancing healthcare delivery and quality. The hospital organised a conference in the hospital premise today which brought many stalwart faculties from the field of nursing to share valuable insights while inspiring the nursing fraternity. In a similar manner, Fortis group of hospitals felicitated the unparalleled dedication and contributions of the nursing staff at their hospitals.

EVENT BRIEF JULY 2016 02

HEALTHCARE INNOVATION AND TECHNOLOGY SUMMIT 2016

HEALTHCARE INNOVATION AND TECHNOLOGY SUMMIT 2016 Date: July 2, 2016 Venue: Bengaluru Summary: Healthcare Innovation and Technology Summit (HITS 2016), will be held at JW Marriott in Bengaluru on July 2, 2016. It will be an exclusive platform where emphasis will be given on top quality hospitals, laboratories and surgeons who want to be in the forefront of providing quality healthcare by 'Enhancing Smart Healthcare Delivery' into their systems. Express Healthcare is the media partner for the event. The platform will strategically help to identify the most technologically advanced solutions that can be integrated. It will focus on how to engage healthcare providers to develop and use technology and innovation with a futuristic approach. Visitors will be able to get an experience about the latest trends, innovations and technologies through keynote presentations, round table and panel discussions. HITS 2016 will also address the new challenges and opportunities that arise from information technology in healthcare. Contact Parvathi Devi Partnership Manager â&#x20AC;&#x201C; Associations Mobile: +91 8884412355 India:+91 80 41234500 US:+1 646 741 8757 UK:+44 203 695 9813 Email: parvathi.d@ibcipl.com Fax:+91 80 41234511

MEDICALL 2016 Date: July 22-24, 2016 Venue: Chennai Trade Center, Chennai Organiser: Medexpert Business Consultants Summary: Medicall is a leading hospitals needs and

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equipment exposition in India. It brings the latest, appropriate and affordable technologies, for the benefit of all hos-

MEDICALL 2016

pitals including smaller hospitals, clinics, nursing homes and physicians setting up group practice.

Contact Medexpert Business Consultants 7th Floor, 199, Luz Chruch Road,

Mylapore, Chennai - 600 004, Tamilnadu, Email: info@medicall.in Website: www.medicall.in

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Sanjeev Vashishta , CEO, SRL Diagnostics

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BREAKING BARRIERS TO DIALYSIS

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IPO is quite suitable to companies that have a proven track record In the recent times leading diagnostic players — Dr Lal Path Labs and Thyrocare who went IPO have got a pleasant welcome at the stock market. Will SRL be the next? To find answers to this, Raelene Kambli speaks to Sanjeev Vashishta , CEO, SRL Diagnostics, who shares his views on the same and provide information on their expansion plans and their partnership with three state governments in India What is SRL’s turnover in the last quarter? We are in the process of finalising our accounts as the audit is under way. Being part of the listed entity, we can’t provide any guidance on the numbers till the time the same are made public following the proper process. However, the company is growing in a very sound manner. The company’s revenues have grown at 15 per cent CAGR during the last four years and during the corresponding period the CAGR growth of EBITDA is around 35 per cent. What is the current valuation of your company? We have not looked into the valuation of the company as there was no need to do so. Valuation is carried out for specific purpose viz, the company is going public or inviting the investors to invest in it unless the company is already a listed entity with an established market cap. Further, the valuation is determined by various factors such as size and scale of operations, the financials of the company, it’s potential to grow/ ability to generate profits /return on investment in the future, how good the management is, whether there is a balanced distribution of revenues/ business from various geographies or it is concentrated in a particular geography etc. Finally, the value of the company has to be determined by someone who

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wants to invest in that company. Given the fact that SRL is the largest network of labs with a very balanced geographical presence, professional management, growing EBITDA margins and all the right building blocks, it should command a good valuation in the market. What is your opinion about going IPO? As CEO of the organisation, my task is to take SRL to the newer heights which it so rightly deserved. As management, we have to ensure that we give best possible diagnostics facilities and services to all our customers. Whether to go public or not is something that the company’s investors’ and board members have to decide. As of now, my focus is to fill the capacities that we have created over the last few years and make the operations more and more efficient and effective. Is going the IPO way a good strategy for the diagnostic player to expand its business? IPO is one of the ways to garner the funds to expand the operations. Various options of funding are available to various enterprises and IPO is one of the options. Like any other industry, raising funds through IPO is one of the options available to the diagnostics industry to garner funds for expansion. IPO is quite suitable to the companies that have a proven track record of consistent performance.

carrying out the business efficiently.

Given the fact that there are very few diagnostics players in the organised sector, the rub off effect on the valuation is imminent Has the successes of your competitors on the stock market have impacted your business in any way — positively or negatively? IPO is just one of the options to garner the funds. Success of the competitors on the bourses doesn’t have any direct impact on our business. However, it certainly gives visibility to all the established players who are

There is news about your company’s valuation being increased after your competitor diagnostic chains going IPO. I would surmise so. Given the fact that there are very few diagnostics players in the organised sector, the rub off effect on the valuation is imminent. As such, SRL is the flag bearer of the diagnostics industry with 315 labs and over 7000 collection points in and outside of India and it is known for the superior quality/ accuracy of results, quick turn around time (TAT) of its tests at affordable prices. SRL recently announced an aggressive expansion plan with an investment of more than Rs 300 crores in the next five years. What is the development on the same? One of our prime focus is to create an unparalleled ‘reach’ to ensure that we are closer to our customers and patients. There is no sense in people travelling long distances for getting superior quality diagnostics services. We are expanding our network to reach out to the masses and also centrifugally taking the technologies out to the network labs beyond the so called reference labs to facilitate quick turnaround time for at least 7580 per cent tests. Now, we are working very closely with various state governments

under the PPP initiatives and setting up labs in the remotest of areas whether it is Rohru and Kurseog in Himachal Pradesh or Pakur, Dumka or Giridih in Jharkhand. We are also partnering with various multilateral agencies including UNICEF where we are testing the masses in 1900 villages spread across all the 30 states in India at the behest of UNICEF. How are you going to raise these funds and how do you plan to utilise these funds? Given the fact that SRL is a profitable company with healthy cash flows, the internal accruals are more than sufficient to take care of all its expansion plan. I am also pleased to share with you that in the first quarter of FY 17, SRL is slated to become debt-free company. SRL has also tied-up with three state governments. Can you throw more light on the same? That’s correct. We are running diagnostics facilities under the Public Private Partnership (PPP) in three states i.e., Himachal Pradesh, Uttar Pradesh and Jharkhand where we are providing superior quality diagnostics facilities at the government determined prices from about 40 labs which we have created in various government hospitals and many collection points. raelene.kambli@expressindia.com

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Driven by the need for better diagnostic services for kidney disorders, the market for renal function tests is witnessing double digit growth BY M NEELAM KACHHAP

aboratory tests represent three per cent of the total healthcare spending, while influencing more than 70 per cent of medical decisions. “The diagnostic market in India is characterised by a large number of unorganised area which is not accredited. However, this unorganised area is growing daily and a huge amount of money is being invested in this sector. As of now, the diagnostic mar-

ket holds up to Rs 37,000 crores per annum which makes it a big market for investors,” says Dr Nilesh Shah, Group President & SBU Head, West India, Metropolis Healthcare.

Market overview With the rise in number of new kidney disease patients every year, India needs better access to diagnostics to detect the disease early. Since kidneys play

an important role as blood purifiers, they need proper circulation and regeneration to work. With our changing lifestyle and food habits, functional damage to kidney is very common. If detected early, these damages can be stopped from progressing. Experts believe that there are 229 endstage kidney disease patients per million population in India. Besides, the number of patients suffering from diseases

that lead to kidney disorders are also increasing. Although hypertension and diabetes are the common lifestyle disorders leading to kidney disease in recent years, chronic kidney disease of unknown origin has been reported from Andhra Pradesh and different parts of the world. While the structural changes in kidney are detected using imaging techniques like ultrasound, MRI and CT, bio-

chemical markers have been used for accurate diagnosis, early detection and screening. "Renal function tests are one of the most common test panel ordered in lab investigation. It comprises around 20 per cent of total lab investigations in India,” informs Dr Barnali Das, Consultant, Biochemistry & Immunology Division, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai.

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The size of the renal function test market in India is about Rs 1360 crores till date Dr Nilesh Shah Group President & SBU Head, West India, Metropolis Healthcare

The individual tests that make up a renal panel can vary depending on the laboratory that performs the testing Dr Barnali Das, Consultant, Biochemistry & Immunology Division, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai.

The reason for increase in the number of renal function test prescribed today is increased disease burden Dr Sudipta Datta, Sr Vice President – Quality Assurance & Laboratory Services, Columbia Asia Hospitals

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“Approximately 18.2 per cent of all tests at our hospital are renal function tests,” she adds. These tests also help in assessing risk and adopting therapy that improves clinical outcomes for kidney disease patients. "The renal function test at the Metropolis Labs contributes to around 3.61 per cent out of the total number of tests that take place,” says Dr Shah. Kidney function tests provide an assessment of the filtration rate of the glomeruli, the principal filtering structures of the kidneys and whole renal blood flow, visual and physical examination of the urine, and determination of the concentration of numerous substances in the urine, notably glucose, phosphate, sodium, amino acids, and potassium, to help detect possible impairment of the specific kidney functions generally involved with their reabsorption. "Approximately five to six per cent of total tests at our hospitals are renal function tests," says Dr Sudipta Datta, Sr Vice President – Quality Assurance & Laboratory Services, Columbia Asia Hospitals.

Market size Global kidney function tests market is seeing a double digit growth and is one of the most promising segments in clinical chemistry market. Although there have been very few data to authenticate the size of the market but experts believe that the market size is about three to four per cent of the total diagnostic market. "The size of the renal function test market in India is about Rs 1360 crores till date," shares Dr Shah. "This is expected to exhibit lucrative growth over the next five years owing to an increasing prevalence of chronic kidney disorders," he adds.

Market drivers Rise in the burden of kidney disorder is one of the main drivers of growth for the renal

function test market. In fact, the demand for kidney function test in India is mainly driven by increasing incidences and prevalence of diabetes. “The reason for increase in the number of renal function tests prescribed today is increased disease burden," says Dr Datta. Other major factors that are expected to drive growth are high prevalence of obesity, hypertension, coronary diseases and renal fibrosis. "The most common causes of and main risk factors for kidney disease are diabetes, hypertension, family history of kidney disease for example, polycystic kidney disease (PKD),” explains Dr Das.

COMMON INVESTIGATION IN RENAL FUNCTION TEST ◗ Creatinine ◗ Urine albumin ◗ Cystatin C ◗ Urinalysis ◗ BUN/ Creatinine Ratio ◗ Osmolality ◗ Urine protein ◗ Creatinine Clearance ◗ Electrolytes: Sodium, Potassium, Chloride, Bicarbonate

Experts believe that human papilloma virus infections which are more common in females and affect kidney function by altering filtration, reabsorption and secretion rate of renal system. This difference in kidney functions can be easily picked up by kidney function tests thus leading to growth in this market. "Rising geriatric population which is more prone towards chronic ailments associated with vital organs is anticipated to upsurge the market growth. In today’s world, fast food and modern lifestyle being adapted by Indians at the speed of lightening, which is causing a lot of health problems in an individual, mostly associated with the kidney," says Dr Shah.

Market segment Kidney function tests market is segmented into different categories. These categories include clearance tests, dilution and concentration tests, urine tests and visual imaging tests. Further, urine tests can be clubbed into microalbuminuria, urine protein and urinanalysis. Additionally, assessment of filtration rate of glomerulus is done using clearance tests. While, deter-

NEW TESTS FOR RENAL FUNCTION ◗ Estimated Glomerular Filtration Rate (eGFR) based on CKD-EPI cystatin C equation: Cystatin C is now considered a better marker for eGFR estimation because of its age and gender independence. ◗ Fibroblast Growth Factor -23 (FGF-23): In patients with chronic kidney disease (CKD), blood levels of fibroblast growth factor -23 (FGF-23) rise in parallel with declining kidney function. FGF-23 inhibits renal reabsorption of phosphate, and excess phosphate has been shown to be associated with mortality. In patients with early stage CKD, FGF-23 showed a strong link to both end stage renal diseases (ESRD) and death. FGF-23 is linked with mortality than reduced eGFR and proteinuria. Therefore, it has the potential of important biomarker for kidney function test. ◗ Neutrophil Gelatinase- Associated Lipocalin (NGAL): is found to be the best to predict acute kidney injury. NGAL could be useful when serum creatinine is in the middle range. NGAL is found in neutrophils as well as in renal tubular epithelium, where NGAL is very much increased in ischemic or nephrotoxic injury.

mination of concentration of numerous substances in urine, including phosphate, glucose, amino acids, potassium and sodium is done using concentration tests. “The individual tests that make up a renal panel can vary depending on the laboratory that performs the testing, but a panel may include electrolytes: sodium, potassium, chloride, bicarbonate; calcium, phosphorus, albumin and anion gap,” says Dr Das. “For those with diabetes or high blood pressure, urine albumin (microalbumin) or random urine microalbumin creatinine ratio, may also be used to detect early kidney damage,” she adds. Of these, concentration tests are the most widely used tests as they are used in drug development and used to determine metabolising power of liver and other associated organs. In India there is a difference in the number of renal function tests prescribed among various regions. “This is more in urban areas in India due to life style and eating habits,” says Dr Das. “Indians have changed their food habits. Fast food and the lifestyle changes has led to a steep rise in obesity and diabetes amongst Indians. Diabetes, in many cases affects the kidneys of the individual, for which the doctor prescribes the renal function test to check the kidneys of the individual. Diabetes is a major cause for the increase in the numbers of renal function tests,” explains Dr Shah. However, some parts of rural India have seen rising incidence of kidney disease owing to water table contamination with pesticides, fertilisers and in some cases heavy metals due to large mining activity. “There is not much variability in renal function tests prescribed in various regions. And the variability known might be due to variable incidence of renal disorders or diseases causing renal complications,” says Dr Shah.

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1.4 2,00,000 1360 patients globally are being diagnosed with kidney issues per year

new End Stage Renal Disease (ESRD) patients in India every year

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is the size of the renal function test market in India till date

Laboratory tests represent 3% of the total healthcare spending, while influencing more than 70% of medical decisions

Renal function tests are one of the most common test panel ordered in lab investigation It comprises around 20 per cent of total Lab Investigations in India

Market players

Drivers of growth

Renal function tests are carried out mostly by automated biochemistry analysers. There are established MNC and Indian players in the market. “All major companies manufacturing IVD equipment are players in this market,” shares Dr Datta. While companies like Abbott Diagnostic and Roche Diagnostics have enjoyed a major market share in India, home-grown Agappe Diagnostics and Transasia Bio-Medicals are not far behind. “Siemens makes equipment, reagents and chemicals used in renal function tests. The other trustworthy companies that provide the reagents are Roche, Beckman, Abbott etc,” shares Dr Shah.

Increasing patient population is one of the largest drivers of growth for this market. According to Transparency Market Research, the demand for kidney function tests is mainly driven by the presence of a large patient population suffering from renal disorders. According to the WHO, there are more than 1.4 million people worldwide, who undergo renal replacement therapy every year with the incidence rate of chronic kidney disease growing by approximately eight per cent annually. To check the large population of kidney disorder patients awareness and early screening with advanced and improved techniques is required. This will further propel market growth higher. Also, new drugs for management of kidney diseases are the need of the hour, consequently, new drug development and in-vivo determination of pharmacokinetic parameters such as renal clearance for novel drugs in order to determine half life is expected to fuel growth of this market. However, high cost of diagnosis and increasing cost of healthcare are some of the barriers of growth for the industry.

Technological barrier Majority of these automated tests are dependent on the use of proper reagents. Most companies make closed system equipment which means that the device works with only specific reagents manufactured by the same company. However, some open system devices are also present in India. But the dream is to have compatible devices which would then drive down the prices of reagents and in turn tests. Other challenges occur when there is in-

terference leading to high or low or invalid results. “Creatinine is the most common renal function test for which different methods are available like enzymatic and Jaffe creatinine. We get high interference in Jaffe creatinine with icteric sample, even bilirubin concentration of 3-4 mg/dl sometimes interfere with Jaffe creatinine method. In other instance drug interferences are sometimes observed in renal function

tests,” explains Dr Das.

Innovation and new tests There are a number of new genetic markers that have been identified to determine the altered state of kidney function. “The emergence of newer biomarkers like uNGAL (urinary neutrophil gelatinase-associated lipocalin), and cystatin C are likely to further improve the monitoring and help in stratifying the risk of progres-

sion, morbidity and mortality in chronic kidney disease,” says Dr Datta. However not everybody agrees. “There are few markers available in market like NGAL, Beta Trace protein, etc. which have predictive or prognostic value for acute or chronic renal injury. But these require more clinical evaluation and validation to judge the clinical utility,” contemplates Dr Shah.

mneelam.kachhap@expressindia.com

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BREAKING BARRIERS TO DIALYSIS

With new business models and renewed interest from the government, the dialysis market in India is ready to break barriers of accessibility and affordability BY M NEELAM KACHHAP

ising incidence of diabetes and hypertension have taken a devastating toll on Indians. The huge number of kidney disease patients bears witness to it. “Nearly 10-15 per cent of India’s 1.25 billion people suffer from kidney diseases and ailments,” says Dr Gaurav Thukral, Senior Vice President and Business Unit Director, HealthCare at HOME India. Of these, a large number of patients progress to end-stage renal disease and require organ transplant and renal replacement therapies to sur-

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vive. "As of 2016, we estimate that about 13 lakh patients in India require some form of renal replacement therapy, with about two lakh new patients being added every year," says Shriram Vijaykumar, MD and CEO, DaVita Care (India) Bangalore. Experts believe that the average age of chronic kidney disease (CKD) patients in India is much lower than patients in western countries. According to some estimates, the average age of CKD patients in India is in the range of

45-50 years where in the western countries, the average age of CKD patients would be around 60 years. This means that in India patients need longer care regimens than their counterparts in other countries. Also, there is a marked difference in the prevalence of CKD among various regions in India. Although it is reported that Northern India has higher prevalence rates than southern India, a new form of CKD has been reported from parts of Andhra Pradesh and is said to be of unknown origin.

Scope of market Renal replacement therapy market is segregated into hemodialysis and peritoneal dialysis (PD). "Haemodialysis is the largest and most widely accepted modality for dialysis, with approximately 90 per cent of the market share. The remaining share goes to peritoneal and other dialysis modalities. Currently, the average life expectancy of patients on End Stage Renal Disease (ESRD) is between three to four years," says Vijaykumar. The size of renal replacement market in India has al-

most doubled in the past five years. "Most recent estimates put the total number at 1.25 1.50 lakh all India. PD market is still relatively small at 6,000 - 8,000 pan all India," says, Akash Nayak, Director of business development and Scientific Affairs, Dr Nayak Dialysis Centres. Renal replacement services are provided by hospitals, stand-alone clinics, nursing homes, dialysis care providers and home healthcare providers. "There are a total of 3300 hospitals (private /government/ NGO's/nursing

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homes and other dialysis chains) that provide dialysis in India. In addition, BBraun, Davita, Nephroplus are few of the chains that represent pure play dialysis players," says Vikas Verma, Business Head Avitum (Renal Division), BBraun India. However, some experts believe that this is just the tip of the iceberg. “Healthcare service providers have so far only seen the tip of the iceberg in this market, as affordability of the average man in India increases and therapy gets cheaper due to higher volumes. There is going to be an explosion in the size of the market,” says Nayak. “This market extends to the dialysis machines, dialysis consumables, pharmaceuticals, skilled healthcare professionals, health insurance, surgical, and many other products and services,” he adds. While it may seem like there are many providers servicing this sector, but like everything else in healthcare, access is a major problem. “Though 70 per cent of the population lives in rural India, sadly 90 per cent of the dialysis facilities are in urban India (i.e. metro cities and Tier I and II cities / towns),” says Verma. Vijaykumar adds saying, “As of 2016, we estimate that about 13 lakh patients in India require some form of renal replacement therapy, with about two lakh new patients being added every year. The larger story, however, is that of access. Only about 10-12 per cent are on some form of renal replacement therapy.”

Mounting costs Experts believe 2.2 lakh new patients of end stage renal disease get added in India every year resulting in additional demand for 3.4 crore dialysis sessions. Needless to say that there is a demand-supply gap with only the demand being met by with around 4,950 dialysis centres in India, largely in the private sector and concentrated in major towns. Besides,

one dialysis session costs about Rs 2,000 mounting an annual expenditure of more than Rs 3 lakh for the patients. "The cost of renal replacement therapy varies in private and government sector," says Dr DS Rana, Chairman, Department of Nephrology, Sir Ganga Ram Hospital, Delhi. Dr Rana has also served as the Past Secretary & President, Indian Society of Nephrology and is the Founder Secretary, Indian Society of Hemodialysis. He says that a few states are providing highly subsidised maintenance haemodialysis to patients of their states mainly in South. "In private sector, the cost of maintenance haemodialysis varies from Rs 2000 to Rs 4000 per session," Dr Rana informs. "The cost of transplantation also varies from Rs 4 lakhs to Rs 8 lakhs and maintenance cost of life saving immuno-suppressive drugs varies from Rs 10000 to Rs 20000 per month," explains Dr Rana.

There is a growing interest in stand-alone dialysis service centres. Cost of setting up a centre is competitive and a slew of investors both Indian and foreign have stakes in this segment Service providers Dialysis service providers engage different business models to deliver services. There are in-centre dialysis, hospitals, independent dialysis centres, home dialysis, PD and home haemodialysis. All these can contribute to better outcomes for patients. Nayak says, "Independent centres can help in reduction of overall cost of dialysis, but most patients in India still prefer to be in a unit attached to a hospital because they feel safer with the easy availability of 24X7

emergency care. Hospitals also tend to stock all the medicines that the patient needs regularly for therapy in their in-house pharmacies. It will take some time before our patients can get used to the standalone model as in the US." Offering a different take, Vijaykumar says, “At present, the Indian dialysis market is largely in-hospital: with most large and medium sized hospitals having their own dialysis unit. Independent or standalone centres is still an emerging concept but is gaining

ground rapidly. Globally, we see that most maintenance haemodialysis is done in independent centres whereas hospitals provide more of the acute and higher end dialysis services. Hospital centres are able to offer advanced therapies like haemodiafiltration (HDF), Double Filtration Plasmapheresis (DFPP), etc.” “Home haemodialysis, which is largely non-existent in India, brings the comforts of a high-quality dialysis programme to patients homes, ensuring better compliance to dialysis regimes, better clearance and zero cross-infections,” he adds.

Opportunity There is a growing interest in stand-alone dialysis service centres. Cost of setting up a centre is competitive and a slew of investors both Indian and foreign have stakes in this segment. “A good quality small unit (five to six new machines) can require an upwards of Rs 50 lakh as an initial invest-

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Though 70 per cent of the population lives in rural India, sadly 90 per cent of the dialysis facilities are in urban India Vikas Verma Business Head Avitum (Renal Division), BBraun India

Independent centres can help in reduction of overall cost of dialysis Akash Nayak Director of business development and Scientific Affairs, Dr Nayak Dialysis Centres.

Haemodialysis at home will be the game changer as its cost prohibitive at this time Dr Gaurav Thukral, Senior Vice President and Business Unit Director, HealthCare at HOME India

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ment, without including the land. Larger units can easily exceed Rs 100 lakh, one crore,” enumerates Nayak. Talking about the market opportunity, Vijaykumar says, "For pure play healthcare service providers, the biggest opportunity lies in creating a quality and outcomes-based healthcare model. Dialysis can be a leading harbinger of change, as this is a space where outcomes are tangible. Results of good quality dialysis leads to improved quality of life for patients. The obvious next step is to look at reimbursements, from private insurance and government providers, for dialysis. Like in the West, if we move to an outcomes-based scenario, it is a win-win situation for governments, providers and pa-

Dialysis is expensive, so affordability remains an imperative challenge for service providers.With insurance still staggering in India and high cost of treatment regimes, drop out rates are high tients alike." “From a capacity building perspective, there are opportunities to create standalone dialysis centres that cater to a wider pool of patients – primarily in suburban and semiurban areas, as well as Tier II cities,” he adds. Similar opportunities exist

for home healthcare players. “Opportunities for home healthcare in dialysis is huge in India. Although acceptance to Peritoneal Dialysis (PD) is low given that Next of Kin (NOK) of the patient finds it difficult to do it at home doctors also don't prescribe it given the fact that compliance

is poor. Home healthcare bridges the gap and increases access to care as dialysis centres are concentrated in cities only. Home PD makes life near normal and not riddled by issues of frequent hospital visit and infections,” says Thukral.

Market for equipment and consumables Besides services, equipment manufacturers also consider India as one of the large markets. "There were 3557 dialysis machines sold in 2015 in India with average price of Rs 6.5 lakhs each," shares Verma. "With regard to consumables, there are various consumables used in dialysis and the market for consumables for 2015 was pegged at a little over Rs 10 billion," he adds.

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2,00,000 80 4,950 Lakhs

3.4

Crores

new patients of End Stage Renal Disease get added in India every year

dialysis centres are in India Dialysis service market stands at around 80 lakh treatments a year

is the demand for dialysis sessions in India every year but only half the demand is met

3557 dialysis machines were sold in 2015 with average price of Rs 6.5 lakhs each

As per current trends, segment will grow by 17-18 per cent in future and mainly because of increasing incidence of diabetes & hypertension

2,000

is the cost of every dialysis session – an annual expenditure of more than Rs 3 lakh In India just around 1300 nephrologists for 1.3 billion population The cost of PD at home varies between Rs 55- 60 k a month

MARKET DRIVERS: 4A - AFFORDABILITY AVAILABILITY ACCESSIBILITY & ACCEPTABILITY There are three segments in dialysis equipment: budget machines (non upgradeable) for chronic / maintenance haemodialysis; premium machines (upgradeable) with options of maintenance dialysis and other therapies like 'Online Haemodial filtration' etc and CRRT Machines (high end) - majorly used in ICU settings to treat sensitive and acute cases ( eg. multi organ failure etc).

Challenges Dialysis is expensive, so affordability remains an imperative challenge for service providers. With insurance still staggering in India and high cost of treatment regimes, drop out rates are high. “Poor healthcare insurance coverage (nearly 80-90 per cent pay out

of pocket for dialysis) makes it very expensive for patients to stay on therapy for the required period since they need to pay a heavy amount out of pocket, relatively low patient compliance and non-adherence to dietary and fluid restrictions is seen sometimes and can make management difficult. These factors lead to high drop-out rate or suboptimal therapy,” says Nayak. Besides, accessibility is also a major factor for drop-outs. If one adds the fact that there are a handful of nephrologists and even fewer dialysis technicians and nurses to service these patients, you begin to understand the hardships surrounding dialysis service in India. “I would say we face two major challenges: lack of a social security net and not enough

Dialysis is expensive, so affordability remains an imperative challenge for service providers.With insurance still staggering in India and high cost of treatment regimes, drop out rates are high trained manpower. We need to build syndicated registries like the USRDS (United States Renal Data System) which tracks outcomes for dialysis and pays providers on the quality of services. Thus, patients, governments and providers have a transparent system that compares dialysis pro-

grammes that are truly beneficial versus those that are in name only,” says Vijaykumar.

The game changer If what Vijaykumar suggests becomes a reality in India, it will change the way dialysis is accessed and delivered in India. With the ‘National Dialysis

Services Programme’ the government has taken a small but correct step in the direction. The government intends to make funds available through PPP mode under the National Health Mission, to provide dialysis services in all district hospitals. Further, the Finance Minister proposed to exempt certain parts of dialysis equipment from basic customs duty, excise/CVD and SAD to bring relief to patients as the government foresees a reduction in cost of dialysis in India. But has this really affected the cost? “Not as yet,” says Nayak. “But we need to understand that the cost of dialysis service is not as dependent on the cost of consumables as one might think. Apart from the consumables and machines, the cost of

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India should manufacture everything including dialysis machines and dialysers which will be major step to reduce the cost of dialysis Dr DS Rana Chairman, Department of Nephrology, Sir Ganga Ram Hospital, Delhi

Although the waiver for duty on dialysis equipment has brought some relief, there is the double whammy of multiple layers of taxation on consumables Shriram Vijaykumar MD and CEO, DaVita Care (India) Bangalore

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the therapy arises from salaries of technicians, nurses and doctors, pharmaceuticals, rent or land cost, utilities including RO water plant, electricity etc,” he further adds. Some experts believe that there are more to tax exemption than which meets the eye. “Although the waiver for duty on dialysis equipment has brought some relief, there is the double whammy of multiple layers of taxation on consumables. We use consumables like blood tubing and dialysers with every dialysis session - which now have both import duties and sales taxes, thereby significantly driving up costs,” says Vijaykumar. Efforts by the government are laudable but there is much more that the government can do for this segment. “India should manufacture everything including dialysis machines and dialysers in India and that will be major step to reduce the cost of dialysis,”opines Dr Rana. “In the absence of adequate number of nephrologists, we should also provide reasonable training in dialysis therapy to physicians so that large number of centres situated in small towns and may be in near future in rural areas can be managed by these trained medical manpower,” he adds. Besides the government, NGOs can also provide support to dialysis services. “NGOs can render real service in this area to make dialysis affordable and accessible,” says Dr Rana. “The government on its end should provide subsidised immune-suppressive drugs, which are required lifelong for transplant patients,” he further adds. Besides this, nurturing good transplant centres is a pressing concern. “Every medical college should have transplant centres. The government, NGOs, print and electronic media should create awareness of cadaver transplant programme for

at home will be the game changer as its cost prohibitive at this time. Future is bright given a mix of CAPD, APD, HD and complete renal replacement therapy at home including post transplant care,” says Thukral. Dialysis care centres are not far behind. “We see pockets of opportunity in the home haemodialysis (HHD) market in India where we are currently the only pan-India provider. Our HHD programme in India closely mirrors that of our parent company, wherein patients enjoy the benefits of a world-class dialysis in the comfort of their own home,” says Vijaykumar. Another new trend in the segment is in the convective dialysis therapies, haemofiltration (HF) and haemodiafiltration (HDF). “Another modality that is gaining ground is online haemodiafiltration which greatly enhances clearances over haemodialysis and has shown improved outcomes as well,” says Vijaykumar.

Although the outcome for ESRD patients may not always be positive, dialysis service has improved and will continue to innovate and improve in future making more organs available for transplantation,” asserts Dr Rana.

Trendy measures Although nothing has changed in the dialysis business in the way dialysis patients approach treatment, if experts are to be believed things will change for better soon. “Dialysis is an everchanging business. With the advent of new technology, better quality dialysers and more awareness of the disease, we are seeing a sea change in the market and patient expectations,” predicts Vijaykumar.

While service providers and equipment manufacturers see a sunrise industry at the cusp of revolution, new models of business are also vying for their share. “This is a growing market for us. Recent focus of the Indian government on dialysis in the budget and National Dialysis Programme would propel growth. When it comes to ESRD, India is growing at twice the world AGR and the graph is bound to go up north in the near future,” opines Verma. And home healthcare providers see a new business opportunity. “Haemodialysis

Future Although the outcome for ESRD patients may not always be positive, dialysis service has improved and will continue to innovate and improve in future. “To be frank, the quality of dialysis has improved so much that we are now seeing patients live on dialysis for 20+ years, we are seeing far more employed patients, and overall far happier patients. A dialysis centre can be so homely nowadays that a patient can relax, watch TV, read a book and calmly avail of dialysis service, rather than 20 years ago when most patients were 'barely alive'. Most people working in the centre needed to keep a bucket close to the patient because they used to vomit so often during therapy! Luckily now is a much better time to be a dialysis patient than before,” concludes Nayak. mneelam.kachhap@expressindia.com

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FO C U S : I P O U P D AT E

OPINION

CAPD,its current status and future in India

DR K SAMPATHKUMAR, Honorary Secretary, Indian Society of PD Meenakshi Mission Hospital, Madurai

Dr K Sampathkumar, Honorary Secretary, Indian Society of PD Meenakshi Mission Hospital, Madurai, elaborates on how PD is one of the choices available in the basket of renal replacement therapy, which works in tandem with and complimentary to HD

idneys are a pair of bean shaped organs in the abdomen regulating vital functions such as fluid, electrolyte balance, production of hormones regulating blood pressure, red blood cell production and bone health. Chronic Kidney disease(CKD) is a major ongoing but silent epidemic in India afflicting 7-10 per cent of the adult population. Diabetes, hypertension, immunologic, hereditary and environmental diseases are the major causes of CKD. When the patient reaches the stage of End Stage Renal Disease [ESRD] > 90 per cent kidney is permanently damaged and survival is not possible without recourse to dialysis therapy or kidney transplantation.

Magnitude of the problem ESRD population in India is increasing at an alarming rate of 10-20 per cent annually. Even a conservative estimate of ESRD burden in India would suggest that about 3,00,000 (age adjusted) people develop ESRD every year. There are currently around 5,00,000 ESRD patients in India. Hospital-based Haemodialysis (HD) or homebased Continuous Ambulatory Peritoneal Dialysis [CAPD] are the two options available for these patients. The unfortunate fact is that only 10 per cent of ESRD population actually end up getting the benefit of dialysis and

Home-based therapy of CAPD offers several advantages including preservation of patient autonomy, less prospects of travel to hospital and improved quality of life with social and professional rehabilitation. PD can be undertaken at home with minimal supervision and lesser disruption to normal lifestyle

the rest are left to die in the absence of state funded free dialysis programmes. But winds of change are sweeping across India with many states including Tamil Nadu setting up such haemodialysis centres catering to economically challenged population. But what is perplexing is that peritoneal dialysis (PD) has not been provided due recognition and funding. In contrast, South East Asian coun-

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cover ) tries like Hong Kong and Thailand have successfully adopted a 'PD FIRST' policy wherein all newly diagnosed ESRD patients are treated by PD only. Currently, approximately 9,000 patients in India are treated by PD. Approximately 30 hospitals in the country have more than 50 patients on PD.

one-month CAPD therapy came down from nearly Rs 35,000 per month to about Rs 19,000 per month.

Government’s initiatives for reducing cost of PD

Why HD is preferred over PD in India? More than 90 per cent of the patients are started on HD rather CAPD due to multitude of reasons. Firstly, the option of PD is rarely offered to patients by a nephrologist. The reasons could be lack of exposure and training in PD. HD involves capital expenditure in the form of procurement of machines, water treatment plant etc and hence financial issues also could cloud the decision making process against PD. Secondly, there is a misconception and fear about high infection rates in PD. Advent of double bag systems and intensive patient education and training in PD lead to remarkable reduction in peritonitis rates. Thirdly, PD is being perceived as the second class form of dialysis since the survival rate was poor in the initial era. It was due to the fact that only the sickest of the lot received PD as a last ditch attempt and the mortality was high. In the recent era, with proper selection of patients, PD gives as good result as HD with many advantages. It is a wrong idea to view PD as competitor therapy to HD. It is one of the choices available in the basket of renal replacement therapy and works in tandem with and complimentary to HD. There are times when patients can switch between the two forms of dialysis harnessing the benefits of both.

CAPD procedure A soft catheter is surgically implanted into the peritoneal cavity at the abdomen and after a few days of wound healing special PD fluid with glucose and electrolyte as

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ingredients is infused into the abdomen. After the fluid is allowed to interact with patient’s capillary blood it is removed through the same permanent catheter carrying with it the waste products like urea and creatinine. The procedure is repeated manually three times a day. Once started, CAPD has to be continued lifelong or till a renal transplantation is carried out. Another attractive but costlier option is available. Automated PD cycler machines can be utilised by the patient who connects PD fluid bags with the catheter before retiring to bed at night. The machine can be programmed to deliver precise volumes of PD fluid in multiple cycles throughout the night as the patient sleeps so that dialysis can be delivered without intrusion into patient’s daytime routine.

Advantages of PD versus HD Home-based therapy of CAPD offers several advantages including preservation of patient autonomy, less prospects of travel to hospital and improved quality of life with social and professional rehabilitation. The procedure is simple and can be quickly learnt by the patient so that he or she can perform the

PD is a safe, efficient and patientfriendly form of therapy whose potential is yet to be tapped by India dialysis herself. PD can be undertaken at home with minimal supervision and lesser disruption to normal lifestyle. Even patients, who stay far away from centres that offer HD or in cities or towns with no facilities of HD or in remote places, can safely undertake PD. Patients in places as diverse as Andaman and Nicobar Islands and interior J&K or Arunachal Pradesh are on PD. Because it can be undertaken by patients in the comfort of their homes and at a pace that suits their lifestyle, PD patients report higher employment and school attendance as compared to HD. The survival of patients during the initial years of dialysis seems to be better with PD than HD. The

'down but not out' kidneys seem to preserve their last vestiges of function better while on PD than in HD. Serious blood borne infections due to bacteria are distinctly less common with PD since the catheter is not in direct contact with blood. Anaemia is more common and severe in HD due to blood loss during the procedure. Hence, HD patients require more iron supplements and erythropoetin injections. Anaemia is less severe in PD patients since there is no blood loss during the procedure. Since PD involves slow removal of waste products throughout the day, the body is able to adapt without producing side effects such as dizziness and vomiting which are common during HD sessions. Lastly, PD is the preferred modality of dialysis for Infants and children suffering from ESRD.

Cost of PD Prior to 1994, CAPD fluid was imported to India through a complex process. of exemption was issued for three months. Subsequently, nephrologists made representations to convince the authorities to allow easier import and convinced industry to set up local manufacturing facilities. This had a positive impact on prices. The price of

Various state governments have taken initiatives at their end to help more number of patients to be able to access therapy. States of Tamil Nadu and Kerala do not levy any VAT on dialysis consumables. This would result in making PD fluid bag cheaper. Other states can also make policy announcement for abolition of VAT. Government can abolish customs duty on imported components and excise duty on local manufacturing. This will make PD fluids and accessories cheaper and hence more accessible for everyone. States like Andhra Pradesh and Telangana state run very efficient dialysis programmes under their Rajiv Gandhi Aarogyasri programme. Some more states are in the process of setting up dialysis units under the PPP model. Dialysis is also covered under the Chief Minister’s Insurance Scheme (Tamil Nadu) and Karunya Scheme (Kerala).The announcement of a national dialysis policy is very welcome. Countries like Thailand and Mexico had challenges similar to India’s diverse geography and shortage of trained manpower. After much discussion between policy makers and specialists, they chose to opt for a smart mix of PD and HD. This mix of PD and HD has ensured that more patients are able to get the benefits of therapy at no extra cost to government. PD is a safe, efficient and patient-friendly form of therapy whose potential is yet to be tapped by India. For that to happen, the nephrologist should feel confident that he is providing a non-inferior form of therapy to HD. The patient should value the autonomy and enhanced quality of life which come along with PD. The government should equalise the cost of HD and PD so that the patient can make his own choice.

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FOCUS:DIAGNOSTICS

INDUSTRY TRACKER

Global transplant market to reach $753.9 million by 2021: Report Asia-Pacific region is expected to become the new revenue-generating pockets in the transplant diagnostics market

he global transplant diagnostics market is projected to reach $753.9 million by 2021 from $535.0 million in 2016, at a CAGR of 7.1 per cent between 2016 to 2021, according to marketsandmarket.com. Market growth can be attributed to factors such as the rising number of solid organ, soft tissue and stem cell transplantations; technological advancements in the field of organ transplantation; increased funding, research grants, and public-private investments; technological shift from serolog-

ical assays to gene-based HLA profiling; and improving healthcare infrastructure across developing countries. In 2016, North America and Europe are expected to be the mature markets for transplant diagnostics products. However, emerging regions such as AsiaPacific (including Japan, China, and India) are expected to become the new revenue-generating pockets in the transplant diagnostics market in the next five years. The North American market is expected to hold the largest share of the global trans-

plant diagnostics market in 2016. It is projected to grow at a highest CAGR during the forecast period owing to easy accessibility and high adoption of advanced diagnostic technologies (such as PCR and NGS) among healthcare professionals, increasing prevalence of target diseases (such as cancer, heart failure, and renal diseases) in the US and Canada, and continuous technological advancements in the field of transplant diagnostics. Europe is expected to hold the second-largest share of the

global transplant diagnostics market in 2016. This leading market position of the European market is due to factors such as rising acceptance of genomebased diagnostic techniques by healthcare professionals, large number of organ transplantation procedures performed annually, presence of a large number of biotechnology and molecular diagnostic companies, and rapid growth in the aging population. Thermo Fisher Scientific, (US) dominated the global transplant diagnostics market with a share of 42 per cent in 2015. In

the past three years, the company adopted strategic acquisitions and geographic expansions as key growth strategies to maintain its dominant position in the global transplant diagnostics market. Other leading players present in the market are Immucor, (US), Olerup SSp AB (Sweden), QIAGEN, (Netherlands), Bio-Rad Laboratories, (US), Affymetrix, (US), Illumina (US), Luminex Corporation, (US), F Hoffmann-La Roche (Switzerland), and Abbott Laboratories, (US), among others.

CORE Diagnostics introduces Fortis to chart new of action for PCDxTumour Profiling in India course SRLDiagnostics Partners with US-based molecular diagnostics company Paradigm

CORE DIAGNOSTICS has entered into a new partnership withUS-based molecular diagnostics company Paradigm to facilitate patient access to Paradigm Cancer Diagnostic (PCDx) in India. Through this association, the two companies aim to provide a growing community of oncologists the most relevant and actionable cancer care available. With molecular testing driving the new wave of personalised cancer treatment protocols, this agreement with enable CORE Diagnos-

tics to add a valuable service to its comprehensive menu of advanced diagnostic tests in India. PCDx is a comprehensive clinical-grade NGS-based test that is designed to provide physicians and patients with a more targeted, personalised approach to cancer treatment by identifying the underlying genomic and proteomic alterations of a tumours DNA, RNA and protein. The test interrogates the most relevant genomic targets at over 5,000x average

depth of coverage with 72 therapeutic associations. Results are typically delivered in four to five business days. The test uses molecular data to help oncologists provide the most effective treatment plan for each patient and devise more accurate therapeutic options for patient care. CORE Diagnostics offers a comprehensive menu of specialised, advanced diagnostic testing in India in the areas of cardiology, oncology, reproductive disorders, endocrinology and infectious diseases.

SRL Diagnostic will soon be vertically demerged from its parent company AFTER THE successful listing of Dr Lal Pathlabs in December 2015 and recently Thyrocareâ&#x20AC;&#x2122;s success in the stock market has enthused the promoter company of SRL Diagnostics to contemplate about a public issue for the company. Reportedly, SRL Diagnostic will soon be vertically demerged from its parent company, Fortis Healthcare. According to industry analysts, his will help SRL Diagnostics to get listed on the Indian bourses. The move is also aimed at giving an exit route to the private equity investors,

who together own 34 per cent stake in the company. To give exit to some of the PE firms International Finance Corporation, NYLIM Jacob Ballas and Avigo Capital Partners, SRL Diagnostics care had appointed Moelis & Co as advisor to facilitate the transaction in 2015. The announcement is expected soon as per some industry sources. Some of the leading PE firms such as Baring Asia, Capital International and Bain Capital were in serious discussion to acquire stakes from the existing investors and even to increase it to majority.

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STRATEGY

SCALE V/S SUSTAINABILITY: WHATWILLYOU CHOOSE? he last few years have seen the rise of many tech start-ups within the healthcare space. These start-ups mainly connect doctors to patients, doctors to other medical experts, patients to pharmacists, patients to healthcare providers, help people maintain their daily vitals through mobile apps, so on and so forth. All, of them established with one intention, to create a niche business segment for themselves within the healthcare space. Initially, when these concepts emerged they were very well received both by the target audience and by investors. Industry analysts were of the opinion that these start-ups have the potential to disrupt the existing models of healthcare delivery. This set a momentum for this trend and these young and technologically-driven start-ups started riding the wave. More and more tech start-ups began to sprout which cater to newer and more niche areas of healthcare. Today, even as the rest of the tech start-ups in India are struggling to secure funds due to dipping valuations, these digital health companies have continued to beckon investors. The only cause of concern is the viability of these business models in the long run. Here is where the question of sustainability and scale comes to the fore. While interacting with healthcare start-ups, investments bankers and analysts, we often have sustainability and scale as an important point of discussion. Sustainability and scale both in their own right are the lifeline of any successful business. While sustainability of a business depends on the ability of the organisation to maintain commercial success, be

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VARUN GERA CEO, HealthAssure Business model

ealthAssure is an aggregator of 2000 primary care centres across 800 cities. We believe there is a large need and gap for preventative care and day-to-day health, be it for general physician, diagnostic, pathology, dentist, specialist doctor, etc., for a family, individual or corporate. We use a strong IT platform to provide our customers access to our wide spread and high quality primary care network at discounted rates and thereby getting health â&#x20AC;&#x2DC;closer to them and helping them lead healthier lives.

Scale v/s sustainability

future ready and to be part of a sustainable society. Scalability can have different meaning depending on the type of the business model . For instance, scalablity for one business can mean allocating and optimising resources to drive the greatest results and volume across market segments, but for another business it could mean increasing the size of the company or it could simply mean revenue growth. This offcourse, is a decision taken depending upon the organisationâ&#x20AC;&#x2122;s strategy for growth and overall vision it undertakes. Nevertheless, this decision also to a certain extent plays a pivotal role in determining the fate of a business organisation eventually. To delve futher into understanding the perspective of these young business enterprises on sustainability and scale, Express Healthcare quizzes co-founders and CEOs of some forward looking start-ups within the healthcare space. As a word of advice to these promising entrepreneurs, we also bring to you a viewpoint of few experts BY RAELENE KAMBLI

At HealthAssure, we did not make a choice between scale or sustainability. We have focused on both from the very beginning to ensure we build a strong base of high quality and complex healthcare ecosystem and a scalable IT and operations platform. This has allowed us to double each year while maintaining our service standards.

Worthwhile decision Healthcare is a very complex industry and this strategy has helped us build on our goodwill and brand. It has also helped us remain focussed, innovate and evolve on our strategy each year.

Learning lessons We have to keep challenging existing ideas within and outside our company. That requires a management culture which has a continuing and clear objective of external customer.

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STRATEGY

DR ASHWIN BONDE, Co-founder, Pulsewell

TUSHAR VASHISHT, CEO HealthifyMe Business model

his start-up uses a combination of cloud-powered software (smartphone application), hardware (wearable pedometers) and human assistance (nutritionists, trainers and yoga instructors) to help people reach their fitness goals. HealthifyMe features the world’s largest Indian calorie counter available for free on Android and iOS phones. HealthifyMe’s premium customers can connect with dedicated experts (diet, fitness, yoga) using in-app messaging interface and via skype. Experts understand the client’s lifestyle and help make changes within their lifestyle providing a plan (diet/exercise chart) and following up on the plan. Experts also con-

nect customers in groups and use social motivation to drive long-lasting results that are empirically proven to be better than offline technologies/services at a fraction of the cost.

Our revenues have increased 10X in the last 12 months and we expect to deliver another 6X in next 12. Simultaneously, we intend to target two million users in the next 12 months as well.

Scale v/s sustainability

Learning lessons

We have taken a balanced approach from the start. Our premium model allows for both. We are able to drive string scale from our free app and monetise our premium services for those who want it. As a result, we have strong unit economics and yet have registered 500,000 users already making us the largest digital wellness product in not just India but South / Southeast Asia as well.

We believe that exploring new possibilities with the product is always beneficial. Our partnerships have helped us alot in gaining traction in the market and has served as a major factor in our achievement. The corporate tie ups with Manipal hospitals and Medanta among others have enabled us to reachout to a large number of consumers and has positioned us at the forefront of healthcare technology in the market.

Worthwhile decision

Business model

ne simple reason behind ‘Pulsewell’ is that healthcare in the current scenario is neither sustainable nor scalable; reasons being asymmetry around information, economics, access and transparency. We are building technology to make sure quality and transparent care is affordable too and is within the reach of each one regardless of your socioeconomic level.

Scale v/s sustainability Being a new concept, which is working well so far, we have chosen sustainability as a way before scale of operations. There are multiple reasons to it — finance availability, team bandwidth, ease of operations, technology, quality and iterations in offering which

happen on a time to time basis.

Worthwhile decision So far, we have been able to keep our head above the water and make sure we can accommodate changes at a rapid pace. It has also helped us attracting top class talent and business alliances.

Learning lessons Make sure you keep your head floating above the water no matter what, try not to have multiple part time people working, go out and talk to as many people as you can about your idea/ product regardless whether they belong to relevant industry or not, you never know where gold is hidden. No idea which can be stolen is worth your time and efforts.

NIPUN GOYAL, Co-founder, Curofy Business model

urofy is developed with an objective of providing nonintruding, spam free and organised network for doctors. Currently, the company’s focus is on building a high quality engaging network of doctors. With a community of highly engaged doctors, Curofy claims to be a medium for stakeholders to engage their potential users and get the word out. From surveys to product launches to even finding brand evangelist, Curofy is a huge opportunity waiting for the entire healthcare industry. Curofy is currently doing pilot project with select players, where the app provides them with a chance to make their con-

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tent available on this highly engaged network of doctors. For example, various hospitals (including St John’s, Cygnus, Columbia Asia, Rockland, Fortis and Apollo) have been pushing jobs on the platform and are getting candidates through Curofy. Similarly, some medical devices and pharmaceutical players are benefiting by reaching out directly to interested doctors.

Scale v/s sustainability We have always tried to scale sustainably. We have tried to build a community at first and so decided to scale first. User generated content was less initially, so we focussed on providing relevant news, which is a sin-

gle user value proposition. It was very popular among the doctors that time. We kept on adding doctors on foot selling them the vision and engaging them on news. As the user increased, content created by them increased and we started focusing on providing them an easy to use user-friendly and intuitive product to engage on case discussions. Now user generated content (discussions) brings most of our engagement as compared to news. With time, sustainability has been our primary focus and we are increasing basket of our services by working with various stakeholders of the healthcare industry to provide resources to the

doctors on a single touch of a button.

Worthwhile decision Single value used case in early days helped us retain our user base. With increase in user base, as content creation increased doctors got more addicted to the platform. Daily Active Users and Weekly Active Users have also been increasing continuously. It has also allowed us test new things and discover the needs of the doctors.

Learning lessons Healthcare is a high margin industry but it’s a tough nut to crack. There are a lot of grey areas in the regulations and hence

understanding the functioning of the stakeholders is a must. Also, the industry still dwells in the non-Internet era and there is huge aversion from technology. However, once this inertia is overcome, the potential dividends are huge. Hence if you persevere and put your daily learnings to use, you will do great. The industry is due for its digital makeover. Be there when it happens. Each day of our journey has been exciting. It feels really great to see the impact that we are creating in doctors’ lives and in the digital healthcare industry. Changing behaviour of an industry is very difficult and we have made some serious progress in this direction.

STRATEGY

HITESH GANJOO, CEO and Founder, Buzz4Health Business model

uzz4health is a customised professional platform for doctors and medical students, which lets them collaborate through real medical cases and other continuous medical education content. The platform has been incepted with the idea that a doctor’s education never ends with a degree; a medical practitioner needs to stay updated with the latest information on new drugs, research, approaches and emerging evidence-based treatment protocols. Buzz4Health gives access to real-world medicine and

helps physicians to share and gain knowledge from multiple specialists with relevant work experience. The customised professional platform helps verified doctors post their medical cases in a click and seek opinion of 100,000+ registered doctors on the platform. To attract more users to its network and make the platform more interesting, Buzz4Health has also adopted a social currency, where doctors can earn credit points if their answers are backed by votes. Buzz4health is in its early revenue stage where it has

partnered with several key opinion leaders across different medical specialisations to run paid accredited (CMEs and others) programmes. Buzz4health aims to disrupt the traditional model of continuous medical education, and envisions a world where physical limitations of space and time don’t hamper the potential opportunities for a healthcare professional to grow.

Scale v/s sustainability Buzz4health focused on scalability in the first 12 months of its online platform, where the

goal was to reach out to a maximum number of verified doctors. After acquiring 1,00,000+ doctors, the strategy has been to launch monetisation programmes on the platform to engage the existing users on the platform and provide them options with paid premium content (accredited by state medical council).

Worthwhile decision We believe that we chose scale first to make sense of the longterm vision and the first 1,00,000+ doctors on our platform will help us drive both

scale and sustainability from here on.

Learning lessons Less is more. Sometimes, it is overwhelming to try and build too many things that seem potentially groundbreaking. It almost seems against conventional wisdom to not build more. This is particularly true of Internet and mobile businesses, where the user has to go through a learning curve. It is almost always good to focus on one thing and build a brand before aggregating a variety of features.

AMIT MUNJAL, Co-founder & CEO, Doctor Insta Business model

octor Insta has three models to cater to different customers. ◗ B2C (For retail customers) User pays a standard fee per consultation with a specialist doctor. 70 per cent goes to caregiver/doctor and 30 per cent comes to our platform. ◗ B2B2C – Hybrid model for employers for their employees, wherein the employer pays a PMPM (Per Member Per Month) fee and the employees can consult a caregiver at a discounted price ◗ DII (Doctor Insta Inclusion) - For the rural areas of India in collaboration with companies running e-Kiosks. User pays a standard fee per consultation with MBBS doctors.

Scale v/s sustainability

Both scalability and sustainability go hand-in-hand. It is not ‘either-or’ but is ‘bothand.’ To give you an analogyhuman body cannot survive with just either heart or brain and it needs both the parts to work efficiently. Similarly, a business can only survive when it is both scalable and sustainable. So, we at Doctor Insta chose 'scalable sustainability' approach.

B2B2C model. We are now providing online consultations to some of the major companies in the country like American Express, PayU, Tech Mahindra, Punj Lloyd etc. We have all the right ingredients to become the next unicorn. The key is to stay passionate and persistent- not to lose focus and stay one step ahead of the competition.

Learning lessons Worthwhile decision We are early in our journey and so far it has been very encouraging and rewarding. This strategy of managing a tight ship has helped us in keeping our customer acquisition cost very low through joint ventures and alliances. It also helped us in getting large volume of users through

It is good to try and fail rather than fail to try. Always believe in yourself. Failures should motivate you to try harder and use them as a learning experience. There are a number of ways we can actually learn from the failure, but in order to do so, we need to look at the failure objectively, like an outsider looking in.

Initially, when we launched Doctor Insta, our focus was primarily on ‘Video Consults’ but with more than 80 per cent of India still not having proper Internet connectivity. We quickly added ‘Phone Consult’ functionality to increase the size of target market. Similarly, in our earlier version of the product, we didn’t have follow up consults free and patients would tell us that their current doctors don’t ask them for consultation fee within two to three days of getting first consult for the same problem. So, we listened and learnt from our patients’ feedback and quickly offered a superior and compelling service offering by giving a free follow up consult within seven days of a patient getting his/her first consult.

We have always tried to scale sustainably. We have tried to build a community at first and so decided to scale first -NIPUN GOYAL, Co-founder, Curofy

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STRATEGY

WORD OFADVICE I

t is important for tech start-ups in healthcare to tap non-Internet users and thus have sustained growth. Ex. Firstcry, Lenskart follows the same model.The reason being only evolved shopper will opt for services online, rest all will prefer offline services. Moreover, it is imperative for these start-ups to understand their customer needs. For eg for a start-up with online platform for healthcare providers needs to understand that a larger group of doctors generally prefer to practice on their own so the start-up really needs an excellent convincing strategy to get as many doctors on board to sustain in the long run.

RYAN ALBUQUERQUE, Co-founder, HealthSaverz Business model

ealthSaverz is India’s first pharmacy focused on chronic patients and senior citizens. We have built a model that ensures chronic patients are dealt with by our team of qualified pharmacists. Original prescriptions are picked up and digitised and orders are taken by pharmacists over the phone. Patients are reminded to refill their prescriptions and we have a mobile app and SMS-based reminder mechanism to ensure patients are reminded to take their medicines daily. We also have a policy of taking back returns of your medicines when the doctor changes your prescription. We are highly compliant and dispense against valid prescriptions only and consider ourselves to be India’s most compliant pharmacy.

Scale v/s sustainability We have clearly chosen sustainability over scale. When we started the company, we had the option to be a marketplace, a pure tech company connecting patients impersonally with pharmacies, taking advantage of the lack of enforcement of regulations, working with scanned copies of prescriptions etc. This is clearly a model that’s far easier to scale. However, we have always been clear that marketplaces are not a valid online healthcare model anywhere in the world. Given the liability around medicines, it is important to ensure an e-pharmacy model instead where the pharmacy is responsible end-to-end from prescription acquisition to dispensing to delivery.

So, we grew the hard way actually picking up prescriptions from customers and educating them. The other area we chose sustainability over scale was in how we acquired and served our customers. We believe you need sustainability to be able to scale, so while many start-ups focused on acquiring users, we have always been focused on acquiring longterm customers. We have focused on ensuring we deliver substantial value to customers while maintaining positive transaction economics. To do that, we’ve had to educate customers with regard to prescription compliance, communicate reasonable lead times to ensure we are not overstocking inventory and doing expensive express deliveries. We say to customers, “A little planning, a lot of savings!” This has required some customer education but it has delivered for us.

AJAY GARG,, Managing Director, Equirus Capital

VIPUL JAIN, Founder, Advancells Business model e create and validate protocols for treatment of various life threatening and life style diseases using regenerative medicine and stem cells. We work closely with hospitals and doctors who use our protocols and our cells to treat their patients. We supply cells to the hospitals and get paid for the same. We also get approached directly by patients who we refer to our partner network who use our products and protocols for treatment.

As the title of the book by by Nathan Furr says: Nail it then scale it! That’s been our motto. We’ve got a vibrant scalable business model that wouldn’t have been possible if we’d listened to conventional wisdom or followed ‘Me-too’ strategy. Our recommendation to others would go your own way and have conviction in whatever you do.

don't think you can choose one or the other.You must build great products which implies that the product and indeed the business model around the product is scalable and sustainable. Of course, you must scale and scale rapidly, but the unit economics must always be sound or you are likely to run into trouble in the medium term.

e are seeing interesting work being done by start-up companies in the domestic formulation market.The market continues to grow with good profitability and good teams from established pharma and healthcare companies who are getting influenced with the overall start-up culture. In our view, start-ups should focus on sustainability.We have seen a lot of startups resorting to quick financing in order to demonstrate scalability, but that is a fallacy. If the business is sustainable, scalability will happen and value will be created.

This strategy has helped us grow in a solid way not just by new customer focused sales channels but by customer loyalty and word of mouth. We’ve grown rapidly since our inception in January 2015.

Learning lessons

Worthwhile decision

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June 2016

NARAYAN SHETKAR, Director, Singhi Advisors

VARUN DUBEY, AVP, Marketing, Practo

Scale v/s sustainability My choice would clearly be sustainability first. We need to make sure we are in the market with the right product and protocol and it can’t be achieved unless we have focus and work on a

small sample size. In healthcare it requires a lot of data spread across years to be able to declare a product or service gold standard for a disease. Hence, unless we sustain ourselves to relentlessly gather and validate that data, scaling up would be an hard option.

Worthwhile decision We have been working in creating, validating and revalidating protocols for the past three years and are finally reaching a place where we can now start to spread the message across the world. Our focus on sustainability has given us the chance to be able to refine our protocols and products so they can now be scaled up without any major change to the process or system.

Learning lessons Failures are an integral part of any startup journey, more specifically a healthcare start up. It is a gritty work to find the perfect product/protocol that requires multiple levels and multiple party validation. Since there are so many complex levels involved, failure is bound to happen till the perfect combination is found. We have had our shares of failures where multiple times we have faltered getting high cell viability numbers v/s cell count. We have had failures in keeping viability for a long period of time. However, each time we have gone back to the drawing board , we have found the right balance for our business to sustain. raelene.kambli@expressindia.com

STRATEGY TREND

Charting new growth in India’s medical tourism market With India offering lowest cost and highest quality treatment, it has become a hub of medical tourism destination. Atandra Roy reports

IMMORTALITY HAS always been man’s dream and goal. The way he scrambles for pills and healthcare, you know for sure he wants to survive. However, the surge in the cost of medicines and hospitalisation has made man’s struggle to prolong his life more difficult and at a time when diseases are on the rise. Offering quality care with affordability has become a very important objective. India’s attractiveness as leading destination for medical tourism lies in its ability to offer both. According to a report released in 2014 by the Commonwealth Fund, the US spent more per capita ($8,508) on healthcare than Norway ($5,669), which has the second most expensive system. Whereas, India is at around one-tenth of the price of comparable treatment in the US or UK. The Medical Tourism Market Report: 2015, found that India was "one of the lowest cost and highest quality of all medical tourism destinations, it offers wide variety of procedures at about onetenth the cost of similar procedures in the US." South-East Asian countries have gained a reputation as the Silicon Valley of Medical Tourism. There is a lot of competition among the countries to offer their healthcare services as the best in the world. According to the Ministry of Tourism, 2014 statistics, around 230,000 patients from all over the world came to India in 2013, with the majority coming from developing and underdeveloped economies. 2015 was the top year for Rus-

helps to create harmony between the body, mind and spirit to enhance wellbeing, has also been luring a lot of medical tourists to India’s shores. Yoga and Ayurveda have emerged as popular forms of alternative health therapies. According to data estimates (Association of Ayurvedic Physicians of India, http://aapiindia.org/), there are around 4,50,000 registered ayurveda practitioners in the country. Additionally, there are around 250 ayurvedic colleges/ institutes in India, more than 8,500 licensed ayurveda pharmacies, and approximately 7,000 manufacturers, reflective of the importance given to this form of alternative medicine in the country.

The OSHO Foundation sians and the Commonwealth of Independent States (CIS) coming to India seeking medical treatment. Normally every year they account for a 30 per cent share of the patients coming to India along with the Persian Gulf countries and various other countries of Africa. Another healthcare report released by FICCI, in collaboration with consultancy firm KPMG, titled, ‘Healthcare: The Neglected GDP Driver’, reveals that the medical travel market in India is set to triple from $2.8 billion in 2014 to $10.6 billion in 2019, registering an increase of 30 per cent annually.

Ayurveda and Yoga India’s strategy is to offer various services across different segments of healthcare

medical tourism. For example, India is a country known as the birthplace of Ayurveda and Yoga. Ayurveda centres around treatment with medicinal plants and herbs, most of them unique to the sub-continent of India and found nowhere else. While Ayurveda cannot help a person who’s just suffered a heart attack, it can help the very same person maintain a healthy diet and better standard of living post recovery from the attack. About 600,000 foreign tourists, many from Europe, visit Kerala, a state with more than 30 million people, every year, and nearly 35 per cent are repeat visitors seeking Ayurveda treatments. Yoga, an ancient art which

The OSHO Foundation was set up in Pune by Rajneesh, a spiritual guru, keeping in mind the suitable climate. The institute itself attracts over 200,000 visitors annually. Most of them are international visitors.

Positive aspects of medical tourism in India India has a fairly large pool of skilled doctors and healthcare professionals trained from internationally reputed institutes. These doctors have a strong presence in advanced healthcare e.g. cardiovascular, organ transplants and have a high success rate in surgery. Private healthcare players like the Apollo Hospital Group, Fortis, Medanta Medicity, etc. offer world-class services to its patients.

Threats and challenges Though India is growing as a destination for medical tourism, it faces stiff competition from countries like Thailand and Singapore. They also offer advanced healthcare at competitive costs. Another point in favour of these destinations are friendlier regulations, for e.g. special visa rules for patients travelling to these countries. Low investment in healthcare infrastructure has also impacted India’s growth as a medical tourism hub.

Mitigating the challenges Timely measures can help in resolving the challenges which hinder the growth of medical tourism in the country. For instance, there have been complaints that the processing time for the M-Visa required by foreign nationals to come to India for medical emergency is very long. Easier regulations and faster processes are needed to give a boost to medical tourism. The government should also invest more on hospital infrastructure and medical research in the country. This would lead to better health outcomes and improve the standard of care in the country. The government should also introduce more industry-friendly policies and investments. The government too must step up efforts to increase awareness of its ancient healing therapies in various parts of the world. Simultaneously, India has to be promoted as a destination of repute for modern systems of medical care.. atandraray@gmail.com (Atandra Ray is an intern with Express Healthcare)

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June 2016

STRATEGY

Never too young to understand breast cancer

AISHA SALDANHA Student, Grade 11, NSS Hill Spring International School

Aisha Saldanha, Student, Grade 11, NSS Hill Spring International School shares her understanding about breast cancer and the need for concerted efforts to control the disease WHAT IS CANCER? Cancer is the uncontrolled division of cells in the body. Breast cancer is one that is localised to the human breast. It is a malignant tumour that spreads to different parts of the breast. Even though it has become common in women, men can be diagnosed with it too. In women, there need not be a risk factor (things which influences the chance of getting a disease) involved. There are numerous factors that could affect the chance of getting this disease, but a specific cause is not yet known. Some factors could be age, lifestyle (including smoking, drinking, diet, physical activity), or even genetic inheritance. This means that breast cancer could be passed on down generations - family history can contribute to one's chance of getting breast cancer. Very often, it also happens to women who were not genetically carrying the risk of getting the disease. Globally, the number of cancer cases is increasing. The rise in urbanisation and awareness in the population have led to an increase in the number of cases reported. In 2015, there were around 240,000 expected new cases of breast cancer in women in the US alone. However, the numbers for breast cancer in the US have been decreasing over the years. The number of women diagnosed in India annually with breast cancer is around one lakh, out of which the mortality rate is around 30,000 per year. About a decade ago, there were only 50,000 cases reported in India. In rural areas, the mortality rate is still high,

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June 2016

The number of women diagnosed in India annually with breast cancer is around one lakh, out of which the mortality rate is around 30,000 per year due to late presentation. The number of young women diagnosed with breast cancer is also increasing â&#x20AC;&#x201D; mainly in the 30-40 years age group. There is no clear cause yet but there is a correlation between the changes in lifestyle and an increasing number of cases in young women. However, with the number of organisations devoted to cancer detection, there is yet a chance for these numbers to decrease. There are several remedies for cancer such as chemotherapy and radiation. For breast cancer oncologists rely on surgery, chemotherapy and radia-

tion the most due to their reliability. Moreover, there are new therapies that are proving helpful, immunotherapy to name a few. These therapies are biological and would have a lower chance of being affected by side effects. All around the world researchers are trying to create effective cancer therapies. Pharma companies are now looking at the opportunity presented by oncology. Therefore we can rely on science and medicine to deliver the end product, hopefully soon. However, even with the improvements in therapy, it is

better to be safe than sorry. There are a number of ways to reduce the chance of contracting breast cancer. This includes being healthy and keeping fit, breastfeeding your baby, drinking less alcohol, reducing cholesterol, etc. These methods are proving to be helpful and can not only reduce one's chance of contracting cancer but also increase one's life expectancy. Exercising is very important as well as maintaining a health diet. Research shows that exercising for around four-seven hours a week can reduce the risk of contracting breast cancer. Ad-

ditionally, an unhealthy diet plays a role in contracting around 30-40 per cent of all cancers. Apart from doctors and family, we can also rely on our government. The Indian government does help patients in need, for e.g., by reducing the monetary rate of drugs and providing check-ups at a lower price. Even NGOs are doing great work for this cause. There are several NGOs that provide free detection and check up camps for women in need, for example, Indian Cancer Society is very active in conducting cancer awareness and detection camps around the city and other parts of India. Their work has benefited many around the country. They not only conduct fundraisers, but also actively engage with cancer patients. They have conducted many detection camps for women for breast cancer and have helped them after the diagnosis. Women today are more at risk to contract breast cancer than ever before. Hence, everyone should be aware of the potential causes of this cancer and be careful to avoid them as much as possible, if possible. Anyone can be diagnosed with this and it is imperative that all women should be on their 'best behaviour'. Also, it should not be just up to NGOs and the government to help, everyone should contribute in some way to help people in need. Volunteer, donate, any kind of contribution is of worth to the society. After all, these women are someone's mother, sister, daughter, and wife. aishasaldanha99@gmail.com

KNOWLEDGE INSIGHT

Socio-economic impact of NCDs Asilent crisis for India Shantanu Parihar, Head of Research, Positive Bioscience, in this article opines that as NCDs have the potential to wreak havoc on India’s socio-economic structure, there is a need for stakeholders involved to work together to find solutions IN THE past few decades, India has taken considerable efforts to reduce premature deaths and disability caused by communicable diseases such as pneumonia, small pox, diarrhoea, and polio. However, there is scope to focus and invest more in the prevention of chronic non communicable diseases (NCDs) such as diabetes, cardiac problems, and cancer and thereby avoid the significant costs these diseases generate for the individual, the family and the society. In 2014, the Organisation for Economic Co-operation and Development (OECD), cautioned that it saw India’s poor health outcome as a major developmental challenge. India lags in healthcare outcomes not only by OECD standards, but also by the standards of the developing world. Indeed, as per a study done by the World Economic Forum and Harvard School of Public Health, India will lose at least $4.5 trillion before 2030 because of the economic impact of NCD. Poorly managed chronic diseases such as Type 2 diabetes mellitus, cancer, cardiovascular diseases, and the complications they induce result in significantly high rate of hospital admissions, increasing the cost of care and consumption of healthcare resources, creating a substantial burden on India’s already strained healthcare systems. Besides the significant healthcare burden on the country, chronic diseases also pose a severe risk to the quality of

life and productivity of patients. NCDs are the leading cause of death and disease burden worldwide. India's weak healthcare system is particularly threatened with this growing problem. The ramifications of growing NCDs are serious and need to be dealt with on a war footing. Its potential to wreak havoc on India’s socio-economic

betes (ICMR-INDIAB) has pegged the number of pre-diabetics and diabetics at 139.6 million. All the major NCDs including cardio vascular disorders, present a similar picture. The possible negative impact of diseases on output, revenue, profitability, business performance, and potential for economic growth can be substantial for the individ-

PREVALENCE CAUSES AND PREVENTION structure means that a wide range of stakeholders involved need to work together to find solutions. Let’s look at diabetes. Deaths due to diabetes in India doubled in 20 years from 1990 to 2010, this, when the International Diabetes Federation estimates that about 33 per cent of diabetics are undiagnosed, and the Council of Medical Research-India Dia-

ual, the family, the company and the society. However, as NCDs are erroneously perceived to be 'diseases of prosperity', the role and responsibility of creating awareness on screening and prevention to contain this alarmingly growing burden is often not seen as a priority. Cancer negatively impacts the ability of families to earn an income, with the patient

and caregivers having to lose working days to focus on treatment. Combined with high treatment costs, the impact on the economics of the families can be severe. Indeed, as per some estimates, around 39 million Indians are pushed into dire financial situations due to the healthcare costs. Cancer treatment runs into lakhs of rupees specially when detected in advanced stages requiring expensive treatment, including surgery, new drugs and diagnostics. With the lack of awareness of tests available for risk assessment of cancer, a majority of cancer cases in India are detected at the late stage. This is a cause for alarm. Government of India’s National Cancer Control Programme estimates that there are between 2 and 2.5 million cancer patients in the country at any given point of time. Let’s look at heart diseases. About 12 per cent of those experiencing heart attacks in India are below 40, while around 20 per cent victims of heart strokes are between the age group of 25 and 40. Together, heart disease and stroke are amongst the most widespread and costly health problems facing the country. On a personal level, the family of the individual who is a victim of heart disease or stroke has to deal with medical bills, lost wages and the real potential of a decreased standard of living. However, economic and social losses due to NCDs are not inevitable. The first step in

tackling NCDs is to create an awareness of its prevalence, causes, and prevention. Interventions that focus on preventive steps such as identifying genetic risks for instance must be incorporated to begin with in the workplace such as health programmes aimed at prevention, early detection, treatment, and care. Higher investment in strong healthcare foundation and early screening for diabetes, hypertension, and cancer, show a good return of investment and those models need to be practiced widely. An Assocham report on preventive healthcare and its impact on corporate sector stated that ‘One rupee spent on prevention saves Rs 133 in absenteeism costs and Rs 6.62 in healthcare costs’. Reducing 'out-of-pocket' expenditure that pushes hundreds of thousands of Indians to below poverty line each year is an issue that must be addressed by the healthcare industry. Preventive healthcare measures should be part of overall company strategy for a healthy workplace. This can bring down the company's and the employee’s expenditure on healthcare insurance. The positive socio-economic impact of preventive health care on well-being of an individual and the potential decrease of total health care expenditure are strong arguments for looking at the healthcare sector from a different perspective—going back to the old adage—prevention is better than cure.

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June 2016

KNOWLEDGE I N T E R V I E W

Early diagnosis is the only way to complete cure Dr Shilpa Lad, specialised radiologist in breast imaging and interventions, NM Medical Center, Mumbai, India, shares details of the various evolving technologies for diagnosis and management of breast cancer in India, in an interview with Atandra Ray What are the new technologies developed lately for diagnosis and management of breast cancer? And what are the success rates for the same? Breast cancer is now the most common cancer amongst urban Indian women. As per Population Based Cancer Registry (PBCR), breast cancer accounts for 25-32 per cent of all female cancers in urban Indian cities. This implies that breast cancer comprises one fourth of all female cancer cases are breast cancer. The cause for concern is that for every two women newly diagnosed with breast cancer, one woman is dying of it in India. Since more patients in India present at later stages, they do not survive long, irrespective of the treatment they may get, hence the mortality is fairly high. Lack of awareness of breast cancer and screening for disease are significant contributory factors for the relatively late stage of the disease presentation in India. Screening mammography (which means mammogram, a specialised X-ray performed in asymptomatic women with the intension of early detection of breast cancer) is the most powerful breast cancer detection tool. Mammograms donâ&#x20AC;&#x2122;t prevent breast cancer but they can save lives by finding breast cancers as early as possible. According to a report by WHO, mammograms have been shown to reduce breast cancer mortality by around 20 per cent in women by early detection. Modern day digital breast tomosynthesis, also called 3D digital mammography, has a 25 per cent to 50 per cent

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June 2016

better detection rate as compared to conventional 2D analogue mammography and involves negligent radiation even less than a standard chest X-ray. In future, it is expected that 3D digital mammography will become more and more common. Most oncologists agree that breast screening mammography should start at the age of 40 and earlier in patients with high risks like genetic predisposition (BRCA 1 and BRCA 2 genetic mutation) and those with strong family history. Breast health awareness implies that women should be aware of the common presenting symptoms of breast cancer such as painless palpable lump in the breast or underarm, nipple inversion, spontaneous bloody or clear nipple discharge, change in size of breast or skin dimpling. Typically, there is no pain associated with breast cancer. Therefore, women often do not realise the above mentioned symptoms until it is too late. If a woman experiences any of the above symptoms, she should immediately consult her physician and undergo a diagnostic mammogram. If the mammogram is abnormal the radiologist will recommend a breast ultrasound for further characterisation of the mammographic abnormality followed by imaging guided breast biopsy for accurate pathology diagnosis of breast cancer or in simple words confirming the diagnosis of breast cancer. Pathology diagnosis or tissue diagnosis plays a crucial role in diagnosis and management of breast cancer. There are several types of

Lack of awareness of breast cancer and screening for disease are significant factors for relatively late stage of the disease presentation in India imaging guided breast biopsy techniques such as Fine Needle Aspiration Biopsy (FNAB), Trucut or Core Needle Biopsy (CNB) and Vacuum Assisted Biopsy (VAB). The selection of the biopsy technique depends on the availability of resources and the characteristics of the breast lesion. Give us more insights on techniques such as FNAB, CNB and VAB. FNAB, also called fine needle

aspiration cytology (FNAC), is a technique by which a few cells are aspirated from the concerning breast lump under imaging guidance, typically ultrasound guidance. FNAB is the most widely available and cheapest biopsy technique for confirmation of breast cancer. However, FNAB has a number of limitations. This technique is cytologists dependent and is often associated with false negatives (i.e. cancer is present but not detected in the aspirated sample) in about 27 per cent of unsatisfactory samples. In such a situation, the patient often assumes that there is no cancer in the biopsy and therefore does not receive any further treatment, only to return later with an advanced stage of breast cancer. Moreover, this type of biopsy is unable to provide information on the cancer subtype and receptors or tumour markers such as oestrogen receptors, progesterone receptors and hereceptin receptors which are crucial for further management of breast cancer. CNB involves obtaining cores of tissue from the breast mass under ultrasound guidance. The sensitivity of this type of biopsy for accurate diagnosis is 96 per cent to 98 per cent. Moreover, information about cancer subtype and receptors or tumour markers is available from this type of biopsy. This type of biopsy technique is now widely available and is relatively cost-effective. VAB involves bigger needle with vacuum assistance for optimal sampling for non palpable breast lesions such as micro-calcifications as well as for complex solid cystic masses with a high accuracy

rate of almost 100 per cent. This technique also has applications for non-surgical removal of benign lesions such as small fibroadenomas. In which stages of breast cancer can these techniques be used and how effective are they? Image-guided biopsy techniques are typically performed for diagnosis of indeterminate or suspicious breast lumps. The biggest advantage of image-guided percutaneous biopsy is that the patient has to undergo a single surgical procedure for treatment of breast cancer following confirmation of breast cancer. Before the advent of image-guided breast biopsy, patients would have have to undergo two surgical procedures. The first surgical procedure for excision biopsy for diagnosis of the breast lump and the second surgical procedure for complete clearance of the breast cancer. Therefore, image-guided percutaneous biopsy is superior to open surgical biopsy for several reasons, including increased accuracy, decreased cost as well as decreased surgical morbidity and cosmetic deformity. Can exposure to radiation emitted through diagnostic imaging techniques such as mammography, X-ray etc., cause cancers? There is a significant myth and misconception associated with the radiation involved in diagnostic imaging. Medical radiation is based on the ALARA concept, which means As Low As Reasonably Achievable. For most women, there is very little risk from routine X-ray imaging such as mammography, chest X-ray or

KNOWLEDGE

dental X-ray. The average glandular dose from a mammogram is about three millisieverts (mSv) or milliigray (mGy) which is equivalent to the ionising radiation that one receives from natural resources such as sunlight in a given year. Children and teens who receive high doses of radiation to treat lymphoma or other cancers are more likely to develop additional cancers later in life. As far as diagnostic medical radiation is concerned, there are no clinical trials that have assessed cancer from medical radiation in healthy adults. Most of what we know about the risks of ionising radiation comes from long term studies of people who survived the 1945 atomic bomb blasts at Hiroshima and Nagasaki. Needless to say, the atomic blast is not the perfect model for exposure to medical radiation because the bomb released extremely high doses of radiation all at once, while medical imaging involves minuscule doses of radiation, that too spread over time. And last but not the least is the risk benefit ratio (RBR). The risk of developing locally advanced breast cancer or stage 3 breast cancer which causes significant morbidity

and mortality is a real threat rather than the postulated theory of radiation-induced cancers. Which means the benefit of a screening or diagnostic mammogram aiding in timely diagnosis of breast cancer and thus leading to effective treatment far out weighs the potential risk from radiation. What are the major factors/causes for growing incidence breast cancer. What are the measures that can be taken to bring down the incidence of the disease? Epidemiological studies worldwide have established risk associations with breast cancer. They are as follows: Age: Age is by far the greatest risk factor for breast cancer. The incidence of breast cancer increases with age with approximately 50 per cent of breast cancers occurring in women aged 50-64 years. Family history: The risk of breast cancer is increased two to three fold in women with more than two first degree relatives typically on the maternal side diagnosed with breast cancer before the age of 50 years. Menses: Early menarche (<12 years) and late menopause (>55 years) is associated with

Children and teens who receive high doses of radiation to treat lymphoma or other cancers are more likely to develop cancers an increased risk of breast cancer. Pregnancy and lactation: For women who have their first child before the age of 25 years, have about half the risk of breast cancer as compared to women who have their first child after the age of 30 years. In addition, breast feeding is also believed to have a protective effect against breast cancer. Obesity: Obesity is associated with an increased risk of breast cancer in post menopausal women. The increased risk may be due to conversion of adrenal androgens to oestrogen in

adipose tissue. Alcohol consumption: The consumption of approximately 15 g or more of alcohol (equivalent to two to three glasses of wine) each day increases the risk of breast cancer by about 50 per cent. Oral contraceptives: The relative risk of breast cancer is marginally increased in women who have used oral contraceptives within 10 years but there is no risk in those who had used oral contraceptives more than 10 years previously. Hormone Replacement Therapy (HRT): HRT is linked to an increased incidence of breast cancer, raising breast cancer risk proportionate to an individual’s pre-existing risk. Genetics: Breast cancer genes BRCA1 and BRCA2 denote high risk but account for only a small proportion of cancers. Li-Fraumeni Syndrome and Cowden's Syndrome are also associated with increased risk of breast cancer. To summarise, age, family history, menses and genetic predisposition are factors that are beyond our control. However, lifestyle changes such as minimising the intake of alcohol, healthy eating habits and increased activity

to control obesity, avoiding prolonged use of oral contraceptives and hormone replacement therapy and planning first pregnancy at an early age followed by breast feeding are some of the factors that we can incorporate in our life to minimise the risk of breast cancer. Is there anything that you would like to highlight? These are exciting times with the state-of-the-art technologies being available for diagnosis and management of breast cancer patients in India. The earlier we start applying these technologies in clinical practice the better will be the outcomes in the long run. The fact remains that we cannot prevent breast cancer. However, we can certainly detect breast cancer early for favourable outcomes and increased survival. One cannot underestimate the value of timely and accurate diagnosis for women with breast cancer. Early diagnosis is the only way to complete cure. At the end of the day, if you save a woman, you save the entire family!" atandraray@gmail.com (Atandra Ray is an intern with Express Healthcare)

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June 2016

IT@HEALTHCARE EXPERT SPEAK

Why healthcare industry should invest in digitisation?

VIVEK NAIDU, Vice President, Information Management, Kodak Alaris India

Vivek Naidu, Vice President, Information Management, Kodak Alaris India gives an insight about Electronic Medical Record, and its benefits for healthcare providers

tilisation of electronic record keeping systems is becoming increasingly predominant within the healthcare industry due to a wide range of benefits. This ultimately results in improved quality of care and patient safety, not to mention controlled costs and time savings for healthcare providers. According to Frost and Sullivan, India’s healthcare information technology market is expected to hit $1.45 billion in 2018, more than three times the $381.3 million reached in 2012. Electronic Medical Record (EMR) systems are designed to keep track of a patient’s entire health and medical history in an electronic, computerised format. Although it may appear to be a daunting task, storing the vast volume of patient records in a digital format makes information more readily accessible and can help healthcare workers and patients navigate through healthcare systems more safely and efficiently. Ultimately, EMR systems can improve quality of care and patient safety, control costs, save substantial time for healthcare providers and, of course, provide extensive storage capabilities in today’s data-driven era. Advantages include increased efficiency, with the ability to reduce duplication of documents; elimination of needless delays in searching for charts; intelligence capabilities such as medical and prescription drug interaction alerts and treatment reminders; and quality measures for tailoring and showcasing data in customised formats for specific specialities. EMR standards were notified by government in September 2013.

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June 2016

These standards have not been made mandatory. The government is working with healthcare providers and other stakeholders for adoption of these standards. Transitioning any healthcare organisation from a paperbased environment to a digital one can be a complicated proposition. However, if the transition is thoroughly planned and executed, the task can be manageable and results in substantial benefits to your practice or organisation. While selecting EMR/EHR process, conversion of document, charts and other information document should be considered while addressing the transition. Conversion of existing documents and information is critical, and requires evaluation and consideration of a scanning solution to integrate into your EMR system or to provide standalone document retention and access. Most scanning solutions have been validated with healthcare systems, but validation needs to be verified prior to use. Staff training on the conversion of back files and day-forward documents procedures is critical for success. After the paper transition is planned and executed, your organisation is ready to go live, with the EMR/EHR solution providing access to paper information electronically. During the transition phase, there is likely to be a slowdown, but once the system has been fully adopted, time and cost savings will be incremental. To ensure that the transition is smooth, you need to make sure everyone in your organisation is on-board, establish solid security protocols, conduct

routine maintenance and backups for your system and develop a disaster recovery plan.

Challenges in converting existing medical records to a digital system With today’s wide variety of paper patient records, including faxed prescriptions, physician orders, referrals, collections of signatures, medical charts and other accumulated patient information, it’s hard to imagine how to convert to a paperless office. To ensure successful migration of paper charts and information to your EMR system, it’s important to first determine what approach you want to use to convert your documents, files and charts. Options include: ◗ Set up a manual in-house process, whereby documents are scanned directly into a solution if it has the capability. ◗ Purchase a solution that provides more sophisticated information indexing and allows users to scan charts into the EMR solution.

EMR systems can improve quality of care and patient safety, control costs, save substantial time for healthcare providers

◗ Outsource the project to a service provider that specialises in document conversion for physicians and healthcare systems. When converting existing data and considering scanning options, first and foremost organisations need to ensure the integrity of data and image quality. They also need to consider ease of use: Is it a simple pushbutton process, or is it more complicated? And, of course, speed: How many scans/pages per minute are demanded? Also, is a backup scanner needed? This is important when considering the high volume of paperwork being transitioned. Finally, you need to consider the level of service from the solution provider. Will the scanner provider replace or fix a unit if there are problems? How promptly will it be able to correct the issue? Will it provide guidance to help make the transition smooth? These are questions that should be considered while selecting a solutions provider. Scanning is a relatively simple method for capturing electronic images of paper documents and storing them for online reference, either through a stand-alone the obvious threats to paper records. Additionally, digital documents can be encrypted along with other security measures to protect files from theft or misuse. When records have been scanned and are digital, organisations can track and audit files and users in the system, and storage becomes far more manageable.

Selecting the right document imaging solution is very important for the

transition to EMR/EHR Once you’ve taken the leap to digital, you need to consider the most effective way to incorporate all of your existing patient documentation and information. Selecting the right scanning solution for your organisation is the first step to becoming a successful 'paperless' environment. What is clear is the need for a high-quality scanning solution that has proven integration and success with your chosen EMR/EHR/ECM solutions. Also, a documented conversion protocol must be established and followed as part of your organisational strategy in the transition to digital. Selecting the correct scanning solution for your transition to EMR is a critical first step that includes the conversion of paper files into electronic images that can be imported into your EMR software platform for access. To make this transition seamless, you need to ensure your solution offers the appropriate scanning volume and high-quality images. Otherwise, this step may be a slow and arduous process. Many organisations mistakenly believe they can get away with 'a nice little scanner' they already have in the office, until they find that they’ve burnt it out after only a few weeks’ time. This phase is an important step in your organisation’s move into the digital era and must be considered as part of its comprehensive plan in transitioning to EMR. Shaving dollars on your document. Conversion step will result in wasted man-hours and frustration resulting in failure to convert your back files and dayforward documents.

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

Zero-friction access to quality care in the cashless format will be our focus for the year Medi Assist India, one of the largest TPAs in the country has been lauded for its innovative use of technology in the healthcare industry. Prashant Jhaveri, Head, Products and Strategy, Medi Assist elaborates on their growth and successes with the effective role of technology, the companyâ&#x20AC;&#x2122;s plans for the Indian market in coming years and more, in an interview with Lakshmipriya Nair

How has Medi Assist helped simplify the medical insurance claims process? As a third party administrator (TPA), our group company, Medi Assist India TPA, handles the entire process of receiving, recording and approving health insurance claims on behalf of the insurer. We play a central role in the ecosystem where all stakeholders interact with us to achieve their specific goals faster approval for the insured; accurate and hassle-free claims processing for the insurer and better patient experience and timely settlements for our network hospitals. At Medi Assist, we give our stakeholders a lot more than the basics. Our members enjoy real-time access to their health benefits using a range of selfhelp channels such as MediBuddy, our mobile app. Our partner insurers get visibility into their portfolio performance through a range of MIS reports and our network hospitals are able to delight their patients by enabling online claims managements and green channel admission for a cashless hospitalisation. How have you leveraged technology to become a differentiator in your space? We have been one of the pioneers in realising the power of technology and leveraging it in our industry. For example, if faxes were the norm for preauthorisation requests, we steered the industry towards online submission of claims on our MediBuddy+ hospital portal. If call centres were the first point of contact for any information, we moved our

members towards self-help using their MediBuddy mobile app or portal to instantly and independently get the answers they seek. If it was normal for hospitals to make their patients wait at the insurance desk for a preauthorisation, we gave our network hospitals the ability to completely eliminate wait time during admission by enabling our members to opt for an eCashless planned hospitalisation even before visiting the hospital. The result is that, today as far as market perception goes, Medi Assist and technology leadership go hand in hand. Our technology platform, MediBuddy, is today a significant differentiator for us. What are the areas where Medi Assist offers its products? Our twin focus areas today are to enable zero-friction access to health benefits for every individual member and to make these services available in a cashless format for our members anywhere in the country. This includes the entire gamut of healthcare services that our members would potentially access during their lifecycle - preventive care, in-patient care, pharmacy benefits, chronic lifestyle condition management, maternity and senior care. What are the specific challenges and opportunities offered by the Indian market? India is unique, diverse and price sensitive. Healthcare in a large and populous country like India can be particularly challenging. There are three emerging requirements that we

Our technology platform, MediBuddy, is today a significant differentiator for us are trying to address today with technology. Young urban Indians are taking to fitness and running in a big way. We are looking to address this need for making fitness a seamless part of their everyday life with mFitness, mobile phone based fitness, apps for walking, running and bodyweight fitness. We are also building a strong network of service providers who can provide cashless access to preventive care.

Then there is the burgeoning middle class with steadily rising disposable incomes that is aspiring for better quality of care for their families. For this price-sensitive segment, we are putting together services like eCashless that gives our members the convenience of planning their cashless hospitalisation using their mobile phones and importantly get full visibility into the cost of treatment upfront. We are also looking to optimise utilisation of their health benefits by simplifying access to a wide range of inpatient and out-patient services in a cashless format. On the other end of the spectrum are the beneficiaries of the various government sponsored healthcare schemes for underprivileged Indians. For these families, we are working on building a pan-India network of hospitals that are on a common platform to enable us to deliver faster cashless facility while also making affordable healthcare accessible to the masses in farflung areas. Is the Indian eco-system conducive for nurturing innovation? There has never been a better time for innovation in India. â&#x20AC;&#x2DC;Make in Indiaâ&#x20AC;&#x2122; is putting the focus back on the Indian manufacturing industry. The Indian services sector is slowly but surely maturing towards R&D and value added solution development. Frugal innovation in India is showing the way forward for many other developing nations. India undoubtedly has great

potential in the years to come. What are your plans for the Indian market in this fiscal? Our plan is to focus on the individual member and on the experience we deliver to each member. Zero-friction access to quality care and access to these healthcare services in the cashless format will be our focus for the year. Can you elaborate on your investment strategies? Our members and their emerging requirements define our tie-ups and investments. We will continue to first identify emerging requirements, evaluate whether we should address these requirements from within or partner with like-minded organisations, and allow this philosophy to guide our strategic partnership and investment decisions. Raising funds is, once again, a derivative of investment decisions we make and the strategic partnerships we choose to form. Our partner of choice would be one that is aligned with the vision and focus of the organisation and its leadership. Our recent investment in Mobiefit is an excellent example of our investment philosophy. We were looking to address the need for everyday fitness for our members. In Mobiefit, we found the right team and offering to address this need; and that cemented our strategic partnership. We will continue to look for opportunities to serve current, emerging and latent needs of our members. lakshmipriyanair@expressindia.com

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LIFE I N T E R V I E W

‘We feel proud that we have created an excellent medical and para-medical manpower to serve the nation’ Dr DS Rana, Sir Ganga Ram Hospital has been re-elected as the Chairman, Board of Management. M Neelam Kachhap speaks with him about his plans for the hospital

You have been re-elected as the Chairman of SGRH for a second consecutive term. How do you feel? Certainly I feel elated. I am grateful to Sir Ganga Ram Trust Society for reposing faith in me and recognising my contribution. I most humbly accept this as god given opportunity to serve this great institution, which I always call as ‘Peoples Own Hospital’.

wife and kids.

What does it mean to be the Chairman of SGRH? It is an honourable position. But of course, it carries a huge responsibility not only to maintain the flagship of the hospital but also carry it forward to the higher level. What challenges do you face in this position and how do you overcome it? Serving as the Chairman, Board of Management in an honorary capacity is my great privilege. This has not only given me a chance to serve this great hospital, but also has given me name and fame in the field of nephrology over the last 35 years. I have been performing this job with honesty, sincerity, integrity and passion as well. However, I still maintain my passion as a nephrologist to serve my patients and do clinical job for four to six hours daily. For this dual job, proper time management and family support are very important. I am fortunate to have unconditional support of my

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June 2016

All major tertiary care hospitals in non-government sector should adopt small medical centres in rural India as their CSR, especially in providing medical manpower

What have been the major achievements in your first term? Medical education is very close to my heart and my first task was to create Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER) to consolidate all teaching, education and research activities under one umbrella. We feel proud that we have created an excellent medical and para-medical manpower to serve the nation. We are the largest hospital of the National Board of Examination to provide postgraduate training in 42 disciplines. We also maintain a top position in bringing out the maximum number of research papers in peer review journals. During the last five years, a huge world-class renovation activity has been undertaken to modernise old buildings and to provide a feel good factor of physical ambience. Besides this, we have maintained pioneership in acquiring the latest technology to help our able and experienced consultants, to provide excellent and ethical healthcare to all sections of the society, for which Sir Ganga Ram Hospital is known and recognised. We have also expanded our out-reach charitable activities.

Share some memorable moments you had during your tenure? There were many memorable moments. However, during this period, I definitely remember the joyous moment when Sir Ganga Ram Trust Society unanimously inducted me as the Member of Sir Ganga Ram Trust Society , giving me the life time opportunity to be a part of Sir Ganga Ram Trust Society, which is engaged in selfless service for the betterment of mankind. What message would you like to give to your colleagues and industry? My doctor colleagues should serve their patients with passion and compassion adhering to medical and professional ethics. All of them should devote at least 10 per cent of their time daily in educating the relatives about the preventive aspects of disease. All major tertiary care hospitals in nongovernment sector should adopt small medical centres in rural India as their corporate social responsibility, especially in providing medical manpower so that majority of people living in villages can avail the services of the doctors working in tertiary-care hospitals situated mainly in bigger cities. I shall like to conclude with “ Love all, serve all, help ever, hurt never” mneelam.kachhap@expressindia.com

LIFE

PEOPLE

MHEPL appoints Sameer Aggarwal as CFO Aggarwal will head the finance team to ensure efficient functioning of the finance department MANIPAL HEALTH Enterprises Private Limited (MHPEL) announced the appointment of Sameer Aggarwal as the new Chief Financial officer (CFO). In his new role, Aggarwal will head the finance team to ensure smooth and efficient functioning of the finance department by providing an array of services to the business right from financial planning and analysis, treasury, tax and other finance operations. Having over 19 years of experience in strategic and operation finance across pricing, taxation, corporate accounting, and treasury and investor relations, he is all set to take on the role of CFO with great zeal. He will be donning sev-

He will focus on compliance with financial regulations with a clear purpose of ensuring positive and continuous growth curve eral hats to drive major financial goals. His key focus would be to

Healthenablr appoints US oncologist Ajith Puthillath as CMIO Dr Puthillath will take on advising and overseeing the clinical operations of the company DR AJITH PUTHILLATH, a renowned oncologist from the US, has joined Healthenablr as the Chief Medical Informatics Officer (CMIO) of the company. In his capacity as CMIO, Dr Puthillath will take on advising and overseeing the clin-

align business and finance strategy, to ensure growth of the business by taking up new business initiatives like improved enterprises cost optimisation, pricing execution and other fiscal process improvements and innovations that add value to the organisation. Additionally, he would also focus on compliance with financial regulations with a clear purpose of ensuring positive and continuous growth curve. Aggarwal has diverse experience across organisations like Marico, Coke, IngersollRand and Wipro. In his previous organisation at 3M, he was responsible for overall finance function and in order to drive governance and compliance.

ical operations of the company. Speaking about his new appointment, Dr Puthillath said, “Health infrastructure in India is skewed to deliver in Tier I cities. There is roughly one doctor per every 1800 people

and healthenablr is a tele health platform that is working toward connecting patients to verified doctors for trusted health information. I am excited to be part of a venture like this.” Dr Puthillath, is a practicing medical oncologist based out of Central Valley California and is currently the cochair of the Breast Cancer Center of excellence, St Joseph Medical Center, California and Vice Chief of Staff – Lodi Health, California. His experience also includes a fellowship in Medical Oncology and Hematology at Roswell Park Cancer Institute (RPCI), the oldest cancer center in the US. “As a digital healthcare ecosystem, getting someone from the healthcare sector, especially someone as accomplished and senior as Dr Puthillath on board, is a big step in the right direction for us,” said Avishek Mukherjee, CTO and co-founder,

Healthenablr India. Dr Puthillath, has presented research papers in the American Society of Oncology meetings and has a deep interested in digital health technologies that improve healthcare delivery models and patient outcomes. He is also at present, part of the advisory board of several healthcare startups based out of the US and has published numerous articles in peer reviewed medical journals. Bamasish Paul, CEO and co-founder, Healthenablr India said, “Not only is Dr Puthillath a highly respected oncologist with envious credentials, he is also very passionate about digital healthcare and extremely committed to the growth of Healthenablr. As the CMIO, he will play a critical role in building our telehealth platform and advise us on incorporating the best practices in the fields of medicine and healthcare that he has learned over the years.”

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TRADE & TRENDS

US hospital installs Carestream’s DRX-Excel Plus R/F system Implements DR Room and mobile X-ray system to enhance patient care and speed access to images

shley County Medical Center (Crossett, Ark.) is the first hospital in the US to install Carestream’s new DRX-Excel Plus radiography/fluoroscopy (R/F) system. The medical centre is a critical access hospital that serves one of the largest counties in Arkansas, encompassing more than 940 sq m. “The DRX-Excel Plus system is an important tool for evaluating patients who may be critically ill or seriously injured. Its ability to provide X-ray imaging studies and fluoroscopy exams allows our physicians to rapidly assess each patient’s condition and prepare them for transport to higher-level hospitals if needed,” said Phillip Gilmore, Chief Executive Officer, Ashley County Medical Center. The centre’s emergency department treats an average of 750 patients a month. Purchasing this system was part of the hospital’s transition to the latest generation of imaging equip-

ment, which included a Carestream DRX-Evolution and a DRX-Revolution Mobile X-ray Imaging System. “We have upgraded our ageing systems to deliver rapid access to high-resolution images, as well as advanced capabilities that reduce patient dose, enhance productivity and offer an efficient user interface. We worked with our local dealer, Southeast Imaging, to evaluate systems from several different providers,” Gilmore reports. “We selected Carestream imaging systems because of their excellent design, consistent user interface and outstanding capabilities. We have also been pleased with Carestream’s installation and user training as well as their service and support.” Productivity-enhancing capabilities offered by the DRX-Excel Plus include a positioning pedal that allows the operator to have their hands free—which is helpful for interventional ex-

ams—and a remote control that can move the table from anywhere in the room. The system offers an ergonomic design and can 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. An elevating table tilts for fluoroscopy exams and can be lowered or raised to provide flexible, comfortable imaging for patients with limited mobility including wheelchair patients. A DRX-Evolution system facilitates capture of advanced imaging exams, including crosstable lateral and other complex exams. “The system’s autotracking feature moves the X-ray tube into position for each exam, which allows a technologist to capture images in seconds. Seriously ill or injured patients can be imaged in wheelchairs or on stretchers, which eliminates the

painful process of moving them to a table,” reports Ronnie Dillion, Radiology Director, Ashley County Medical Center. He adds that the DRX-Revolution enhances the speed and quality of all mobile imaging exams and completes the facility’s transition from CR to DR technology. All three imaging systems use Carestream DRX Plus 3543C cesium iodide detectors, which offer excellent image quality and extremely low dose. In addition, these detectors can be submerged in one metre of water for 30 minutes without failure, which achieves IPX Level 7 rating for liquid resistance. A re-

duced weight and thinner profile allow even easier handling. These detectors also deliver faster calibration time, boot time, preview time and full-resolution display time, as well as increased battery life to enable more imaging between battery changes. Every Carestream DRX detector can be shared with any member of its extensive family of DRX imaging systems. Contact Nilesh Dattatray Sanap Carestream Health India 022- 67248816 nilesh.sanap@carestream.com

Sysmex Partec: Excellence in flow cytometry Amardeep Gupta, Business Manager, Partec, Sysmex India gives an overview on how Sysmex Partec provides excellent automated cell analysis tools with higher precision and more affordability than ever before MORE THAN 45 years of ‘Flow Experience’ characterises the pioneering leadership of Partec. Almost 60 patents in the field of cell analysis impressively demonstrate the commitment of Partec to push the stages of

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June 2016

technological innovation with further development of sophisticated and cutting-edge flow cytometry instrumentation. Partec was established in 1967 and in 1968-69 brought to the market, the Impulsecytopho-

tometer ICP 11, the first fluorescence-based and commercial flow cytometer (FCM). This analysis method was later renamed in 1978. Continued scientific research and development resulted in today’s advanced

generation of high precision instruments and procedures for cell analysis. Today, in addition to most advanced FCM instruments, Sysmex Partec provides complete solutions for many cell analysis applications, covering

reagents, protocols, accessories, application support, training and service. Sysmex Partec is the newly formed collaboration between Partec, a worldwide leading pioneer, developer and manufac-

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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)

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TRADE & TRENDS turer of flow cytometry systems and Sysmex Corporation, a leading international supplier of in vitro diagnostic products. Sysmex Partec products are used in a wide range of applications in healthcare. The company is recognised as a global leader in essential healthcare by widely providing robust and affordable hi-tech diagnostic solutions to resource poor markets. With its new partnership, Sysmex Partec is now available

in more than 150 countries worldwide. By combining the latest scientific and biotechnological knowledge into clever and cost-effective solutions, based on easily applied analysis procedures and instruments, Sysmex Partec can provide excellent automated cell analysis tools with higher precision and more affordability than ever before. The Sysmex Partec product portfolio can be generally characterised by the combination of

Amardeep Gupta, Business Manager, Partec, Sysmex India

groundbreaking all-in-one design with outstanding ergonomics, while featuring optimal performance. In addition to the CUBE 6 instrument, this portfolio also includes the CUBE 8 flow cytometer, a red dot design award winner for 2012 and an iF design award winner for 2013Flow cytometry has evolved today to become the key method for precise and rapid cell analysis. With continuous innovation, Sysmex Partec now makes avail-

able flow cytometers, reagents and new, dedicated applications that are easier to use and more affordable than ever before. Sysmex Partec will continue to expand the broad range of applications, which can be perfectly covered with Sysmex Partec Flow Cytometry technology by dedicated instruments for human healthcare, microbiology, industrial applications, food quality control, plant and animal research, etc.

Poly Medicure: In pursuit of excellence The company proposes to invest Rs 60 crores in a new greenfield project at IMT Faridabad in Haryana POLY MEDICURE is one of the leading medical devices manufacturer and exporter in India with a dominant position in the medical devices market having a focus on innovation, safety and quality. It has a vision to provide highest quality of healthcare available to all. Polymed has six manufacturing facilities, four in India (two facilities in Faridabad and one in Jaipur and one in Haridwar), two facilities overseas (one facility in China – wholly-owned subsidiary and one joint venture in Egypt.) The company has over 400,000 square feet manufacturing area with 100,000 + square feet clean room area and state-of-the-art facilities with a capacity to expand rapidly. Polymed was founded by Himanshu Baid, who started his career as a trainee engineer for six months at Philips Communication Industries in Nurenberg, Germany. He is very passionate about the development of his business in India and abroad and his moto is to provide medical devices at an affordable cost to the society. The company is proposing to invest Rs 60 crore in a new green field project at IMT Faridabad in Haryana and is geared up to launch a slew of products in the third quarter of 2017 with

all statutory approvals. “For an excellence in growth, we have our own in-house R&D facility like; rapid prototyping using 3-D printer, process validation and customisation of products. Design, manufacture and maintenance of injection moulds, semi automatic assembly lines using CNC tooling machines, manufacturing process capabilities include injection molding, extrusion, insert molding, compression molding, blow molding, ultrasonic welding, RF & HF welding, UV bonding, laser welding etc all these technology support to gear up in Indian and overseas market,” said Himanshu Baid, Managing Director, Poly Medicure. “We have highly experienced and trained manpower consisting of over 75 engineers, who constantly working for development of new products and processes. Semi- automatic and automatic assembly machines designed using latest technology and developed equipped tooling facility, ethylene oxide and steam sterilization facilities are available in house,” Baid added. Polymed's manpower stands at par with those globally. There are 1500 full time employees working at different facilities. With best technical and product

Himanshu Baid Managing Director, Poly Medicure

trainings, Kaizen, 5-S, Six Sigma, Leadership Skills, they are capable to create high-quality and innovative solutions for the medical devices industry. Through its R&D initiatives, the company has filed approximately 400 international patents worldwide. The company is exporting its products to more than 90 countries and has a gross turnover of Rs 394 crores. The company started its manufacturing operations in 1997. Polymed produces more than 100 different types of med-

ical devices including Safety IV Cannula-Quick Flash IV Cannula-Infusions Sets, CVC, Blood Bags-Blood Lines, haemodialysis catheter-Thoracic catheters, blood collection tubes, needle free extension lines, safety scalp vein and safety PSV sets, vacuum drainage bottles, anesthesia, urology, surgery and wound drainage,-gastroenterology and respiratory range of devices. The products have been well accepted in the global market. The company has successfully implemented a QMS (Quality Man-

agement System) which has been accredited by DNV, Norway with ISO 9001:2008, ISO13485: 2003 and CE - 0434 from DNV, Norway thus making the entire product range compliant with international quality standards. The company is constantly adding new products in our existing vast product basket. The company is also launching new products in gastrology and nephrology. The company has received top exporter award (first prize) for highest export of plastic medical disposables for the last four years - FY 2011-12, 2012-13, 2013-14 & 2014-15 from The Plastics Export Promotion Council. The company has also received Silver Patent Award given by Pharmaceuticals Export Promotion council for Year 2009 – 2010 & 2010-2011 and 2011-2012 and Gold Patent Award given by Pharmaceuticals Export Promotion council for Year 2010 - 2011.

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June 2016

TRADE & TRENDS

RIH Foundation receives donation for Hamilton T1 Ventilator The device will enable medical practitioners to extend better care while shifting patients from rural healthcare centres with this equipment ROYAL INLAND Hospital (RIH Foundation) has received a new ventilator for ‘High Acuity Response Team’ (HART) following a generous donation of about $442,000. The advanced piece of device will enable medical practitioners to extend better care, when shifting patients from rural healthcare centres with this state–ofthe-art equipment. Research analysts at 'Allied Market Research' weighing up on the growth rate, demand, opportunities, share and size and tech-

nology advancements in the 'World Mechanical Ventilators Market' indicate that advance Hamilton T1 device has been developed for intensive transport especially for those who need help with breathing. Officials at the facility revealed that the device is also a boon for the RIH Emergency Department. This indicates that patient with respiratory problems can use the equipment, when it’s not in use for patient transport. Sources reveal that the mechanical ventila-

tor was being used by high acuity response team members based in the Kamloops area since March 24, 2016. The ventilator was bought after having received a generous sum by ‘TB Vets Charitable Foundation.’ HART is popular for having a ground–based transportation team for critical patients. The team further consists of Royal Inland Hospital trained respiratory therapist as well as nurses. TB Vets has been being making winds for extending its support to medical respiratory

research and development. It has been recognised for recognising respiratory therapists. Medical practitioners at RIH foundation echoed their sentiments by saying that they are thankful to TB Vets for providing a life – saving respiratory device. They said not only the community but the surrounding region will now have an access to the equipment. In 2015, RIH had approached TB Vets Charitable Foundation to help them buy a new ventilator especially for

the High Acuity Response Team programme. Their old ventilator had become obsolete and needed an urgent replacement to make sure patients with respiratory problems could be shifted safely by the team. The Hamilton T1 mechanical ventilator bought by RIH is particularly developed for transport ventilation of patients needing intensive care. Moreover, patients including both adults and infants who need help with breathing problems.

Virtual dissection technology from KS Biomed Services,Ahmedabad Offers a life-size, virtual dissection experience on an interactive touch screen to study the human body KS BIOMED Services, Ahmedabad brought state-of-the-art technology of virtual dissection to India in collaboration with Anatomage, US, three years back. Since then many medical institutes in India have experienced the technology empowerment, which the skilled laboratory equipment has. A state-of-the-art virtual dissection table can provide a great value to traditional anatomy learning. The Anatomage table uses 3-D images from digitally scanned human body to offer a life-size, virtual dissection experience on wide and interactive touch

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June 2016

screen. It has the capacity to render limitless views of the human body in exquisite detail. The technology allows learners to visualise skeletal tissues, muscles, organs and soft tissue and further customise the interaction by virtually slicing, layering and segmenting the anatomy. The selections can be rotated or flipped in any direction for detail view of anatomical structures. The static images of text book or limited view capability of computerised images are widely used in India but with very limited desired outcome of

in depth understanding of correlation between organs/ structures/etc. Anatomage table has particular utility in helping students understand three-dimensional relationships in ways that static images, like those in textbooks, cannot. The Anatomage table is being demonstrated across India and feedback from anatomy/ clinical/surgical specialist is overwhelming. Also students' feedback is hugely positive. Anatomage table is emerging as a valuable tool to supplement dissection. Students feel that the table should be made available for further study outside

scheduled laboratory sessions in every medical institute in India. The Anatomage table also has wide applications for teaching faculty, PG students and practising physicians as well. Clinicians and surgeons can practice 'patient-specific' medical visualisations and plan surgery or counsel patients. The ability to import actual patient radiology images from CT/MRI workstation is one of the best applications of table to enable doctors to interact with scan data. Himanshu Bhatt, Director, KS Biomed Healthcare feels that now is the time when In-

dian medical institutes are ready to adopt this technology as part of Indian government’s great move of skilled learning through skilled laboratories in medical institutes. Contact KS Biomed Services KS Biomed Healthcare 701,Shikhar,Opp. Netune House, Mithakhali Ahmedabad-380009 Gujarat Phone:079-26421102-04 Mobile:9978911705 Email:himanshu_bhatt@ksbiomed.com URL: www.ksbiomedservices.com

TRADE & TRENDS

Biomedical engineering: Challenge for small and medium hospitals GP Singh Shekhawat, Co-founder & Director, Vertex Medical, expounds on the importance of biomedical engineering services in small and medium hospitals and how outsourcing can be great option WITH TECHNOLOGICAL advances in the healthcare, we see a number of biomedical equipment increasing rapidly in any hospital. To improve the patient care and diagnosis, all hospitals are investing heavily on the biomedical equipment.

Large multi-specialty or super-specialty hospitals Hospitals have biomedical engineering department to manage these assets. They have invested to set up the biomedical engineering department and keep investing to meet the training demands for engineers. However, they also find it difficult to keep the biomedical engineers technologically updated and motivated enough to stop them from leaving the jobs frequently.

Small and medium hospitals On the other hand, hospitals face the challenge to manage these biomedical equipment assets. The number of equipment is less compared to large hospital thus makes it unviable for them to have a biomedical department. It has also been observed that the well maintained and calibrated equipment can have a lifespan of seven to ten years compared to two to three years if not maintained properly. Most of the time, small hospitals are run by the doctor and not by any professional team to manage these assets. They also face challenges in managing biomedical equipment life cycle, planning new equipment, repair and maintenance, staff training etc.

GP Singh Shekhawat, Co-founder & Director, Vertex Medical

Biomedical engineering outsourcing: A viable solution The biomedical engineering service provider company can help the doctors/owners of the small and medium hospital to manage the assets available in the form of biomedical equipment more effectively. The service provider will be managing the total life cycle of any biomedical equipment. The service providers role starts from the new equipment planning. They will help in justifying the requirement of proposed equipment, evaluating various products, finalising specification, making comparatives of available options. This will largely help decision makers to finalise the proposed biomedical equipment in time. It will save a huge amount of time and energy to the doctors. We have seen the sales person waiting for the surgeon to come out of the operation theatre to discuss about the required equipment. In most of the small hospitals,

the decision making process is taken by the doctor himself. They are not able to spend time to research the product. The service provider having expertise can do a lot of the home work before the decision maker can meet the sales person. The service provider will be ensuring that the site requirements are fulfilled before the equipment arrived at site. It has been observed that many times the sites are not prepared as per the equipment vendor requirements. The equipment landed at site

in this situation kept lying idle for many days. It defers the RoI from the equipment and keeps the capital blocked. The vendor also has the dissatisfaction as the payment to be released after successful handover of the equipment is also delayed as installation in pending. The service provider can help minimise the loss due to delay in installation. The service provider ensures that the equipment is installed properly and the operators are given adequate training to operate the same. Operator training is important

as all the equipment are sophisticated electronic devices. Service provider engineer also takes active participation in the training process. In the absence of trained operator, he can train another available staff. The regular periodic maintenance and calibration also needs to be followed by the service provider engineers. In case of a breakdown, the service provider engineer will try to resolve the fault. In case supplier service engineer is required to resolved, the service provider engineer will initiate the same and follow up till the equipment becomes functional. Apart from this, the service provider will help the hospital to meet regulatory requirements like AERB license. Any X-ray machine needs AERB clearance before the operation of any X ray machines. Most of the time, small hospitals are not aware of such compliances. All the documentation has to be maintained by service provider engineers to meet any future quality certification like NABH accreditation etc.

What to look for the service provider? Service providers should have the infrastructure and trained manpower to handle the clientâ&#x20AC;&#x2122;s requirement. Training and development of biomedical engineers is very crucial aspect of the same, as the service providers are maintaining the hospital assets through these engineers only. Regular training and skill updation is very important.

EXPRESS HEALTHCARE

June 2016

TRADE & TRENDS

ISIC installs Samsung’s XGEO GC80 series radiologysystem New digital XGEO GC80 series radiography system by Samsung is the first installation in Delhi NCR and promises to radically improve spinal injury diagnosis

ADDING A NEW edge to its already advanced spinal treatment mechanisms, Indian Spinal Injuries Centre has incorporated a new radiology device that offers much better and in-depth diagnostic results, helping doctors to get quick excellent clarity digital images with maximum radiation. India’s leading spine and neurology care hospital, Indian Spinal Injuries Centre (ISIC) is notably the first hospital across Delhi NCR to add Samsung’s new digital XGEO GC80 series radiography machine to its imaging centre. A spinal injury is one of the most complex injuries to treat and manage. However, often in the absence of mechanisms to detect minute aberrations and damage, such injuries go untreated and worsen over time. Accurate diagnosis is key to assure faster treatment and rehabilitation of a spine injury patient. “Neurologic consequences are severe and sometimes irreversible. An undiagnosed spine injury can cause devastating neurological damage. For early treatment, timely

EXPRESS HEALTHCARE

June 2016

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and accurate diagnosis becomes imperative. Currently, while there is dearth of recorded data to display the prevalence of spinal injuries in the country, there also lack information about techniques and measures used to diagnose patients with SCI. There is a need for active radiographic assessments to deal with the cases of acute trauma. The new radiography system gives us highly improved technological support to have a much detailed and closer assessment of the spine, much better than what current devices offer,” said Dr HSChhabra, Medical Director & Chief of Spine Services, Indian Spinal Injuries Centre.

The newly installed XGEO GC80 series has been approved for delivering highquality digital radiography performance along with a simplified workflow, to maximise user experience. Offering best diagnostic solution, the installed machine opens new possibilities by increasing throughput and improving workplace. The system is enabled with next generation S-Vue imaging engine to deliver high-resolution images through advanced processing and adaptive filtering, which enhance image contrast and sharpness. Further, assuring clearer image for accurate diagnosis, the machine provides stitched images

rather than separated images. The in-built smart stitching technology captures two or more images consecutively and then stitches the multiple images into one image. “Ideally, the thickness of bones varies from each other as well as on basis of region. Therefore, the advanced image processing technology effectively of the machine would effectively separate thick and thin parts to display overlapping areas and contours more sharply and clearly. Additionally, the technology would also provide a clear picture in case of an implant by displaying regions-of-interest (ROI) without artifacts. Further, the machine is also enabled to display

the details of organs such as lung, spine and inguinal region with different characteristics in detail on a single page,” said Dr Anita Aggarwal, Sr Consultant cum Chief of Radiology Services, Indian Spinal Injuries Centre. The ergonomic and flexible design receptors of the machine further enables users to take images at any position without a table by enabling tilting angles at -20º ~ +90º, thereby assuring patient comfort along streamlined workflow. While the presence of both useful audio and intuitive user interface, while eases the use with soft handling, the machine also keeps safety and accessibility as its top priority.

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