Express Healthcare (Vol.10, No.9) September, 2016 by Indian Express

VOL.10 NO 9 PAGES 80

www.expresshealthcare.in SEPTEMBER 2016, `50

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Welcome to the 6th International Patient Safety Congress, being held on 21st & 22nd October, 2016 in ITC Grand Chola, Chennai, India Patient safety is the commitment that drives the best in the healthcare industry, the focus that ushers in the most sweeping paradigm changes in healthcare delivery. Over the years, this emphasis has evolved into a science that has been shaped and nurtured by the brightest visionaries in healthcare. The spirit of collaboration has transcended national boundaries and come together to create a body of innovative thinking and practice that has truly forged a stronger patient safety matrix in hospitals, across the globe. A strong safety culture ensures a well-rounded involvement of the care providers, reducing errors and instilling confidence. Staff support is an important component for achieving the best results. Sharing best practices and continuous education are keys to ensuring the percolation of the culture of safety across all levels. To continuously redefine the standards of safety protocols, it is imperative to stay a pace ahead of the evolving ecosystem. Every day is th a learning experience. The 6 International Patient Safety Congress is the forum where this rich learning is shared. It is the platform where the next game-changing ideas are given their final shape and form. The future of patient safety is in a comprehensive plan that brings together all stakeholders of care, patients, care providers, hospital administrators and policy makers, who are dedicated to improving healthcare safety through support, collaboration and partnership. KEY HIGHLIGHTS

ASIAN PATIENT SAFETY AWARDS – CATEGORIES

Ÿ 150 Speakers, 1500 healthcare leaders from

Ÿ Innovation in Safe Communication

more than 15 Countries Ÿ The Asian Patient Safety Awards in 6 Categories Ÿ Posters/ Papers Presentation Ÿ 16 breakout sessions

Ÿ Medication Safety Ÿ Anaesthesia & Surgical Safety Ÿ Infection Prevention and Practice Ÿ Innovation in Staff Education on Patient Safety Ÿ Innovation in Patient & Family Education on Safety

WHO SHOULD ATTEND? Ÿ CEO’s / Directors - Medical Services/ Hospital

Administrators / Physicians

Eligibility: All Healthcare units including Hospitals/ Clinics / Integrated Public and Private Healthcare Entities Last date for awards nomination – September 15th, 2016

Ÿ Nursing Directors/Superintendents/ Supervisors/

In-charges / Staff Nurses Ÿ Technicians / Paramedical Staff

POSTER/ PAPER PRESENTATIONS

Ÿ Medical Students / Students studying MHA /MBA Ÿ Innovation in Patient Safety Process/System can be highlighted in the

congress through poster presentation.

REGISTRATION

Ÿ Award winning papers will be given 10 minutes to present their

innovation and best practices during the congress. Regular Registration

INR 4000

(Last Date: Oct 20, 2016)

Spot Registration

Last date for Poster/ Paper Submission – September 15 , 2016 INR 7000

For registration, log on to www.patientsafety.co.in For more details, please contact : Balaji.V International Patient Safety Congress Secretariat, Apollo Hospitals, 21, Greams lane off Greams Road, Chennai -600006 Tel. + (91)-44-28296218 , +91 98417 34209 Email: patientsft@gmail.com

Apollo Hospitals, International Patient Safety Congress Secretariat, 21, Greams lane off Greams Road, Chennai-600006 Tel. + (91)-44-28296218

www.patientsafety.co.in

CONTENTS MARKET Vol 10. No 9, SEPTEMBER 2016

Chairman of the Board Viveck Goenka

GOVT SHOULD CONSIDER LEVYING ADDITIONAL TAX ON PRODUCTS WITH HIGH SUGAR, SODIUM, TOBACCO CONTENT: IMA AND HCFI

HEALTH MINISTER LAUNCHES ‘MERA ASPATAAL/ MY HOSPITAL’ INITIATIVE

Sr Vice President-BPD Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty

WHAT DOES IT MEAN TO BE A LEADER?

BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bengaluru Assistant Editor Neelam M Kachhap

KNOWLEDGE

Delhi Prathiba Raju Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Senior Designer Rekha Bisht

Artists Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East Marketing Team Ajanta Sengupta, Ambuj Kumar Arun J, Douglas Menezes E.Mujahid, Mathen Mathew Nirav Mistry PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

DIAGNOSIS FOR DOWN SYNDROME

INTERVIEWS P12: DEVANG MODY President Consumer Business, Bajaj Finance

P14: FRANCISCO RODRIGUEZ Business Development Director, Middle East and India, IGENOMIX

P39: PUNEET SAHNI Head of Product Development, SBI General Insurance

P41: DR MONA BHATIA HoD, Radiodiagnosis and Imaging, Fortis Escorts Heart Institute, New Delhi

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

Calling all Healthcare Senators...

he healthcare sector in India has many pain points but that is precisely why it has attracted so much attention from entrepreneurs, both new age start-ups, as well as the old world players. The first category, like all start-ups are probably referred to as ‘upstarts’ for disrupting the status quo, are sharp-eyed about identifying problems and finding solutions. The second kind of start ups could be spin offs from India’s blue blooded business families, who are today global names, ranging from IT to realty, and have chosen to invest in the healthcare sector due to a mix of philanthrophy and hard-nosed business sense. Thus it is no wonder that the NASSCOM Start-up Ecosystem Report 2015 found that 6-8 per cent of the recent B2C start-ups in India have been in the healthtech sector. In fact, technologies have transformed most sectors and now it is the turn of healthcare. The sector is hurtling towards change at a pace seldom seen before and as our cover story analyses, digital technologies such as robotics, artificial intelligence, 3D printing, Internet of Things and nanotechnology are being implemented in different avataars, from aggregating doctor appointments, to minimally invasive surgeries. But while these have great potential to transform healthcare delivery, there is always a flip side. Will they add to the cost? Will they protect patient identity? (See cover story in the Express Healthcare September 2016 issue, And the digital revolution begins ..., pages 18-27) The NASSCOM Start-up Ecosystem Report 2015 also reveals that India has the fastest growing startup-base worldwide but as someone holding recently commented, are all of them confronting real world problems? Or are some of them merely jumping onto the band wagon, hoping that the rising tide of angel fund flows raises their boat too and then waiting to exit? For instance, there are a number of sites and apps promising to streamline the painfull procedure of getting an appointment with the right doctor. But are their business models differentiated enough to ride out the rough patches as they scale up? Will all of them survive the scrutiny of investors who will hold them to their ambitious targets? Many of them will fade away, while some will be acquired as consolidation sets in. This is what is happening in India's booming e-commerce sector, with Flipkart and Snapdeal exploring a merger to take on their deeppocketed MNC rival Amazon.

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September 2016

We have a good mixof gurus and shishyas, as well as clinical practitioners turned healthcare management pros, who are todaythe backbone of many corporate hospital chains

This is still a long way off for health-focussed start ups but it pays to learn from the mistakes of others. We hope our upcoming event, Healthcare Senate, from September 22-24 at HICC Hyderabad, will see discussions that will throw up new ways of looking at old problems. The patient-driven innovation session brings together start ups at various stages of their journey, as well as funders who sit on the other side of the deal table. Another session at Healthcare Senate will pick the brains of CXOs who have to navigate the perennial ropewalk between balancing profitability with responsibility 24x7x365 as well as new models of raising capital. We have a good mix of gurus and shishyas, as well as clinical practitioners turned healthcare management pros, who are today the backbone of many corporate hospital chains, as CXOs heading their hospitals into the next phase of growth. But our Healthcare Senators will not just focus on revenue flows. As the draft Surrogacy (Regulation) Bill, 2016 makes its way through Parliament for approval, we are sure the medico-legal-ethical aspects of the bill will also be debated thread bare. One of our panelists in this session, Dr Suganthi Iyer, Deputy Director, PD Hinduja Hospital and Medical Research Centre, Mumbai gives a preview of her views on the factors deciding medico-legal claims and compensation issues. The September Express Healthcare issue, as a curtain raiser to the event, has insightful articles from some of our panelists, presenting divergent opinions. For instance while doctors dissuade their children from following in their footsteps, a healthcare entrepreneur recounts his thrilling ride as “challenging but satisfying.” The Express Healthcare September issue ends with ‘What does it mean to be a leader’, the distilled wisdom of some of the outstanding men and women who have shaped healthcare in India. Their grit, financial acumen, compassion for the patient combined with a passion for excellence, will continue to push the boundaries of success and inspire future leaders. This edition features 11 such leaders who have in their own individual way, redefined their spaces. We hope to feature many more prominent personalities and their Leadership Mantras in the future editions of Express Healthcare. And of course, hear some of them live at Healthcare Senate. See you in Hyderabad! VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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LETTERS QUOTE UNQUOTE

AUGUST 2016

Check out the online version of our magazine at

www.expresshealthcare.in

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.

EXPRESS HEALTHCARE

September 2016

The government will bear expenditure upto `1 lakh per year, so that my poor brothers are not deprived of healthcare facilities and their dreams are not shattered

Prime Minister, India Speaking at Red Fort while giving the Independence speech

Our Associate: Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com CHENNAI Arun J The Indian Express (P) Ltd. Business Publication Division 8th Floor, East Wing, Sreyas Chamiers Towers New No 37/26 (Old No.23 & 24/26) Chamiers Road, Teynampet Chennai - 600 018 Telephone (Board): +91 44 24313031/32/34 Fax: +91 44 24313035 Mob: +91 9940058412 Email id: arun.j@expressindia.com

JP Nadda Union Minister of Health and Family Welfare

Narendra Modi

Mobile: +91 9999070900 Fax: 0120-4367933 Email id: ambuj.kumar@expressindia.com

Patient satisfaction is the ultimate test for assessing quality of services, provided by a healthcare facility. To further build upon the gains so far, we are now making a paradigm shift and expanding the programmes from grassroots upwards to build the continuity of care

BENGALURU Mathen Mathew The Indian Express (P) Ltd. Business Publication Division 502, 5th Floor, Devatha Plaza, Residency road, Bangalore- 560025 Board line: 080- 49681100 Fax: 080- 22231925 Mobile: +91 9840826366 Email id: mathen.mathew@expressindia.com HYDERABAD E Mujahid The Indian Express (P) Ltd. Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082 Board line- 040- 66631457/ 23418673 Mobile: +91 9849039936 Fax: 040 23418675 Email Id: e.mujahid@expressindia.com

Speaking at the launch of ‘Mera Aspataal / My Hospital’initiative

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Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents. The Indian Express (P) Ltd., cannot be held responsible for such contents, nor for any loss or damages incurred as a result of transactions with companies, associations or individuals advertising in its newspapers or publications. We therefore recommend that readers make necessary inquiries before sending any monies or entering into any agreements with advertisers or otherwise acting on an advertisement in any manner whatsoever.

MARKET I N T E R V I E W

‘The current market size of the life care segment is of about ` 5,000 crores of untapped potential’ Recently, Bajaj Financing has ventured into life care financing in healthcare. Devang Mody, President Consumer Business, Bajaj Finance explains to Raelene Kambli on the opportunities for the company in this segment of business and its way forward This a new segment of financing. Why did you choose to venture into this segment? How much of this segment will contribute to your business? In the retail financing segment, we are present in consumer durable financing, digital product financing, furniture financing and recently extended it to financing options for lifestyle segments. All our financing segments are in the discretionary spends category. We have a reason to believe that ‘life care’ can be a large discretionary spend category in India. This segment caters to the medical elective procedures. Since these are elective procedures, they are not covered by medical insurance. Today customers desire to spend on best medical facilities for themselves and their families. Finance for discretionary and elective procedures is common in the western countries. We (Bajaj Finance) increase the spending power of our customers (through our products), to fulfil their desires without burning a hole in their pockets. With our deep understanding of retail financing, we are in best position to cater to the segment who would want to avail these elective procedures. The current market size is of about ` 5,000 crores of untapped potential, which is fast moving from an unorganised segment to an organised one. Which are the areas of discretionary procedures that you would be financing? We have begun offering easy EMIs on elective procedures

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September 2016

like hair restoration, knee replacement surgery, all knee care-related procedures, IVF, maternity care treatment, eye care treatment- lasik, eye cataract, ICL and retina surgery, dental care treatments, bariatric surgery and selective laproscopic procedures. What business model did you choose to enter this segment of financing and why? For example, your release mentions about you partnering with companies? The business model is similar to our sales financing business. With life care finance, we intend to convert the medical bills of patients opting for elective procedures into easy EMIs. The reason why we have chosen to cover only elective procedures at this point of time is because these procedures have considerably low risk and minimal insurance coverage. The market of these procedures continues to grow at 18 per cent Y-O-Y. We are also expecting a shift in the consumption pattern for these services as more and more people prefer getting these procedures done at places that hold some aspirational value. Proposition for our partners (in this case doctors and hospitals offering elective treatments) has increased foot fall of customers due to easy access to EMI. For this, our partners bear the sub-venation on behalf of customers. Who are your partners in this venture and how many more partnerships is Bajaj Finance looking at by the end of this year? We launched the business

Manipal Ankur, Venu Eye New Delhi, Spectra Eye New Delhi and Dr Agarwal’s. We are looking to tie-up with more partners with a national or regional presence.

The total disbursals in Q1 FY17 are a little over ` 18 crore, while we expect this to go up to ` 120 crore by the end of this financial year about eight months ago. Currently, we are active in metros and expanding our geographic presence to tier-II locations. We have over 15 active relationships that include Mydentist, Richfeel, DHI, Vibes, Enhance, Centre for Sight, Partha Dental, EyeQ, Axiss Dental, Denty's, Vasan Dental, Cloudnine, My Family Dentist Delhi,

What is the advantage that you have in these partnership? More and more customers today want to opt for these procedures and we have the role to enhance their need and meet aspirations by paying in EMIs. Hence, we will need to tie up with these partners to service their needs. Most of these partners are well entrenched in these customer segments with great brand equity. Our partnership with them will help us get access to their customers while servicing their needs. This, in turn, will help us cross sell financial service products to those customers to enhance our relationships with them. What role will these partners play in this venture? In medical procedures (especially elective procedures), we have witnessed a pattern in which most consumers aspire to avail premium services but due to budget constraints and non-availability of an easy finance option or insurance coverage, they settle for basic services. The main role of our partners is to pitch our finance product to the customers, it will help them upsell in doing so. Apart from this, we will work closely with our partners. On basis of their feedback, we will develop different products that will better suit customers’ needs. Which segments and

geographies have seen the maximum traction in Life care financing? The figures of early business suggest that metros cities in Western and Southern India have witnessed good traction. We are working on initiatives towards increasing traction in other locations as well. By the end of FY17, we hope to have more traction. From a category standpoint, we have seen that the categories such as dental care, hair restoration and cosmetic care and stem cell storage, where there is no insurance coverage, have picked up faster than categories that have some insurance coverage. We believe as awareness increases customer activation will also increase. What are the total disbursals of loans that Bajaj Finance has done at the end of the first quarter of FY 2016 -2017. How much does it expect? The total disbursals in Q1 FY17 are a little over ` 18 crore, while we expect this to go up to ` 120 crore by the end of this financial year. Who are your competitors in this space and how will you differentiate yourself from them? Since we launched this category in India, we don’t have any competitors as on date. However, with the market estimated at ` 5,000 crore and slated to grow by 18 per cent Y-O-Y, we will see the market expand and new players entering this segment helping to build it further. raelene.kambli@expressindia.com

MARKET I N T E R V I E W

‘We are likely to see us venturing in South India with future possibilities’ Francisco Rodriguez, Business Development Director, Middle East and India, IGENOMIX, in an interaction with Sanjiv Das, talks about business prospects of IGENOMIX in the Indian market

Infertility is a growing concern in India and worldwide. Being a leading provider of genetic testing services for reproductive health patients and clinics, are there any new techniques in the pipeline for the Indian market? IGENOMIX is constantly trying to awaken the population to the various genetic diseases and also trying to guide young couples, planning to start a family, about genetic disorders that they might pass on to their kids. We’ve had our presence in more than 50 countries, and provided services to IVF clinics for more than 18 years. Now as we are spreading our roots in India, we have introduced a panel for the carrier genetic diseases for the Indian population. We have also launched two very important tests Non-Invasive ERA and Non-Invasive PGS that require no biopsy. In addition to these we have also introduced cancer screening panels for the Indian population. Recently, IGENOMIX has strengthened its international expansion with the entry of the venture capital fund Charme Capital Partners. Can you throw some light on the same? Yes, Graham Snudden, the founder of BlueGenome has joined us as a shareholder. This venture will help us in reinforcing our R&D and will definitely help us in re-

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September 2016

searching and bringing new technologies and development in the field of genetics. Not just that Charme Capital Partners will strengthen our market presence through their important networks and contacts. In the year 2013, you have opened a lab in New Delhi? Do you plan to venture into other cities also? As the business will grow, we can potentially see IGENOMIX expanding. The Indian market is in the early stage for the moment and Igenomix is committed to bring new technology to India. With an existing lab in North India, we are likely to see us venturing in South India with future possibilities. What is your growth trajectory for the Indian market? We stepped in the Indian markets in the year 2013, in 2014-2015 the growth was 60 per cent in terms of sales, and we achieved profitability in our operations. India is a tough market which is full of myths and rumours regarding infertility, obstetrics and gynaecology. Therefore, it isn’t easy to increase the professionalism in this sector with the use of genetic service. So our only recourse are the doctors and the physicians. Genetics has come to stay as an important and essential part for the physicians and doctors, otherwise the clinics will stagnate and will not be using the latest

technology, and for sure will not be competitive against other clinics.

We invest 15 per cent of the profit in R&D as a means of providing the best and latest services to our clients

What services do IGENOMIX offer? IGENOMIX has dedicated itself to help have a future generation that is healthy and free of any kind of genetic disorder, not only that we are bent at offering effective solutions to different infertility problems. We offer PGD which is a Preimplantation Genetic Diagnosis, that is performed during IVF treatment so as to screen embryos that are at risk to develop a serious genetic disease. We also offer PGS or Preimplantation Genetic Screening for aneuploidy, which is a very important test conducted during IVF treatments to screen embryos for numerical chromosomal abnormalities. Another test is ERA, Endometrial Receptivity Analysis that indicates the window of implantation during IVF, hence increasing the chances of successful transfer. Then the next test helps to eliminate the biggest worry of all expecting Parents-Miscarriage. Not many people know that majority of miscarriages are caused by chromosome abnormalities. POC or Products of Conception test helps answer all the questions of the anxious couples who worry about, “will it happen again?”. Next is CGT and NACE, CGT- Carrier Genetic Test, helps in determining the risk of having a baby with a genetic disease and

NACE-Non-Invasive Prenatal Screening test, that informs pregnant women about the chromosomal abnormalities that are the major causes of Down’s, Edward’s and Patau’s Syndrome. Then we have MItoScore, which is a Mitochondrial biomarker that indicates the level of energy of the embryo and helps in selecting the embryos that has the highest probability for successful implantation during IVF. What differentiates IGENOMIX from other leading service providers? What makes us different is that we understand how anxious the ‘would be parents’ are so we have cut down all the mediators and given a direct access to the lab directors and technicians for the counselling and tech support. The test samples are handled with utmost care and strict quality measures are taken for the best results. IGENOMIX covers all the genetic needs, as we offer test that cover pre-conception phase, pre-implantation as well as pre-natal phase. We use the latest art of technology, that includes Arrays CGH and next generation sequencing that gives out results that are highly accurate. Not just that We invest 15 per cent of the profit in R&D as a means of providing the best and latest services to our clients. sanjiv.das@expressindia.com

MARKET NEWS

Govt should consider levying additional tax on products with high sugar, sodium, salt or tobacco content: IMA and HCFI

INDIAN MEDICAL Association (IMA) and Heart Care Foundation of India (HCFI) has urged Government of India to levy an additional tax on products with high sugar, sodium, salt or tobacco content to reduce the burden of lifestyle disease. It may be noted that in June 2016, the Government of Fiji increased taxes on tobacco, alcohol and sugar sweetened beverages as all lead to increased risk of developing NCDs. The tobacco and alcohol taxes have been increased by 18.5 per cent and a new levy on sugarsweetened drinks has been introduced. Mexico started a similar tax in 2014, which resulted in a 12 per cent reduction in sugary drinks sales within a year of the tax being implemented. “IMA and HCFI commends this decision taken by both the Governments of Fiji and Mexico to control these cardiovascular risk factors through taxation. We believe that a similar tax must also be imposed in India, which has seen a considerable rise in the number of lifestyle diseases over the past decades owing to the high stressed unhealthy lifestyle. India is already the diabetes capital of the world and is inching towards becoming the heart disease capital as well. The

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The first and foremost step is to raise awareness about the increasing burden of lifestyle diseases in the country and find ways to prevent them

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September 2016

MARKET country is more at risk than ever before and steps must be taken on priority to raise awareness and reduce the disease burden,” said Dr KK Aggarwal, President, HCFI and Secretary General, IMA. The first and foremost step is to raise awareness about the increasing burden of lifestyle diseases in our country and the ways in which they can be prevented. In the long run it is important for the administration to consider following taxation laws similar to that in Mexico and Fiji. Given the diversity of India, it would be recommended to take Mexico and Fiji’s policy on sweetened beverages as a benchmark and customise it to suit the Indian needs. Evidence has shown that simple increases in tobacco prices through taxation are the most cost-effective way for governments to reduce tobacco use. According to the World Health Organisation, a 10 per cent increase in tobacco retail price (in middle income countries) results in a five per cent decrease in consumption. A new report in The Lancet has estimated that reducing sugar content in sugar sweetened drinks by 40 per cent over five years could prevent half a million people from becoming overweight and a million people from becoming obese. EH News Bureau

Health minister launches ‘Mera Aspataal/ My Hospital’initiative The initiative was launched at the third National Summit on Good and Replicable Practices and Innovations in Public Health Facilities held at Tirupati JP NADDA, Union Minister of Health and Family Welfare, has launched the ‘Mera Aspataal/ My Hospital’ initiative at the Third National Summit on Good and Replicable Practices and Innovations in Public Health Facilities at Tirupati in Andhra Pradesh. Faggan Singh Kulaste, Minister of State for Health and Family Welfare, Kamineni Srinivas, Minister of Health, Medical and Family Welfare, Government of Andhra Pradesh were also present at the occasion, along with other senior officials. Speaking on the occasion, Nadda stated, “Patient satisfaction is the ultimate test for assessing quality of services, provided by a healthcare facility. To further build upon the gains so far, we are now making a paradigm shift and expanding the programmes from grassroots upwards to build the continuity of care.” Nadda informed that the ICT-based Patient Satisfaction System (PSS), ‘Mera Aspataal/ My Hospital for implementation in public and empanelled private hospitals, is envisaged to empower the patient by

The Union Minister for Health & Family Welfare, JP Nadda releasing a book on Winds of Change, at the National Summit on Good, Replicable practices and innovations in public health care systems in India

seeking his/ her views on quality of experience in a public healthcare facility. He further added that a multi-channel approach will be used to collect patients’ feedback i.e. web portal, mobile application, Short Message Service (SMS), Interactive Voice Response System. Srinivas stated that health of Indians has taken a big leap with NHM. The minister highlighted various steps taken for pregnant women, reducing infant mortality rate, maternal mortality rate and reducing out-of-pocket expenditure for the patients. He also appreciated the Centre’s help for free drugs and diagnostics for the poor and telemedi-

cine schemes. The Union Health Minister also released operational framework on management of common cancers, guidance note for outsourced call centre for tele-consultation, grievance redressal and providing information about schemes. Nadda gave away awards to the states on the basis of health indicators and service delivery. The best performing large states for decline in IMR was given to Haryana and West Bengal. In this category the best performing small states were Nagaland and Tripura. Similarly, for service delivery in public health facilities, Tamil Nadu

and Andhra Pradesh were awarded amongst large states and Sikkim and Himachal Pradesh were awarded amongst small states. Best performing Union Territory was Dadra and Nagar Haveli. C K Mishra, Secretary, MoHFW, Dr (Prof) Jagdish Prasad, DGHS, Dr AK Panda AS & MD (NHM), Poonam Malakondaiah, Principal Secretary to Government, Health, Medical & Family Welfare Department, Andhra Pradesh and other senior officers of the Health Ministry were also present on this occasion. EH News Bureau

Medica Hospitals: Promoting excellence through innovation The hospital’s critical care unit is among the most advanced in the country, equipped with the latest support devices and a very experienced and skilled clinical team MEDICA HOSPITALS, one of the major healthcare chains in eastern India today, has built and managed a number of healthcare facilities across eastern India over the past few years. The healthcare chain launched its operations with Medica North Bengal Clinic (MNBC) in Siliguri in 2008, and

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September 2016

soon followed up with its flagship hospital — Medica Superspecialty Hospital (MSH) — in Kolkata. Medica Cancer Hospital in Siliguri is the only comprehensive cancer facility in North Bengal, and RC Agarwal Memorial Hospital run by Medica in Tinsukia is a multi-specialty unit that has brought quality health-

care to the region and had dire need of it. In 2014, the hospital chain began operations in Jharkhand with hospitals in Jamshedpur (Kantilal Gandhi Memorial Hospital) and Ranchi (Bhagwan Mahavir Medica Superspecialty Hospital), bringing world class healthcare to the region. Tata Steel Medica Hospital in Kalin-

ganagar, Odisha, was the latest addition to the bouquet of hospitals in 2015. Built in collaboration with Tata steel, the hospital brings much-needed multi-specialty care to the region. The second unit of this collaboration is coming up in Gopalpur. One of the largest healthcare unit in eastern India, the 500-

bed Medica Superspecialty Hospital, located in Mukundapur, off EM Bypass, was inaugurated on April 15, 2010, with the commitment to bring the best in healthcare to Kolkata. A promise that the hospital has been fulfilling in many ways since its inception. A unit of Medica Synergie, the largest integrated healthcare

MARKET provider in eastern India, Medica has brought to the city a fresh approach in healthcare – not just in technological advancements and innovative treatment techniques, but also in the area of patient care. Leading it from the front is the Founder and Group Chairman, Dr Alok Roy, whose vision was to gift to the people of Kolkata and eastern India a healthcare facility that would be at par with international standards. The NABH accredited hospital has 10 ultra modern Operation Theatres with Green OT certification ensuring the best safety protocols, Imaging Department equipped with the latest technology and NABL accredited Lab with facilities for genetic counselling and testing. The hospital’s critical care unit is among the most advanced in the country, equipped with the latest sup-

port devices and a very experienced and skilled clinical team to provide the best possible care for complex cases. The hospital’s emergency department has 24x7 consultant coverage and is fully equipped to handle all kinds of emergency situations within the golden period. Medica has institutes on neurology, cardiology, orthopaedics, gastroenterology, kidney diseases, critical care, ENT and breast diseases with special thrust on emergency medicine, along with a host of other specialities, which include endocrinology, dermatology, general medicine, general surgery, gynaecology and obstetrics, paediatrics and neonatology, psychiatry, plastic surgery, respiratory medicine, dentistry and rehabilitation services. Medica Superspecialty Hospital has instituted a number of innovative projects/ schemes

Medica Superspecialty Hospital has instituted a number of innovative schemes keeping the welfare of patients in mind keeping the welfare of patients in mind.

Project HOPE Healthcare for Overseas Parents and Elders (HOPE) is a project conceived by Dr Roy, for the benefit of the elderly parents of young professionals settled abroad, who do not have any support system here to deal with medical emergencies. Under this project, Medica promises to take care of the medical needs of these ‘parents and elders‘. For those willing to register their parents under this

scheme, Medica offers its considerable services, including one complete check-up, ambulance pick-ups whenever required and escorts throughout their hospital visit. Bills for subsequent checkups or treatment will be sent directly to the sponsor, to be paid within 15 days of receipt of bill. KARMA (Kolkata Accident Rescue & Medical Assistance) was launched by Medica in collaboration with Kolkata Police in March 2012. The project provides 24-hour trauma care service for victims of road accidents in the city. 18 ambulances, with

trained emergency technicians, are stationed at various points across the city for transport of accident victims to nearest healthcare unit with trauma care facility. Movement of the ambulances is regulated by the Karma Command Centre, based on calls received at the Karma helpline no (66070707) at the hospital or toll free Kolkata Police no (1073). Medica has recently launched ‘Homecare Services.’ The facilities provided include, doctors’ home visits, nursing attendants at home, pharmacy and physiotherapy support, regular health monitoring, e-health book for maintaining records, home-hospital set-up for chronic or bed-bound patients and a dedicated care managers for coordinating all requirements. Homecare was launched with the aim of making advanced care more accessible. EH News Bureau

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r X from a leading multi-speciality hospital in Delhi, is busy performing a complex heart surgery, when he realises that the patient is losing a lot of blood and he needs immediate assistance to deliver blood to the patient. He immediately alerts the nurse. The nurse in turn makes a call to arrange required blood. Comes in drone Happy Feet (fictional name) with the required blood quantity. Dr X immediately supplies the blood to the patient and successfully completes the procedure. Moral of the story.... This prompt action by drone Happy Feet augmented the entire process of delivering blood to a surgeon when needed. It saved time and provided better outcome. Does this seem preposterous to you? Perhaps 10 years ago, it would have seem absurd, but not today. Recently, Fortis Hospital, Mumbai has announced a collaboration with IIT-Bombay to employ drones to transport hearts in case of transplants in a bid to save travel time and lives. Dr Anvay Mulay, Head of Cardiac transplant team at Fortis who is in-charge of this project says that utilising drones to transport hearts will accelerate the process of transplants and will save the lives of patients. In crowded cities like Mumbai, where traffic congestion is a normal sight, using drones to transport medical requirements and save patient lives is laudable strategy. Moreover, this urges us to reflect on how healthcare in India is advancing and how this advancement will impact the business of healthcare?

Digital technologies such as robotics, artificial intelligence, 3D printing, Internet of Things and nanotechnology have great potential to transform healthcare delivery

Digital technologies setting precedent

BY RAELENE KAMBLI

Today, digital technology is invariably touching every sphere of healthcare diagnosis, delivery,

management and research in India. As per Deloitte Touche Tohmatsu India, with increased digital adoption, the $ 100 billion, Indian healthcare market will grow at a CAGR of 23 per cent to $ 280 billion by 2020. The sector is currently witnessing new levels of mobility and connectivity that are changing healthcare delivery and management in ways never thought before. Right from choosing a doctor, making an appointment to buying medicines, patients are now using Internet to manage their healthcare requirements. Moreover, healthcare systems and medical devices now-adays are developed using microprocessors, miniature electronic circuits, wired and wireless digital networks and are slowly replacing older generations of mechanical and analog electromechanical devices used in patient diagnosis, monitoring and treatment. What’s gripping about these technologies is that they have the ability to add more intelligence to medical decisions and research in healthcare.

Mobile applications Let’s look at the widespread use of mobile applications and Internet of things in healthcare. These technologies have changed the dynamics of healthcare communication and management. Healthcare apps are becoming increasingly useful in maintaining health records, managing diseases and increasing connectivity with doctors and patients. It

not only keeps doctors and patients connected but is also making healthcare more convenient, less expensive in some cases and more preventative by nature. They also make the patients more aware of their healthcare needs and provides them with a wider choice. From the business perspective, the real beauty of these apps lies in the creation of a competitive marketplace for the health and wellness sector. On the other hand, increasing adoption of IOT in healthcare has convinced experts to believe that universal coverage of healthcare in India is not very far to achieve.

Internet of Things IOT has some how shifted the focus of healthcare delivery from ‘hospital-centric’ to ‘patient-centric’ model. And the good news is that hospitals across the country are all geared-up to explore this field wholeheartedly.

Healthcare robots Healthcare robots are also setting a precedent in India. Physicians and nurses are superhero saving the lives of patients, but these superheroes also need sidekicks to assist them. Robots play this part. They amplify the surgeon’s potential with superhuman precision and thereby provide better patient outcomes. An example to this is the very famous da Vinci robotic surgical system which is being utilised in various surgical fields. Using this robotic system, surgeons operate through just a few small incisions. The da Vinci system features a magnified 3D highdefinition vision system and tiny wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables surgeons to operate with enhanced vision and precision. Benefits to the patient include smaller incisions that lead to less stress on the body, reduced chances of infection and faster recovery times post-surgery.

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cover ) Artificial Intelligence (AI) Artificial Intelligence is another technology that has found immense scope. It is becoming a vital tool in healthcare data mining. IBM’s Watson computer, named after IBM’s first CEO, Thomas Watson, is a diagnostic AI machine built to understand the natural language that is presented in raw data without relying on a pre-organised database to pull information. This is extremely helpful for keeping track of all the different symptoms and potential causes and diseases for any given patient. It can pull information from context and learning algorithms to make connections that would otherwise take years to discover. Additionally, experts are intrigued by Watson's capabilities in concocting new drugs that take interactions and side effects into account. This can enable healthcare providers to design treatment plans to meet the needs of the patient. On the same lines, Atomwise, an big data analyical and super computing firm has successfully developed a virtual search where safe and existing medicines could be redesigned to treat deadly viruses that damage physical, psychological and economy legacies. The idea behind this was to fight back against these viruses months or years faster, than the usual time and Atomwise's virtual system was effective in the endeavour to search in an appropriate treatment for Ebola virus. This is just a tip of the iceberg; we do not yet have complete comprehension of what form this digital wave will take. Still, the industry representatives seem upbeat about this trend. They cite more examples to tell us how these new age technologies are reforming healthcare delivery and their business models in India.

Industry testimonies Says, Dr Narayan Pendse, Associate Vice President, Medical Operation & Systems Group

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DIGITAL TECHNOLOGIES

MOBILE APPLICATIONS

HEALTHCARE ROBOTS

INTERNET OF THINGS

ARTIFICIAL INTELLIGENCE

(MSOG), Fortis Healthcare, “Off-premises real-time monitoring of ICU patients in remote areas with limited local clinical talent pool by means of an e-ICU is a simple but great example of what technology is capable of. Surgical applications of robotics are now well developed and have improved quality of surgery by allowing visualisation and access to body parts historically considered poorly accessible. 3D printing is improving minimal access procedures by adding the missing dimension of depth for accurate localisation of disease and intervention area”. “Advancement in technology makes the perfect case for the IoT in providing connected care solutions. This calls for an open IoT ecosystem for clinical and remote medical devices that can bring together patient monitoring data into a single data management and analytics platform. With the patient information available at finger tips and possibility of monitoring multiple patients concurrently through remote patient

monitoring, medical professionals and doctors can improve their efficiency and thus bring down the overall healthcare costs. Due to its live monitoring feature, the overall patient engagement can be improved especially for those who are suffering from chronic diseases,” informs Sudip Singh - Senior VP and Global Head of Engineering Services, Infosys. He further explains how Infosys is building a connected healthcare ecosystem by utilising IOT. “The Infosys Connected Care Testbed, is an open and developing ecosystem of edge devices, communication protocols, cloud-based platforms and applications, with a focus on cost-effective IoT technologies for healthcare providers. It creates multiple opportunities for healthcare providers to improve hospital and clinical patient health outcomes as well as enable remote patient monitoring to reduce health relapse rates after a patient returns home meeting the regulatory requirements. The engineering services team at

Infosys has also developed a comprehensive 3-D human heart model using CT-scan imaging. The model captures biomechanics of the heart in the most realistic manner, helping medical equipment manufacturers and regulatory agencies to optimise design, enhance quality and shorten time-tomarket for their products, leading to improved and affordable healthcare to all. Plus, Infosys has also partnered with GE Digital to deliver industrial IoT solutions with advanced implementations in manufacturing, aviation, transportation and healthcare industries. These IoT solutions, based on GE’s Predix platform and Infosys’ Aikido services, will help enterprises simplify, automate and transform their business,” he updates. Speaking about the research advances in nanotechnology A Nandini, VP Delivery, GlobalLogic says, “Delivery and controlled release of therapeutics, membranes for cleaning blood, miniaturised probes for recognising disease are few of the most researched branches under nanotechnology. Research on reconstruction of the brain through super-computer-based models and simulations to prevent neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, and treat acquired brain injury and mental health including depression and bi-polar disorder are also underway”. Dr Nagarjun Mishra, Chief Officer - Business & Strategy & Co-founder, Purple Health expounds on the research and developments in the field of robotic technology. He goes on to say, “Nowadays, many new engineering technologies aim to create a series of practical and effective microrobots. We should move into the future by creating some pragmatic working devices that will help us to cure some of the deadly ailments as well as advance our capabilities directly. A need of the hour is a concerted effort

to develop the working model of a microrobot in the near future, thereby easing into the advancement of the use of nanotechnology. In some ways, the future is already here. India has about 30 health facilities performing high-end robotic surgeries including urology, gynaecology, paediatric, general surgery and bariatric (weightloss) surgeries. The greatest impact has been in cancer surgery. It is now possible to remove tumours from almost any organ in the abdomen or chest with great precision and accuracy while saving normal and healthy tissues. Robotic surgery is preferred over traditional laparoscopic techniques because robots operate in 360degree mode and have better precision and reach leading to better outcomes.” Jyotsna Pattabiraman, CEO, Grow Fit, shares some out-of-the-box global concepts where technology is utilised to enhance health management. Being enthused with the idea of applying a bio-hackers mentality to achieve health goals, Pattabiraman spells out how this concept functions and says that this concept can be applied in India too. “Rather than following conventional wisdom, biohackers use experimental trialand-error methods to gain new capabilities. The holy grail for biohackers is to achieve something called the quantified self, where they can achieve an outcome using an algorithm of some kind. For example ◗ Hacking sleep by using binaural sounds ( e.g. brain.fm) to induce sleep and relaxation ◗ Hacking nutrition by using products like Soylent, an engineered product consisting of mixtures of nutrients ◗ Hacking athletic achievements by following a specific combination of events, for example, using interval training to ramp up to marathon Pattabiraman also talks about an increasing curiosity to explore the potential of the

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concept of transhumanism or directed evolution. â&#x20AC;&#x153;This means transcending the limitations of our human bodies through a combination of genetic engineering and device implantation. For example, some people have implanted a glucometer, even though they are not diabetic so that they can measure the impact of nutrition on their blood sugar continuously. Rich Lee, a biohacker, implanted a device that allows him the power of echolocation through magnets implanted in parts of his ears. This allows him to listen to music without earbuds, for example. Another commercially product, Circadia, is a lightweight implant that measures several metabolic indicators such as the composition of your sweat and transmits them via bluetooth. While these experiments are doubtless bold, they do indicate what is happening at the intersection of biology and technology.â&#x20AC;? True to a certain extent that these experiments will push imagination to new horizons. But how far can these experiments succeed if applied in India? And if so, what impact can it have on the industry and largely on the economy? As a matter of fact, India is yet not ready for experiments like these. But, for technologies such as robotics, AI, IOT, nanotechnology, 3D printing there is immense scope and offcourse the industry is all gung ho to explore them further.(look for more industry voices sharing their views on digital revolution in Indian healthcare Pg no: 24) However, here the question is all about kind of impact these technological advancements can have on the industry.

The impact: Bouquets and brickbats At the time when India is slowly progressing towards becoming a digital economy,

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cover ) investing in digital technological innovation and building the infrastructure for the same seems to be an obvious choice for healthcare players. Reasons being that leveraging digital technologies will help business leaders in healthcare discover new profitable, scalable and sustainable ways to help their business grow. On a larger picture, moving towards a digital future will create a healthy healthcare system in India. Explaining this further, Dr Pendse, says, “Simple interventions like better public health record keeping and surveillance by use of Electronic Health Records (EHR) can improve disease prevention programmes (like vaccination, screening for chronic diseases like diabetes, etc.) and help reduce the economic burden of disease by keeping the workforce healthy. Cost saved on employing manpower and maintaining inefficient infrastructure can be spent on improving accessibility to good quality healthcare”. Chipping in, Mukul Asher, professorial fellow of the Lee Kuan Yew School of Public Policy says, “The technology will increase transparency and accountability, allow development of a robust database which has been lacking so far and has been effectively hampering implementation of health policies and assessment of the outcomes. In terms of the labour market and the economic impact, what is increasingly happening is that we are witnessing very slow movement of formalisation of employer-employee relationship. In European countries, they started the formalisation of this relationship, but they didn’t have the opportunity of leveraging the current day technology, to increase the coverage over a period of time and bring more informal workers into the formal system. Today, across most of the low and middle income countries, including India, we continue to have a larger infor-

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mal labour workforce and contracted system of working is still in trend. Technology will allow us to have healthcare products and service delivery mechanisms that are portable – not tied to the employer and can be taken all over the country. The fact that India is using the Aadhar card, digital technology and developing new schemes where citizens become members and can access healthcare anywhere in the country, is going to be very helpful in income growth, improving quality and affordability of healthcare.” Furthermore, industry people are also of the opinion that these new age technologies will open new avenues for medical practice and research.Pattabiraman says, I do not see healthcare practitioners becoming under-employed but rather, acquiring new skills in data science and technology. I see them migrating to personal medicine and tackling lofty goals like extending human lifespans, reversing Alzheimers and who knows, bio-adopting humans for life on other planets. Likewise, Harsha Muroor, Founder and CEO, Teslon Technologies feels that utilising digital technologies can have a larger impact on healthcare cost and accessibility. “Having

accessibility to high quality healthcare at the right time can save a life and also save huge expenditures leading to complications. Using technology to educate patients on healthcare can work as preventive means for further hospitalisation and occurrences. Affordable quality healthcare has always been a major challenge. In our point of view technology will help save millions of dollars on healthcare expenditure. The costs of healthcare will drop significantly as the conditions will be diagnosed at a much earlier stage leading to faster recoveries. The accessibility of care will be transformed.” To this point, many technology providers will agree that digital technologies can bring down healthcare cost. However, in an financial stretched healthcare sector, will digital technologies such as robotics, AI, nanotechnology etc., not be an expensive luxury? And how many people in India can really afford paying for this kind of luxuries? Currently, the cost of acquiring and deployment of these technologies are high in India. And these cost burden are incidentally transferred to patients making these services overpriced. Joy Chakraborty, COO, P D Hinduja Hospital states,

“Rising cost of acquisition to the healthcare companies, time taken to adapt to newer technology, over dependency etc., are some of the drawbacks. Moreover, the biggest disadvantage of all is that these technologies are being developed in the West and so importing these to India increases cost.” For instance, a da Vinci system that costs approximately $ 1.4 million (` 7 crores) and annual maintenance costs of $ 100,000 with a lifespan of five years. This high cost of installation and maintenance will certainly raise the cost of surgical procedures conducting using this robot. Also, insurance do not reimburse robot procedures in India. So, in the bargain patients spends the entire healthcare cost out-of-pocket. Equally, fee charges of online consultation platforms are also excessive when compared to physically visiting a general practitioner (GP). During an investigation on a story on online consultation platforms in healthcare, we spoke to few video conferencing and mobile consultation start-ups who charge a fee of Rs 400-500 per consultation of any kind of ailment. That would mean a patient seeking an online consultation on through these mobile apps could pay around Rs 400

for a cardiac ailment or even a common cold. Now general practitioners would anyway charge a fee of around Rs 200 in a metro city for common cold. So, the difference in the fee structure of these new age doctor consultation platforms is almost double of what a physician would charge. With such disparity in the fee structures of digitally-enabled healthcare services, how many patients would seek for these services? This is something that service providers need to retrospect on. Having said that, if over a period of time cost of deploying these technologies will reduce, we can hope that the cost of services to patients may reduce in future. Besides this, one more concerning area is the lack of a regulation on data privacy and cyber-security. Data theft in healthcare is not as stolen credit card where the payout is immediate and ends as soon as the card is blocked or account is cancelled. Healthcare cybercrime has a larger, and a longterm impact. It can include a complete digital record of an individual illness, with personal information, medical prescriptions and insurance claim data. Time and again, experts have brought to the fore this important issue of data security, but very little has been done on this front. Regulation on data security is quite needed. More concerns are also on the how this digital wave will disrupt the manpower space within healthcare. Agreeing with this point, Bansal says, “Excessive usage of technology and analytics might create underutilisation of skills of medical practitioners. However, such technologies will also demand different skill sets for instance, data scientists will have to play a bigger role in some areas. The traditional educational system would also undergo a radical change to cater to the changing needs of the new age healthcare segment.

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But Dr Pendse thinks otherwise. â&#x20AC;&#x153;Given the fact that India will continue to lag behind on the optimal patient to healthcare worker ratio, I do not see increasing technology application leading to underemployment. On the contrary, such technologies will supplement and complement the current model. New skills and competencies will have to be developed to make use of these advancements which will help create more employment opportunities,â&#x20AC;? he asserts. Concurring that increasing technological application in healthcare will create new learning areas for healthcare. That bring us to the question on whether this would inflate the cost education and training of such specialised field of healthcare. Well most industry people have not yet contemplated on this aspect as we haven't reach that stage yet where the need for speacialised education and training is made fundamental.

Balancing risk and rewards Against this backdrop, the upsurge of digital technologies in healthcare is going to take root. Internet users in the country are forecast to grow to 730 million by 2020 with 75 per cent of growth in new users coming in from rural areas, predicts a joint studyconducted by YourStory.com, Nasscom and Akamai. As we look to the future, the digital revolution has the potential to be truly a game changer for patients, especially in areas of disease management, aging, and discovery and development of new medical innovations. All the same, it is important to wisely utilise these digital tools. Finally, healthcare providers who come up with strategies that balance risk and rewards of digital technologies will indeed achieve economic value in the long run. raelene.kambli@expressindia.com

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cover ) MORE INDUSTRY VOICE

KAUSTAV GANGULI Healthcare Lead,

ARPAN BANSAL AVP, Newgen Software

Senior Director,Alvarez & Marsal

ndia is at a very early stage of adopting digital technologies often because even the basic

infrastructure or system required for applying these innovations lack across the healthcare eco-system, at large. There are some areas like robotic surgeries that are beginning to see adoption, especially in specialities related to spine, heart or urological procedures. On the other hand, adoption

of solutions like big data analytics is still some distance away as India doesnâ&#x20AC;&#x2122;t yet have integrated EHRs both in private and public healthcare segments. Our innovation focus has to make the benefits of some of these innovations frugal and available to a large majority of the population.

SIVA NARREDDY Sr Director, Cigniti Technologies

mplementation and adoption of latest technology will definitely help mankind in the coming years. Introduction/usage of technology should be taken positively. Accuracy in technology can help cut down a lot of problems, like sur-

geries resulting in less bleeding and fewer complications, etc. Technology allows clinicians to perform miracles, but is also a seductive and self-perpetuating force that needs careful monitoring by those who use it.

he concept of connected world and disease surveillance is creating a solid platform for both structured as well as big data analytics, for predictability in drug supply chain, paramedical workforce deployment and availability of preliminary as well as speciality healthcare facilities. A lot of emphasis is also given to the health informa-

DR GAGAN GAUTAM Head - Urologic Oncology and Robotic Surgery, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket

HARSHA MUROOR Founder and CEO, Teslon Technologies

s a matter of fact, we are amidst the revolution. Products and services like Carenation, Lybrate aim to revolutionise care delivery and also disrupt the healthcare market by opening doors to new models that are drastically different from

what the traditional hospitals are used to. The healthcare research industry will also have a huge impact with the ease of which smaller entities can perform better research and quickly deliver results leading to a highly competitive market.

TUSHAR RANGATREYA Founder & CEO, SmartifyHealth

his is a spectacular beginning of a digital care revolution, since we witness a massive technological shift in healthcare, driven by smart phones, security systems, IoT, big data and cloud computing. These technologies are empowering patients to ac-

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tion exchange and citizencentric health records standardisation across regions and medical facilities throughout the world. This will change face of the industry in terms of predictability and connected healthcare network, covering both payers as well as providers. Huge investments from governments, states, WHO, corporate etc. are now targeted at this segment which will have multi-fold impact on innovation in technology.

cess healthcare easily, understand the choices they have, and have control over their health decisions. These technologies are also unlocking new possibilities for healthcare delivery partners - care providers and payers - in terms of simplified diagnostic tools etc.

he field is now more than 15 years old. We at present are just seeing the tip of the iceberg. In the foreseeable future, it would be possible to operate on a patient without a single cut on the body, through robotic instruments inserted through the bodyâ&#x20AC;&#x2122;s natural orifices. It would be possible to superimpose the most advanced imaging and microscopic technology on to the camera of a robotic system to precisely determine the locations and extent of cancer in the body so as to ensure that it is removed completely

each time and every time, by surgery. You could even have a scenario where the entire surgery is performed on a 3D printed model of the offending cancerous organ a day prior to the actual surgery and is later on, fed into a computer-controlled robotic system thereby ensuring an error free surgery on the actual patient. The possibilities are many. However, at present and in the foreseeable future, the human touch and judgement during surgery does not seem to be readily replaceable with a technological equivalent.

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ear of unknown has always limited the outcome of cancer. ‘Right here right now’ answers are hard to come by while a patient’s condition detoriates. Even with the new age detection tools, all cancers are not diagnosed in its early stage and all that the patient is worried about is how much time do they have left. Advance cognitive computing has emerged as a ray of hope in the fight against cancer. “Oncologists depend on a vast amount of complex, ever-changing information to find suitable care for their patients,” says Rob Merkel, Vice President, Oncology and Genomics, IBM Watson Health. “It is very difficult for a person

to keep abreast and analyse this vast amount of literature and this is where cognitive computing plays a role,” he added. Watson for Oncology is the first commercially available cognitive computing capability that analyses high volume of data, understands complex questions posed in natural language and proposes evidencebased answers. “The introduction of Watson for Oncology will be a game changer for cancer patients across the country,” says Dr Ajay Bakshi, MD and CEO, Manipal Hospitals which was the first hospital to deploy Watson for Oncology in India. The

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cover ) cognitive computing platform is now in use by oncologists at six locations in the Manipal Hospitals’ network to provide information and insights to physicians to help them identify personalised, evidencebased cancer care options across India. “Cancer is a family of thousands of various complex cancer groups with varied treatment protocol with millions of evidence and medical literature. In oncology this is an era of organ preservation protocol with a thrust on minimum effective treatment and not maximum tolerable treatment with multidisciplinary MDT team approach for optimal results for cancer patients. Watson Oncology is creating a new partnership between people and computers that enhances scales and accelerates human expertise,” says Prof Dr Somashekhar SP, Chairman and HOD Surgical Oncology Robotic Surgeon, Manipal Hospital. But how does Watson for Oncology work? Watson for Oncology is a knowledgeable colleague to the oncologist. It is trained by Memorial Sloan Kettering clinicians to interpret cancer patients’ clinical information and identify individualised, evidence-based treatment options. The corpus of Watson is fed with numerous clinical papers, textbooks and medical journals which can remember and it can be fed with patient data. At the click of a button, the super-computer analyses all this information and provides treatment options. “As a doctor in oncology, it is very important to keep ourselves updated with the medical information that is coming every day. However, it is equally difficult to keep pace with that barrage of knowledge due to time constraints. Technology of IBM Watson, I think, would not only help me in selecting the best treatment option for my patient, but the additional information that it gives regarding outcome data, references, side effects of drugs used. It would also be informative to the patient,” says Dr Poonam Patil,

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From a clinician stand point, Watson would help in personalised decision making for each individual cancer patients Consultant & HOD Oncologist, Manipal Hospital. From a clinician stand point, Watson would help in personalised decision making for each individual cancer patients. “We would be able to get the ‘best standard of care’ treatment option within minutes. This would not only improve quality of patient care,

but also improve our efficiency in the clinic,” says Dr Amit Rauthan, Consultant Oncologist, Manipal Hospital. But what if the super-computer does not have Indian study to fall back on? “Watson corpus is fed with publications that are relevant. If it is appropriate peer reviewed literature, it is part of Watson,” assures Merkel. At present, the super-comp suggests chemotherapy but soon will also be able to suggest surgery. “The overall care plan shows everything today and then the detailed therapy options shows chemotherapy,” explains Merkel. “Cervical cancer is the first disease that we would show radiation and surgical intervention for. It would be a multi-disciplinary approach with all three integrated treatment solutions,” he adds. Clearly Watson for Oncology is on the right path. In time to come rare cancers, new chemical entities and im-

munotherapies would also be ingested into the system. “There is an entire strategy on how we are going to integrate these things over time. We are looking at it very broadly,” shares Merkel. “What if it is a rare disease or new drug that has suddenly become available. If there is a clinical trial and peer reviewed literature we could ingest that in. But sometimes, you get into a situation where you have very rare circumstances for an individual. We are working on how we are going to address that issue in long term. There may not be a perfect paper for that patient but we have a whole range of capabilities on how to analyse patients, how to determine cohorts, how to render thoughts on how you may approach a patient like this,” says Merkel. Recently, Manipal Hospitals announced the introduction of an expert second opin-

ion cancer care consulting service for patients as well as oncologists. “Second opinion and multiple opinions in oncology field is a norm and with IBM’s Watson Oncology, it is not the era of second opinion, but will be the final and last opinion ever required. Beyond this, no more evidence based opinions would be required,” opines Dr Somashekhar. “I have no doubt that this option is going to scale to many organisations quickly,” says Merkel. “Manipal is first and that is a testament to their innovative nature. But it is not going to be exclusive to Manipal it is going to transform rapidly,” he adds. “Around the world, Watson for Oncology is deployed at 18 academic medical institutions with engagements in Europe and South Asia. It is scaling very quickly,” Merkel concludes. mneelam.kachhap@expressindia.com

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Artificial intelligence could improve diagnostic power of lung function tests: Study Researchers included data from 968 people who were undergoing complete lung function testing for the first time ARTIFICIAL INTELLIGENCE could improve the interpretation of lung function tests for the diagnosis of longterm lung diseases, according to the findings of a new study. The results, presented at the European Respiratory Societyâ&#x20AC;&#x2122;s International Congress, explored the potential use of artificial intelligence for improving the accuracy of the diagnosis of lung diseases.

Current testing requires a series of methods including a spirometry test, which measures the amount (volume) and the speed (flow) of air during breathing, followed by a body plethysmography test measuring static lung volumes and airways resistance and finally a diffusion test, which measures the amount of oxygen and other gases that cross the lungs' air sacs. Analysis of the

results of these tests is largely based on expert opinion and international guidelines, attempting to detect a pattern in the findings. In this new study, researchers included data from 968 people who were undergoing complete lung function testing for the first time. All participants received a first clinical diagnosis based on lung function tests and all other nec-

essary additional tests (such as CT scans, electrocardiogram, etc.). The final diagnosis was validated by the consensus of the large group of expert clinicians. The researchers subsequently investigated whether a concept known as â&#x20AC;&#x2DC;machine learningâ&#x20AC;&#x2122; could be used to analyse the complete lung function tests. Machine learning utilises algorithms that can

learn from and perform predictive data analysis. The team developed an algorithm process in addition to the routine lung function parameters and clinical variables of smoking history, body mass index, and age. Based on the pattern of both the clinical and lung function data, the algorithm makes a suggestion for the most likely diagnosis. EH News Bureau

EXPRESS HEALTHCARE

September 2016

HEALTHCARE SENATE SPECIAL

EXPRESS HEALTHCARE

September 2016

EXPRESS HEALTHCARE, a leading magazine of the Indian Express Group, chronicling all the major events in the healthcare industry in India has been a witness to the reformation that healthcare in India has been undergoing in the last 16 years. Taking it a step further, now we intend to be a part of this reformation through Healthcare Senate, a leadership platform for knowledge exchange. Healthcare Senate, the national private healthcare business summit, will be held at HICC, Hyderabad from September 22-24, 2016. It would host the game changers, path finders and opinion leaders of the healthcare industry, to facilitate sharing of innovative ideas and experiences, and convert them into reality. The three-day event will encompass expert speakers, panel discussions, case studies and power discussions, a technology showcase featuring leading IT providers, the Express Healthcare Excellence Awards in the private sector, prefixed peer-to-peer networking and relationship building (gala dinners, excursions and entertainment). To be held concurrently with Healthcare Senate on September 23, 2016, Express Healthcare Excellence Awards will celebrate the spirit of excellence and leadership in healthcare delivery in the private sector. The awards will recognise private hospitals and industry leaders for their vital contributions to healthcare in India. It seeks to honour the pathfinders, innovators and game changers from within the private healthcare industry. The Association partners for the event are National Accreditation Board for Hospitals & Healthcare Providers (NABH), NATHEALTH, Association of Healthcare Providers India, Consortium of Accredited Healthcare Organisations and Karnataka Imaging Education Foundation. EXPRESS HEALTHCARE

September 2016

C K Mishra, Health Secretary, MoH&FW, GoI

Dr K K Kalra, CEO, NABH

Preetha Reddy,Executive Vice Chairperson,Apollo Group of Hospitals

Thumbay Moideen, Founder President,THUMBAY Group- U.A.E

Dr AVelumani, Promoter, Chairman, MD and CEO, Thyrocare

Vishal Bali, Senior Healthcare Advisor for TPG Growth in Asia & Founder, Medwell Ventures

Ameera Shah, MD, Metropolis Healthcare

Dr Sabahat Azim, CEO, Glocal Healthcare Systems

Apoorva Patni, Director, Currae Healthcare & Currae Healthtech Fund

Viren Shetty, Senior - VP, Strategy and Planning, Narayana Hrudayalaya

Dr Rupali Basu, President & CEO Eastern Region, Apollo Hospitals Group

Dr Rana Mehta, Partner & Leader - Healthcare, PricewaterCoopers India

Joy Chakraborty, COO, P D Hinduja Hospital & Medical Research Centre

Dr Tarang Gianchandani, CEO ,Jaslok Hospital

Dr Alexander Thomas, Executive Director,AHPI

Dr Suganthi Iyer, Deputy Director, Legal & Medical, P D Hinduja Hospital & Medical Research Centre

Dr Harish Pillai, CEO,Aster Medcity, Kochi & Cluster Head-Kerala

Dr N Krishna Reddy,Vice Chairman, CARE Group of Hospitals

Dr Ram Narain,Executive Director, Kokilaben Dhirubhai Ambani Hospital

Dr Vivek Jawali, Director, Fortis Hospitals, Bengaluru

Mahendra Bajpai,Advocate, Supreme Court of India

Dr Aniruddha Malpani, Director and Values Custodian- Solidarity Investment Advisors,TiE Mumbai,AllizHealth

Dr Nikhil Datar, Founder President, Patient Safety Alliance

Manpreet Singh Sohal, CEO, Global Hospitals, Mumbai & Hyderabad

Sanjay Prasad, President & CEO, Mission of Mercy Hospital & Research Centre

Chayan Chatterjee, Co-founder & COO, Lattice Innovations

Suresh Satyamurthy, Founder,Tarnea Technologies

Dr Nagarjun Mishra, Chief Officer -Business & Strategy & Co-founder, Purple Health

Dr Alok Roy, Chairman & MD, Medica Synergy, Kolkata

HEALTHCARE SENATE SPECIAL EXPERT SPEAK

Claims and compensation

DR SUGANTHI IYER Dy DirectorHinduja Hospital,Mumbai

Dr Suganthi Iyer, Deputy Director-Hinduja Hospital,Mumbai, talks about the need for awareness on claims to be made, as well as basis of compensation in case of medical negligence

he amount of compensation granted over the years in courts for medical negligence has increased by leaps and bounds in the last few years. Ever since the ` 11-crore award for damages in the Kunal Saha matter, the claims in complaints have shot up and also in addition the grant of compensation. Hence, there is a need to be aware on what basis the claims should be made, as well as the basis of compensation in case of medical negligence. In addition, the quantification of the claims in a complaint needs to be justified. If the claim is excessive, the complaint could be returned to the complainant for reduction of claim and directed the same to be filed in a lower court with amendment in the claim. The amount of compensation in case of medical negligence is calculated on the basis of different types of damages that may have occurred: ◗ Loss of earnings (calculated on the basis of age of the victim, current earning and number of years of future earnings, any other financial loss) ◗ Pecuniary (cost that the victim is required to incur — future hospitalisations, employment of medical attendant, etc.) ◗ Non-pecuniary (compensation for mental trauma, loss of a limb, loss of amenities, wife’s company, prospect of marriage, etc., future pain and suffering and other factors — usually high amounts are claimed) ◗ General damages (physical

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September 2016

Courts can dismiss a complaint if claim is ‘excessive’and the complaint can be returned to the complainant to be filed in the lower court. Hence, in a case of medical negligence, if the claim is ‘excessive’and ‘unjustified’, the same could pointed out to the courts so that the claim can be reduced by the order of the court defect and future suffering such as being confined to a wheel-chair, etc., depends upon extent of disability) ◗ Special damages (costs of special measures, need to buy equipment, employ nursing care, or modify the victim’s home) ◗ Punitive damages (where the judge intends only to punish the doctor for having been negligent)

III(2015)CPJ 15 SC---K Vs State of Tamil Nadu & Ors The complainant’s wife delivered a premature child in the 29th week of pregnancy weighing 1250 gms. The infant was kept in an incubator in an ICU for 25 days and given blood transfusion and 90-100 per cent oxygen. After discharge, the child was taken for regular follow-up and the only advice given was to keep the child isolated and confined to the four walls of the sterile room so that she was protected from infection. No examination of the child for the onset of the Retinopathy of Prematurity (ROP) was done which is standard precaution in such a

case. What was overlooked was that a premature baby administered supplemental oxygen and blood transfusion is prone to ROP which in usual course makes a child blind. ROP was discovered when the child was taken for immunisation at four and half months and later confirmed at Shankar Netralaya that the child had been rendered blind for life. Held: The next question was the compensation and the child Sharanya had been rendered blind for life and it would affect education, career as well as marriage prospects. Besides, she would need help all her life and additional future expenses. The courts relied on the following while arriving at the amount of compensation. ◗ Restititio in integrum: This principle provides that the individual entitled to damages should as nearly as possible get that sum of money which would put him in the same position as he would have been if he had not sustained the wrong. It must necessarily result in compensating the aggrieved person for the finan-

cial loss suffered due to the event, the pain and suffering undergone and the liability that he would have to incur due to the disability caused by the event. ` 42,87,921 was considered as deemed fit for the financial hardship faced by the parents on behalf of treatment of Sharanya. Inflation over the time erodes the value of money. Hence, the courts were of the view that inflationary principle must be adopted at a conservative rate of one per cent per annum for the rest of her life. The formula to commute the future amount was FV=PV× (1+r)n. FV is future value, PV is present value, r is rate of return and n is time period. Accordingly, the amount arrived at an annual inflation rate of one per cent over 51 years was around ` 1,38,00,000. The principle of apportioning for inflationary fluctuations in the final lumpsum award for damages has been upheld and applied in numerous cases of medical negligence. A learned Judge has to be mindful of matters which are common knowledge, such as

uncertainties as to future rates of interest and future levels of taxation. Taking a reasonable and realistic and common sense view of all aspects of the matte,r he must try to fix a figure which is neither unfair neither to the recipient nor to the one who has to pay. A judge cannot ignore the inflationary trends and it would be improper if he applied the entire sum awarded to him in the purchase of an annuity which over a period of years would give a fixed and predetermined sum without any provision The liability was ` 1,30,00,000 (State of Tamil Nadu and Hospital) and ` 8,00,000 by the doctors. Further, the amount of ` 42,87,921 in lieu of past medical expenses was ordered to be paid to the complainant.

III(2011)CPJ 239 NC ---S N Vs P Nursing Home & Ors. The complainant filed a complaint seeking compensation of ` 1,50,00,000 with an interest of 18 per cent p.a. till the date of actual payment of compensation alleging medical negligence that during the course of her treatment for fractures of her hip and pelvis, blood was transfused to her and she became HIV positive. The court enquired as to the basis of quantification of the claim of ` 1.50 crores for the complainant. In the case of Tara Devi Vs Sri Thakur Radha Krishna Maharaj (1987) 4 SCC 69, the Supreme Court held that: The principles that Continued on page 34

EXPERIENCE

Entrepreneurship journey: Challenging,yet gratifying

SAURABH ARORA Founder & CEO, Lybrate

Saurabh Arora, Founder & CEO, Lybrate, shares his experience as a entrepreneur and lays emphasis on facing challenges fearlessly

hese are interesting times when environment for entrepreneurship in India has become so positive, like never before. But, what does it actually imply? This, perhaps, points to an economy which has a plethora of opportunities, which is open to embrace risk takers, provide all possible support to them in finding solutions to problems that are unique to India and let them contribute in the development of the country in their own way. It is the very reason that a number of start-ups are mushrooming in almost every sector in India, trying to solve different problems. Being an entrepreneur today seems much easier compared with a few years back as anyone can take a plunge in the sea of opportunities available now, and always get back to doing things, in case things don’t turn out favourably. While it is easy to decide to follow your heart and jump in the entrepreneurship fray, the journey is not a cakewalk. There are umpteen challenges when you choose to walk the path of your own. A fresh set of bottlenecks keep uncovering themselves in the course to follow. However, when the zest to fix a problem is deep within, then there is no stopping and looking back. It was that passion to make healthcare available to the billion-plus population of India and solve the core issue of inaccessibility of doctors in the country that we decided to in-

There are umpteen challenges when you choose to walk the path of your own.A fresh set of bottlenecks keep uncovering themselves in the course to follow. However, when the zest to fix a problem is deep within, then there is no stopping and looking back cept Lybrate, a platform that could seamlessly connect patients with doctors from anywhere, anytime.

Challenges encountered when starting up When we started, we were amply clear about the problem we were there to fix, but a lot of things were mired in confusion as we either did not have the capability to do certain things initially on our own, or we were not able to find the right approach to do things. Finding right people: The formidable challenge was to find the first person to rest his faith in the vision we had and join us, leaving his stable and secure job. Finding those first few people was a herculean task and most of the initial hiring happened through referrals only. It is a continuous endeavour to find passionate and smart people who believe in the idea of Lybrate of making healthcare accessible to all. Finding initial users: It is difficult to find the initial users who could give constructive

feedback. And when it is about someone’s health, it gets all the more sensitive. Given Lybrate is an online doctor consultation app, there is an initial hitch in people about using it, for we all have the ingrained notion that a visit to a doctor and physical examination is a must if we are not well. Breaking that perceived notion and bringing people online to consult doctors is a task. But when people use the Lybrate platform and see value in it, they come back to use it again. Today, more than five million interactions between patients and doctors happen on the Lybrate platform and that bears testimony to what Lybrate has to offer. Finding right product market fit: A new product needs a lot of iterations and improvement over time to fit into the needs of users. To arrive at a product that serves the multifarious requirements of the vast audience is a continuous process and an uphill task. We have to learn from the changing user behaviour and im-

prove the product as per market feasibility. Finding the market fit isn’t easy: ◗ Slow technology adoption: The Lybrate platform is meant for doctors and people. All one requires to use it is an Internet connection and a smartphone. However, technology adoption in healthcare has been slow in India. Hence, creating awareness is the primary thing to let people know how the platform will make healthcare communication and delivery seamless, for both doctors and users. This has to be done continuously and consistently. ◗ Product that caters to varied needs: A product that is for the masses has to fulfil the different requirements. So, while we have created a product that enables doctors and users to talk, the product needs regular upgradation to justify the ever-changing, distinct preferences of users and make the communication process absolutely seamless. In the beginning, Lybrate app allowed communication via text only. But, we later intro-

duced audio and video features after seeing users preferred those modes too. Likewise, Lybrate’s unique Health Feed, which consists of health tips that are posted by doctors themselves, has undergone changes over time to let users have customised feeds as per their interest and preference. Lybrate’s recently launched feature, Lybrate Lab+, was introduced when we realised that over 70 per cent people left their treatment mid-way because of the requirement for lab tests. Users now can easily book a lab test suggested by the doctor during an online consult from any of our trusted lab partners, and even do so otherwise. The samples are picked up from the location and time that suit the users and reports are shared with the doctor and user automatically. Now, the process of online doctor consultation on Lybrate reaches a logical conclusion without getting the loop broken. This entire process did not happen in a day. Be it noted that we had to be on our toes to understand what all was required to satisfy the user or push him to take his health seriously. And this still continues, making us to regularly upgrade the platform to make the process convenient, user friendly and smooth for users. ◗ Building solutions that drive revenues: A company has to work on solutions that bring in revenues. Until people find value in the services, they

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September 2016

HEALTHCARE SENATE SPECIAL are not willing to shell out money for using them. This is never an easy thing to do. It needs sustained efforts to build those solutions that users find worth spending for. No matter, how big the challenges are, to be doing things that makes you believe that you are making a difference and working for a cause is very satisfying. This is what encourages and pushes you to overcome the bottlenecks and stay focused on the goal. With Lybrate, we have democratised Indian healthcare. We aim to make healthcare accessible to the billion-plus population of India and solve the core problem of doctor shortage in the country which is greatly compounding accessibility issues.

We are driven by this passion to realise our vision, slowly but steadily.

Don’t worry about making mistakes and challenge the status quo There are multiple start-ups like Lybrate that are working to address different problems plaguing the country. The risk takers know the problem they want to fix and are good at doing certain things. But doing everything, and doing everything right is not possible. Mistakes are a part of any entrepreneur’s journey. What is important is to learn from them faster and not repeat the same mistakes. When we began Lybrate, we went door-to-door to rope

in doctors on our platform, as that was the established norm. Soon we realised that doing so was not scalable. We then invested in product and technology to make it feasible for doctors to register themselves on Lybrate. We followed suit of others initially. But when we found that out to be obstructive, we did not hesitate to challenge it and do something that wasn’t done before. It is all about learning from mistakes and be brave to challenge the status quo.

What should be kept in mind? There is nothing like pursuing your passion and trying to make a difference. There are something that should always

be kept in mind: ◗ Do your research and establish clear need before building a solution ◗ Be thrifty while building solutions in early stages ◗ Have a good team; focus on quality not quantity ◗ Have mentors that can stop you from making bad decisions ◗ Solve a real need and exploit a business opportunity instead of starting up for the sake of it

First fundraising During your very first investment, either from friends, family members or early stage investor, there’s no business, there is not even a proven need and neither a proof that people will use the product. All bets are on you and the passion that

you execute. You are the product, you are the business and if you are not passionate enough, then the other person will see through it. Your hundred per cent commitment hence is of supreme importance before you approach an investor. You have to be all in with or without investment. You can take feedback on your idea. But you can’t seek funding without committing to yourself first, and before others commit their dollars to you. It is never easy to take the path less travelled. But if you are sure of the goal you want to attain, the path itself becomes a direction. In a nutshell, this is what an entrepreneur’s journey is all about. Challenging, yet gratifying.

Continued from page 32

Claims and compensation regulate the pecuniary jurisdiction of civil courts are well settled. The valuation of a suit depends upon the reliefs claimed therein and the plaintiff’s valuation in his plaint determines the court in which it can be presented. It is also true that the plaintiff cannot invoke the jurisdiction of a court by either grossly overvaluing or grossly undervaluing a suit. The court always has the jurisdiction to prevent the abuse of process of law. If a complainant grossly overvalues or undervalues his complaint by bringing it within the jurisdiction of a particular forum, the complaint can be directed to be presented in the proper forum. In the current case, the question is whether the complainant can legitimately claim compensation as high as ` 1.50 crores. Held: The complainant has claimed a sum of `50,00,000 towards mental agony and ` 45,00,000 towards future expenditure on HIV medication and a further sum of ` 35,00,000 towards future medical expenses relating to progressive failure of immune system. The complainant has

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September 2016

not described the basis of arrival at the said figures. What has been submitted is that the complainant has suffered irreparable loss and to mitigate her present and future expenses, the amount claimed is not excessive. However, the Consumer Courts can grant compensation commensurate with the loss or injury and cannot be arbitrary, imaginary or for a remote cause. The complainant should have made a just and reasonable claim for compensation where compensation upto ` one crore is claimed. Hence the complaint was ordered to be returned to the complainant for presentation before appropriate consumer court after making amendment in the complaint in accordance with the law.

VI (2000) SLT 267— SUPREME COURT OF INDIA ---C S Vs HT Hospital & Ors. In this case, the complainant alleged medical negligence during surgery and had made a claim of ` 34 lakhs. The same was dismissed on the ground that the claim was excessive with liberty to the com-

plainant to approach district forum or state commission. The Supreme Court observed: “The National Consumer Forum disposed off the complaint by styling the claim as ‘exagerrated’ or ‘excessive.’ The National Commission held that the complainant was drawing a salary of ` 3000 plus allowances. This is not admitted by Opposite Party. Even if this contention was correct, and he suffered permanent disability, the claim of ` 34 lakhs is excessive. This exaggerated claim has been made only for the purpose of invoking the jurisdiction of the National Commission. While quantifying damages, consumer courts are required to make an attempt to serve ends of justice so that compensation is awarded in an established case, which will not only serve the purpose of recompensing the individual but bring about a qualitative change in the attitude of the service provider. Calculation of damages depends upon facts and circumstances of every case. All relevant factors to assess compensation on the basis of accepted legal princi-

ples is taken into account. It is not merely the injury or harm or agony or physical discomfort, loss of salary suffered by the complainant which is an issue but also the quality of conduct committed by the respondents which decide the compensation.

II(2012)CPJ 676 NC---R K Vs G Eye Institute & Ors. In this case, a claim of ` 3 crores with 12 per cent p.a. from March 2010 till date of payment was filed for alleged negligence in cataract surgery. In this case, the complainant had incurred expenditure of ` 86,050 towards medical treatment and the complainant has failed to give a break up of rest of the high claim of ` 2.99 crores. The compensation in a case of medical negligence has to be commensurate with the injury and is granted by well established norms. No compensation exceeding ` 1 crore has been granted so far in a case of medical negligence resulting in loss of one eye. The complainant continued to serve with the government despite loss of vision in one eye and had several years to go for

retirement. Held: Complainant has overvalued his claim and has misused the jurisdiction of the National Commission. The legitimate value of the claim cannot exceed ` 1 crore by any stretch under any circumstances. Hence, it is directed to return the complaint to the complainant with liberty to file the same before appropriate consumer court after making amendment in the complaint in accordance with the law.

Take-home messages ◗ Compensation is based on different types of damages ◗ Inflationary principle is adopted while granting compensation ◗ In a complaint, basis of quantification of claims has to be justified. ◗ Courts can dismiss a complaint if claim is 'excessive' and the complaint can be returned to the complainant to be filed in the lower court. Hence, in a case of medical negligence, if the claim is ‘excessive’ and ‘unjustified’, the same could pointed out to the courts so that the claim can be reduced by the order of the court.

HEALTHCARE SENATE SPECIAL OPINION

Intricacies of being a doctor Dr Meenu Walia, Director-Medical Oncology and Haematology. Max Super Speciality Hospital, Patparganj gives an insight on why doctors today are perceived more as a ‘service provider’ rather than a dedicated professional by the society

remember there was a time when one took pride in being a doctor. They slogged years to reach the pinnacle of this reputed profession. Their children looked up to them with pride and they in turn, wanted their kids to be a healthcare professional too, someday. But this supposed illusion of mine was recently shattered. I was at a small get-together where some of my MBBS batch mates were present. Like all old friends reminiscing, we began discussing the good old days, asking each other if we ever regretted becoming a doctor. I, for one, take huge pride in being a doctor. So, as you might have guessed by now. The fact that at least seven out of 10 said that they would not want their children to take up this profession, came as a huge shock to me. But it also left me pondering – We used to put this profession on a pedestal? What changed? When did we begin viewing it through a different lens? When I was a child, the only two glamorous professions that existed for the so-called intellectuals of the society were either 'medical' or 'engineering.' But today, the world is no longer the same. The world has moved leaps and bounds in the past decade. Internet has opened a whole new world of opportunities for the young. In fact, recently a reputed publication reported that fewer students are opting for medicine. This is a serious issue. Is it the availability of alternate and more lucrative careers or the changing attitude of society at large? So what is the hardest part that is deterring young people

from choosing medicine as a profession? Is it the hard, arduous and long journey of becoming a doctor? Unless the desire to excel is strong, it is really tough to get through the ordeal of never-ending studies, tutorials and further studies. The journey also entails a prolonged incubation period between entry into MBBS to becoming a full-fledged specialised doctor which drains many. While your batch mates in other fields are planning retirement, a doctor after completing his studies and super specialisation has just started making a name for himself/herself in the field. The two hardships enlisted above are no secret. While most people willingly embrace them, it is the paradigm shift in the expectations from this profession that shakes young people. Most of us from my generation were attracted to medicine as a profession simply because of the enormous respect that was associated with the profession. The word doctor invariably was

suffixed with Sahib as a token of respect. But the society, at large is not very tolerant at present and medical profession is not an exception to this. The recent change in the attitude of the society is catastrophic. Doctors today are perceived more as a 'service provider' rather than a dedicated professional. Medical practitioners have become more defensive. Physicians are constantly worrying about missing a threatening diagnosis, unintentionally spreading infection or committing a technical error. The fear stems from a profound anxiety of dealing with many grey areas of medical practice. With time, one has realised that medical science is also an art rather than simple scientific formulas. Doctors today also fear and are more often than not, paranoid of being sued for malpractice, which haunts majority in this field nowadays. However, there are always two sides to a coin. Being a doctor is extremely rewarding. It al-

ways was and it will continue to be so. Making challenging diagnosis, helping patients deal with and overcome devastating illnesses, and comforting families after a loss of a loved one - these are powerful emotional experiences that a doctor faces every single day. No other profession can provide such profound sense of fulfilment like medicine. Those who have an inquisitive mind and a quest for learning, medicine is their journey to embark upon, with its endless opportunities. The intricacies of the human body can be incredibly fascinating. Exploring reasons behind its functioning, treatment, etc can be really intriguing to a human mind. With new advancements being made every day, there is always something new to learn and new thresholds to cross. The increasing number of diseases globally, continuing mortality and ongoing research on incurable diseases, provide ample opportunities for inquisitive minds to challenge and rechallenge themselves. On a personal front, I feel no other profession can give such an opportunity for deep insight into life as this. Seeing the miseries of disease and death at such close quarter, changes one’s perspective towards life. If nothing else, it definitely evolves the soul and forces almost everybody in this profession to ponder about life and death questions. Especially in specialities like cancer, nephrology etc where you see prolonged illnesses. One sees humanity and human behaviour both at its best and worst. The harsh realities of human relationships and complex equations guiding hu-

DR MEENU WALIA Director-Medical Oncology and Haematology. Max Super Speciality Hospital, Patparganj

man behaviour may be depressing for some but definitely teaches a lot. One witnesses so many different kinds of cases right from cerebral palsy, Down syndrome to various hypochondriacs. You see young children suffering from incurable diseases, for no fault of theirs. At times, doctors need to find super-human strength to helplessly watch the condition of their patients going downhill. You see patients suffering from terminal illnesses and clinging desperately to hope. All this can be very-very depressing and emotionally draining. Yes, being in this profession can be quite stressful and hard especially while announcing critical medical conditions and near death situations. But equally rewarding part of being a doctor is watching the relief, happiness on the faces of the patients and the attendants of a cured one. This profession brings with itself,tremendous responsibilities. As a doctor, your patient’s health and very often, their life, is in your hands. You may find yourself under extremely stressful situations and may have to take life saving decisions within split seconds. It requires immense strength to be able to handle it and take responsibilities, whether things go right or wrong. Undoubtedly, it is still the best profession to be able to give back to society. Being a doctor empowers you to be able to do something for the sick and ailing, instead of just watching helplessly. The feeling that your knowledge or actions can help someone and society at large - is what makes this job so immensely satisfying.

EXPRESS HEALTHCARE

September 2016

HEALTHCARE SENATE SPECIAL INSIGHT

Top health insurance trends

VARUN GERA CEO, HealthAssure

Varun Gera, CEO, HealthAssure, talks about the various measures being taken by the private sector and the government to increase healthcare insurance penetration in the country

he healthcare sector in India is one of the fastest growing industries in the country, and there is immense potential for enhancing healthcare services penetration in India. It is, in fact, expected to advance at a CAGR of 22.87 per cent during 2015–20 to reach $280 billion. The size and diversity of India is also reflected in the status of the healthcare industry in our country. While India is known for its quality of doctors and medical institutions, we as a country represent less than half of doctors per 1000 population as compared to other countries such as the Russian Federation with a ratio of 4.3, Argentina with 3.8/1000 and the US with 2.4/1000. Similarly, though India has the largest chain of hospitals in Asia, our bed density stands at 0.9 per 1000 people which is less than one-third of the WHO norms of three beds per 1000 people. India spends less than $1 per capita on healthcare research and only three per cent of that figure was spent on public health research, according to a recent media report. However, India is also the largest exporter of formulations with 14 per cent market share. It ranks 12th in the world in terms of export value. In fact in the recent past, we have witnessed tremendous activity in the healthcare sector on all fronts viz. growth and investments in hospitals in tier I and tier II cities and in primary care deliveries. There have also been entries of many standalone health insurance companies and significant growth in their customer

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September 2016

acquisition, e-commerce startups in healthcare, insurance broking, fitness, etc. Upto 20 per cent of the Indian population is being covered for hospitalisation with government as the payer, and regulatory policies and government emphasis on health initiatives such as Mother and Child Tracking System (MCTS) and Facilitation Centre (MCTFC) are further improving the current scenario. However, while medical care in our country is scaling new heights, medical costs too, are escalating faster than wages. Considering the rising healthcare cost inflation and changing disease patterns with a shift towards lifestyle diseases in the urban areas, the health insurance market

would have significant headroom for growth as it would replace out-of-pocket expenditure. Health insurance, remains an important viable alternative to cover the medical care costs of our country’s vast population. The payers viz. health insurers and the government tend to have the maximum influence in the healthcare ecosystem and there has been a lot of activity and trends in both these segments. Some trends that are reflected in both domains include:

Payer — Health insurers India has seen a significant rise in the number of health insurers and more specifically standalone health insurers in the recent years. The gross

healthcare insurance premium was $2.9 billion in 2013 expanding at a CAGR of 26 per cent over FY08-13. [*Source: http://www.ibef.org/download/H ealthcare-August-2015.pdf, Page 14] We are seeing the evolution of the market with launch of new products by health insurers, such as: ◗ Single disease covers: Single-disease insurance cover is catching on in the health insurance domain and is designed for specific ailments such as diabetes, high blood pressure and cancer. Singledisease covers offer comprehensive coverage for that particular disease and serve as an add-on cover to regular health insurance policies. Policies targeting critical illnesses look to provide cover against

lifestyle diseases, given that treatment of such ailments can be expensive. ◗ Fitness, wellness and disease/care management products: Many insurers are now focusing on wellness and other allied services which focusses on programme, support and access for better health of its customers. ◗ OPD coverage: More and more insurers are now focussed on including OPD coverage for its customers and thereby moving from being a finance company to a healthcare company. ◗ Health insurance portability: With the new regulations, customers have a choice of porting from one insurance company to another more easily than ever before. ◗ Modern distribution models: Online sales of insurance products has become a significant distribution channel for insurance companies and has allowed customers to compare the various policies available to and make informed choices. Further, insurance companies have created their own large online channel of sales through digital marketing and social media. ◗ Banca regulation facilitation health insurance growth: The regulator allowing Bancassurance to tie up with one life, one general and one health insurer allows for further penetration and evolution of health insurance. Additionally, the regulator has allowed for banks to act as brokers thereby allowing them to tie up with multiple insurers and allowing for broader distribution of insurance, leading Continued on page 38

INSIGHT

Evolution of health marketing

PAWAN GUPTA Co-founder, Curofy

Pawan Gupta, Co-founder, Curofy, explains that the influx of social media and technology has determined a new set of rules and requirements for the healthcare segment

ealthcare marketing is relatively a new phenomenon which has now become mainstream in the industry. Rigorous changes in healthcare policies, consumer expectations and attitudes within the sector itself are the primary factors facilitating the growth of marketing in this sector. Primarily, policy changes in healthcare were encouraged in the West, where this industry is very organised. It engendered the importance of healthcare services, their delivery and end consumers in the sector. Moreover, the approach of the commoners towards healthcare has changed a lot through education and awareness. Their efforts to reduce cost made them dig deeper into market policies such as insurance and health benefits plans. As global recession engulfed countries during the early 80s, fiscal constraints enforced governments to cut short their expenditure on heads such as public health. This encouraged broad privatisation and commercialisation of healthcare. Further, with the growth of pharma and medical equipment industries, the process received massive impetus. International collaborations and mergers began in the 90s as entities such as insurance companies started to play pertinent roles. Thus, importance of business-oriented healthcare gradually took root in the landscape. Healthcare transformed rapidly into a business-oriented industry with increasing influence of global enterprises that for-

ayed into this sector. Along with these developments, concepts like marketing gained ground rapidly. The influx of social media and technology has determined a new set of rules and requirements for the healthcare segment and marketing is deemed to be essential to address these requirements. Social media is greatly influencing the mindset of consumers, about 54 per cent of consumers prefer to take advice from social channels, more than half of all the chunk. People in the age group of 18 to 24 tend to use more of social media compared to the older generations. This makes it necessary for the healthcare sector to tap and influence their future consumers, drive their business and benefit the consumers. Most organisations have now implemented social media guidelines where they state what to write and what not to, around 31 per cent of healthcare professionals are using social media channels to monitor and reach their clients. These mediums have affected the masses to such an extent that 41 per cent of the people will reach out to social media to take a decision regarding doctors and hospitals. Social media is slowly helping to improve the way people feel about transparency and authenticity, which will hopefully lead to more productive discussions and innovations regarding an individual’s health. This statistic shows that social media platforms can be vehicles to help scale both positive and negative

word of mouth, which makes them important channels for an individual or an organisation in the healthcare industry to focus on, in order to attract and retain patients. Consumers are using social media to discuss everything in their lives including health, and it is up to your organisation to choose whether it’s time to tune in or not. The most important way for industry stakeholders to reach out to patients is marketing through healthcare professionals (HCPs). Traditionally, the whole industry focused on feet on the street sales to reach out to the doctors. The underlying reason being that there was no online world of doctors where the industry could best reach

out to them. Till date, the significant marketing expense is towards massive sales force hiring, training and deploying them for sales. Repeated efforts have demonstrated that e-mails, Facebook and other online sources are not effective ways to reach out to HCPs. They are always spammed by industry stakeholders thus encroaching personal space. Privacy concerns, especially with drug companies, also need to be addressed in order to guarantee that sensitive data is not accidentally released to the public on social media. It shows how many companies in healthcare still don’t know the first thing about the use of social media. This can be corrected by creating clear

and concise guidelines on how social media should be used by the organisations and their staff. Also, every major pharma and medical devices company have started making websites and apps of their own to engage with their key opinion leaders (KOLs). If this phenomenon is to continue, each doctor would be flooded with more than 20 websites and mobile apps with repetitive content everywhere. The way out would probably be a central app which can moderate all the communications for a doctor. Show that you have a solid editorial statement and a strategy to back it up, it’s time to think about the content itself. The healthcare industry is always releasing new reports and information. While you want to keep your consumers informed, you also want to make it relevant. Do the grunt work for your audience by discovering what interests them and publishing content on those topics. Find out by running a focus group or inviting existing patients to fill out a short survey. Try to find out what are the most studied issues. Once you have finalised the topic, consider the different platforms — videos, e-books, newsletters, white papers – that you can use to communicate your message. Decide which platform works best for your topic and audience. Now start serving your customers with the content they care about, and that shows you care about them. Marketing directly to patients has also taken a different turn altogether after the success of social networks.

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HEALTHCARE SENATE SPECIAL Social media and internet utility such as blogs have become prominent channels for consumer rating and feedback. Heathcare organisations are allowing users to share their experiences online and even link their blogs to official websites. Peer review is an important marketing technique as it helps to mould strategic decisions. Product reviews and ratings by consumers are reliable information to improve the prospects of the business. These, in turn, assist organisations to adopt new health marketing strategies. All the major hospitals, labs and diagnostics providers have developed their own online audience as against door-to-door and affiliate mar-

The opinions of people in our online social circles are continuously influencing our decision making, even when it comes to healthcare options keting that used to be before two years. Video marketing converts to traffic and leads much more easily than other forms of content because it efficiently gets across the point, shares a human element and is able to highlight the value of the facilities more quickly. YouTube traffic to hospital

sites has increased 119 per cent year-over-year. This is just the onset of a revolution in healthcare marketing. With time, the expense in offline and online marketing is expected to undergo a paradigm shift. The positive outcome of the shift could be because online marketing is quite cheaper com-

pared to offline marketing. This would result in cost savings for the caretakers ultimately. Thus, with time, the industry as a whole is undergoing an evolution. Starting with all offline activities, immense expenditures have been incurred on creating a massive sales force. Times are indeed changing with the advent of various online platforms which grabs the attention of care providers and caretakers. The opinion and viewpoints of the people in our online social circles are continuously influencing our decision making, even when it comes to our opinion on healthcare options.

Healthcare professionals should take note of this fact and use social media in an impactful way to ensure that they become a part of the process which forms an opinion of a person’s healthcare options. The fact that most hospitals use Facebook over other social media channels should be noted because time, staff and budget are always limited, and your efforts on social media should be targeted and focused on where your organisation can make the most impact. This might lead to a few people losing their jobs but would ultimately benefit the caretakers owing to lower cost in the online marketing world.

Corporation (ESIC): ESIC scheme covers large population of almost six crore of the Indian population for primary and secondary care. Apart from a major push by government to upgrade their infra facilities they have also embarked on a path towards biometric cards for their members and an ERP system for efficient healthcare delivery. The labour ministry also plans to give more flexibility to workers on their health insurance scheme and even opt for private health insurance schemes. This change is aimed to protect formal sector workers against events of sickness, maternity, disablement and death. ◗ Universal Health Coverage plan: Establishing a system of Universal Health Coverage (UHC) in the country would mean that each individual would have assured access to a defined essential range of medicines and treatment at an affordable price, which should be entirely free for a large percentage of the population.

The 12th Five Year Plan plan focuses on providing universal healthcare, strengthening healthcare infrastructure, promoting R&D and enacting strong regulations for the healthcare sector. Factors such as rising income levels, ageing population, growing health awareness and changing attitude towards preventive healthcare are expected to boost the demand for better healthcare services in future. For India to reach its rightful goal of becoming a developed nation, it needs to financially empower its entire population. A key element of this empowerment is a basic risk cover that covers elements of life, disability and health. Besides insurance, other areas in healthcare such as hospital infrastructure, medical technology and manpower, need to be developed simultaneously. This empowerment can only be achieved through the collaborative public private efforts of the government, regulators and private enterprises.

Continued from page 36

Top health insurance trends... to higher penetration. ◗ Focus on customer education, ethics and quality delivery: The regulator has a lot of focus on the above and ensures that the market evolves with customers understanding their rights, education on the need for insurance and regulating insurers for delivery as per the product registered with a good customer experience.

Payer — Government As India’s economy and political structure evolves, it needs to focus on healthcare. There have been many important steps taken by the government which will go further in evolving the healthcare market: ◗ Healthcare financing: India has made significant progress to financially cover greater population for healthcare and one of the biggest achievements has been the increased focus on healthcare financing by governments (by both central and the state). This increase has been contributed largely by government-sponsored financing and health

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A major achievement has been increased focus on healthcare financing by governments (Centre and states) insurance schemes, which together covered 247 million people in 2010, wherein 112 million were covered by government-sponsored health schemes like CGHS (3 million), Arogyasri (70 million), Kalaignar (35 million), others (4.4 million), and 135 million through government-sponsored health insurance, like Rashtriya Swasthya Bima Yojana (RSBY) (80 million) and Employer Employee Con-

tribution Scheme (55 million) in the overall health insurance cover. ◗ Public Health Foundation India (PHFI): India faces a severe shortfall of public health professionals, and capacity building efforts are urgently required to address emerging public health challenges. To address this gap, PHFI has been launched as a public private initiative and currently there are four such institutes operational in India with many more on the anvil. ◗ State level initiatives: Government initiatives such as creation of National Health Mission for providing effective healthcare to urban and rural population, enhancing scope of RSBY to include rickshaw pullers, taxi drivers, sanitation workers, rag pickers and mine workers and additional funds provided to the National Programme for the Health Care of Elderly for senior citizens have all contributed to the growth of a robust healthcare infrastructure in the country. ◗ Employee State Insurance

STRATEGY I N T E R V I E W

‘SBI General ranks seventh in the health space with a market share of 4.1 per cent’ SBI General insurance intends to expand its reach within the health insurance segment. Puneet Sahni, Head of Product Development, SBI General Insurance, speaks about their current market share and explains their vision to strengthen health insurance in India, in conversation with Raelene Kambli What is SBI General's market share within the health insurance sector? How much does that contribute to overall insurance business? Amongst the private players, SBI General ranks seventh in the healthcare space with a market share of 4.1 per cent. The total business that comes from the health insurance is 10.6 per cent. Tell us about SBI General health insurance's geographical coverage in India? SBI General has a very strong presence pan India due to the vast network of SBI branches. The top five states where we get the maximum business from are: ◗ Uttar Pradesh - 13 per cent ◗ Maharashtra - 13 per cent ◗ Madhya Pradesh - 12 per cent ◗ Rajasthan - 10 per cent ◗ West Bengal- 8 per cent

There are well-known players in the health insurance segment who already enjoy a huge market share. How would you differentiate yourself from the rest? With our simple products and tightly sewn claims servicing, we have been able to create our space within the segment. Apart from simple products, we have a wide variety of product bouquet to suit across all segments of customers on both indemnity and benefit side. We have been working on establishing our footprints through alternate and agency network apart from bancassurance through the variety of product offering in the health insurance segment. Also, our exposure to the huge network of our parent organisation is definitely an additional advantage to us. With the affinity of the strong brand like SBI and renowned international player like IAG, we have been able to establish

trust and have been growing in all channels and geographies in the health insurance segment.

With our simple products and tightly sewn claims servicing, we have been able to create our space within the segment

Do you have to be associated with government schemes such as the government's recently announced ‘Health Protection Scheme’?And how would you like to partner with such schemes? The government scheme is generally finalised through a tender process and all insurers who meet the criteria can participate in the tender. While being associated with the government schemes is one part, the other part which is contribution to increase in penetration is where we are playing our part by enabling distribution of health insurance, personal accident and other products through a wide network of SBI Branches spread across the country. Considering bank's huge network in Tier-II and III cities, we have been able to

increase our share of the pie in health insurance at a faster pace. Do you think insurance is a viable route to provide universal healthcare to the poeple of India? Yes insurance is viable for universal healthcare, provided: ◗ The government takes the expense/subsidise the insurance premium for weaker sections ◗ The government takes steps to standardise medical expenses on treatment which will enable the economies of scale to play a part in this scheme In the current situation where very few people take health insurance as they can afford, the treatment cost for same treatment is widely different across hospitals. For a universal healthcare to operate efficiently, this needs to be plugged and regulated. raelene.kambli@expressindia.com

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KNOWLEDGE INSIGHT

Diagnosis for Down syndrome

DR PRIYA KADAM Program Director, MedGenome NIPT

Dr Priya Kadam, Program Director, MedGenome NIPT, elaborates on how gene-based diagnostics can help early detection of chromosomal abnormalities in pregnancies

or any expecting parent, the prospect of having a child with a congenital/genetic disability is always daunting. Every parent wants to have a child that is healthy and normal in every aspect. Unfortunately, approximately 2.5 per cent of infants are born with congenital anomalies; these accounted for 8-15 per cent of perinatal deaths and 13-16 per cent of the neonatalmortality in India(1). Of these, six per cent are identified to be afflicted with chromosomal anomalies (2). These are disorders which arise from a missing, extra or irregular portion of chromosomes. While a healthy human cell has 23 pairs of chromosomes, often individuals affected by chromosomal disorders, have an abnormal number of chromo somes – a condition referred to as Aneuploidy. Aneuploidy can manifest as monosomy (missing a chromosome from a pair) or trisomy/tetrasomy (having more than two chromosomes per pair). Down syndrome is the most commonly occurring chromosomal abnormality. Most cases of Down syndrome are caused by an extra copy of chromosome 21. Parents of these children are genetically normal, the extra chromosome occurs by random chance. In two to four per cent of the cases of Down syndrome, the extra chromosomal material on chromosome 21 is transferred by a Robertsonian Translocation. The probability of this type of Down syndrome is not related to the mother’s age. Some children without Down syndrome might inherit this type of translocation and have a higher probability of having

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children of their own who might have Down syndrome. These cases are often referred to as familial Down syndrome. Every year between 23,000 and 29,000 children are born in India with Down syndrome, which is the highest in the world (3).Children with Down syndrome have delayed physical and mental development, specific head and facial features, and short stature. They tend to typically have speech impediments, as well as hearing and vision disorders. They tend to have poor immune function, and are prone to leukaemia, epilepsy and thyroid disease. They are also prone to gastrointestinal disorders as well as face a higher risk of periodontal diseases. These children are at a greater risk of autistic behaviour, especially those with severe intellectual disability, and also risk

having heart defects. Depression is also observed among people with Down syndrome. The International Society for Prenatal Diagnosis (ISPD) recommends the use of Non Invasive Prenatal Testing (NIPT) as a first line screening in all pregnant women. NIPT is a trial to check chromosomal abnormalities in an unborn baby. The NIPT test can be used to screen for chromosomal disorders in pregnant women from the ninth week of gestation onwards. It has the highest accuracy rate of 99.84 per cent and negative predictive value, which means that it will prevent women from having to undergo unnecessary invasive tests. NIPT is superior to traditional screening methods like NT scans or maternal serum screening, since they have relatively lower detection rates, for instance a detection

rate of 79 – 90 per cent for Trisomy 21. These low detection rates mean that a proportion of affected pregnancies go undetected until birth. Positive screen results typically have to be followed up with invasive screening methods like amniocentesis or chorionic villus sampling (CVS), that have a one in 300 rate of procedure induced pregnancy loss. Non Invasive Prenatal Screening (NIPS) is also better than other any other non invasive screening tests available in the market today, as it is the only NIPS test that detects Triploidy. Triploidy is caused by an extra copy of all chromosomes. Abnormalities are often present in both the placenta and the foetus. It is found in about one in 1000 first trimester pregnancies; most babies with triploidy are miscarried or stillborn. Of those

rare babies born alive, most die before one year of age. Mothers carrying triploidy foetuses may also experience pregnancy complications such as pre-eclampsia, severe nausea, excessive bleeding, and placental disease. Microdeletions are a group of conditions caused by a loss of small portion of certain chromosomes. These are largely undetected during pregnancy. They cause physical and/or intellectual impairments, which can be more severe than whole chromosome abnormalities. Early detection of Down Syndrome by prenatal genetic testing can help in timely identification of the disorder. This helps parents choose appropriate disease management options, and in cases where there is no cure, can help them choose the best care giving options that they can provide. Early intervention with educational and other services improves the functioning of young children with Down syndrome.

REFERENCES : 1. PS, Arya, Viji A. Thottumkal, and M. G. Deepak. "CONGENITAL ANOMALIES: A MAJOR PUBLIC HEALTH ISSUE IN INDIA." International Journal of Pharmaceutical, Chemical & Biological Sciences 3.3 (2013). 2. Sheth, Frenny, et al. "Prenatal screening of cytogenetic anomalies–a Western Indian experience." BMC pregnancy and childbirth 15.1 (2015): 1. 3. Krishnekumaar and Dr. K.S. Meenakshisundaram. “A Study of Down syndrome - The Medicare & Positive Parenting for A Healthy India.” AEIJMR – Vol 3 – Issue 9 – September 2015 ISSN - 2348 - 6724

KNOWLEDGE I N T E R V I E W

â&#x20AC;&#x2DC;Cardiac CT market will rise more than double in five yearsâ&#x20AC;&#x2122; Dr Mona Bhatia, Head of Department, Radiodiagnosis and Imaging, Fortis Escorts Heart Institute, New Delhi talks about cardiac CT imaging scenario in India. She expounds on the needs for more radiologists specialising in this field and the urgent need for data integration, in a conversation with Raelene Kambli What kind of transformation you have seen in the field of cardiac CT and what does the future behold? Cardiac CT has taken of in a big way in India only in the last five to seven years. Before that, the entire cardiac testing remained in the hands of cardiologists doing the invasive coronary angiogram because effectively they were looking at the stenosis and fix it. This was really an era of nuclear medicine and cardiology, both worked in sync where more emphasis was given to angiography and ischemia testing. The game changing happened when we found that CT technology grew in terms of its resolution and capabilities. Now non-invasively we could review the coronary arteries and inform patients about their proper condition, which would also help them in the management of the disease with the guidance of their cardiologists. It is actually the technological advancements in the last five to six years that have given radiologists the capabilities to read the CT to high accuracy. Mind you that even though we have technological advancements in the country, we still do not enhance machine to fulfil the growing demand. In fact, we also have a serious resource crunch in terms of trained Cardiac CT radiologists.

Doctor you have pointed out about serious resource and equipment crunch. What is the demand for cardiac CT imaging like? Is the demand growing? We are a country with a population of around 1.3 billion and there is a growing incidence of cardiovascular diseases. The sad part is that people are being detected with CVDs at a very young age. So, a country with a younger population, screening them is vital. We need to prevent coronary heart diseases in India. For this, our aim should be to access the risk in maximum number of people so that prevention can begin at an early stage. In India, how many cardiac CTs do we have as compared with the demand? We have less than 1,000 cardiac capable CTs and the demand is huge. Taking into account that 50 per cent of our population is young, I feel the demand will only increase. How many radiologists in India practice cardiac CT imaging? I think less than 300-400 radiologists in India specialise in Cardiac CT. It is less in number compared to the demand. Where does India stand as compared to other emerging cardiac imaging market?

ers to consolidate the available data. It has to be a multihospital, multiple centre, which collate ethnic data and then start analysing it to get more clarity on India-specific information. Most of the information available is based on the US data, which most of the time stands inappropriate for Indian people. How can we integrate data? I think if the IT sector works with the healthcare sector, integrating data will become easy and also protected. Will integrating also create a risk of cyber-crimes? No. I donâ&#x20AC;&#x2122;t think that this will give rise to cyber-crimes, as this data will be cyber secured.

The world looks upon India in a big way.We have the volumes and data. But the problem in our country is that the data is not captured in a systematic way The world looks upon India in a big way. We have the volume and data. But the problem in our country is that the data is not captured in a sys-

tematic way. So this is a big barrier for us to understand our actual problem. India currently requires a concerted effort by all stakehold-

Where do you see the cardiac imaging sector in the next five years in India? The cardiac CT sector is on an exponential rise in India. Patients have started to become more aware of the choices they have. Also, patients are looking for more non-invasive methods to diagnosis. I feel this will change more within the sector. The market will rise more than double in the next five years. The other thing is that the number of cardiac cases will rise which will in turn open more business opportunities for the cardiac CT market players. raelene.kambli@expressindia.com

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KNOWLEDGE I N T E R V I E W

‘The robotic system offers certain distinct advantages over conventional laparoscopic surgery’ In times when the world argues on how much robotics can replace human touch, Dr Gagan Gautam, Head - Urologic Oncology and Robotic Surgery, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, is successfully conducting robotic-backed surgeries. He believes that this field has immense scope and in times to come will play an important role in changing healthcare delivery. Raelene Kambli interacts with Dr Gautam and Dr Harit Chaturvedi, Chairman - Max Institute of Oncology, Max Super Specialty Hospital, Saket, to understand how this robotic system has benefitted the hospital and its profitability

Tell us about the characteristics and functionality of the da Vinci Surgical System? Dr Gautam: At Saket, we are equipped with the da Vinci Xi robot, which is the latest generation robotic surgical system developed by US-based Intuitive Surgical. It consists of a patient-side robotic ‘cart’ a machine with four ‘arms,’ which hold the telescopic camera and surgical instruments. These are inserted into the patient’s body through very small cuts (miniature incisions). These instruments are controlled by ‘masters’ (which can be equated to mini joysticks) located at the surgeon console. A console is like a flight simulator situated in the same operating room as the patient is undergoing surgery. The surgeon controls the movement of the robotic arms by making precise movements with his/her hands while holding the master controls. It is important to note that a robotic surgical system is not a ‘robot’ in the real sense of the word. It is not capable of any independent actions or movements. It just translates the movements of the surgeon’s hands into those of the surgical instruments. The robotic system offers

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With multiple cancer specialists picking up robotic surgery, this field is bound to expand rapidly

The healthcare sector as a whole is short on manpower by about 25 per cent.There is no question of limiting opportunities

-Dr Gagan Gautam

-Dr Harit Chaturvedi

certain distinct advantages over conventional laparoscopic (keyhole) surgery. The tips of robotic instruments can be moved in all possible directions due to the presence of a wrist joint near the tip (an ‘endowrist’).

This along with the scaling of movements (the instrument moves one inch for every three inch movement by the surgeon) affords a very high degree of accuracy, which is unprecedented in the history of surgical science. The

telescopic 3D camera which magnifies the view of the surgical field up to 10 times also plays a major role in providing millimetric precision to robotic surgery, something which greatly helps the surgeon to remove

cancerous parts/ organs while avoiding damage and complications to other normal parts of the body. How is this system enhancing cancer surgeries at your hospitals?

KNOWLEDGE Dr Gautam: Since September 2015, when this system was installed at our Saket facility, we have operated almost 200 cancer patients with this technology. It has been used most commonly for cancers involving prostate, kidney, urinary bladder, large intestine, rectum and uterus. However, the applications of this system are many. It can even be used to operate tumours in the chest and throat. With multiple cancer specialists picking up robotic surgery, this field is bound to expand rapidly and many more patients will hopefully be benefited by this latest surgical advancement. What is the cost effectiveness of this system in the long run? Dr Chaturvedi: Though it has cost us a fortune to install the daVinci Xi system at our facility, I strongly believe, that there should be no reason to compromise on the health services we have to offer to our patients. If there is any recent technology established to be of proven benefit to the patients, then we must have it. After all, if we have the best men and we focus so much on processes, quality control, we must have the best technology. This trio in an academic environment contribute to delivery of latest therapeutic options to our patients.

A robotic surgery is not an automated surgery being performed by a robot independently. Instead it is a surgery where the robot gives more control to the surgeon. It gives a magnified, 3D view to the surgeon and improves precision What is the cost difference of robotics-led surgeries in comparison to the surgeries conducted by the team of doctors at your hospital? Dr Chaturvedi: The improvements in patient parameters, such as reduced need for blood replacement, lesser need for post-operative pain killers, shorter duration of hospital stay, and earlier return to work significantly bring down any cost differences for robot-led surgeries in comparison to the conventional open surgeries along with the benefits of faster recovery. The related complications both in short term like wound infections, paralytic ileus, sub-acute obstructions and long term, for example, incisional hernias have actually proven that this technology brings down the cost. There are studies where, in the group of patients who had ro-

botic surgery the cost was lesser compared to laparoscopy or open surgery When do you think, you will break even on the investments you have made in installing this system? Dr Chaturvedi: I don’t think it is fair to compare a longterm goal to a short-term one. The quality of healthcare we intend to offer would change the outlook of cancer treatments available in India. We want to provide ‘cutting-edge’ technology in cancer care and eventually bring it to within the reach of everyone. We have made break even, the day we acquired this. If we do not adopt the relevant modern tools, we actually get left behind in this fast moving world. Getting the modern tools also help in getting top professionals and in creating the right environment for good profes-

sionals to thrive. Having said this as we have said, this technology is cost effective for all the stake holders. Exactly how do you see this technology shifting the landscape of jobs within the healthcare space? Dr Chaturvedi: It won’t. A robotic surgery is not an automated surgery being performed by a robot independently. Instead it is a surgery where the robot gives more control to the surgeon. It gives a magnified, 3D view to the surgeon and improves precision. Like most of the modern technology, robot has not laid off people. The skill set requires further training in certain areas. We have to focus on improving the care and clinical outcomes for our patients and society at large. The healthcare sector as a whole is short on manpower by about

25 per cent. There is no question of limiting opportunities, in fact this will lead to better opportunities for better trained workers. Some experts are of the opinion that increased adoption of robotics in healthcare practice can cause decoupling of productivity and employment. What is your opinion on the same? What precautions should be taken to prevent this? Dr Chaturvedi: When laparoscopic surgery came to India about three decades ago, it was not immediately adopted by everyone. But now, we understand its benefits, and the technology has percolated up to the grass root levels across the country. Basic laparoscopic surgeries are being conducted even in the remotest peripheries, without causing any such decoupling. The benefits of technology will eventually seep through. As in laparoscopic surgery, the need for staff in the operation theatre has not gone down. The productivity goes up along with the employment. The staff is less fatigued and more productive. It’s an interesting era where the nature of jobs is continuously evolving, all this for the larger good. raelene.kambli@expressindia.com

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TRADE & TRENDS

Foundation stone of India’s first exclusive medical device manufacturing park laid The 270-acre Andhra Pradesh MedTech Zone will have state-of-the-art and the best global facilities for R&D, manufacturing, testing, export and regulatory facilitations and logistics

Chandrababu Naidu, Chief Minister, Andhra Pradesh with other delegates

THE FOUNDATION stone of India’s first exclusive medical device manufacturing park, Andhra Pradesh MedTech Zone (AMTZ), was laid at Nadupur village of Pedda Gantyada Mandal in Vishakhapatnam by Chandrababu Naidu, Chief Minister, Andhra Pradesh. Also present were Union Ministers Venkaiah Naidu, Ananth Kumar, Kameini Srinivas, Health

Minister, Andhra Pradesh, Henk Bekedam, WHO Representative to India and representatives from Indian medical device industry. Rajiv Nath, Forum Coordinator, AiMeD was also present during the event. AMTZ, the 270-acre exclusive manufacturing zone is the result of MoU signed between the state government and AiMeD nine months back

with a view to promote manufacturing of high-tech and high-end medical devices within the country. The zone will have state-of-the-art and the best global facilities for R&D, manufacturing, testing, export and regulatory facilitations and logistics. It will house 200 medical devices manufacturing units. “The AMTZ project will be a game changer for India in

the field of healthcare. This has global consequences, from being Pharmacy of the World to being the Medical Devices Manufacturing Hub of the World,” said Bekedam. “The launch of AMTZ is the dawn of a new era in the history of medical devices and electronic industry in India. “Medical device manufacturing could be the next big thing for Indian economy after the

IT revolution. This facility is not only a big milestone for the country which will catapult India into the league of top medical equipment producing countries in the world but equally important it will help bring down overall healthcare cost while ensuring tremendous saving in terms of foreign exchange,” said Rajiv Nath, Forum Coordinator, AiMeD.

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September 2016

TRADE & TRENDS

India joins WHO’s Global Injection Safety Campaign As India and world gears up to eliminate the killer hepatitis by 2030, Safe Point India lauds the acknowledgement of the role that safe injections can play in eliminating a big public health scourge SAFE POINT India, a frontline not-for profit society working in the field of public health and safety, has lauded and fully endorsed the World Health Organisation's (WHO) and Government of India’s (GoI) noble initiative to eliminate viral Hepatitis by 2030 by launching Global Safe Injection Campaign. It is especially happy to note the acknowledgement of the role that safe injections can play in eliminating a health scourge that claims over 3,50,000 lives each year globally and is the number two communicable disease killer of human lives after tuberculosis. On World Hepatitis Day, India became one of the first countries to join WHO’s Safe Injection Campaign. As per WHO, 33 per cent of Hepatitis B and 42 per cent of Hepatitis C cases are attributed to unsafe injections. It may also be noted that in the South-East Asia Region, viral hepatitis is driving rates of liver cancer and cirrhosis, and is causing premature death and disease with over 100 million people chronically infected with hepatitis B and hepatitis C. GoI on the World Hepatitis Day committed to renew the effort to eliminate unsafe injections and has announced threeyear transition time for manufacturers to phase out standard disposable syringes and switch to auto disable syringes and safety syringes as part of hepatitis elimination intervention strategy. “Injections should be life giver, not life taker and prevention is always better than cure. Sadly, as pointed out by WHO, nearly 33 per cent of Hepatitis

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September 2016

Dr Gottfried Hirnschall , Director WHO HQ, Geneva; Dr Henke Benkedam WHO Representative - India, Anupriya Patel, Minister of State for Health, Amitabh Bachan, Brand Ambassador WHO Hepatitis campaign, Poonam Khetrapal Singh, WHO Regional Director, SEARO

B and 42 per cent of Hepatitis C are attributed to unsafe injections. Unsafe injections mostly in the form of reuse of safety injections continues to be a serious threat to life of patients and health workers, casting shadows over public healthcare and immunisation programmes while raising individual and national healthcare cost burden,” said Rajiv Nath, Project Director & Trustee, Safe Point India, a frontline not-for-profit society working in the field of public health and safety. “I am happy to note that safe injections along with vaccination and better access to healthcare has now been officially endorsed as key to eliminate a major public health scourge. Swach Bharat Campaign for addressing Hepatitis A & E and a

Swach Injection Abhiyan has long been needed for addressing Hepatitis B&C for ensuring Clean Healthcare and Clean Needles. This will not only ensure better health to common Indians but would also bring in great savings in terms of public health spending in the long run,” added Nath. Nath added, “For WHO to hold its global conference in India and the presence of Amitabh Bachan as the Brand Ambassador to lead the campaign to decimate Hepatitis by 2030 is indicative of the importance of the issue. Globally 400 million people (approx 40 million in India) are estimated to be infected by Hepatitis and WHO estimates that 95 per cent of the patients are unaware that they are infected as

Hepatitis C is a slow killer.” “We fully laud WHO and Government of India’s initiative and determination to eliminate viral hepatitis by 2030. Hepatitis remains a major public health scourge in India. It is not only a killer disease but also severely impairs quality of life besides causing heavy financial burden on infected who mostly happens to be from the poor strata of society. This is a great initiative which has our full support and endorsement,” said Pradeep Sareen, Marketing Head of HMD, Hindustan Syringes & Medical Devices. “Yes it means a lot of efforts and investments to upgrade our technology and shift of capacities from STD disposable to auto disable syringes for the

curative injections but we appreciate the need for this change in the interest of patient safety. And we have the experience as we are the leading supplier globally of auto disable syringes both for immunisation and therapeutic injections,” he explained. Nath informed that a number of pilot projects on injection safety would be undertaken by GoI and WHO starting from Punjab which has the highest incidence of Hepatitis C even though it is an affluent state possibly due to dangerous cocktail of drug abuse and unsafe injection practices. The other states reported with high incidence of Hepatitis C are Haryana, North Eastern states and coastal areas of Andhra Pradesh and Tamil Nadu.

Ventura Business Solutions and Smart Medical Systems launch GI Endoscopy technology in India Innovative G-EYE endoscope technology allows doctors to enhance the prevailing detection rate of 60 per cent to 98 per cent VENTURA BUSINESS Solutions introduced India’s first smart endoscopy technology, G-EYE endoscope and NaviAid in a strategic partnership with Israel-based, Smart Medical Systems, a developer and manufacturer of world-leading gastrointestinal (GI) endoscopy devices. In India and other parts of the world, endoscopy procedures give only 60 per cent detection rate but with use of SMART's G-EYE Endoscope technology, this detection rate gets enhanced to 98 per cent thus almost eliminating missing of detection of any growth that may need surgery or loss of life later on. This revolutionary solutions can improve the diagnosis and therapy of GI (gastro-intestinal) disorders and diseases, most notably, colorectal cancers.

Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide and there are a growing

number of colorectal cancer patients in India. With this new G-EYE endoscope technology doctors can ensure early diagnosis and effective treatment of

colorectal cancer and other gastrointestinal diseases which are common in the country. The products have received rave reactions from wellknown hospital chains in India including Asian Institute of Gastroenterology, Fortis, Apollo, Max, Gangaram, Aster CMI, Sunshine, Manipal, Columbia Asia Hospitals, and PGI Chandigarh. The two companies held an event to launch Smart’s product line in New Delhi as a part of their strategic partnership, under which Ventura will deploy Smart’s products in the Indian and South Asian market. The launch event was graced by nutrition and gastroenterology expert, Dr Zamir Halpern from Tel Aviv Sourasky Medical Center, Israel. SMART's flagship product,

the G-EYE endoscope, uses innovative balloon technology to uncover pre-cancerous polyps that are hidden behind the colon's natural folds. Pricewise, Smart's solution costs almost one fifth of the nearest competitor, which means it is highly affordable for the hospitals and patients alike. The company has additional balloon products under development and commercialisation, designed to allow standard endoscopes to access and visualise portions of the GI tract currently only accessible with the use of highly specialised equipment. The G-EYE endoscopy technology also provides the ability to perform double balloon enteroscopy on-demand which means no prior preparations of the equipment or the patient is required.

8th edition of e-Radiograph explores complexities of imaging of musculoskeletal infections Discussions were held on key features of various radiological modalities used in imaging of musculoskeletal infections CARESTREAM HEALTH India’s eRadiograph has come a long way starting from the first edition to the 8th edition. After covering various intricate subjects in its previous editions, the recently released 8th edition of this medical primer focuses on yet another important topic, musculoskeletal infections and the challenges involved in the imaging of these. Discussions were held on recent changes in

imaging trends like metal artefact reduction sequences in MRI and role of diffusion tensor imaging in peripheral imaging. Titled 'Imaging of Musculoskeletal Infections', the content was developed by Dr Deepak Patkar, Head Department of Imaging, Nanavati Superspecility Hospital; Chairman, Indian College of Radiology and Imaging; Mus-

culoskeletal Imaging Sub-speciality Head, IRIA. In the edition, various radiological modalities which are appropriate for different musculoskeletal infections were discussed in details. Owing to the complexity of the subject, the entire edition was divided into six distinct chapters, for easy understanding. Each of the chapters provided latest information on challenges involved

in imaging of different musculoskeletal infections and the suitable radiological modality for the same, with the help of relevant examples and images. Collectively, the chapters covered key imaging features of all the radiological modalities from plain radiograph to MRI and nuclear imaging, highlighting the role of each of these modalities in case of various aspects of musculoskeletal infec-

tions. Nilesh Sanap, Marketing Manager, Carestream Health India says, “We are committed to provide latest information, by an expert, on a new and challenging topic in each edition of the eRadiograph. The objective behind this is to help radiology professionals in their daily work by equipping them with the knowledge of industry's latest best practises."

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September 2016

TRADE & TRENDS

Carestream surpasses one billion square metres of DRYVIEW Film Carestream DRYVIEW film for medical imaging use is sold in more than 140 countries CARESTREAM HEALTH’S focus on the radiology profession has earned it the number one market position for its DRYVIEW Laser Imaging Film, resulting in the production of more than one billion square metres of this and other specialty films at its White City, Oregon facility. Carestream DRYVIEW film for medical imaging use is sold in more than 140 countries. It contains more than 25 different

components, including nano particles, with four layers coated simultaneously on the top of a PET film base and two layers on the back. The six-layer DRYVIEW film is coated in one pass at a rate of hundreds of feet per minute with in-line quality inspection to meet FDAregulated Class 1 medical device requirements. The company’s manufacturing capabilities include its contract manufacturing operations

that apply specialised manufacturing processes using hightechnology coating assets to help contract-coating customers and partners develop better products at a competitive cost using coated or cast film-based advanced materials. “In today’s rapidly changing environment where the mandate to provide better outcomes has never been greater, we have proven coating technology options to help organisations suc-

ceed,” said Michael Fanset, GM, Carestream Contract Manufacturing. “We work with business partners and customers to take products from concept to market quickly and efficiently across a diverse range of industries, from display and electronics materials, to membranes and cast films, medical films, device components and beyond.” Carestream Contract Manufacturing offers optimal product design, technology integra-

tion, manufacturing support, distribution, and finishing (slitting and packaging) capabilities with facilities in Asia and North America. The company can create structures of up to 20 precision-coated layers in a single pass, with options for two-sided coating, radiation cure, on-line inspection and lamination. Carestream adheres to top global standards for quality and certification including ISO 9001, ISO 13485 and ISO 14001.

Siemens launches mid-volume coagulation analyser Enhances efficiency via a wide optical spectrum, which allows clotting, chromogenic, immunologic and aggregation1 testing capabilities on a single platform SIEMENS HEALTHINEERS Laboratory Diagnostics business launched the Sysmex CS-2500 System — a mid-volume, fully-automated coagulation analyser with smartly-designed PSI technology — in major markets including the US. Together with Lab Alliance of Central New York, the first US customer to install the high-volume Sysmex CS5100 System, the company celebrated the availability of its new Sysmex CS Hemostasis System portfolio in the US. The launch of the new Sysmex CS-2500 System will enable mid-volume laboratories to leverage globally-proven PSI technology, while providing regional reference laboratories and integrated delivery networks (IDNs) with the ability to standardise testing results across multiple Sysmex CS and CA hemostasis systems. “Labs today are challenged

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September 2016

to increase their output without sacrificing the accuracy or reliability of their results. The Sysmex CS Systems are the answer to this demand,” said Franz Walt, President, Laboratory Diagnostics, Siemens Healthineers. “The increased operational efficiency and uninterrupted workflow delivered by the Sysmex CS-5100 and CS-2500 Systems provide our customers with the confidence, consistency and increased capacity they need to deliver timely and accurate haemostasis test results.” In most markets, the Sysmex CS-2500 System features simultaneous multi-wavelength scanning and proven PSI technologies including primary-tube sample-volume checks, clog detection, assay-based pre-analytical sample-quality checks for haemolysis, icterus and lipemia (HIL) interference; automated mixing studies; automated

The launch of the new Sysmex CS-2500 System will enable mid-volume laboratories to leverage globally-proven PSI technology, while providing regional reference laboratories and integrated delivery networks (IDNs) with the ability to standardise testing results across multiple Sysmex CS and CA hemostasis systems platelet aggregation; and clot waveform analysis (CWA) —enabling labs to raise the quality of test results, achieve cost-effective method consolidation, simplify operations, and increase diagnostic confidence.

The new system enhances efficiency via a wide optical spectrum, which allows clotting, chromogenic, immunologic and aggregation1 testing capabilities on a single platform. With an onboard capacity of up to 3,000

tests and up to 40 reagents, the Sysmex CS-2500 System delivers extended walk away time to streamline workflow. Anne Chamberlain, Haematology Manager, Laboratory Alliance of Central New York, remarked, “The Sysmex CS Systems and the services offered by Siemens Healthineers are the perfect fit for our laboratory and laboratory networks similar to ours. The intuitive system software, readily accessible patient analysis data and result traceability simplifies our operations. This enables our lab to deliver quality test results, which positively impacts patient care for our clients.” To help labs ensure consistency and improve productivity, the systems use the same reagents, controls and calibrators as other coagulation analysers offered by Siemens Healthineers.

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LIFE

WHAT DOES IT MEAN TO BE A LEADER?

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LIFE DR AVELUMANI Promoter, Chairman, MD and CEO Thyrocare

LEADERS ARE THOSE WHO SEE WHATOTHERS FAILTO SEE Maximise leadership skills Focus, learn, grow and enjoy - these four words in the same order maximises the impact for an individual or organisation. Discipline makes tough things to look easy.

◗ ◗ ◗ ◗

Leaving Coimbatore at 1982 Marrying Sumathi at 1986 Resigning Govt Job at 1995 Deciding rate for Thyroid. 1996

Common mistakes to avoid Important decisions Four decisions. They were not discussed with any.

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September 2016

Distractions are main reasons for failures. Also leaders often do what is easy to do rather than doing what is right to

do. Lack of frugality leads often one into personal and corporate failures.

Favourite resources Reading, listening, talking, interacting if ideally blended, a lot can be inspiration from life and business. Leaders are those who see what others fail to see. No specific book or blog or mentor I follow.

DR N KRISHNA REDDY Vice Chairman, CARE Group of Hospitals

LEADER’S ACTIONS SHOULD REFLECTVALUES HE ESPOUSES Leadership is dharma... For me, leadership is a role/duty/karma, to be discharged according to the dharma. I believe that one needs to lead oneself, before one thinks of leading others. A leader needs to understand and articulate the core purpose of the organisation that he/she leads; his/her actions shall reflect the values that he/ she espouses; he/she shall be able to vision the future and make others dream the same; and he/she shall identify missionaries to make the vision a reality, even beyond himself or herself.

nicate the core philosophy in a consistent and continuous way; to trust in the abilities of associates and delegate; to create space for independent thinking; to guide than command; to work on strengths than harping on weaknesses and to have belief.

I believe in constant change... Life is a journey and change is constant. Every decision – important or unimportant – changes the course of life. I must confess I have no life transforming decision or event.

Common mistakes to avoid The key to success The key to maximise leadership skills are to commu-

The common mistakes one should avoid are - to equate healthcare with any other business; to forget the core

purpose of Medicine, i.e., “to do no harm; to relieve suffering; and to prolong life”; to get in to the trap of market valuations; and to forget the highest ethics and morals needed.

Ancient wisdom has been my guiding spirit... The Upanishads, that speak of universality of beings; the Gita, that speaks of the means to attain universality; the four noble truths of Buddha, that lays down the middle path to being happy and compassionate; and the Tao Te Ching of Lao Tzu, that speaks of living in alignment with natural patterns – are the core resources that light up my way.

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September 2016

LIFE DR TARANG GIANCHANDANI CEO, Jaslok Hospital

LEADERSHIP IS A PRIVILEGE AND NOTA RIGHT Leadership is a privilege Believe in yourself, your team, believe in change to be the change. Leadership is a privilege and canâ&#x20AC;&#x2122;t be considered an obligation or right. A leader of a hospital has to be a risk manager, strategic change leader and above all a patient-centric operational person with team-based approach.

Build strong teams Create leaders at all levels and build strong teams. The key change has to be always top down but one needs to take the people together. Empowerment,

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September 2016

motivation and leading by examples always goes a long way towards the achievement of goals for various leaders.

Change is imperative The fact that I ensured that all stakeholders accept the change and new ways of working by bringing them on the same page and making them realise how the change is imperative.

Avoiding mistakes A leader should always have his head on his shoul-

der. No leader can be successful without the support of the various stakeholders or his team. Success should not bring a feeling of superiority. Leader is because of and by the people and hence should never consider him or her above your stakeholders.

Blogs and publications According to me blogs and publications are good resources for leaders to understand and find new ideas. Books give an overall perspective about the strategy and change management.

DR HARISH PILLAI CEO, Aster Medcity Kochi & Cluster Head – Kerala

ALEADER MUSTBE WELL READ IN SEVERAL DIMENSIONS Empowering to excel I always aim to read up the social and cultural history of the place where the project is located. It is essential to understand mindscape and behaviour prior to focussing on the strategic positioning of the entity. Command and control vs delegation and democratic; peer role vs mentorship; experience vs youth are all aspects that need to be covered. Essentially at heart, I am a democrat and will facilitate a creative environment to empower all staff to excel. I have also had avatars as a benevolent dictator since the situation demanded this specific style.

Keys to maximise leadership skills First key is the effective relevance of the organisational chart. The second key is a detailed credentialing and competency matrix of each individual (right person for the right job); third key- the role banding exercise and accuracy of authority band and responsibilities; fourth is the role of senior executives in mentorship and reducing power distance and fifth is the enabling environment for self development and expression.

and divine grace has surely played a role in shaping my destiny. The first decision was to become the only student from my MBBS batch to go for higher studies in Hospital Management in 1996 especially when the field was not well recognised (my parents thought that I had lost my mind!!); second was to accept a dual job offer as a faculty at the Apollo Institute of Hospital Administration and Executive Assistant to MD; third to realise that I am unfit to teach PG students due to lack of relevant practical experience and to move on to fullfledged operational assignments; fourth to go for my first international assignment in 2001 far away from all comfort and support systems, fifth to pursue a further international post graduate MBA course while transiting between two jobs, sixth to become the first Indian hospital CEO to head Egypt’s biggest private tertiary care hospital; seventh – to get the facility JCI accredited in 2010 and manage the affairs of the hospital in the midst of the Arab spring and revolution in 2011; eighth to finally move on and come back to India to successfully commission and operate a large quaternary care hospital in one of the toughest and cost-sensitive tier II cities in India.

Turning points I have always taken calculated risks. Lots of good luck

Pitfalls to avoid

◗ To think that you know it all ◗ To imagine that success with one approach in one project can be easily replicated in another ◗ To create comfort zones and recruit familiar people and previous work colleagues in the new place ◗ To take easy short cuts to please key stakeholders including the owner /board ◗ To have a bloated head and takes one self too seriously

Books that inspire I am an avid reader – some of my current favourite books are: ◗ Being Indian- Pawan Varma ◗Towards Freedom- Jawaharlal Nehru ◗ Wings of Fire- APJ Abdul Kalam ◗ Steve Jobs- Walter Isaacson ◗ Biography of Elon Musk ◗ Imagining India- Nandan Nilekani ◗ India Grows at Night- Gurcharan Das ◗ Makers of Modern India- Gurcharan Das Essentially to become a good healthcare leader we must be well read in several dimensions and try to become a thought leader

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LIFE DR BS AJAI KUMAR Chairman & CEO, HealthCare Global Enterprises

I BELIEVE IN ADEMOCRATIC FORM OF LEADERSHIP A democratic leader

The decision that changed it all

I believe strongly in a democratic form of leadership. It’s a consensus form of leadership, where you involve everyone, but the final decision has to be taken by one person. I believe everyone is equal, and that is why if you come to my office, you will see I have an oval table. There is no head chair because I believe everyone should have an equal voice. I encourage my management to give me their views (pros and cons) in an objective manner. However, as a leader, the final decision will be taken once I have heard everyone’s voice, equally.

I had lived in the US, built my practice, and stayed there for 28 years, and it was a decision I took in my 28th year that changed it all. It was my decision to focus on the Indian scenario in oncology, the great unmet demand and need for comprehensive cancer care treatment. I took a decision in spite of opposition from my own parents, and brought my wife and family back to India. This decision was pivotal in my growth story as an entrepreneur and the journey of HCG, which is the largest cancer care network in India today. It has been fascinating to work with some amazing doctors and be a part of this incredible transformative journey in the landscape of cancer care treatment in India. Today, the world looks at us as a place where they can receive the best treatment, and this is phenomenal.

Creating a growth culture I also believe that once you take that final decision, you should not look back. Sometimes, in hindsight, it may not be a good decision, but you should not regret it. It’s more important you focus on what you have learned from it. This is the culture in which I like to run an organisation and this is how a team should learn. It is really about how you, as a leader, can make your management team comfortable to say what they really believe. They shouldn’t be yes people. Also, all discussions should be issue based, and should never be personalised. Another thing leaders should do is to encourage employees to surround themselves with people who are better than them. I truly believe this brings out the best not only in every employee and leader, but also the organisation.

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September 2016

Learning lessons It is absolutely necessary that leaders should recognise contributions made by employees across all levels, and ensure they are given growth opportunities. A leader should not take all the fame for his success. A true leader is one who properly delegates, empowers, and understands the capabilities of each employee at all levels of management. The leader should nurture employees, and should communicate the expectations on how employees will be measured. It’s like that saying, you know, an iron fist in a velvet glove. Another mistake a leader can make is when they think

of the company as an employment agency. While you have to develop a system that attracts talent and nurtures them, you should also ensure people who are not contributing will be removed. However, if an employee has made a mistake, you should immediately counsel them and reassign them.

Books that matter I’m a voracious reader, and have enjoyed reading books like Siddhartha by Hermann Hesse, Meditations by Marcus Aurelius, Republic by Plato. Siddhartha is an amazing book that talks about how do you get yourself free and become a free thinker. Another book I’ve enjoyed reading is The Story of Philosophy by Will Durant. I actually took time off in the 80s in Kathmandu and stayed there to finish reading this book. It is an in depth read into the subject, and I thoroughly enjoyed it. I also constantly read on Hindu mythology, and have read the Ramayana and Mahabharata several times. In these books, when you read the small stories and behaviour of the characters, it really depicts your own life. Another epic book is War and Peace by Leo Tolstoy. Right now, I’m almost done with Capital in the TwentyFirst Century by Thomas Piketty. The key thing with books is you should read few books, but you should read them in depth and as you age. The same book in your 20s, 30s, 40s, 50s, 60s, will give you different information, different food for thought, different reflections. Apart from books, I really enjoy reading The Economist. It gives you lot of food for thought.

JOY CHAKRABORTY COO, PD Hinduja National Hospital and Medical Research Centre

A LEADER SHOULD WALK THE TALK Leading by example My leadership philosophy is very simple. I strongly believe that a true leader carries the responsibility of being a positive example in the workplace and is someone who brings his team together to work collaboratively to meet organisation goals. The best leaders lead by example and I truly believe in that. One should be able to walk the talk and thus become a person others want to become. A leader creates more leaders who are motivated and empowered to accomplish any responsibility or task assigned to them. Being accessible, approachable and available to the team is of utmost importance and at the core of my leadership philosophy.

and help them grow to learn from mistakes. One should also inspire people to take more challenges.

Deciding moments Post my graduation, I had various fields to choose from but my passion for medicine got converted into practice in healthcare delivery. Looking back, it has been a wonderful 18 years of journey since that decision which has brought me success in my professional life and a personal satisfaction that I could part of the changing healthcare delivery system in India. My stability in the organisation has also led to a 360 degree growth enhancement.

Mark of a true leader Inspiring progress The most important key to maximising the leadership skills within an organisation is providing honest feedback that helps the team realise their strengths and weaknesses, provide support and guidance to everyone to overcome weaknesses and excel in their work area. The other major characteristic that constantly gets overlooked is transparency. Allowing more transparency in your style of leadership opens yourself to more meaningful relationships — both with the team as a whole and with the individuals of that team. One should also create an environment where people do not shy away from taking responsibilities for failures

A true leader should always be open to receive and provide honest feedback. Also, he/she should be able to define the strategic goals that are in alignment with the organisational goals and be able to draw realistic timelines to achieve these goals. A leader should never indulge in blame games. He should remain contemporary and be a forward thinker.

Source of inspiration I take a lot of inferences and learnings from our epic mythology books. Apart from this, there is a lot of learning from real life case studies in our everyday life. To keep myself updated on the healthcare industry

worldwide, I also read a lot of books from the American College of Healthcare Executives (ACHE) and for people management, books from the stable of Society of Human Resource Management (SHRM). Management books too help extend knowledge and keep you updated on latest management philosophies and techniques developed for efficient and effective management and thereby, these books serve as an important resource pool for leaders. Some of the books that have helped me grow are: Jack Welsh’s Straight from the Gut; Radhakrishnan Pillai’s Corporate Chanakya; Peter Watson’s Ideas – A History of Fire to Feud; CK Prahlad’s Fortune at the Bottom of the Pyramid; James Daniel’s Lean Thinking; Harvard Business Review – Leadership in a Changed World and Robin Sharma’s Leadership Wisdom. Apart from media, publications provide detailed insights into the political, economic and social development in the country and the world. So, it is also a very important resource. I read at least one financial daily, one mainline daily and a couple of healthcare trade and business publications including Express Healthcare regularly. Today, technology advancements like various social media platforms serve as important resources to keep abreast of the current developments of the world. I follow LinkedIn, Twitter and Facebook in that order to keep myself updated of the current developments in the industry.

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September 2016

LIFE OP (OM) MANCHANDA CEO, Dr Lal PathLabs

AGOOD LEADER SHOULD KEEP HIS TEAM MOTIVATED On leadership... As a CEO, one has to do two things; one is to lead the business and second is to lead people. One will get a lot of external help and advisory services to lead their business well but to lead people, you have to depend on yourself completely. A successful leader is not just someone who is managing his profits well, but someone who can move in a team, ensuring that each individual grows with the business, benefiting from the business success. Managing people is a difficult balance. While handling people, one needs to be fair in dealings. Just as managing a business requires a lot of at-

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September 2016

tention to detail, in the same way while we are dealing with people we need to be careful about a lot of small things. We should not let our professional stress pass on to our employees. A good leader is indeed one who can keep his team motivated at all times – good or bad.

My mantra... For me, having a motivated team is the most important aspect of running the business because I believe no single person makes a business successful. It’s a team effort where every individual matters.

Maya Angelon’s word to inspire... ‘People will forget what you said, people will forget what you did but people will never forget how you made them feel’. So it’s extremely important to ensure that we treat people well, not just in our personal dealings but in a professional capacity as well. As an individual and as the company CEO where I am responsible for a big team working directly or indirectly with me, I have always believed in ensuring the happiness of my people. This is something which was taught to us at IIM Ahmedabad and I have made it a part of my leadership style since then.

DR RUPALI BASU President & CEO Eastern Region, Apollo Hospitals Group

ALEADER SHOULD ENABLE HIS/HER TEAM TO EXCEL Leadership: A multi-faceted role Warren Bennis had once said “Leadership is the capacity to translate vision into reality”. In order to be a truly effective leader, you have to first understand the organisation and its level of maturity – whether it is in the infant, mature or transformational stage. Also, it is about fitting your role and leadership strategy to the need of the organisation. Whenever I have taken up the role as a new leader, I have had the structure and organogram established, policies and by laws rolled out and implemented, indicators published and regular review mechanisms put in place. Once this is done, I have given my team the freedom to explore and experiment while keeping a close watch and providing guidance wherever necessary. I encourage and appreciate performance so

that people can truly excel. I also believe that every successful leader has an instinct which is difficult to define but which enables them to take winning decisions at the most opportune moment. This has been the key to success in transforming our hospital to an institution with clinical, operational, technological and education and research excellence, in less than a decade.

Learnings as a leader A leader cannot afford to make mistakes. Wisdom consists of anticipating the consequences. I have strongly relied on establishing systems of checks and balances, independent vetting of facts, ability to read early warning signs of potential problems, creation of a credible image and acquiring deep seated

knowledge about the environment in which I operate. I also believe that through strategic actions, the environment can be moulded to our benefit and crises can be avoided in many instances.

Sources of inspiration The resources on which I rely as a leader spring within myself. I have built my life on the principles of intelligence, integrity and energy. Knowledge about the market and a strong connect with it is essential for growth. Integrity to me is non-negotiable. It is the mark of a true leader. Energy or passion is what makes you reach out for more. As the great Nelson Mandela said, “There is no passion to be found playing small – in settling for a life that is less than the one you are capable of living.”

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LIFE ANU ACHARYA CEO, Mapmygenome

LEADERSHIP DEVELOPMENT HAPPENS ATALL LEVELS People are key to a leader People are our strength and I believe that everyone has the potential to do great things, to become a great leader, and to help a business achieve its vision and mission. Just as we recommend ‘know yourself’with your DNA, we make sure to understand key strengths, skills, and their ambitions that can make each employee an asset to the team. Right from hiring to operations and marketing, I am an active participant working with the team. This gives me better insights into progress of work as well as people’s mindset. Internal communication in the team is especially essential in the startup phase, when only a vision and faith keeps us going. In addition to skill development, focus is also on the core values of discipline and accountability. Leadership development happens at all levels. We recruit, train, and support people who drive the

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business strategy.

The decision that changed my life... In 2009-2010, we had already built our first venture Ocimum Biosolutions. As a B2B service provider, with 10+ years of expertise in genomics and shrink-wrapped life-sciences software development, we wanted to reach higher. We wanted to offer personal genomics and molecular diagnostics services to people. When we did the groundwork and presented a proposal to the Board Members, our ideas were vetoed. We decided to startup Mapmygenome with a vision to touch a 100 million lives. This is one decision that changed the way I look at life, health and lifestyle.

Be apart of the team... There are some who want to just manage and delegate, but a true leader knows that there are instances when

he or she has to chip in and work with the team in order to succeed. Especially in a startup, there is no task that is too big or small for a person. Another key attribute for success is a thorough understanding of the technology and process, especially relevant to the team one is handling. Team members turn to their leaders for advice, especially when there is a problem. Without an understanding of the situation and technology, a manager stands to harm the company’s credibility and lose respect of team members. Learning should never stop.

Staying updated is important Standard references like Forbes, HBR. Books such as The Art of War, etc. Leadership forums, LinkedIn Groups, networking opportunities, conferences, webinars – one just has to look for learning opportunities with eyes and ears open.

AJAY GUPTA Executive Director, KGD Architecture

LEADERSHIP SKILLS CANNOT BE TAUGHT Leadership is a way of life As we mature from adolescence to adulthood we all inculcate leadership traits and qualities from our environment but the key is to harness these traits to build synergy in a group of people or team members to facilitate the betterment of the people involved and then to achieve a unified goal for the betterment of the organisation and beyond.

Trust and transpar ency an important element Leadership skills cannot be taught but a conducive environment created in a organisation to help harness all that trait in every employee of the organisation. Some of the key factors which can help in doing so are trust and transparency, trust of the employees in the manage-

ment and transparency of the management with the employees which can facilitate the leadership growth in an organisation. Senior members of the organisation should be given opportunities to take some calculated risks to help them explore their inner leadership qualities and in turn build confidence.

you have to earn from your team members and colleagues, the biggest mistake we make is to force a leader on a group of people without the leader earning the role with his or her actions and contributions.

Understanding human nature is vital Moving back to India... Listening to my inner self and moving back to India after leaving a successful career in Architecture in the US to help run and grow KGD as a international and global architectural and engineering firm.

Forcing yourself onto your team is a big mistake Leadership is not an assigned role but a role which

Leaders seeking inspiration and fresh ideas need to understand the people around them, the best way to better yourleadership qualities is to try and understand human nature and how everyone around you are different but have varies skills and attributes which can be harnessed for a unified goal. We all need to remember the word Leader applies only when we have fellow team members who have full trust and faith in you to lead.

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LIFE ARJUN KALYANPUR MD, CEO and Chief Radiologist/Pusher Teleradiology Solutions

HARD WORK IS THE ESSENCE OF SUCCESS IN LEADERSHIP Constantly learning and improving To me learning is a key driving force for continued growth. Continuing education is necessary in clinical medicine, and is equally critical in entrepreneurship and leadership. The day an entrepreneur/ leader begins to believe that he/she knows it all, is the day the organisation begins to decline.

Positive energy and passion A genuine love for what one does and the positive energy that this engenders is what sets apart special organisations from the mundane. I am blessed to find fulfilment both in being a physician and an entrepreneur, which makes my work greatly satisfying and brings pos-

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itive energy to what I do. Communicating this to the team is a key part of my role as a leader.

Client satisfaction is the ultimate satisfaction Having respect for one’s client, identifying and empathising with the clients’ pain points, and visibly working to address these are all critical hallmarks of success in a services industry. This is one of my guiding principles and one I regularly impart to my colleagues.

Work is fun, more work is more fun Edison’s famous 99 per cent perspiration and one per cent inspiration rule is one that has always guided and

motivated me. Unfortunately, hard work today is underrated and undervalued. I believe that it is the essence of success in leadership, and in life.

Always helping the community Many studies have shown that genuine happiness comes from giving. Our not for profit Telerad Foundation provides us an avenue for giving back, both in terms of helping charitable hospitals in underserved areas and in providing free educational opportunities for radiology students. At the organisational level, this translates into a deep sense of fulfilment on the part of both the individual and the leader. Simply put, it is my belief that giving is good.

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