Express Healthcare (Vol.10, No.10) October, 2016

VOL.10 NO 10 PAGES 72

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JP Nadda Union Minister of Health and Family Welfare (Letter of support from MoHFW for Healthcare Senate 2016)

SEPTEMBER 2016

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EDITOR’S NOTE

Proposed NMC Bill draws flak

H

ow much regulation is too much?

That is the question that will be hotly debated by the medical fraternity, when the proposed National Medical Commission Bill, 2016 (NMC) is tabled in Parliament in the upcoming winter session.

The draft of the NMC Bill was released in August by the Niti Aayog, and was open for public opinion till the end of the month. September saw the Niti Aayog discuss the Bill with healthcare secretaries of various states as well.

Most associations of doctors, like the Indian Medical Association (IMA) and The Alliance of Doctors for Ethical Healthcare (ADEH) were unanimous in their rejection of the Bill, which seeks to replace the Medical Council of India (MCI). While IMA representatives dubbed it “old wine in a new bottle”, ADEH termed it “even worse than the disease it is supposed to remedy.”

Among the various points of contention is the fact that the Bill seeks to govern the medical community, as an extension of the Ministry of Health & Family Welfare (MoHFW) without understanding the nuances of medical practice and education. But there has been ample evidence that self regulation efforts via the MCI have been flawed, spawning corrupt practices when it came to recognising medical colleges. But MCI officials point out that they are overseen by the MoHFW, as are other self regulatory associations of professionals like dentists, nurses and pharmacists but these are not facing the axe, unlike the MCI. The proposed NMC Bill does has imperfections.

For instance, even after the hue and cry about the lack of ethics, there is no separate board of medical ethics. Instead this duty is proposed to be clubbed with the medical registration. So also, the NMC Bill, possibly in an attempt to add to the number of medical staff, is apparently proposing that even if anyone does not pass the exit test post the MBBS, they can still get registered in the Medical Registry and continue to practice. Is this a backdoor entry for practitioners from other systems? This angst is also a sign of the ongoing rivalry between allopathic practitioners and other systems, wherein the former would like to keep out the later from the Medical Registry. The Niti Aayog's proposed National Exit Exam for MBBS students, in addition to an entry exam, too has come in for a lot of flak.

Also, while it is common knowledge that admis-

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While IMA representatives dubbed it “old wine in a newbottle”,ADEH termed it “even worse than the disease it is supposed to remedy”

sions to medical colleagues command huge premia, euphemistically called donations, the NMC Bill has proposed to make it more transparent by allowing private medical colleges to fix the fees for 60 per cent of its seats. But isn't this simply institutionalising the corrupt practice of 'selling' medical seats in what is presently called the 'management quota'?

Some experts feel the Niti Aayog is being too naive when it assumes that private medical colleges will stick to the declared fees or to the 60 per cent limit. The 40 per cent of seats which are supposed to be reserved to deserving meritorious students at lower fees, will simply have so many qualifying criteria attached to them that few will end up being used.

While the Niti Aayog has a commendable objective, how will this be implemented and monitored?

This will end up being a hollow promise on paper, just like beds reserved for economically weaker patients often go unused due to convoluted qualifying criteria and lengthy procedures. The medical fraternity is very vocal and have threatened to take to the streets if the Bill does get tabled in Parliament in this winter session. Will the Niti Aayog have to back down?

Meanwhile, Express Healthcare crossed another milestone as the inaugural Healthcare Senate was judged a super success. Over three days, healthcare senators, the stalwarts in the sector came together to discuss challenges facing the sector as well as celebrate the vision and good work done. Supported by the Ministry of Health and Family Welfare as well as the Government of Telangana, Healthcare Senate had just the right mix of management mantras at the conference and breakaway breakfast meetings and techspeak one-on-ones at the adjacent medtech expo.

The Summit saluted individual passion as well as team spirit. Four healthcare pioneers were honoured with Citations for forging new paths while eight teams made it through an exhaustive nomination and Jury round, to bag Healthcare Excellence Awards for outstanding work in CSR, HR, patient care and marketing practices. Healthcare Senate 2016 was everything we hoped for and more, and for that, a big thanks to our speakers, panelists and delegates. For indepth coverage, see pages 18-36 in the October issue of Express Healthcare. We hope to make the next edition even more relevant so do send us your feedback.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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CONTENTS Vol 10. No 10, OCTOBER 2016

Chairman of the Board Viveck Goenka Sr Vice President-BPD Neil Viegas

USHERING THOUGHTLEADERSHIP IN INDIA'S PRIVATE HEALTHCARE

Editor Viveka Roychowdhury*

MARKET

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HEALTHCARE SECTOR SEES 88 FUNDING DEALS WORTH $397 MN IN 2016

13

SOUTH-EAST ASIA COUNTRIES TO SET UP FUND FOR HEALTH EMERGENCIES PREPAREDNESS

Chief of Product Harit Mohanty

STRATEGY

BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das

39

Delhi Prathiba Raju

INDIA’S MARCH TOWARD’S UNIVERSAL HEALTH COVERAGE: LESSON’S FROM RSBY

CRITICARE

Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Senior Designer Rekha Bisht Artists Vivek Chitrakar, Rakesh Sharma

42

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, Douglas Menezes, E.Mujahid, Mathen Mathew, Nirav Mistry PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia

CRITICAL CONNECTIONS

LIFE Opinion leaders in India's private healthcare sector came together at Healthcare Senate - The National Private Healthcare Business Summit to share innovative ideas and create a roadmap to turn them into reality. Healthcare Senate citations and Express Healthcare Excellence Awards were also held at the three-day event to celebrate the spirit of excellence and leadership in healthcare delivery in the private sector. Glimpses of the event....| P14-35

63

SKILL INDIA: GAINING PACE IN HEALTHCARE

66

A FUTURE AS A HOME-CARE NURSE

INTERVIEWS P12: DR DHARMINDER NAGAR Managing Director, Paras Healthcare

Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

P37: JITENDRA ARORA Director-eHealth, Ministry of Health & Family Welfare

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.

MARKET REPORT

Healthcare sector sees 88 funding deals worth $397 mn in 2016 Healthcare startups have gained significant portions in terms of value and number of deals HEALTHCARE STARTUPS cornered 73 deals amounting to $113.45 million, out of the $397.41 million deals so far this year, according to News Corp VCCEdge Healthcare Sector Funding insights.

“The year 2016 so far has registered 88 funding deals amounting to $397.41 million.

This includes 54 angel/seed deals worth $11.19 million, 23 venture capital funding deals worth $155.83 million and 11 private equity deals amounting to $230.39 million,” the report said.

Since 2012, the sector has witnessed 558 funding deals to the tune of $5,657 million. Startups in the healthcare space have received funding worth $735 million from 336 deals since 2012.

So far this year, there were 13 series A funding deals worth $45.33 million and six series B deals worth $56.92 million, while startups with consumercentric digital modes of service delivery have raked in $77.3 million so far this year.

The report further noted that eHealth players like online pharmacies and aggregator portals topped in terms of deal volume with 35 deals worth $50.96 million.

Biotechnology attracted the top private equity and venture capital deals so far in 2016 with Quadria Capital’s investment of $70.27 million in Concord Biotech. Other top private equity deals during the year were in the healthcare facilities and services space such as that of ADV Opportunities Fund I LP investing USD 45 million in Dr Agarwal’s Health Care and TPG Growth Equity III LP investing $33 million in Cancer Treatment Services International.

“Startups and investors alike see a huge opportunity in the demand and supply gap that exists in the Indian healthcare sector both as social cause and a business case,” Nita Kapoor, Head – India New Ventures, News Corp and CEO, News Corp VCCircle said.

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Kapoor further noted that while startups with consumercentric business models and digital modes of service deliv-

ery such as facilitating doctor appointments, efficient information management system and online pharmacies have

been attracting investor interest, trends suggest that there will be money backing for those startups focusing on corporate

tie-ups, medtech, virtual diagnostics and preventive care.

EH News Bureau

MARKET

I N T E R V I E W

‘Our aim is to bridge the gap between demand and supply in healthcare’ Dr Dharminder Nagar, Managing Director, Paras Healthcare, in an interaction with Prathiba Raju, elucidates on the hospital group’s plans to expand their footprints in tier-II and III cities which have a population of over two million What are your expansion plans in North India for the current fiscal, particularly in tier-II and tier-III cities?

What innovations do you plan to bring in the existing hospitals?

The expansion strategy of Paras Healthcare are in two phases; phase one is from 2015 to 2020 and phase two from 2021 to 2028. By 2020, Paras Healthcare intends to establish tertiary healthcare facilities in other tier-II and III cities in North India. Our aim is to bridge the gap between demand and supply in healthcare.

Also, we will target cities with a population of two million plus that also have a medical college.

Tertiary care centres will be established, which will focus on oncology, cardiology, orthopedics and neurology. They will further evolve into specialised transplant centres. We are in talks with many government agencies for a chain of cancer institutes and tertiary care centres. Also, we are in talks with private companies which are keen to collaborate in operations and management of hospitals.

While setting up a new unit, Paras Healthcare mainly adheres to its three tenets of healthcare. They are: present accessibility of healthcare in the region, presence of affordable healthcare at the location and last existence of a specialised quality healthcare provider. By providing exceptional medical expertise, infrastructure and technology to the areas that lack the same, we are able to create a healthcare revolution in the

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rural areas. Paras Patna, Darbhanga, Gurgaon along with Panchkula are some of the examples.

What has been the patient response to Paras Bliss as a centre for specialised mother and child care? Where will the future centres come up?

Paras Bliss, the new chain of specialised mother and child care centres, is our prime focus. The patient response has been very encouraging. Over the past few months, we have been able to provide neonatology care for pre-term babies.

We have also been able to perform complex pregnancy surgeries and numerous lap-gynae procedures. The response to tertiary care, neonatal intensive care unit (NICU) facilities have been most promising.

Through our unique feature of developmental supportive care, we have been able to deliver best care to the infants.

Paras Bliss is the only unit to have a neonatal ambulance, providing assistance 24x7. The exceptional response in the patient engagement programmes strengthens our belief that the community needs and is looking forward to patient centric, engaging hospital care units to provide them the right guidance. Our future units will open in North India.

The cities under consideration are – Jaipur, Kanpur, Lucknow and Jammu. The aim is to provide specialised maternity and neonatology care in areas where it is deficient. We will expand its foothold in the next five years in six major cities of North India.

We are in talks with many government agencies for a chain of cancer institutes and tertiary care centres As a private player in India’s healthcare industry, what are the pressure points you face during the process of expansion?

The most challenging aspect is to bring specialised medical professional and administration staff in tier-II and tier-III cities, followed by acceptability as an exceptional tertiary care provider by the public.

The acceptance of costs

associated with healthcare is also a major challenge. People usually accept spending the same amount in different cities, but they need to understand the advantages of the availability of specialised tertiary care services in their city.

Unprofessional approaches by existing small players is also an important challenge.

Moreover, the civic authorities are usually not prepared and one has to run around for various licenses, approvals and sanctions. The government needs to streamline the systems and provide a single window model to all healthcare providers.

Also, when all the aspects and factors are clear, the availability of suitable land and cost of real estate proves to be a deterrent.

Paras Patna has been successful in overcoming all major hurdles and it is a well established and recognised healthcare provider with the largest employee base in the organised private healthcare sector of Bihar. Also, we have been successful in bringing medical professional of repute back to their roots and provide state-of-the-art facilities, latest technology to the common man.

How challenging is it for private sector players to operate in the country’s healthcare space. As a private player, how do you balance the needs of the patients and commercial interests of the organisation?

Paras Healthcare is an organi-

sation with a social conscience.

Our target and service group is the middle class. If we look at the population set up, India has the largest population of middle class dwellers, with presence in both rural and urban India. Paras Healthcare has been uniquely highlighting and featuring itself as a true partner in health. We ensure in simple structure, building environment with maximum focus on medical expertise.

Paras Healthcare takes a strong stand against non-required superfluous technology.

Each technology intervention is decided on the benefit it shall bring to the patients and the medical outcomes. We ensure that no added cost of the extra frills is put on the patient and believes in patient empowerment and support.

Due to robust technology selection, building process management, central buying unit along with exceptional technology aided monitoring system and indicators, we are able to save more and pass on the benefits to our patients.

What is the capex that Paras Healthcare’s looking at in the next three years? How would it be funded?

At present, Paras Healthcare is looking at a balanced debt and equity model. Our earlier units have been internally funded with limited support from nationalised and private banks.

However, to realise the future goals of the organisation, we are at present open to equity participation. prathiba.raju@expressindia.com

MARKET

South-East Asia countries to set up fund for health emergencies preparedness A resolution for promoting physical activity across the region was also passed IN A critical step for emergency preparedness across the WHO South-East Asia Region, Member countries agreed to establish a dedicated funding stream aimed at building preparedness for health emergencies in the region, which is one of the most disaster-prone.

“To date, post-disaster funding through South-East Asia Regional Health Emergency Fund has done an excellent job of helping countries respond to health emergencies once they’ve occurred, as we saw most recently in Nepal and Sri Lanka.

The new funding stream will allow countries to invest in infrastructure and human resources that will enhance preparedness,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia.

In recent years, earthquakes, cyclones and floods have caused health emergencies in the South-East Asia Region. The region has also been threatened by a range of emerging diseases, including SARS, MERS CoV, pandemic influenza and Zika virus. Establishing a joint funding stream under the SouthEast Asia Regional Health Emergency Fund (SEARHEF) to help countries better prepare for such events was seen by member countries as a key priority for the regional health agenda. At present, SEARHEF funds are disbursed only once a disaster has occurred.

Another resolution passed by the session called for promoting physical activity across the region. The session also passed a resolution on health workforce strengthening which is vital to achieving universal health coverage – a key part of the Sustainable Development Goal of leaving no one behind. “Ex-

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October 2016

panding health workforces across the region is one part of what countries in the Region are trying to achieve, but we also need to increase staff retention, particularly in rural areas, as

well as provide further training to health workers to enhance their skills,” Dr Khetrapal Singh said.

The Regional Committee meeting is WHO South-East

Asia Region’s highest decisionmaking body, and includes health ministers and senior health ministry officials of the 11 member countries of the region – Bangladesh, Bhutan, Democra-

tic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.

EH News Bureau

HEALTHCARE SENATE 2016

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USHERING THOUGHTLEADERSHIPIN INDIA'S PRIVATE HEALTHCARE Opinion leaders in India's private healthcare sector came together at Healthcare Senate - The National Private Healthcare Business Summit to share innovative ideas and create a roadmap to turn them into reality. Healthcare Senate citations and Express Healthcare Excellence Awards were also held at the three-day event to celebrate the spirit of excellence and leadership in healthcare delivery in the private sector Glimpses of the event....

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October 2016

HEALTHCARE SENATE 2016

DAY 1 SEPTEMBER 22, 2016

INAUGURALCEREMONY

(L-R) Dr Sabahat Azim, Dr NC Borah, Dr A Velumani & Viveka Roychowdhury at the inauguration of Healthcare Senate 2016

T

he inaugural edition of Healthcare Senate - The National Private Healthcare Business Summit commenced with an auspicious note. Dr NC Borah, Chairman & Managing Director, GNRC Group of Hospitals; Dr A Velumani, Founder, Chairman, Managing Director and CEO, Thyrocare; Dr Sabahat Azim, CEO, Glocal Healthcare and Viveka Roychowdhury, Editor, Express Healthcare & Express Pharma lit the ceremonial lamp and kick-started the three-day summit. Supported by the Ministry of Health and Family Welfare as well as the Government of Telangana; Healthcare Senate 2016 was a large gathering of India's most influential healthcare stakeholders. Various insightful sessions and discussions were held at the event to deliberate on the future of healthcare in India and to guide future leaders within the private healthcare sector to replicate successful models of healthcare delivery.

HEALTHCARE SENATE 2016 ◗ Inaugural ceremony ◗ Welcome Note ◗ Keynote address: My Entrepreneurial Journey: Small Town to Small Exchange ◗ How can hospitals leverage cloud computing to better their service offerings? ◗ Corporate presentation by Aurobindo Pharma ◗ One on one meetings ◗ Healthcare Senate Citations Nite ◗ Gala Dinner

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Welcome Note V

iveka Roychowdhury, Editor, Express Healthcare, in her welcome address, thanked all the dignitaries, speakers and delegates for being a part of the inaugural edition of Healthcare Senate, on behalf on The Indian Express Group. She gave an overview of the journey traversed by Express Healthcare in the 16 years since its inception, withstanding the test of time. She said that Healthcare Senate and Healthcare Sabha, a platform launched in

March earlier this year for public health stakeholders, were a part of Express Healthcare's evolution to the next level. She also highlighted that they were attempts to bring the stakeholders of on the same platform and create a blueprint for the future leaders to reform and revolutionise healthcare in India. She gave a preview of the sessions in store for the thought leaders of the private healthcare fraternity at the three-day event, held at HICC, Novotel in Hyderabad.

With Healthcare Senate,we plan to reach out to more people in the sector,strengthen existing bonds and create new ones

KEYNOTE ADDRESS

MyEntrepreneurial Journey: Small town to stockexchange Dr A Velumani, | Founder, Chariman, MD & CEO,Thyrocare

D

r A Velumani, Founder, CMD & CEO, Thyrocare, the keynote speaker on the first day of Healthcare Senate 2016, gave a very rousing and inspiring account of his life's journey from a small village in the state of Tamil Nadu to build a business which had a very successful IPO in the recent past.

His speech was filled with several interesting anecdotes interspersed with humour, a combination which left the audience spellbound.

In a very candid address, Dr Velumani described the struggles he underwent as

the son of a landless farmer but also revealed that they made him a stronger personality. Thus, he believes that poverty can actually be a hard but effective teacher.

He spoke about the major choices which actually transformed his life including the one to leave his village and come to a city like Mumbai

and later on, quit the relative security of a government job at BARC to embark on a risk-filled journey as an entrepreneur. He also mentioned about the support he received from his wife, late Mrs Sumathi Velumani, in his lifealtering decisions.

He shared invaluable insights for the benefit of all entrepreneurs. He advised them to step out of their comfort zones and explore new areas of growth as only those have the courage to take risks and venture into the unknown would be successful. In his inimitable style he stated, “In life, there is security and there is prosperity, but there is nothing called secured prosperity.”

He explained the disruptions he ushered in the diagnostics sector by bringing down the cost of thyroid testing. He provides low-cost, high-quality diagnostics services with the help of people, technology and systems.

His volume-driven model has brought in cost and concept disruptions. If replicated, it could serve as a great model of services delivery for Indian healthcare which is duelling with twin concerns of affordability and accessibility. Thus, he highlighted how cost and quality are not inversely proportional and how right pricing has a pivotal role in ensuring success. He also

In life,there is security and there is prosperity,but there is nothing called secured prosperity emphasised on focus, IT, HR and logistics as pillars on which a flourishing business can be built. Sharing the details of his IPO, he explained why it was received so well.

His address did not just touch on entrepreneurship but also comprised lessons on mentoring and parenting.

He asked the audience to ensure that their wards and protegees are allowed to make their own mistakes and learn though experience. His quirky way of explaining his philosophies had the audience in splits, but they also found it to be educating and inspiring. The august audience of leaders and gamechangers at Healthcare Senate 2016 were very appreciative of his session and gave him a standing ovation.

KEY TAKEAWAYS + Without focus there is no success + Be a disruptor or get ready to be disrupted + If you are not ready to lose a billion, you cannot make a billion + Maintain TTT – Trust, Truth and Transparency + Experience is nothing but the number of problems you solve in the course of your life

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October 2016

HEALTHCARE SENATE 2016

PARTNER SESSIONS

Cloud computing to better healthcare services Aakash Shah, | Director Sales, National and International Market, eClinicalWorks

I

n this session, Aakash Shah, Director Sales National and International Market, eClinicalWorks spoke on how hospitals can leverage cloud computing to better their service offerings. In his presentation, he also gave an overview of his company's software offerings for healthcare organisations. He pointed out that eClinicalWorks is one of the oldest companies offering solutions for electronic medical records.

He also spoke on cloud computing and its advantages as well as outlined the various ways for digitisation of healthcare organisations. He gave an overview on the current projects that they are working on, including a telemedicine software device. Shah informed that they are also working on a

What we really want to do to make a difference is to reduce the cost of care, improve the quality of care and engage the patients to ensure satisfaction

kiosk application system which will reduce the registration time as a barcode given to the patient will help inform the doctors that the patient has arrived when he/she shows the barcode at the registration desk.

Shah apprised that the company's solutions have been installed in over 40 countries across the world, with the US a major area of deployment. He also elaborated on some of the projects that his company has executed for clients across the world. Shah said that the company aims to engage the patient and improve transparency in healthcare through its solutions. He summed up by saying that eClinicalWorks' vision is to reduce the cost of care but improve the quality of care.

Journeyof Aurobindo Pharma BV Ramana, | Head Marketing, Aurobindo Pharma

B

V Ramana, Head Marketing, Aurobindo Pharma, in his session, highlighted that his company, which began as a supplier of APIs in 1986, has grown to become one of the top five pharma companies in India in terms of sales turnover and market cap. It has established its presence in over 150 countries across the world. He informed that the company has

the ability to indigenously manufacture everything from start to finish – from intermediates to formulations and even packaging.

Ramana highlighted that Aurobindo Pharma is $2 billion company and said that their progress was a result of their unwavering focus on quality.

He also drew attention to the fact that Aurobindo Pharma's medicines have passed stringent quality tests by leading

drug regulatory bodies like the UD FDA, UK's MHRA and others. He also said that the company is one of the leading supplier of antiretroviral viral medicines to treat AIDS, one of the most dreaded diseases on our times. Ramana elaborated on some of the growth plans of the company as well.

He ended his session with a corporate film which traced the growth trajectory of Aurobindo Pharma.

We are a $2 billion company and the reason we have grown to this phenomenal size is because of our commitment to quality.

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EXPRESS HEALTHCARE HOSTS HEALTHCARE SENATE CITATIONS ATHICC,HYDERABAD Four visionaries who have chosen areas of practice with huge challenges were recognised for their contributions to improve healthcare in India

(L-R) Rajiv Kapahi, Dr Sabahat Azim, Dr NC Borah, Dr Neelam Kler, Mr Nagarajan & Viveka Roychowdhury

T

he inaugural edition of Healthcare Senate 2016, the National Private Healthcare Business Summit, hosted by Express Healthcare, sought to celebrate the spirit of excellence and leadership in healthcare delivery in the private sector. Pathfinders, innovators and game changers from the private healthcare industry were honoured with citations and awards for their vital contributions to healthcare in India at the three-day event held from 22-24 September, 2016 at HICC, Hyderabad.

Held on September 22, Healthcare Senate Citations, supported by Boston Scientific, were received by four visionaries who have chosen areas of practice

with huge challenges, of serving the underserved and difficult to access corners of our country.

The ceremony began with an introductory address by Viveka Roychowdhury, Editor, Express Healthcare, who explained the vision and mission behind the endeavour. She also read out a Letter of Support from JP Nadda, Minister of Health & Family Welfare, Government of India. The Chief Guest for the evening, Navin Mittal, Secretary Finance & Commissioner & Ex-Officio Secretary, Information & Public Relations Dept, Government of Telangana, lauded Express Healthcare for launching this platform and highlighted the various measures being undertaken to improve healthcare access and delivery in

Telangana. Rajiv Kapahi, Senior Director – India Hub Finance, Operations & Distributions, Boston Scientific India, also addressed the audience.

The winners of the Healthcare Citations were: Dr Nomal Chandra Borah, Chairmancum-Managing Director, Guwahati Neurological Research Centre Limited (GNRC) in recognition of his efforts to provide access to quality, affordable healthcare for in the underserved areas of India’s Northeast regions via GNRC. Dr Neelam Kler, Chief of Neonatology, Sir Ganga Ram Hospital, New Delhi, in recognition of her pioneering efforts to improve neonatal care standards in the country Dr R D Ravindran, Chairman and

Director Quality, Aravind Eye Care System, in recognition of his contribution to provide low-cost, effective eye care to the masses. The award was received on his behalf by Mr Nagarajan, Advisor to Aravind Eye Care Systems.

Dr Sabahat Azim, Founder, CEO & MD, Glocal Healthcare Systems in recognition of his efforts to deliver rational, high-quality, cost-effective healthcare to medically underserved areas of India.

The winners thanked Express Healthcare for recognising their work and spoke on their vision to improve healthcare in India. The evening came to a close with a networking gala dinner for all the winners and delegates of Healthcare Senate 2016.

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DAY 2 SEPTEMBER 23, 2016

PANEL DISCUSSION

Recent Practices in Accreditation and Hospital Pharmacies

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HEALTHCARE SENATE 2016 ◗ Panel Discussion: Recent Practices in Accreditation and in Good Hospital Pharmacy Practices ◗ Power Back up Solutions ◗ Panel discussion: Cost Burden of Medico-legal Tangles ◗ Industrial Association with Startups: The Kerala scenario ◗ LIV – a first of its kind in India.A new package for Medical Oxygen ◗ Panel discussion: Patient Driven Innovation in Healthcare ◗ Power Discussions ◗ One on One Meetings ◗ Peer to Peer Networking ◗ HITS Awards Nite & Gala Dinner

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ay 2 at Healthcare Senate 2016 began with a panel discussion on 'Recent practices in accreditation and hospital pharmacies'.

The panelists of this session were Dr Suresh Saravdekar, Director, The Rural Centre, Krishnamurti Foundation India, Varanasi- UP; Dr Harish Nadkarni, Consultant for NABH, CEO & MD, Quality Care and Dr Arun Palaniswami, DirectorQuality Systems, Kovai Medical Center and Hospital. Dr Saravdekar, the moderator, began the session by emphasing on the importance of accreditation for quality healthcare services in India. He urged Dr Nadkarni to share his insights on accreditation and various quality assurance bodies that provide these certifications to Indian hospitals. Replying to this, Dr Nadkarni spoke of bodies such as NABH, JCI and Australian Board of Accreditation. He went on to speak about how most of these accreditation boards lay emphasis on medical management within hospitals. “Right from medical procurement to dispension of medicines, accreditation ensures that the entire process is well managed,” opined Dr Nadkarni.

Continuing the discussion, Dr Saravdekar asked Dr Palaniswami to provide a comparison of accreditation parameters between the US and India. Replying to the same, Dr Palaniswami went to say, “Clinical pharmacists is a heavily integrated model within the US hospitals. The pharmacy team within a US

(L-R) Dr Suresh Saravdekar, Dr Harish Nadkarni and Dr Arun Palaniswami

hospital intervenes at clinical levels to ensure quality medical procurement and dispension of medicines.

These clinical pharmacists regularly interact with doctors, nurses and other clinical staff. This, in turn, bring down medical errors by a substantial level. A clinical pharmacy is well respected within a hospital in the US.” Dr Palaniswami further highlighted the biggest challenge in setting up the clinical pharmacist model in India. He said, “Day-to-day interactions between doctors and clinical pharmacist and other hospital staff is a huge challenge in India.”

Dr Saravdekar, agreeing with this viewpoint, urged the panel to provide solutions for the challenges that hinder adherence to good hospital pharmacy practices in India. He also explained the ideal process of medical procurement within a hospital. “Every hospital should have a medical procurement committee. This should be a therapeutic committee comprising var-

KEY TAKEAWAYS + Widen the role of a clinical pharmacist within hospitals + Every hospital should constitute a stringent formulatory policy for medical procurement + Prescription auditing is paramount

ious clinicians, the Medical Director and pharmacists.

This committee is also in charge of preparing a formulary policy that decides the parameters of medical procurement. However, in India the biggest challenge is to set up a good formulary policy that chooses the right medicines at the right price,” explained Dr Saravdekar.

When asked to share his experience on the same, Dr Palaniswami replied that the US hospitals has a strict formulary policy, however in India, doctors decide the medicines they would prefer to prescribe to their patients.

Dr Saravdekar further ques-

tioned Dr Palaniswami on defining the criteria to judge that a low-cost medicine is of good quality? He added that Indian hospitals or rather doctors in India believe that high cost of medicines is proportional to good quality.

Replying to this, Dr Palaniswami said that in the US hospitals, they have a surveillance team that checks the background of all the manufacturing units of companies that approach them to sell their medicines.

The discussion moved forward with comparisons drawn between the US and Indian procurement policies.

They also discussed the role of NABH and JCI in formulating these policies in India.

The panel discussed other issues such as errors made by nurses and other pharmacy staff while dispensing medicines. The panel finally concluded that prescription auditing is paramount and every hospital needs to conduct timely audits on medicine prescriptions and its dispensation within hospitals.

PARTNER SESSIONS

Power back-up Solutions Suraj Kumar Sing| Head I-UPS Co-ordinator South, Exide Industries

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uraj Kumar Sing, Head I-UPS Co-ordinator South, Exide Industries began his session with an explanation for his presence at Healthcare Senate. He said that there is a strong connect between his industry and the healthcare sector, both at the micro level and the macro level. Expounding further on how his power back-up solutions serves as a support system to healthcare providers, he said, “The entire healthcare sector is becoming more and more technology driven and this is possible because of robust IT infrastructure which in turn needs a powerful and reliable power supply system.”

Sing highlighted various aspects where power back-up solutions play an important role in providing good patient

KEY TAKEAWAYS + It is important to check on the reliability of the manufacturer + It is important to check for the capacity matching of a hospital in comparison to the battery solution + Check for the quality of the battery that has a consist product line care. He went on to explain the functioning of an uninterrupted power supply (UPS) and a power battery. He also emphasised that a UPS system will function well only if it has a powerful battery. Therefore, it is very important to have a durable power battery for a hospital's UPS system.

He then provided a check list to ensure that a hospital has a powerful UPS battery solu-

tion in place. Firstly, it is important to check on the reliability of the manufacturer in terms of technology experience, design experience and manufacturing experience.

Secondly, it is important to check for capacity matching, which means that every hospital should choose a power battery as per its requirement.

Also, he urged the audience to keep hospital expansion in mind while choose these solutions.

He stressed, “Check for the quality of the battery that has a consistent product line and the manufacturers' assembly line should be automated with minimum human interface”. Finally, Sing advised hospitals to choose a battery from a manufacturer who will provide them good after sale service.

PANEL DISCUSSION

Cost Burden of Medico-legal Tangles

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egal costs always have an adverse effect on an organisation's balance sheet. They also have an adverse effect on the reputation of the hospital. The second panel discussion on Day 2 of Healthcare Senate 2016 focussed on the 'Cost Burden of Medico-legal Tangles'.

Moderated by Mahendra Bajpai, Advocate, Supreme Court of India; the panel comprised Manpreet Singh Sohal, CEO, Global Hospitals, Mumbai and Hyderabad; Dr Vivek Jawali, Director, Fortis Hospitals, Bengaluru; Dr Suganthi Iyer,

Deputy Director, Legal & Medical, P D Hinduja Hospital & Medical Research Centre, Mumbai; Dr Alexander Thomas, Executive Director, Association of Healthcare Providers (India) and Dr Nikhil Datar, Founder President, Patient Safety Alliance, and Medical Director, Cloudnine Hospital, Mumbai.

Bajpai began the session by citing the controversial case of Dr Kunal Saha v/s Dr Sukumar Mukherjee and others and how it stirred the entire healthcare fraternity. He said, “The compensatory structure of medico-

The compensatory structure of medico-legal cases in India has changed.Previously, compensations for medico-legal cases would not be more than `5 lakhs, but today patients are being compensated in crores

legal cases in India has changed. Previously, the compensations for medicolegal cases would not be more than `5 lakhs, but today the compensation scenario has changed tremendously where patients are being compensated in crores.” He stressed upon the fact that the rising compensation structure for medico-legal cases has adversely affected the entire healthcare delivery system.

Leading the session further, Sohal pointed out, “Most doctors and healthcare providers believe that ignorance of law is a

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bliss. They believe that since they provide healthcare to the masses they are above the law.”

He stressed on the need for hospitals to be more aware of the laws of the land and implment measures to ensure compliance with them. Bajpai asked the audience if they were aware of a written law in India that regulates the conduct of the doctors. He went on to say that this law clearly mandates that a practitioner should maintain medical records of their patients for a certain number of years, the methods to be adopted by a doctor while prescribing medicines, so on and so forth.

To the panel's dismay only a few doctors knew about these provisions in the law. Bajpai then agreed with Sohal’s view that many in the medical profession were ignorant about legal matters. He further informed that the above mentioned regulations were part of Indian Medical Council Professional Conduct Ethics Regulations 2002.

Dr Jawali opined that every hospital should maintain a transparent line of communication with their patients and relatives to avoid medico-legal issues. Moreover, he recommended establishing a crack team that comprises doctors from within the hospital and lawyers. The core responsibility of this team is to inspect all legal aspects of a hospital. In times of medico-legal cases, this team has to check for very bit of information, legal documentation even at the ward boy level to ensure ethical implementation of medico-legal strategies, he advised.

Dr Thomas intervened to say that documentation is not the most important thing. He stressed upon preventive measures to avoid getting entangled in such cases. He agreed with Dr Jawali that communication plays a pivotal role in better patient management and patient care. He referred to a study made by a member of the Harvard University that stated, India has

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(L-R) Dr Suganthi Iyer, Manpreet Singh Sohal, Mahendra Bajpai, Dr Vivek Jawali, Dr Alexander Thomas and Dr Nikhil Datar

around 5.2 million medical errors every year. Of these, medical errors have costed the lives of around 5-10 per cent patients. He further said that said that the major reason for medico-legal burden is not lack of core competence but poor communication. Addressing hospital administrators present at the conference, he said that hospitals lose upto two per cent of their revenue to medico-legal tangles. He also highlighted that NABH, CAHO, MCI and various other bodies within the healthcare sector have felt the need to ensure healthy communication and have introduced training programmes for nurses, doctors and other support staffs within hospitals. Dr Thomas also emphasised that accreditation has proven to reduce medico-legal tangles within hospitals. He advised, “We, doctors, need to regulate ourselves. There is a dire need to include ethics in the curriculum. Medical education is totally commercialised today. Therefore, once a doctor completes his/her education the only motive they have is to

KEY TAKEAWAYS + Communication at all level is key to reduce medico-legal errors + Ignorance of law is not bliss. Hospital administrators and doctors need to have a basic knowledge of the laws associated with their jobs + Hospitals must take responsibility for medical errors and report them + Hospitals should set-up a crack team comprising medical director, HODs and lawyers + Training staff members is a must

recover all the money invested.

This is why they resort to kickbacks, cuts etc. We need medical reforms that can ensure a change in this area.”

Dr Datar drew attention towards understanding of medical complications and medical errors. He also underlined that out of the overall medico-legal cases recorded

worldwide, the actual cases of negligence is only around 5-10 per cent, the rest is poor communication, medical complications, high costs etc. He further said, “We need to have a policy in place that defines medical negligence and deficiency of services. “ Adding to this, Dr Jawali reminded the audience that any rise in cost burden to a hospital results in rise of healthcare costs which adversely affect the patients. This also results in trust deficit among patients, a bigger loss to the hospital.

Picking up lessons from what Dr Datar spoke, Bajpai asserted that there is a need for Indian hospitals to take responsibility for medical errors and report them. Identifying medical errors and reporting them will minimise errors and reduce medico-legal tangles.

Dr Iyer brought to light that courts today are taking inflation into consideration while declaring compensations to patients. She also pointed out another important medicolegal issue that concerns the

sector — the involvement of third party insurance players.

However, she also pointed out that often doctors and nurses become victims of misplaced anger. Raising her concerns on the same, she called them as malicious acts done with the intention to exhort money from doctors and hospitals.

She summed up by saying, “Employees at different need different kinds of training in communication to bring down medio-legal errors and reduce the such cost burdens on a hospital”.

Sohal once again brought up the issue of ignorance of law and spoke about the furore cause by the recent organ donation scandal and sex detection scandals that have caused many medical practitioners to lose their reputation and employment. The moderator summed up the session with a word of caution that medicolegal tangles have far-reaching effects. The panel advised hospitals to have a sound strategy in place to deal with these sensitive and crucial issues.

POWER DISCUSSIONS

Industrial Association with Start-ups: The Kerala scenario Ashok Kurian Panjikaran| Manager-I, Kerala Start Up Mission

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shok Kurian Panjikaran, Manager-I, Kerala Start Up Mission began by explaining the prime focus of his organisation. He explained that the Kerala Start-up Mission is a government-run organisation that promotes start ups within the state. The organisation incubates these companies right and connects them to the industry.

He elaborated on technology start-up policy implemented by the organisation to encourage entrepreneurs including students starting from standard eight. He informed that the Mission has tied-up with 157 colleges and are also trying to get more industry participation.

The aim is to encourage companies to collaborate with start ups where problems can be identified and solutions be developed

He highlighted that the Mission has incubation and accelerator facilities as well a huge campus exclusively for these start ups.

He further informed, “The aim is to encourage companies to collaborate with start ups where problems can be identified and solutions be developed.”

He finally explained the different ways in which corporates can associate with these start ups. The ways included conducting hackathons, providing funds, providing infrastructure facilities and incubating some start ups. He summed up by giving more details about the healthcare start ups that are being incubated at the Mission.

POWER DISCUSSIONS

LIV- AFirst of its kind Oxygen Cylinder in India Dr Biswarup Ghosh, | Head of Sales, Healthcare, Linde India

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r Biswarup Ghosh, Head of Sales, Healthcare, Linde India started his session by with an explanation on the importance of oxygen supply within hospitals and went on to speak about his company-the Linde Group. Dr Ghosh said that the Linde Group has been operating in 100 countries and employs around 65,000 people across the globe. He informed that the company, with various gases and engineering solutions, is among the largest industrial and healthcare gas players in the world. Apart from healthcare, Linde provides gases to steel, refineries,

petrochemical, pharma and automobile industries around the world, he said. In India, Linde is present for the last 81 years.

Dr Biswarup also informed that they have a huge R&D plant where most of their innovations happen. One such innovation is Linde's new package for medical oxygen called LIV. This is a mobile gas cylinder which is made of aluminum. Further, he explained the unique features of this product and outlined the various advantages of using it within a hospital. He further stated, “This oxygen cylinder can be utilised by nurses and other staff extremely easily.

This oxygen cylinder can be utilised by nurses and other staff extremely easily During an emergency, this oxygen cylinder proves to be very useful. It has an ergonomic handle, is easy to carry and easy to use.”

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PANEL DISCUSSION

Patient-driven Innovations in Healthcare

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n the age of the consumer, entrepreneurs and organisations are waking up to the need to design their business models around customer requirements. Healthcare industry is no different.

The panel discussion on 'Patient-driven innovations in healthcare', brought to fore these innovations and highlighted strategies that will enhance caregiving in India.

The panel, consisting of Chayan Chatterjee, Cofounder & COO, Lattice Innovations (moderator); Lalit Pai, CEO, Nightingales Home Healthcare Services; Dr Aniruddha Malpani, Director and Value Custodian at Solidarity Advisors; Dr Nagarjun Mishra, Chief Officer-Business & Strategy & Co-founder, Purple Health and Suresh Satyamurthy, Founder, Tarnea Technologies.

Chatterjee started off by talking about the changes that the healthcare industry is currently witnessing. He led the conversation towards understanding the concept of patient-driven innovations. He said, “This is the phase where innovations in healthcare will be research and technology driven, and patient needs will play a significant role. Organisations which will seize patient needs and design their innovations around these needs will be the ones who will succeed.”

Moving on, Chatterjee asked the panel to share their perspectives on the challenges faced by them in implementing patient-driven innovations.

Dr Malpani began by accentuating on the importance of keeping patients first. He mentioned that at times doctors are rude to patients and they need to respect them.

“It’s time doctors realise that patients and healthcare providers stand on the same

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(L-R) Dr Nagarjun Mishra, Dr Aniruddha Malpani, Lalit Pai, and Suresh Satyamurthy. Chayan Chatterjee (not in the picture), moderated the session

KEY TAKEAWAYS +Keep patient first +Healthy communication among healthcare providers and patients is a must +Pick up a problem that affects patients and try to solve it +Follow an unified process +Interaction with patients can bring in new ideas for healthcare delivery

side.” Pai pointed out, “As a community, we do not talk about patient outcomes. There is an urgent need for communication at all levels within the healthcare system and so that we shift our focus to driving successful patient outcomes. It’s time that healthcare communication becomes more objective.”

Citing the example of a USbased online patient networkpatientlikeme.com, a very successful business model, Chatterjee asked Dr Mishra about the workability of a similar model in the Indian context? Replying on the same, Dr Mishra stated that these concepts are a good way to empower patients, however the Indian patients still have some apprehensions about sharing their medical information with others. Nevertheless, there is some slow progress in this area. He referred to FaceBook's new initiative for pregnant women, wherein expectant mothers can interact and share their experiences, problems and medical conditions.

Pai and Dr Malpani chipped in with their views on how interaction with patients can

bring in new ideas for healthcare delivery that can be beneficial for the patients as well as healthcare providers.

Satyamurthy brought in a new perspective to this discussion. He spoke about the role of pharmacies in empowering patients. He shared experiences where patients take help from their pharmacists to understand the doctor prescription. He went on to admit that he began his venture with once such idea.

Taking the conversation forward, Dr Malpani gave examples of how small innovations can be done within hospitals taking patient requirements into consideration.

Adding to this, Pai spoke about how various digital technologies can be leveraged to bring out these innovations. However, he also raised concerns

about regulations in this area.

Satyamurthy further engaged the audience by asking them about their mobile phones and convinced the entire congregation present to believe that innovations comes from increasing needs and no government can bring about innovations until the people want it and work for it. Therefore, he urged hospitals to understand patient needs to bring about these innovations.

Chatterjee finally asked the panel for their recommendations on design and product development. The panelists suggested looking at one problem that affects patients and trying to resolve it. Keep patients first and the rest will fall in line. Don't try too many things and follow a unified process to run your business, were some invaluable advices.

POWER DISCUSSION

Fostering healthypartnerships between pharma cos and hospitals

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n the sidelines of Healthcare Senate 2016, Alkem laboratories organised two power-packed discussion on the 'Role of pharmaceutical companies in propelling growth for corporate hospitals'.

The first discussion was chaired by Venugopal Vijayendran, President- Marketing and Sales, Alkem Laboratories along with senior management team of Fortis Hospitals on September 23, 2016. Vijayendran began the discussion by highlighting the challenges in dealing with corporate hospital clients in the process of medicine procurement. He pointed out that despite the price cut or discounts on medicine given by pharma companies, hospitals continue to sell medicines at a higher cost. He said that hindrances caused by corporate hospitals will only drive pharma companies to either cut down on discounts given to them or stop selling their medicine to these hospitals. He then asked the panel of five to seven members to share their opinion on the same and come up with ideas that can strengthen their partnerships. Dr Vivek Jawali, Director, Fortis Hospitals, Bengaluru gave a bird eye view of the current situation. He said that if the government, pharma companies and hospitals do not work to make medicine accessible and affordable, patients will suffer. He highlighted that only unity among these three stakeholders can build a better healthcare system within the country.

Ajay Vij, Head—Supply Chain Management, Fortis Healthcare and Satpal S Gambhir Head Administration, Fortis Healthcare agreed to Dr Jawali and pointed out that the idea behind such collaborations and discount deals is to bring about affordability of medicine among

Top CXO’s from corporate hospitals brainstorm on ideas for better strategic alliance with pharma companies

Delegates at a power discussion, partnered by

Only unity among stakeholders can build a better healthcare system within the country patients, therefore unity among the stakeholders is a must.

Other members on the panel raised concerns that if they sell medicine at a price lower than the MRP, the hospital's balancesheet would suffer.

The discussion progressed as

each of the members present at the table shared there views on the problems and provided simple strategies that would allow each stakeholder to benefit from these partnerships. The key lesson from this discussion was that both stakeholders- pharma companies corporate hospitals need to work on their shortcomings. At the end of this discussion the panel was convinced that there is room for future business dialogue.

This healthy discussion with the management team of Fortis Hospitals set stage for further deliberations. Alkem had another round of discussion with more corporate hospitals management official on September 24, 2016.

Dr Suresh Saravdekar, Director, The Rural Centre, Krishnamurti Foundation of India and ex-Assistant Director and Con-

sultant (hospital supplies procurement), Ministry of Medical Education & Health, State of Maharashtra opened the floor for discussion on a positive note saying that the Indian pharma companies should be seen as a partner by the corporate hospitals, as both are working for the betterment of the patients’ health.

“Pharma companies need to have patient education programmes that talk about the pharmacology, the mode of action carried behind the product, etc. Such programmes will help the pharma companies to build the trust with the end user,” said Dr Krishna Singla, General Manager, Shah Hospital, Kaithal, Haryana.

Giving a healthcare providers’ point of view, Sameer Mehta, Director, Dr Mehta’s Hospital said, “Going forward

pharma companies and corporate hospitals will need to lower the prices of medicines. In the next 10 years , the role of a pharmacist will change from being just a purchasing manager to a clinical pharmacist.”

Dr Aniruddha Malpani, Director and Values CustodianSolidarity Investment Advisors, TiE Mumbai, AllizHealth urged pharma companies and hospitals to keep patients first and come up with strategies that will make healthcare delivery affordable, reliable and accessible.

While summing up the discussion, Sambit Mohanty, General Manager, Alkem Laboratories thanked all the participants for sharing their valuable inputs and hoped that these discussion will guide both stakeholders to design better mechanisms for patient care and healthcare dleivery.

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POWER DISCUSSIONS

Assuring qualitymedicines

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he hour-long discussion at the Healthcare Senate presented by Glenmark Pharmaceuticals focused on how hospitals should assure quality medicines to the comman man.

The discussion began with Dr Suresh Saravdekar, Director, The Rural Centre, Krishnamurti Foundation of India and Ex-Assistant Director and Consultant (hospital supplies procurement), Ministry of Medical Education & Health, State of Maharashtra, pointing out that maintaining quality of medicines is a continuous process.

He went on to say how important it is to shift from assumed quality to assured quality of drug.

Sharing his views about quality medicine, Dr Milind Khadke, General Manager, clinical administration, Kokilaben Dhirubhai Ambani Hospital, said, “We need to focus on research molecule. A stringent clinical trial policy is needed, though India has a policy in place and the current scenario is better than what it was around 10 years ago, much needs to be done. We also need to concentrate on logistics and cold chain.”

“In order to assure quality of the medicines, we need to develop and establish some standards and timely evaluation of the same,” said Yogendra Nath Awadhiya, Head - Hospital Operations and Administration at Wockhardt Hospitals.

Jaiprakash S Vastrad, Sr General Manager, Sagar Pharma, Bangalore said, “In India, the pharma market should concentrate more on the quality concept of the drug products. We need to educate manufacturers as well as conduct studies on areas such as certificate analysis and chemical equivalence .”

Further, AG Prasad, Vice

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Around 15 delegates gathered to discuss strategies to improve access to quality medicines

The dignitaries opined that the industry and the service providers should come together and maintain a registry or data of the therapeutic results of the two different companies of the same drug and analyse it President- Sales and Marketing, Glenmark said, “During the post independence era multinational pharma companies dominated the Indian market. The Government of India wanted to encourage the local players and had liberalised formulations so much that they are finding it

difficult to contend it now.

Moreover, there are 13,000 manufacturers but only 29 testing laboratories. And there was a time when WHO Good Manufacturing Practice(GMP) was required only for the drugs which were exported; but today we have 500 companies that

are accredited with WHO GMP and upgraded to Certificate of Pharmaceutical Product (COPP).”

While Prasad's suggestion was commended by the participants, Ajay Vij, Head - Supply Chain Management, Fortis Healthcare Limited, Gurgaon, informed that quality comes with a cost. He stressed that manufacturers should follow all the quality standards and maintain the consistency in what they manufacture.

“Manufacturers have to go that extra mile to ensure that the whole supply chain is well maintained. When it comes to quality assurance of drugs, we lack the consistency at three levels —manufacturing, supply chain and in the hospitals. This is crucial and should be taken care of,” Vij added.

While Prasad concluded

the discussion by thanking all the participants for sharing their views on this extremely important subject, the dignitaries unanimously agreed that investment in quality manufacturing, and in depth analytical test report and good practices would assure quality medicines. The dignitaries opined that the industry and the service providers should come together and maintain a registry or data of the therapeutic results of the two different companies of the same drug and analyse it. A concrete data can help in quality medicines.

Summing up the discussion, Prasad said, “Even countries like Nepal and Bhutan are more stringent with regulations. The standards and guidelines set by the government of India should also be more stringent.”

POWER DISCUSSION

Leadership in healthcare

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ealthcare Senate 2016, the National Private Healthcare Business Summit, hosted multiple power discussions wherein select delegates gathered to discuss on certain crucial issues and deliberate on the way forward. This session, headed by Dr A Velumani, Founder, Chairman, MD and CEO, Thyrocare, also saw a lot of knowledge sharing on diverse yet interconnected topics such as entrepreneurship, disruptions in business, volume-driven business models, steps to increase efficiency and efficacy of services etc.

Many of the issues raised at the power discussion were themes that Dr Velumani had touched upon in his very wellreceived key note address on the first day of Healthcare Senate. However, the delegates were eager to know more about the strategies and measures which helped him be a very successful entrepreneur. In a free-wheeling and interactive session, the delegates posed several questions to Dr Velumani which ranged from the reasons for choosing this model of business, its sustainability and replicability in other areas of healthcare business, and his strategies for further expansion, to the status of Nuclear, his second business venture to offer affordable PET scans, and the relevance as well as effectiveness of the volume-driven profit model in radiology.

Dr Velumani answered these questions in detail and pointed out that volumedriven businesses would always thrive in India, given the country's huge need for costeffective healthcare solutions to serve its populace. However, he stressed upon combining quality with cost-efficiency. He debunked the myth that cost

Dr Velumani shares his experiences from his entreprenurial journey with the delgates at Healthcare Senate 2016

KEY TAKEAWAYS + Cost-effectiveness and

Delegates debate and discuss on models of entrepreneurship and leadership in a power discussion powered by Thyrocare at Healthcare Senate and quality are often inversely proportional to each other and highlighted with examples, how he has offered both, affordability and excellent services to his customers, with timely and strategic investments in people, systems and technology.

The coversation then moved to disruptions in

healthcare and their role in propelling progress. Dr Velumani said that disruptions happen when someone serves an unmet need in the most cost-effective and efficient way, thereby ensuring that a large number of people benefit from it. He urged everyone in the room to do the same.

Identify unmet healthcare

quality can go hand in hand.

In fact, quality can drive affordability +Cost, reach, systems and technology are crucial to success in business +A healthcare disruption should be something that affects a lot of people positively + Look for untapped opportunities to help serve a huge number of people. + Volume-driven models is the way forward in for healthcare delivery in India needs and look for strategies which would help serve the need in the best possible way, at affordable costs, he asserted.

The participants also discussed on ways and means to make a business more sustainable in the long run.

They discussed on pricing strategies, effective handling of logistics, challenges in implementing effective systems, ways to ensure better reach of their services etc. Dr Velumani, acting as a mentor, gave valuable insights and guided young entrepreneurs to look for innovative measures to deal with challenges in their businesses. His parting advice to them was to find opportunities which others haven't spotted and be a disruptor in that space. He once again reiterated that entrepreneurship is not for the fainthearted and it takes courage to walk down untrodden paths and succeed against all odds.

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DAY 3 SEPTEMBER 24, 2016

KEYNOTE ADDRESS

Investing in quality Dr K K Kalra | CEO, NABH

HEALTHCARE SENATE 2016 ◗ Keynote Address: Investing in Quality: Best Practices for Accreditation ◗ Envisioning Digital Transformation in Health ◗ Panel Discussion: Raising Capital for Healthcare ◗ H.A.I - How will patients choose hospitals in the future? ◗ Panel Discussion: Balancing Profitability with Responsibility ◗ One on One Meetings

D

r KM Kalra, CEO, NABH informed that quality and patient safety should be seen as more than just a marketing strategy. In fact, it should be one of the basic tenets on healthcare delivery.

Giving an insightful keynote address on the third day of the first edition of the Healthcare Senate 2016, Dr Kalra informed that the healthcare industry is witnessing a paradigm shift and the patients are becoming more aware about their needs and rights. They, rightfully, seek and demand quality in hospitals and nursing homes. Hence, healthcare organisations should be willing to start the step-by-step journey towards quality improvement.

“There is a general myth that quality comes only at high cost. However, even at lower, affordable price s, quality can be given. But, in our

KEY TAKEAWAYS + Assuring quality and patient safety should be a basic tenets of healthcare delivery + There is a general myth that quality comes only with a cost, but even at lower, affordable prices, quality can be given. + Accreditation stimulates a culture of safety in the healthcare space. It ensures safe use of high risk medication, reporting errors, risk assessment and good governance.

country the main challenge is the scarcity of staff and lack of skill.

Giving quality care in India because there is lack of documented evidence.

For example; medical errors, hospital acquired disease are found in one

out of ten patients globally. The number of deaths annually is more than one lakh in the US. But, in India we don’t have any data. The National Accreditation Board for Hospitals and Healthcare (NABH) has started collection of data from the accredited hospitals,” Dr Kalra said.

Throwing light on how NABH is assisting healthcare providers in assuring quality to patients, he said, “Accreditation is a tested tool to bring quality and safety, it helps in bringing about a positive transformation in healthcare. It is a trend followed globally to maintain standards in healthcare delivery. However, accreditation is not an endpoint. Quality is a journey; one has to demonstrate continuous improvement time and again. There is a need for continuous quality improvement and the standards should be modified as per the needs.”

He also said that accreditation stimulates a culture of safety in the healthcare space. It ensures safe use of high risk medication, reporting errors, risk assessment and good governance. It also leads to best practices and innovation.

He suggested that clinical trials should also be accreditated. “Accreditation for clinical trials research is an integral part of advancement in medicine. We need to promote clinical trials in an ethical way. Very soon NABH will be coming out with the ethics committee for clinical trials,” Kalra added.

Summing up, Kalra pointed out that accreditation in healthcare is a simple measure. He also opined that NABH alone cannot bring about a transformation in healthcare delivery. He called for stronger and more meaningful collaborations between the government and private stakeholders to enhance the healthcare sector in India.

◗ Peer to Peer Networking ◗ Express Healthcare Excellence Awards Nite & Gala Dinner

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Accreditation is a tested tool to bring quality and safety,it helps in bringing about a positive transformation in healthcare

2016

PARTNER SESSIONS

Envisioning digital transformation in health

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SY Aravindakshan, National ManagerIndustry solutions (Healthcare), Microsoft India, in his session, spoke on how healthcare delivery is undergoing a digital transformation. He informed that digital technologies are taking hospitals to the patients and enhancing healthcare delivery.

Highlighting the huge shift in the healthcare industry, he pointed out, ”We have three strategic themes or pillars which can change the face of the healthcare delivery. First is the clinical excellence, second is patient engagement and third would be in terms of productivity.”

“Nowadays, patients have started to demand consistent digital experiences as they are looking for online sharing of

TSY Aravindakshan, | National Manager-Industry solutions (Healthcare), Microsoft India

KEY TAKEAWAYS + A major digital disruption is taking place in the healthcare industry and patients are moving from curative healthcare to health management and wellness + Three strategic pillars which can change healthcare delivery are clinical excellence, patient engagement and productivity + Hospitals should provide patients with a consistent digital experience

medical records and booking consultants. They also look for hospitals which have a mobile

app. There is a major digital disruption in healthcare industry and the patients are moving from curative healthcare to health management and wellness. Besides, the big focus is into care continuum where hospitals should explore to engage with patients long before they come to the hospital and long after they go out of the hospital. This requires a lot of technology enablement,” he added.

He also presented three video documentaries, case studies of technology enabling patient care in different ways.

Finally, Aravindakshan also informed the audience about the various digital solutions offered

by Microsoft to revolutionise the healthcare sector.

PARTNER SESSIONS

HAI- Howwill patients choose hospitals in future?

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im Galekop, Advisor Dispolin Inprev, India and Director TiGaMed, Belgium addressed a very crucial topic—hospital acquired infections (HAIs) and their far reaching, adverse effects on the the healthcare industry.

Galekop emphasised on the importance to curb HAIs by not just by controlling it but also taking effective measures to prevent it. In his view, the healthcare industry and hospitals should share the responsibility of eliminating HAIs. Stating, statistics he informed that out of all the HAIs, 40- 60 per cent of them are preventable. He also pointed out that preventing these infections

Tim Galekop, | Advisor Dispolin Inprev, India and Director TiGaMed, Belgium wouldn't cost as much money as it does to eliminate it after its occurence. Educating us further about HAIs and surgical site infections, he said, “Even globally developed countries are facing high levels of HAIs in their hospitals.”

Referring to antimicrobial drug resistance (AMR) as another huge issue, he explained that we are becoming resistant to antibiotics and spending a substantial amount on these drugs as the intake increases.

He focussed on infection prevention techniques and recommended measures to

implement them at all levels.

He also advised measures like aseptic techniques for contamination prevention, not reusing single use medical devices and minimal invasive techniques to reduce the incidence of HAIs in India.

He summed by highlighting that education hospital staff and the board would go a long way in curbing HAIs. He also stated that instilling discipline in hospital operations is key to control infections. Everybody working in the medical industry has a role to play in the reduction of HAIs.”

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HEALTHCARE SENATE 2016

PANEL DISCUSSION

Raising capital in healthcare

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he panel discussion on 'Raising capital in healthcare', addressed the issue of lack of access to capital in healthcare and deliberated on the funding trends in healthcare. Dr Rana Mehta, Partner & leader- healthcare, PwC India (moderator); Apoorva Patni, Director, Currae Healthcare & Currae Healthtech Fund; Dr N Krishna Reddy, Vice Chairman, CARE Group of Hospitals and Dr Harish Pillai, CEO, Aster Medcity, Kochi & Cluster Head-Kerala were the esteemed panelists for this discussion.

Dr Mehta commenced the session by talking about the transformations happening within healthcare and how they put India on the global map. He also drew attention towards the biggest deterrent to its growthlack of access to capital. He pointed out that beyond the top 10 players from the healthcare sector, access to capital still a huge concern. “In India, we have seen a a lot of process and product innovations within healthcare, however we do not see any financial innovations in this space, both in terms of funds deployment and in making healthcare more affordable and accessible”.

He asked Dr Reddy to list three or four imperatives for fund raising in healthcare. Dr Reddy replied, “It is important for both investors as well as providers to understand the dynamics of fund raising. One key area that will have significant impact is the role of government policies in healthcare. Be it universal health insurance, price control, quality regulations or emphasis on digital health, these policies will cause disruption within the sector and hence can have an influence on funding patterns as well as financial models. Accordingly, investors and providers will have to

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L-R: Dr Harish Pillai, CEO, Aster Medicity, Kochi & Cluster Head- Kerala; Dr N Krishna Reddy, Vice Chairman, CARE Group of hospitals and Apoorva Patni, Director, Currae Healthcare & Currae Healthtech Fund

KEY TAKEAWAYS +Biggest deterrent to the

Healthcare business will be a volume game,both providers and investors will need to leverage it wisely moderate their performance as per these changing scenarios.

Also, providers will have to think deeply and come up with strategies that can sustain in these changing environment.” He further stated that healthcare offers more periodic and timely returns to its investors. The growth of the sector will continue to rise at 20 per cent. Dr Reddy also highlighted that the business environment within healthcare is going to be a volume game with lower margins and driven by efficiencies leveraged by digital health.

Patni shared his company's experience as a technology provider and mentioned that the reason they entered the healthcare space was because they realised that this sector had immense opportunities for

technology adoption which would add value to their existing business. He also stated that healthcare technology sector has many white spaces which could be filled by them. Therefore, they created Currae Healthtech Fund with the idea to back entrepreneurs with disruptive ideas that will make healthcare more affordable and accessible. He said that they are seeing great success on that front.

Dr Mehta then asked Dr Pillai to share his perspectives on the funding trends in the global market vis-a-vis India. Dr Pillai, highlighting a paradox, stated, “The world looks at India as one market, but the fact is that we as a country have too many layers and several smaller markets.

Therefore, we can call ourselves the United States of India. As a

healthcare sector's growth is lack of access to capital +Government policies will influence healthcare financial models +Healthcare business will be a volume game +Leverage opportunities wisely +Providers need to keep the investors aligned to their business philosophy

healthcare market, India leverages clinical knowledge in various sectors. In healthcare per say, investors who focus on these aspects will continue to remain in this sunshine industry.

Dr Reddy further elaborated on the ethos set by Care Hospitals and how their business model has continued to please all their investors. He informed that Care Hospitals has received five rounds of investments and they have been successful in doing so because they enjoy a very good reputation. He emphasised, “Every hospital needs to stick to their philosophy of existence and

keep the investors aligned to your philosophy. Unless the investor is aligned to your philosophy, you will not achieve your goals. Stick to your value system and grow with this ideology. ” Dr Pillai also shared Aster's experience in fund raising and explained how they have kept their investors happy without diluting their business principles.

Later, Patni shared his viewpoint as an investor and stressed that business models which have a viable plan and a focussed approach to caregiving will certainly be winners.

Dr Reddy additionally indicated that investors should remember that healthcare will slowly move out of hospitals and therefore these disruptive models will need investor focus as well.

Taking the discussions forward, the panel provided investment trends for the coming times and summed up the session by reiterating that healthcare business will be a volume game—both providers and investors will need to leverage the opportunities available in a wise manner.

PANEL DISCUSSION

Balancing profitabilitywith responsibility

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he last session of Healthcare Senate 2016 saw CXOs of leading hospitals across the country share the stage to discuss a topic which has a lot of relevance, especially in the current times – Balancing profitability with responsibility. Amit Misra, Head – Consulting Services, North India, IMS Health moderated the session. The panelists were Joy Chakraborty, COO, PD Hinduja Hospital and Medical Research Centre; Dr Tarang Gianchandani, CEO, Jaslok Hospital; Dr Alok Roy, Chairman and MD, Medica Synergy; Dr J Sivakumaran, COO, Kovai Medical Center and Hospital; and Aloke Mullick, COO, KIMS were the panelists.

Misra the moderator began the session by asking each panelist about the measures implemented at their organisation to achieve this goal.

Improving operational efficiency, right pricing of services, using feedback from patients to reduce errors etc., were the suggestions given by experts to build a profitable yet responsible healthcare organisation.

Dr Gianchandani said that being responsible as a hospital involves various aspects such as being true to the organisation's values, being completely ethical and transparent, provide quality healthcare to all without any discrimination etc.

However, at the same time they have to ensure that it is a profitable venture as well. She explains that trust hospitals try to balance profitability and responsibility by offering subsidised or even free treatment to the needy but at the same time charge patients who can afford to pay for the services they get.

Dr Roy opined that social relevance and healthcare are

Amit Misra, Head – Consulting Services, North India, IMS Health; Dr Tarang Gianchandani, CEO, Jaslok Hospital; Dr Alok Roy, Chairman and MD, Medica Synergy; Aloke Mullick, COO, KIMS; Dr J Sivakumaran, COO, Kovai Medical Center and Hospital and Joy Chakraborty, COO, PD Hinduja Hospital and Medical Research Centre

KEY TAKEAWAYS + Social relevance and healthcare are deeply intertwined + Operational efficiency is paramount to balance profitability with responsibility + Quality would be the determenant which would drive patient footfalls to a hospital + Healthcare should be a shared value between all the stakeholders deeply intertwined. Therefore, healthcare is beyond just profitability and the social angle of the business should also be given a lot of importance. He also elaborated on the various measures that his hospitals have put in place such as educating the people about hy-

giene to prevent diseases, conducting health camps to spread access to healthcare facilities, etc.

Dr Mullick said that responsibility and profitability actually go hand-in-hand. Explaining further, he said that happy patients are the best way to attract more patients and thus make your organisation profitable. However, only a hospital which is aware of its responsibilities and ensures that they offer quality services in the most cost-effective manner and operate within an ethical framework can keep patients happy. He said that his organisation measures its progress on the basis of the patient feedback and they continuously take efforts to eliminate any concerns or complaints raised by the patients. This helps them to be both, respon-

sible and profitable.

Dr Sivakumaran recommended adoption of energy conservation as a measure to cut down costs. He said that these steps have helped them bring down operating costs considerably and also build a more environmentally sustainable organisation. In turn, the patients have benefitted in two ways— a better healing environment and more cost-effective services. He urged other hospitals to undertake such activities as well to strike a balance between profitabiltiy and responsibility.

Chakraborty said that constantly adding value to the services offered in terms of quality is how a healthcare organisation can be profitable and responsible. He urged accreditation as a way to achieve this and said that quality

would be the determinant which would drive patient footfalls to a hospital. He also spoke of being responsible and accountable to the people working in the hospital to ensure that they are happy and satisfied. This, in turn, would also drive quality and the end beneficiaries would be the patients.

The moderator also led the discussion to other interesting areas such as the outreach programmes undertaken by hospitals to help improve health access, steps to achieve financial sustainability, making healthcare a shared value between all the stakeholders, building trust in patients' mind etc. The audience appreciated the session and interacted with the panelists for further clarity on different aspects of healthcare delivery.

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HEALTHCARE SENATE 2016 AWARDS

Express Healthcare Excellence Awards held at Healthcare Senate 2016 Recognises the pathfinders, innovators and game changers from the private healthcare industry

H

ealthcare Senate 2016, the National Private Healthcare Business Summit, held from 22-24 September, 2016 at HICC, Hyderabad, concluded with the Express Healthcare Excellence Awards.

Partnered by United Biotech, it sought to recognise the pathfinders, innovators and game changers from the private healthcare industry for their invaluable contrbutions to healthcare in India.

Held on 24 September, 2016, a packed hall awaited to know the winners of the first edition of Express Healthcare Excellence Awards. The evening began with an inaugural address by the Guest of Honour, Lav Agarwal, Joint Secretary, Department of Health & Family Welfare. He lauded Express Healthcare’s initiative to recognise healthcare leaders. He also highlighted that health is a priority area for the government and gave an overview of the various initiatives undertaken to improve healthcare in the country.

RK Diwan, Executive Director, United Biotech, sponsors of Express Healthcare Excellence Awards 2016 also took the stage to give the welcome note. He expressed his pleasure in being a part of the event and spoke on the need to appreciate healthcare leaders in the country.

Ms Viveka Roychowdhury, Editor, Express Healthcare explained the categories for the awards and the rigorous process undertaken to choose the winners.

She also introduced the eminent jury comprising Dr KK Kalra, CEO, NABH; Prof Marriappan, Chairperson, Centre for Hospital Management, School of Health Systems Studies, Tata Institute of Social Sciences (TISS), Mumbai; Dr Ragini Mohanty, President

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Innovation, Head—Healthcare Management Programmes, Principal L N Welingkar Institute of Management Development & Research; Mr Bejon Misra, International Consumer Policy Expert, and Founder at Partnership for Safe Medicines (PSM) India; and Mr Kewal Handa, Promoter, Director, Salus Life Care. Dr Kalra, Prof Mariappan and Dr Mohanty were present at the ceremony and gave away the awards to the winners alongwith Mr Agarwal, Ms Roychowdhury and Mr Diwan.

The eight winners across four categories were: ✦ Express Healthcare Excellence Award for Innovative Marketing Practices: It went to Narayana Health (Registered as Narayana Hrudayalaya Ltd) for creating patient education videos and awareness materials across all the specialities which NH specialises in and effectively utilising the Internet to reach out to a large audience. ✦Express Healthcare Excellence Award for Inspirational Workplace: Lotus Hospitals for Women and Children, Hyderabad bagged the award for their initiatives to build a result-oriented organisation capable of making rapid decisions and create a highly competent workforce that can support it at every level ✦Express Healthcare Excellence Award for Corporate Social Responsibility: There were two winners in this category.

Six Sigma Star Healthcare (P) Ltd won it for their endeavour to provide free medical treatment to needy people, stuck up in high altitudes.

Indraprastha Apollo Hospitals, New Delhi bagged

the award for their CSR project ‘A Healthy Start’ which attempts to improve access to sanitation and clean drinking water as well as spread hygiene awareness among underprivileged school children.

Express Healthcare Excellence Award for Patient Care: This crucial category had four winners.

They were: ✦PD Hinduja Hospital & Medical Research Centre, Mumbai for their initiatives to provide quality healthcare for all. ✦Aster Medcity, Kochi, for their innovative robotic system which has reduced waiting time, eliminated dispensing errors and simplified inventory management. ✦Indraprastha Apollo Hospitals, New Delhi for their successful initiatives to reduce the numbers of errors and improve overall safety of high-alert medications. ✦Satguru Partap Singh Hospitals, Ludhiana for development of dedicated tracheostomy care nurses to decrease complications and ICU readmission rate of tracheostomised patients.

The winners thanked Express Healthcare for recognising their initiatives and vowed to continue their good work for the betterment of people. The Express Healthcare Excellence Awards was a true celebration of the spirit of excellence and leadership in healthcare delivery in the private sector.

The inaugural edition of Healthcare Senate 2016 came to a close with a vote of thanks to all the dignitaries, speakers, delegates and winners for making the event a resounding success.

EXPRESS HEALTHCARE EXCELLENCE AWARD FOR INNOVATIVE MARKETING PRACTICES

EXPRESS HEALTHCARE EXCELLENCE AWARD FOR INSPIRATIONAL WORKPLACE

EXPRESS HEALTHCARE EXCELLENCE AWARD FOR CORPORATE SOCIAL RESPONSIBILITY

NARAYANA HEALTH

LOTUS HOSPITALS FOR WOMEN AND CHILDREN

SIX SIGMA STAR HEALTHCARE (P) LTD

EXPRESS HEALTHCARE EXCELLENCE AWARD FOR CORPORATE SOCIAL RESPONSIBILITY

ESTEEMED JURY

EXPRESS HEALTHCARE EXCELLENCE AWARD FOR PATIENT CARE

INDRAPRASTHA APOLLO HOSPITALS, NEW DELHI

DR KK KALRA, PROF MARRIAPPAN, DR RAGINI MOHANTY, BEJON MISRA AND KEWAL HANDA

PD HINDUJA HOSPITAL & MEDICAL RESEARCH CENTRE, MUMBAI

EXPRESS HEALTHCARE EXCELLENCE AWARD FOR PATIENT CARE

EXPRESS HEALTHCARE EXCELLENCE AWARD FOR PATIENT CARE

EXPRESS HEALTHCARE EXCELLENCE AWARD FOR PATIENT CARE

ASTER MEDCITY, KOCHI

INDRAPRASTHA APOLLO HOSPITALS, NEW DELHI

SATGURU PARTAP SINGH HOSPITALS, LUDHIANA

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HEALTHCARE SENATE 2016 HEALTHCARE IT AWARDS he Winners at the maiden Healthcare IT Awards were felicitated in different technology categories like Artificial Intelligence, Big Data, IoT, EHR, Cloud, CRM, Data Centers (Infrastructure Transformation), EMR, Mobile Apps, Enterprise Mobility, Networking.

The awards were presented to the winners by the Chief Guest, Dr. A. Velumani, Promoter, Chairman, Managing Director and Chief Executive Officer, Thyrocare Technologies

Care Hospitals

MIOT Hospitals

Fortis Healthcare

Manipal Hospitals

Max Healthcare

Nayati Healthcare

Sir Ganga Ram Hospitals

Ruby Hall Clinic

Jaypee Healthcare

Apollo Hospitals

SRL Diagnostics

T

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HEALTHCARE IT SESSIONS

Use cases of Internet access management Keynote Address: Healthcare’s digital future: in healthcare : Samiksh Aggarwal, Asst. VP, Sumit Puri, CIO, Max Healthcare Sales, Data Networks, Sterlite Technologies

The role of cloud in driving efficiency : Dilip Ramadasan, CIO & CTO, Dr Agarwal's Eye Hospital

Global Trends in Imaging IT: Robin Gu, Marketing Head, APAC, Agfa Healthcare

How 3D printing can transform healthcare: Dr Mahesh Kappanayil, Senior Cardiologist, Amrita Institute of Medical Sciences

Agfa Healthcare Power Discussion

Data Security for the Digital Healthcare Industry : Noman Khan, Regional Business Manager, Seqrite – Enterprise Security Solutions by Quick Heal

Niranjan Kumar, CIO, Sir Ganga Ram Hospital introduced the ‘Healthcare Tech’ platform to the congregation of Healthcare IT professionals

[L-R] Sumit Singh, CIO, WockHardt Hospitals, Veneeth Purushotaman, CIO, Fortis, Deepak Sagaram, CIO, Global Hospitals, T.S.Y Aravindakshan,National Manager, Healthcare, Microsoft, Niranjan Kumar, CIO, Sir Ganga Ram Hospitals, Vishal Gupta, GM-IT, Suasth Healthcare

Tech-Themes that are changing the face of Healthcare :Nagendra Balasubramaniam, Account Executive, Microsoft

Power Back up Solutions: Suraj Kumar Singh, Head - Institutional UPS (South), Exide Industries Limited

Ensuring information security in healthcare: Ishaq Quadri, Group CIO, KIMS Healthcare

Video conferencing solutions for healthcare segment: Kaushal Singh, Head Sales, HDVC Panasonic

Innovation versus RoI challenge: Dirk Dumortier VP Sales Enablement & Healthcare Solutions, APAC, Alcatel-Lucent Enterprise

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October 2016

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

‘We are working in the direction of citizen empowerment through information dissemination’ Government of India’s National eHealth Authority (NeHA) will accelerate adoption of electronic health records (EHR) of patients. It will provide a well-connected ICT platform that can inter-operate across healthcare providers, both in public and private sectors, without compromising on patients’ confidentiality, informs Jitendra Arora, Director (eHealth), MoHFW, in a tete-a-tete with Prathiba Raju

NeHA will map the landscape of eHealth. It will monitor and evaluate eHealth uptake in India and also increase involvement of states by promoting to set up state health record repositories and health information exchanges What will be the role of NeHA? Ministry of Health and Family Welfare (MoHFW) has envisaged NeHA as the statutory body to promote and adopt eHealth standards, of storage and exchange of EHR standards in India. It will focus on areas like policy and promotion; standard development; legal aspects including regulation, privacy and security

of health data, health exchange and capacity building. NeHA’s first draft note is ready, but it would be further refined. Later, it will be submitted to the Union Health Minister, JP Nadda by the end of October 2016.

Why is NeHA essential?

Various regulatory aspects like privacy, security, access, disclosure and exchange will be taken care of by the proposed NeHA.

Every country, during the adoption of national e-health strategy, has focussed on developing an authority or agency that would take care of key regulatory and promotional issues. It is necessary to maintain privacy and confidentiality of patients’ health records. The National Knowledge Commission (NKC) in 2009 had recommended for the establishment of a National Health Information Authority (NHIA) to maintain the flow of information between various healthcare establishments and provide guidelines in the context of maintenance and use of EHR. NeHA will map the landscape of eHealth. It will monitor and evaluate eHealth uptake in the country and also increase the involvement of states by promoting to set up state health record repositories and health information exchanges.

What are the focus areas outlined under Digital India Programme for health?

Digital India Programme prepared by the Ministry of Electronics and IT covers in its ambit the use of ICT in healthcare. The programme envisages online medical consultation, online medical records, online medicine supply and pan-India exchange of patient information.

Can you tell us about the latest measures on eHealth

by MoHFW? The Union Health Ministry has been progressively using ICT under the overall objective of Digital India programme. We are working in the direction of citizen empowerment through information dissemination. A host of online services have been launched. These include National Health Portal (NHP) for one-stop authentic health

information to citizens and ORS – the portal for getting online hospital appointment and test reports (http://ors.gov.in/), which is running successfully in AIIMS Delhi.

Potential use of mobile technology is also being harnessed in several ways for strengthening and widening the reach of various services as well as increasing citizen participation through various mobile apps viz. Indradhanush immunisation programme, monitoring and reporting of dengue; Swasth Bharat and mobile health initiatives like tobacco cessation, mDiabetes; mHealth initiatives like Kilkari, mobile academy and ANMOL (ANM online) -IVR-based services for parents of children and frontline health workers.

What are the key problems and challenges faced by the current eHealth system in

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IT@HEALTHCARE

India?

The main problem and challenge we face is the compartmentalised approach.

Take any IT system, they work in silos. The other issue is of data duplication, maintenance of multiple registers, delay and errors in data entry due to manual processes.

What is MoHFW’s vision for eHealth?

MoHFW has envisaged establishing a system for interoperable EHRs of citizens, which will be created, made available online and would facilitate patients with better health outcome, affordability and decision support system.

To set up a robust EHR system, one of the key requirements is implementation of EHR Standard-compliant Hospital Information System (HIS) in all the hospitals, healthcare facilities and setting up of an Integrated Health Information Platform (IHIP).

What is the status of HIS in public healthcare facilities?

As far as roll out of HIS is concerned, NIC team at Tripura has already developed cloud compatible ‘eHospital’ application, which is compliant with EHR standards. All the central government hospitals, AIIMS pan India and other autonomous hospitals under the health ministry are implementing e-Hospital in a time bound manner. All the states and UTs have been requested to adopt EHR standards in all e-health applications and implement eHospital application. No hospital has so far introduced EHR standards fully, although a few hospitals have worked on it partially. So far, Tamil Nadu and Gujarat have already implemented HIS solutions developed by TCS in public health facilities. Haryana and Kerala have awarded contract to private vendors for implementation of EHR compliant Hospital Management Information System (HMIS) in their states.

What are the current challenges in adopting EHR

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standards?

There is a need to standardise EHR maintained by different hospitals, to ensure that these records are shared across other clinical establishments. Therefore, the ministry has decided to implement the standards for seamless information flow and smooth movement of health records of beneficiaries across hospitals.

The Indian healthcare system being diverse, ranging from private, corporate and large public hospitals to single doctor clinics, throws up huge challenges in adoption and implementation of EHR standards. However, while recommending the EHR standards, due consideration was given to ensure that these standards are implementable with ease by public hospitals, corporate hospitals of various sizes, diagnostic centres as well as small rural public healthcare facilities and establishments.

Doctors and other service providers need to adjust their work flow in order to incorporate EHR use, and also to use the information gained for continuous improvement of healthcare delivery.

Implementation of EHR improves clinicians’ decisionmaking by providing access to patient health record information when they need it.

It also streamlines the clinician’s workflow, cuts delays, plugs gaps in care, helps in reducing medical errors and ensures rationalisation of treatment and avoidance of duplication of investigations.

When did MoHFW notified the EHR standards and why is it being revised now ?

The EHR standards were notified by the government in September 2013 after wide consultation with domain experts and stakeholders. We also placed the revised draft in public domain till March 2016 and sought comments/views.

More than 100 comments were received from various stakeholders including general public. EHR review committee members have reviewed these comments and updated the revised EHR standards for India

2016 document. EHR standards is a living document required to be updated every two years due to change in advancement in technologies and global standards and therefore it is currently under revision. The updated version will be notified shortly.

Which clinical standards has been adopted in the notified EHR Standards?

EHR standards include Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) which provide a consistent terminology across all healthcare domains. This allows clinicians to communicate effectively and accurately across clinical domains and over the lifetime of a patient record.

however, understanding SNOMED CT and its implementation for its adoption is important. The Union Health Ministry has designated C-DAC, Pune as interim National Release Centre (iNRC) for distributing and managing SNOMED CT license within India.

What is the current situation on protecting health data privacy in India?

In India, a statute specifically protecting health data privacy does not exist. Health legislation in India is specific to certain health conditions including mental or physical illness, disability, communicable diseases and HIV/AIDS; and covers some privacy aspects.

The MoHFW has assigned

We have empanelled private vendors from nine regions to facilitate the roll-out of e-hospitals in states.They will help hospitals identify ICT infrastructure gaps, software configuration, functionality and impart training.The EHR will be rolled out in a phased manner pan India and the target is to complete it by 2020 How can IT vendors and hospitals get the SNOMED CT licence in India ?

To obtain a country licence, India has become a member of International Health Terminology Standards Development Organisation (IHTSDO) in April 2014, which owns and administers the rights to SNOMED-CT by paying membership fee every year.

Presently, 28 countries are members of this organisation.

Vendors can use SNOMED-CT Standards of IHTSDO 'free of cost' to develop various EHR products for use in India.

SNOMED CT is available for usage in the country,

drafting of Electronic Health Data Privacy, Confidential and Security of India Act work to 'National Law School of India University (NLSIU)' and a first draft is ready. The 'substantive part' of the law is regarding confidentiality, privacy, ownership of health data and establishment of NeHA. How will the government implement eHospital application of NIC in a time-bound manner across the country ?

To facilitate eHospital implementation, we have empanelled private vendors from nine regions who will assist

states in the roll-out of e-Hospital. They will help hospitals in identifying the ICT infrastructure gaps, software configuration, functionality and imparting training.

Manpower for hand-holding can also be hired through these empanelled vendors for any length of term depending upon the requirement of different hospitals. For smooth implementation, the MoHFW has framed implementation guidelines elaborating various steps to be followed with a defined timeline. Roll out of EHR will be in phases and is targeted to be complete by 2020.

How do you plan to achieve interoperability between health IT systems?

The ministry has envisaged setting up of an Integrated Health Information Platform (IHIP) for interoperability between health IT systems. IHIP is expected to address various key issues and challenges for different stakeholder groups such as fragmented information systems, accessibility and quality of data, duplication of data collection – data redundancy, sub-optimal resource utilisation— due to duplicate information systems, and most importantly, owing to the lack of common EHR system.

How will the proposed IHIP help patients and citizens?

Today, most of the patient records have a decentralised storage, and get trapped in multiple healthcare facilities such as primary care, specialists, hospitals, pharmacy, home healthcare etc. IHIP will work to enable the EHRs of citizens to be made available nationwide with the help of a centralised accessible platform.

It will facilitate continuity of care, confidential and secure health data or records management, better affordability, optimal information exchange to support better health outcomes, better decision support system, fewer redundancies and medical errors, low data redundancy, big data analytics etc. prathiba.raju@expressindia.com

STRATEGY INSIGHT

India’s march toward’s universal health coverage: Lesson’s from RSBY Maurya Dayashankar, Assistant Professor & Chair Healthcare Management, TA Pai Management Institute Manipal India and Asher Mukul, Professorial Fellow, Lee Kuan Yew School of Public Policy, Singapore, argues about the critical issues existing in social health insurance programmes like the Rashtriya Swasthya Bima Yojana (RSBY)

L

imited financial protection and risk-pooling in healthcare is an important contributor to uncertainty and volatility in financial status of the Indian households. Last decade has seen rapid expansion of health insurance coverage, and at present 23 per cent of the population have some form of health insurance coverage compared to 2005 when merely five per cent of the population was covered. Rashtriya Swasthya Bima Yojana (RSBY), covering around 120 million population across 29 states, is one of the biggest drivers of expansion in health insurance coverage. Therefore, it is being viewed as a promising approach to expand health insurance coverage.

In Union Government Budget 2016-17, RSBY received a new taxonomy as Rashtriya Swasthya Suraksha Yojana (RSSY). In addition to new name, the coverage of the scheme has been increased to `100,000 from present `30,000 and budgetary allocation in 2016-17 has been pegged at `1500 crores. Although resources has been increased, the design and implementation of the scheme has remained untouched. We argue that there are critical issues at the level of the design and implementation, which must be sorted out before it expands

TABLE 1: EXPENDITURE ON RASHTRIYA SWASTHYA BIMA YOJANA Year

Total Expenditure (in INR crore)

Central Government (in INR crore)

State Government** (in INR crore)

2016-17

1875

1500*

148.75

2015-16

743.75

595

375

2013-14

1466.7

1100*

366.7

2012-13

1409.3

1057

352.3

2011-12

1230.7

923

307.7

2010-11

678.7

509

169.7

* Planned outlay data not actual expenditure ** Computed based on central government expenditure. Central Government contributes 75% of the total premium (except Jammu and Kashmir where their contribution is 90% ) (Source: Computed from expenditure budget Ministry of Labour and Ministry of Finance)

further.

Launched in 2008, RSBY is primarily targeted at the below poverty line (here by referred to as BPL) populationi. It also includes specific vocational groups such as domestic workers, Beedi workers and construction workers, etc. The states can enroll non-BPL households but they must bear full cost of these households.

The scheme is voluntary, families who are in the state BPL list or specific vocational group can enroll in the scheme by paying `30 as a registration fee. On enrolment, they get a smart card which has biometric information of the beneficiary and this card can be used throughout India at any RSBY approved hospital.

The benefit package comprises a maximum insured

sum of `30,000 per BPL family per annumii. Any family member can avail of this sum. The benefit package of the scheme covers hospitalisation expenses (including OPD expenditureiii and transportation expenditureiv) of all diseasesv including pre-existing diseases. There is no user charge or co-payment at the time of utilisation of service as the scheme is 100 per cent prepaid.

The scheme is funded through general taxes where state and central government both contribute. Central government pays 75 per cent of the total funding and state government pays remaining 25 per cent vi. Beneficiary only pays a token amount of `30 as a registration fee per annum. In the Union Budget 2013-14,

` 1466.7 crores was allocated to RSBY scheme (both Central and state government combined together).

Families who are in the state BPL list can enroll in the scheme by paying `30 as registration fee. Till 2014, 37.7 million families were enrolled in the scheme. On enrollment, they get a smart card which has a photo of the head of family, thumb impression of four other family members and value of `30000. This card can be used throughout India at any RSBY network hospital.

By 2014, more than 12000 hospitals (both public and private) across 29 states were empanelled in the scheme. The BPL family, when falls ill visits the network hospital. Providers at the network hospital diagnose the case, select the appropri-

MAURYA DAYASHANKAR Assistant Professor & Chair Healthcare Management, TA Pai Management Institute Manipal India

ASHER MUKUL Professorial Fellow, Lee Kuan Yew School of Public Policy, Singapore

ate procedure from the list of 1094 packages, and block the package amount in the card.

The provider after completing the treatment fills in the case details through an online claims database and submits the claim, which TPA is supposed to reimburse within 30 working days.

The scheme is implemented through a Public private partnership (PPP) mode, where state government contracts with an insurance company to provide defined health insurance coverage to a defined population in a district on the basis of a premium per family decided through a competitive bidding process. The insurance company provides health insurance coverage, and defined healthcare services in collaboration with other agencies and healthcare facilities from both public and private sector.

RSBY scheme performance Success of any health insurance programme in developing country context, depends on containing cost and providing good quality care that is accessible and affordable to the population who would have not utilised the care in absence of programme or otherwise would have incurred catastrophic cost. The present scheme design and implemen-

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STRATEGY

tation approach while trying to achieve all of this but at the same time fails to do so, which must be sorted out before it can be expanded further.

Within a span of six years, the coverage of the scheme has increased to approximately 120 millionvii which is estimated to around 53 per cent of the BPL population of the districts in which the scheme has been implemented. Performance in the utilisation function can be measured by the hospitalisation ratio, which is rate of hospitalisation among the enrolled beneficiary. In the context of the RSBY scheme, higher hospitalisation rates can be considered a desired performance goal given the population to which the programme is targeted. By March 2015, there were more than 11 million hospitalisation under the scheme.

A number of studies have raised issue of overall effectiveness of the scheme in terms of reducing healthcare expenditure of the targeted population (Saharawat and Rao 2011’ Selvaraj and Karan 2009) but they ignore the fact that although the benefit package included all expenses in principle, in practice beneficiaries spend considerable amount of money on drugs, investigations, travel and food during a hospitalisation episode (La Forgia and Nagpal, 2012).

Institutional design issues First, though the coverage has increased but access to healthcare among the intended beneficiary is still limited because of scheme’s approach to identify beneficiary. The scheme is mainly targeted towards low income groups and relies on the state Below Poverty Line (BPL) lists to identify BPL population. But these BPL lists have extensive errors leading to high leakage. Dreze and Khera, (2010) found that in state of Andhra Pradesh, 57 per cent of the households listed as BPL actually do not belong to the BPL category.

Example of Himachal Pradesh is illustrative in terms of how they have overcome these deficiencies by continually revis-

40

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ing BPL lists after every enrolment. There is a need to urgently improve database and dynamically maintain database of intended household beneficiaries to bring exclusion and inclusion errors within internationally benchmarked range.

Second big issue is ensuring quality of the service provided. Health insurance programmes are known to have threat of spiralling cost due to unnecessary healthcare provision (supplier induced demand) and utilisation (moral hazard) because of the perverse incentives to providers and patients. In order to contain cost, RSBY scheme pays insurance companies a fixed premium per year for a family, who then pay providers a fixed price for providing a package of services for defined disease category. When a fixed price payment method is used, bidders bid aggressively to get the contract but, shred quality in order to reduce cost, induce

demand and get engaged in fraudulent activities. Therefore monitoring quality, supplier induced demand and ensuring accountability for unethical behaviours becomes critical during policy implementation. In RSBY scheme quality monitoring is limited and at present there is no link between quality and payment.

For many activities the standards have been defined but are not monitored and do not play a significant role in awarding of contracts either to insurance company or hospitals. Investment in quality can save cost in long run but the short duration of the contracts in RSBY further reduces incentives to agencies in investing in quality. In absence of quality monitoring, both insurance company and healthcare providers have incentive to reduce quality to cut costs. Insurance companies in order to get contract bid aggressively that has led to unsustainable premiums. In recent biddings

the premiums have gone as low as `169 out of which insurance company has to pay out at least `100 only for making smart card and thus they are left with only `69 to provide health insurance coverage of 30,000 per year for a family.

Similarly healthcare providers get empanelled in the scheme even though the package rates in RSBY are lower than market price anticipating that they can make up by inducing demand and providing low quality services.

Poorly defined packages and lack of standardisation of medical care provides ample discretion to providers, in terms of package choice, course of treatment and quality of service. Providers select low-cost cases, choose a higher paying package, select the cheapest treatment plan, use low quality instruments, consumables and drugs, and discharge patients prematurely leading to a low quality low cost service (La Forgia and Nagpal 2012). Thus

RSBY has emerged as low cost scheme providing low quality services, leading to underutilisation and thus provides limited financial protection to targeted population groups.

Ensuring quality of the contracted services requires monitoring specially by district level agencies who are responsible for facilitation and monitoring of the scheme implementation. Studies (Maurya, 2015; Asher et. al., 2015) suggest that district level agencies lack accountability, motivation and incentive to make the scheme work and if the rent seeking opportunity is available they collude with private agencies, leading to fraudulent and benefit-cheating behaviourviii, fourth key issue in the scheme.

The role of district administration is to facilitate implementation of the scheme specifically supporting insurance company, in enrolment of beneficiary and empanelment of the hospital as insurance

STRATEGY

company being an outsider in the district is dependent on district administration. The district administration tends to exploit this dependence of the insurance company and seek rent in lieu of the providing support. District administration also serves as arbitrator for the disputes between agencies at the district level which further bolsters veto power of the district administration. District administration use their clout to pressurise insurance company to empanel their favoured hospitals in return of the support they provide during enrolment.

A number of hospitals have sprung up in rural areas to capture the money coming from this scheme (International Insurance News, 2011), and anecdotal evidence suggests that many of these hospitals are owned and managed by friends and relatives of those involved in the scheme.

These hospitals collude with public agencies (more specifically district administration) to get empanelled (i.e. to become officially approved provider of healthcare services) in the scheme and once empanelled the hospitals under the immunity of these officials get engaged in extensive frauds.

When the claims reach a threshold level, insurance companies, because of the inability to control frauds end up behaving opportunistically denying and delaying claims payment resulting into non-provision of care. Opportunism in hospital empanelment attract fraud prone hospitals in the scheme.

If agencies foresee possibility of opportunism in the hospital empanelment and claims management, they behave opportunistically even during enrolment of the beneficiary leading to a vicious cycle of opportunism and counter opportunism.

Fourth critical issue limiting effectiveness of the scheme is shorter investment cycle. In the present design, the contract is renewed every year in the scheme, providing agencies limited time for learning and investment, as the invest-

The RSBY could bring traditional medicine aspect (including Yoga) which is more conducive for preventive medicine, rather than relying solely on curative care.

The Ministry of AYUSH could be made an integral part of the RSBY ment cycle is too short.

Shorter durations of contracts prevent agencies from investing in strategies for improving scheme performance, like pricing of the premiums and investment in preventive healthcare. One of the critical process in the scheme implementation is the enrolment of beneficiary. At present, this is repeated every year causing great inconvenience to both the beneficiaries and implementing agency, disrupting the delivery of the services. Every year contracting adds to the transaction cost and provides recurrent rent seeking opportunities to the stakeholders involved in the process. Increasing duration of the contract, will increase the investment cycle and reduce opportunity for rent seeking and disruption in services.

Economic theory suggests that insurance as financing tool is efficient for low risk and high cost conditions such as tertiary care. RSBY mainly covers secondary care (and primary care as providers convert ambulatory care to hospitalisations) as the highest claims were made in the category of elective surgeries like cataract (26.4 per cent) and therefore rather than insurance these high risk and low cost conditions would be more efficiently covered by other financing tools than insurance.

As public programmes for healthcare proliferate there is a need for moving away from a scheme based approach to systemic integrative outcome based approach. There are three areas which may be sug-

gested to enhance coherence and greater systemic approach which in turn could improve effectiveness of the RSBY. First is to move beyond just shifting to the RSBY scheme to the Ministry of Health as undertaken by the NDA government elected in May 2014, where it should have been located since its inception. Though at the national level, the scheme has been moved to the ministry of health , but at the state level, the scheme is implemented by non-health departments leading to coordination and convergence gaps between RSBY scheme and state public health system. Bringing in health department will also improve control over public hospitals, which are one of the big stakeholders in the scheme, as observed in states like Punjab and Himachal Pradesh. The RSBY design and provisions need to be integrated with objectives of other programmes of the Ministry. Shifting of the ESIS (Employee State Insurance System) which is a mandatory scheme for health care provision for covered private sector workers, from the Ministry of Health and Family Welfare to Ministry of Labor.

All major health schemes should be within the Ministry of Health for better policy coherence, and provision of integrated set of programmes and schemes. The second area concerns encouraging the development of medical devices sector, health care technologies and traditional medicine, which are becoming increasingly relevant for health care

delivery in an affordable manner. The RSBY (and healthcare services in other schemes) thus could bring traditional medicine aspect (including Yoga) which is more conducive for preventive medicine, rather than relying solely on curative care. The Ministry of AYUSH could be made an integral part of the RSBY (and ESIS).

RSSY with increased coverage, has a good potential for up scaling further given its unique design and extensive use of technology (use of Smart Cards for identification of beneficiary, online claims monitoring) provided certain design and implementation issues are addressed to prevent low cost, low quality service which is contributing to underutilisation of the scheme by beneficiary and thus providing inadequate financial protection.

References Asher M., Vora Y.,& Maurya D (2015). An Analysis of Selected Pension and Healthcare Initiatives for Informal Sector Workers In India, Social Policy & Administration, Vol 6.

GIZ (2005), “Health Insurance For India’s Poor: Meeting the Challenge With Information Technology” Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Accessed from http://health.bmz.de/goodpractices/GHPC/Health_Insurance_India_New/index.html International Insurance News (2011), Low Cost Indian Health Insurance Spurring National Healthcare Investment: International Insurance, 12 May, http://www. globalsurance.com/blog/lowcost-indian-health-insurancespurring-national-healthcareinvestment-354920.html (accessed 22 June 2015).

La Forgia, Gerard, and Somil Nagpal. 2012. GovernmentSponsored Health Insurance in India: Are You Covered? World Bank Publications.

Maurya D. (2015) Inter-Organizational Relations In Public Private Partnerships: National Health Insurance in India Un-

published Thesis National University of Singapore Reddy, S., Sakthivel Selvaraj, Krishna D. Rao, Maulik Chokshi, Preeti Kumar, V. Arora, S. Bhokare, and I. Ganguly. 2011.

“A Critical Assessment of the Existing Health Insurance Models in India.” A Report Submitted to the Planning Commission of India, January, New Delhi.

Selvaraj, Sakthivel, and Anup K. Karan. 2012. “Why PubliclyFinanced Health Insurance Schemes Are Ineffective in Providing Financial Risk Protection.” Economic & Political Weekly 47 (11): 61–68.

Shahrawat, R., and K. D Rao. 2011. “Insured yet Vulnerable: Out-of-Pocket Payments and India’s Poor.” Health Policy and Planning.

The Financial Express. April 1 “The Soaring Cost of Medical Inflation.” 2015. http://www.financialexpress.com/article/industry/insurance/the-soaringcost-of-medical-inflation/59590 (i)BPL population in India is considered as those earning less than a dollar per person per day. (ii) The Benefit package has been revised in 2016-17 budget to 100, 000 INR per family per year. (iii) Includes OPD expenditure for five days before hospitalization and post hospitalization visits (including lab investigations). (iv)Transportation assistance of 100 rupees per visit up to a maximum of 1,000 rupees per year (10 visits a year). (v) The conditions which are not included are congenital external diseases, drug and alcohol induced illness, sterilization and fertilityrelated procedures. (vi)Except in case of J& K and North Eastern States where state governments 10% of the premium and Government of India contributes 90 per cent . (vii) As of April 2014 (GIZ, September 2015) (viii) Opportunism leads to benefit-cheating which reduces fairness and adversely affects intended outcomes of the RSBY

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CRITICARE

CRITICAL CONNECTIONS How can technology assist intensivists to reach more patients through eICU? An analysis.

BY M NEELAM KACHHAP

T

ranscending past shortage of doctors, eICUs are making their presence felt in India. The first eICU was deployed in India about four years back. Since then this new technology has had a slow but steady growth, with early adopters in North and

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South Indian cities. With the benefits stacking up for it, eICU will not take long to penetrate the far ends of India even the neighbouring countries.

Almost all hospitals be it private or public has intensive care unit (ICUs). If you look closely these 10-20 beds

which are separate section at any hospital are always full.

For many, ICUs seems like a place that admits patients of poly-trauma (accidents) mostly, but given the rising incidents of new age infections diseases like dengue, Chikungunya, swine flu and Zika coupled with rising bur-

den of geriatric population, ICU are in demand more than ever.

"In India five million patients require ICU care but only 70,000 ICU beds are available," says Dr Amit Varma, Executive Director, CritiNext, Fortis Escorts Heart Institute (FEHI), Delhi.

CRITICARE

eICU is a technology-enabled remote critical care monitoring solution and is based on Hub and spoke model.

The Hub being a technology-enabled centre, where clinicians are available 24/7

eICU has the potential to focus on untapped opportunities, geographic locations and underserved segments in the developing world

There is a requirement of about 50,000 trained intensivists in the country while there may be only about 8500 trained intensivists and every one of them in a metro city

Dr Amit Varma

Dr Arindam Kar

S Shankar

Executive Director, CritiNext, Fortis Escorts Heart Institute (FEHI), Delhi

Director, Medica Institute of Critical Care, Medica Superspecialty Hospitals, Kolkata

Senior Director and Business Head, Patient Care and Monitoring Solutions, Philips Healthcare

Outlining the need for more ICU beds as he points out that changing demographics that yield a higher proportion of geriatric individuals in the overall population will further increase the burden on supply side infrastructure.

Putting the shortage of ICUs into perspective, Dr RK Mani, CEO-Medical Services, Chairman Pulmonology & Critical Care Medicine, Nayati Healthcare, Mathura says, "There is no formal survey data available. But if we consider data from the vendors who supply ventilators to ICUs, we see that we have no more than 320 centres and 30,000 registered ICU beds against a requirement projected to be 1.2 million for the population." And it seems like eICUs are the only visible solution for this growing critical care crisis.

Lack of trained manpower is another crisis, the critical care is facing in India. ICUs admit critically ill patients with a wide range of life threatening ailments. This needs special expertise primarily observation and prompt action which is pro-

vided by skilled doctors, nurses and specialised machinery. Like the rest of healthcare delivery, ICUs also struggle with huge manpower demand supply gap.

At first sight, ICU and intensivists seem to be in short supply in India. But the fact is that the medical education system did not upgrade courses to train enough doctors to be intensivists until a few years back.

"Intensive care is an emerging super speciality in India although in the developed world it has been so since the 1980’s. MCI has recognised it as a super speciality in 2009. Until then, there were no postgraduate courses offered by the government. The only training courses (IDCCM, FICCM) available until then were run by the professional bodies such as the Indian Society of Critical Care Medicine (ISCCM)," informs Dr Mani.

Even then the number of trained intensivists is nowhere near the required figure.

"There is a requirement of about 50,000 trained intensivists in the country while

there may be only about 8500 trained intensivists and every one of them in a metro city," laments Dr Arindam Kar, Director, Medica Institute of Critical Care, Medica Superspecialty Hospitals, Kolkata.

So, how does eICU solve this problem? With the help of specialised software, cameras, microphones, and highspeed computer data lines, intensivists connect to patients virtually. “eICU is a technology-enabled remote critical care monitoring solution and is based on Hub and spoke model. The Hub being a technology-enabled centre, where clinicians are available 24/7 to monitor the remote locations. Hub provides round the clock clinical decision support in the form of clinical assistance and realtime monitoring of vitals, ventilators, labs and all critical care information about the patient," explains S Shankar, Senior Director and Business Head, Patient Care and Monitoring Solutions, Philips Healthcare. "eICU provides 24x7 coverage and remote monitoring assistance to bed side team

eICU provides 24x7 coverage and remote monitoring assistance to bed side team and is great value to hospitals providing secondary level and tertiary level care in urban, semi urban and rural areas

There must be excellent on site ICU team who can receive strategic guidance from an expert and implement with discretion. It cannot be effective if adequate staffing are not available on the ground

Dr N Ramakrishnan Senior Consultant & Director, Nithra Institute of Sleep Sciences, Chennai

CEO-Medical Services, Chairman Pulmonology & Critical Care Medicine, Nayati Healthcare, Mathura

and is great value to hospitals providing secondary level and tertiary level care in urban, semi urban and rural areas," says Dr N Ramakrishnan, Senior Consultant & Director, Nithra Institute of Sleep Sciences, Chennai.

Indeed round the clock monitoring is of vital importance to critical ill patients and gives confidence to doctors in remote locations who struggle to save lives.

"Through this system, we can provide patient data with vital waveforms, alarms, smart alerts and two-way video communication, all in real time, ensuring that a super specialist sitting in a command centre at a major metro city can view, interact, assess and treat patients in distant remote ICUs with full confidence and on a 24X7 basis," explains Kar. Talking about the set-up at Fortis Escorts Heart Institute, Delhi, Varma says, "Today at Critinext eICU, we manage over 350 ICU beds in 10 different cities in India with one site in Bangladesh.”

In Chennai the eICU has been functional since 2013.

“InteleICU has been in operation from June 2013 and has covered more than seven hospitals across South India monitoring 30 odd ICU beds.

More than 5,000 odd ICU patients have benefited from the InteleICU solution to-date.”

The eICU in Kolkata is being deployed in a phased manner. “The state-of-the-art e-ICU set up at Medica Super Specialty Hospital was initiated in the year 2014 and was implemented phase wise in the critical care units of the hospital,” shares Dr Kar. “As part of the preliminary phase, the three medical ICUs and one neuro ICU of the central surveillance unit in Kolkata were inter-connected with each other. In the second phase, connection was established with the ICU of our partner hospital at Ranchi. In continuation to this venture, further expansion to our group hospitals at Siliguri, Jamshedpur, Ranchi, Gopalpur and Kalinganagar have already been formulated. In the third phase, plan is to rope in ICUs of government hospitals, following a PPP model,” he adds.

Dr RK Mani

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Apart from the obvious bridging of distance benefit, eICus have solved the problem of scarcity of resources.

“This facility (eICU) will soon be available to us. From my previous experience on a smaller scale, patients and caregiver teams on site will greatly benefit from expertise available from a distant site as intensive care is a highly demanding and scarcely available resource,” says Dr Mani.

Talking about the benefits of eICU, Dr Ramakrishnan says, “The TeleICU solution is a complete solution to remote monitoring and managing critical care bringing forth world class protocols and best practices and secured and real time monitoring with high quality medical assistance by trained/ specialist critical care team monitoring patients with an 'Extra Pair of Eyes.' It can be customised for hospitals especially in remote areas where qualified intensivists are not readily available.”

Besides, eICUs are clinically-proven programme to improve quality and to reduce severity-adjusted mortality rates. According to a study published in 2004 in Critical Care Medicine, use of telemedicine can dramatically reduce hospital mortality rates for ICU patients by 27 per cent and ICU length of stay by 17 per cent, while also providing significant cost savings. In addition, job satisfaction and retention rates have been shown to increase among hospital nurses working with an e-ICU. “ICU care delivered by super specialised intensivist led team provides distinct advantages to the patients– the mortality and complication rates are low and duration of ICU stay and overall costs of ICU care are less. The continuous monitoring of ICU patients help intensivist pre-determine possible complications and thereby limit any additional damage to patients,” shares Dr Kar. Clearly there is a huge opportunity do deliver special-

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BENEFITS OF eICU ◗ Increased access and affordability of healthcare + Access to broader range of specialists to patients around the clock + Reduction of costs of healthcare because of technology + Reduction of patient and relatives’ travel costs ◗ Better clinical outcomes + Improvement in care parameters like ALOS, patient morbidity, mortality + Improvement in organisation’s brand preference, quality and safety + Higher patient satisfaction scores ◗ A platform for expansion into other areas of care + Emergency life-saving care in ambulances + Expansion into neonatal / perinatal care for addressing the high infant mortality

ist-led ICU care to patients who are miles away from a specialist—a revolution that has been made possible because of the advancement of technology. So how much does this technology cost?

“For full online data acquisition for ICU patients includ-

CONCERNS WITH eICU ◗ High cost of technology ◗ Lack of cooperation between on site physicians and eICU specialists ◗ 'Big Brother' concerns, particularly among young physicians with limited experience ◗ Staff turnover at remote sites ◗ Limits access to patients in ICU ◗ A breakdown in the relationship between health professional and patient ◗ Different knowledge and skills required of health professionals and ergonomic issues ◗ Issues concerning the quality of health information ◗ Organisational and bureaucratic difficulties. ◗ Depersonalisation ◗ Physical and mental factors ◗ Lack of confidence of patients and health professional ◗ Capex investments by spoke hospitals, specifically camera ◗ Monthly collections ◗ Connectivity/ bandwidth reliability ◗ Push back by regional clinicians ◗ Lack of medical equipment infrastructure ◗ Usage of eICU decreases over time ◗ Price per day per bed

ing ventilator, monitor and infusions the investment for 25 beds would be approximately a crore,” estimates Dr Mani.

Providing another perspective Dr Ramakrishnan says, “A total investment of less than ` 3 lakhs excluding the bedside digital patient

monitors is the investment needed to connect a remote rural five-bedded ICU to a monitoring centre.”

Infact, once deployed there is no limit to the size of ICU connected to the technology. “The Intellispace Consultative Critical Care (ICCC)

can cover all the ICU’s (adult to neonate). The size is limitless because you just need an Internet connection to connect the remote locations,” shares Shankar. Talking about the benefits of technology, Dr Verma says, “A 1000ICU beds can be manned by only 20 intensivists.”

Indeed, eICUs have proven to be an indispensable tool to monitor and treat critical patients but does the technology have any limitations? One of the major concerns for this technology is penetration of Internet services. “You need an Internet connection to connect the remote locations. The limitations would be non-availability or insufficient Internet solutions at smaller towns,” explains Shankar. Besides the availability of trained staff is a must for the success of eICU. “If there are lack off backup trained staff at the bed side, the TeleICU monitoring will not be effective and not be able to deliver the required results,” shares Dr Ramakrishnan.

In addition there is a fear of technology the insecurity of 'Big Brother' watching. “eICU is relatively new. Many bedside doctors and nurses do not understand how the system works. They believe that the nurses and intensivists at the eICU command centre are watching them and trying to take over.

In reality, the purpose of the system is to provide improved safety through redundancy and enhance outcomes through standardisation. The eICU team has a supportive role. They have an overview of all the patients in the unit and can alert the bedside staff if any problems occur,” elaborates Dr Varma. eICU is not a a way to enforce totalitarian regime and ensuring conformity but a means to enable care by building relationships.

Sometimes its the inert fear of adopting new technology that results in lack of cooperation between on site physicians and eICU specialists. “Another barrier to ICU

CRITICARE

FACT SHEET POPULATION

1189.17

million

TOTAL DOCTORS

ICU DOCTORS (INTENSIVISTS)

0.0001

HOSPITAL BEDS

ICU BEDS

0.18 3,117 HOSPITALS HAVE

RECOGNISED HOSPITALS

million

million

0.88 TOTAL OF 5,915

million

0.70

million

telemedicine is the clinician’s acceptance of the technology.

Few clinicians feel that everything is running perfectly and nothing needs to be fixed.

Showing these physicians comparative data and the benefits of eICU may change their mind,” opines Dr Varma.

Adding to this, Dr Mani says, “There must be excellent on site ICU team who can receive strategic guidance from an expert and implement with discretion. It cannot be effective if adequate staffing and competencies are not available on the ground.”

Intraoperability is also a concern here as various devices need to communicate with the eICU software. “The lack of integration was a problem at some hospitals, especially those that did not have eICU software compatible medical equipment e.g. monitors ventilators & ABG machine etc.” says Dr Varma.

Even though the benefits and limitations are understood by clinicians, there is still the matter of returnon-investments. “The nonadapters think that only cost is the concern but there are huge benefits clinically and financially by using eICUs. In the long run, the advantages and benefits are immense and this is also a clear differentiator for hospitals,” says Shankar.

The concept of telemedicine has been around for a long time. In fact, the World Health Organisation (WHO) has defined the opportunities and developments of telemedicine in member states. However, there is no legislation which deals with the practice of telemedicine or eICU in India. The practice of telemedicine in India is governed by those laws which govern a normal patient/doctor relationship.

Dr Milind Antani, Partner Pharma & Healthcare Practice, Nishith Desai Associates stated in an interview that, 'In India, generally, Section 304-A of the Indian Penal Code (IPC), 1860, is the relevant provision under which a complaint against a medical

ICU BEDS

The concept of telemedicine has been around for a long time. In fact, the World Health Organisation (WHO) has defined the opportunities and developments of telemedicine in member states.

However, there is no legislation which deals with the practice of telemedicine or eICU in India.

The practice of telemedicine in India is governed by those laws which govern a normal patient/doctor relationship practitioner for alleged criminal medical negligence is registered. Section 304-A provides that whoever commits culpable homicide not amounting to murder shall be punished for life or imprisoned for a term up to 10 years and fined as well. Section 337 of the IPC deals with hurt caused by an act endangering the life or personal safety of others. However, the simple

lack of care attracts only civil liability. Therefore, only civil negligence may not be enough to hold a medical professional criminally liable.'

There is, however, a guideline issued in May, 2003 by the Department of Information Technology, Ministry of Communications and Information Technology called Recommended Guidelines & Standards for Practice of

Telemedicine in India.

The guidelines outlines the necessary information on telemedicine, including, definitions and concepts, standards required for hardware, software and clinical devices, including the security aspects and finally the telemedicine process guidelines.

However, these guidelines are not binding in Indian courts but it would be in the interest of

the hospitals to follow them.

Future is bright for eICU technology in India, as the existing users are exploring new avenues of revenue streams using this technology.

“We are tying up with ICUs of government hospitals, following a PPP model, with technological support of vendor and Critinext. Now, we are focusing on connecting ICUs in the North Eastern part of our country as well as neighbouring countries like Nepal, Bangladesh, Myanmar and other countries,” shares Dr Kar. In South India, smart connected city initiatives will provide impetus to uptake this technology. “When connectivity improves and the smart cities are interlinked, wider coverage by Intensivists can be envisaged,” says Dr Ramakrishnan.

Mulling over the future of eICU, Dr Varma says, “Clearly, innovative measures are the order of the day to optimise efficiency of scarce critical care resources. EICU has the potential to focus on untapped opportunities, geographic locations and underserved segments in the developing world.

The burgeoning Asian market offers a challenging opportunity for value creation. Other than clinical improvement, eICU also introduces paperless ICU culture by electronic medical record system and increased focus on ICU performance.”

Like telecommunication, eICu technology will also become cheaper as more vendors enter the market benefiting the patients. “The technology should get easier to set up and less expensive.

Expertise can then be available even in remote areas,” thinks Dr Mani.

Summing it up, Dr Varma says “While it will never supplement on site staffing, however, a country which lacks basic medical staffing at general level, this will help to provide specialised care at bedside which would not have been possible at all.” mneelam.kachhap@expressindia.com

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TRADE & TRENDS

Medisystems launches bed-head panels Wide range of bed-head panels for any application within hospitals MEDISYSTEMS BED-head panels are specially fabricated units for hospital use, designed to converge all the essential utilities around the patient's bed. These bed-head panels are configured to carry user terminals for electrical power, illumination, communications, biosignals, data, medical gas and carry a medical rail with a range of mountable accessories like examination lamps, BP instrument holder, case sheet holders, IV and infusion pump stands, bowl holders and the like.

Medisystems circuit protected bed-head panels have now become part of ICU and patient room infrastructure in every hospital. Standard configuration panels are available for ICU, wards, private rooms / suites. Custom configurations to closely meet user requirements are also available.

Medisystems bed-head panels are constructed from light weight extruded aluminium sheets and sections and from

stainless steel. The aluminium is surface treated with epoxypolyester powder coats in a seven stage process which ensures life time protection to the metal surface with ease of cleaning and ability to withstand damage from common hospital fluids like saline, drugs, blood etc. These light weight panels can also be mounted on non-brick walls made of siporex or gypsum board. All panels have safety metal partitions between high voltage, low voltage and medical gas outlets.

Medisystems manufactures a very wide range of such panels to meet practically every kind of need. Such panels are available in standardised as well as custom configurations which include horizontal, vertical, running length or wall angular orientation, in colours and finish of choice.

Medisystems patient bed lamps Patient-bed lamps are designed

to accompany Medisystems bed-head panels or can be purchased individually. Medisystems patient-bed lamps have carefully profiled mirror optic reflectors, to throw uniform light towards the bed areas for examination or reading purposes. They are available in two feet and three feet lengths and mounted at a height of 1.85 m on the wall behind the patient’s bed.

Patient bed lamps are made in light weight powder coated aluminium with glass diffusers and mirror optic reflectors.

They come pre-fitted with uplighter, downlighter and LED night lamps. All lamps can operate independently. Made with energy efficient T5 FTL’s or LED tubes and electronic ballasts, they have long lamp life, low electricity consumption and are quick and easy to replace by hospital staff. Each lamp has a colour temperature of 6500 K cool daylight and is designed to give over 1150 lumens of uniform lighting ade-

quate for bedside areas.

Medisystems medical rail and accessories Medisystems also offers a range of medical rail mountable accessories. Each of these accessories is fixed on one or more sliders which can be smoothly moved on the rail and fixed at any desired location along the length of the rail.

Medical rail accessories include case sheet holders, SS bowl for medicines , utility baskets, blood pressure instruments, IV poles, infusion pump stands, suction bottles, examination lamps and rail slider clamps for just about any mountable item.

With more than 75 installations in hospitals and nursing homes all over the India and overseas, Medisystems undertakes the design, assembly, factory test, supply, delivery, field testing and commissioning of bed-head panels in standardised as well as almost any type of custom configuration or fin-

ish to meet the requirement of every type of hospital.

Contact details medisystems@gmail.com

Vertical Corner Panel for ICU in Wood Finish

Horizontal Room Panel in Wood Finish

3elementPatient-bedLamp

ICU Panel in Horizontal Orientation

Vertical Panel for a Private Room in Wood Finish

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Horizontal Panel for a Private Room

TRADE & TRENDS

Medisystems electronic nurse-call systems The ideal patient care solution for modern hospitals MEDISYSTEMS ELECTRONIC Nurse-Call Systems are modern microcontrollerbased digital systems.

Each system comprises a central display unit placed at the nurse-station countertop which is cable linked to its associated set of bed units – mounted at each bed side, along with door units – mounted at the patient’s room entrance, and emergency alert units – mounted within the patient room toilets.

Since these systems are installed by the company all over the country, their components, spares and parts have been carefully selected for easy indigenous availability. The systems are also modular. This allows the user to select the correct system size initially, followed by a convenient future upgradation, whenever needed.

For example, if the ward strength is increased after two years from 16 to 20 beds, all that is needed is the addition of the bed unit modules and upgrading of the central unit software.

The systems’ features have been designed to cater for hospital practices prevailing in India. Hence, the basic audiovisual arrangement has been designed as a simple red-yellowgreen lamp code with easily recognisable audio chimes. The reset button has been placed only at the patient’s bed site -- to ensure that no call goes unattended. To avoid confusion during multiple calls, the calling bed number is not merely indicated on the panel but it is clearly enunciated in numerics or through ward graphics.

Added features include: ◗ Toilet emergency alert: Available to the patient in the event of distress while locked within the toilet ◗ Nurse presence registration : Implemented by the nurse as

Electronic nurse-call systems

Electronic nurse-call systems

Electronic nurse-call systems

she enters the patient’s room and indicated on the central display as well as in the corridor so that the nurse can be easily located. ◗ Nurse help request: Can be requested by the attending nurse from the patient’s bed side, if the situation should require. ◗ Additional call signals: Allows patient to call a ward attendant or room service from the hospital’s cafeteria or canteen either through the nurse display or directly. ◗ Instrument alarm relay: A useful feature especially in the ICU/post-op area where a number of monitors and syringe/infusion pumps are at the bed side. ◗ I-V drip sensor: It monitors drip flow and alerts the nurse to halt and replenish with a fresh

drip, avoiding ingress of air bubbles in the I-V line. ◗ Code-Blue Alert: A hospital wide alert, for cardiac and other emergencies when help must be secured from wherever available, within the hospital’s premises. ◗ Patient-nurse intercom: It enables the nurse to talk to the patient and go suitably prepared to the bed side, reducing to and fro trips. ◗ Nurse-call response monitoring: A monitoring system to capture and data log all nurse call activity. Reports highlight delayed response to calls, level of call traffic on a given floor or ward, and intra-day call load on the nurse-station. This feature is implemented on a single PC terminal at the Matron’s or Medical Director’s desk and may, optionally, be linked

through the hospital’s main server to the rest of the hospital information system. ◗ SMS alerts – Specific alert calls can be relayed to selected cell-phones including the concerned physician and key hospital staff. ◗ Corridor display modules – Enhance call capture for hospitals having long corridors with one or more bends. ◗ Multi-function handsets: In addition to the nurse-call function, these enable the patient to also conveniently switch lamps, fans, audio and TV from the same handset; and to change the TV channels and sound volume (when integrated with a suitably selected institutional model TV set). ◗ Call transfer facility: Allows night shift duty transfer of calls from any nurse-station to

another nurse-station on the same floor. This enables optimal deployment of night shift duty nursing staff.

After commissioning, these systems require virtually no maintenance except to replace any physically damaged module or to upgrade the software /hardware elements, whenever needed.

Nurse-call system installations are directly implemented

by Medisystems engineers and technicians, or by their authorised representatives, working in close co-ordination with the hospital’s electrical consultants and contractors.

Customer support is prompt and monitored through the company’s service centre and its local service representatives.

Contact details medisystems@gmail.com

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TRADE & TRENDS

New age solutions from ICONS Infocom Helping you empower your EMR/RIS/PACS with Front end or Back end Dragon Medical Indian Edition Speech Recognition & Philips Speech Exec Dictation Workflow Solutions ICONS Infocom is a distributor of Nuance Dragon Medical Speech Recognition & Philips Digital Dictation workflow solution provider in India. They have 18 years of rich experience in speech recognition solutions and have installed them in many hospitals, diagnostics centres in India.

Dragon Medical Practice Edition: This front-end speech recognition was created for clinics or practices with 24 or less providers. This locally installed desktop solution helps you improve documentation, eliminate transcription costs, increase efficiency, profitability and physician satisfaction. up with the latest regulations and technologies doesn’t mean productivity has to lag behind.

ICONS Infocom has clinical speech recognition solutions designed specifically with practices like yours in mind.

Indian English edition Dragon Medical Practice Edition version 3.2 offers high-quality documentation at the point of care—and at a price you can afford.

Benefits : The final word in speech recognition: Dragon Medical 3.2 is the go-to speech recognition solution for more than 10,000 healthcare facilities and 500,000 physicians worldwide. Our solutions ensure 300 million patient stories get told accurately every year.

When doctors speak, your EHR listens : Clinicians can document patient stories more completely and ‘in their own words’—enabling them to update the history of present illness, review of systems, physical examination, and assessment and plan in real time.

Highly accurate clinical speech recognition from word one The whole story: Covering

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nearly 90 specialties and subspecialties, Dragon Medical Practice Edition helps clinicians document the complete patient history and physical information. And the experience is the same from workstation to workstation.

Fast and accurate: The clinical narrative is updated in real time, so clinicians don’t have to wait for transcribed reports or spend time typing into their EHRs allowing more time to spend with patients.

Complete EHR Navigation: Dragon Medical Practice Edition lets clinicians navigate any Windows-based EHR system using voice commands—three times faster than most people can type or click with a mouse—supporting EHR adoption.

Healthcare-compliant: Dragon Medical Practice Edition supports HIPAA patient confidentiality guidelines, a critical requirement for any practice concerned with patient confidentiality.

Time saver : Using speech recognition technology, clinicians dictate, edit, and sign medical records right at the point of care—HUGE saving in annual documentation costs.

ICONS Infocom has 18 years of rich experience in speech recognition solutions and has installed them in many hospitals and diagnostics centres in India Back end Speech Recognition Solution: Philips DPM range of Recorder with SpeechExec & Dragon Medical customised solution from ICONS Infocom A system that is greatly appreciated by practitioners for its productivity: For the three years since they put this process into practice, they have made significant productivity gains. Once a report is recorded, the Philips voice recorder is placed in a docking station and the data are automatically loaded in the software installed by us, to be handled by the secretaries.” At their workstations, the latter then identify the dictations that are meant for them.

Optimal security for

patient data: We guarantee optimal security for patients’ medical data. On the other hand, the voice recorder is capable of infallible rapid scanning of the patient’s identification number in order to anticipate an eventual error in identification and to enable automatic allocation of the dictation to the correct patient.

Why dictate?

Discover the benefits which dictation can bring to you and your business ◗ Save time: On average, people can speak seven times faster than they can write.

Dictation can save you a lot of time. Dictate just 10 letters and you’ll save a whole hour in time! ◗ Concentrate on your core competency: Don’t waste your

energy on typing and formatting. Dictation allows you to focus on your core competencies. This will save you and your organisation time and money. ◗ Be more flexible: You can dictate anytime, anywhere and have your files sent immediately to your office for transcription.

You can dictate whilst driving to work in the morning for example, and get work done even before you arrive in the office. ◗ Organise your work: Using the SpeechExec dictation software you can quickly categorise and organise your thoughts, work or letters. ◗ Improve your speech : Studies have shown that dictating can improve your short-term memory, pronunciation and general speech quality. In other words… dictation allows you to increase your productivity and efficiency, saving you time and money.

In other words – dictation allows you to increase your productivity and efficiency, saving you time and money.

The Philips SpeechMike Premium dictation microphone and Dragon speech recognition software enable doctors to work independently, swiftly and effectively.

TRADE & TRENDS

Innovation in medical devices: An emerging market perspective Biten Kathrani, Director R&D, Asia Pacific, Middle East & Africa, Boston Scientific speaks on driving innovation in the medical devices industry of India MEDICAL DEVICES are integral to a patient-centric care continuum, from screening to diagnosis to treatment and monitoring. In India, the medical devices industry is classified into four groups: consumables (syringes, for example); implants (stents, pacemakers); instruments and appliances (surgical equipment); and diagnostics (imaging, IVD). The device industry is growing fast in India, despite the rising burden of non-communicable diseases and rising spending capabilities amongst the affluent and growing middle income population. Innovation is seen as a key growth driver to cater to the growing patient population.

What does it take to innovate?

At Boston Scientific, we have a three-step innovation process based on the wellknown Biodesign approach of ‘Identify, Invent, Implement,’ conceptualised by faculty at Stanford University.

Identify: The starting point of medical device innovation is to determine the unmet needs in the clinical environment. “Voice of Customer” input is key to needs-

Biten Kathrani, Director, Research and Development Asia Pacific, Middle East & Africa, Boston Scientific

driven innovation and defining an early value proposition.

This requires dedicated innovation teams to interact with stakeholders, immerse in the clinical environment and identify the clinical and non-clinical needs. Prioritised needs are then passed on to the Invent phase.

Invent: The next step is to invent the value proposition by developing innovative concepts with a focus on the four As (awareness, access, adoption and affordability) so that we are creating a device that truly has real-world applications, rather than just creating for the sake of innovating.

Implement: We consider the physician as our partner in the innovation journey.

Multiple concepts generated in the invent phase must be prototyped and tested in a simulated lab environment in partnership with physicians, in order to gain critical feedback, improvise on the go and optimise the solution. It is important to iterate at this stage to resolve gaps in the solution.

The final concept, coupled with a business case, is transitioned to a new product development (NPD) process, driven by our quality system.

The NPD process focuses on ‘design to manufacture’, performance, safety and efficacy of the final product.

Collaborative innovation Principles of frugal innovation are key to success in emerging

markets. Frugal innovation does not mean ‘cheap’; instead, it means ‘more for less for more’ or better clinical outcomes with less use of resources such as time, funding or materials to impact more patients who can benefit from the innovation.

The best way to encourage innovation in an organisation is to create an atmosphere that is conducive for good ideas to take root and eventually yield results. Organisations need to invest in talent, infrastructure, collaborations with stakeholders and partnerships with academia, and support all of this with the right culture and long term commitment.

Commit to quality: An innovative idea will remain just that, without the appropriate rigour in the development cycle. Invest in building a robust quality system and drive the NPD process to deliver on performance, safety and quality attributes of the product. A stage-gated development cycle with appropriate design reviews allows capturing compounding and/or conflicting deliverables early in the design cycle and provides room to innovate and solve the problems. This needs investment in stateof-the-art laboratory infrastructure to translate an idea from laboratory experiments to clinical experience. R&D is often a time- and resourceconsuming process that requires long-term commitment, but is an indispensable aspect of improving healthcare in the long run.

Intellectual property and innovation incentives: Developed markets invest in generating and protecting intellectual property (IP) to gain competitive advantage. As

R&D centres in India and emerging markets develop innovative solutions, it is important that companies invest in IP awareness and protect their innovations through patents. To encourage R&D engineers and scientist to be IP savvy, companies need to develop and deploy incentives for them.

Learn and adopt from diverse industries: Ultrasonography, now indispensable to healthcare, was originally developed to help scientists study flaws in metals and in oceanography.

Such adaptation of technology helps cut down the cost involved in primary research.

Likewise, the use of 3D technologies like 3D printing and 3D visualisation are now being adopted for anatomical visualisation and simulation that will help further innovation and new solutions.

Foster collaboration: One of the ways medical device companies can encourage innovation is by holding internship programmes where budding graduate students from pharmacology and business schools get a chance to interact with the best-ofthe-best. This helps to create a competitive yet engaging environment where young talent with their own unique way of looking at a situation can develop new and entrepreneurial medical technologies.

Democratise the innovation process: Many organisations and research institutes can get into a trap of innovating within their own four walls. Innovation can come from anywhere and anyone.

Innovation is not just about products but is required across the entire value chain including business models innovation. It is important to

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TRADE & TRENDS encourage all employees, no matter what their level of seniority or role, to ‘think outside the box.’ It is equally important to collaborate with innovators in the ecosystem – academia, research institutions, start-ups and independent innovators.

Advantage India Frugal innovation comes naturally to Indians. Indian innovators have delivered multiple value innovations such as the world’s most inexpensive heart valves, a non-electric victrectomy device, Jaipur foot, intraocular lens, value ECG machine and stents.

Several global device companies have setup R&D centres in India to cater to emerging markets and global product development.

The healthcare scenario in

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India is ripe for innovation, and we should capitalise on the opportunities. India offers robust capabilities across several R&D institutions; a high calibre STEM (Science, Technology, Engineering and Mathematics) talent pool; leadership position in information technology; the government’s ‘Make in India’ and ‘Innovate in India’ initiatives; and the inherently costconscious Indian mentality are drivers for innovative thinking.

The Indian healthcare industry has grown to $3 billon with a CAGR of ~10% and is expected to exceed $280 billion by 2025. Needs-based innovation coupled with cost effective solutions that blend R&D investments with leveraging current capabilities are among the nation’s priorities

At Boston Scientific, we recognise the potential India has for the global medical devices industry to help deliver the innovative solutions that will help this sector grow.

At Boston Scientific, we recognise the potential India has for the global medical devices industry. We have created a state-of-the-art, integrated R&D facility to drive

development of new medical devices for the region, as well as an Institute for Advancing Science physician training centre in Gurgaon, India.

At this facility, we intend to focus on cutting-edge medical device innovation to address unmet needs in emerging and global markets.

References World Health Organization.

Medical Devices: Managing The Mismatch. 2010. Available from: http://apps.who.int/iris/bitstream/10665/44407/1/9789241 564045_eng.pdf Jaroslawski S et al. BMC Health Serv Res. 2013 May 30;13:199.

Infosys Consulting. Viewpoint.

Indian Medical Device Industry – Current State & Opportunities for Growth. 2015. Avail-

able from: https://www.infosys.com/consulting/insights/Documents/indian-medical-device-industry.pdf Deloitte; NATHEALTH. Medical Devices. Making in India A Leap for Indian Healthcare.

2016. Available from: http://www2.deloitte.com/in/e n/pages/life-sciences-andhealthcare/articles/medicaldevices-making-in-india.html Deloitte; AIMA. Innovative and sustainable healthcare management: Strategies for growth. 2012. http://www2.deloitte.com/content/dam/Deloitte/in/Documents/life-sciences-health-care/in-lshc-inno vative-healthcare-noexp.pdf Navi Radjou and Jaideep Prabhu. Frugal Innovation: How to do better with less.

Stanford Byers Center for Biodesign http://.biodesign.

Stanford.com

BUSINESS AVENUES

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

Ultrasonic Washer

Washer Disinfector

Arcania Bedpan Washer

Steam Sterilizer

Vertical Chamber Autoclave

Pharmalab India Private Ltd.

Registered Office: Kasturi, 3rd, floor, Sanghavi Estate, Govandi Station Rd, Govandi (E), Mumbai 400 088, INDIA. • E-mail: pharmalab@pharmalab.com • Website: www.pharmalab.com • CIN No. U29297MH2006PTC163141.

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Sterilizer Test Kit

October 2016

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PEEP

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Blood Bank Equipments

Blood / IV Fluid Warmer

Plasmatherm Blood Donor Chair

Blood Collection Monitor

Blood Bank Centrifuge

Biological Refrigerator

Platelet Incubator with Agitator

Benchtop Sealer

Centrifuge Bucket Equalizer

Blood Bank Refrigerator

Biological Deep Freezer

REMI SALES & ENGINEERING LTD.

Remi House, 3rd Floor, 11, Cama Industrial Estate, Walbhat Road, Goregaon (East), Mumbai-400 063. India Tel: +91 22 4058 9888 / 2685 1998 Fax: +91 22 4058 9890 E-mail: sales@remilabworld.com l Website: www.remilabworld.com

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High-accuracy surgical and endoscopic displays

The complexity of general and minimally invasive surgery places high demands on both the medical staff and the equipment used. Barco has designed a complete line of surgical and endoscopic displays, boom-mounted or trolley-mounted, from HD to 4K, that provide unsurpassed precision while meeting the specific image-guided surgery requirements in the digital operating room.

MDSC-8258 Slimline 58" Quad HD surgical display

MDSC-2242 42" full HD large-screen surgical display

MDSC-2226 26" full HD surgical display

Modi Medicare, 4/102, Deep Sunil, Garodia Nagar, Ghatkopar(E), Mumbai - 400 077 +91-22-2506 5664, +91-98670 01110

MDSC-2232 32" full HD surgical display

MDSC-2224 24" full HD surgical display

MDSC-8232 31" 4K UHD surgical display

E192HSA 19" surgical color LCD display

Barco - India A38, A B&C, Sector-64, 201301, Noida, UP, India Tel: +91 120 4020000 Mob: +91 99714 41118 Email: sales.in@barco.com

www.barco.com

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FEBRILE ILLNESS DIAGNOSIS

WEIL-FELIX TEST

BRUCELLOSIS

SALMONELLOSIS

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

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

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

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

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

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

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

●

Stained Febrile antigens in convenient dropper vials.

●

Suitable for both slide and tube test protocols.

●

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

508, 5th Floor, Western Edge-I, Kanakia Spaces, Opp. Magathane Bus Depot, Western Express Highway, Borivali (E), Mumbai-400066 T: +91-22-28702251 F: +91-22-28702241 E: info@omegadiagnostics.co.in W: www.omegadiagnostics.com www.omegadiagnostics.co.in A subsidiary of Omega Diagnostics Group PLC ODX/SEP016/FEBIL/EXPHEALTH/V3.0

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CIN :U51909MH2011FTC219692

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

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LIFE TREND

Skill India: Gaining pace in healthcare The private sector in India is undertaking several skilling and training programmes to scale up the number and quality of human resources in healthcare

By Lakshmipriya Nair

I

ndia is poised on the precipice of an evolution which can transform it into a global economic power. But, a severe crunch of skilled manpower has become a manacle restraining the country’s growth trajectory and impeding its global competitiveness. The Labour Bureau Report 2014 revealed that only two per cent of the Indian workforce is skilled; and a mere 6.8 per cent of the population aged 15 years had received or were receiving skills training.

Realising the urgent need to invest in skilling and training available human capital, the Government of India launched the Skill India initiative in 2015 to build a workforce which is responsive and competent to deal with the altering dynamics of the economy. It aims to empower 500 million people with the right tools for bet-

ter employment by the year 2020. The National Skill Development Mission and the new National Policy for Skill Development and Entrepreneurship 2015 have been some of the significant endeavours under ‘Skill India’ in this direction. In the recent past, Pradhan Mantri Kaushal Vikas Yojana-2, India International Skill Centres, IndiaSkills Online and a Labour Management Information System (LMIS), which were also inaugurated by President Pranab Mukherjee at Vigyan Bhawan in New Delhi.

Healthcare is one of the sectors which is in dire need of skilled professionals. A study by Public Health Foundation of India for the Ministry of Health and Family Welfare exposed that there is approximately 97.9 per cent skill gap across various verticals of healthcare. It had also

highlighted that India had a requirement for around 6.5 million allied healthcare professionals (AHP) while the current supply is less than 300,000.

In a bid to address this massive gap, the Healthcare Sector Skill Council (HSSC), under the National Skill Development Corporation (NSDC), has also committed to skill 4.8 million people in a phased manner over the next decade in the healthcare space. Thus, there seems to be increased impetus to skill healthcare professionals. The private healthcare sector too has taken up the mantle of ensuring that healthcare resource gap is mitigated.

A slew of initiatives have been introduced to train and skill professionals in healthcare and allied sectors in the past few years such as:

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LIFE

We have pledged to carry out robotic surgeries at no additional cost for a significant proportion of people, thereby making it more affordable in the long run.To fulfil the objective, we intend to have a broad base of well-trained surgeons, anaesthetists and nursing staff

The Tech Mahindra CSR initiative's focus would be to evolve a well-designed and delivered training programme which would create a pool of allied health professionals. The curriculum has been designed as per HSSC benchmark

Through the standardised curriculum in phlebotomy training with HSSC, together we will be able to enhance the clinical practices in creating sustainable improvements in Indian healthcare

Dr Saurabh Bhargava

Loveleen Kacker

Varun Khanna

Samarth Jain

Head of Urology Department, Narayana Health City

CEO, Tech Mahindra Foundation

MD, BD India & South Asia

Co-Founder and CEO, Positive Bioscience

GE Healthcare: Partnering with the government GE has tied up with leading healthcare and education experts and set up institutes across the country. These institutions will reportedly train and instruct over 100,000 new and existing healthcare professionals over the next five years.

Speaking at its announcement in April 2015, John L Flannery, President and CEO, GE Healthcare, said, “The initiative is among the largest skill enhancement programmes for GE Healthcare in the world. This is a great example of how we can use our scale and experience to partner with India. We hope that the skilling of 100,000 healthcare professionals will address an important government priority of bridging the skill deficit.”

The first institute, fully funded and run by GE India, is based in Mumbai while the second one is in partnership with Max Institute of Healthcare Education and Research (MIHER). The company has also signed MOU with several other private and public partners to set up healthcare education and training institutes

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across India. It plans to set up at least one institute per state over the next five years, helping to train over 100,000 new and existing healthcare professionals through courses ranging from radiologists to cardiologists; from process excellence to finance.

Teleradiology Solutions: Educating the radiologists In another noteworthy venture, Teleradiology Solutions, in collaboration with National Board of Medical Examiners, is offering online radiology education to post graduate radiology graduates across the country through its flagship e-learning portal www.radguru.net. It is an endeavour to address the acute scarcity of radiologists in India.

At the launch of the venture in September 2015, Dr Arjun Kalyanpur, Chief Radiologist and Co-founder of Teleradiology Solutions, had highlighted that there are only 10,000 radiologists for a population of over a billion, necessitating technology innovations such as teleradiology and e-learning.

The portal offers interactive and stimulating training for radiology residents through live

case discussions, quizzes and an archive of interesting cases – reviewed and guest lectures conducted by national and international faculty from institutions like Yale, UMass, Baylor, Harvard etc. Reportedly, the partnership with the National Board of Examiners allows over 800 postgraduate students in radiology to acquire training from Radguru's faculty. This platform is another attempt to bridge the rising gap in healthcare education across the country.

Tech Mahindra: Skilling the SMART way Skilling is being undertaken as part of Corporate Social Responsibility too. For instance, Tech Mahindra Foundation has launched the Tech Mahindra SMART Academy for Healthcare in Delhi, in collaboration with the HarijanSewakSangh – a social development organisation founded by Mahatma Gandhi in 1932. It has two purposes: skill paramedics for the healthcare sector and at the same time create employment for people from low-income families.

Loveleen Kacker, CEO, Tech

Positive ATGC workshops have been designed to enhance the education of clinical oncology professionals on the topics of cancer genomics, cancer risk assessment, and application of precision medicine in clinical practice

Mahindra Foundation said, “One of the major challenges in the Indian health sector as on date is the non-availability of trained allied health professionals. In fact, there is a shortage of over 14 lakh such professionals.

The Tech Mahindra CSR initiative intends to bridge some of this gap. The focus would be to evolve a well-designed and delivered training programme which would create a pool of allied health professionals. The training would comprise classroom lectures, laboratory exposure, internship in hospitals as well as seminars/workshops conducted by experienced faculty.”

She added, “The conceptual framework of module/curriculum has been designed as per Health Sector Skill Council benchmark- a part of NSDC. The modules are designed as per the benchmark of National Occupational Standards (NOS).

The focus will be to give priority to students from low-income families. They are being charged a miniscule (20 per cent) of the sum being currently charged by other institutes offering similar courses. A six months course fee including tuition fees, uniform,

books and certification is pegged at Rs 8600 only. There is also an option of scholarship/ subsidy on this sum for very needy students. If the Smart Academy for Healthcare creates a pool of professionals, it will in a small way, surely improve the healthcare scenario in the country.”

Tech Mahindra Foundation intends to seek recognition from the NSDC and affiliation from the HSSC.

BD: Training for best practices Recently, Becton, Dickinson & Co (BD) and Healthcare Sector Skill Council (HSSC) have also joined hands to develop co-branded training modules for ‘Phlebotomy Technician Course’. The venture aims to offer training on best practices in phlebotomy to laboratory personnel and make them more employable.

As the Knowledge Partner in this initiative, BD has developed a training module for candidates enrolled for fresh training as well as RPL (Recognition of prior learning) training for the phlebotomy technician course run by HSSC. BD will also train

LIFE the master trainers who will in turn, impart the training to healthcare professionals and support them in driving best practices in pre-analytical processes for more accurate diagnosis.

On the occasion, Varun Khanna – MD-BD India & South Asia, said, “At a time when the Skill India Movement is looking at bringing about convergence and focusing on industry linkages, this initiative comes as BD’s commitment to enhance the skills of laboratory technicians. It will address the shortage in human resources both in terms of skill and number leading to universal health coverage for all. Through the standardised curriculum in phlebotomy training with HSSC, together we will be able to enhance the clinical practices in creating sustainable improvements in Indian healthcare.”

Positive Bioscience: Empowering the doctors Initiatives to spread awareness and educate medical professionals about medical disciplines which are lesser adopted but have huge potential are also being undertaken. For instance, Positive Bioscience, a genomics player has introduced Positive - Academy for Training in Genomics and Clinical applications (ATGC) to help oncologists gain competency at using genomics in their practice. The initiative will be rolled out across the country in association with ICON and Molecular Oncology Society (MOS).

“Positive ATGC workshops have been designed to enhance the education of clinical oncology professionals on the topics of cancer genomics, cancer risk assessment, and application of precision medicine in clinical practice. The workshops will include topics on technology and equipment, understanding and applying genomic report to clinical practice, as well as concept of pathways and its utility in clinical practice. Positive ATGC will conduct sixmonth training programmes on genomics for doctors. It will conduct regular workshops in Delhi, Hyderabad, Bangalore,

A study by PHFI for the MoHFW exposed that there is approximately 97.9 per cent skill gap across various verticals of healthcare.

It had also highlighted that India had a requirement for around 6.5 million allied healthcare professionals (AHP) while the current supply is less than 300,000 and Mumbai. Participants of the workshop will be awarded a certificate, which will be accepted as CME. The workshops will also be available online. Positive Academy for ATGC aims to reach out to over 200+ doctors by 2017,” informs Samarth Jain, Co-Founder and CEO, Positive Biosciences.

“With the vast increase in knowledge stemming from genetics research and the development of new technologies in genomics, Genetics education and training of oncologists is critical for building capacities to understand, interpret, and appropriately apply such information. As the advancement of genetic technologies accelerates, so must the education and training efforts. This initiative is our contribution to enabling the integration of genomics into clinical practice, so that patients in India can benefit,” adds Jain.

NH-Infosys Foundation: Training robotic surgeons In a similar endeavour, Narayana Health recently launched the Institute of Robotic Surgery supported by Infosys Foundation at its flagship unit at Narayana Health City. At the launch of the institute, Dr Devi Shetty, Chairman – Narayana Health, said, “Infosys Foundation donated ‘da Vinci Surgical Robot’ to develop Infosys Institute of Robotic Surgery to train robotic surgeons for the future. The philosophy of creating the institution is to train any surgeon with a passion to learn robotic surgery and certify them to start robotic surgical programme in different parts of the country. NH Foundation along with Infosys Foundation strongly believes that this is the only way robotic surgery services will be available to the common man of this country”.

Speaking on the partnership, Dr Saurabh Bhargava, Head of Urology Department, Consultant Urologist and UroOnco Surgeon at Narayana Health City, said, “Our training programme is mentorbased rather than building patient base to have a learning experience. We have acquired skills, so that we have competence to train others, that’s what needs to be done. So the learning experience takes place with a mentor in place at Narayana Health.” The training is provided in a phased manner. Phase 1 includes basic training explaining the concepts, technology, features and functionalities. The operating surgeon has to first understand the technical aspects of its work, how to set it up, how each part works and its role.

Then the surgeon attends a simulator workshop and practices on mannequins, followed

by a period of observation.

Then, with a mentor in place, the surgeon begins with simple techniques, gradually moves on to more complex surgeries.

Elaborating further, Dr Bharghava informed, “We, in partnership with the Infosys Foundation, have pledged to carry out robotic surgeries at no additional cost for a significant proportion of people, thereby making it more affordable, in the long run. In order to fulfil the objective, we intend to have a broad base of welltrained surgeons, anaesthetists and nursing staff.” Thus the aim of the initiative is to create a pool of individuals who can undertake robotic surgeries and procedures. He adds, “We have taken a leaf out of the Skill India programme which talks about having a broad pyramid base in order to deliver to a large section of the society. We have also incorporated a robust mentoring process whereby these professionals share and exchange knowledge easily, thereby helping to overcome the learning curve in a shorter spell of time.”

Creating a skilled India These are just a few of the ventures undertaken by the private sector to create a more skilled workforce in the healthcare sector. Yet, they comprise only the tip of the iceberg. A lot more needs to be done to alleviate the problem. We need many such programmes to be undertaken at a large scale to meet the huge demand for skilled human resources. However, there are multiple ways in which the private sector can contribute significantly to address this issue. One of them would be to collaborate with the government to research, analyse and set quality standards for training courses.

They can also help reduce the skill-job mismatch and wastage of talent by offering more onthe-job training and invest in training infrastructure. These measures would help to significantly improve the impact, reach and quality of skilling programmes. lakshmipriya.nair@expressindia.com

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October 2016

LIFE INSIGHT

Afuture as a home care nurse Usha Prabhakar, Senior Director-Nursing and Clinical quality, Healthcare at Home India, says how home-based healthcare, initially an unorganised sector, is catching the eye of investor brands and following certain protocols

I

ndia’s evolving economy is seeing several new services that are being conceived to convenience a modern society. Among them is home-based healthcare, a service that is gaining traction among recipients of medical facilities wishing to recover in the comfort of their home. What used to be an unorganised sector once is now an attractive area for investor brands as it follows certain protocols, besides being quite technology intensive. This is why seeking out a career as a home care nurse is a lucrative alternative to traditional hospital nurses. To qualify, an aspirant must have the following qualifications: ◗ GNM or B Sc Nursing ◗ Registered with State Council ◗ Training on life saving technique and infection control By and large all home care nurses in India, and globally, are registered general nurses. Their role involves providing care to the patient by working in collaboration with other healthcare providers such as the primary doctor, members of staff at the hospital where the patient may have been cared for, as well as members of the patient’s family.

Many homecare nurses are in fact specialists in providing palliative care or end-of-life care to patients. By providing expert management on pain and other symptoms combined with compassionate listening and counselling skills, home and palliative care nurses promote the highest quality of life for the patient and family. Some nurses do like to specialise in areas like oncology care, critical care, paediatrics or geriatric care. Diabetes management, Chemo port flush,

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PICC line dressing, VAC dressing, bed sore or wound management and dressing, post cardiac surgery care, post organ-transplant care, stoma-care and dialysis at home, are some of the other health cases that require specific knowhow and for such cases, nurses with both experience and technical training are preferred.

There is a distinct body of knowledge with direct application to the practice of home and palliative care nursing. This includes pain and symptom management; end-stage disease processes; psychosocial, spiritual, and culturally sensitive care of patients and their families; interdisciplinary collaborative practice; outcome evaluation skills; loss and grief issues; patient education and advocacy; bereavement care; ethical and legal considerations and communication skills. Besides being good at decision making and clinical governance, independent nurse practitioners at home are more confident, accountable and updated with thorough knowledge and competent clinical skills.

Broadly speaking, the popular areas of specialisation, and associated responsibilities, are as follows: ◗ Home oncology: Caring for a cancer patient in their home is both rewarding and demanding.

This job requires the nurse to take on a team approach since doctors, nurses, social workers, physiotherapists and family members must work in collaboration to make the patient most comfortable. ◗ Mother and child care programme:

management.

As more and more expectant mothers have the demands of a job looming on the horizon shortly after having their baby, this journey has become incredibly stressful. The paucity of correct information, guidance and education has made the role on a home care nurse very important, especially as families go nuclear and the guiding hand of an elder is conspicuous by its absence. More and more small families are recognising the difference a home care nurse can make to the mental health of women and children. ◗ Maternity services: Not just after but before delivery, more young women bereft of parental guidance are likely to fall back upon these services. Here trained nurses deal with aspects like changes during pregnancy, diet, exercise, preparing for a new arrival and, finally, postpartum care and caring for the infant both of which is an equally important aspect. HCAH deputes its nurses for one-to-one sessions, clinical sessions over the phone and doorstep, antinatal and post natal exercises, counselling and stress

◗ Home dialysis: Nearly ten to 15 per cent of India’s 1.25 billion people suffer from kidney ailments –a direct consequence of the rising incidence of diabetes. Of these, a large number of patients progress to endstage renal disease and require organ transplant and renal replacement therapies to survive. The renal replacement therapy market is segregated into haemodialysis and peritoneal dialysis (PD). Renal replacement services are provided by hospitals, stand-alone clinics, nursing homes, dialysis care providers and home healthcare providers. Renal nurses provide such services at home safely and educate both patient and family. ◗ Autonomous working and decision making: There is a freedom to work alone and independently when nurses work with homecare service providers. This not only hones their decision-making skills, but also clinical skills. As nurses have to make independent visits to patients’ places, the accountability on them is high.

This gives the nurse complete control over the situation, thereby making them more confident and independent. ◗ ICU services at home: This includes setting up of ICU at home with all relevant necessary equipment, handling critical care patient round the clock in shifts, and administering noninvasive ventilation- BiPAP and CPAP to Asthma, COPD and respiratory disease patients, as well as monitoring invasive ven-

USHA PRABHAKAR, Senior Director Nursing & Clinical quality, HealthCare at Home India

tilator at home.

After gaining practical experience a nurse may opt for a bigger role such as nurse counsellor, nurse educator, manager, human resource recruiter, and clinical quality control manager, industrial or corporate nurse. With palliative care, hospice care and home-based healthcare also being in demand abroad, many can hope to find suitable employment in another country. Since India is a hospital tourism hub, Indian healthcare providers are respected globally, and this includes the nursing community as well. The India International Healthcare Recruiters website, for example, counts countries like Abu Dhabi, Australia, Ireland, New Zealand, South Africa and the UK as the top recruiters for nurses, including homebased healthcare.

Nurses, consistent with their individual educational preparation, experience and roles, also promote the highest standards of end-of-life care through community and professional education, participation in demonstration grants, and in end-of-life research. As society’s needs change and awareness regarding issues surrounding end-of-life needs increases, nurses are called to advocate for the terminally ill and their families through public policy forums, including the legislative process. In light of the recent debate on euthanasia, and the Indian medical community’s emphasis that palliative care deserves attention instead, such legislative and policy initiatives by the homecare nursing community takes their role beyond the ambit of caring for a patient by the bedside.

REGD. WITH RNI NO. MAHENG/2007/22045, POSTAL REGD. NO. MCS/162/2016 – 18, PUBLISHED ON 8TH EVERY MONTH, POSTED ON 9TH, 10TH, 11TH EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE, MUMBAI – 400001

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