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CONTENTS MARKET Vol 10. No 11, NOVEMBER 2016
Chairman of the Board Viveck Goenka Sr Vice President-BPD Neil Viegas
DIABETES CARE ACROSS THE LIFESPAN
Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das, Mansha Gagneja
India is in the throes of a diabetes epidemic but one patient refused to be just a statistic and decided to use his experiences to help other diabetics manage their diabetes better. Founder & CEO Ashok Jain’s Lifespan Clinics is just three years old but it is a good start | P20-23
Delhi Prathiba Raju Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Senior Designer Rekha Bisht Artists Vivek Chitrakar, Rakesh Sharma
Marketing Team Ajanta Sengupta, Ambuj Kumar, Douglas Menezes, E.Mujahid, Mathen Mathew, Nirav Mistry, Rajesh Bhatkal PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar
INTELLIGENT HOSPITALS ARE PIVOTAL TO SMARTER HEALTHCARE DELIVERY: EXPERTS
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GNIDSR KOLKATA SIGNS MOU WITH IIT- KHARAGPUR AND IIEST-SHIBPUR
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MCGM, AHI, BHAMLA FOUNDATION, PFCD LAUNCH JAAN BACHAO CAMPAIGN
KNOWLEDGE
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Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East
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INSURANCE IN BARIATRICS
INTERVIEWS P12: MANASIJE MISHRA
P31: ABHISHEK DWIVEDI
MD, Indian Health Organisation
Co-founder, AlternaCare
P13: SYED RIAZ QADRI
P32: DR SELWYN COLACO
MD, Vermeiren India Rehab
COO, Cytecare Hospitals
P14: RAJNEESH BHANDARI
P34:HARISH PILLAI
Founder, NeuroEquilibrium Diagnostic Systems
COO, Indus Health Plus
P24: SUDHA VASUDEVAN Madras Diabetes Research Foundation & Dr Mohan’s Group of Institutions
Express Healthcare® Regd.with RNI no. MAHENG/2007/22045,Postal Regd. No. MCS/162/2016 – 18,Printed for the proprietors, The Indian Express (P) Ltd. by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright © 2016 The Indian Express (P) Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.
EDITOR’S NOTE
Building a manifesto for a healthy India
T
he second draft of the medical devices regulations seems to have got both MNC and domestic medical device manufacturers on the same page. Both groups are protesting against the draft regulations and asking for changes. For instance, the common grouse is that medical devices are being judged by the same yardstick as medicines. The recently formed Medical Technology Association of India (MTaI), which comprises the likes of Johnson & Johnson, Bausch & Lomb, Smith & Nephew, C R Bard, Terumo, Boston Scientific and Vygon, has pointed out that globally, most orthopaedic implants are granted a shelf life of 10 years, a time period supported by bio-material evidence. But the draft rules dated October 17, have included all medical devices, including orthopaedic implants, under a common five year shelf life. Is this mere oversight on the part of the Drugs Technical Advisory Board (DTAB), or have they decided to play safe? Another instance where the MTaI says that the Indian regulator is being unreasonable is on the process of putting Unique Device Identifiers (UDIs) on medical devices. While this is being rolled out as per the classification of the device in a stage-wise manner in the US and EU, the two major markets of the world, the draft medical device rules mandate that every medical device should have a UDI from 2017 in India. The association has pointed out that it will not be feasible to do so only for products being exported to India. A third grouse is that while the initial notifications allowed all medical devices to put the manufacturing date and physical manufacturer’s address on the label prior to distribution in India, the new draft bill now requires that these details have to be added at the time of manufacturing. This is an unprecedented change from global norms, according to the MTaI. Previous drafts of the medical devices regulations have been branded as protectionist of local manufacturers but in this case, the Association of Indian Medical Device Industry (AIMED) has called it “an assault on the ‘Make in India’ programme as they will “legalise pseudo manufacturing, result in closure of domestic manufacturing and drive jobs out of India.” While the Ministry of Health & Family Welfare welcomes comments on the draft, it clearly has its
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India ranks a low143, ahead of Pakistan (149th) and Bangladesh (151st), out of 188 countries, on 33 of the 47 health-related SDG indicators
own mind. It might relax some rules but both industry lobbies would do well to not take the Ministry for granted. The Health Ministry's stance with all segments of the sector has been very tough. For example, more medicines have been brought under price control in the past year. Therefore medical device manufacturers cannot expect a lenient line. This stance is quite understandable. After all, the Health Ministry faces the tall task of providing quality healthcare, medicines and medical devices to every Indian citizen, on a very tight budget. Just how tall a task it is was illustrated in a recently released report in The Lancet on the progress of 188 countries on 33 of the 47 health-related SDG indicators. India ranks a low 143, ahead of Pakistan (149th) and Bangladesh (151st). While Iceland topped the ranking, followed by Singapore and Sweden, the US came 28th, an indicator that bigger economies need not necessarily have more efficient health systems. The buzzword is efficiency, doing more with less, measuring progress against health indicators and continuous benchmarking. Clearly, we in India have a long way to go but we have already taken the first step. An recent study done by researchers at IIM Ahmedabad, titled 'Development of a Health Index of Indian States', ranks 21 Indian states on a unique outcome:input matrix which does not just show their relative status, but also indicates which ones are performing better with lesser resources (inputs) as well as those unable to utilise resources optimally. So while Kerala ranks first on outcome variables, followed by Maharashtra, the input variables chart is topped by UP, followed by Bihar. Maharashtra, Tamil Nadu and Andhra Pradesh bag the top three positions on the outcome-input matrix. The authors plan to make this an annual exercise, and include more states next time, hoping that the government will use this matrix to identify focussed policies for further work. As we start the countdown to the second edition of Healthcare Sabha, due in February 2017, we will take forward our agenda. While the first edition identified India’s public health-related crises areas, our 2017 edition will focus on getting thought leaders to build a ‘Manifesto for a Healthy India’. We will use evidence-based methods to discover excellence models which will achieve equity in health for all citizens of India. Come, help us make this a reality. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com
LETTERS WONDERFUL INITIATIVE!
WELL EXECUTED EVENT!
CONGRATULATIONS!
want to take this opportunity to congratulate you for this wonderful initiative and effort taken by you to organise the event. It was definitely well organised where a lot of values were added to make it a successful one. I am sure you will be organising similar events in coming days too and it will be my pleasure to be associated with the same.
I
H
he entire programme of Healthcare Senate was well managed and organised in a scientific way. The event was knowledgeable and innovative. It is a must attend event for all healthcare leaders. Team members deserve great appreciation from the core of my heart.
Joy Chakraborty COO, PD Hinduja Hospital and Medical Research Centre
Rajesh Kumar Gupta Director, Pushpanjali Hospital & Research Center – Agra
ealthcare Senate 2016 was not only an excellent but an interactive programme with full of information. It was a well thought and executed senate. I, personally and on behalf of my institution, is extending hearty congratulation to your institution, support partners and event team for successful completion of Healthcare Senate.
T
Dr Pradeep Bhardwaj CEO, Six Sigma Healthcare, Delhi; Medical Director, High Altitude Medical Rescue
OCTOBER 2016
Check out the online version of our magazine at
The inaugural edition of Healthcare Senate, the national private healthcare business summit, celebrated the spirit of excellence and leadership in healthcare delivery in the private sector. For detailed coverage of the event, check out: http://www.expressbpd.com/healthcare/healthcare-senate-special/
www.expresshealthcare.in
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Mobile: +91 9999070900 Fax: 0120-4367933 Email id: ambuj.kumar@expressindia.com Our Associate: Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com CHENNAI The Indian Express (P) Ltd. Business Publication Division 8th Floor, East Wing, Sreyas Chamiers Towers New No 37/26 (Old No.23 & 24/26) Chamiers Road, Teynampet Chennai - 600 018 Telephone (Board): +91 44 24313031/32/34 Fax: +91 44 24313035 BENGALURU Mathen Mathew
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Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents. The Indian Express (P) Ltd., cannot be held responsible for such contents, nor for any loss or damages incurred as a result of transactions with companies, associations or individuals advertising in its newspapers or publications. We therefore recommend that readers make necessary inquiries before sending any monies or entering into any agreements with advertisers or otherwise acting on an advertisement in any manner whatsoever.
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MARKET I N T E R V I E W
‘We want to make quality healthcare accessible and affordable’ Recently, Aetna International, a Fortune 100 company, invested ` 100 crores in its fully owned subsidiary, Indian Health Organisation (IHO). Manasije Mishra, MD, Indian Health Organisation, in an interaction with Sanjiv Das, divulges more about the utilisation of the investment and about IHO's initiatives to enhance healthcare in India How will the recent investment of ` 100 crores by Aetna International in Indian Health Organisation (IHO) help improve healthcare access? In which programmes/solutions would these funds be utilised? Our vision is to become a healthcare partner for our members, helping them to stay healthy at every stage of their journey. We want to make quality healthcare accessible and affordable. We have developed a number of innovative products and services and there are many new ones in the pipeline. These include digital health solutions which will primarily focus on preventive care. This is the expertise that Aetna has developed by working with individuals, healthcare providers and governments over the last 160 years in the US. We will also be using the funds to invest in technology, customer service and distribution. Recently, you have launched Classic Family Consultation membership. What are the benefits of this product? Classic Consultation plan was developed with a focus to enable Indian families manage their day to day medical expenses effectively. The product offers: ◗ Unlimited tele-consultation- Even for a minor health concern, you need not rely on self-medication, surfing on the Internet, etc. Our medical experts are available to you for providing expert advice.
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◗ 10 free doctor consultations at quality hospitals and clinics to pay for your families’ medical needs. ◗ Dental: Free consultations at IHO network dental clinics and discounts upto 30 per cent on further treatment. ◗ Risk assessment and health check for two members: Comprehensive health checkup covering 61 tests for understand the risks ◗ Professional guidance and motivation: Professional guidance on diet management, lifestyle changes, simple exercises to manage your health. ◗ Discounts at IHO Network centres: IHO Network advantage to ensure that your savings on every penny that you spend on health. ■ 10–15 per cent discount on medicines at retail pharmacies, ■ 15 – 25 discount on diagnostic tests for your family members ■ 10– 20 discount on minor treatment/hospitalisation at top hospitals/nursing homes ■ Upto 50 per cent discount on any additional consultation at clinics/nursing homes ■ Our service team helps to make any appointments you need. This is a health solution that delivers convenience and quality at an affordable cost of `5880 for a family of four for one year. The product enables tax savings up to `1500. We estimate this product will help a family save at least 50 per cent on health related expenses in a year. Considering then a normal family in a metro spends around `20,000 –
We will also be using the funds to invest in technology, customer service and distribution
IHO has a strong physical network of health partners across 38 Indian cities. In the next three months, our Classic Consultation plan will be expanded from five cities to 25 cities. Our tele-consultation services can be accessed from anywhere and we believe this is very useful in small towns and villages where it is difficult to access quality medical services. This is backed up with an online pharmacy service which can deliver quality medicines at a 25 per cent discount anywhere in India. We are already distributing such products in over 500 cities. We are in discussion with some partners to further expand this into rural India during 2017.
Which are the other products you intend to launch in the Indian market? Our product pipeline looks strong and we’ll be launching several new products in 2017. We would be delighted to share details once these products are ready.
What are your plans/ initiatives to improve healthcare in the next three years? We see a lot of our customers talking to us about how IHO membership has helped them realise their health problems before any complications could arise and take preventive action. Recently, one customer was saying that ‘he realised that he was diabetic because of free check-up that he got through his IHO membership and was happy that he could manage his condition effectively before any complication could arise.’ These stories will serve as a real motivation behind our future initiatives.
Apart from catering to the urban population, do you also plan to reach out in rural areas?
What are the opportunities and challenges specific to India? How do you plan to leverage the opportunities?
30000 in year on health, this is a significant saving.
I see three big challenges: ■ Fast-paced life, sedentary lifestyle, self-medication, rising burden of chronic diseases, lack of proper knowledge about the preventive health. ■ Healthcare expenses are on the rise, much faster than the average inflation rate. Not only on hospitalisation, but also on day-to-day medical expenses like consultation, diagnosis, medicines, minor treatment and home care treatments. ■ India is a country where funding for healthcare is a serious problem. Insurance penetration is low and the government only spends about three per cent of GDP on health. Hence, over 60 per cent of the health expenses have to be self-funded. We will focus on preventive health by providing our members the knowledge, tools, professional guidance and motivation to manage health. In addition, when our members need treatment, we will help them access quality healthcare at a discount. We will help cut down the cost of healthcare. Why do you think India is lagging behind when it comes to health insurance? We are not an insurance company and we focus on discounted pre-paid health packages that make quality healthcare affordable. Our products provide considerable savings on out of pocket expenses on a day-to-day medical expenses that are usually not paid for by employers or insurance companies. sanjiv.das@expressindia.com
I N T E R V I E W
‘We would be manufacturing around 100,000 wheelchairs and 25,000 beds by 2020’ Syed Riaz Qadri, MD, Vermeiren India Rehab shares more details about the company’s recently launched manufacturing facility, its role in the company’s growth plans, the opportunities it seeks to tap and more, with Usha Sharma What was the reason behind Vermeiren Group’s setting up of state-of-theart manufacturing facility in India? How is it going to benefit the Indian population? India is one of the emerging markets with significant growth potential across categories like automobiles, tourism, electronics and others etc. With the potential of the population and growing demand, the medical equipment sector is set to witness exponential growth. Moreover, people are getting more aware about quality and ask for customised products as per their requirement. Innovative, best quality products will be manufactured in the facility. It will be supplied in the Indian market at competitive prices as it is manufactured locally. Moreover, the government is also planning to give benefits for Indian manufacturing units through exemption of taxes and duties. Thus, patients will be able to reap several benefits through the newly launched facility. Which products will be manufactured from the newly built facility and what business opportunities do you foresee? What percentage of growth have you chalked from the rehab care equipment market? Currently, we will be starting with manual wheel chairs with different models. We will be able to supply around
20-30 per cent of wheelchairs initially from our facility as per the requirement. In the first year, how many wheelchairs, hospital beds, shell chairs, comfort chairs and other products do you plan to manufacture from the newly launched facility? Are you in partnership with any hospitals? In 2016, we would be manufacturing around 8000 wheelchairs and in 2017 it may reach around 35,000 to 40000 wheelchairs. We would manufacture hospital beds in 2018, post construction of our building’s second phase. We also plan to manufacture around 100,000 wheelchairs, 25,000 beds and other products by 2020, to meet the market require-
There are plans to develop R&D centres in India and the focus will be to not only tap the untapped rural areas across India but also the urban areas
ments. What will be the USP of your products and how cost effective will they be for the Indian patients? Since, we manufacture in India, our products will be more cost effective than those of other importers as we can save the cost of manpower, transportation cost and other miscellaneous expenses for clearance. As of now, since we are in the SEZ, we will be paying import duties for local sales in India. But the government is thinking of new policies in which duties can be exempted for local manufacturers, which in turn will help us to price our products in a more competitive manner. Reportedly, you have plans to open a R&D centre in India and the focus will be on rural areas across India. Can you share your strategies to achieve these goals? Yes, we have plans to develop R&D centres in India and the focus will be to not only tap the untapped rural areas across India but also the urban areas with an aim to meet the growing demands of medical equipment market in the country. Will India be your gateway for Asia Pacific? Yes, we can supply to Asia Pacific countries as per requirement and as of now, we are able to supply to Europe and the Middle East as well. u.sharma@expressindia.com
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MARKET I N T E R V I E W
Our diagnostic equipment has been developed in line with the ‘Make in India’ campaign Despite being a medical condition which affects 60 million people in India, Vertigo remains highly undiagnosed. Rajneesh Bhandari, Founder, NeuroEquilibrium Diagnostic Systems, shares his vision to address the needs of vertigo patients through his chain of specialised clinics, in an interaction with Mansha Gagneja Why did you choose to enter into such a niche area of healthcare? Tell us about the prevalence of vertigo in India? Vertigo is a condition when one experiences a sense of spinning or swaying. Often accompanied by nausea, sweating, or a problem with walking, it affects five per cent of the population in any given year, which adds up to 60 million people in India. In most cases, patients are not aware that a disorder of the inner ear also causes vertigo and dizziness. Owing to low awareness and lack of proper diagnosis, a majority of the patients are treated symptomatically without identifying the underlining cause. A large part of the population in the country is in the need for correct diagnosis and treatment. Lack of awareness and dire need of correct diagnosis and treatment drives us to step into this area. Do you think there are enough providers to treat vertigo in the country? There are very few specialised vertigo and balance disorder clinics in India. Other Indian companies do not have access to diagnostic equipment, thereby relying on imported equipment that are comparatively expensive. There are a few centres across the world which use virtual reality for targeted vestibular rehabilitation therapy, however, there are none in our country. A vestibular evaluation requires a multidisciplinary approach,
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involving diagnosis by a panel of ENT, neurologist and psychiatrist. How has the diagnosis and treatment of vertigo evolved over the years? Vertigo can be treated if the underlining cause is diagnosed. There have been tremendous scientific strides in the field of evaluation and treatment of vertigo in the last five to 10 years. It is now possible to diagnose the precise cause and thus provide specific treatment. Diagnosis of the underlining cause of vertigo requires a battery of tests. Currently, most diagnostic equipment being used, are not manufactured in India, hence very expensive. NeuroEquilibrium has developed Vertigo diagnostic equipment like Video Nystagmography, Subjective Visual Vertical, Craniocorpography and Dynamic Visual Acuity indigenously and has applied for three patents. The diagnosis is very cost effective and the vestibular testing with a battery of other vital tests costs less than a MRI. The vestibular rehabilitation has to be customised based on the diagnosis of the underlining disorder. We provide targeted rehabilitation therapy including the use of virtual reality. How have you contributed towards enhancing vertigo treatment? We provide patients with comprehensive vertigo and balance evaluation,
customised reporting, one click patient data retrieval, rehabilitation module and patient monitoring module, making it the world’s first robust diagnostic system that helps doctors to diagnose and treat vertigo cases easily. It is a comprehensive diagnostic system, which integrates various diagnostic tests on one platform and sends the diagnostic reports to a cloud server, which helps in providing proper diagnosis and treatment to vertigo patients. We have been working towards the development of diagnostic equipment and related technologies for more than two years and launched the products in April this year. Our diagnostic equipment has
been developed in line with the ‘Make in India’ campaign and we have already applied for three patents. We have already set up speciality vertigo and balance disorder clinics in Jaipur, Kolkata and Pune in collaboration with leading ENT camp and neurology clinics. What is your business strategy to tap your target audience? How are you planning to partner with ENT specialists? We are looking forward to partner with leading ENT clinics, neurology clinics and hospitals to provide multidisciplinary diagnostic services within these clinics. By setting up specialised vertigo camp and balance
disorder clinics in the premises of leading ENT clinics as a clinic-in-clinic, we can provide vertigo diagnostic services to patients at the doorstep of these clinics. How many rounds of funding have you received so far? How do you plan to utilise these funds? Presently, the company is bootstrapped and the promoters have made the investments. We plan to raise $2 million in the next three to four months. The funds will be utilised to set up 125 specialised vertigo camp and balance disorder clinics and virtual reality-based targeted rehabilitation to treat a million patients by 2021. manshagagneja@gmail.com
MARKET POST EVENTS
Intelligent hospitals are pivotal to smarter healthcare delivery: Experts A panel discussion hosted by Express Healthcare, in association with Schneider Electric, highlight the importance of adopting the right technology blueprint in hospitals
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Today we are recognized as one of the leaders when it comes to versatile innovation and Industrial design for the homecare and hospital market. Our brand is based on the same values we started up with – quality, a focus on patients and customers, and a commitment to innovation.
Our range of products Lakshmipriya Nair Mumbai
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© 2014 Breas Medical – All rights reserved. Breas Medical reserves the right to make changes in specifications and features shown herein, or discontinue the product described at any time without notice or obligation. Contact your Breas representative for the most current information. Breas and the Breas logo are trademarks of Breas Medical AB.
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Ved Prakash · D-76, Defense Colony, Jajmau Kanpur-208 010 · Phone +91 99364 17333 vedprakash.bajpai1956@gmail.com
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xpress Healthcare, a leading publication from The Indian Express Group, alongwith Schneider Electric, recently organised a knowledge-sharing event in Ahmedabad. The event brought the experts, thought leaders and peers from the healthcare industry to jointly discuss just what it takes to leverage technology to keep processes and infrastructure at peak performance, anywhere and anytime in the healthcare sector. Held at Ahmedabad, the event revolved around intelligent hospitals. It commenced with live demos of solutions from Schneider Electric for the healthcare sector. A presentation by Anindya Nandy, Country Leader - Healthcare, Schneider Electric gave an overview on the changing paradigm of healthcare and spoke on making hospitals
MARKET more intelligent to improve efficiency and efficacy of healthcare delivery. The highlight of the event was a panel discussion which centred on the importance of adopting the right technology blueprint in hospitals to continuously improve patient safety, boost patient satisfaction levels, and reinforce hospital security, among other issues, all within a tight budget. It highlighted that leveraging technology effectively can lead to improved financial performance and 'smarter' healthcare delivery, thereby creating more intelligent hospitals. It also touched on the gaps in current systems and the challenges which are hindering swifter adoption of technology in hospitals. Viveka Roychowdhury, Editor, Express Healthcare & Express Pharma was the moderator for the session. The panelists were Ravi Bhandari, CEO, Shalby Hospitals, Ahmedabad; Dr Bharat Gadhvi, CEO, HCG Hospital, Ahmedabad; Neeraj Lal, COO, Sunshine Global Hospitals, Vadodara; Neha Lal, GM Admin & HR, GCS Medical College, Hospital & Research Centre; Pankaj R Dharkar, President, Pankaj Dharkar and Associates and Srirangarajan Kadaba, Director, Solution Business, Schneider Electric. Roychowdhury, in the course of discussion, raised several pertinent issues such as what does it entail to be an intelligent hospital, what are the encumbrances which prevent hospitals from becoming truly intelligent, the roadmap for hospital providers in India to become world-class facilities etc. Bhandari began the conversation by asking a very relevant point. He asked that since the emphasis of the discussion is on intelligent hospitals, does it mean that hospitals were not intelligent until now? He then pointed out that hospitals, especially in the private sector, have tried to be at par with the current standards but also clarified that intelligence is an evolving concept and a continuous process. He advised the audience to keep upgrading
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Express Healthcare and Schneider Electric hosted a panel discussion on intelligent hospitals at Ahmedabad. Ravi Bhandari, CEO, Shalby Hospitals, Ahmedabad; Dr Bharat Gadhvi, CEO, HCG Hospital, Ahmedabad; Neeraj Lal, COO, Sunshine Global Hospitals, Vadodara; Neha Lal, GM Admin & HR, GCS Medical College, Hospital & Research Centre; Pankaj R Dharkar, President, Pankaj Dharkar and Associates and Srirangarajan Kadaba, Director, Solution Business, Schneider Electric were the eminent panelists
Anindya Nandy, Country Leader - Healthcare, Schneider Electric
A Revanand, Regional Sales Director, Proximity, Schneider Electric
An enrapt audience at a panel discussion on intelligent hospitals
A live demo of Schneider Electric’s solutions for the healthcare sector
their standards and adopt technology to improve their processes, reduce errors and
Dr Gadhvi pointed out any intelligent hospital does not rest only on technology and sys-
offer best quality services to its patients. Continuing the discussion,
tems but also on intelligent people. He highlighted how important it is for people in a
MARKET hospital to be intelligent and emphasised on the need for effective training measures to optimise the use of these intelligent systems. He also said that there is a need for a mindset change and make systems for idiot proof. Kadaba took up the conversation and spoke on how data needs to be effectively evaluated and analysed to ensure that intelligent hospitals are created and sustained. He gave instances of how data can be effectively utilised to build intelligent hospitals. He spoke on the need to invest wisely and train hospital personnel to become more intelligent. He also expressed the hope that soon all hospitals would go down this route. Neha Lal gave an account of the challenges and benefits of implementing intelligent systems in a large public hospital. She also elaborated on the measures taken at her hospital to become more smart. But, at the same time she also admitted that first there is a need for measures to train people who would be using these systems to optimise the potential of intelligent systems. Neeraj Lal emphasised on the need for smart people to run smart systems as well. He also pointed out that now India has solution providers like Schneider Electric who offer great products to become intelligent organisations. He also gave examples of how things are done at his hospital. He also addressed a major issue that prevents hospitals from opting for intelligent systems – cost. However, he pointed out that the advantages of investing in the right technology are many and those who opt to do it at the right time would emerge as the leaders in the industry. Dharkar, as an infrastructure expert, spoke on various technological advances which are making healthcare very efficient. At the same time, he also pointed out that operating and maintaining these systems effectively come with their own set of challenges. He said that architects and infra consultants in healthcare should incorporate many of these systems right from the
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Leveraging technology effectively can lead to improved financial performance and ‘smarter’healthcare delivery, thereby creating more intelligent hospitals
designing stage to avoid hassles later. He also urged companies like Schneider Electric to come up with data or studies which give a comprehensive idea about the extent of the benefits accrued by implementing intelligent systems and processes in a hospital. The audience raised several queries and interacted
with the panelists to further understand the role of technology in enhancing healthcare. It was followed by a vote of thanks by A Revanand, Regional Sales Director, Proximity, Schneider Electric. He thanked all the participants for making the event a great success. lakshmipriya.nair@expressindia.com
MARKET
GNIDSR Kolkata signs MoU with IIT- Kharagpur and IIEST-Shibpur To conduct advanced interdisciplinary research in contemporary fields of oral healthcare
(L-R) Dr Ajoy Roy, Director, IIEST Shibpur, Taranjit Singh, MD, JIS Group, Chandrima Bhattacharya, Chairperson, West Bengal, Medical Services, Government of West Bengal, Dr SK Bhattacharya, Deputy Director, IIT-KGP, during the MoU signing ceremony in Kolkata
KOLKATA-BASED Guru Nanak Institute of Dental Sciences and Research (GNIDSR), an institute under the aegis of JIS Group Educational Initiatives, IIT-KGP and IIEST (Shibpur) have signed a Memorandum of Understanding (MoU) in order to conduct interdisciplinary research in contemporary fields of oral healthcare for the first time in India. The MoU signed between these three institutes will encompass the following the areas of research: ◗ Ph D programme under JIS University in oral and dental health services ◗Early detection and prevention of oral pre-cancers and cancers
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◗Precise molecular pathologybased grading of oral cancers ◗Therapeutic target identification for oral pre-cancers and cancers ◗Non-invasive diagnostic methods for malignant potentiality of oral pre-cancers ◗Oral stem cells and its therapeutic application ◗Tissue engineering based therapeutic support for oral and dental diseases ◗Development of bio-materials based oral implants ◗Bio-sensors for diagnostic and therapeutic applications Speaking on the occasion, Sardar Taranjit Singh, MD, JIS Group Educational Initiatives said, “Millions of people, especially from the economically underprivileged sections
of our society, today suffer from oral and dental diseases particularly from oral precancer and cancer but no breakthrough has yet been achieved towards treatment and management of these malignant diseases resulting in the loss of millions of lives. Taking into consideration this dire situation, GNIDSR a research-oriented institute and a hospital catering to oral healthcare has taken the initiative to conduct advanced multi-disciplinary research in the areas of oral cancer and pre-cancers, stem cells, tissue engineering , biomaterials, implants and sensors by entering into this MoU jointly with IIT-KGP and IIEST (Shibpur).”
Chandrima Bhattacharya, Chairperson, West Bengal Medical Services, Government of West Bengal, was the Chief Guest for the occasion. Also present on the occasion were Dr SK Bhattacharya, Deputy Director IIT - KGP; Dr Ajoy Roy, Director, IIEST Shibpur; Dr Suranjan Das, Vice Chancellor, Jadavpur University and Dr Dibyendu Mazumder, President - Dental Council of India, Prof (Dr) RR Paul, Deputy Director & InCharge (R&D), GNIDSR and Prof (Dr) TK Pal, Principal, GNIDSR. Speaking to Express Healthcare, Dr Dibyendu Mazumder, President - Dental Council of India (DCI) said, “This is a commendable initia-
tive and a first-of-its kind by a private dental institute in the country. Coming together of GNIDSR, IIT, Kharagpur and IIEST, Shibpur to further advanced interdisciplinary research in contemporary fields of oral healthcare will open a new chapter in oral care.” Dr Mazumder said that DCI has asked all its 308 affiliated dental colleges to set up two satellite centres in their region to focus on dental care. He said, “We are hopeful that we can now have access to vital statistics on oral cancer, which we are starved off now. These data will be helpful in chalking out our future course of action.” EH News Bureau
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MCGM,AHI,Bhamla Foundation,PFCD launch Jaanbachao campaign The launch aimed to create awareness on prevention of non-communicable diseases MUNICIPAL Corporation of Greater Mumbai (MCGM) launched Jaanbachao.in, a campaign to promote healthy lifestyle featuring actor Akshay Kumar in collaboration with Asian Heart Institute, Bhamla Foundation, Boston Scientific & Partnership to Fight Chronic Diseases (PFCD). The campaign is aimed at creating awareness on prevention of non-communicable diseases (NCDs) such as diabetes, hypertension and heart diseases. Present on the occasion was Devendra Fadnavis, Chief Minister, Maharashtra. As a part of this campaign, a short film motivating citizens to adopt a healthy lifestyle was premiered at the launch. The film, directed by filmmaker Rajkumar Hirani, and featuring Akshay Kumar, highlights simple tips which can be easily followed by people as a part of their daily routine. “Both these killer diseases are hampering the health of today’s young population. Jaanbachao film has put across five simple health tips which people can follow to fight with non-communicable diseases. We want to raise a healthy nation and prevention and awareness are the key factors to achieve this goal,” said Fadnavis. “India is burdened with a twin epidemic of infectious and NCDs. Unhealthy eating habits, lack of exercise, smoking, alcohol consumption and stress along with poor health seeking behaviour puts Indians at high risk for NCDs. The brunt of NCDs is borne by most people in their most productive years and it affects their families and the nation at large,” said Dr Ramakanta Panda, VC and MD, Asian Heart Institute, Mumbai. EH News Bureau
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DIABETES CARE ACROSS THE LIFESPAN 20
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India is in the throes of a diabetes epidemic but one patient refused to be just a statistic and decided to use his experiences to help other diabetics manage their diabetes better. Founder & CEO Ashok Jain’s Lifespan Clinics is just three years old but it is a good start BY VIVEKA ROYCHOWDHURY
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ccording to the latest (seventh) edition of the International D i a b e t e s Federation (IDF) Diabetes Atlas, 1 in 11 adults have diabetes (415 million). What is more worrisome is that almost half (46.5 per cent) of adults with diabetes are undiagnosed. The figures for India are equally, if not more, depressing. The IDF has predicted that by 2030, over 100 million Indians would be diabetic. According to the 2015 country report on India in the seventh IDF Diabetes Atlas, one in every 12 adults in India has diabetes, with 52.1 per cent of the adult population undiagnosed. So India has a higher percentage of undiagnosed diabetics than the world average. In terms of numbers, diabetes cases in the 20-79 years age group in India are at 69,188,600, of which 36,061,100 are not aware that they have diabetes. Diabetes related expenditure per person is projected to be $94.9 per adult person with diabetes, based on mean diabetes cost ratio of 2. The problem of late diagnosis increases the cost of dealing with the disease, not just in terms of treatment costs but also loss of productivity. India's dream of reaping its demographic dividend could very soon turn into a nightmare if a sizable section of the nation's workforce is held back by diabetes related health complications. Thus the theme for this year's World Diabetic Day(WDD), Eyes on Diabetics, was chosen by the International Diabetes Federation (IDF) to highlight the importance of screening for diabetes and for its complications. (See Box: WWD 2016: Eyes on Diabetes.) With specific importance for low resource countries like India saddled with a huge diabetic disease burden, this WDD will also highlight feasible and costeffective solutions that exist to help identify people with undiagnosed type II diabetes and those at risk of developing it in
the future.
Solutions of all sizes While corporate hospitals and pathology laboratories in India have put all their might behind this cause, management of diabetes requires more than clinical care or a battery of path tests at regular intervals. It calls for sustained personal contact with the patient and caregivers. More importantly, diabetes management needs a change in lifestyle, which is more effective when done by the whole family. Large hospitals do strive to retain the personal touch and follow up but often fail for a variety of reasons, ranging from high attrition rates, distance between hospital and patients'' resi-
soft drinks business of Cadbury Shweppes, Jain turned entrepreneur after his company was taken over by Coca Cola. A few false starts later, he started Oxygen Healthcare Communications around 2000, an agency advising pharmaceutical companies on advertising strategies. It was around this time that he was diagnosed with diabetes and came to see a business opportunity in the severe lack of disease management options. And thus Lifespan Clinics (Lifespan) took shape as a diabetes management initiative. Unlike most patients, Jain decided to accept his disease condition. Rather than hide it, the Lifespan website proudly proclaims that it is ‘Founded by
says,“We’ve treated around 40000 patients over the last three years. Every month, about 4000 patients come to us, which is quite satisfying and something to be proud about. Of the customers who've taken our annual plan, 6-7 per cent have reduced their blood sugar levels. We’ve had testimonials of people who've said that it has literally transformed their lives, because their diabetes is under control, they now understand their diabetes better.” But he concedes that in proportion to the problem, the numbers are very small. Lifespan currently has around 33 clinics, of which six are franchisees. The goal is to expand to 40 clinics by end of
WWD 2016: EYES ON DIABETES N
ovember 14 is World Diabetes Day (WDD) and this year, the International Diabetes Federation (IDF) has decided to focus on integrating screening for diabetes complications into ongoing care for people living with diabetes. Under the theme, Eyes on Diabetes, IDF is advocating screening for type 2 diabetes to modify its course and reduce the risk of complications as well as screening for diabetes complications as an essential part of managing type 1 and type 2 of diabetes. With specific importance for low resource countries like India saddled with a huge diabetic disease burden, this WDD will also highlight feasible and cost-effective solutions that exist to help identify people with undiagnosed type 2 diabetes and those at risk of developing it in the future. IDF's focus is driven by estimates that globally as many as 193 million people, or close to half of all adults living with diabetes in 2015, are unaware of their disease. Most of these cases are type 2 diabetes. The earlier a person is diagnosed, the earlier treatment can be initiated in order to reduce the risk of harmful and costly complications. A person with type 2 diabetes can live for several years without showing any symptoms, during which time high blood glucose is silently damaging the body. Diabetes is a leading cause of cardiovascular disease, blindness, kidney failure and lower-limb amputation. Over one third of all people currently living with type 1 and type 2 diabetes will develop some form of damage to their eyes that can lead to blindness. These complications can be prevented or delayed by maintaining blood glucose, blood pressure and cholesterol levels as close to normal as possible. Many complications can be picked up in their early stages through screening, so that treatment can be given to prevent them becoming more serious.
Source: IDF
dence, etc. Which is where initiatives like Ashok Jain's Lifespan India fit in. With its tagline proclaiming it to be the ‘world's largest chain of diabetes management clinics,’ this in an initiative which aims to address the accessibility issue. Jain, a diabetic himself for over two decades, has no clinical background and sees the treatment gaps from a patient's side. An engineering graduate, who made it big as CEO of the
a diabetic.’ This smart positioning strategy may have helped form a bond with potential customers. Likewise, it helps Lifespan stand out from other ventures in this arena.
Three years young Seated in his office in the first clinic in Worli, Mumbai Jain feels satisfied that in terms of what they have achieved, it (the positioning and strategy) seems to have worked. Relating their achievements, he
this financial year. Given the founder's mission to help fellow diabetics cope with the disease, this target is dictated solely by finances. Jain indicated he'd like a faster growth rate butwould like to grow organically. Jain has therefore chosen the slow and steady route, preferring to open his own clinics, restricting franchisees to just 25 per cent of the total number. According to Jain, profits from his communications agency, Oxygen Healthcare
Communications, are ploughed into running Lifespan. As a group, they have invested around ` 20 crore in Lifespan, and are clocking a 40-45 per cent growth over the last financial year.
SWOT analysis The strengths of the Lifespan model go much beyond Jain's own empathy with fellow diabetics. Care management systems have been built into the organisation. For example, he says, everything is automated and is on a cloud. Non-invasive tests have been built into the care model, like the Lifespan RISC test, which in seven minutes, measures 30 cardio-metabolic parameters like insulin resistance, vascular markers like arterial stiffness, etc. and a host of other health indicators. All these parameters give the doctors and dieticians at Lifespan an indication of the overall health status of an individual. For instance, diabetes often comes with cardiovascular conditions, hypertension, sight issues, etc. With this 360 degree view of an individual's risk profile, the clinician adds in the patient's family history so that a personalised treatment strategy can be devised. Lifespan currently has a staff strength of close to around 150 staff (doctors and dieticians) across the country, all offering the same standard of care.
The weak links Jain says that financing remains the single largest weak link, as expansion and setting up more clinics, adding staff, etc requires finances. His second pain point is finding like minded doctors and staff and then training them to follow the Lifespan model. Explaining his credo, Jain says, “Most doctors don't think of patients as customers. If they did, they'd ask, why should a customer keep waiting or calling for me? Why can't I be available all 24 hours, maybe through an email? Why should I overload my patients with so many medicines, some of which they do not require? Just because a new expensive medicine is launched, why should I give it to them? When you start looking at it
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1 in 11 adults have diabetes (415 million)
542,000 children have type 1 diabetes
(Clockwise from left) Co-promoted brands of healthy food choices on display at a Lifespan clinic; the Lifespan RISC test machine; a patient examination room.
from a customer service angle, I think that is where we fail.” The third pain point ensuring that sufficient time is given to each patient. Speaking from personal experience, Jain believes that diabetes is not just a medical disease, it is a behavioral disorder. And that requires a huge amount of consultation and counseling, which needs a lot of time. Doctors just don't have that kind of time. Therefore Jain’s team needs to train the staff to spend half an hour with every patient, and counsel them on these aspects.
Opportunity to do good Inspite of these pain points, the business opportunity for Lifespan is only going to increase, given IDF’s figure. Ask Jain how he plans to grow Lifespan, and he turns philisophical, almost spiritual. Äs he puts it, “The opportunity to do good in the country is very, very high. Numbers show that 10 per cent of our population is diabetic but 20 per cent are pre diabetic. Worse, the new numbers say that 33 per cent of India is pre diabetic. According to Assocham figures released recently, 43 per cent in Delhi are pre diabetic. It is the
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46.5 per cent of adults with diabetes are undiagnosed opportunity to do good for one out of three Indians, because that is the incidence of diabetes in our country. I'd not call it a market, but an opportunity to do good.” Jain feels ignorance is the biggest threat to tackling diabetes, ranging from self-denial, lack of knowledge about diabetes, etc. He is specifically dismissive about what he terms 'grandmother's stories' linked to diabetes, like the use of traditional karela, methi etc to control/cure diabetes. Most borderline or early stage diabetics comfort themselves saying, “A little diabetes won't harm me”, not knowing that the disease can impact many other organs and systems of the body. Illustrating patient ignorance levels, he says that though the heart is the single largest organ that gets affected by diabetes, its been shown that people can link the impact of diabetes on eyes and kidneys, but never the heart. As much as 76 per cent of diabetics died of heart prob-
lems, he points out.
Business strategy Jain's ambition is to reach 2000 clinics, but his ramp up is dictated by how well his other businesses are doing, because that is his primary source of funding. Jain has a strategic relationship with The Times of India Group, whom he refers to as an “advertising VC” who is an equity partner in Lifespan. But Lifespan does face competition from the local unorganised diagnostics players, to the bigger chains like Thyrocare, Metropolis, SRL etc as well as hospitals groups. For instance, hospital chains have diabetes management initiatives like Apollo Hospitals' Sugar Clinics, which is a partnership with pharma company Sanofi India. So will a minnow like Jain’s Lifespan survive in such a competitive market, even though the unmet need is too great? Also, as in any business,
12 per cent of global health expenditure is spent on diabetes ($673 billion)
Three quarters of people with diabetes live in low and middle income countries
By 2040, 1 adult in 10 (642 million) will have diabetes
1 in 7 births is affected by gestational diabetes
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Every six seconds a person dies from diabetes (5 million deaths)
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STATUS OF DIABETES IN INDIA: IDF DIABETES ATLAS - 7TH EDITION (INDIA REPORT 2015)
1 in 12 adults has diabetes
52.1 per cent of adults with diabetes are undiagnosed Number of Diabetes cases (20-79 years): adults
69,188,600 Number of people with undiagnosed diabetes (20-79) adults
36,061,100 1,027,900 Diabetes related deaths: adults
Diabetes related expenditure: $94.9 per adult person with diabetes, based on mean diabetes cost ratio of 2.
Lifespan needs volumes to become sustainable but the founder is hampered by finances to expand the chain. Most diagnostic chains build volume and expand their market by offering discounted package deals. In a price sensitive market like India, with poor insurance coverage, discounts are a given. A cursory glance at Lifespan's site reveals similar discounts, For instance, the pre-diabetes proactive plan, for pre-diabetics who are at higher risk due to their weight, is priced at `18875 and available at a discounted price of `8500. So it seems that though Jain will get a lot of personalsatisfaction from meeting patients' needs, the business front will be challenging for the next few years at least. Unless he changes his business strategy. Jain remains confident that he i on the right track, because as he puts it, his model is built around a core of customer satisfaction. Every customer who walks in to Lifespan, gets a feedback call. According to him, 84 per cent of such feedback is positive. Annual packages were started in January this year so its too early to check the renewal rate, but around 40-45 per cent of customer/patients who were on the four month packages have now upgraded to the annual package, which could be one indicator that they see value in Lifespan's services. In terms of pricing, he says they have bundled every service possible to make it as value-added to the patient. And he doesn't see hospitals, diagnostics chains as competition but collaborators because they too are helping diabetics. But he points out that some of such ventures turn out to be recruitment centres for hospitals, whereas Lifespan's focus is to try to ensure that patients manage their disease so that they do not need to go into a hospital. Jain says its too early to think of an IPO, and he's not thinking in terms of too many financial goals right now, but
MOSTDOCTORS DON'TTHINKOF PATIENTS AS CUSTOMERS.IFTHEYDID,THEY'D ASK,WHYSHOULD ACUSTOMER KEEPWAITING OR CALLING FOR ME? WHYCAN'TI BE AVAILABLE ALL24 HOURS,MAYBE THROUGH AN EMAIL? WHYSHOULD I OVERLOAD MYPATIENTS WITH SO MANYMEDICINES,SOME OF WHICH THEYDO NOTREQUIRE? JUSTBECAUSE ANEWEXPENSIVE MEDICINE COMES,WHYSHOULD I GIVE ITTO THEM? WHEN YOU STARTLOOKING ATITFROM A CUSTOMER SERVICE ANGLE,I THINKTHATIS WHERE WE FAIL ASHOK JAIN, Founder & CEO, Lifespan Clinics
more in terms of expanding to help more patients.
Future plans The fast food industry is today seen as the main cause of the current epidemic of lifestyle diseases. So shouldn't these corporations, like Jain's previous employer, play a major role in rectifying their mistakes and curbing this epidemic with healthier food choices? Jain counters this strategy, saying that we need to work on increasing consumer awareness rather than on the corporations. State bans on alcohols and sin taxes on colas, cigarettes etc don't work long term
because if the consumer doesn't know better, he will ensure that he gets his fix. If leading brands adopt healthier choices, the customer will move to unhealthier smaller brands.“The biggest problem is not the corporations, but educating the consumer. If cola companies, for example, set aside two per cent of their budgets to educate the customer on healthy food choices, then this might help. When his tastes change, they will have to follow and change their offerings.” So can policy makers crack the whip and make such corporations fall in line? On initiatives by some state governments to impose such taxes like Kerala's fat tax, he concedes that this approach might help but not in its current avataar, which selectively targets the organised fast food industry and turns the blind eye to unhealthy foods in the unorganised sector is meaningless. Consumption of oily Indian snacks is around 95 per cent, so going after the five per cent will have no impact. “If you can ban unhealthy foods across the spectrum, and have a mechanism to implement this, it will work. But banning or taxing without education and counseling is meaningless. And the education should be at every level, starting from from schools to work places.” Jain's other businesses support this aspect of his beliefs. Oxygen TV, a part of Oxygen Communications, is present in around 6500 doctors' waiting rooms, beaming in consumer education programmes on diseases. The programmes are supported by advertisements of health foods brands, which are also displayed in Lifespan clinics. It is revenues from such collaborations that are the lifeblood of Lifespan and to some extent de-risk Jain's business model. The success of Lifespan and its strategy seems guaranteed, given India's humungous diabetes burden. But can they scale up fast enough to be sustainable? viveka.r@expressindia.com
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‘Dietary fibre show strong inverse relation with the risk of type II diabetes’ Sudha Vasudevan Sr Scientist & Head, Department of Foods, Nutrition &Dietetics Research (FNDR), Madras Diabetes Research Foundation & Dr Mohan’s Group of Institutions, explains the importance of maintaining a nutritional diet in diabetes management in an interview with Raelene Kambli How can nutrition aid diabetes management? What nutritional principles would you suggest to your patients? Diabetes is a chronic progressive metabolic disorder. Hence, to manage diabetes it is important to remove those dietary factors that aggravate the risk of diabetes and poor glycemic control (Example: Total calories, quantity and quality of carbohydrates and fats) while enhancing the diet with healthier foods that will mitigate this burden. Thus, the primary goal of diabetes management is to achieve normal blood glucose levels to retard or prevent diabetes complications and improve overall quality of life. The quality and quantity of carbohydrates consumed has the strongest influence on glycemic response especially the postprandial blood glucose. The protein requirement is similar to a person without diabetes (10-15 per cent of total calories) and diabetic kidney disease. Total fat and the type of fat can also influence the risk of diabetes as well as the cardiovascular complications of diabetes. Thus, balancing the quantity and quality (lower dietary glycemic load, higher MUFA fatty acids in the diet) and of these macronutrients (carbohydrates 55-60 per cent energy; Fat <30 per cent energy and protein 10-15 per cent energy and total calorie restriction); increasing the nutrient dense (vitamins and minerals) and intact dietary fibre rice sources would help achieve optimal nutrition.
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In terms of key nutrients, besides carbohydrates and fats, does adequate intake of protein matter? Protein from foods has shown to improve insulin secretion. However, the quality of protein is very important as many protein rich foods are also high in fats like meat, chicken etc. Vegetable protein foods like pulses and legumes are also rich sources of fibre that could also aid in blood glucose control. Similarly, dairy foods rich in protein has also been shown to have inverse association with the risk of diabetes (CURES study) from both national and international studies. In one of our five day continuous glucose monitoring clinical study carried out in overweight Indians have shown significant 24-hour reduction in glycemic response in the diet containing brown rice and legumes compared to white rice diet. However, the protein intake goals should be individualised. For those with diabetic kidney disease (with albuminuria, reduced estimated glomerular filtration rate), dietary protein should be maintained at the 0.8 g/kg body weight per day while for others 1g/kg body weight is allowed. What is the role of Low GI foods in managing diabetes? Low GI foods elicit lower peaks of blood glucose and hence less insulin demand and easier way to control blood glucose. However, authentic low GI foods are very few in
Balancing the quantity and quality of macronutrients ; increasing the nutrient dense and intact dietary fibre rice sources would help achieve optimal nutrition the global food market suggesting the challenges in developing healthy low GI choices. A review of many clinical trial studies on type II diabetes participants have shown that low GI diet helps in 0.5 per cent reduction in HbA1c ( ˜ 10.5 per cent reduction in the risk for deaths related to diabetes and its complications).
Can you provide some scientific evidence on the role of nutrition in managing Diabetes? Dietary fibre shows strong inverse relation with the risk of type II diabetes. In a study carried out by Chennai Urban Rural Epidemiological study (CURES). The high GI and GL diet along with low fibre content increases insulin demand and further leads to reduced blood lipids and waist circumference and cardiovascular diseases. Both national and international studies have shown that substituting brown rice over white rice markedly lowers blood glucose and insulin levels (Sun et al., 2010 – a tudy by Harvard group, US; Mohan et al., 2014 – study by Madras Diabetes Research Centre, Chennai, India). Whereas data on the ideal total dietary fat content for people with diabetes are inconclusive. Diet emphasising elements of a Mediterraneanstyle diet rich in MUFA and omega 3 fatty acids by increased consumption of nuts, traditional oils like groundnut oil, mustard oil and canola oil have also shown beneficial effects on glucose and lipid levels in type II diabetes. What are the nutritional factors that influence the development of type II diabetes? Urban population-based, epidemiological cross-sectional study by CURES, showed that our diets continue to be high in simple carbohydrates, the major source of energy (64
per cent E), followed by fat (24 per cent E) and protein (12 per cent E). The commonly consumed highly polished white rice in India has a high GI value, and the refining process leads to a loss of bran and germ rich in micronutrients and phytonutrients. Higher intake of refined cereals, and a high glycemic-load diet was associated with metabolic syndrome and risk of type II diabetes in Asian Indians. The study also showed use of omega-6 poly unsaturated fatty acids (PUFA) rich vegetable oils like sunflower/safflower oil can aggravate the risk of insulin resistance and metabolic syndrome in Asian Indians. What role does food processing have on nutritional value of food ? With rapid urbanisation, there is a large shift from traditional foods to processed foods, canned foods and ready-to-eat snacks in both the developed and developing world. The advanced processing methods like milling of grains to yield refined grain or flour, canning of fruits and vegetables with added sugars or salt diminish essential food components like fibre, micronutrients and phytonutrients in the diet. Almost 80 per cent of the foods available in the market today are refined foods and are rich in hidden fat, sugar and extra added salt. It is advisable to avoid or minimise these foods in the diet of population with diabetes. raelene.kambli@expressindia.com
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DRUG UPDATE Raelene Kambli Munich
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iabetes is often understated by patients and healthcare providers, therefore it is one of the leading metabolic diseases worldover. According to the International Diabetes Federation, by 2040 there will be one in every ten individuals suffering from diabetes. The World Health Organisation has warned in a report on World Health Day early this year on the increasing numbers of diabetics worldwide. The report says that the number of adults worldwide affected by diabetes has quadrupled since 1980. Nearly one in 11 people are now affected by the disease, with obesity and unhealthy eating included in the factors driving the rise as per this report. As per IDF Diabetes Atlas 2015, it now affects 415 million people globally and without effective prevention and management the number of cases is predicted to rise to 642 million people by 2040. Type II diabetes is the most common form of diabetes and in developed countries it accounts for up to 95 per cent of all cases. In keeping with the increasing number of people diabetes worldwide, the European Association for the Study of Diabetes organises an annual conference that focuses on research in diabetes management. This year the conference was organised in Munich and saw representatives and diabetes research experts from across the world presenting their studies. Some of the research papers presented during the annual meeting included: Management of hyperglycaemia in type II diabetes, 2015: a patient-centred approach, New WHO criteria on use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus, cardiovascular disease and diabetes in people with severe mental illness position, prevention of amputation by diabetic education, etc. One among the many scientific programmes at the EASD was conducted by Boehringer
A multi-pronged approach to diabetes management International diabetes experts lay emphasis on having holistic approach toward diabetes management Ingelheim in partnership with Eli Lilly on Insulin: A historical Perspective. On the sidelines of this event, Boehringer Ingelheim also organised panel discussions on ‘A new conversation in type ÍI diabetes’ and ‘Diabetes-where science and art meet? The panelist for these discussion comprises Jilly Cater, Healthcare journalist from UK who also moderated the discussion, Georg van Husen, Therapuetic Area Head, Cardiometabolism, Boehringer Ingelheim, International, Germany, Professor Robert Chilton, Associate Professor of Medicine, Cadiology Division, University of Texas, USA, Professor Merlin Thomas, Diabetologist, Head of Biochemistry of Diabetic Complications Laboratory at the baker IDI Heart and Diabetes Institute, Austria and Su Down, Diabetes Nurse Consultant, Somerset Partnership NHS Foundation Trust, UK. The panel began with presenting global statistics on dia-
betes. The panel also discussed various aspects of diabetes management and research happening in this field. Speaking about the growing prevalence of diabetes, Husen said, “Every 6 seconds a person dies due to complications caused by diabetes. Globally, there are around 400 million people living with diabetes and this number is going to increase by 50 per cent in the next few years.” He further pointed out that diabetes reduces the life expectancy of a person by six years. Going forward, he recommended that combination of different treatment option is the need of the hour to manage diabetes. Professor Chilton stated that drugs cannot solve the problem of diabetes. There is a need to correct eating habits of people. He further went on to accentuate the growing numbers of CVDs across the global due diabetes. He also spoke about the overuse of stents in CVD patients. “You don’t live longer
with stents. People forget to take medicine while they have stents. Therefore a holistic approach to managing diabetes is a must. There is a need to balance the glucose, salt and sugar among diabetes for better management. Moreover, we need better drugs that can maintain this balance in patients.” Talking about the importance of Empaglifozin drug in managing diabetes, he said that this drug has proved to reduce death risk in many patients. Additionally, Professor Thomas drew attention towards the increasing kidney-related disorders caused by diabetes. He also spoke of his book Understanding type II diabetes and explained the relevance of research in the field of diabetes management. The discussion further moved on to breaking various myths about insulin intake and the effectiveness of insulin in diabetes management. Journalists from various countries present at the event asked questions re-
lated to diabetes management relevant to their countries. When asked about the Indian scenario, Dr Thomas who has closely worked with various experts in India said that India is undergoing a diabetes pandemic. It is a must that the Indian government takes responsibility in combating diabestes. “There are many poor patients in India who are deprived of medicine as they cannot afford it. The Indian government should provide subsidy on diabetes drugs and services related to diabetes management in order to curb the menace,” he summed up. IDF Diabetes Atlas 2015’s report indicates that India has 69.2 million diabetics. It is the largest contributor to regional mortality with 1.1 million deaths attributable to diabetes in 2013 (IDF 6th Edition). IDF’s reports also mentions that Indians are prone to diabetes because of the ‘Asian Indian phenotype’ - these are certain unique clinical and biochemical abnormalities in Indians which include increased insulin resistance, greater abdominal adiposity i.e. higher waist circumference despite lower body mass index, lower adiponectin and higher high sensitive C-reactive protein levels. This phenotype makes Asian Indians more prone to diabetes and premature coronary artery disease. Moreover, the awareness of diabetes and its complications is less in India. When asked about the awareness of diabetes in India, Dr Thomas went on to say that people in India do not take diabetes very seriously and so there is a need that healthcare providers go that extra mile to create more awareness among patients especially in term of medicines, nutrition and lifestyle changes. The key learning from this discussion was that diabetes affects different organs of a human body; therefore, there is a need for a multi-pronged strategy to combat diabetes. (The author attended EASD 2016 as a BI invitee) raelene.kambli@expressindia.com
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cover ) INSIGHT
Say no to diabetes
DR RAMA MISHRA Diabetologist & General Physician, WellBeeing Lifestyle Health Centre, Bangalore
Dr Rama Mishra, Diabetologist and General Physician, WellBeeing Lifestyle Health Centre, Bangalore, elaborates more on various treatment methods to curb the menace of diabetes
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iabetes, like any other disease can be curbed by either prevention or controlling. The main causes of this widely spread disease are poor diet patterns, deteriorating fitness levels, shooting stress which immediately need to be worked upon. The word DIABETES, in itself constitutes all the factors which help cause it. DI (Diet –Improper), ABE (Absence of Basic Exercise) and TES (Tension-Emotion-Stress). Recently, there has been a shift which shows that the lifestyle diseases are slowly progressing and proving to be more fatal than the communicable diseases. These disorders are driven by negative effects of globalisation, cultural influence and consumption of unhealthy food products. Social concerns, such as ignorance, negligence, low concern on preventive care, low levels of education and also lack of finance, are associated with high risk factors of the most common problems. These include cardiovascular diseases,
The cost of diabetes reversal is much lesser when compared to the life-long treatment with various drugs and treatment
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cancer, chronic respiratory diseases and diabetes which account for 80 per cent of Noncommunicable diseases(NCD) deaths. These NCDs are largely preventable and the most common modifiable risk behaviours are tobacco use, unhealthy diet, physical inactivity, excess consumption of alcohol and stress. Controlling or reversing diabetes is a multi-pronged approach which involves several steps: ◗ Scientifically treating and addressing the root cause of the problem ◗ Creating awareness to improve the food-fitness habits ◗ Influencing behavioral changes ◗ Symptomatic relief and reducing long-term risk. ◗ Monitoring the changes and improvements constantly Thus a need for synergetic effect arises, which involves a combination of more than one system of medicine. While modern system of medicine focusses on the symptomatic relief, many traditional systems worldwide focus on addressing the root cause of the problem. Hence, combining the benefits of old and new, can provide the best of both systems to an individual who is interested in evidence based, proven, risk free solution. By combining modern medicine with proven and evidencebased practices from other traditional science, integrative approach evolves. This approach helps relieve suffering, reduce risk and stress and
maintain the well-being. Integrative medicine makes use of appropriate therapeutic approaches, healthcare professionals and evidence-based disciplines to achieve optimal health and wellness. Holistic medical treatment with a combined and complimenting practice of both proven-scientific Eastern and Western medical treatments seem to tackle the growing menace of diabetes. Integrative medicine can be seen in various main stream treatments in western countries and is already becoming popular. This system neither rejects
conventional medicine nor accepts alternative therapies uncritically. Effective interventions that are natural and less invasive are used wherever and whenever possible during the treatment. Among the various treatment options and newer molecule entries in the healthcare industry, integrative medicine has emerged as a safe choice. The fundamental principle of integrative medicine is that, it integrates the strength of all systems of medicine and reduces the ill effects of excessive medication. Interventions under an inte-
grated approach for diabetes should ideally include screening, diet corrections, fitness specific to influence causative factors (insulin secretion or resistance), treatments to stimulate pancreas, insulin secretions, evaluation and gradually reducing the dosage of medication in those who are already on medication. In fact, in those who have not started on medication, the sugar levels can be controlled to normalcy without starting any medication. The cost of diabetes reversal is much lesser when compared to the life-long treatment with various drugs and treatment.
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FO C U S :WO R L D D I A B E T E S DAY
REPORT
NCDs in the development agenda The Partnership to Fight Chronic Diseases in this paper attempts to sensitise decision makers at all levels towards the growing burden of non-communicable diseases and shape their opinion towards a multi-stakeholder approach THE PARTNERSHIP to Fight Chronic Disease (PFCD) with technical support from the National Health Systems Resource Centre (NHSRC) recently released an advocacy paper – ‘NCDs in the Development Agenda.’
of years of life lost because of CVD in India increased by 59 per cent, from 23.2 million in 1990 to 37 million in 2010 ◗ The rate of CVD mortality in India in the 30-59 year age group is double than that in the US
◗ The incidences of CVDs have increased significantly for people between the age 25 and 69 to 24.8 per cent, resulting in the loss of more productive people
CANCER ◗ Prevalence of cancer in India
is estimated to be 3.9 million people with reported incidence of 1.1 million in 2015 ◗ The National Cancer Registry Program of the India Council of Medical Research (ICMR) shows that new cancer cases or its incidence in India is esti-
DIABETES ◗ The WHO estimates that 80 per cent of diabetes deaths occur in low and middle-income countries and projects that such deaths will double between 2016 and 2030 ◗ India is a home to 65.1 million diabetic patients at present, compared to 50.8 million in 2010, and the number expected to increase to 101.2 million by 2030, according to the International Diabetes Federation ◗ India’s diabetic population is seen rising by a staggering 79 per cent to 123.5 million by 2040, according to The International Diabetes Federation ◗ Indians are diagnosed with diabetes on average 10 years earlier than their Western counterparts
CARDIOVASCULAR DISEASES (CVDs) ◗ CVDs have now become the leading cause of mortality in India, with a quarter of all mortality attributable to it ◗ Ischemic heart disease and stroke are the predominant causes and are responsible for more than 80 per cent all CVD deaths ◗ The Global Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100,000 population in India is higher than the global average of 235 per 100,000 population ◗ Premature mortality in terms
Substantial burden of NCDs limits the government’s ability to address this public health concern singlehandedly. No one single player can successfully deal with the challenges associated with it. Our elected as well as nominated representatives can play an important role in not only creating awareness amongst the people, but also mobilising resources and support from all concerned groups to strengthen early screening, diagnosis and primary care Dr Kenneth Thorpe, Chairman, PFCD
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cover ) mated to grow by 25 per cent by 2020, with around 1.4 million in 2016 to over 1.7 million by 2020 ◗ Breast and cervical cancers among women, head, neck, lung and gastrointestinal cancers among men represent more than 60 per cent of the incidence burden ◗ According to a Tata Memorial Hospital study, more than 20 per cent of the world’s childhood cancer deaths happen in India ◗ At least 70,000 kids between the ages of four months and 14 years are diagnosed with one of the 16 forms of childhood cancers annually
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) ◗ India is estimated to have 30 million COPD patients ◗ According to the recent Global Burden of Disease Study, COPD has become one of the major causes of death in the country ◗ India contributes a significant and growing percentage to global COPD mortality rates, with India projected to be amongst the highest in the world ◗ The prevalence rate is likely to average around five per cent in the adult population with higher rates in smokers, males, rural areas, depending on the type of domestic fuel use and socioeconomic status
MENTAL ILLNESS ◗ At least five per cent of the population in India lives with a mental illness, which translates to over 50 million people, spread across both urban and rural area ◗ According to recent papers published in The Lancet and The Lancet Psychiatry, 38.1 million years of healthy life will be lost due to mental illness in India by 2025, an increase of 23 per cent from 2013 ◗ Nearly half of those with severe mental disease aren't treated and of those with less severe versions, nearly nine in 10 go uncared for ◗ According to the government’s estimates, about 1 in 5 people in the country need counselling, either psychological or psychiatric
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◗ Depression, the most prevalent form of mental illness, is estimated to exist in three of every 100 in urban areas, and of this one in three are severely neurotic
National Action Plan and Monitoring Framework for Prevention and Control of NCDs ◗ National NCD Monitoring Framework outlines 21 indicators and 10 targets for the prevention and control of NCDs ◗ The specified indicators and targets will be used to track progress of actions designed to prevent and control NCDs until 2025, in India ◗ Suggested action points by diverse sectors to meet the NCD targets at various levels have been outlined
Screening Guidelines for the prevention, early
detection and control of: Diabetes ◗ Hypertension ◗ Common cancer
institutions ◗ Advertisement of tobacco products is prohibited. Surrogate advertisement is also not allowed
Awareness ◗ M-Diabetes initiative under which information is being provided through mobile telephony network on how to prevent and manage diabetes ◗ Digital and broadcast media campaigns to raise public awareness on diet and/or physical activity
Reduction measures for the harmful use of tobacco ◗ Ban on smoking in many public places and work places as well as on public transport ◗ Ban on the sale of tobacco products to person below 18 years, and in places within 100 metres radius from educational
Draft National Health Policy 2015 ◗ Inclusion of NCDs for the very first time in the draft National Health Policy ◗ It would support an integrated approach where screening for the most prevalent NCDs would be incorporated into the comprehensive primary health care network ◗ It would ensure emphasis on medication and access for select chronic illness on a round the year,basis
Unhealthy Diet Reduction Measures ◗ Marketing to children restrictions
◗ Marketing of breast-milk substitutes restrictions References 1. http://www.searo.who.int/india/topics/tobacco/economic_bur den_of_tobacco_related_diseases_in_india_executive_summary.pdf 2. http://www3.weforum.org/ docs/WEF_EconomicNonCommunicableDiseasesIndia_Report_2014.pdf 3. http://www3.weforum.org/ docs/WEF_EconomicNonCommunicableDiseasesIndia_Report_2014.pdf 4. http://apps.searo.who.int/ PDS_DOCS/B0361.pdf 5. http://www3.weforum.org/ docs/WEF_EconomicNonCommunicableDiseasesIndia_Report_2014.pdf 6. https://www.pharmamedtechbi.com/publications/p harmasia-news/2016/4/20/whoraps-indias-low-level-publichealth-care-investment 7. https://www.pharmamedtechbi.com/publications/p harmasia-news/2016/4/20/whoraps-indias-low-level-publichealth-care-investment 8. http://thelancet.com/journals/ lancet/article/PIIS01406736(10)61884-3/fulltext 9. http://dcp3.org/sites/default/files/resources/Circulation%20article_D P.pdf 10. http://dcp3.org/sites/default/files/resources/Circulation%20article_D P.pdf 11. http://dcp3.org/sites/default/files/resources/Circulation%20article_D P.pdf 12. http://www.omicsonline.org/ open-access/risk-factors-associated-with-the-increasing-cardiovascular-diseases-prevalence-inindia-a-review-2155-9600-5-331.p hp?aid=36844 13. http://www.ey.com/Publication/vwLUAssets/EY-Call-foraction-expanding-cancer-care-inindia/$FILE/EY-Call-for-actionexpanding-cancer-care-inindia.pdf 14. http://icmr.nic.in/icmrsql/ archive/2016/7.pdf 15. http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3978965/ 16. http://www.who.int/mediacentre/factsheets/fs312/en/ 17. http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3775194/
KNOWLEDGE I N T E R V I E W
‘All COPD patients must be screened for heart diseases’ Dr Sundeep Salvi, Director, Chest Research Foundation speaks on the current state of COPD in India, the kind of research underway in understanding its prevalence and the co-relation between CVDs and COPD in conversation with Raelene Kambli Can you share some latest data on COPD in India? According to the latest Global Burden of Disease, COPD is the second leading cause of death in India and the third leading cause of death in the world. An earlier report from the Government of Maharashtra (2010) stated that COPD was the first cause of death in Maharashtra. The most objective diagnostic test for COPD in the community is to perform Spirometry after giving a short-acting bronchodilator. Such kind of research studies are only few in India so far. This study has taken place in four centres across India (Mumbai, Pune, Mysore and Kashmir) and the latest COPD has been reported to vary from 5.5 to 18 per cent. My guesstimate is that roughly 10 per cent of people over the age of 40 years have COPD in India. What kind of research have you done on COPD so far? CRF studied the prevalence of COPD in 22 rural villages near Pune. The prevalence was found to be 5.5 per cent and that 85 per cent of these had never smoked in their life. Earlier research from the western world established tobacco smoking as the leading cause of COPD. But our research at CRF showed that you don’t have to be a smoker to have COPD in India. In fact, majority of the cases of COPD occur among non-smoker. This seems to be the case in most of the developing countries in the world. The world was not aware about this and the publications of CRF in some of the leading medical
journals in the world (Lancet, CHEST, etc) educated the world about Non-Smoking COPD. What are your learning from this research? You don’t have to be a smoker in India to develop COPD. Exposure to biomass fuel smoke, mosquito coil smoke, dhoop agarbatti smoke and smoke from outdoor air pollution, industries such as mining, leather and occupations such as farming are the other main risk factors for COPD in India. Also, poorly treated chronic asthma and people who had lung TB in the past are also more vulnerable to develop COPD. During research, how important it is to take into account the everyday lives of patients and the way they use their medicines? Very important! Many patients of COPD do not receive a proper diagnosis, therefore do not receive appropriate treatment. Some get diagnosed to have COPD, but do not receive the proper treatment and some get the right diagnosis and right treatment, but do not take their medicines regularly. All this contributes to poor quality of care of COPD patients, that contributes significantly to increasing suffering and death. What kind of impact will this information have in better management of COPD? Knowledge about the true burden of COPD, its risk factors and the proper treatment need to be informed to the doctors, so that they will diag-
Knowledge generation is crucial to create awareness, treat disease better and bring about a policy change nose the disease early, treat it properly and ensure that the patients take their medicines regularly. Can you elaborate on the association between COPD and CVDs? COPD not only affects the lungs, but affects all other organs of the body. The harmful air pollutants that get deposited in the lung over a long period of time not only causes lung tissue damage, but also releases a whole host of chem-
icals and mediators that enter the systemic circulation and get deposited in other organs. The heart is the first organ where the inflammatory soup mediators get deposited and cause damage there. A significantly large number of patients of COPD have an associated heart disease that is directly related to the lung damage. COPD patients have a four to five fold increased risk of having heart disease than those who do not have a heart disease. This manifests an increased rate of heart attacks, hypertension and cardiac failure. What kind of research is underway to understand this relation further? We are in the process of research on how common is CVD in COPD and what causes it and how it can be treated better. What is the need of the hour in term of management of both these conditions, especially in patients who suffer from this dual conditions? All COPD patients must be screened for heart diseases and all heart disease patients must be screened for COPD. Both diseases need to be treated appropriately for better outcomes. In particular, patients with COPD and heart diseases must not be denied a beta blocker. Many physicians worry about the side effects of beta blockers in causing bronchospasm in patients with COPD. It does not. And being the best drug so far to treat heart disease, these drugs should not be denied.
You talk about 'Liberation through Research, Education and Advocacy''. Can you elaborate on the same. Very little research takes place in the field of COPD or asthma in India. We largely rely on research developed from the western world. This imported knowledge is usually not relevant to our people. We need to generate our knowledge that is relevant to the needs of our people. Example: mosquito coil or agarbattis – their impact on our health can only be studied in India, not in the western world. Whatever new knowledge is generated needs to be disseminated to people at large, be they health care providers, researchers or even policy makers. This will enhance the quality of care that we can offer to people. Knowledge generated in our country needs to be translated to policy decisions that will help reduce the disease burden and improve survival and quality of life. This can only be achieved through proper advocacy. CRF has been working very closely in all these three areas of research, education and advocacy to help reduce the suffering of people with chronic lung diseases. Do you think an inclusive approach to research would also be beneficial? Yes, knowledge generation is crucial to create awareness, treat disease better and bring about a policy change. Unfortunately, very little research takes place in the medical field in India. raelene.kambli@expressindia.com
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KNOWLEDGE OPINION
Insurance in bariatrics Dr Ramen Goel, Director, Center of Bariatric & Metabolic Surgery, Wockhardt Hospitals bats for the inclusion of bariatric surgery under insurance coverage. He explains that contrary to popular belief it is more than just a cosmetic procedure and often is a life-saving surgery INSURANCE FOR bariatric surgeries has been a controversial subject in our country for almost 20 years. Routinely almost all insurance companies (private or public) had been declining claims and pleas for payments (cashless or reimbursement) citing various reasons. These refusals arise from a perception that obesity is a self inflicted problem and these self indulging individuals have no right to insurance largesse. Mostly reasons cited for rejection includes exclusion of obesity and related treatment in policy document and/or bariatric surgery is a cosmetic procedure. None of these arbitrary pronouncements can withstand evidence-based scientific and legal scrutiny.
Is obesity the outcome of self-indulgence? This populist perception exists even amongst few medico-professionals, even though enough scientific data exists to contrary. Let’s examine this basic issue in detail: ◗ World Health Organization (WHO) has declared obesity as a disease many years back. ◗If indulgence is the only factor for weight gain how to justify large number of slim people eating larger portions while most of obese keep restricting their food intake and still not lose weight.
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DR RAMEN GOEL Director, Center of Bariatric & Metabolic Surgery, Wockhardt Hospitals
◗Studies have shown that 92 per cent of overweight and 98 per cent of morbidly obese are likely to regain weight within three years of a serious weight loss attempt. ◗Increasing role of intestinal hormones and gut bacteria is recognised as obesity-causing factors. ◗ Once we accept that obesity is an illness, it is easier to accept that obese person is not the cause but a victim of a disease over which he/she has no control.
Obesity treatment in exclusion list of insurance policy Once bariatric surgery gained acceptance, insurance companies started including obesity treatment in the exclusion list to avoid insurance claims. This was done without any scientific basis and long-term impact assessment on health of denied insured persons. To provide legal status to exclusion list, these insurance com-
panies got an amendment approved by the regulator. Though the regulator went through the drill of public hearing, not many responses were elicited. This was expected as, on one side lobby of well organised corporates was well represented, while on the other side individual insured persons remained poorly organised and unrepresented. That policy exclusion is not the final word and has been established in various forums worldwide. The burden of proof, scientific and otherwise, should lie at the doorstep of insured companies and not an individual with limited options. It is a situation where governments have risen to occasion ahead of private sector, whether it is Blue Shied in the US, NHS in the UK or even CGHS in India, which offers free bariatric
surgery to its citizen or employees. (The central government’s health scheme has been offering reimbursement to patients for bariatric surgery since November 2013. In August 2014, the Medical Council of India stated in a letter that “bariatric surgery is gastrointestinal non-cosmetic surgery under the rubric of surgical gastroenterology and not plastic surgery.”) One can presume that insurance companies are united by financial interest and not the societal requirements.
A cosmetic surgery An untruth spoken a thousand time cannot change the reality. Bariatric surgery is now accepted worldwide as treatment of multiple diseases like diabetes, high BP, sleep apnoea, obesity, PCOD etc. The cosmetic reason for
claim refusal is obviously a figment of imagination without any scientific/medical background. The argument to refuse insurance cover include: ◗ Surgery does not involve any skin level manipulation. Bariatric surgery involves stomach/intestinal re-routing with resultant hormonal/gut bacterial levels. ◗ Bariatric surgery is neither done by plastic/cosmetic surgeons. This is done by gastrointestinal surgeons with entirely different qualifications. ◗It is not considered a cosmetic surgery by insurance companies in any other country. Even though most of the patients, due to better health and enhanced fitness levels may look better, that cannot be the reason to deny a life saving surgery to millions looking forward to better health.
STRATEGY I N T E R V I E W
â&#x20AC;&#x2DC;Start ups can and are already playing a vital role in improving the public healthâ&#x20AC;&#x2122; Abhishek Dwivedi, co-founder, AlternaCare explains how start ups can add value to public health delivery in India. He further speaks about the public health scenario of the state of Uttar Pradesh and his tie-up with the UP and Rajasthan government, in an interaction with Raelene Kambli How has technology helped you to re-imagine healthcare in India? Within the Indian healthcare ecosystem, accessibility and affordability have always been a pain point for the majority. Technology has been instrumental in improving accessibility as well as affordability in healthcare. Some products leveraged the amalgamation of information technology and cloud telephony to enable patients connect with the most relevant doctors to consult within 60 seconds. Moreover, evolution of the digitalisation of the prescriptions, applications of IOT in the diagnostics domain, remote monitoring, instant lab report generation, innovative world class surgical devices, etc., have been attributed to the advancement and acceptance of technology within the Indian healthcare domain. How is technology changing the business landscape of the Indian healthcare sector? Any business landscape becomes more lucrative if there is a substantial increment in the ease of doing the same while maintaining exponential year-on-year growth in profits. Technology has done the same in the Indian healthcare sector. It has made discovery and delivery of doctors, hospitals, diagnostic labs, ambulances, pharmacies, etc., extremely easy. Not only this, the health-related content available online also plays a vital role in the education on diseases, medicines, symptoms,
instruments, etc. The remedies on multiple issues be it around alternative therapies or scientific general medicine are readily available. The brick and mortar model of healthcare has always been highly cost intensive but technology has reduced the recurring operational costs. Medicine practices in the past used to be very secluded, however, with the help of technology, doctors from across the globe can share their insights about various cases on one platform seamlessly. What role can start ups play in improving public health ? Start ups can and are already playing a vital role in improving the public health in various ways. From online registration to the generation of medical records electronically, the startups can been highly instrumental. The accurate analytics on the EMRs, telemedicine can definitely help in the proper channelising of healthcare resources including the medicines, health tech wearable devices, diagnostic machines, remote monitoring, etc. All thanks to a multiple well funded startups, which are actually growing the awareness among the masses around the generic drugs, online booking in hospitals/clinics for primary, secondary and even tertiary care. Which initiatives have you taken from your end in this regard? We are in the process of starting health kiosks in PHCs
From online registration to the generation of medical records electronically, the startups can be highly instrumental in public health
based in tier III towns and even in the rural areas of India. The UP and Rajasthan governments have extended good support to us on the same. Apart from this, more than 50 per cent of our consultations over the call still come from tier II and III towns. The main issues revolve around diseases prevalent in these towns such as HIV, TB, sexual disorders, renal, gastro problems. Our platform seamlessly connects those patients to highly qualified doctors for consultations and within 48 hours, the patients also receive medicines through our delivery partner across 4000 pincodes or through speed post by Indian post (in case that PIN code is not covered by our delivery partner). Within villages, there is still a huge scarcity of qualified doctors. World Health Organisation (WHO) has specified the doctor : patient ratio to be maintained at 1: 1000 but in Indian rural towns, it is 1: 2800. We are also trying to bridge this gap through the concept of virtual clinics implemented in multiple tier III towns. How effective can experiential learning be in terms of incubating start ups in public health? While incubating a public health startup, key experiential learnings mostly include the user behaviour of customers in tier II-III towns or even in deep rural areas. The ability of the product is to make swift penetration in var-
ious diverse remote geographies while maintaining decent ROIs. Secondly, start ups working in the public health domain also need to hand hold their potential customers and merchants as most of them are not tech-savvy. Hence, entrepreneurs belonging from smaller and not so developed towns would be more aware of the ground realities and hence can develop solutions to serve the public health space. However, healthtech start ups in the public health domain need to form an advisory board consisting of experienced doctors of tier II-III towns in order to leverage the learnings gained from their experiences. What should be the primary focus for start ups who intend to venture into the public health domain? How should they go about achieving their goals ? Well, I think the best way to go about this is to identify challenges one by one and try to solve it in series using relevant technology. Build a tech product which is simple, easy to use, which will connect the dots in the best operational flow while maintaining the unit economics. It is very difficult for the the healthcare sector in India to completely shift focus towards technology, therefore it imperative to adopt technology phase by phase. Always focus on the trust to be built on the users/patients rather than the Continued on page 33
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STRATEGY I N T E R V I E W
‘Success depends on strategies focused on customer acquisition and retention’ Dr Selwyn Colaco has recently joined Cytecare Hospitals as the COO and will be leading the development and management of strategic clinical and business operations for the group. In an interview with Raelene Kambli, he shares his vision and business strategy for furthering the growth of Cytecare Hospitals Dr Colaco, you have a background of being a quality assessor. So, what are the changes that you would like to make within the organisation to lay more emphasis on quality? At Cytecare, we are building a common vision of quality. We envisage a cancer care system that is accessible, effective, safe, patient-centred and efficient. Cytecare will focus on systems and processes that will drive quality. Quality improvement is a proven, effective way to improve care for patients. We will look at opportunities to develop, optimise and streamline processes. Quality will be a continuous process and an integral part of everyone’s work in the organisation. Our aim is to sustain this effort and get NABH accreditation within 12 months of launch. Patient and staff safety is an important part of any quality initiative in healthcare. To build a culture of safety at Cytecare, we hope to build an organisation wide belief that harm is untenable. To build a culture of quality and safety, we are planning a number of initiatives. One such initiative is to position Cytecare as a highly reliable organisation, one that although doing complex and risky procedures, is safe and reliable. Effective teamwork, good communication and shared learning are key components of this concept. To begin with, we are training all managerial and nursing staff on quality, accreditation, dimensions of quality and
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patient safety. They are being introduced to infection control practices – hand hygiene, standard precautions, biomedical waste management and prevention of needle stick injury. These are some of the initiatives we have undertaken and these efforts will be intensified in the coming months after launch. You will be leading the development and management of strategic clinical and business operations. What is your business goal for the group? And how would you achieve that? Business goals are driven by the vision of the promoters. This focuses largely on outcome-based healthcare delivery and is based on building trust, through customer experience driven growth and transparency in treatment plans. This ethics-driven vision will sustain growth and close the existing trust deficit between the patients and healthcare organisations. At Cytecare, we will pursue a hub and spoke model for the development of centres to ensure access to a greater number of people. Financial goals are hence driven not by aggressively pushing numbers but by using a more sustainable model which is based on increasing through put by building a collaborative care platform that will change the way ‘Cancer Care’ is delivered. This we believe will enable the care providers to focus on individual verticals of care, built to sup-
Healthcare is increasingly driven by patients who seek the best clinical care. Hence delivering good care with excellent outcomes is fundamental to a hospital port patients and their families fighting cancer. We are confident that the clinical team will deliver care of the highest quality, and work together with us to help achieve our financial goals
much quicker. We plan on growing the hospital by adding on spokes to the Bangalore hub; and growing the network by starting work on a new hub in the near future. We believe that people are fundamental to achieving business goals. And building an engaged clinical team, which together with a high performing management team will enable the hospital to execute its plans effectively. Delighting our customers requires building customer profiles and measuring data across a wide variety of channels and touch points. This multichannel approach to address marketing and operational effectiveness requires gathering actions and data from every landing area in the consumer journey which begins with exploring options, expressing interest, planning the visit, managing the experience and ends with building sustainable relationships. To support this process, we have built a high quality, state-of-the-art IT backbone that is geared up to provide all necessary data. By learning where, when, and how customers are most likely to access care, and which products they are looking for, we can determine product offerings and design personalised campaigns to create value from high margin customers. We hope to optimise our marketing plans, define communication channels and manage customer experience that will ultimately define and build strong brand loyalty.
What strategy innovation are you planning to introduce currently? The fundamentals of healthcare delivery have not changed, and it is still very important to have the best clinical talent available to treat patients. However, in addition to an excellent facility and stateof-the-art equipment; innovative and path-breaking processes are being implemented to create an integrated, patient-centric approach that drives better outcomes for cancer patients. This requires implementation of global guidelines and clinical governance protocols. Being organ-site focused, our approach will be to offer collaborative care through a combination of multidisciplinary consults and formal 'Tumor Boards' to deliver the right treatment plans for the individual patient. Driving growth also involves an unwavering focus on patient experience and Cytecare is focusing on several processes to provide patients and their caregivers a better experience. These include a focus on customer orientation, integrated marketing communications and branding strategies that are all part of designing a growth trajectory for the hospitals. A thorough understanding of the hospital customer will enable us to customise service offerings for individual needs. We plan to implement processes to manage both internal and external customers through a 'contact centre' which is quite
STRATEGY unique in a healthcare setting. These will be supported by service verticals which ◗Will help patients and care givers to deal with the psychological stresses that are a part of cancer treatment; ◗Help those in the system who access care often to ‘Navigate’ through the their care programme ◗Enable access to pain and palliative care services which will mitigate the pain and the many complications faced along the way. Rehabilitation and nutrition services, we believe also need to be strengthen, to deliver cancer care optimally.
you would like to replicate here at Cytecare? All the organisations I have had a privilege of working with are doing excellent work in their own way. I have acquired skills and knowledge along the way and hope to put that experience to good use. However, I don’t think I would like to replicate anything, instead look at building a patient support platform that will argument the strengths in clinical care. This will be a unique model and I sincerely hope that it will set the trend in cancer care and be something for others to emulate.
What are your learning lessons while working with Fortis, BGS Global and Apollo? Any strategy that
What according to you, are the pre-requisite for a hospital group or an individual hospital to
maintain profitable as well as be sustainable in the long run? Healthcare is increasingly driven by patients who seek the best clinical care. Hence, delivering good care with excellent outcomes is fundamental to a hospital and to that extent is non-negotiable. However, in the rapidly changing urban marketplace, price although important, is not necessarily the deciding factor. If organisations can deliver care that is of high quality with a focus on good outcomes, they will be able to deliver exceptional value to patients. In such a situation, price is not necessarily the only consideration. As the industry evolves, it is quite clear that success depends in part on strategies focused on customer
acquisition, and more importantly on retention strategies through customer experience. Doing so requires an organisation wide focus on driving this exceptional experience. Even though this is central to customer expectations, healthcare is playing catch-up in terms of putting the customer first. The ability to change will be an important factor in determining profitability and sustainability in the long run. The other determinant, as we all know, is the ability of organisations to manage costs. However, the big challenge is to do so without compromising on quality. Any message for the industry? We have made a quite entry
into the cancer care space, and we are here to innovate and grow. We plan on steady growth and a sustainable business model. There is a dearth of research data and effective implementation and governance of standard evidencebased protocols for cancer therapy in India. Understanding this need, Cytecare will pioneer process-driven, organ-site focused, patient-centric cancer care. I am happy to be part of this transformational journey and our team will continue to monitor, develop, enhance and scale the overall operations of the hospital network. We hope to make a difference to doctors, cancer patients and caregivers that will change the dynamics of cancer care in the country. raelene.kambli@expressindia.com
Continued from page 31
Startups can and are... GAPS IN PUBLIC HEALTH SYSTEM IN UTTAR PRADESH Particulars
Required
In position
Shortfall
Sub-centre
31037
20521
10516
Primary Health Centre
5172
3692
1480
Community Health Centre
1293
515
778
Health worker (Female)/ANM at Sub Centres & PHCs
24213
22464
1749
Health Worker (Male) at Sub Centres 20521
1729
18792
Health Assistant (Female)/ LHV at PHCs
3692
2040
1652
Health Assistant (Male) at PHCs
3692
4518
*
Doctor at PHCs
3692
2861
831
Obstetricians and gynaecologists at CHCs
515
475
40
Paediatricians at CHCs
515
547
*
Total specialists at CHCs
2060
1740
320
Radiographers at CHCs
515
181
334
Pharmacist at PHCs & CHCs
4207
5582
*
Laboratory technicians at PHCs & CHCs
4207
1836
2371
Nursing staff at PHCs & CHCs
7297
2627
4670
discounts to be offered.
Since you closely work with the UP government, can you share your opinion on the current state of public health there? ◗ Limited budget allocation for public health by the Central Government ◗Increasing infrastructure requirements for fulfilling healthcare demands of rapidly growing population ◗Low penetration of healthcare services in villages ◗Extensive travel and waiting time to get from rural to urban care ◗High out of pocket expenditure for low income population ◗Shortage and absenteeism of doctors at government healthcare facilities ◗Doctors’ preference to practice in metro cities ◗Accessibility for under served population and delay in care ◗Increasing disease burden of the state ◗Presence of quacks or under qualified doctors Can you share some details your UP and Rajasthan
Our alliance is not only successful in tracking the work of government doctors but patients now have the option to consult doctors by investing less time, money and energy public health project? We would be solving the issues such as availability of good doctors, ease of consulting, medicine deliveries EMRs, training of patients, awareness on preventive healthcare and a couple of more things on the same lines.
Share some key learnings from this partnership? The book of renowned rural journalist P Sainath, 'Everybody loves a good drought,' claims that most of the tier III towns have government doctors refusing to see patients in government premises. Moreover, they themselves refer those patients to their private clinics where they are overcharged most of the time. Let’s not talk about the deep interiors/rural regions where the term health or medicine is completely alienated due to similar or even more serious reasons. Our alliance is not only successful in tracking the work of government doctors but patients now have the option to consult doctors by investing less time, money and energy. Which are the other state governments that you would be interested in partnering? We are in talks with Government of Karnataka and Rajasthan and looking forward to similar alliances soon. raelene.kambli@expressindia.com
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STRATEGY I N T E R V I E W
‘Extending the wings of preventive care’ Harish Pillai, COO, Indus Health Plus in an interaction with Prathiba Raju, urges the need of PPP in NCDs and informs that it would help to curb the burden of these diseases in the country
What is the status of preventive healthcare in India? How Indus Health Plus cater to this? The country shoulders a big burden when it comes to noncommunicable disease (NCD) as one in four Indians is a potential cardiac patient, one in ten is a diabetic and we are third largest in the cancer. When Indus Health Plus started its programme in 2000 it focused on 35 plus age group and thought they would be prone to NCDs like cardiac arrest and diabetes, but to our surprise the age group from 28 to 32 are prone to cardiac arrest, diabetes which are preventable. Hypertension and unhealthy lifestyle are the main reason for the diseases. Every hospital, every diagnostic centre was catering to corporate and executive set-ups, so Indus Health Plus started a agent model with eight agents as of now it has 85,000 agents across 17 states and 78 cities in 122 hospitals and diagnostic centres. Is your presence in pan India? In the retail mass model, we have a strong presence in Western and Central India, while in southern part of India, we are placed in Karnataka, Andhra Pradesh and Kerala. In Tamil Nadu, we have started the retail mass model only a year ago in Chennai, but through our corporate programme, we have a good presence in the districts like Salem, Trichy and South Yercaud. What is your experience working in metros, tier I
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and tier II cities? Our growth in tier-I and tierII cities are much better than the metros. This is because we have highly discounted product and our prices are 50 per cent less than the market prices, so patients commonly in tier-I and tier-II cities see more value for money. Moreover, these developing cities only have few super speciality hospitals. When they see a product which is already heavily discounted, they adopt much easily. It is not that metro cities are not opting for it but the adoption rate is more in tier-I and tier-II cities comparatively. With the highly discounted rates how do you mange to earn profit? It’s a global phenomena that everybody loves a good discount. When we were looking for pricing of our product, we had combined all the factors viz radiology, technology. Apart from it, we have noticed that people are also missing the personalised attention of the doctors, so we offer a customised preventive master package. The packages cost nearly one third or even lower as compared to many hospitals. We also have our Indus Health Plus team in hospital who help the patients during and after the treatment. Besides, offering discounted rates also gives us the benefit of large volumes. What are your expansion plans geographically? Indus Health Plus has six lakh clients in 2016 and now our target is to reach around
government there are looking for bringing those NCD numbers down. Though our basic model remains the same, we have tweaked our programme as per each countries needs. As mentioned, we have both retail and corporate programme. In retail programme, we are already present in 17 states and hope to be in at least 25 states by 2018. Currently, in corporate programme, we are present in 24 states.
In India, health is a state subject, therefore the central government should set out a strong policy document to encourage PPP in NCDs. The central government should come out with active NCD action programme so the pandemic diseases can be controlled ◗ In-house call centre ◗ Health check-ups, report generation and doctor's consultation in a single day ◗ Live doctor chat service to enable the availability of doctors consultation ◗ Health Friend card takes care of medical and hospitalisation expenses
ten lakh clients by 2018. Already, we have our presence in the UAE and now we are trying to get into other Gulf Corporation Council (GCC) countries like Oman, Qatar and Saudi Arabia and few African countries. We are concentrating on these regions as they are also the countries witnessing high burden of cardiac arrest, diabetes and cancer and the
What was your turnover in the current fiscal? The turnover for the current fiscal was ` 100 crore and we hope to reach ` 400 crore by 2020. The challenge of turnover is always there because our price is heavily discounted. Our focus is to reach to more people and help them in NCDs, which is easily preventable. When it comes to NCD, what are your expectations from our government? We don’t have large scale detection programme on preventive healthcare. We are working with many other countries where the governments proactively come forward and give us the opportunity to work with government hospitals. But, in India, health is a state subject, therefore the central government should set out a strong policy document which should encourage PPP in NCDs. The government should need to come out with active NCD action programme, so the pandemic diseases can be controlled. prathiba.raju@expressindia.com
IT@HEALTHCARE I N T E R V I E W
‘Digital therapeutics sits at the intersection of science, technology and design’ Sanjay Govil, Founder and Chairman, Infinite Computer Solutions, a provider of custom technology-based business process solutions, next-gen mobility solutions and product engineering services, shares his views on the growing trend of digital therapeutics, its potential to bring about a positive transformation in healthcare delivery and his company's offerings in this space, with Lakshmipriya Nair
How has technology empowered stakeholders of healthcare? IT has made significant contributions to the medical industry, and almost every area in healthcare – from medical tools to pharma development – has been touched by technology. The major areas now transformed by technology are the service aspects of healthcare, encompassing the use of electronic medical records (EMR), tele-health services, mobile apps, mobility solutions in remote patient monitoring (RPM) and wearables. These technological advances will dominate the future of healthcare as they are changing the way that doctors and patients interact, with an increased focus on patient centered care. The patients’ overall control of their own care has greatly improved. Patients are now able to monitor their health by using wearables to check their vitals, and mobile health (mHealth) systems offer more analysis of what the numbers might mean. In fact, The Economist recently estimated 2.5 billion people have at least one message app installed on their mobile devices, and according to Activate, that number is expected to grow to 3.6 billion within the next few years. Patients have more means to be proactive about their care. Physicians can also offer more care options for their
patients and improve their own efficiencies. Diagnostic imaging applications, such as ultrasound machines, digital radiography and computed tomography, can both guide diagnosis and inform patients on their issues. Overall, healthcare providers will be motivated to provide ‘accountable’ care and payers will incentivise both patients and providers to deliver far improved patient results.
system in which the client can collaborate with other stakeholders. We’re always looking for what’s next. One of our focuses is bots, enhanced by Artificial Intelligence (AI) and Natural Language Processing (NLP), and powered by Predictive Analytics (PA). We believe that they are an ideal tool for patients and providers, as they have the power to warn about possible health illnesses before they occur.
How do you intend to become a differentiator in the health tech space? We welcome the growth of these technology start-ups, as one of the most powerful factors driving the transition to a more patient-centric approach to care is the growing availability, range and use of new technologies. We intend to stand apart from the market by leveraging our deep domain and technology expertise, as well as our ability to help our customers scale quickly. For healthcare in particular, we offer near market-ready solutions that allow quick customisation – a concept we call Platformization – that relies on our extensive knowledge of what healthcare providers and payers need in the market. We now provide 25 platformized solutions, and have formed global partnerships with Fortune 500 companies. Our domain experience doesn’t end there, as we fully
How do you intend to be a pathfinder in digital therapeutics, a growing trend in India? We are very excited about digital therapeutics, and the way digital systems can treat medical conditions, instead of medicine or even surgery. This is a very exciting development that sits at the intersection of science, technology and design. In fact, Infinite’s PC3 platform was specifically built for digital therapeutics solutions, and the benefits for both physicians and patients include scalability, cost effectiveness, lower barriers to access, and the ability to test which curriculum work best for different patients. Each programme can also be individualised to fit your personalised needs. It also tackles one of the hardest challenges in healthcare: changing an individual’s behaviour to better their health, which is important when treating chronic diseases
We aim to be at the forefront of innovation in the healthcare industry understand the challenges of digital transition. For example, our Patient Centered Connected Care (PC3) platform integrates, rather than replaces, legacy systems, maximising efficiency and resources. This, as well as our customisation and integration of the PC3 platform for any payer/provider, makes us stand out in the crowded marketplace. Customers also have the option to use the platform as a standalone solution or as a fully integrated
and drug compliance. Conventional medical treatments have long struggled with this aspect. Our digital therapeutic platforms have shown an impressive ability to do just that by using latest behavioural therapy science, including group dynamics and game theory, and engaging patients on multiple fronts. H ow can your offerings change healthcare delivery in the country? Our PC3 platform programmes offers patients and healthcare professionals more choices for care with a convenient interface, with a combination of web and mobile access as well as bot interactions. It provides around-the-clock access to an online educational curriculum, and can collect patient’s data using smart devices. By providing easy access to this information and data, patients are able to educate themselves on and track their health issues. What are your growth plans for the next three years? In the next three years, we're planning to leverage our proprietary IT solutions and platforms expanding our healthcare-focus technology capabilities. We aim to be at the forefront of innovation in this industry – our works in bots is indication of our ambitions – and we’ve set aside resources to build new solutions for the market. lakshmipriya.nair@expressindia.com
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Healthcare Information Technology Senate (HITS): Some Highlights The Healthcare Information Technology Senate (HITS) was organised as a part of the Healthcare Senate 2016 in Hyderabad. The event was attended by 150+ healthcare IT professionals. The gathering saw presentations from hospital CIOs and major vendors about the contemporary topics on how IT is being adopted by major hospitals. Some of the topics include cloud computing, 3D printing, digital technologies and Information Security Abhishek Raval Mumbai
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Keynote Address Healthcare’s digital future Sumit Puri, CIO, Max Healthcare
How 3D printing can transform healthcare: Dr Mahesh Kappanayil, Senior Cardiologist, Amrita Institute of Medical Sciences
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he Healthcare Information Technology Senate (HITS) under the parent platform of Healthcare Senate saw the presence of 150+ healthcare IT professionals. HITS hosted talks on myriad topics from some of the marquee hospital CIOs. Sumit Puri, CIO, Max Healthcare spoke on ‘Healthcare’s Digital Future’ and the digital strategy of the hospital. He informed about the hospital’s connected healthcare programme for the elderly using technology devices. Sumit also touched upon the partnership with GOQii for preventive healthcare. Dr Mahesh Kappanayil, Senior Cardiologist, Amrita Institute of Medical Sciences showed various live cases of how 3D printing helped cardiologists at Amrita to precisely identify the heart ailment, which otherwise
Ensuring information security in healthcare: Ishaq Quadri, Group CIO, KIMS Healthcare
would not come out in the conventional cardiogram. Presenting the case for the deployment of cloud in the healthcare sector, Dilip Ramadasan, CIO & CTO, Dr Agarwal’s Eye Hospital listed out the benefits from implementing cloud at the hospital. The desktop costs were reduced by 75 per cent; launching new modules in the HIS; cloud will help to manage the massive storage requirement that would come up as a part of the Mission 2020 programme, where the plan is to have 50 overseas centres and 150 in India. The panel discussion had some of the top hospital CIOs talking about their respective IT initiatives. The last session was by Ishaq Quadri, Group CIO, KIMS Healthcare Management who, presented some of the best practices in security from a hospital’s angle.
Video conferencing solutions for healthcare segment: Kaushal Singh, Head Sales, HDVC Panasonic
abhishek.raval@expressindia.com
Innovation versus RoI challenge: Dirk Dumortier VP Sales Enablement & Healthcare Solutions, APAC, Alcatel-Lucent Enterprise
Global Trends in Imaging IT: Robin Gu, Marketing Head, APAC, Agfa Healthcare
Data Security for the Digital Healthcare Industry : Noman Khan, Regional Business Manager, Seqrite – Enterprise Security Solutions by Quick Heal
IT@HEALTHCARE
Healthcare’s digital future Sumit Puri | CIO, Max Healthcare
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umit Puri defined digital as “user experience and interactions powered by technology,” in which the patient should be at the centre of all the value creation coming out of the interactions. The digital architecture of Max Healthcare (MHC) is built on the characteristics of convenience, collaboration and engagement. The digital platform supports APIs, service bots, mobile / tablet apps, kiosks and social media. MHC has partnered with GOQii for solutions related to preventive healthcare. A host of patient and clinical KPIs have been built for the patients to book appointments faster with the doctors. The physicians can also inform the patients about any potential
The digital architecture of Max Healthcare (MHC) is built on the characteristics of convenience, collaboration and engagement
change in the appointment. Apps have been built for enabling clinical care pathways. For example, with diabetes and oncology apps, the patients can manage the key disease solving interventions independently. MHC engages with the patients on social media and alerts are sent for medicine refills; wearable monitoring devices are provided and the queries can be posted to doctors. The hospital does remote emergency care with an ambulance tracking feature. The medical administration has been bar coded to help nurses to medicate patients. MHC is conducting pilots for remote OPDs and in understanding how the hospital can provide technology enabled low cost care in ICUs.
Global trends in Imaging IT Robin Gu | Asia Pacific Marketing Head, Agfa Healthcare
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obin Gu gave an elaborate introduction of the company. He also explained the vision for enterprise imaging, which is to have one patient record — all the disparate records of a particular customer can be consolidated with a one view; one enterprise wide imaging solution and not have separate imaging platforms. The patient’s records can be checked with a single window view on the electronic health records platform, instead of having to check different platforms for specific details. Typically, hospitals face the challenge of operating disjointed IT systems for imaging and other process workflows run for the patients. The core strength of Agfa lies in bringing them all together and work as one. The
Typically,hospitals face the challenge of operating disjointed ITsystems for imaging and other process workflows run for the patients.The core strength of Agfa lies in bringing them all together and work as one company provides one login for using any imaging solution. Robin stated that one out of two hospitals globally use solutions from Agfa. The company can also provide a common platform for Integrated Health Networks
(IHN), wherein different hospitals can come together to host the patient data for better collaboration and efficiency. The governments abroad subsidise hospitals for joining such a consortia.
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Wi-Fi management for healthier hospitals Samiksh Aggarwal | Asst VP, Sales, Data Networks, Sterlite Technologies
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hen the hospitals get digitized, Internet connectivity is crucial for different user categories. There are three types of user groups at hospitals: Registered group (existing customers), non registered users (first time users) and the trusted user group (internal staff). The users can download the mobile app, register the user in the system and start scheduling appointments with the doctors and also start conducting many other functions. The users are connected with the Hospital Information System (HIS), and the 24Online Internet Access Management System (from Sterlite Tech-
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The solution has a single console for managing the Internet access for network of hospitals
nologies). Users can get registered and the information is stored in the system. For the hospitals, the access management system is beneficial for ensuring smooth and secure Internet access; adhering with legal compliance; proper monitoring and management of the users and extensive reporting of the relevant logs. The solution also has a single console for managing the internet access for network of hospitals. Hospitals like Kokilaben Ambani hospital, Hinduja hospital, Medanta Hospital, Global hospitals and HCG are some of the clients of Sterlite Technologies.
IT@HEALTHCARE
Tech-themes that are changing the face of healthcare
Nagendra Balasubramaniam, Account Executive, Microsoft
agendra Balasubramaniam, Account Executive, Microsoft presented on four themes to change the healthcare landscape in the country using technology. Moreover, how enhanced technology interventions can help reduce cost and move the profitability northwards. The four themes include: cloud computing, Big data and analytics, geographical freedom and IoT. Cloud computing enables to break down the walls of healthcare and bring in data portability. The LV Prasad Eye Institute has used the big data platform from Microsoft for clinical operations,
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which is basically a self service business intelligence (BI) platform. BD & A can also be used for staffing and resourcing. Nagendra also touched upon using telemedicine using the VC experience; leveraging the IoT technology model using wearables for monitoring patients and making healthcare more proactive. In the panel discussion on 'How emerging technologies are transforming healthcare', TSY Aravindakshan National Manager - Health Industry Microsoft stressed on IT playing a strategic role in achieving the business goals. He gave the examples of the purposeful role of
technology intervention in clinical BI, productivity related KPIs and patients engagement. He said that the business wants to drive three specific priorities using IT: to drive productivity of the existing systems; effectively use current data and patient engagement. The other panelists include Veneeth Purushotaman, CIO, Fortis Healthcare; Sumit Singh, CIO, WockHardt Hospitals; Dr Deepak Sagaram, CIO, Global Hospitals; Niranjan Kumar, CIO, Sir Ganga Ram Hospital, Vishal Anand Gupta, Head IT, Suasth Healthcare.
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TRADE & TRENDS
GSLMedical College,Rajahmundry,AP,installs first technologically advanced virtual dissection table Himanshu Bhatt, KS Biomed Services, says that the technology will allow students to visualise skeletal tissues, muscles, organs and soft tissue, and further customise the interaction by virtually slicing, layering and segmenting the anatomy KS BIOMED services has installed its first technologically advanced virtual dissection table as part of their most advanced simulation lab. According to the Dr Gani Bhasker Rao, Chairman, GSL Medical Institute, who is the most renowned surgeon himself, this is one of the best technology for modern time learning for new age students who can connect very easily with advance technology. As per Dr B Rao, GSL Medical Institute has taken this initiative of adopting virtual technology as part of their ongoing advancement of state-of-the-art simulation lab of India. The anatomage virtual dissection table allows lifelike and neverbefore-available interaction and visualisation of the human body
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and its systems which is being used by more than 600 medical/paramedical institutes across world. The table is a big eight feet touch screen which uses real 3-D images of human body (male and female) from digitally scanned CT scan data to allow students to perform a lifesize, virtual dissection on Anatomage Tableâ&#x20AC;&#x2122;s touch screen interface with flawless detail The technology allows students to visualise skeletal tissues, muscles, organs and soft tissue, and further customise the interaction by virtually slicing, layering and segmenting the anatomy. The selections can be rotated or flipped to accommodate any viewpoint. 360 degree rotation of virtual cadaver is one
Himanshu Bhatt, KS Biomed Services
of the amazing feature of this technology where with just finger touch, one can position cadaver like never done before. Isolating or highlighting specific organ/structure is so handful for more relevant studies of
anatomy. One can create their own curriculum, as well as digital image library on Anatomage Table with help of many most advanced tools inbuilt in table in addition to readymade curriculum given inbuilt in table of Mayo Hospital-USA. In a country like India cadaver recourses are not available/allowed for paramedical courses like nursing/ physiotherapy/ radiology-cardiology technician. Learning anatomy is equally important to become a good paramedic. Anatomage Table is able to add unbelievable values to these kind of paramedical education. For these reasons more than 125 paramedical schools across the world are using Anatomage Table technology for their stu-
dents resulting in best of paramedical professionals for healthcare industry. A digital library of 500-plus abnormal cases is a wonderful tool to teach abnormal anatomy and diseased patient details. A live case review for surgical planning also can be performed leading to virtual surgery on CT SCAN raw data image. My experiences were overwhelming while conducting virtual anatomy workshops not only at GSL Medical College but across the country. Institute like GSL Medical College has already emerged as a trend setter in medical/paramedical teaching in India. Welcome to teaching and learning in the 21st century- A real digital way as part of digitising India.
TRADE & TRENDS
Meditek Engineers: Reforming healthcare,inspiring life Meditek was established to provide unrivalled service and support for all medical equipment MEDITEK ENGINEERS is a privately-owned company led by a competent team with many years of experience in providing excellent service to both public and private hospitals. Meditek was established to provide unrivalled service and support for all medical equipment. We have an efficient infrastructure and highly trained and multiskilled staff to bring you a range of services to suit every situation. First generation entrepreneur Anil Phirke realised the need of quality production of medical equipment and established Meditek Engineers in the year 1989. Meditek Engineers is an ISO 9001:2008 and ISO 13485 certified company engaged in the business of manufacturing and marketing full range of medical beds and furniture. Ranging from five function motorised intensive care beds to operation theatre trolleys, we have solutions for every need of the hospital. Meditek Engineers is headquartered at Mumbai. The display showroom and manufacturing plant are in Ambernath near Mumbai and spans a pan India presence. With exceedingly superior hospital solutions, the company has also marked its international footprints in African countries.
The management The managing body of Meditek Engineering is a team of experienced domain experts. With a passion to deliver superior results, the company has complemented each other well. The team’s proficiency encompasses all the factors, necessary for the governance of a successful hospital equipment manufacturing company.
A state-of-the-art manufacturing facility Being a solution provider for hospital equipment and allied components, from ‘Concept to Delivery’ Meditek Engineers' engineering and design centre is self sufficient in technology for conceptualising, developing, testing and manufacturing of related products. The company is proud to have developed a setup that is absolutely wellequipped and state-of-the-art as per global standards. It offers a turnkey medical device manufacturing service that spans the entire supply chain from component procurement to distribution, all within a quality controlled environment. It generates, develops and refines the product concept to ensure that all the requirements for a commercially and technologically viable product are met. Meditek takes pride in its full-fledged in-house manufacturing facilities such as ◗ Hydraulic shearing. ◗ Bending and pipe bending machine. ◗ Seven tank pre-treatment plant for metal surface treatment. ◗ Automatic conveyorised polyester epoxy powder coating plant. ◗ Modern assembly and welding set up with test laboratory. The excellence thus acquired is aptly reflected in the performance and quality offerings of the company. It has developed a surprisingly unique range of advanced products required for the healthcare industry, making it the most costeffective manufacturer of the given product range.
built with perfection and precision. These beds have been envisaged considering the com-
plexity of the ICU operations and the critical stage of the patients' health. It provides maxi-
mum comfort to the patients and efficiently support the latest healthcare practices.
5101 - Five function full motorised ICU bed ◗ Easily removable polymer moulded head and foot end boards for easy access to the patients ◗ Minimum height of 420 mm for the convenience of patients to get in and out of the bed ◗ LED backlight on patient control to improve the visibility of control buttons at low light conditions ◗ Auto contour button on patient handset prevents the forces urging on the patients foot end while giving the backrest position ◗ Conveniently mounted nurse control panel at the foot end of the bed enables the staff to easily control all the functions of the bed and to lock individual function of patient handset if required. Electronic CPR button on the nurse control ◗ Clear access to bed from bottom and top for effective bed cleaning. ◗ Heavy duty IV pole for syringe pump
5102 - Five function full motorised ICU bed ◗ Easily removable polymer moulded head and foot end boards for easy access to the patients ◗ Minimum height of 420 mm for the convenience of patients to get in and out of the bed ◗ Auto contour button on patient handset prevents the forces urging on the patients foot end while giving the backrest position ◗ Clear access to bed from bottom and top for effective bed cleaning ◗ Heavy duty IV pole for syringe pump ◗ Four non rusting 125mm dia. polyurethane casters 2 with brakes and 2 without brakes
ICU advanced care These are technologically advanced, high-tech products
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TRADE & TRENDS 5103 - Five function semi motorised ICU bed ◗ Polymer moulded head and foot end boards. ◗ Tuck type split moulded railings (Set of 4). ◗ Patient handset ◗ Electric actuators for backrest and height adjustment ◗ Manual operation for kneerest, Trendelenburg / Reverse Trendelenburg position ◗ Four non-rusting 125 mm dia. Polyurethane wheels 2 with brakes and 2 without brakes. ◗ Stainless steel telescopic IV rod. ◗ Four IV location. ◗ Body coloured PVC buffer on all four corners. Contact details Meditek Engineers W-13(A) Additional MIDC, Near Hotel Krishna Palace, Ambernath(E) - 421506, Thane, Maharashtra Tel: +91 251 2620200, 2620258 Mob: +91 98220 92808 email: info@meditekengineers.com
Carestream scientists, researchers from leading medical schools to present papers documenting medical imaging advances at RSNA All 2016 RSNA scientific papers and posters are available for viewing on the RSNA programme website CARESTREAM SCIENTISTS and researchers from The Johns Hopkins University School of Medicine and Toronto University Health Network will participate in scientific papers and posters that will showcase advances in medical imaging and enterprise image management at the Radiological Society of North America (RSNA) conference. All 2016 RSNA scientific papers and posters are available for viewing on the RSNA programme website including these outlined below: ◗ Scientists from The Johns Hopkins University School of Medicine and Carestream will present a scientific paper as part of RSNA’s Musculoskeletal Science Session entitled 'Quantitative Assessment of Trabecular Bone Microarchitecture Using High-Resolution Extremities Cone-Beam CT' on Sunday, November 27, from 11:55-12:05 pm (SSA14-08)
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◗ Scientists from Toronto University Health Network and Carestream will present a scientific paper entitled 'Novel Ultralow Dose (ULD) X-ray Evaluation of Lung Nodules using Dual Energy and Digital Tomosynthesis Technologies' (this technology is INVESTIGATIONAL-not available for commercial sale) on November 28, from 11:50-12:00 pm (SSC03-09) ◗ Scientists from The Johns Hopkins University School of Medicine and Carestream will present a scientific paper entitled 'Development of a Dedicated Cone-Beam CT System for Imaging of Intracranial Hemorrhage' on November 30, from 11:00-11:10 am (Room S403B) ◗ Scientists from The Johns Hopkins University School of Medicine and Carestream will give an oral presentation entitled 'A Cone-Beam CT System for Imaging of Intracranial Haemorrhage: Performance
Characterisation for Translation to Clinical Studies' on November 30, from 11:30-11:40 am. ◗ The Deputy Director of Information Technology and Communications of the Andalusian Health Service (Andalusia, Spain) will present a poster session on Tuesday, November
29, from 12:45-1:15 pm, entitled 'Realising benefits of an enterprise imaging platform in 27 months by standardising processes and tools to share images and information for over 18,000 daily clinician accesses within a public healthcare system that serves more
than 8,500,000 inhabitants.” The health service employs Carestream’s enterprise image management system to manage more than 10 million exams per year Contact details www.carestream.com/rsna.
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Business Avenues Please Contact: ■ Mumbai: Douglas Menezes 91-9821580403 ■ Ahmedabad: Nirav Mistry 91-9586424033 ■ Delhi: Ambuj Kumar 91-9999070900 ■ Chennai/Bangalore: Mathen Mathew / Amit Tiwari 91-9840826366 / 91-8095502597 ■ Hyderabad: E.Mujahid 91-9849039936 ■ Kolkata: Ajanta 91-9831182580
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LIFE PEOPLE
Cytecare Hospitals appoints Dr Selwyn Colaco as COO Dr Anthony Pais has been appointed as the Clinical Director and Senior Consultant, Oncoplastic Breast Cancer Surgery DR SELWYN COLACO has been appointed as the COO of Cytecare Hospitals. Dr Colaco
is currently leading the development and management of strategic clinical and business operations for the Cytecare hospital network. New processes are being implemented to create an integrated, patient-centric approach to drive better outcomes for cancer patients. He is a physician manager and empanelled NABH assessor, with over two decades of clinical and management experience. He has worked in several hospitals including Manipal Hospital, Apollo Health, Narayana Health, BGS Global and most recently,
Fortis Hospitals. Cytecare Hospitals also announced the appointment of Dr Anthony Pais as Clinical Director and Senior Consultant, Oncoplastic Breast Cancer Surgery. With professional expertise in surgical oncology, Dr Pais will closely work with doctors to introduce the best-inclass technologies for treatment of breast cancers. Dr Pais brings with him decades of experiencing cancer surgery, scarless breast surgery, breast conservative surgery, sentinel node biopsy and reduction and augmentation mammoplasty.
Dr Pais is an active member of Breast Surgery International, Switzerland and a member of American Society of Breast Diseases. During his career spanning more than two decades, Dr Pais has received many awards like Dr Sathyanarayana Setty Memorial Gold Medal for ‘Recent Advances and Experience’ on Breast Cancer, Dr Mahadevan’s Award for ‘Innovative Techniques in Head and Neck Reconstruction in an Adverse Setting’ and Pioneer’s Award of Excellence in Teaching. EH News Bureau
AWARDS
Dr Sushil Shah,Chairman and Founder, Metropolis Healthcare bags MadhavAward 2016 DR SUSHIL Shah, Chairman and Founder, Metropolis Healthcare was awarded the Madhav Award for his significant contribution to the pathology industry. The award was bestowed by The Scindia School during their annual celebrations held recently. The award was presented by Jyotiraditya Scindia, President of the Board of Governors of The Scindia School and Member of Parliament along with the Chief Guest, Ratan Tata in Gwalior. The Madhav Award is annually held by The Scindia School to honour achievements of the Old Boys (alumni) and their strong bond with the alma mater. Dr Shah was honoured for his pursuit towards a vision of a consolidated diagnostic industry in India. His academic vision
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and an overarching scientific outlook are the major driving forces behind Metropolis Healthcare’s success. On winning the award, Dr Shah said, “It is an honour to receive The Madhav Award from my alma mater. This award is not just a testament for the hard work we put in here at Metropolis Healthcare but also will serve as an inspiration to the existing students of The Scindia School. I truly believe that integrity, ethic and hard work pays off no matter what you do.” The Madhav Awards were initiated in 1984 to recognise an eminent Old Boy every year and was named after HH Maharaja Madhavrao Scindia. EH News Bureau
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